This paper reviews the advances concerning the diagnosis and treatment of carpal collapse. Systematic study on carpal collapse was launched only two decades ago. The improved roentgenologic diagnosis has deepened our understanding of the disorder. Its classification has helped doctors conduct objective follow ups of the progress and prognosis of the disease. And the related biomechanical research has made clear mechanism of the collapse which can serve as an important basis for choice of operative methods. The various partial carpal arthrodesis, of which the commonest is four corner arthrodesis, and proximal row carpectomy are proved to be effective in relieving most symptoms and ending the continuation of collapse, so they have become major treatment methods for the disease. But operative methods have to be chosen in the light of detailed conditions of radiocarpal and midcarpal joints. The silicon arthroplasty has been abandoned due to its serious complications.

Objective:To study the X-ray manifestations of distraction osteogenesis in tibial bone transfer, put for-ward the classification and formulate the standard treatment protocols.Methods:Data of 42 cases among 321 cases with dysplasia of distraction osteogenesis who had tibial bone transfer from January 2012 to December 2018 were retrospectively analyzed. There were 27 males and 15 females aged from 4-65 years old, with an average of 33.1 years. The dysplasia sites were 26 cases of proximal tibia, 3 cases of tibial shaft and 13 cases of distal tibia. The length of tibial defect ranged from 3.5 cm to 21.7 cm, with an average of 6.7 cm. The main management protocol included systemic assessment, local assessment, fixator adjusting stimulation and surgical intervention. The fixator adjusting stimulation included transport slowing, transport stopping, transport backing, and accordion techniques. The main surgical intervention was second site osteotomy and bone grafting. According to the X-films, the dysplasia of the tibia transport can be divided into four types: longitudinal defect; transverse defect; insect erosion defect; full-length defect. External fixation index (EFI) was used to evaluate the healing and mineralization of distraction osteogenesis. The limb function was evaluated by Paley method.Results:All 42 cases were followed up for 33.71 ± 11.7 months (range, 24-72 months). The types of dysplasia were as follows: 25 cases (59.5%) of longitudinal defects, 8 cases (19.0%) of transverse defect, 2 cases (4.8%) of insect erosion defect, and 7 cases (16.7%) of full-length defects. After the treatment, except for 2 cases of amputation, all the dysplasia healed and the patients recovered limb walking. External fixation index of 40 cases was 1.55-2.83 months/cm, with an average of 1.76 months/cm. According to Paley evaluation method, 27 cases were excellent, 10 cases good, 1 case fair, and 2 cases poor, thus the excellent and good rate was 92.5% (37/40). The complications after treatment included: nail tract infection (3 cases), axial displacement of transferred segment (4 cases), clubfoot (2 cases), and amputation (2 cases). The total incidence of complications was 26.2% (11/42), which was symptomatically treated.Conclusion:The X-film manifestations of dysplasia at the osteotomy site in tibial bone transport can be divided into four types: longitudinal defect, transverse defect, insect erosion defect, and full-length defect. The different types were treated by general and local evaluation, frame adjustment stimulation and surgical intervention. The remedial results of the dysplasia were excellent.

BACKGROUND:In animal experiments, transplantation of autologous nucleus pulposus cellscan effectively repair the intervertebral disk degeneration. However, nucleus pulposus cells have a poor ability of proliferation in vitro, which limits its application as seed cells in treatment of intervertebral disk disease.
OBJECTIVE:To construct recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase and observe the human telomerase reverse transcriptase mRNA expression in human nucleus pulposus cells in vitro.
METHODS:After the plasmid pSNAV2.0-pRSV-hTERT was constructed and identified, recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase were constructed, amplified and purified by AAVMaxTM package and purification system. The optimal multiplicity of infection for human nucleus pulposus cells was detected by recombinant adeno-associated virus type-2 vector carrying enhanced green fluorescent protein. According the optimal multiplicity of infection (5 × 104 v·g/cell), three different multiplicity of infection (1×104, 5×104, 1×105 v·g/cell) of recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase were determined to transfect the first passage human nucleus pulposus cells in vitro. In control group, the cells were transfected with adeno-associated virus type-2 vector without human telomerase reverse transcriptase. At 1, 2, 4 weeks after transfection, mRNA expression of human telomerase reverse transcriptase in human nucleus pulposus cells were semi-quantitatively detected by RT-PCR.
RESULTS AND CONCLUSION:The recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase was successful y constructed, and the titer of the obtained vector was more than 2×1011 v·g/mL. The optimal multiplicity of infection was 5×104 v·g/cell. The mRNA expression of human telomerase reverse transcriptase in human nucleus pulposus cells could be detected in different multiplicity of infection (1×104, 5×104, 1×105 v·g/cell). At 2 weeks post-transfection, mRNA expression of human nucleus pulposus cells was the highest (P<0.05), as detected by semi-quantitative RT-PCR. Moreover, the stable and high mRNA expression of human telomerase reverse transcriptase could be detected at 4 weeks post-transfection. In control group, no human telomerase reverse transcriptase mRNA expression was found. The recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase can be successful y constructed, and can mediate a stable mRNA expression of human telomerase reverse transcriptase in human nucleus pulposus cells. Our findings provide a novel strategy of enhancing the properties of nucleus pulposus cells.

