BACKGROUND:Elastic stable intramedulary nailing and titanium plate fixation are two methods for the treatment of midshaft clavicular fractures. Current research about comparison of these two methods is not too much, and most of cases were retrospectively analyzed. OBJECTIVE:To compare the efficacy of elastic stable intramedulary nailing and titanium plate fixation for midshaft clavicular fractures. METHODS:The PubMed database, CBM, EMbase database, Cochrane Library database, CNKI database and Wangfang database were searched to collect the trials on midshaft clavicular fractures. The searching time ranged from the date of building to September 2015. The quality of trails was evaluated. RESULTS AND CONCLUSION:(1) Seven trials involving 512 patients were included. (2) Meta-analysis results showed the postoperative functional recovery was better in the elastic stable intramedulary nailing group than that of the plate fixation group (P< 0.01). (3) The average bone union time, operation time, incision length,intraoperative blood loss and the hospital stay of the elastic stable intramedulary nailing group were less than those of the plate fixation group (P< 0.01). (4) There were no significant differences in incidence rate of complications between two groups.(5) It is concluded that elastic stable intramedulary nailing for treating midshaft clavicular fractures is superior to the plate fixation in the efficacy. As the first choice for treatment of midshaft clavicular fractures, above conclusions are needed to be verified by large-scale multi-center randomized controled trials.

BACKGROUND:Indian hedgehog homolog (Ihh) protein and its signal protein Gli1, as wel as Runt related transcription factor 2 (Runx2) are closely related to the pathogenesis of osteoarthritis. The increased expression of these factors is one of the major causes of degenerative joint changes.
OBJECTIVE:To explore the roles of Ihh, Gli1 and Runx2 in the development of osteoarthritis.
METHODS:Thirty Sprague-Dawley rats were randomly divided into two groups:control group (n=10) and model group (n=20). In the model group, rats received unilateral anterior cruciate ligament transection, to establish osteoarthritis model. Ten experimental rats were kil ed at 4 and 12 weeks after surgery respectively. Another 10 rats received unilateral knee arthrotomy as pseudo-operation controls and 10 pseudo-operation rats were kil ed at 12 weeks after surgery.
RESULTS AND CONCLUSION:In the model group, cartilage degeneration was obvious at 4 weeks and became severer at 12 weeks after anterior cruciate ligament transection operation. Expression levels of Ihh, Gli1 and Runx2 in the cartilage were increased significantly at 4 weeks after operation, but decreased at 12 weeks after operation. Experimental findings indicate that Ihh, Gli1 and Runx2 play important roles in the development of osteoarthritis, and their expression levels are significantly increased at early stage of osteoarthritis, which can be regarded as the indicators in the prophylaxis and treatment research of osteoarthritis.

Objective To compare the primary clinical results of the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) techniques for femoral tunnel drilling in single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Data of isolated ACL rupture patients who had undergone single-bundle ACL reconstruction with autologous semitendinosus and gracilis tendons from March of 2012 to February of 2014 were retrospectively analyzed.The femoral tunnels were drilled with AMP techniques in 14 patients (group AMP) and with AAMP techniques in 23 patients (group AAMP).All the patients were followed up for 6 to 29 months.At the latest follow-up the Lysholm,Tegner and international knee documentation committee (IKDC) scores were used to estimate knee joint function,while the Lachman test and Pivot-shift test were used to estimate knee joint instability.Results The average follow-up time was 16.07±7.31 months in group AMP and 13.35±5.92 months in group AAMP.In group AMP,the Lysholm,Tegner and IKDC average scores were 89.86±7.90,8.64±1.65 and 89.31±8.16,respectively.While they were 92.17±6.72,8.91±1.16 and 90.89±7.80 in group AAMP,respectively.In group AMP the Lachman test was negative in 11 patients and positive in 3 patients.In group AAMP the Lachman test was negative in 20 patients and positive in 3 patients.The Pivotshift test was negative in 9 patients,positive in 5 patients and negative in 20 patients,positive in 3 patients in group AMP and AAMP,respectively.There were no significant differences in Lysholm,Tegner,IKDC scores,the negative rates of Lachman and Pivot-shift tests between two groups.Conclusion Single-bundle ACL reconstructions using AMP and AAMP techniques for femoral tunnel drilling have similar excellent primary clinical results.

BACKGROUND: Wnt signaling pathways can stimulate the proliferation and differentiation of neural stem cel s, and promote the repair of spinal cord injury. The electrical field stimulation can change the protein expression of Wnt signaling pathways.
QBJECTIVE: To explore the influence of oscil ating electric field on motor function recovery and the expression of Wnt-3a protein in rats with spinal cord injury.
METHODS: A total of 36 Sprague-Dawley rats models with spinal cord injury were induced by the Al en’s method. Al rats were randomly divided into oscil ating electric field stimulation group and spinal cord injury group. The stimulating electrodes were added in both groups. The oscil ating electric field stimulation group received oscil ating electric field intervention.
RESULTS AND CONCLUSION: At 3 days after model establishment, Basso, Beattie, and Bresnahan (BBB) locomotor rating scale scores and Wnt-3a expression were similar between the oscil ating electric field stimulation group and spinal cord injury group. At 7 and 14 days, significant differences in BBB scores and Wnt-3a expression were detected. These results indicate that oscil ating electric field stimulation can activate Wnt signaling protein in the early stage of spinal cord injury, which may be associated with the promoting effect of oscil ating electric field stimulation on spinal cord injury.

