Acetabular fracture is an intra-articular fracture, and its treatment principle is also equivalent to that of intra-articular fracture, namely anatomical reduction of articular surface and firm fixation. Therefore, the choice of surgical approach is of great importance to the surgical exposure, reduction quality and fixation effect of acetabular fracture, which directly affects the surgical curative effect. Proper surgical approach is not only good for clear surgical exposure, easy operation, and ideal reduction quality and fixation effect, but also has great advantages in shortening the operation time, reducing intraoperative bleeding, reducing surgical trauma and avoiding surgical complications. The selection of surgical approach for acetabular fractures is closely related to the fracture injury mechanism, fracture classification, and clinical manifestations, etc.. The surgical efficacy depends on the fracture reduction quality, fixation effect, and surgical trauma degree, etc., which are closely related to the selection of surgical approach. At present, the alternative surgical approaches are generally divided into anterior approach and posterior approach. However, due to the complexity of acetabular fractures, no single surgical approach can fit all acetabular fractures, and each approach has its own indications, advantages and disadvantages.

Objective To investigate the effects of brain-derived neurotrophic factor (BDNF) pretreatment on H9c2 myocardial hypoxia/reoxygenation (H/R) injury, and explore its mechanism. Methods The H9c2 myocardial cells were cul?tured in vitro and (95%O2+5%CO2) oxygen cultured 12 h after (95%N2+5%CO2) hypoxia cultured 4 h to establish the H/R model. The cells were divided into normal control group, H/R group, different concentrations (1, 10, 100μg/L) BDNF pre?treatment in H/R groups and TrkB-inhibitor group (with 100μg/L BDNF and 1∶1 000 TrkB inhibitor pre-treatment in H/R group). The cell survival rate was measured by MTT method in different groups. The lactate dehydrogenase (LDH), creatine kinase (CK), malondialdehyde (MDA) and superoxide dismutase (SOD) content and activity were detected after H/R injury. The apoptotic rate of H9c2 myocardial cells were detected by flow cytometry, and the expressions of TrkB, Bcl-2 and Bax protein were detected by Western blot assay. Results Compared with the normal control group, the survival rate of H9c2 myocardial cells was decreased significantly in H/R model group (P < 0.05), LDH, CK and MDA contents were increased and SOD activity was decreased (P<0.05). The cell apoptosis rate was increased significantly (P<0.05). The anti-apoptosis Bcl-2 protein expression was decreased, pro-apoptosis Bax protein expression was increased in H/R model group (P<0.05). Compared with the H/R model group, the cell survival rates of H9c2 myocardial cells were increased after pre-treatment with different concentrations of BDNF (P<0.05);LDH, CK and MDA contents were decreased and SOD activity were in?creased respectively (P < 0.05). The cell apoptotic rates were decreased (P < 0.05). The expressions of TrkB receptor and Bcl-2 protein gradually increased, while the expression of Bax protein was gradually decreased (P<0.05). The role of BDNF was inhibited by TrkB inhibitor. Conclusion BDNF pre-treatment can promote the cell survival rate of H9c2 myocardial cells after H/R injury, which plays a protective role by inhibiting the cell apoptotic rate and maintaining antioxidant capacity, and associates with BDNF-TrkB signaling pathways.

Objective: To investigate the effect of tanshinone IIA (TSN) on left ventricular hypertrophy (LVH) and cardiomyocyte apoptosis in spontaneous hypertensive rats (SHRs). Methods: A total of 60 SHRs at 8 weeks of age were randomly divided into 3 group: Blank control group, the rats were sacriifced at 8 weeks, TSN group, the rats were treated with TSN at 1 ml/(kg?d) for 18 weeks and Solvent control group, the rats were treated with the solvent at 1 ml/(kg?d) for 18 weeks. n=20 in each group and 15 rats were used for the experiments. The systolic blood pressure (SBP) and left ventricular mass index (LVMI) were examined, cardiomyocyte’s diameter and surface area were measured by HE staining, the apoptosis rate was evaluated by TUNEL method and the apoptosis related protein expression s of Bcl-2, Bax and p53 were determined by Western blot analysis. Results: ①Compared with Solvent control group, TSN group had decreased LVMI (3.23 ± 0.24) mg/g vs (4.58 ± 0.68) mg/g,cardiomyocyte’s diameter (16.13 ± 1.77) μm vs (27.15 ± 3.52) μm and surface area (230.23 ± 69.37) μm2 vs (490.12 ± 118.96) μm2and decreased apoptosis rate (7.45 ± 1.78) % vs (10.61 ± 2.77) %, allP<0.01.②With NAPDH reference correction, compared with Solvent control group, TSN group presented increased protein expression of Bcl-2 (0.97 ± 0.31) vs (0.40 ± 0.11) and decreased Bax (0.37 ± 0.15) vs (1.81 ± 0.44), decreased p53 (0.83 ± 0.18) vs (2.72 ± 0.28), allP<0.05 or P<0.01. The above indexes were similar between TSN group and Blank control group,P>0.05. Conclusion: TSN could inhibit the development of LVH and decrease the cardiomyocyte apoptosis, which might be via up-regulating the protein expressions of Bcl-2 and down-regulating Bax and p53 in SHRs.

