Platelet-rich plasma(PRP) is a highly-concentrated plasma enriched in platelets and various growth factors. These growth factors will be released abundantly by platelets when PRP is activated by thrombin, which plays a key role in accelerating wound healing, bone repair, and meanwhile, in controlling of inflammatory process. Biocompatibility and versatility of PRP have been confirmed in clinical studies as well as its excellent effects on tissue reparation. These have lead to the extensive use of PRP in many medical fields as a therapeutic alternative. Mechanism of PRP in bone and tissue repair the application of PRP in the field of orthopedics is reviewed in this article. In addition, attempt is made to discuss about some problems still existing in the clinical application of PRP.

Bioglass is one of the most important inorganic biomedical materials and is widely used in clinic. Orthopedists and researchers pay more and more attentions to bioglass due to its excellent biocompatibility and bioactivity. This paper introduces the current research status and development of bioglass in bone repairing,bone tissue engineering, anti-infection drug delivery material and interventional therapy. Brief review is given to the potential application of bioglass in orthopaedics.

We used near-infrared spectroscopy technology to monitor and assess the treatment effect of dehydrating agent in injured rat brain in real time style. We employed the brain edema model in rats resulting from Feeney' s freefall damage, then treated with different doses of mannitol, and collected reduced scattering coefficient (p',) and intracranial pressure (ICP) values after the injury and during the treatment. The results showed that brain edema happened 1 h after the injury in rats' brain tissue, peaked around 72 h after injury, and then began to decrease gradually. The reduced scattering coefficient and ICP values of the treatment group injected with mannitol all decreased after administration. Compared with the effect of low-dose mannitol treatment, that of high-dose mannitol treatment was much better. The duration of the plateau was longer and most experiments results declined significantly. From this we conclude that the reduced scattering coefficient and ICP are consistent with the trend changes, and the reduced scattering coefficient could be used as an indicator for monitoring cerebral edema.
Animals ; Brain Edema ; diagnosis ; Brain Injuries ; therapy ; Dehydration ; Diuretics, Osmotic ; therapeutic use ; Intracranial Pressure ; Male ; Mannitol ; therapeutic use ; Monitoring, Physiologic ; Rats ; Spectroscopy, Near-Infrared

A total of 52 patients with chronic lateral epicondylitis were randomly assigned into platelet-rich plasma (PRP) (n =28) or corticosteroid (n =24) group.The visual analog pain scale (VAS) and Mayo elbow score had no significant difference between two groups within 1 week post-treatment.However,VAS and Mayo elbow score improved more significantly in PRP group versus corticosteroid group at Month 1 and 6 post-treatment (P ＜ 0.05).The PRP trigger point injection treatment of elbow lateral epicondylitis achieved clinical outcomes and it was superior to glucocorticoid treatment.

Retrospective analysis was performed for the clinical data of 15 chronic insertion achilles tendinitis patients undergoing platelet-rich plasma (PRP) trigger point injection.The scores of Validated Victorian Institute of Sports Assessment-Achilles (VAS-A) and foot function index (FFI) improved greatly versus pre-treatment (all P ＜ 0.05).Tendon insertion structure inflammation decreased significantly on magnetic resonance imaging.At the last follow-up,all patients recovered normal gait and daily activity.The trigger point injection of PRP is efficacious for chronic insertion achilles tendinopathy.

Objective To observe the effects of platelet-rich plasma (PRP) gel in the treatment of [Ⅳ stage pressure ulcers.Methods A total of 12 patients with stage Ⅳ pressure ulcers were treated with PRP gel from December 2012 to December 2013 in our department.The PRP gel was formed by autologous PRP mixed with thrombin and calcium chloride.The PRP gel was applied to the wound after dressing.Time intervals between dressing were 4 days.Overall pressure ulcer improvement was assessed every week until complete wound healing.Results All stage Ⅳ pressure ulcer wound infection was controlled and fresh granulation tissue was found after 2 times of PRP gel covering.The time of ulcer wound healing were 6-10 weeks (mean 8 weeks).The times of changing the PRP gel were 16.No patients experienced adverse reactions during treatment.Conclusions PRP gel can effectively control the pressure ulcer infection and promote ulcer wound healing.

Objective:To study the effects and safety of metformin combined with vildagliptin on the glycemic control for patients with newly diagnosed type 2 diabetes mellitus.Methods:60 patients with type 2 diabetes mellitus who were treated from February 2015 to April 2016 were selected and divided into the control group and the observation group according to different treatment methods.The control group was treated with routine treatment.The observation group was treated with vildagliptin based on the control group.The blood glucose,glycosylated hemoglobin,two-hour postprandial blood glucose and serum as well as urinal amylase were measured before and after treatment,and the clinical curative effect of the two groups and the levels of interleukin-6,tumor necrosis factor and C-reactive protein were compared.Results:After treatment,the total effective rate of observation group was 90％,which was significantly higher than that of the control group(66.7％,P＜0.05).After treatment,the serum interleukin-6,tumor necrosis factor,C-reactive protein and fasting blood glucose,glycosylated hemoglobin and postprandial blood glucose levels were significantly lower than those of the control group[(7.63± 1.12)dvs(8.68± 1.30)d;(7.23± 0.95)d vs(7.89± 1.20)d;(11.14± 1.56)d vs(12.12± 1.89)d];[(12.12± 1.89)d vs(ll.20± 1.34)d;(6.89± 0.96)d vs(8.23± 1.10)d;(1.65± 0.23)d vs(3.65± 0.48)d] (P＜0.05).After treatment,the INS level of observation group was significantly lower than that of the control group (P＜0.05) and the GLP-1 level was significantly higher than that of the control group (P＜0.05).Conclusion:Metformin combined with vildagliptin could effectively control the blood glucose of patients with newly diagnosed type 2 diabetes and enhance the safety.