BACKGROUND:In an additional changing magnetic field, magnetosomes can invade the tumor cells and inhibit their proliferation.OBJECTIVE: To study the effect of targeted delivery of pHSP70-shPLK1/DOX compounds with magnetosome of magnetotactic bacteria on the treatment of osteosarcoma.METHODS: Human osteosarcoma cell U2OS was divided into four groups: group A: magnetosomes of magnetotactic bacteria+pHSP70-shPLK1/DOX complex; group B: magnetosomes of magnetotactic bacteria; group C: magnetosomes of magnetotactic bacteria+pHSP70-shPLK1/DOX complex, combined with magnetic intervention; group D: magnetosomes of magnetotactic bacteria, combined with magnetic intervention. After 12, 24, 48 and 72 hours of culture, the uptake rate of osteosarcoma cells was observed; cell cycle was evaluated by flow cytometry; PLK1 mRNA and protein expression levels were detected by RT-PCR and western blot, respectively; cell proliferation was explored by MTT assay; cell adhesion and invasion were checked by adhesion assay and Transwel chamber assay, respectively; and the apoptosis rate was measured by apoptosis detection Kit.RESULTS AND CONCLUSION: (1) After culture of 12 and 24 hours, the uptake rate was the highest in group D; meanwhile, the uptake rate was the highest in group B after 48 and 72 hours of culture. (2) The ratio of G2/M phase decreased and the ratio of G0/G1 increased gradualy in group A, group C and group D; the G2/M phase ratio of C group was the lowest at each time point, followed by group D, and that of group A was the highest; and the G2/M phase ratio increased gradualy in group B. (3) Folowing 12 and 24 hours of culture, the expression of PLK1 in group B and group D was higher than that in group A and group C (P < 0.05); in addition, the expression of PLK1 in group B was higher than that in the other three groups after 48 and 72 hours of culture (P < 0.05), and the PLK1 level in group D was higher than that in group A and group C (P < 0.05). (4) The proliferation, adhesion and invasion ability in group B were the highest at different time points, but the apoptosis rate was the lowest. Furthermore, the proliferation, adhesion and invasion abilities in group C were the lowest at different time points, and the apoptosis rate was the highest. To conclude, our experimental results show that the targeted delivery of pHSP70-shPLK1/DOX complex by magnetosomes of magnetotactic bacteria can enhance the apoptosis of osteosarcoma cells and inhibit their proliferation and invasion.

BACKGROUND:Peripheral nerve injury is a common disease in clinic, which severely affects the patients' quality of life. How to promote peripheral nerve regeneration is an issue of concern.OBJECTIVE:To study the effect of modified rabbit defensin 1 on peripheral nerve regeneration and functional recovery. METHODS: Eighteen Sprague-Dawley rats were randomly divided into three groups. The rat sciatic nerves were transected and bridged by biodegenerated chitin conduits, followed by the injection of neurotrophic factor (group 1), modified rabbit defensin 1 (group 2) and normal saline (control group) into the gluteus, respectively, for consecutive 7 days. RESULTS AND CONCLUSION: The sciatic nerve function index in the groups 1 and 2 was higher than that in the control group at 4 weeks postoperatively. The order of motor nerve conductive velocity was as follows: group 1 > group 2 > control group. The diameter regenerated fibers and axons, and the myelin thickness in the group 2 were less than those in the group 1, but were more than those in the control group. These results indicate that the modified rabbit defensin 1 can promote peripheral nerve regeneration, which may be related with the clearance of residual myelin by macrophages and the improvement in nerve regeneration environment.

Objective To investigate the clinical treatment strategy of concomitant diseases and perioperation complications in elderly patients with hip fracture aged ≥ 80 years and the clinical prognosis.Methods A retrospective analysis was conducted in 95 hip fracture patients aged 80 and over years(80～90 years old) undergoing operation.There were 42 cases with femoral neck fractures and 53 cases with intertrochanteric fracture.71 cases (74.7％) had preoperative concomitant medical diseases.Screw fixation was performed in 3 cases (3.2％),hemiarthroplasty in 75 cases (78.9％),total hip replacement in 4 cases (4.2％),proximal femoral nail antirotation (PFNA) in 9 cases (9.5 ％) and reconstruction interlocking nail fixation in 4 cases (4.2 ％).Results No mortality was found during hospitalization.Postoperative anemia was the most common (74.7％),followed by hypoproteinemia (68.4％),digestive disorders (30.5％),electrolyte disturbance (28.4％) and psychiatric symptoms (15.8 ％).At least one-year follow-up was made in 73 cases.39 cases (53.4 ％) acquired independent activities after surgery,48 (65.8％) patients recovered to the preoperative level of activity.The concomitant diseases before surgery (OR =0.23,P =0.011),preoperative ability of activity (OR=0.23,P=0.025),the American Society of Anesthesiology (ASA) classification (OR=0.19,P=0.025) were the related factors influencing the one-year mortality.Conclusions The treatment of concomitant diseases should be emphasized in treating fracture.The active prevention during preoperative,intraoperative,postoperative period could reduce or avoid fatal complications and acquire good functions.