[ABSTRACT]AIM:Tostudytheprotectiveeffectofbrain-derivedneurotrophicfactor(BDNF)onvascularendo-thelial cells with H 2 O2-induced oxidative injury .METHODS: Human umbilical vein endothelial cells ( HUVECs ) were cultured in vitro, and the oxidation injury model of HUVECs was established by treatment with H 2 O2 .The oxidatively in-jured HUVECs were cultured with different concentrations (1, 10 and 100μg/L) of BDNF.At the same time, the control group (no injury), PBS treatment after H2O2 injury group and TrkB inhibitor group (with 100 μg/L BDNF and 1∶1 000 TrkB inhibitor) were also set up.The viability of the HUVECs was detected by MTT assay .The levels of LDH, MDA, SOD and GSH were measured .The releases of NO , ET-1 and ICAM-1 were analyzed by ELISA .The changes of ROS pro-duction and cell apoptosis were evaluated by flow cytometry .The protein levels of TrkB , p-TrkB, cleaved caspase-3, Bcl-2 and Bax were determined by Western blot .RESULTS:Compared with uninjured control group , in H2 O2 oxidative injury plus PBS treatment group , the viability of the cells was decreased significantly , the LDH and MDA levels were increased significantly and the activities of SOD and GSH were decreased significantly .The NO secretion was decreased , and the ET-1 and ICAM-1 concentrations were increased significantly .The ROS content and apoptotic rate were increased significantly . The protein levels of cleaved caspase-3 and Bax were increased but Bcl-2 protein expression was decreased significantly . Compared with PBS treatment group , in H2 O2-injured HUVECs treated with different concentrations of BDNF , the cell via-bility was gradually increased , the LDH and MDA levels were decreased and the activities of SOD and GSH were increased gradually .The secretion of NO was increased but ET-1 and ICAM-1 were decreased gradually .The ROS content and apop-totic rate were decreased significantly .The TrkB and p-TrkB levels were significantly increased significantly , the protein expression of cleaved-caspase 3 and Bax was decreased gradually and the Bcl-2 protein expression increased gradually .The role of BDNF was inhibited by TrkB inhibitor .CONCLUSION:BDNF protects HUVECs from oxidative injury by binding with TrkB to activate the BDNF-TrkB signaling pathways .

Objective:To explore the efficacyof direct anterior approach (DAA) combined with direct posterior approach (DPA) for the treatment of Pipkin IV fracture.Methods:Data of 18 patients with Pipkin IV fracture treated through DAA combined with DPA from January 2016 to April 2019 was retrospectively analyzed. There were 13 males and 5 females, with an average age of 43.2 years (range,19-56 years). Fractures were caused by traffic accident in 15 and by falling in 3. The fracture lines of 13 cases were located below the fovea of the femoral head and 5 cases were located above the fovea. According to Letournel-Judet classification for acetabular fractures, there were 14 cases of posterior acetabular wall fractures, 2 cases of posterior wall fractures involving posterior column, and 2 transverse plus posterior wall fractures. The operation was performed through DAA approach to treat the femoral head fractures, and DPA approach was used to treat acetabular fractures. Radiographs and CT scans of the pelvis were reexamined after surgery, and fracture reduction, healing, and complications such as femoral head necrosis, sciatic nerve injury, superior gluteal neurovascular injury and heterotopic ossification were evaluated. Quality of acetabular reduction was evaluated according to the criteria proposed by Matta. Thompson-Epstein scoring system was used to evaluate hip function.Results:The average operation time was 133 min (range, 75-205 min). And the average blood loss was 371 ml (range, 240-600 ml). All 18 patients were followed up for 6 to 36 months, with an average period of 15.7 months. All fractures healed 10 to14 weeks after surgery. Three patients had symptoms of sciatic nerve injury after the injury, who recovered 6 to 12 weeks after the operation. All femoral head fractures were reduced. According to Matta criteria of reduction quality, anatomic reduction was gained in 13 cases, and satisfactory reduction was obtained in 3 cases, while unsatisfactory reduction was found in 2 cases, and the overall satisfactory rate was 88.9%(16/18). Two patients had Brooker I level heterotopic ossification. There was no iatrogenic vascular injury, avascular necrosis of femoral head, infection, internal fixation failure or other complications. According to the Thompson-Epstein scoring system at the latest follow-up, the functional results of the affected hip were excellent in 7 cases, good in 8, fair in 2 and poor in 1.Conclusion:Treatment of Pipkin IV fractures through DAA combined with DPA approach reduces surgical invasion. And it can directly reduce and fix the femoral head and posterior acetabular fracture, and protect the important structures such as the arteriae circumflexa femoris medialis, sciatic nerve and lateral femoral cutaneous nerve, and reduce the occurrence of complications such as femoral head necrosis and heterotopic ossification. Therefore, DAA combined with DPA is aneffective method for the treatment of Pipkin IV fractures.

