Objective To improve the accuracy of X-ray diagnosis of the deltoid ligament injury by evaluating the influence of plantar flexion on the diagnosis.Methods Twenty-four patients with ankle supination-extemal rotation fracture which was distal fibula fracture but no medial malleolus fracture were treated from February 2010 to December 2010.All the patients were taken Mortise radiograph with the ankle in four positions of plantar flexion(0°,15°,30° and 45°)applied with rotational stress and the deltoid ligament injury was identified with MRI.The medical clear space(MCS)and the superior clear space(SCS)on each radiograph were measured.The results were tested by a one-way analysis of variance model(ANOVA),based on the following criteria:(1)the MCS≥ 4 mm and MCS ＞ SCS,or when MCS≥5 mm and MCS ＞SCS.The MRI examination was taken as the gold standard to compare the influence of X-ray diagnosis of the deltoid ligament injury with different plantar flexions and different standards.Results The average MCS in four positions of plantar flexion(0°,15°,30°,and 45 °)with rotational stress were(4.10 ±0.79)mm,(4.55 ±0.72)mm,(4.99 ±0.56)mm and(5.71 ±0.86)ram,with statistical difference(P ＜0.05).The average SCS in four positions of plantar flexion(0°,15°,30°,and 45°)were(3.56 ±0.41)mm,(3.50 ±0.43)mm,(3.71 +0.44)mm and(3.93 ±0.51)mm,with no statistical difference in the four groups(P ＞0.05).With the MSC≥4 mm and MSC ＞ SCS as the diagnostic criteria,the prevalence of false-positive findings of deltoid injury based on the ratio with the four positions of plantar flexion(0°,15°,30° and 45°)were 50.0％,66.7％,88.9％ and 94.4％ respectively.With the MSC≥5 mm and MSC ＞SCS as the diagnostic criteria,the prevalence of false-positive findings of deltoid injury based on the ratio with the four positions of plantar flexion(0°,15°,30° and 45°)were 5.6％,11.1％,38.9％ and 77.8％ respectively.Condusions Different plantar flexion angle is an important factor for X-ray diagnosis of deltoid ligament injury of the ankle joint.The prevalence of false-positive findings of deltoid injury increases with the increase of plantar flexion.

Objective To evaluate correlation of radial head fracture with forearm interosseous membrane (IOM) injury.Methods Twenty-six patients with radial head fractures were studied prospectively between September 2007 and June 2010.There were 15 men and 11 women,with an average age of 37.6years (range,21-53).According to the Mason classification,there were 7 cases of type Ⅰ,9 cases of type Ⅱ,10 cases of type ⅢL All patients were subjected to forearm X-ray,CT scans and the MR within a week.Clinical and radiographic data of all the patients were collected.Spearman rank correlation statistical analysis was used to analyze the correlation between the radial head fracture and the IOM injury.Results The radial head fractures and IOM injury were directly related.The IOM injury was noted in all type of radial head fracture.The more severity radial head fracture had,the more IOM injury happened.In Mason Ⅰ-Ⅲ fractures,IOM injury was found in 2,4 and 7 cases respectively.The different degree of radial head fracture caused different effects on IOM injury.The severity of radial head fracture was correlated with damage degree of IOM.In Mason type Ⅰ and type Ⅱ fractures,the IOM injury were just partial disruption with distal part of the IOM and did not reach the biomechanically essential central band.In type Ⅲ fractures,central band disruption was found in 3 cases.Conclusion Mason Ⅰ-Ⅲ radial head fractures are associated with forearm IOM injury.There was a positive correlation between radial head fractures and IOM injury.If IOM lesions are suspected,magnetic resonance imaging should be performed,especially Mason Ⅲ fractures.

