Objective To evaluate the effect of tourniquet on incisional infection based on animal model,and evaluate the effect of ischemia preconditioning on incisional infection,so as to provide experimental basis for the ra-tional use of tourniquet in clinic.Methods 100 BALB/c mice were randomly divided into 4 groups,with 25 mice in each group.Group A:tourniquet+methicillin-resistant Staphylococcus aureus (MRSA)incisional infection;group B:ischemic preconditioning+ MRSA incisional infection ;group C :MRSA incisional infection;group D:blank control.The survival rates,temperature,routine blood testing,and change in soft tissue beside femoral incision were compared among 4 groups.Results During observation period ,the survival rate in group A was 68%,in group B,C,and D were all 100%,group A was lower than group B,C,and D (P <0.05).The temperature at each time point was significantly different among group A,B,and C (P <0.01 );temperature curves of 4 groups were significantly different (P <0.01 );except basal body temperature,temperature at the other time points among 4 groups were significantly different(all P <0.01);routine blood testing results (white blood cell count,total granu-locyte count,and total lymphocyte count)among 4 groups on the third,and seventh day were significantly different (all P <0.05);on the seventh day,routine blood testing results of 4 groups all returned to normal level,but group A was slightly higher than group B,C,and D.Section of epithelial tissue revealed that epithelial tissue in group A was not healed,inflammatory response of peripheral tissue was most serious;epithelial tissue in 10 mice in group B was healed,partial peripheral tissue revealed inflammatory response;epithelial tissue in 4 mice in group C was healed,most peripheral tissue revealed inflammatory response.Conclusion Mice incisional infection will be aggrava-ted by using lower limb tourniquet,incision healing and body function recovery time will be delayed,even lead to death.Ischemic preconditioning before making an incision model can reduce the severity of incisional infection,and shorten wound healing time.

Objective To compare the safety and clinical outcome between minimally invasive internal fixation and open reduction in treatment of calcaneus fracture based on Meta analysis.Methods A computer-based online search of the Cochrane library,Medline database,CNKI,Wan Fang database,the Chinese biomedical literature database,PubMed,Ovid database and all was performed for clinical trials regarding minimally invasive internal fixation and open reduction in treatment of calcaneus fracture.Meta analysis was used to analyze the postoperative local soft tissue,calcaneal last follow-up Bohler angle and Gissane angle.Results A total of 17 studies were included(used Jadad quality grading,one is 7 points,two is 4 points,four is 3 points,ten is 2 points),involving 1138 patients,including 569 patients used minimally invasive internal fixation and 569 used open reduction.Meta analysis showed that the incidence of postoperative local soft tissue poor healing used minimally invasive internal fixation is lower than used open reduction about,the difference was statistically significant [OR =0.26,95％ CI:(0.14,0.47),P ＜ 0.01].Meta analysis showed that the calcaneal last follow-up Bohler angle of minimally invasive internal fixation was lower than open reduction,the difference was statistically significant [WMD =-1.29,95％ CI:(-2.39,-0.19),P =0.02].There were no statistically significant differences in the calcaneal last follow-up Bohler angle between minimally invasive internal fixation and open reduction[WMD =1.01,95％CI:(-3.02,5.04),P =0.62].Conclusions Regardless of the calcaneal fracture type,minimally invasive internal fixation or open reduction,the postoperative Bohler angle and Gissane angle at the calcaneus mechanical recovery characteristics are the same.However,the postoperative soft tissue healing of minimally invasivc internal fixation is less better than open reduction.