Femoral neck fractures are not common in young patients,accounting for merely 3％ of all these fractures.However,since the young femoral neck fractures are mostly caused by high energy violence,they usually jeopardize local blood supply and mechanical environment,resulting in higher risks of non-union and avascular necrosis.Besides,young patients often make a greater demand for functional recovery.Consequently,young femoral neck fracture is always a clinical challenge.In this article,we introduce in details the latest techniques and standards for reduction of young femoral neck fracture,compare advantages and drawbacks of various internal fixations,illustrate up-to-date progress in treatment methods and concepts for delayed and nonunited femoral neck fractures,and lastly put forward some unsolved issues open to dispute.In treatment of young femoral neck fractures,it is necessary for us to get familiarized with their anatomy and biomechanical characteristics,grasp the principles of treatment on the whole,and choose operational and internal fixation methods based on the clinical evidence before we can improve therapeutic efficacy,accelerate rehabilitation progress and restore function of the hip joint as much as possible.

Objective:To evaluate the clinical efficacy of Gushen Jianpi Huashi Decoction combined with irbesartan in the treatment of spleen and kidney deficiency syndrome of diabetic nephropathy (DN).Methods:According to random number table method, 97 patients with DN who met the inclusion criteria and from January 2018 to September 2020 were randomly divided into two groups, 48 in the control group and 49 in the study group. The control group took irbesartan on the basis of routine treatment of western medicine, and the study group took Gushen Jianpi Huashi Decoction on the basis of the control group. Both groups were treated for 14 days as a course of treatment, a total of 6 courses of treatment. Traditional Chinese Medicine (TCM) syndrome scores were performed before and after treatment, BUN and SCr levels were detected by automatic biochemical instrument, and serum IL-6, TNF-α, and CRP levels were detected by ELISA. The Urinary microalbumin excretion rate (UAER) was measured by radioimmunoassay, and the clinical efficacy was evaluated and adverse reactions were recorded.Results:The total effective rate was 91.8% (45/49) in the study group and 75.0% (36/48) in the control group, and there was significant difference between the two groups ( χ2=4.99, P=0.025). The scores of TCM syndrome in the study group was significantly lower than that of the control group ( t=29.75, P<0.01). After treatment, the serum BUN [(4.49 ± 0.68) mmol/L vs. (5.16 ± 0.61) mmol/L, t=5.11], SCr [(63.42 ± 4.09) μmol/L vs. (69.01 ± 4.35) μmol/L, t=6.52] and UAER [(72.58 ± 5.88) μg/min vs. (85.63 ± 6.49) μg/min, t=10.44] in the study group were significantly lower than those in the control group ( P<0.01), the serum IL-6, CRP and TNF-α levels in the study group were significantly lower than those in the control group ( t values were 9.44, 7.24 and 18.08, respectively, P<0.01). During the treatment, the incidence of adverse reactions was 14.6% (7/48) in the control group and 16.3% (8/49) in the study group, but there was no significant difference between two groups ( χ2=0.06, P=0.812). Conclusion:The Gushen Jianpi Huashi Decoction combined with irbesartan can improve the renal function of DN patients, reduce the level of inflammatory cytokines and improve the clinical effect.

Objective To develop a simple and patient-reported scoring system for evaluating the efficacy of functional reconstruction of adult hip diseases.Methods A candidate indicators list to evaluate hip function was established through literatures review and panel discussion.Using two rounds of Delphi method,experts were invited to judge and score the importance of screening indicators including pain,daily living ability,activity level,labor ability and self-assessment score of the overall hip status,with explanation of the degree of similarity and the basis for determination.In the second round of consultation,the content of integrity and rationality of the scale were added for evaluation.The final indexes of the scale were determined according to the boundary value of the indexes (average value,full frequency,coefficient of variation).The positive coefficient,authoritative coefficient,and coordination coefficient of the two rounds were calculated,and then the weights of each index was identified to form the final rating scale.Results Two rounds of Delphi reclaimed 25 and 24 experts' responses,which from 28 and 25 questionnaires,and the positive coefficients of the two rounds experts were 89.3％ and 96％,respectively.The authoritative coefficient of the first and second level indicators were generally above 0.85;and both of the expert coordination coefficient with the index importance (so called as Kendall coefficient) were above 0.3,and the second round of the coefficient was higher than the first one,and it indicated the final one was better at the consistency.The candidate index of "by bus" in the mobility was rejected in accordance with the threshold of the boundary value on the importance.Finally,it was determined that the hip scoring system (Shanghai Sixth People's Hospital,SSPH) consisted of two parts:the first part had ten indicators out of four dimensions such as pain,daily living ability,activity level,and labor ability;and the weight scores of these four aspects were 45,25,21,9,respectively.The second part was the patient's self-evaluation score for the overall status of the hip (VAS,out of 100 points);the total score was the sum of the two parts,and the final weights accounted for 85％ and 15％ between the two parts respectively.Conclusion The SSPH hip score based on patient-reported outcomes formed by the Delphi is simple and feasible,and it can be used as a reference for evaluating the clinical efficacy of hip functional reconstruction.