Objective To investigate the feasibility of closed reduction assisted with Kirschner wires for irreducible femoral neck fracture.Methods From June 2008 to April 2011,32 patients with irreducible femoral neck fracture were treated.There were 15 males and 17 females,aged from 21 to 59 years (average,46 years).According to Garden classification,there were 6 of Ⅱ,16 of Ⅲ and 10 of Ⅳ.According to displacement direction of the femoral head showed by preoperative X-rays and CT scans,irreducible femoral neck fracture was divided into 3 types:angulation-impaction (11 cases),rotation-separation (15 cases) and abduction-impaction (6 cases).One to three Kirschner wires were penetrated into the femoral head to reduce the displacement in opposite direction of fracture displacement.After reduction was satisfied,guide pins were penetrated,and then the fractures were fixed with cannulated screws.Results Anatomic or nearly anatomic reduction was achieved in 30 patients after closed reduction assisted with Kirschner wires.Two patients underwent open reduction finally due to failure of closed reduction.The operation time ranged from 40 to 80 min,and the blood loss ranged from 20 to 50 ml.According to Garden index,anatomic reduction was achieved in 29 and acceptable reduction in 1.Among 30 patients who had undergone closed reduction,29 patients were followed up for 12 to 20 months.Bone union was achieved in 28 patients,and the fracture healing time ranged from 4 to 10 months.One patient with rotation-separation displacement before closed reduction underwent total hip replacement due to avascular necrosis of femoral head occurred at 15 months after closed reduction.Conclusion Closed reduction assisted with Kirschner wires is an effective method for irreducible femoral neck fracture,which can achieve satisfactory anatomic reduction rate and fracture healing rate.

Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type Ⅲ,and 21 type Ⅳ.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were used to access outcomes.Results One hundred and twenty five patients (135 feet) were followed up for 12 to 28 months (average,18.5months).All fractures healed after an average of 13 weeks (range,8-16 weeks).There were on nerve injury or osteomyelitis.Incision dehiscence occurred in 4 feet,which healed after removing the plate.Subtalar joint traumatic arthritis occurred in 17 feet,with walking pain.Collapse of articular surface occurred in 5 feet after weight-bearing.According to AOFAS ankle-hindfoot scale,excellent result was got in 94 cases,good in 29 cases,fair in 14 cases,poor in 6 cases; and the excellent and good rate was 92.9％.Conclusion Open reduction and internal fixation via modified lateral L-shaped incision for treating displaced intra-articular calcaneal fractures can obtain satisfactory results,but the skilled surgical techniques are needed.

Objective To investigate the effect of osteoinductive calcium phosphate ceramics (OICPC) on tendon healing in bone tunnels. Methods Anterior cruciate ligament reconstruction with semitendonous tendon was performed in the knee joints of 30 New Zealand rabbits by suspended fixation. OICPC grains were implanted into the bone tunnel of 15 rabbits which were the experimental group and the other 15 rabbits without OICPC implants severed as the control group. Specimens were collected four weeks, eight weeks and 12 weeks after surgery. Sections were stained with H. E., Sirius Red and Masson. Histological changes in the interface tissue between the bone tunnel and the tendon graft were observed, and the morphology of interface tissue was classified according to Yamakado method. Histomorphometry was done on Masson stain sections to measure new bone formation around the grafted tendon. Results In OICPC group, histological sections obtained four and eight weeks after surgery showed statistically greater new bone formation than those in the control group. Abundant penetrating Sharpey fibers appeared at eight weeks and direct connection was found at 12 weeks in the experimental group. On the other hand, Sharpey fibers appeared only at 12 weeks in the control group. Conclusion OICPC has a capability of enhancing biological fixation of a tendon to the bone tunnel.

