Objective:To discuss the diagnosis,differential diagnosis,classification methods and treat-ment of the capitellar fractures of the distal humerus.Methods:In the study,28 adult patients with the capitellar fractures were treated in Beijing Jishuitan Hospital from Sep.2008 to Jan.2014.There were 10 females and 18 males with an average age of 34 years (range:14-66 years).According to Dubber-ley classification:ⅠA type in 6 cases,ⅠB type in 2 cases,ⅡA type in 8 cases,ⅡB type in 4 cases,ⅢA type in 4 cases,and ⅢB type in 4 cases.Sixteen patients were treated with a single Kochr approach,1 with a lateral approach combined with a medial approach,2 combined with anterior elbow approach and 9 combined with posterior median approach.All of the fractures were fixed with Herbert screws,7 cases with support plates,and 4 cases with the hinged elbow external fixator.All of the pa-tients were followed up for clinical examination and radiograph check.They were evaluated with Broberg-Morrey score system.Results:The average follow-up time was 28.5 months (range 12 -72 months). The average bone union time was 8 weeks.The average ulnohumeral motion was 1 12°(60°-150°)and forearm rotation was 145°(100°-170°).The average Broberg-Morrey score was 92.5 points (range:62-100 points).The excellent and good rate was 91.8%.The complications of traumatic arthritis was in 2 cases and elbow stiffness was in 2 cases.Conclusion:Attention should be paid to the diagnosis and differential diagnosis of capitellar fractures without missing the combined injury.According to Dubberley classification,appropriate surgical approach and the internal and external fixed methods could be chosen. Early postoperative,reasonable and effective exercise is helpful to the recovery of elbow joint function.

Objective To investigate the outcomes of infection mauagement after patellar fracture surgery using vacuum sealing drainage (VSD) combined with closed irrigation-suction within the articular cavity.Methods We treated 7 patients who had been inflicted by infection after patellar fracture surgery from June 2008 to March 2012.They were 5 men and 2 women,aged from 19 to 52 years (average,40.5years).There were one open aud 6 close patellar fractures.Their infections occurred 14 to 21 days (average,17.7 days) after internal fixation.One infection was superficial and 6 were deep,resulting in pyogenous arthritis of the knee.All cases were given debridement and VSD treatment and immobilized with braces.The 6 cases of deep infection were irrigated continuously with 4000 mL 0.9％ NaCl every day within the articular cavity.Direct skin suture or transplantation of local skin graft was performed after growth of fresh granulation tissue.Neer system was used to evaluate the knee functions at the last follow-up.Results After the VSD was applied for 7 to 12 days,the wound surface and knee cavity were very clean and fresh granulation tissue emerged.The wound was closed by direct suture for one superficial and one deep infection.Local skin grafts were transplanted for 5 deep infections.The infections were effectively controlled without pain,swelling or local fistula.The patients were followed up from 3 to 48 months (average,21 months).The functional outcome according to Neer' s criteria at the last follow-up was excellent in 2 cases,good in 3 and fair in 2.Conclusion In management of infection after patellar fracture surgery,VSD combined with closed irrigation-suction within the articular cavity can drain sufficiently,control infection effectively and stimulate fresh granulation growth,facilitating wound closure by direct suture or transplantation of a local skin flap.

Objective To explore the diagnostic and clinical application value of combined detection of C-reactive protein (CRP),serum prealbumin (PA) and white blood cell (WBC) count in neonatal infectious diseases.Methods A total of 187 fullterm newborns were collected in this study,including 92 newborns of bacterial infection as the infection group and 95 newborns of non-infection diseases as non-infection group.The abnormal rates of CRP,PA and WBC in the two groups were measured;the sensitivity,specificity,false positive rate and false negative rate were compared between the single detection and combined detection of WBC,PA,CRP;the changes of the three indexes in the infection group were compared between before and after treatment.Results The abnormal rates of CRP,PA and WBC in the infection group were significantly higher than those in the non-bacterial infection diseases group (P＜0.05).The sensitivity and specificity of combined detection of CRP+ PA + WBC were higher than those of single detection of CRP,PA and WBC;after treatment,the level of CRP in the infection group was significantly decreased,the level of PA was significantly increased and the WBC count returned to normal(P＜0.05).Conclusion The combined detection of CRP,PA and WBC has an important clinical value in the early diagnosis of neonatal bacterial infection.

Objective To type Acinetobacter baumannii using infrequent restriction site PCR (IRS PCR). Methods Strain specific electrophoretic patterns from PCR products by amplifying DNA sequences flanking infrequent restriction sites of 15 strains of Acinetobacter baumannii were compared with the results of biotyping and antimicrobial susceptibility. Results The 15 bacteria were divided into 5 gene types with IRS PCR, but 3 with biotyping, and 4 with antimicrobial susceptibility. Conclusion IRS PCR method for typing Acinetobacter baumannii is of strong sensitivity, high recognition, good repeatability, convenient operation, and wide range of application.