Objective:To evaluate the anterior expansion of sacral foramen and decompression of sacral plexus via the lateral-rectus approach (LRA) in the surgical treatment of sacral fractures complicated with sacral plexus injury.Methods:From January 2013 to June 2018, 11 patients were treated at Department of Orthopaedics, The Third Hospital Affiliated to Southern Medical University for obsolete sacral fractures complicated with sacral plexus injury. They were 8 males and 3 females, aged from 17 to 54 years (average, 38 years). According to the Denis classification, all the sacral fractures belonged to Denis Zone Ⅱ. According to British Medical Research Council (BMRC) grading system, the nerve injury was complete damage in 2 cases and partial damage in 9. The mean time from injury to surgery was 6 months (range, from 0.7 to 12.0 months). After the sacroiliac joint was exposed via the LRA, the lumbosacral trunk was exposed and released between iliac vessels and the iliopsoas. Next, the S1 foramen was expanded and the S1 nerve root was released after separation of the median sacral artery and the internal iliac artery. Reduction and fixation of the sacroiliac joint was carried out for patients with unstable sacral fracture. X-ray and CT examinations of the pelvis were performed to evaluate fracture healing and neurological function recovery postoperatively.Results:Of this cohort of 11 cases, operation succeeded in 10 but failed in one whose sacral fracture was found to have completely healed with the S1 foramina totally occluded. The surgical time averaged 110 min (range, from 70 to 220 min) and the blood loss 1, 100 mL (range, from 450 to 2, 800 mL). Postoperative X-ray and CT examinations showed that the sacral foramens were expanded significantly without any complications. The follow-up time averaged 18 months (range, from 12 months to 4 years). By the BMRC grading system at the last follow-up, the neural function was completely recovered in 5 cases, partially recovered in 4 cases and not recovered in one.Conclusion:Significant anterior expansion of sacral foramen and decompression of sacral plexus via the LRA is a viable and effective alternative for treatment of sacral fractures complicated with sacral plexus injury.

Aim To investigate the effect of Ding''s herb enema prescription on intestinal tissue related target in rat colitis induced by dextran sulfate sodium(DSS), and to elucidate the mechanism of Ding''s herb enema prescription in improving the intestinal inflammation and intestinal fibrosis.Methods Rats were fed with 3.5％ DSS.The rats were randomly divided into positive drug group, model group, Control group, and Ding''s herb enema prescription group.The positive drug group was treated with mesalazine enema, and Ding''s herb enema prescription group was treated with Ding''s herb enema prescription.The colon mucosa was taken once a day for 6 weeks.The changes of intestinal inflammatory response and intestinal fibrosis related proteins were detected by GSR-CAA-67 antibody protein array, and the differentially expressed proteins were screened out.Results Eight proteins showed statistical differences, including IFN-γ, erythropoietin(EPO), TIMP-2, TIM-1, IL-6, TIMP-1, TNF-α, IL-22 (P<0.05).On the other hand, Ding''s herb enema prescription and mesalazine significantly antagonized the effect of IL-6 and TIMP-1 (P<0.05).The antagonized effect of Ding''s embolization enema on TNF-α and IL-22 was also significant(P<0.05), but mesalazine had no similar effect (P>0.05).Conclusions Ding''s herb enema prescription has the effect of multiple targets, which may improve the intestinal inflammatory response and intestinal fibrosis to achieve the purpose of treatment of ulcerative colitis(UC).

