Objective To investigate the expression of Toll-like receptor 4 (TLR4)in peripheral blood monocytes and its correlation with TNF-α and IL-6 in type 2 diabetes (T2DM)patients with neuropathy. Methods Healthy volunteers (NC,n=44),T2DM without neuropathy (n=44)and T2DM with neuropathy (n=44)were recruited in the present study.The expression of TLR4 mRNA and protein in peripheral blood monocytes was detected by RT-PCR and flow cytometry. ELISA was undertaken to measure the plasma concentration of TNF-αand IL-6. Results The levels of HbA1 c[(9.09±1.62)%vs(8.36±1.10)% vs (5.30±0.89)%],the protein expression of TLR4[(42.02±9.69)% vs (31.27± 6.87)% vs (11.96±5.54)%],the mRNA expression of TLR4[(2.98±1.06)vs (1.74±0.47)vs (1.12 ±0.52)],TNF-α[(8.75±3.14 )vs (6.27±3.64)vs(3.19±1.17)pg/ml]and IL-6[(3.63±1.81)vs(2.60 ±1.14)vs(1.54±0.58)pg/ml]in patients with diabetic neuropathy significantly increased compared with T2DM and NC group;TLR4 showed a positive correlation with TNF-αand IL-6(r=0.631,P <0.0001;r=0.447,P =0.0023). Conclusion TLR4 of monocytes may take part in the occurrence of systemic inflammation and has a close relationship with the development of diabetic neuropathy.

Objective To investigate the clinical value of spiral computerized tomographic shaded surface display (SSD) and multiplanar(MPR) imaging of complex shoulder fractures. Methods Twenty four cases of complex shoulder fractures including 16 cases with displaced proximal humeral fractures and 8 cases with displaced fractures of glenoid fossa were examined preoperatively with X ray, 15 cases of them were examined with SSD and MPR. On the basis of X ray or SSD and MPR of SCT all fractures were classified with Neer and modified Ideberg system; the true rate of fracture classification by use of two methods was compared with each other. Results Evidenced by intraperative observation, 10 of 16 displaced proximal humeral fractures cases were Neer three part fractures, 6 were four part fractures cases. Among the 8 cases of glenoid fossa fractures, there were 2 cases of type Ⅲ, 3 cases of type Ⅳ and 3 cases of type Ⅴ. The true rate of SSD and MPR of SCT is 93.3%(14/15) while X rays is 41.7%(10/24); there was significant difference between two methods (Fishers exact test, P=0.02). All SSD and MPR of SCT play an important role in the treatment of complex shoulder fractures. Conclusion SSD and MPR of SCT is able to clearly display complex shoulder fractures three dimensionally. It is helpful to correctly classify the fractures, select appropriate surgical approach, prepare surgical instruments and understand the complexity of the fractures.

Objective To investigate the influence of common X-ray, two-dimensional computed tomography (2D-CT), spiral computed tomography (SCT), and three-dimensional (3-D) reconstruction on the classification in displaced proximal humeral fractures. Methods Three groups were divided on the basis of various imaging methods, including group A (common X-ray), group B (common X-ray and 2D-CT), and group C (3-D reconstruction of SCT and 2D-SCT). 46 cases of displaced proximal humeral fractures were classified with Neer system. The true rate of fracture classification by use of three methods was compared with each other, and clinical significance of SCT and 3-D reconstruction was evaluated.Results Based on operation, 46 cases of displaced proximal humeral fractures in group A included 26 cases of Neer two-part fractures, 13 cases of three-part fractures, and 7 cases of four-part fractures. The true cases of common X-ray were 22 in Neer two-part fractures and 8 in three and four-part fractures, there was significant difference between Neer two-part fractures and Neer three and four-part fractures (P

Objective To investigate the expression of neurotrophin- 3 (NT- 3) gene in Schwann cells (SCs) of rat sciatic nerve introduced by adenovir al vector in vivo. Methods Recombinant adenoviral vector for NT- 3 was propagat ed in 293 packaging cells and was titered by tissue culture infections dose 50 ( TCID50) method. Ad- NT- 3 was injected intraneurally into the rat sciatic nerv e following axotomy of the sciatic nerve which was repaired after the immediate injury. Immunohistochemical staining was employed to determine the expression of NT- 3 in SCs in rat sciatic nerve, and the expressive intensity difference was measured with LEICA M550 imagine analysis system on the tissue slides. Results Two days after injection of NT- 3 into the rat nerve, positive stain in the SCs were apparent in the vicinity of anastomosis. There was significant increase of the amount of NT- 3 expression 7 days following injection of Ad- NT- 3 (vs. 2 days group P0.05). Compared with the 2 days group, the 14 and 28 days groups still maintained a relatively high leve l of NT- 3 (P