BACKGROUND:Sirius red is a strong acid anionic dye. Being not-easyto-fade and specific, sirius red becomes the best dye for collagen staining.Collagen is a major component of extracellular matrix and has some specific physiological functions. Through synthesis and reconstruction of collagen, bone fracture repair will be accomplished.OBJECTIVE: Picric acid-Sirius red stained slides were observed under a polarized light microscopy for evaluation the dynamic changes in the ratio of different collagen types and their distributions in bone fracture healing.DESIGN: It was a controlled observation.SETTING: It was conducted in the Department of Orthopedics, Renmin Hospital, Wuhan University; Department of Traumatic Orthopaedics, Tianjin Hospital; Department of Traumatic Orthopaedics, Jishuitan Hospital,Medical Department, Peking University; Tissue Engineering Center of Institute of Basic Medical Sciences, Academy of Military Medical Sciences of Chinese PLAMATERIALS: It was conducted at Tissue Engineering Center of Institute of Basic Medical Sciences, Academy of Military Medical Sciences of Chinese PLA from March 2002 to September 2003. Three healthy adult Chinese sheep, male and in weight from 25 to 35 g, were selected.METHODS: All the animals were anesthesized and sterilized; a transverse osteotomy of the trunk of metatarsus was performed; and the end of fracture was fixed with a six-hole Medoff sliding plate. At the post-operative month 1, 3 and 6, samples were taken from bone fractures. After decalcification with EDTA, they were stained with Picric acid-sirius red, and the types and distribution of collagens were observed under a polarized light microscopy.MAIN OUTCOME MEASURES: Types and distributions of collagens in bone lesion in different period of bone healing were investigated.RESULTS: Three sheep used in this study entered the statistical analysis.①Morphological features of various collagens under a polarized light microscopy postoperatively: Type Ⅰ collagen packed tightly, with a strong refraction and yellow, orange or red thick fibres. Type Ⅱ collagen formed a loose reticulation with fibres exhibiting different colour and a weak refraction. Thin fibres of type Ⅲ collagen with weak refraction and green colour formed a loose reticulation. ②Quantitative studies on various collagens under a polarized light microscopy postoperatively: At postoperative month 1,red or orange fibres (type Ⅰ collagen) were rarely seen in bone fracture,while green fibres (typical of type Ⅲ collagen) were dominant with a disorder pack. At postoperative month 3, red or orange fibres increased significantly and the ratio of type Ⅲ collagen reduced. The collagen fibres assembled regularly. At postoperative month 6, thick yellow-red collagen became dominant and thin green type Ⅲ collagen decreased dramatically and arranged in an obvious oblique, spiral and crossed orientations.CONCLUSION: Picric acid-sirius red stain combined with polarized light microscopy technique is not only capable of identifing type Ⅰ and type Ⅲ collagens in bone fraction, but also can reflect the morphological features,distribution and the ratio of these two type collagens. This approach has the virtues of easiness in operation, strong specificity and high sensitivity.

Objective To intensify the diagnosis and treatment of primary osseous Hodgkin disease (HD) and reinforce the impression of its features of pathology and imaging. Methods The clinical manifestation, laboratory examination, treatment and outcome of a patient with primary Hodgkin disease of the supermaxilla were first reported and the pertinent literatures were reviewed. Results Pain of the right supermaxilla was the first clinicM symptom. Plain X-rays showed mixed osteolytic and partially osteosclerotie lesions in the right supermaxiUa. The tumor was removed and the pathohistology was HD lymphocyte-depletion. The clinical diagnosis was primary HD of the supermaxilla (Stage Ⅰ ). The case was treated with ABVD regimen and no obviously adverse reaction appeared. Conclusion Primary osseous HD rarely presents as a malignant bone lymphoma and is easily misdiagnoed. Pathological and immunohistologic studies can be useful to confirm the diagnosis of primary osseous HD. Early diagnosis and the differentiation from other disease should be performed and the prognosis of the present-day chemotherapy regimen appears good.

Objective To investigate the cytokine spectrum and henlatopoiesis-supportive function of umbilical cord derived mesdnchymal stem cells(UC-MSC),and compare with those of normal adult bone marrow derived mesenchymal stem cells(BM-MSC).Methods The mRNA of cytokine production of UC-MSC and BM-MSC were determined by reverse transcriptasc polymerase chain reaction(RT-PCR)analysis.To evaluate hematopoiesis supporting activity,cord blood(CB)CD+34 cells were co-cultured with UC-MSC or BM-MSC.Colony-forming cells(CFC)were determined after 5 weeks of culture.Results RT-PCR assay showed that UC-MSC had a cytokine spectrum very similar to that of BM-MSC.including expression of the mRNA ofstem cell factor,leukemia inhibitor factor,macrophage colony stimulating factor,Flt3-ligand,interleukin-6,vascular endothelial growth factor and stromal derived factor-1.but UC-MCS additionally expressed mRNA of granulocyte macrophage and granulocyte colony-stimulating factors.After co-culture with CD+34 cord blood cells for 5 weeks,no significant difference in CFC was observed between the CD+34 cells/UC-MSC and CD+34 cells/BM-MSC co-cultures (P＞0.05). Conclusion The cytokine spectrum and hematopoiesis-supponive function of UC-MSC ale similar with that of BM-MSC.