Objective To compare the safety and the clinical outcomes between proximal femoral nail antirotation (PFNA) and InterTan nail in treatment of femoral intertrochanteric fracture using a Meta analysis.Methods A computer-based online search was performed of the Cochrane library,Medline database,CNKI,Wan Fang database,the Chinese Biomedical Literature Database,PubMed,Ovid database for clinical trials regarding PFNA and InterTan nail in the treatment of femoral intertrochanteric fractures.A Meta analysis was done to compare operation time,intraoperative bleeding,time for fracture healing,postoperative Harris hip score,and postoperative complications between the 2 groups using statistical software RevMan 4.2.Results A total of 7 studies were included (one of 7 points and 6 of 2 points by Jadad quality grading),involving 491 patients (all one-sided).PFNA was used in 266 patients and InterTan nail in 225.The operation time in the PFNA group was significantly shorter than in the InterTan nail group [WMD=-15.58,95％ CI (-21.60,-9.56),P ＜0.001].The Harris hip score at the last follow-up was significantly lower in the PFNA group than in the InterTan nail group[WMD =-2.33,95％ CI (-4.14,-0.53),P =0.01].There were no statistically significant differences between the 2 groups in bleeding volume [WMD =-33.89,95％ CI (-71.88,4.11),P =0.08],bone healing time [WMD =1.60,95％ CI (-2.32,5.52),P =0.42],or postoperative complications [OR =1.90,95％ CI (0.98,3.69),P =0.06].Conclusions Although InterTan nail may lead to longer operation time than PFNA,the risk of surgery may not be much increased and the former has an advantage of better hip functional recovery than the latter.

Objective To investigate the MRI features of intracranial lymphoplasmacyte-rich meningioma and the corelation between the MRI features and pathologic findings. Methods The MRI and pathologic data of 7 patients with lymphoplasmacyte-rich meningioma were reviewed retrospectively. All cases were proved by surgery and pathological examinations. Results All lesions were solitary. The tumors crawled along meninges in 6 cases and in 5 cases the tumors did not appear as mass lesions. In 2 cases, the tumors appeared as half-moon. The boundary of all of the tumors was unclear, accompanying heavy peritumoral brain edema. The brain invasion can be seen in 7 cases. The lesions showed hypo-isointense signal on T1 WI in 7 cases, hyper-isointense signal in 5 cases and hypo-isointense in 2 cases on T2 WI.Enhancement scan demonstrated marked enhancement in 7 cases. Extensive thickening of the meninges was observed in 6 cases. Pathological results showed that the cells were abundant and diversified, with a great quantity of lymphoplasmacytes, and there were typical meningeal epithelial cells area in the surgical specimen. Conclusion The MRI findings of lymphoplasmacyte-rich meningioma show some features different from other common meningiomas, which would be helpful to the diagnosis and differential diagnosis.

Objective To analyze the MRI features of rare intracranial germ cell tumors of the pineal region compared with pathologic findings.Methods The MRI and pathologic data of 32 patients with rare intracranial germ cell tumors of the pineal region were reviewed retrospectively.All cases were proved by surgery and pathological examinations.Results Fourteen teratomas with malignant transformations were cyst-solidary which were mixed signals on plain MRI and the solid components showed obvious enhancement.The adiposity signals could be seen in teratomas.The level of serum or CSF AFP was high.Microscopically,many tissue components could be seen.The signal of 6 yolk sac tumors were homogeneous,and they had great enhancement after enhanced scanning.Increasing of preoperative serum AFP level could be seen in all patients.The 5 embryonal carcinomas were well-defined margin masses and heterogeneous with cystoid variation and necrosis and moderate to severe edema.The solid components showed obvious enhance.The signals of 7 mixed germ cell tumors were atypical,which depended on the components of germ cell tumors.Conclusion The MRI findings of the rare intracranial germ cell tumors of the pineal region(teratomas with malignant transformations,yolk sac tumors endodermal sinus tumor,embryonal carcinomas and mixed germ cell tumors)show some feature which are correlated with pathology.Suggestive diagnosis could be made combined with clinical data and MRI features.

Objective To analyze the MRI features of Ewing sarcoma/peripheral primitive neuroectodermal tumors(pPNETs) arising from the meninges.Methods The MRI imaging of 9 patients with Ewing sarcoma/pPNET were reviewed retrospectively,and imaging features and pathological characteristics were analyzed.Results The age of most patients ranged from 10 to 20 years.Magnetic resonance revealed a spindle-like lesion with a wide base in 8 cases.The lesions showed heterogenous iso-or hypo-intense signal on T1 WI in 7 cases,heterogenous hypo-iso-intense signal on T1 WI in 2 case,and iso-or mildly hypderisointense on T2WI in all cases.The solid part of the tumor was heterogeneously enhanced after injection of gadolinium with cyst degeneration or necrosis.The dural tail sign could be seen in 3 cases.The adjacent skull erosion could be seen in 6 cases.The breakthrough of the plate of cranium and soft-tissue invasion was present in 2 cases.The right eye proptosis was present in 1 case.The distant metastasis was found in 3 cases.Pathology showed that the lesions had high cell density.Hemorrhage and necrosis could be observed.The cells were like lymphocytes and spindle cells with transparent cytoplasm.CD99 and Vimentin were expressed in all tumor cells.Conclusion The imaging findings of the meningeal pPNET are different from meningiomas,which could be useful for the diagnosis and differential diagnosis.