Objective The articular neurohistology is a new approach to explore stabilized and chronic pain mechanisms for joint research. Furthermore, the distribution of mechanoreceptors and their functional condition play an important role in the movement and stability of joint. The animal experimental study suggest that there is a various characteristics of the type and amount of mechanoreceptors in different joints. Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs as joint mechanoreceptors are widely distributed on nearly all of human joint, and have impact on stabilization of joint. The present investigates the neurohistological features of Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs in the rotator cuff and the capsule, and explores their behaviors for maintaining stability of the shoulder joint. Methods Six rotator cuffs and capsules of shoulder joint were obtained from cadavers died of the accident. The tendinous tissue of subscapularis, supraspinatus、infraspinatus, and teres minis were resected from the interface of tendon and muscle to great and lesser tuberosity of humerus, the capsule tissues of glenohumeral were harvested as well. Then, the tissues were cut into a small fragments fixed with the formalin buffer solution, and embed in paraffin. The section was made along the longitudinal axis of the tendon at 150 ?m interval with Leitz 1516 machine. The modified Bielschowsky staining and the S-100 immuohistochemical staining were adopted to observe the mechanoreceptors of Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs. The distribution density and size of the sensitive nerve endings were analyzed with Leica imaging process system. Results The tendinous part of rotator cuff could be divided into three layers: synovial, intermediate and articular layer. The morphology of the these three types of mechanoreceptors, Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs, could be identified clearly in the every layer of the tendious tissues under microscopic examination. Pacini corpuscle was ellipse and had multi layer capsule with the thickness of 20-40 ?m; Ruffini corpuscle was columnar and 350-550 ?m in size; Most of Golgi tendon organs were found at the interface of tendon and muscle. Among of them, the Pacini corpuscle and Ruffini corpuscle were much more than the Golgi tendon organs in rotator cuff and capsule of shoulder. The results of immuohistochemical staining and the counting of nerve ending assisted by the computer showed the number of sensory nerve endings in the subscapularis, supraspinatus and anterior capsule of the shoulder were much more than in the infraspinatus, teres minis and posterior capsule. The diameter of nerve bundle in the subscapularis, supraspinatus and anterior capsule was thicker than in the other periarticular structures. In periarticular structures, the mean value of nerve fiber counting were 25 in infraspinatus, 25 in supraspinatus, 13 in subscapularis, 10 in teres minis, 22 in anterior capsule and 12 in posterior capsule. Conclusion Shoulder capsule and rotator cuff are rich in the three type of mechanoreceptors, Pacini corpuscle, Ruffini corpuscle and Golgi tendon organs. However, there are a different distribution density and size of them in rotator cuff and capsule of shoulder, but the three of mechanoreceptors are mainly concentrated in the subscapularis, supraspinatus and the anterior capsule. S-100 immuohistochemical staining is much more sensitive than the modified Bielschowsky silver staining in displaying the innervations of the rotator cuff and capsule. The characters of the sensory nerve ending distribution in shoulder imply that the innervations of the shoulder play an important role in keeping the stability and mobility of the shoulder.

[Objective]To investigate the morphological changes of the roof of the subacromial bursa and the extent of involvement of the subacromial bursa after rotator cuff tear.[Method]For the experimental group,the roof of the subacromial bursa was obtained from patients with rotator cuff tear both at the tear site and 2.5 to 3.0 cm distal to the tear site during surgery of rotator cuff repair.For the control group,the roof of the subacromial bursa was obtained during surgery of recurrent shoulder dislocation or humeral shaft fracture at the exposure site.The specimens were processed for histological staining,immunohistochemical analysis and for transmission electron microscopy.The number of cells were quantitated by counting cells with blue-stained nucleus in the subacromial bursa using a computer image analysis system.[Result]The number of cells increased significantly in the roof of the subacromial bursa obtained from both sites,the tear site and the distal site,in the patients with rotator cuff tear,compared with the normal bursa(P

