Objective To access the relationship between the polymorphism of G protein-coupled receptor kinases 4(GRK4,including R65L,A486V and A142V) and essential hypertension.Methods All the literature on the subjects was searched by keywords such as essential hypertension,hypertension,G protein-coupled receptor kinases 4 gene,and polymorphism in the electronic databases,Medline of Year 1997 to 2006.RevMan 4.2 software was used for Meta analysis.Results A total of 857 cases and 913 controls from 4 studies were included.The ORs of genotypes of R65L,A142V and A486V were 0.97(0.75 to 1.25,P=0.81),0.81(0.30 to 2.08,P=0.65) and 1.48(1.16 to 1.8,P=0.001) respectively.Conclusion GRK4 gene polymorphism A486V is significantly associated with susceptibility of essential hypertension.People who carries A486V have a higher risk to be subject to essential hypertension.

BACKGROUND: Re-injury of organism and sufficient of materials exist in the autologous transplantation of tendon to treat defected tendon following trauma. Carbon fiber artifical tendon, human hair tendon and other artifical tendons are also proved to be transplantable. But immunological rejection and biomechanical inadaptability exist following artifical tendons are transplanted. Therefore, the development of new human tendon substitute is the major problem to be solved at present.OBJECTIVE: To observe the porcine small intestinal submucosa as artificial tendon to repair 2 cm tendon defect of the 3rd toe of the left and right feet of chicken, and the immunological rejection and biomechanical adaptability following repair.DESIGN: A randomized and controlled animal experiment.SETTING: Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University.MATERIALS: Totally 45 Leghorn chickens, aged 12 weeks, of either gender, with body mass of 4.0 to 4.4 kg, were chosen.METHODS: This experiment was conducted at the Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University from September 2002 to June 2003. ① Totally 45 Leghorn chicken, aged 12 weeks, were randomly divided into 3 groups. The third toe of the left and right feet was chosen from 20 chicken respectively of autologous transplantation group and porcine small intestinal submucosa group, flexor digitorum profundus muscle tendon was cut off at middle phalanx, and 2 cm tendon defect model was created. The defected tendon in the autologous transplantation group was performed in situ suture; the defected tendon in the porcine small intestinal submucosa transplantation group was repaired with porcine small intestinal submucosa; There was not any treatment on the 5 Leghorn chicken in the blank control group. ② Histomorphologyl, transplantation immunology, biomechanics and functional recovery were measured at 3,6 and 9 weeks following tendon transplantation.MAIN OUTCOME MEASURES: ① Gross observation of operated toes of chicken and optical observation of grafts in each group. ② White blood cell (WBC) differential count at 3 days preoperation,3 days postoperation,and 1 week and 2 weeks postoperation. ③ Biomechanical test and functional recovery test of chicken in each group.RESULTS: Totally 45 chicken entered the stage of result analysis. ① At 9 weeks after operation, morphology of porcine small intestinal submucosa was basically the same as that of normal tendon by naked eyes; Under optical microscope, fibroblasts on the porcine small intestinal submucosa arranged in order along long-axis and collagen extracellular matrix appeared.② Within 2 weeks after operation, there was no significant difference of WBC measurement between porcine small intestinal submucosa transplantation group and autogolous transplantation group (P ＞ 0.05), suggesting that porcine small intestinal submucosa, as xenogenic material, has no obvious immunological rejection. ③ In the biomechanical test, biomechanical adaptability at postoperative 12 weeks was superior in the porcine small intestinal submucosa group to in the autologous transplantation group [(22.22±0.90),(20.78±0.94) ,P ＜ 0.05]. ④ In the test of functional recovery, there was no obvious difference of activity of metecarpophalangeal joint (P ＞ 0.05), the activity of proximal interphalangeal joint was superior in the blank control group to in the porcine small intestinal submucosa group and autologous transplantation group [(21.0±1.6)°, (15.1±1.7)° , (16.0±2.1)° ,P ＜ 0.05].CONCLUSION: There is no evidence of immunological rejection after porcine small intestinal submucosa is transplanted into the body of chicken. Therefore, porcine small intestinal submucosa can be used as the xenogenic material to repair tendon defect.

