Objective To establish a method of measuring bone mineral density (BMD) in the proximal humeral region, and explore the relationship between proximal humeral BMD level and age and body mass index (BMI).Methods A scanning procedure was developed, using a shoulder & forearm position device.Firstly, 30 subjects were examined on the proximal humerus with 2 successive scan sessions to de-termine the short-term precision.Secondly, scanning of the right proximal humerus BMD in 92 healthy women was done.Results Short term precision revealed that RMS SD was 0.011 g/cm2, and RMS CV (coefficient of variation) on BMD measurement was 2.4%.Proximal humeral BMD values decreased with age.No correlation existed between the proximal humeral BMD and BMI.Conclusions The method of measuring BMD over the proximal humeral region is reasonable, and the short term precision of the result is acceptable.Proximal humeral BMD tends to decrease with age.Since the shoulder is subject to the least in-fluence of weight and stress loading, the proximal humeral BMD scan might be an early stage indicator of osteoporosis.

Objective: Identification of the genes specially expressed in tumor cell but not in normal cell is important for understanding the molecular mechanisms of carcinogencsis. This study will focus on identification of differentially expressed gene fragments in human stomach cancer. Methods: By using the new developing mRNA differential display (DD) technique, genes fragments differentially expressed in stomach cancer tissues from a patient and the adjacent normal tissues beyond the tumor mass were studied. Results: Two differentially displayed complementary DNA fragments from stomach cancer tissues, scgl and scg2 (stomach cancer-associated gene, scg), cofirmed by Northern Blot, were cloned and sequenced. The nucleotide length of scgl is 194 base pairs and that of scg2 is 343 base pairs. After searching against GenBank databases by BLASTN, neither scgl nor scg2 had significant homological gene sequences with the known genes. Conclusion: These results suggested scgl and scg2 might be complementary DNA fragments of novel genes expressed in stomach cancer tissues, but not in normal tissues and may play a role in the occurrence and development of stomach cancer. Further characterization of full-length of these two complementary DNA fragments will be continued.

OBJECTIVETo increase prokaryotic expression level of IFN-alpha 1C gene through the quantitative theory of translational control and the translational enhancer sequence.

METHODSStepwise polymerase chain reaction (PCR) was used to alter the 5 terminal cDNA sequence of IFN-alpha 1C in three different grades of base mutation. In this way, the free energy (Delta G) of the secondary structure in translational initiation region (TIR) was decreased gradually. An expression plasmid (pBVE) was constructed to contain the translational enhancer cDNA sequence by modifying pBV220 upstream of the SD region.

RESULTSThe expression levels of three kinds of IFN-alpha 1C modified gene were all increased. Furthermore, it presented an increasing trend with decreasing in delta G varying from -50,241.6 to -22,190.0 J/mol. The highest expression was 2.43 x 10(8) U/L, covering twelve times more than its original cDNA. IFN-alpha 1C gene and its modified cDNA was inserted into pBVE as reporting genes. E.Coli cells harbouring pBVE/IFN-alpha 1Cs cDNA produced two to five times more IFN than cells harbouring pBV220/IFN-alpha 1Cs.

CONCLUSIONSpBVE containing translational enhancer is a high level prokaryotic expression vector. The theory of quantitative translational control can effectively be used to enhance the IFN-alpha 1C gene expression level in E.coli.

DNA, Circular ; genetics ; Enhancer Elements, Genetic ; Escherichia coli ; genetics ; Gene Expression ; Gene Expression Regulation ; Genetic Vectors ; Interferon Type I ; genetics ; Peptide Chain Initiation, Translational ; genetics ; Polymerase Chain Reaction ; methods

BACKGROUND: Tendon is a fibrous tissue that connects bone and muscle. The main function is to conduct stress from the muscles to the bone during exercise. Tendinopathy is a commonly seen disease, characterized by tendon inflammation, degeneration and injury. Autophagy is widely involved in the development of many degenerative diseases. The research method based on autophagy provides a new idea for tendon repair. OBJECTIVE: To review the process and regulation mechanism of autophagy, and to analyze the pathological mechanism of autophagy involved in the tendinopathy so as to provide a reference for the prevention and treatment of tendinopathy. METHODS: The articles concerning autophagy and tendinopathy were retrieved by computer in CNKI, WanFang and PubMed databases. The keywords were "autophagy, tendon, fibroblast, tendinopathy" in English and Chinese, respectively. Finally, 54 articles were obtained through systematic induction and analysis after excluding the irrelevant and repetitive articles. RESULTS AND CONCLUSION: Autophagy can alleviate the damage to human tendon stem cells induced by oxidative stress. With the increase of the degree of extracellular matrix degradation in the tendon tissue, autophagic cell death occurs in the tendon cells due to excessive autophagy. Prostaglandin E2 significantly induces fibroblast death and autophagy in a dose-dependent manner. The muscle atrophy after the rotator cuff injury is regulated by autophagy. Rapamycin prevents peritendinous fibrosis through activation of autophagy. In conclusion, autophagy plays an important role in tendinopathy. Autophagy will become a new hotspot in tendinopathy. Further understanding of autophagy and its role in tendinopathy will contribute to finding a targeted autophagy pathway and provide new theoretical and methodological support for the intervention and treatment of tendinopathy.