BACKGROUND: Compound materials have strong osteogenic ability, which reinforce the substitute materials used alone. Compound material will be commonly used to repair bone defects in tissue engineering. OBJECTIVE: To explore the osteogenic capacity of tetracycline loaded bio-derived bone in vivo. DESIGN, TIME AND SETTING: The randomized controlled observation was performed at Tissue Engineering Laboratory (State Key Laboratory) of West China Center of Medical Sciences, Sichuan University from September 2004 to January 2005. MATERIALS: Twenty-four New Zealand white rabbits were randomly divided into 2 groups (n=12). Rabbit models of radial middle segment defect (1.5 cm) were established. Tetracycline collagen bio-derived bone was made of fresh human bone. METHODS: The tetracycline collagen bio-derived bone was implanted into radial defects of experimental group, and collagen bio-derived bone was implanted into control group. All rabbits were executed 6 and 12 weeks after operation. MAIN OUTCOME MEASURES: Osteogenic condition in all specimens was examined by X-ray and histological methods. RESULTS: Twenty-four animals were included in final analysis. ①X-ray results showed that osteotylus was seen in the whole defect area of the experimental group in postoperative 6 weeks, while only in the defect ends of the control group. In 12 weeks after surgery, new bone tissue filled all defect area of the experimental group, which was basically consistent with normal bone, even medullary canal was formed. Osteogenic images were found in the control group. ②Histological results suggested that new osteoid formation was observed in internal pore zone in the experimental group in 6 weeks, while no bone tissue was found in the control group. In 12 weeks, much woven bone was seen in the experimental group, and lamellar bone structure had formed and medullary cavity of bones had transfixed. Osteoid formation was observed in the control group. CONCLUSION: Both tetracycline collagen bio-derived bone and collagen bio-derived bone can promote bone formation, but tetracycline loaded bio-derived materials show superior effect in repairing defects.

BACKGROUND: Each matrix material alone possesses the limited ability of osteogenesis, so it is a future direction of tissue engineering that apply composite materials on the repair of bone defect by enhancing osteogenesis. OBJECTIVE: To study the osteogenesis ability of collagen loaded bio-derived bone implanted in animals. DESIGN, TIME AND SETTING: A random controlled animal experiment was completed in Tissue Engineering Laboratory of West China Center of Medical Sciences, Sichuan University between January and April in 2004. MATERIALS: Sixteen New Zealand white rabbits were adopted to prepare 1.5-cm segmental defect model at the middle part of radius. Human bone was extirpated from donators, and collagen Ⅰ was the product of Sigma Company. METHODS: Rabbit models were divided into 2 groups by randomization, experimental group and control group, with 8 rabbits in each group. The extirpated bone was made into pure bio-derived bone by means of defatting, decellularization and deproteinization. Collagen loaded bio-derived bone was established by the vacuum absorption of collagen on pure bio-derived bone. Collagen loaded bio-derived bone was implanted into the defects of experimental group, while pure bio-derived bone for the control group. MAIN OUTCOME MEASURES: At 6 and 12 weeks after operation, all specimens were examined by X-ray and histological methods. RESULTS: The result analysis included all of 16 rabbit models. X-ray results showed that, osteotylus was seen in the whole defect area of experimental group at 12 weeks postoperatively, at this time osteogenesis was more obvious compared with 6 weeks, the bridge grafting of defect area was obviously visible. In the control group, osteotylus was only observed on two ends of the defects, no osteogenesis was found in the central part of defect area. Histological results showed that, new osteoid formation could be seen in internal porous zone of the experimental group at 6 weeks postoperatively, while in control group fibrous connective tissue filled internal porous zone and no new bone formed; at 12 weeks, much more woven bone-like tissues were visible and trabecular-like structure had formed in the experimental group, while osteoid tissue could be seen in bone defect area of control group. CONCLUSION: Both pure bio-derived bone and collagen bio-derived bone can enhance osteanagenesis, but collagen loaded bio-derived bone scaffold material is more effective.