Objective To investigate the clinical characterstics of bone Langerhans-cell histiocytosis (LCH) and evaluate its diagnosis,therapy and prognosis.Methods 25 cases with biopsy confirmed bone LCH during the last 8 years were retrospectively analyzed.Results The patients included 18 males and 7 females,13 children and 12 adults,ranging from 1.5 to 55 years old with a median age of 17.Cases with unifocal lesions were 17,including 11 cases of skull LCH,and the remaining 8 were with multifocal lesions.First symptoms were predominantly pain and local masses,and rarely constitutional symptoms.The manifestation of radiography was osteolytic bony lesions.12 cases had masses in soft tissues.Patients with solitary lesions underwent surgical operation,followed by radiotherapy or chemotherapy.Cases with multifocal lesions received chemotherapy and radiotherapy.Pathological examination showed proliferation of well differentiated histiocytes,and large numbers of infiltrating eosinophils.Positive rates of CD1a,S100,Vimentin and CD68 were higher in immunohistochemistry.Patients with restricted involvement in bones can achieve a satisfactory therapeutic effect.2 cases died when multiple systems were compromised.Conclusion Bone LCH occurs predominantly in children and teenagers,involves solitary bones,and morbidities in males are much higher than females.Skull is most commonly affected.Principal clinical manifestations are pain and local masses.Diagnosis of bone LCH depends on microscopic examination.Combination therapy appears to be an effective method of treatment.Prognosis of disease is related to the degree of bone involvement,histological classification and simultaneously encroachment of other organs.Most patients have good prognosis.

In order to study the chondrogenic phenotype differentiation of adult sheep bone marrow-derived mesenchymal stem cells (MSCs) in a defined medium as potential seed cells for cartilage tissue engineering. MSCs were isolated by density centrifugation with Percoll solution from bone marrow aspirated from sheep iliac crest. The third passage of MSCs were induced with H-DMEM containing TGF-beta3, IGF-I, Dexamethasone and VitC. The shape and ultrastructure of cells were observed, toluidine blue stain for GAG and immunohistochemistry for type II collagen were applied for chondrogenic phenotype identification. After 14 days of induction, MSCs changed from a spindle-like appearance to a polynal shape, a large amount of endoplasmic reticulum, Golgi complex and mitochondria were observed, and the differentiation of MSCs chondrogenic phenotype was verified by positive staining of toluidine blue and immunohistochemistry. MSCs derived from bone marrow can differentiate to chondrogenic phenotype when induced in vitro and can be used as optimal seed cells for cartilage tissue engineering.
Bone Marrow Cells/*cytology ; Cell Differentiation ; Cell Separation ; Cells, Cultured ; Chondrocytes/*cytology ; *Chondrogenesis ; Mesenchymal Stem Cells/*cytology ; Phenotype ; Sheep ; Tissue Engineering

Objective To explore the efficacy and safety of moderate-dose of etoposide (VP16) with granulocyte-colony-stimulating factor (G-CSF) for mobilization of peripheral blood stem/progenitor cells.Methods VP16 at 1.2 g/m2 was injected intravenously by six divided doses via a central vein, 2 times every 12 hours for 3 days in 31 patients with malignant lymphoma (30 non-Hodgkin lymphoma and 1 Hodgkin lymphoma). All patients received G-CSF 5 μg/kg were given twice daily subcutaneously from the day of the nadir of white blood cell (WBC) till the day before the last APBSC harvest. Results The mean time for the collection of stem cell was 12 days (10-15) following etoposide chemotherapy. The mean number of mononuclear cell (MNC) and CD+34 cells in collection were 7.8×108/kg (5.2-11.3×108) and 7.2×106/kg (5.3-13.1×106). respectively. 18 patients completed collection with a single apheresis, and 13 patients underwenttwice. All patients were recovered for haematopoiesis in following APBSCT. Median (range) time for the recovery of absolute neutrophil count (ANC)＞0.5×109/L and platelet＞20×109/L were+12 (+9-+18) days and +14 (+10-+21) days respectively. Slight adverse events coursed by the regimen could be tolerated. Conclusion VP16 at moderate dose with G-CSF is an effective and safe mobilizing regimen for autologous peripheral blood stem/progenitor cells in patients with malignant lymphoma. It was suggested to use extensively.