BACKGROUND:The treatment of displaced acetabular fractures consists of formal open reduction and internal fixation.However,extensile exposure can lead to a lot of complications Percutaneous screw fixation for acetabukar fractures can decrease these complications Recently developed fluoroscopic-based computerized navigation technology not only allows the surgeon to achieve maximum accuracy of screw fixation but also significantly reduce radiation exposure time.OBJECTIVE:To evaluate the clinical application of the fluoroscopic-based computerized navigation system for percutaneous screwing for acetabular fractures.METHODS:A total of 18 adult patients with 20 non-displaced and displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system.All acetabular fractures were acetabular anterior column fractures and posterior column fractures,which were fixed by varied hollow screws Static muscle contraction and limited active and passive motion were performed at 2 days,and weight-bearing exercise was performed at 4 weeks after operation.The time of screw implantation,screw position deviation,screw biocompatibility,as well as adverse effect after screw implantation was observed.In addition.d'Aubigne and Postel scoring was used in follow-up.RESULTS AND CONCLUSION:A total of 30 acetabular screws were inserted.The average operation time for per screw was24.1 minutes from the image acquisition to wound closure.The average fluoroscopic time for per screw was 27.6 seconds.Compared to the final position of the screw,the average wire tip error was 1.5 mm and the average trajectory difference was2.25°.One patient sustained a transient femoral nerve palsy which was attribute to reduction clamp inserting from the use of the limited open reduction method rather than screw fixation itself and resolved 2 months after the operation.No evidence was noted of secondary displacement of the fragment or screw failure Using the rating system of d'Aubigne and Postel,13 patients had excellent results,4 patients had good results,and 1 patient had a fair result.The excellent to good rate was 94%All results demonstrated that percutaneous screw fixation of acetabular fractures with fluoroscopy-based navigation can produce excellent results in selected patients with non-displaced and displaced fracture amenable to closed or limited open reduction,which becomes a safe and effective alternative to traditional open reduction and internal fixation for the treatment of certain acetabular fractures.

OBJECTIVE: To review the development and mechanism of platelet-rich plasma (PRP) and the unsolved problems so as to provide reference for the clinical application of PRP.DATA SOURCES: Articles on effects of platelet-rich plasma on bone repair are searched from Medline between January 1995 and June 2005 on computer. The key words were platelet rich plasma, bone, and repair.Meanwhile, the same search was conducted to determine the correlated articles during January 1998 to June 2005 from Wanfang database with key words of platelet-rich plasma, bone and repair in Chinese.STUDY SELECTION: Literatures at home and abroad on the PRP and bone repair were chosen; Non-randomized controlled literatures were included.DATA EXTRACTION: Totally 40 out of 49 reports related to PRP and bone repair met the criteria. 9 reports were excluded due to the repeated same research. The rest 40 reports were sorted out and conducted literature review.DATA SYNTHESIS: Platelet-rich plasma was originally used in clinic to repair mandibular defect in 1998, by adding PRP to grafts with a radiographic maturation rate 1.62 to 2.16 times that of grafts without PRP. Up to now, PRP has been used in many medical areas to accelerate tissue healing due to its advantages of safety, simple, low-cost. But some problems still remain to be studied and solved.CONCLUSION: PRP includes many sorts of growth factors and has been proved to be beneficial to the maturation of both bone tissue and soft tissues. PRP is autologous and can be produced easily and safely from autologous blood, without the concerns of transmissions and immunological rejection of various diseases.