Objective To analyze the risk factors associated with periprosthetic femoral fracture following hemiarthroplasty (HA) for displaced femoral neck fracture in aged patients.Methods From January 2013 to June 2016,120 patients over 80 years old were treated by HA for displaced femoral neck fractures.They were 45 males and 75 females,with an average age of 85.2 years (from 80 to 97 years).Their fractures were Garden type Ⅲ (72 cases) and Garden type Ⅳ (48 cases).The time from injury to operation averaged 5.1 days.The patients were divided into a fracture group and a non-fracture group according to the presence or absence of the periprosthetic fracture.The general data of the 2 groups were compared;multivariate logistic regression analyses were done to indentify the influencing factors associated with periprosthetic femoral fracture.Results The 120 patients obtained a mean follow-up of 26.1 months (from 13 to 48 months).Periprosthetic femoral fracture occurred in 11 cases,giving an overall incidence of 9.2％ (11/120).Compared with the non-fracture group,the average age was significantly older,the incidence of past fractures was significantly higher,significantly more types of uncemented stem were used,and American Society of Anesthesiologists (ASA) grading was significantly more severe for the fracture group (P ＜ 0.05).There were no significant differences between the 2 groups concerning the general data (P ＞ 0.05).Multivariate Logistic regression analyses revealed that age [OR =1.268,95％ CI (1.059,1.517),P =0.010] and type ofuncemented stem [OR =0.072,95％ CI (0.008,0.625),P =0.017] were independent risk factors for periprosthetic fracture.Conclusions The incidence of periprosthetic femoral fracture in the elderly patients may be high following HA for femoral neck fractures.Since age and uncemented stem may be independent risk factors for periprosthetic femoral fracture,surgeons should pay enough attention to them in clinic.

Objective To compare the outcomes of Dresden technique versus open surgery for acute Achilles tendon ruptures.Methods From January 2013 to June 2017,67 patients were operatively treated for acute Achilles tendon rupture at Department of Orthopaedics,China Japan Friendship Hospital.Of them,Dresden technique was used in 32(minimally invasive group) and open surgery in 35(open surgery group).The 2 groups were compared in terms of baseline characteristics,operation time,operative incision length,hospital stay,postoperative complications like incision infection and tendon re-rupture and the Achilles Tendon Total Rupture Score(ATRS).Results The 2 groups were compatible due to insignificant differences in the baseline characteristics(P>0.05).They were followed up for 18 months.The minimally invasive group had significant shorter operation time(40.0min),incision length(3.0cm) and hospital stay(5 d) than the open surgery group(42.5 min,10.0 cm and 6 d)(P<0.05).No sural nerve lesion was observed in either group.The rate of wound complications was 0% for the minimally invasive group and 8.6% for the open surgery group;the rate of re-rupture was 3.1% for the former and 2.9% for the latter;the ATRS at the final follow-up was 98.0 for the former and 98.5 for the latter.There were no significant differences between the 2 groups in the above comparisons(P>0.05).Conclusions Percutaneous suture of the Achilles tendon with the Dresden instruments is a safe,fast and standardized surgical procedure for acute Achilles tendon ruptures,leading to shorter operation time,incision length and hospital stay,better functional recovery and a tendency of decreased wound complications than the open surgery.

Objective:To investigate the effects of lengths of intramedullary nails on the treatment efficacy of osteoporotic unstable intertrochanteric fracture.Methods:Retrospectively analyzed were the data of patients with osteoporotic unstable intertrochanteric fracture who had been admitted to Department of Orthopedics, China-Japan Friendship Hospital from January 2017 to December 2019. According to the lengths of intramedullary nails, the patients were divided into 2 groups. In the short nail group of 135 cases, there were 38 males and 97 females with an age of (82.2 ± 7.7) years and an intramedullary nail with a length of 170 mm was used. In the long nail group of 32 cases, there were 8 males and 24 females with an age of (81.5±7.1) years and an intramedullary nail longer than 300 mm was used. The amount of intraoperative hemoglobin drop value, operation time, Harris hip score at 6 months after surgery, incidence of complications and mortality were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability between groups ( P>0.05). There were no significant differences between the 2 groups in intraoperative hemoglobin drop value [(19.8±2.2) g/L versus (20.0±2.1) g/L], Harris hip score (72.0±3.0 versus 71.2±3.6), incidence of complications [3.0% (4/135) versus 6.2 (2/32)] or mortality [14.3% (19/135) versus 15.6% (5/32)] ( P>0.05). The long nail group needed significantly longer operation time than the short nail group [(84.6±5.6) min versus (92.0±7.2) min] ( P<0.05). Conclusions:In the treatment of osteoporotic unstable intertrochanteric fracture, short and long intramedullary nails show no significant difference in hemoglobin drop value, functional score, complications or mortality, indicating they can both lead to safe and reliable curative efficacy. However, long nails need longer operation time.