AIM:To investigate whether nimesulide a selective cyclooxygenase 2 (COX-2) inhibitor and piroxicam (an inhibitor of COX-1) protect the rat hearts against oxidative stress induced by hydrogen peroxide, superoxide anion or hydroxyl free radical. METHODS: Cardiac contractility, lactate dehydrogenase (LDH) and malondialdehyde (MDA) were analyzed by the Langendorff method in isolated rat hearts. Production of 6-Keto-PGF1?, a marker of COX activity, was measured in isolated rat hearts. RESULTS: Rat hearts were exposed to hydrogen peroxide (H2O2), pyrogallol (which produced superoxide anion) or Vit C+Fe2+ (which produced hydroxyl free radical) for 10 min followed by reperfusion for 30 min. H2O2 decreased cardiac contractility and increased LDH release, which was inhibited by nimesulide (3 mg/kg) LVDP 72%?10% vs 61%?11%, LDH (5.5?2.5)U/L vs (8.0?2.1)U/L, P

Objective To analyze risk factors for soft-tissue defects after surgery on leg trauma,to discuss methods for prevention of soft-tissue defects and its treatment.Methods A retrospective analysis was conducted on 217 cases of soft-tissue defects with bone exposure and / or internal fixation exposure after surgery on leg trauma from January,1999 to December,2012.Soft-tissue defects with various flaps were used in 201 cases,including neurocutaneous flap(89 cases),random flap(21 cases),free flap(75 cases),cross-leg flap(16 cases),and by skin grafting in 16 cases.For the 117 internal plate-fixated fractures,96 removed the plate and 21 cases did not remove the plate.For the 13 intramedullary nail fixations,4 cases of intramedullary nails were removed,9 cases were not removed.For the 56 cases of external fixation of the fractures,39 patients had unadjusted external fixation,17 cases re-adjusted external fixations.Results Of the 217 cases of soft-tissue defect after surgery on legs,201 cases were conducted flap surgery.The flap was completely necrosis in one case,and partial distal necrosis were in 14 cases,of which 6 cases healed after changing the dressing,5 underwent debridement and skin grafting,3 cases underwent flap surgery again.In cases of fracture patients,177 cases healed within 1 year,delayed union 23 cases,nonunion eight cases.Nonunion healing after bone grafting and re-fixation surgery.In 9 cases of uncontrollable osteomyelitis,6 patients underwent bone removal and bone transport surgery,3 patients underwent amputation.Conclusion Soft-tissue defects after surgery on leg trauma is a serious complication whose prevalence is associated,in a certain degree,with incorrect surgical time and methods.It is crucial for early repair of soft-tissue defects by using various kinds of proper flaps whenever soft-tissue complication occurs.In patients with early stage internal fixation,flap surgery without internal fixation removing is feasible if little soft-tissue defect,little exposed internal fixation and mild infection,otherwise it is necessary to remove internal fixation and re-fix by external fixation before flap surgery.

Objective To establish the reconstructive ladder for the leg without sufficient recipient vessels by case analysis and literature review.Methods From January,2009 to January,2015,772 cases were treated in our center using free flap for leg coverage and 129 cases were found intra-operatively to have insufficient recipient vessels.There were 113 males and 16 females,and the age ranged from 4 to 71 years,averaging 36.5 years.The wounds were post-traumatic (n=108) and non post-traumatic (n=21).The management methods included elongating incision (n=25),vessel transfer(n=22),Flow-through anastomosis(n=17),end-to-side anastomosis (n=13),useing neighboring vessels (n=1S),anastomosis distal to the injured zone (n=14),cross-leg free flap (n=7),and abandoning free flap transfer(n=13).Results Except for the cases of abandoning surgery (n=13,10.1％),there were 86 cases whose flap healed totally (66.7％),9 cases total lost(7.0％),and 11 cases marginal loss (8.5％).It established a reconstructive ladder for this special situation according to the principle of difficulty level.Conclusion The insufficient recipient vessels of the leg were had multi-causes which should be taken account generally before surgery.The optimal protocol for each case should be chosen from the reconstructive ladder based on the technical difficulty level.