Objective To investigate the surgical treatment and outcome of distal humeral shear fractures in adults through Kaplan approach.Methods Nine patients with closed shear fracture of the distal humerus were surgically treated through Kaplan approach from September 2005 to September 2009.The lateral collateral ligament was released only in 1 case.All the fractures were classified into type 1A (3 cases),type 1B (1 case),type 2A (1 case),type 3A (1 case) and type 3B (3 cases) according to Dubberley classification.Under the direct vision,cannulated screw was used after anatomic reduction was confirmed by fluoroscopy.Results All fractures were reduced anatomically without any neural or vascular injury.Only 1 case of grade 1 heterotopic ossification was found 12-24 months postoperatively.There were excellent in 4 cases,and good in 5 cases.The average Broberg-Morrey score was 94.2.The average arc of flexion-extension was 116°.As to the 4 cases with posterior comminution,the averaged score and the arc of flexion-extension was 92.8 and 104°,respectively.Conclusion Through Kaplan approach,the reduction and internal fixation of distal humeral shear fractures can be manipulated successfully with lateral collateral ligament intact,and the short-term outcome is satisfactory.Dubberley classification which focused on the severity and prognosis is helpful to make a surgical plan.

is lesion size and staging in pre-operative and etiologies are the risk factors associated with postoperative progression.

Objective To investigate the clinical outcome of tibiotalocalcaneal arthrodesis plus retrograde intramedullary nail in treatment of severe posttraumatic tibiotalar and talocalcaneal arthritis.Methods A total of 17 cases of severe posttraumatic tibiotalar and subtalar arthritis were treated with tibiotalocalcaneal arthrodesis plus retrograde intramedullary nail between June 2003 and June 2006.Patients were evaluated by a standardized follow-up examination using ankle-hindfoot scale of the American Orthopedic Foot & Ankle Society(OFAS)score. Results Of all,14 cases were followed up postoperatively,with a mean follow-up period of 14.6 months(6-23 months).Bony fusion was achieved in 12 cases (86%)after an average of 11.6 weeks(8-19 weeks)but a delayed union in 2 after 17-19 weeks.Two cases(12%)complained heel pain at the nail entry point at initial stage of operation.The average anklehindfoot score improved from 47 points(43-55 points)preoperatively to 75 points(69-86 points)postoperatively. Conclusion Tibiotalocalcancal arthrodesis plus retrograde intramedullary nailing is proved to be effective in treating severe posttraumatic tibiotalar and talocalcaneal arthritis by marked relief from pain and improvement of life quality.

Objective To report the preliminary results of treatment of fracture nonunion at the distal femur and the proximal tibia with Less Invasive Stabilization System (LISS). Methods From February 2003 to August 2004, LISS fixation and bone grafting were employed to treat 5 cases of fracture nonunion at the distal femur and 4 cases of fracture nonunion at the proximal tibia. The nonunion had resulted from failure of internal fixation in 7 cases, failure of external fixation in 1 and infection in 1. The history of nonunion lasted from 10 to 111 months (mean 29m). Results All the 9 patients were followed up for an average of 8 (6 to 16) months only to reveal solid bone union in all the fractures, with a mean healing time of 4.7 months (ranging from 4 to 6 months). No loosening or breakage of the implants occurred in this series. Conclusion Due to its advanced design, LISS can be used to treat effectively fracture nonunion at the distal femur and the proximal tibia.

BACKGROUND:Studies has confirmed that platelet-rich plasma(PRP) can affect the proliferation and differentiation of bone marrow mesenchymal stem cells and adipose derived stem cells. OBJECTIVE:To observe the effects of PRP on the proliferative and osteogenetic activity of skeletal muscle stem cells(SMSCs) in vitro,in addition,to elucidate the potential mechanism by which PRP affects SMSCs. DESIGN,TIME AND SETTING:A randomized controlled animal experiments was completed in the Center Laboratory of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from June to October in 2008. MATERIALS:Nine New Zealand,ordinary grade rabbits,weight of 2.5-3.0 kg,1 year old,irrespective of gender. METHODS:The right soleus was dissected and cultured for SMSCs. PRP was prepared with central artery of rabbits’ ears. The cells were randomly divided into the experimental group and the control group. In the experimental group,the SMSCs were interfused with PRP(special culture media including 12.5% PRP) . There was no intervention in the control group. MAIN OUTCOME MEASURES:①Morphological observation. ②The proliferative ability of the cells was detected with MTT. ③ The osteogenetic ability was measured with alkaline phosphatase(AKP) staining,alizarin red staining and osteocalcin immunofluorescence assay. RESULTS:MTT method showed that the proliferative activity of the experimental group was obviously stronger than that of the control group(P