Objective To investigate laryngeal reinnervation for recurrent laryngeal nerve injury caused by thyroid surgery. Methods Included in this series were 42 patients with recurrent laryngeal nerve injury, undergoing nerve decompression in 8 cases, end-to-end anastomosis of recurrent laryngeal nerve in 6, anastomosis of main branch of ansa cervicalis to recurrent laryngeal nerve in 21, end-to-end anastomosis of recurrent laryngeal nerve in 6 cases, phrenic nerve graft combined with nerve muscular pedicle (NMP) technique or nerve decompression in 7. All cases were subjected to preoperative and postoperative videolaryngoscopy, voice recording, acoustic analysis and electromyography. Results In 5 patients with unilateral injury and with a course less than four months, nerve decompression restored functional adductory and abductory motion of the vocal cord. Although functional motion of vocal cord was still absent in two patients receiving nerve decompression with a course longer than 4 months and in one less than 4 months, and in all cases with unilateral vocal cord paralysis receiving ansa cervicalis anastomosis and end to end anastomosis of recurrent laryngeal nerve, these procedures did result in symmetric vibration of the vocal cords and physiological phonation. Good inspiratory abductent motion of the glottis was observed on the reinnervated sides by the phrenic nerves in 6 cases with bilateral vocal cord paralysis and the vocal cord excursion was from 3 to 5 mm. On the opposite reinnervated sides, 2 cases with nerve decompression restored functional adductory and abductory motion of the vocal cord; while 4 cases with NMP technique restored only slight abductent motion or no motion. These patients have achieved sufficient airway so that exercise to tolerance for daily activities is adequate without a tracheotomy. In no case was the voice weakened, no was there any problem with aspiration. Conclusions Nerve decompression seems to be the best procedure in laryngeal reinnervation; Main branch of ansa cervicalis technique achieves satisfactory reinnervation of adductor muscles; Phrenic nerve graft yields more satisfactory vocal cord abductory motion than NMP technique. Selection of the laryngeal reinnervation protocols should depend on the course, severity, type of nerve injury.

Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra?operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduc?tion and internal fixation of pelvic fracture through lateral?rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospec?tively reviewed. There were 3 males and 4 females, with an average age of 34 years (range, 16 to 61 years). According to AO classi?fication, all 7 cases belonged to type C3 (3.2:5 cases;C3.3:2 cases), including 5 cases with limb fracture, 2 cases with craniocere?bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average (10 to 33 days). Patients received damage control surgery treatment including bleeding control and temporary ex?ternal fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral?rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta (≤60 min) for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiological evaluation postoperatively, reduction of pelvic fracture was rated as anatomic in 5 cases, satisfactory in 2, without complications. All 7 cases were complicated with lumbosacral plexus injury or lumbosacral trunk injury at different degrees (M0 2 cases, M1 2 cases, M2 2 cases, M3 1 case). According to the BMRC scoring system, 5 cases had well recovered and the other 2 cases had no improvement after three months (M4 2 cases, M5 3 cases). Conclusion Surgical management of pelvic fracture through preoperative internal iliac artery embolization and intra?oper?ative occlusion of abdominal aorta could effective control bleeding and achieve favorable conditions for reduction. Lateral?rectus approach can provide adequate exposure of the anterior and posterior ring, and this approach could also provide excellent visual control of reduction and fixation.

Objectives To explore therapeutic effect,indication and timing of nerve decompression for traumatic recurrent laryngeal nerve injury inducing vocal cord paralysis. Methods A total of 42 patients with recurrent laryngeal nerve injury inducing vocal cord paralysis within six months, were divided into nerve decompression group (15 cases), end to end anastomosis of recurrent laryngeal nerve group (six cases) and nonsurgical treatment (21 cases). Nerve decompression was performed in the patients who were operatively found to have compressing sutures or compression due to cicatricial hypertrophy. Results In 13 patients with a course less than four months, nerve decompression restored normal functional adductory and abductory motion of the vocal cord in 11 patients and motionless in two. Although functional motion of vocal cord was not seen in two patients with a course less than four months and two longer than four months, the mass and tension of the reinnervated vocal cord became much the same as the contralateral normal vocal cord, thus resuming symmetric vibration of the vocal cords and physiological phonation. End-to-end anastomosis of recurrent laryngeal nerve failed to restore motion of the glottis. Nevertheless, the procedures enabled adductory muscles to be reinnervated and then restored normal voice. Although nonsurgical treatment improved severe hoarseness, the vocal cord didn't restore normal functional motion of the vocal cord and normal voice. Conclusions Early and mid-stage recurrent laryngeal nerve decompression may restore normal motion of the vocal cord. End-to-end anastomosis of recurrent laryngeal nerve enables adductory muscles to be reinnervated and thus restores normal voice.