AIM:To investigate the effect of puerarin on acute high glucose-induced attenuation of ACh relaxation in isolated rat aortic rings, and to elucidate its underlying mechanism. METHODS: The thoracic aortic rings with endothelium of male Sprague-Dawley rats were mounted on a bath system. Isometric relaxation of aortic rings was measured. RESULTS: ① After incubation with high concentration of glucose (44 mmol/L), the vascular relaxation responses to ACh decreased. ② After coincubation with puerarin (10-10-10-8 mol/L) and high glucose, the high glucose-induced attenuation of ACh relaxation responses of artery was partly inhibited in a dose-dependent manner. ③ After incubation with puerarin for 2 h, the HO-1 activity of thoracic aorta increased. ZnPPIX (an inhibitor of heme oxygenase-1) abrogated the protective effect of puerarin. CONCLUSION: Puerarin prevents the acute high glucose-induced attenuation of endothelium-dependent relaxation in aortic rings. The mechanism might be involved in the activation of heme oxygenase-1.

AIM: To explore the protective effect of curcumin on high glucose-induced decrease in contraction of isolated rat aortic rings, and to elucidate its underlying mechanism. METHODS: The thoracic aortic rings with endothelium of male Sprague-Dawley rats were mounted on a bath system. Isometric contractions of aortic rings were measured. HO activity was also evaluated. RESULTS: (1)Four hours after incubated with 44 mmol/L of glucose (high glucose),the vascular contraction responses to phenylephrine (PE) decreased compared to control group (containing 11 mmol/L of glucose). (2)Coincubation with curcumin (3×10~(-11)-3×10~(-10) mol/L) and high glucose,the high glucose-induced decrease in contraction responses to PE of arteries was partly inhibited. (3)Four hours after incubation with curcumin,the HO activity in thoracic aorta increased. ZnPP,an inhibitor of HO-1,completely abrogated the protection effect of curcumin. (4)Methylene blue,an inhibitor of guanylate cyclase (GC),partly abolished the protective effect of curcumin. CONCLUSION: Curcumin prevents the high glucose-induced decrease in contraction responses to PE in intact aortic rings. The mechanism might be mainly involved in the activation of HO-1 and GC.

Objective To evaluate the results of NiTi shape memory alloy four-corner arthrodesis concentrator (NTMA-FCAC) for carpal collapse. Methods We reviewed retrospectively 13 patients who underwent scaphoid excision with four-corner arthrodesis using NTMA-FCAC for carpal collapse from August 2006 to June 2009. There were eight males and five females, with an average age of 38 years (range, 23-61years). The cause of carpal collapse was SNAC in 7 cases, perilunate dislocations in five and SLAC in one.The injury mechanisms included traffic accidents (5 cases), falling from a height (4 cases), crashes (3 cases)and sprain (1 case). Objective measurements included grip strength and range of the wrist. Radiographs were performed in all patients. A visual analogue scale (VAS) was used to assess wrist pain. The results were evaluated according to the Krimmer wrist scores. Results The mean follow-up time was 26.5 months (range,6-36 months). Clinical evaluation yielded the mean grip strength of (32.49±6.21) kg (80.8% of opposite side).The mean range of the wrist reached over 53% of the healthy side. Non-union and wound infection were not seen. The mean VAS scores had improved from 4.46±1.27 preoperatively to 1.31 ±0.95 postoperatively. The mean pain scores under stress had improved from 7.00±1.41 preoperatively to 2.62±1.26 postoperatively.There were remarkable differences between them. The mean Krimmer wrist score was 79. Conclusion Four-corner arthrodesis using NTMA-FCAC is an effective method for carpal collapse, preserving a majority of wrist function.

AIM:To investigate the effect of high glucose on the expression of an endoplasmic reticulum stress marker glucose-regulated protein 78(GRP78),and explore its underlying mechanism.METHODS:(1) Human umbilical vein endothelial cells(HUVECs) were exposed to normal glucose(5.5 mmol/L) and high glucose(30 mmol/L) for 24 h,36 h or 48 h.Cell viability was determined by MTT method.Cell apoptosis was detected by flow cytometry analysis.The expression of proteins was evaluated by Western blotting analysis.RESULTS:After treated with high glucose for 24-48 h,the expression of GRP78 increased early but decreased at 48 h of incubation,while cyclooxygenase-2(COX-2) expression increased in a time-dependent manner.COX-2 selective inhibitor nimesulide inhibited high glucose induced changes of GRP78 expression and also inhibited high glucose induced cell apoptosis.CONCLUSION:Prolonged high glucose exposure changes the expression of GRP78 in a COX-2 dependent manner in HUVECs.