[Objective]To observe complications of tibial pilon fractures with Ⅲ leaves type plate and analysis of causes and prevention of complications.[Method]Fourty-two cases of the final pilon fractures were treated with Ⅲ leaves type plate from July 1999 to December 2003.There were 30 males and 12 females,the average age was 45.3 years(ranged,15～62 years),9 cases were open fracture and 33 cases were open fracture.According to the Ruedi-Allgower classification,there were 15 cases of type Ⅰ fracture,18 cases of type Ⅱ fracture and 9 cases of type Ⅲ fracture.[Result]Fourty-two cases were followed up for an average of 28 months(ranged,14～60 months),The time to fracture union averaged 16 weeks(ranged,11～26 weeks).The complications included infection in 6 cases,cases with severe traumatic arthritis and 3 cases with ankylosis.After evaluated according to the criteria of Bourne,there were 19 cases assessed as being excellent,17 as good and 2 as poor,the excellent and good rate was 85.7%.[Conclusion]Ⅲ leaves type plate is a good internal fixation for tibial pilon fractures,but the complications should be prevented.

Tumor surface antigen human epidermal growth factor receptor 2 (Her2) is a type I receptor tyrosine kinase, which belongs to human epidermal growth factor receptor family. Her2-overexpression is associated with tumorigenesis and metastasis. Due to significant clinical effects, Her2-targeted cancer therapy especially therapeutic antibody has become the hot spot in the field of cancer treatment. Anti-Her2 antibody drugs include monoclonal antibodies, antibody-drug conjugates, bispecific antibodies and emerging "two in one" antibody. Based on structure and function of Her2, this review focuses on recent advances in active mechanisms and clinical researches of these antibodies.

Objective To investigate the effect of rivaroxaban on prevention from deep venous thrombosis after hip replacement surgery .Methods 80 patients with lower limb parallel arthroplasty were randomly divided into observation group and control group from January 2014 to January 2015.40 cases in each group.Control group was given aspirin treatment, observation group was given rivaroxaban treatment, indicators changes were followed up and recorded.Results PT, APTT values of observation group one week after treatment were (35.79 ±2.16),(15.84 ±2.11) s, which were better than control group (45.64 ±2.12),(18.72 ±2.02) s (P<0.05).TT, D-dimer of observation group(13.48 ±2.10)s,(2.34 ±0.33)g/L after a week were better,than control group (16.38 ±1.79)s, (1.42 ±0.21)g/L (P<0.05) respectively.Conclusion Effect of rivaroxaban in prevent deep venous thrombosis after hip replacement surgery is exact without obvious adverses reaction, it is worthy of further research and application.

Objective To explore whether or not the cartilage damage in the pathogenesis of pathologic synovial plicae is due to the matrix metalloproteinase. Methods The immunohistochemical method was used to detect the expression and distribution of matrix metalloproteinase-1(MMP-1) and tissue inhibitor of metalloproteinase-1(TIMP-1) in arthroscopically clarified pathologic synovial plicae and normal synovial plicae of the knee joint.Results The positive expression rate of MMP-1 and TIMP-1 had significant differences between the pathologic and normal synovial plicae(?~2=16.014,P=0.000;?~2=4.059,P=0.044).The expression of MMP-1 was positive in the synovial lining cells,monocytes,lymphocytes,endothelial cells,and chondrocytes,but negative in the normal synovial plicae.The TIMP-1 expression was only detected in the synovial lining cells and a small quantity of fibroblast cells.The immunohistochemical analysis revealed a greater number of positive cells and intensity of staining of MMP-1 than TIMP-1.Conclusions The development of pathologic synovial plicae may yield MMP-1 and TIMP-1 with unbalanced distributions,which may be the biological basis of the pathogenesis of cartilage destruction.

Objective To investigate the expression and significance of MMP-3 in knee joint synovium of different stage in osteoarthritis (OA) patients. Methods MMP-3 protein were detected by immunohistochemical method in knee synovial tissues from 90 OA patients (the OA group) and OA group was divided into 3 subgroups according to Kellgren and LawrenceX-ray diagnosing standards: the gradeⅠ(n = 30), gradeⅡ (n = 30) and grade Ⅲ subgroups (n = 30). 30 patients were enrolled as control group. Immunohistochemistry was used to detect the expression of MMP-3 protein in the tissue. Results The expression level of MMP-3 protein in OA group was significantly higher that in the normal synovium (P < 0.05). There existed significant difference in the expression of MMP-3 protein between the grade Ⅲ subgroup and the gradeⅠ, or Ⅱsubgroups (P < 0.05). The expression of MMP-3 protein related positively to the severity of OA (r = 0.912, P < 0.05). Conclusion The expression of MMP-3 protein related closely to the pathogenic mechanism of OA. It may serve as an important indicator of early diagnosis and the activity of OA.

Obiective To construct the manageable, stable and reliable computer terminal environment for the hospital. Technology was successfully applied to the outpatient doctor workstation and the student electronic reading room in one hospital, and the system was running well.Conclusion The technical application can not only ensure the system security and stability, but also realize centralized management and improve efficiency.