Objective Studies show that miRNA plays an important role in regulating the development, metastasis, inva-sion, and angiogenesis of carcinoma.This study aimed to investigate the expression of miR-155-5p in esophageal squamous cell carci-noma ( ESCC) and its role in the occurrence and progression of ESCC. Methods We collected 20 surgical specimens of ESCC and another 20 from the adjacent normal tissue at least 5 cm from the lesion and determined the expression of miR-155-5p in the tissues by qPCR.We transfected the miR-155-5p mimic, inhibitor and negative control plasmid into the Eca109 cells, measured the proliferation and apoptosis of the cells by CCK8 assay and flow cytometry, and examined their migration using the scratch test. Results The ex-pression of miR-155-5p was significantly up-regulated in the ESCC tissue as compared with that in the normal tissue (529.42% vs 100%, P<0.05).The scratch test showed a markedly increased migration of the cancer cells when miR-155-5p was overexpressed. No remarkable differences were observed in the apoptosis rates of the cells transfected with the miR-155-5p mimic ([5.43 ± 3.09]%), inhibitor ([5.28 ±1.98]%), and negative control plasmid ([5.67 ±1.99]%) (P<0.05). Conclusion The ex-pression of miR-155-5p is significantly up-regulated in the ESCC tissue, which may act as a potential maker for the diagnosis of ESCC. The up-regulated expression of miR-155-5p does not significantly in-fluence the proliferation and apoptosis but enhances the migration of Eca109 cells, which may be related to early metastasis of ESCC.

Objective To investigate the protective effects of pretreatment with valsartan, an angiotensin Ⅱ type 1 receptor blocker, on the brain against ischemia-reperfusion (I/R) injury. Methods Thirty-six healthy male C57BL/6J mice aged 10-12 weeks weighing 20-25 g were randomly divided into 2 groups (n - 18 each): valsartan group (V) and control group (C). In group V valsartan 2 mg?kg-1 dissolved in 2.5% NaHCO3 100 ?l was given intraperitoneally (i.p. ) every day for 10 days before experiment while in group C 2.5% NaHCO3 100?l without valsartan was given. The animals were anesthetized with intraperitoneal pentobarbital 40 mg?kg-1. Middle cerebral artery occlusion (MCAO) was produced by inserting an 8-0 nylon thread with rounded end into the left internal carotid artery and advancing it cranially until resistance was felt. MCAO was maintained for 1 h. The nylon thread was then withdrawn for reperfusion. A laser doppler blood flow detector (Omegaflo FLO-C1, Omegawave Co, Netherlands) was used to detect local cerebral blood flow (LCBF) at central and marginal infarct area [LCBF (%) = LCBF during I/R / baseline LCBF ? 100% ]. The model of MCAO was considered established when LCBF at central infarct area was 20% lower than the baseline value. LCBF was measured 10 min before MCAO (T0, baseline), as soon as MCA was occluded (T1) at 10, 30, 50 min of ischemia (T2-4) and at 10, 30, 60 min of reperfusion (T5-7) . MAP was measured immediately before valsartan administration, at T0 and T5. Neurological function deficit (NFD) was evaluated and scored (0 = no deficit, 4 = worst result) at 23 h after reperfusion was started . After evaluation of NFD the animals were anesthetized again and killed. The brains were removed. Cerebral water content was measured [cerebral water content (%) = (wet weight - dry weight) / wet weight ? 100%]. Infarct area was measured. Mortality rate was recorded.Results Pretreatment with valsartan did not affect MAP significantly but significantly reduced infarct area, brain water content, NFD and mortality rate and improved focal cerebral blood flow after MCAO. Conclusion Valsartan pretreatment can decrease cerebral infarct area induced by MCAO through improvement of focal cerebral blood flow after MCAO.