Objective To explore the influence of brief ischemic on fracture healing.Methods Two hundred and forty wistar rats (weight was 200 g and half male) were made the right tibial midpiece closed fracture model.1.0 mm K-wires were used to fix the fractures.Rats were divided into 4 groups.Group A was 24 hours,group B was 48 hours,group C was 72 hours,and group D was the control group.Tourniquet was used on the root of the thigh of right lower limb.Tourniquet was inflated 10 min,then released 10 min,and repeated 3 times to make the brief ischemic model.48 rats were made brief ischemic at 24 hours after the fracture fixed.Then group A was at every 24 hours,group B was at every 48 hours,and group C was at every 72 hours made brief ischemic.Group D at every 24 hours after the fracture fixed was used tourniquet on the root of thigh of right lower limb each time 1 hour,but the tourniquet was not inflated.Group A,B,and C were made brief ischemic 5 weeks.Group D was tourniquet treated 5 weeks.Group A and D at 1 day,3 days,5 days,and 7 days after fracture fixed were detected the serum VEGF.All groups of rats were X-ray examinated and detected of serum VEGF at every two weeks after the fracture fixed.Every two weeks,every group randomly selected 12 rats to do immunohistochemical staining.We used the Image Pro Plus software to quantitative compare the IGF-2 positive cells in the fracture area.Results X-ray results were used three points method for analyzing.The scores of group A,B,and C were significantly higher than group D at 2 weeks,4 weeks,6 weeks after fracture fixed (P ＜ 0.05).The scores between group A,B,and C were no significant statistical difference at 2 weeks,4 weeks,6 weeks after fracture fixed (P ＞ 0.05).The levels of serum VEGF of group A were significantly higher than group D at 3days,5days,and 7 days after fracture fixed (P ＜ 0.05).The levels of serum VEGF of group B and C were obviously higher than group A and D at 2 weeks (P ＜ 0.05),and there was no obvious difference between group B and C (P =0.79,P =0.90,P =0.88).The same result was found between group A and D (P =0.94,P =0.551,P =0.53).There were no significant difference between four groups on the levels of serum VEGF at 8 weeks (P =0.66).Immunohistochemical results were that group B,group C VEGF positive cells were significantly higher than group A and group D at 2 weeks,4 weeks,6 weeks (P ＜0.05).There was no significant difference in group B and group C (P =0.19,P =0.10,P =0.38),or group A and group D (P =0.07,P =0.17,P =0.18).There was no significantly different in four groups at 8 weeks (P =0.08).Conclusions Brief ischemic can promote the healing of fracture and stimulate the expression of VEGF.The mechanism may be related to the signal channels of VEGF and other biological factors.This study will give new idea to clinic for promoting fracture healing.

AIM To study lipid-lowering effects of gallic acid on glutamate-induced obesity mice.METHODS The obese model was established through subcutaneous injection of 3mg/(g · d)sodium glutamate into neonatal mice.After the model was established,the mice were divided into normal control group,model group,positive control group [simvastatin 30 mg/(kg · d)],high-,and low-dose group of gallic acid [400,200 mg/(kg · d)],and were intragastrically administered for ten weeks.Mice in each group after the last administration were fasted for 12 h except water.Blood was sampled from mouse eyes.The organs and adipose were obtained to determine the organ index and fat index.The levels of HDL-C,TG,LDL-C and TC in serum and liver were determined by using the corresponding reagent kit,and the serum leptin level was determined by ELISA kit and simultaneous determination of SOD,GSH-Px and MDA levels in liver.RESULTS Compared with the normal control group,the body weight and fat weight significantly increased in the model group;the levels of TC,TG and LDL-C in serum and liver significantly increased;the serum leptin level significantly reduced;the activity levels of SOD and GSH-Px in the liver significantly reduced;and the level of MDA significantly increased.Compared with the model control group,the body weight and fat weight significantly reduced in the gallic acid group mice and the levels of TC and TG significantly reduced in the serum and liver;SOD and GSH-Px levels significantly increased,MDA level significantly decreased in the liver.CONCLUSION Gallic acid can significantly reduce the blood lipid level of glutamate-induced obese mice.