Objective To investigate the factors that affecting the efficacy of arthroscopic debridement in the treatment of knee osteoar-thritis. Methods The clinical data of patients with knee osteoarthritis treated with arthroscopic debridement in our hospital from January 2009 to December 2013 was retrospectively analyzed,and the treatment effect was evaluated by Lysholm score. The factors that may affect the efficacy were selected to make a single factor analysis,and then made a multiple logistic regression analysis with the factors which were of sta-tistical significance through single factor analysis. Results Single factor analysis showed that age,course of disease,body mass index,psycho-logical factor,preoperative VAS score,preoperative Kellgren-Lawrence grade,preoperative Lysholm score and postoperative rehabilitation exer-cise were the factors that affected the efficacy of knee arthroscopy in the treatment of knee osteoarthritis,and the difference between the two groups was statistically significant. Further multivariate analysis showed that high body mass index,high preoperative VAS pain score,low Ly-sholm score,high psychological expectations and high preoperative Kellgren-Lawrence grading were expected to be the independent risk fac-tors of knee arthroscopy in the treatment of knee osteoarthritis. Strict compliance with the postoperative rehabilitation exercise was the protect factor. Conclusion High body mass index,high preoperative VAS pain score,low preoperative Lysholm score,high preoperative Kellgren-Lawrence grading,and high psychological expectations were expected to reduce the effect of surgery,while strict compliance with the postoper-ative rehabilitation exercise can improve the curative effect.

Objective To evaluate the expression and clinical significance of matrix metalloproteinase 14(MMP-14) in osteoar-thritis(OA) patients in synovium and synovial fluid of knee joint .Methods Semi-quantitative RT-PCR were used to detect the ex-pression of MMP-14 mRNA in 32 case of OA (experimental group)and 26 non-OA patients(control group)synovium ;protein level expression of MMP-14 in synovial fluid were analyzed by ELISA .Results The expression of MMP-14 mRNA in experimental group synovium of knee joint was significantly increased compared with control group (P<0 .05);but the protein level of MMP-14 was low in experimental group synovial fluid compared with control group (P<0 .05) .Conclusion The expression of MMP-14 is increased in OA patients synovium and maybe promote the progress of OA directly ;the protein level of MMP-14 is decreased in OA synovial fluid ,indicated the function of MMP-14 in OA synoviocyte indirectly .

BACKGROUND:A large number of studies have shown that adult stem cels derived from multiple tissues are available to differentiate towards nucleus pulposus-like celsin vitro. It is unclear whether mesenchymal stem cels derived from nucleus pulposus tissues have the ability to differentiate towards nucleus pulposus-like phenotypes induced by transforming growth factor-beta 1. Up to now, there are few reports on the difference between the differentiation ability of mesenchymal stem cels derived from nucleus pulposus tissues and adipose-derived mesenchymal stem cels. OBJECTIVE:To compare the ability of mesenchymal stem cels derived from nucleus pulposus tissues and adipose-derived mesenchymal stem cels differentiating into nucleus pulposus-like cels under induction of transforming growth factor-beta 1. METHODS:The groin fat tissue and the coccygeal spine of rats were taken respectively to isolate and culture mesenchymal stem cels derived from nucleus pulposus tissues and adipose-derived mesenchymal stem cels by mechanical enzyme digestion method. Flow cytometry was employed to detect the expression of CD105, CD90, CD29, CD45, CD44, CD34, and CD24 of both two kinds of stem cels. Mesenchymal stem cels derived from nucleus pulposus tissues and adipose-derived mesenchymal stem cels were divided into complete induction group (complete induction medium with transforming growth factor-beta 1), incomplete induction group (complete induction medium without transforming growth factor-beta 1) and control group(DMEM/F12 containing 10% fetal bovine serum and 100 mg/L penicilin/streptomycin), respectively. After 14 days of culture, real-time PCR was used to detect the expression of colagen type II, Aggrecan and SOX-9 in each group. RESULTS AND CONCLUSION:CD105, CD90, CD29 expressed positively and CD45, CD44, CD34, CD24 negatively in both two kinds of stem cels. After 14 days of induced differentiation, the expressions of colagen type II, Aggrecan and SOX-9 in the two kinds of cels were significantly higher in the complete induction groups than in the control groups (P < 0.05). Under the induction of transforming growth factor-beta 1, the expression of colagen type II, Aggrecan and SOX-9 in mesenchymal stem cels derived from nucleus pulposus tissues was significantly higher than that in adipose-derived mesenchymal stem cels (P < 0.05). These findings suggest that both two kinds of mesenchymal stem cels have the ability to differentiate towards nucleus pulposus-like cels induced by transforming growth factor-beta, and mesenchymal stem cels derived from nucleus pulposus tissues may be more suitable as seed cels for nucleus pulposus tissue engineering research.

Objective To explore the clinical efficacy of polyetheretherketone( PEEK) cages and titanium cages combined with pedicle screw fixation operation in treatment of lumbar degenerative disease,and provide reference for clinic. Methods The data of 50 patients with lumbar degenerative disease in our hospital from March 2011 to March 2013 were retrospectively analyzed. All patients were treated with pos-terior decompression,bone graft and transpedicular screw internal fixation,according to the different cages,they were divided into PEEK group and titanium group. The PEEK group with 25 patients used polyetheretherketone cages,and the titanium group with 25 patients used titanium cages. The JOA scores of patient before surgery,1 month,6 months and 1 year after surgery between two groups were recorded and compared. The ROM of fusion levels and adjacent segment of patients before and after operation between two groups were compared. Results There was no statistical significance of difference in JOA score,Oswestry score and fusion rate between two groups(P>0. 05). There were statistical significance of differences intervertebral disc height change between 2 groups(P<0. 05). The ROM of fusion levels and adjacent segment of patients in PEEK group was better than those in titanium group(P<0. 05). Conclusion The polyetheretherketone cages combined with pedicle screw fixation operation have a good effect in the treatment of patients with lumbar degenerative disease,especially in matter of lumbar spinal motion and intervertebral height lost.