This study was aimed to analyze compatibility rules of Chinese drugs and prescription design in the pre-vention and treatment of scleroderma. The database of scleroderma treated by Chinese medicine was set up. And then, association rules were used to analyze the prescription compatibility rules. The results showed the highest fre-quency of drugs in the treatment of scleroderma were Astragalus, Angelica sinensis and Salvia. The tonifying and re-plenishing medicinal, blood-activating and stasis-resolving medicinal and exterior-releasing medicinal were with the highest frequency. The commonly used formula in the treatment of scleroderma was Y ang-He decoction. For herbal groups, occurrence of the highest was the combinations of Ramulus Cinnamomi-Astragalus and Carthamus tinctorius L.-Astragalus. Three kinds of herbals were commonly coupled, such as Polygonum multiflorum Thunb. and Caulis Spatholobi with Salvia, P. multiflorum Thunb. and R. Cinnamomi with Salvia, P. multiflorum Thunb. and Astragalus with Salvia, prepared Radix Rehmanniae and Codonopsis with C. tinctorius L., prepared Radix Rehmanniae and Codonopsis with R. Cinnamomi, Codonopsis and Radix paeoniae rubra with R. Cinnamomi. Four kinds of herbals such as R. Cinnamomi, Glycyrrhiza uralensis Fisch., Astragalus and Codonopsis were commonly coupled. It was con-cluded that compatibility rules of Chinese medicine in the prevention and treatment of scleroderma laid the founda-tion for herbal medicine selection and prescription design.

Objective To study the physical characteristics of the OPEN stereotactic body radiotherapy system for the clinical application. Methods The 0. 125cc ioniztion chamber, 160 mm polystyrene sphere model,Gafchromic EBT2 films and IBA film analysis software were used to evaluated the focus position tolerance,dose rate,repeatability,linear relation,penumbra and composite error of the OPEN stereotactic body gamma knife. We used the DTA method to verify the accuracy of dose distribution between the plans and measured value. Resualts The focus error was 0. 36 mm,max dose rate tolerance 3%,linear relation error 2%,repeatability error 0. 3%,composited error 2. 5 mm. There was 90% pass rate when the distance away from test point was less than 2 mm and the dose error was set less than 5 % . Conclusions Parts of the test resualts were similar to the head gamma knife national protocal of OPEN stereotatic body gamma knife. The deliver dose distribution can meet the clinic need.

Objective To analyze the genotype and molecular epidemiology of carbapenem-resistant Enterobacteriaceae.Method A total of 201 carbapenem-resistant Enterobacteriaceae were isolated from 14hospitals in 11 cities.The MICs of 14 antimicrobial drugs were detected using agar dilution method.Phenotypes of carbapenemases were screened using modified Hodge test and ethylene diamine tetraacetic acid (EDTA) test.Drug resistance genes were screened using PCR method.The strains carrying carbapenem resistance genes were confirmed by conjugation test.Homology analysis was carried out using pulsed-field gel electro-phoresis (PFGE) method and the epidemiological correlation is analyzed based on the Multilocus Sequence Typing (MLST) method in order to study the molecular epidemiology of carbapenem-resistant Enterobacteriaceae.Results Fifty-three strains among 201 carbapenem-insensitive Enterobacteriaceae were detected positive carbapenem-resistant genes,among which included 33 Klebsiella pneumoniae,9 Citrobacter freundii,6 Escherichia coli and 5 Enterobacter cloacae.Among the 53 strains,43 were from Beijing,6 strains from Hangzhou,3 strains from Nanjing and one from Fuzhou.Resistance genes-harboring plasmids were successfully transferred from 28 of 53 strains to Escherichia coli EC600.The PFGE spectmm showed that 33 Klebsiella pneumoniae were classified into three types,9 Citrobacterfreundii classified into four types,5 Enterobacter cloacae classified into four types,while 6 Escherichia coli were the same type.Based on the results of MLST test,29 Klebsiella pneumoniae strains producing KPC-2 type carbapenemase were all ST11,while among the four Klebsiella pneumonia carrying IMP-4 carbapenem resistant gene,three strains were ST876,one was ST147.Conclusions Carbapenem-resistant genes were detected only in hospitals from Beijing,Hangzhou,Nanjing and Fuzhou,and type KPC-2 was the most common,followed by IMP-4 and IMP-8.High homology of resistant strains could be related to horizontal transfer of carbapenemase genes,which should cause great concern.