Objective To observe the curative effect of open reduction and internal fixation for capitellum and trochlea fractures.Methods A retrospective case series study was performed on 14 patients with capitellum and trochlea fractures without involving lateral and lateral column treated by open reduction and internal fixation from April 2008 to August 2016.There were four males and 10 females, aged from 24 to 62 years (mean, 41.4 years).Dubberley classification was type ⅠA in four patients, type ⅠB in three, type ⅡA in two, type ⅡB in one, type ⅢA in two, type ⅢB in two.Three patients were combined with ipsilateral capitulum radius fractures, and one patient with ipsilateral ulna olecranon fracture.Visual analogue scale (VAS) for elbow pain, elbow activity and Mayo elbow performance score (MEPS) were evaluated.Postoperative complications were also observed.Results All patients were followed up for 24-55 months (mean, 27.2 months).Fracture healed after (21.3±2.1)weeks.VAS was (2.1±1.9) points at 24 months postoperatively, with painless in three patients, mild pain in seven and moderate pain in four.Elbow flexion and extension angle was (93.4±15.2)°, elbow flexion angle was (114.3±11.1)°, elbow extension angle was (33.6±20.7)°, forearm front rotation angle was (75.2±12.5)°, and forearm back rotation angle was (83.2±8.2)°.No patients had elbow instability, ischemic necrosis or internal fixation loosening.MEPS was (74.2±17.8)points, including excellent results in 3 cases, good in 8, fair in 2 and poor in 1.One case of Dubberley type ⅢA developed mild ulnar nerve symptom and alleviated after 3 months.Five cases (two type ⅢA, one type ⅢB, one type ⅡA, one type ⅡB) had a small amount of heterotopic ossification 6 month after operation, but elbow flexion and extension activity was good.One case of Dubberley type ⅢB combined with fracture of the olecranon process had elbow heterotopic ossification 1 month after operation, further developed large displaced ossification around the elbow 6 months after operation, and showed elbow flexion and extension of 30° 2 years after operation that was significantly limited compared to the contralateral side.Conclusion Open reduction and internal fixation of capitellum and trochlea fractures can improve elbow activity and reduce incidence of postoperative complication.

BACKGROUND:Some studies have shown that blocking the venous return can promote fracture healing but there is no study about the effect of repeated transient ischemia on promoting fracture healing. OBJECTIVE:To observe the promoting effect of repeated transient ischemia on early fracture healing based on micro-CT technique. METHODS: Forty-eight Wistar rats were used to make animal models of right tibial midpiece closed fractures folowed by K-wire fixation. Rats were randomly divided into four groups: 24-hour group, 48-hour group, 72-hour group and control group. Tourniquet was used on the root of the affected thigh, inflated for 10 minutes, and then released for 10 minutes. Three above-mentioned cycles were taken as an ischemic treatment. At 24 hours after fracture fixation, the ischemic treatment was first carried out, and after that, it was done every 24 hours in the 24-hour group, every 48 hours in the 48-hour group and every 72 hours in the 72-hour group. In the control group, the tourniquet with no inflation was used once on the right lower limb every 24 hours after fixation. Al the rats were kiled at 2 weeks after modeling to take out the right tibia with removal of K-wires for micro-CT observation. RESULTS AND CONCLUSION:The trabecular bone volume and total volume in the regions of interest were significantly higher in the 24-hour group than the other three groups (P < 0.05), but the tissue mineral density and calus tissue mineral density were significantly lower in the 24-hour group than the other three groups (P < 0.05).There was no significant statistical difference in the bone volume fraction among the four groups (P > 0.05). These findings indicate that within 2 weeks after fractures, the repeated transient ischemia can promote fracture healing, which may be related to the improvement in the secretion of growth factor, revascularization and osteoblast proliferation induced by repeated transient ischemia.