OBJECTIVES: Heparin is mainly used as an anticoagulant in clinic, and it also has a certain anti-inflammatory effect. At present, after portal vein islet transplantation in diabetic patients, heparin is mainly infused through the peripheral veins of the limbs to achieve the purpose of anticoagulation and protection of the graft, rather than through the portal vein. In this study, animal experiments were conducted to investigate the effect of heparin infusion via the portal vein and marginal ear vein on the instant blood-mediated inflammatory reaction (IBMIR) after portal vein islet transplantation, which is the choice of anticoagulation methods for clinical islet transplantation to provide a basis for decision-making. METHODS: A total of 50 neonatal pigs (Xeno-1 type, 3-5 days) were selected. Islets were isolated and purified from the pancreas of neonatal pigs. Ten non-diabetic Landrace pigs (1.5-2.0 months) served as recipients, and 12 000 IEQ/kg neonatal porcine islets were transplanted into the liver through the portal vein. All recipients received bolus injection of 50 U/kg of heparin 10 minutes before transplantation. After the bolus injection of heparin, the experimental group received heparin via the portal vein [10 U/(kg·h), 5 recipients], and the control group received heparin via the marginal ear vein [10 U/(kg·h), 5 recipients]. The superior vena cava blood was collected from the 2 groups pre-operation at 1, 3, 24 h post-operation of the transplantation. The portal vein blood was collected from the experimental group at 1 and 3 h after the transplantation as well. The levels of complement C3a, C5a, thrombin-antithrombin complex (TAT), β-thromboglobulin (β-TG), and D-dimer as well as activated partial thromboplastin time (APTT) in superior vena cava blood from 1 and 3 h post-transplantation were detected in the 2 groups, and the levels of anti-Xa and anti-IIa in the portal vein and superior vena cava blood from 1 and 3 h post-transplantation in the experimental group were detected. Twenty four hours after the transplantation, the liver tissues in the 2 groups were collected for pathological examination to observe the inflammatory cell infiltration and peripheral thrombosis around the islets graft in liver. RESULTS: Before transplantation, there was no statistically significant difference in C3a, C5a, TAT, β-TG, D-dimer levels and APTT between the 2 groups (all P>0.05). At 1 and 3 h after transplantation, the C3a, TAT, and D-dimer levels in the experimental group were significant decreased than those in the control groups (all P<0.05), and at 3 h after transplantation the C5a was significant decreased than that in the control group (P<0.05). At 1 and 3 h after transplantation, the anti-Xa and anti-IIa levels in the portal vein blood were significantly increased than those in the superior vena cava blood in the experimental group (all P<0.05). Pathological results showed the presence of islet cell clusters in the liver blood vessels. The thrombus formation and neutrophil infiltration around islet graft was not obvious in the experimental group, while massive thrombus formation and neutrophil infiltration in the control group. CONCLUSIONS Compared with marginal ear vein infusion of heparin, the direct infusion of heparin in the portal vein has a certain inhibitory effect on complement system, coagulation system activation and inflammatory cell infiltration in portal vein islet transplantation, which may attenuate the occurrence of IBMIR.
Animals ; Anticoagulants/therapeutic use* ; Heparin/therapeutic use* ; Humans ; Islets of Langerhans/pathology* ; Islets of Langerhans Transplantation/physiology* ; Portal Vein ; Swine ; Vena Cava, Superior

To investigate the feasibility and clinical application of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) technique in non-invasive assessment for early chronic allograft nephropathy (CAN).
 Methods: A total of 23 renal allograft recipients were recruited from inpatients or outpatients according to the inclusion and exclusion criteria for this study. Recipients were divided into a CAN group (n=12, pathologically confirmed early CAN patients) and a control group (n=11, volunteers with long-term stable renal function). Abdominal MRI was performed on patients of renal allograft with a multi-b value DWI sequence. IVIM2b-new software was used for obtaining the IVIM-DWI quantitative parameter pseudo-color maps and the values of IVIM-DWI of renal parenchyma, including the pure diffusion coefficient (D), perfusion correlation diffusion coefficient (D*) and perfusion fraction (f). The IVIM quantitative parameters between the two groups were compared using independent sample t test. ROC analysis was performed when the differences in parameter were statistically significant and the area under curve (AUC) was calculated.
 Results: In IVIM bi-exponential analysis, The D value was significantly decreased in the CAN group compared with the control group (P<0.05), whereas there are no significantly difference in value of D* and f between the two groups (all P>0.05). The AUC of D value for distinguishing the early CAN from the control were 0.784 with sensitivity and specificity at 58.3% and 90.9%, respectively.
 Conclusion: The IVIM-DWI quantitative parameter D can non-invasively assess early CAN to some extent. IVIM-DWI technique is expected to be an effective, easy and non-invasive method to detect early CAN, and assist early diagnose as well as dynamically monitor CAN.
Allografts ; Diffusion Magnetic Resonance Imaging ; Humans ; Kidney Diseases ; surgery ; Kidney Transplantation ; Magnetic Resonance Imaging ; Motion

OBJECTIVES: To investigate whether necrostatin-1 (Nec-1) can protect islet cells from the damage induced by TNF-α. METHODS: After isolation and purification, the neonatal porcine islet cell clusters (NICCs) were divided into 3 groups (islets 10 000 IEQ/group): a Nec-1 group (Nec-1+TNF-α was added to the culture medium), a TNF-α group (TNF-α was added to the culture medium), and a control group (pure medium). The number of cells was observed after 48 h of co-culture. The cell death was evaluated by AO/EB staining. Insulin secretion and DNA of islets were detected by chemiluminescence and nucleic acid quantitative analysis. RT-PCR assay was used to examine the mRNA expressions of insulin gene, glueogan gene and somatostatin gene. Flow cytometry analysis was used to detect the viability of B cells. RESULTS: The number of islets in Nec-1 group, TNF-α group and the control group were (8 425±2 187), (4 325±778), and (7 122±1 558) IEQ, respectively. Compared to the other two groups, the number of dead cells in TNF-α group was greatly increased. The insulin/DNA values in the Nec-1 group, TNF-α group and blank control group were (13.21±3.15), (2.47±0.45), and (7.44±0.97) mIU/mg, respectively. Compared to the TNF-α group and the control group, the mRNA relative expression levels of insulin gene (6.73±1.07), glucagon gene (10.13±1.98), somatostatin gene (8.57±1.11) were significantly increased in the Nec-1 group (all <0.05), the rate of live cells (97.32±1.87)% and live B cells (90.86±3.68)% were increased significantly in the Nec-1 group (all <0.05). CONCLUSIONS TNF-α can induce neonatal porcine islet cells damage, which is attenuated in the presence of Nec-1. Nec-1 can increase the content of endocrine cells in NICCs.
Animals ; Imidazoles ; Indoles ; Insulin ; Islets of Langerhans ; Swine ; Tumor Necrosis Factor-alpha ; genetics