Objective The olecranon is likely to become shorter following the treatment of its comminuted fractures, which will lead to the compromise of the function of elbow joint. So through the cadaver experiment, introduce the method of making different thickness and direction in osteotomy so as to intimate the shape change of the olecranon after the comminuted fractures, and explore its effect on the flexion-extension function of the elbow joint. Methods Through three cadaver(six arms), osteotomy at 25 mm below the olecranon process was made horizontally and fixed with two screws temporarily, furthermore, the bone fragment of 1 mm, 3 mm and 5 mm in length was resected in order, then specimens were divided into two groups: In the first group, osteotomy was made up to 7 mm and 8 mm continually, and the changes of the range of the elbow joint movement were measured; in the second group, the additional wedge osteotomy of 5 mm and 7 mm was performed respectively, then the outcomes between the two groups were compared. Results If the osteotomized bone was within 3 mm, shortening internal fixation was satisfactory for the reconstruction of the elbow joint function. However, in cases of osteotomized bone of 5 mm, the extension function would be limited as the loss of the trochlear notch is too much. In order to keep the normal range motion of the elbow, the dorsal cortex distal to osteotomy should be scarified about 3 mm for the wedge osteotomy. When the shortage attained to 7 mm, the elbow instability would occur, even if advanced wedge osteotomy was accomplished. Conclusion In cases of the comminuted olecranon fractures, if the osteotomy is made within 3 mm, the shortening fixation is appropriate; if it has not exceeded 5 mm, the fracture should be treated with advanced wedge osteotomy tilting back to keep the radian of the trochlea; and if it has reached 7 mm, bone grafting is necessary for recovering of the flexion-extension of the elbow joint.

Objective To introduce a new bilateral triceps brachii approach for the treatment of intercondylar fractures of the humerus, and explore the possibility for the operation without injuring the mechanism of extension of the elbow. Methods With fresh cadaver specimens, the triceps brachii was stripped off from the distal end of the humerus, the muscle belly was elevated and retracted bilaterally, then the height was recorded, and the exposure of the distal humerus was observed, especially to the trochlear region when the elbow were flexed at 15? , 30? , 45? , 60? , 80? respectively. Results Through the cadaver specimen observation and the clinical application, the reduction and fixation of the intercondylar fractures of humerus should be performed when the elbow is flexed at 45?－ 60?， at 15?－ 30? flexion, fracture over the supracondylar can be treated and finally at 80? flexion, the reduction of the trochlear region can be examined. Conclusion This bilateral approach through the triceps brachii is suitable for the treatment both of the intercondylar and epicondylar fractures.

Objective To explore the relationship of the expression level of monocyte Chemotactic protein-1 and nuclear factor κB(NF κB)with atrial fibrosis of atrial fibrillation patients with rheumatic heart disease.Methods About 200 mg right atrial tissue were taken from 26 patients with rheumatic heart disease undergoing valve replacement surgery and divided into sinus rhythm (SR) group (n=12) and atrial fibrillation (AF) group (n=14).Masson staining and atrial myocardial fibrosis markers were used to determine the level of fibrosis.The mRNA levels of cytokines in atrial tissue were measured by reverse transcription polymerase chain reaction (RT-PCR)The protein level of MCP-1 and phosphorylation of NFκB in atrial tissue were detected by Western blotting.Results Compared with SR group,the AF group showed that collagen volume fraction (AF:0.42 ± 0.03;SR:0.13 ± 0.02),the mRNA levels of myocardial fibrosis markers such as transforming growth factor (TGF)-β1,type Ⅰ collagen and type Ⅲ collagen,and cytokines such as IL-1β and TNF-α,and the protein level of MCP-1 (AF:0.170±0.003;SR:0.040±0.005) and level of phosphorylation of NF-κB (AF:0.35 ± 0.02;SR:0.12 ± 0.03) were significantly increased (all P＜0.05).In addition,the expression levels of cytokines,the protein expression level of MCP1 and the phosphorylation level of NF-κB were positively correlated with collagen volume fraction of the right atrial myocardial tissue (all P＜0.05).Conclusions Activation of NF-κB may induce the expression of MCP-1 in the myocardial tissue of patients with rheumatic heart disease,and sequentially stimulate the secretion of cytokines and extracellular matrix deposition,and finally participate in the occurrence and persistence of atrial fibrillation.