[Objective]To evaluate the unreamed femoral nail with spiral blade (UFN-SB) in the treatment of nonpathologic subtrochanteric femoral fractures.[Method]Twenty-seven patients who suffer subtrochanteric femoral fracture.Those fractures were classified with Seinsheimer’s way.Two cases of typeⅠ,9 cases of typeⅡ(5 of typeⅡ_A,3 of typeⅡ_B,1 of typeⅡ_C),12 cases of typeⅢ(7 of typeⅢ_A,5 of typeⅢ_B),3 cases of typeⅣ,1 case of typeⅤ.[Result]All cases were fellowed-up for 9~42 months,average 15 months.The authordidn't find any severe complications.All these patients could exercise early and bearing weight early.The authordidn't observe broken or loosen or quitted of this kind of internal fixation.[Conclusion]The UFN-SB is a better way for the treatment of subtrochanteric fractures of the femur.It can provide a satisfied restoration,a dependable fixation.It does good use to the concrescence of bone.It prevents short,rotation and varus angulation of femoral.The author get very good curative effect,less trauma,good sciatic function by using this kind of way to heal subtrochanteric femoral fracture.Especially in old people who suffer osteoporosis,this kind of interlocking way decreases the quantity lose of the bone,increases the contact area between bone and internal fixation,provides better angulation stability and rotation stability.

Objective To determine the main predictors of circulatory crisis after replantation in patients with severed distal finger so as to establish the theoretic basis in reducing the morbidity of circulatory crisis. Methods 65 severed distal fingers underwent replantation were respectively reviewed. All the clinical parameters including age, sex, dominant hand or finger, preservation of the severed finger, platelet level, ischemia duration, cause of injury, manner of venous drainage, repair of artery, order of reparation and plane of division were investigated as predictive risk factors for circulatory crisis of finger after replantation. In order to find the risk factors of circulatory crisis, the data was dealt with t test, ?2 test, analysis for variance or multivariate Logistic regression analysis. Results 13 replanted finger suffered from impaired circulation in 65 fingers. Univariate analysis demonstrated that many factors were significantly correlated with the circulatory crisis of finger, such as the manner of venous drainage(?2=6.714,P=0.035), the cause of injury (?2=9.049,P=0.011), the preservation of severed finger(?2=6.452,P=0.040), the age(?2=14.838,P=0.001), the platelet level(uc= 2.961, P=0.003). The multivariate Logistic regression analyses showed that platelet level (OR=1.015, P=0.030), the age(OR=0.349, P=0.031) and the manner of venous drainage(OR=0.278,P=0.036) were the significant independent predictors for circulatory crisis. The incidence of circulatory crisis in patients less than 6 years old was 61.5%, significantly higher than any other age group(P

Objective To evaluate the effects of Burch-Schneider(BS) acetabular reinforcement ring applied in primary or revision total hip arthroplasties in 9 patients with combined or cavitary acetabular bone defects. Methods A retrospective follow up that averaged 3.8 years was performed with a special scoring system comprising the patients symptoms, signs and function. Results The excellent and good function were achieved in 89% of all cases. Conclusion 1)BS reinforcement ring could be effectively and reliably applied in primary or revision total hip arthroplasty or in patients with severe acetabular bone defects. 2)BS reinforcement ring shows the biological fixation feature, so as to provide good foundation for long-term satisfactory function of hip. 3)The lower ear of BS ring need not to be fixed to ischium with screws as usual, but be inserted in obturator foramen above transverse ligament, thus imparting some elastic resilience to it. 4)The upper ear should be folded through such a curve that its curvature was in compliance with that of ilium, which would be better performed in one session. 5)The appropriate amount of 0.8 cm?0.8 cm?0.8 cm morcellized allografting bone was used to snugly fill the space, which would be conducive to desirable incorporation between prosthesis and bone, and the authors propose that the patients should be allowed weight-bearing earlier.

BACKGROUND:In recent years, the spinal internal fixation technology has made rapid development based on biomechanics and material sciences.
OBJECTIVE: To review the biomechanical characteristics of the lumbosacral spine and the application of various internal fixation materials in the reconstruction of spinal stability after lumbosacral spinal tuberculosis.
METHODS:A computer-based search of Medline and Chinese Journal Ful-Text Database was performed for relevant articles using the keyword of “lumbosacral spinal tuberculosis, biomaterials materials, fixation” in English and Chinese, respectively.
RESULTS AND CONCLUSION: Rigid internal fixation is a conventional treatment for lumbosacral tuberculosis, which improves the spinal alignment and stability during the spinal reconstruction. Metalic materials such as stainless steel, titanium and titanium aloys have been widely used in rigid internal fixation, but metal sedimentation, non-transparency, stress shielding and osteoporosis after internal fixation impact the fusion effects and imaging observation. Absorbable materials as newly-developing materials have good biocompatibility and biodegradability in orthopedic internal fixation. To select the appropriate material for internal fixation, the biomechanical properties of internal fixation materials wil be investigated according to the degree of vertebral damage and lumbosacral stability.