Objective To observe the clinical effect of surface electrical stimulation on bladder spasm among patients with spinal cord injury,and compare it with that of therapy combining electrical stimulation with bladder function training.Methods Forty-two patients with bladder spasm after spinal cord injury were randomly divided into an experimental group (n=21) and a control group (n=21).Patients in the experimental group were further divided into three subgroups:patients with cervical spinal injury (n =7),thoracic spinal injury (n =9) and lumbar spinal injury (n =5).Both the experimental group and control group were given normal bladder function recovery exercise,while the experimental group was given the extra electrical stimulation on the surface of the sacral nerve.Urodynamic tests including the maximum detrusor pressure,bladder capacity,residual urine volume and bladder compliance were conducted for both groups before the treatment,after the first and the second 18-days of treatment and during a follow-up visit 2 months after the intervention.Results After the first course of treatment,significant differences were found in all measurements in the experimental group and most measurements of the control group except for the residual urine volume.Significant differences were found in all measurements after the second course of treatment compared to those after the first course in both groups.After the two courses of treatment and during the follow-up visit the average residual urine volume of the experiment group was significantly better than that of the control group.After the second course of treatment the average maximum detrusor pressure and bladder compliance of the experimental group were significantly better than those of the control group.Conclusion Surface electrical stimulation significantly improves the urodynamics and bladder function of patients with bladder spasm after spinal cord injury and its therapeutic effect is greater for patients with cervical and thoracic spinal injury than for those with lumber spinal injury.

Objective To investigate the characteristics of central cord syndrome without fracture or dislocation and assess the effect of surgical management.Methods Twenty-one cases of central cord syndrome without fracture or dislocation were diagnosed with X-ray radiography,CT and MRI and treated surgically.Spinal cord dysfunction and its recovery rate were evaluated using American Spinal Injury Association (ASIA) system.Radiological and clinical evaluation was performed for all cases.Pre-and postoperative ASIA scale and score were statistically analyzed.Results All cases sustained cervical spinal cord compression resulting from cervical disc herniation in 18 cases,of which five were accompanied by ligamentum flavum hypertrophy and reductus,developmental cervical spinal canal stenosis in two cases and posterior longitudinal ligament ossification in one case.Neurological dysfunction involved in the upper extremity in 15 cases and upper and lower extremity in six cases.Mean period of follow-up was 13.5months.ASIA scale was improved from C (n =9) and D (n =12) before operation to C (n =1),D (n =6) and E (n =14) in the last follow-up.ASIA score of motor and sensory dysfunction revealed a (84.3 ±12.5)％ and (62.7 ± 14.6)％ improvements,with significant difference as compared with the preoperative one (P ＜ 0.05).Conclusions Cervical disc herniation is the major factor of spinal cord compression in central cord syndrome without fracture and dislocation.Neurological dysfunction occurs mostly in the upper extremity.Surgery is an effective method to release spinal cord compression and restore neurological function.

BACKGROUND:Positioning of the distal locking screws of a tibial intramedulary nail is often chalenging and time consuming. The traditional free-hand technique under fluoroscopic control involves considerable radiation exposure.OBJECTIVE: To evaluate the results of a new electromagnetic navigation system (TRIGEN-SURESHOT navigation system) for distal locking of tibial intramedullary nail in tibial diaphyseal fracture and to compare the effects with the free-hand method.METHODS: Forty-five cases of tibial diaphyseal fracture in the Second Hospital of Anhui Medical University from May 2014 to August 2015 were analyzed retrospectively, and were divided into two groups. Patients in navigation group (n=23) were treated with intramedullary nail using the TRIGEN-SURESHOT navigation system for distal locking, and the remainings in free-hand group (n=22) were given the free-hand method.RESULTS AND CONCLUSION: All cases were followed up for 17-32 months. The one-time success rate of distal locking nail operation was 100％ in the navigation group, which was significantly higher than that in the free-hand group (P < 0.05). The locking nail time in the navigation group was significantly less than that in the free-hand group (P < 0.05).No significant differences were found in the incidence of adverse events and fracture healing time between two groups (P > 0.05). To conclude, the effect of the TRIGEN-SURESHOT navigation system for distal locking of tibial intramedullary nail is satisfactory, exhibiting the advantages of short operation time, high success rate, and no radiation.