Objective To investigate the effect of intraoperative dripping of intravenous tranexamic acid (TXA) on the perioperative blood loss in elderly patients undergoing hip arthroplasty for femoral neck fracture.Methods From January 2016 to August 2017,118 elderly patients with femoral neck fracture were treated with hip arthroplasty at Department of Orthopaedics,China-Japan Friendship Hospital.They were 45 males and 73 females,with an average age of 77.1 years.Of them,60 (TXA group) were subjected to intravenous TXA dripping over 10 minutes by 2 doses (15 mg/kg TXA dissolved in 100 mL of saline) with the first dose before incision and the second one at wound closure;58 (control group) were subjected to intravenous administration of 100 mL of saline solution in a similar fashion.Blood routine tests were carried out one day before operation,and the first and third days after operation.The transfusion rate and volume,and surgical blood loss were recorded.The total blood loss on postoperative 1-day and 3-day were calculated according to hemoglobin balance method.The 2 groups were compared in terms of blood loss and complications.Results The blood transfusion rate (21.7％),blood transfusion volume (310.8 ± 85.7 mL),surgical blood loss (424.3 ± 87.6 mL),total blood loss on postoperative 1-day (1,284.6 ±288.7 mL) and total blood loss on postoperative 3-day (1,501.2 ± 337.1 mL) in the TXA group were all significantly lower than those in the control group (41.4％,379.8 ± 110.2 mL,526.7 ± 113.8 mL,1,534.8 ± 279.2 mL and 1,887.4 ± 431.8 mL,respectively) (P ＜ 0.05).There was no significant difference between the 2 groups in postoperative complications (P ＞ 0.05).Conclusion In elderly patients undergoing hip arthroplasty for femoral neck fracture,intravenous TXA administration may lower transfusion rate,reduce transfusion volume,and decrease surgical blood loss and postoperative total blood loss without increasing the risks of surgery-related complications like thrombosis.

Objective:To explore the incidence and morphology of the posterolateral fracture fragment affecting the fibular notch in posterior pilon fracture.Methods:A retrospective analysis was conducted of the CT and clinical data of the 31 patients with posterior pilon fracture who had been treated at Department of Orthopaedic, China-Japan Friendship Hospital from May 2013 to May 2018. They were 17 men and 14 women, aged from 20 to 68 years (average, 42 years). The injury affected the left side in 13 cases and the right side in 18 ones. The incidence of the posterolateral fracture fragments affecting the fibular notch was counted. The morphologic indexes of the fragments were measured like axial angle of their fracture line, fragment area, fragment height, and sagittal angle of their fracture line.Results:A posterolateral fracture fragment affecting the fibular notch was found in all the 31 posterior pilon fractures, giving an incidence of 100% in the posterior pilon fracture. The fracture line of the fragments tended to be in the coronal plane. The axial angle of the fracture line was 20.25°±9.48°; the ratio of the fragment area to the distal tibial articular area was 15.78%±6.75%; the fragment height was 36.59 mm ± 10.70 mm; the sagittal angle of the fracture line was 18.37°±5.45°.Conclusions:A posterolateral fracture fragment affecting the fibular notch can be found in all the posterior pilon fractures. It does not affect a large articular area and its fracture line is usually located in the coronal plane. These data may help choose appropriate surgical approach and internal fixation.

Objective:To analyze the influence of comprehensive rehabilitation on postoperative functions in the elderly patients with femoral intertrochanteric fracture.Methods:From June 2015 to June 2019, 144 elderly patients were treated at Department of Orthopedics, China-Japan Friendship Hospital for femoral intertrochanteric fractures by internal fixation with proximal femoral nail anti-rotation (PFNA). Of them, 65 received comprehensive rehabilitation, including intervention measures for details, prevention and management of comorbidities and complications and active exercise of the injured limb, while 79 conventional rehabilitation. In the comprehensive rehabilitation group, there were 22 males and 43 females with an age of (76.6±6.7) years, and 18 cases of type 31-A1, 35 cases of type 31-A2 and 12 cases of type 31-A3 by the AO type. In the control group, there were 23 males and 56 females with an age of (75.2±7.0) years, and 25 cases of type 31-A1, 39 cases of type 31-A2 and 15 cases of type 31-A3 by the AO type. The 2 groups were compared in terms of visual analog scale (VAS), Harris hip score, Barthel index, postoperative ambulation time and complications at 6 months after operation.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative or intraoperative general data ( P>0.05). The comprehensive rehabilitation group had a significantly lower VAS score (1.5±1.0), a significantly higher Harris hip score(83.9±5.4), a significantly higher Barthel index (81.6±5.4), significantly shorter postoperative ambulation time [(2.6±1.0) d], and a significantly lower incidence of complications [4.6% (3/65)] than the control group did [1.9±1.2, 80.2±7.9, 78.2±7.9, (3.2±1.4) d, 16.5%(13/79), respectively] (all P< 0.05). Conclusion:For elderly patients with femoral intertrochanteric fracture, comprehensive rehabilitation can significantly reduce complications, promote functional recovery of the hip, and speed up recovery of capabilities of daily living compared with conventional rehabilitation.