BACKGROUND:At present, the anatomic reconstruction of coracoclavicular ligament is a trend for the treatment of acromioclavicular joint dislocation. Endobutton plate is a new and effective surgical method found in recent years. Although the recent curative effect is satisfactory, as a method of internal fixation, its rigid fixation does not conform to the requirements of the biomechanics. Furthermore, a randomized control ed clinical study and systematic evaluation are absent.
OBJECTIVE:To systematical y evaluate clinical outcomes and safety between endobutton plate and the other surgical methods for treatment of acromioclavicular joint dislocation.
METHODCochrane (2014-01), PubMed (1966-01/2014-03), Medline (1966-01/2014-03), EMbase (1984-01/2014-03), CNKI (1979-01/2014-03), VIP (1989-01/2014-03) and Wanfang (1989-01/2014-03) databases were searched by computer. Six Chinese journals about orthopedics were searched by hand. References of relevant literatures were searched. Randomized control ed trials that were related to different surgical methods for the treatment of acromioclavicular joint dislocation were col ected. In accordance with inclusion criteria, some literatures were included and their qualities were assessed strictly. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Col aboration.
RESULTS AND CONCLUSION:Final y 7 published studies with randomized control ed trials met al the inclusion criteria. A total of 359 patients were included, containing 152 cases of endobutton plates fixation, 149 cases of clavicle hook plate fixation, and 58 cases of screw fixation. Except two researches addressed the comparison among three surgical ways, the remaining were about two ways. Meta-analysis showed that the excellent rate was better in endobutton plates fixation than in clavicle hook plate fixation (P=0.0002) and in screw fixation (P=0.009). Compared with other fixation methods, there were significant differences in shoulder joint pain (P=0.01), but no significant difference was detected in operation time, upper limb muscle strength, bleeding amount, redislocation and surgical wound infection (P=0.44, P=0.10, P=0.37, P=0.21, P=0.96). Results indicated that, the efficiency of endobutton plates fixation for acromioclavicular joint dislocation was better than clavicle hook plate fixation and screw fixation, and caused less shoulder pain than clavicle hook plate fixation. There was no significant difference in operation time, upper limb muscle strength, bleeding amount, redislocation and surgical wound infection among the three methods. Due to the limited number of cases in this study, the multicenter, large-sample and long-term clinical randomized control ed studies are needed to increase the strength of the evidence.

Objective To evaluate the clinical value of fiberoptic ductoscopy in diagnosis and treatment of patients with galactophoritis or mammary duct ectasia. Methods From November 2005 to March 2008, fiberoptic ductoscopy were performed in 120 women with nipple discharge. The duct of 95 cases as non-malignant lesion were insufflated and perfusioned with entamycin and dexamethasone. Results Ninty-five of 120 cases were non-malignant disease,which contained one side 81 and two sides 14; the discharge was bloody,ivory, stramineous in 21, 17, 57 patinents, respectively; and the dignosis were 17 mammary duct ectasia, 53 galactophoritis, and 25 mammary duct ectasia with galactophoritis. Of the 95 cases, hich were intradutal insufflated and perfusioned with gentamycin and dexamethasone, the nipple discharge were decreased or disappeared in 81 cases, the effective rate was 85.3%. Conclusion Fiberoptic ductoscopy is a convenient,safe, accurate method in diagnosis and treatment of patients with galactophoritis or mammary duct ectasia.

BACKGROUND:There are many treatment methods for knee osteoarthritis,among which electroacupuncture,as an important non-drug treatment,is effective in the treatment of knee osteoarthritis,but its exact mechanism is not clear. OBJECTIVE:Effect of electroacupuncture on the expression of p53 and P21 in articular cartilage and subchondral bone of aged rats with knee osteoarthritis. METHODS:Eight 6-month-old male Sprague-Dawley rats were included in the young group and sixteen 24-month-old male Sprague-Dawley rats were randomly divided into old group(n=8)and electroacupuncture group(n=8).The rats in the electroacupuncture group received electroacupuncture stimulation once a day,5 days a week,for 8 continuous weeks,and the other two groups did not do any treatment.Eight weeks later,the level of type Ⅱ collagen C-terminal peptide in peripheral blood was detected by ELISA,the morphology of left knee cartilage and subchondral bone was observed by safranin O-fast green staining,the degree of knee cartilage degeneration was evaluated by modified Mankin's score,the microstructure of left knee cartilage and subchondral bone was detected by micro-CT,and the expression levels of matrix metalloproteinase 13,P53,P21 Mrna and protein were detected by RT-PCR and western blot respectively. RESULTS AND CONCLUSION:Compared with the young group,the level of C-terminal peptide of type Ⅱ collagen in the peripheral blood was increased in the old group(P<0.05).The micro-CT results showed that the bone volume fraction,bone mineral density and the number of bone trabeculae were decreased in the old group compared with the young group(P<0.05),while the trabecular separation increased(P<0.05).Safranin O-fast green staining showed that in the old group,the surface layer of cartilage was uneven with fissures,the morphology of chondrocytes was irregular and stained unevenly,the boundary between the cartilage and subchondral bone was blurred,and the matrix loss was serious.The Mankin's score was higher in the old group than the young group(P<0.05).The expression of matrix metalloproteinase 13,P53,P21 at Mrna and protein levels increased in the old group compared with the young group(P<0.05).Compared with the old group,electroacupuncture decreased the level of C-terminal peptide of type Ⅱ collagen(P<0.05),increased the bone volume fraction,bone mineral density and the number of bone trabeculae(P<0.05),and decreased the trabecular separation(P<0.05).Safranin O-fast green staining showed that in the electroacupuncture group,the surface of cartilage was smooth and red staining was uniform,and the cell morphology and structure were between the young group and the old group.Following electroacupuncture treatment,the Mankin's score(P<0.05),matrix metalloproteinase 13 and P21 Mrna expression(P<0.05),and matrix metalloproteinase 13 and P53 protein expression decreased(P<0.05),while there was a decreasing trend of P53 Mrna and P21 protein expression,but with no statistical significance(P>0.05).To conclude,electroacupuncture may delay articular cartilage degeneration and subchondral osteoporosis in aged rats by inhibiting the expression of P53 and P21,so as to protect joints and delay joint aging.