Objective To discuss the clinical features in the diagnosis and treatment of Maisonneuve fracture.Methods Twenty-three patients(16 males and 7 females)with Maisonneuve fractures were surgically treated in our hospital from August 2005 to August 2009.Mean patient age was 35.3 years(range,25-43 years).The causes of injuries were fall down injury(10 patients),sports related injury(8 patients),traffic injury(4 patients),and high falling injury(1 patient).All of the fractures were closed.The surgical procedures include ORIF of the medial malleolus or repair of the medial deltoid ligament and percutaneous screw fixation of the disrupted distal tibiofibular syndesmosis.The ankle function was evaluated by Baird-Jackson criteria.Results In all the 23 patients,9(39.13%)were misdiagnosed at the time of admission or emergency.Twenty-two patients were followed up and the average follow up time was 16.8 months(range,12-25months).No patient complained of pain,tenderness and obvious swelling of the ankle,and range of motion of the injured ankle was similar to that of the contralateral side.At the latest follow up,19 patients had resumed their preinjury activity level.Radiographs of all 22 patients showed union of all the fractures and normal mortises.And there was no traumatic arthritis and breakage of the syndesmotic screws.Baird-Jackson ankle functional score was from 85 to 100.In all the 22 patients,11 were rated as excellent,8 as good,and 3 as fair.The excellent and good rate was 86.4%(19/22).Conclusion Maisonneuve fracture is easy to be misdiagnosed.The lack of knowledge of this fracture and only initially focus on the local condition are the main reasons for the misdiagnosis.Surgical treatments include ORIF of the medial malleolus or repair of the medial deltoid ligament and percutaneous screw fixation of the disrupted distal tibiofibular syndesmosis.

ObjectiveTo explore the application and outcome of locking compression plate in the treatment of unstable distal radius fracture.Methods From January 2006 to December 2008,eighty-two patients with consecutive unstable distal radius fractures were preformed with open reduction and locking compression plate fixation by volar, dorsal or bilateral approaches. There were 31 males (bilateral fractures in two patients) and 49 females with an average age of 51 years (range, 17-74 years).According to AO/OTA criterion, there were seven patientswith type A3 fractures, four with type B 1, 12with type B2, 10 with type B3, 16 with type C1, 21 with type C2 and 12 with type C3. The locking plate fixations through simple volar approach was performed in 61 patients, fixations through dorsal approach in 12, volar 1/3 radius cylindrical steel plate fixation through volar and dorsal approach in five, bilateral fixations through volar and dorsal approaches in four. Furthermore, the external fixator was used in 19 patients, fixation of the ulna fractures in seven, and bone graft in 39. ResultsThe patients were followed up for average 20.7 months ( range, 1-4 years), which showed postoperative complications including bubble appearing around the incision in three patients, infection in one, median nerve injury in three, screws penetrating into extensor compartment in four, threads penetrating into radiocarpal joint because of reduction loss in two, rejection in one and traumatic arthritis in seven. According to the Cooney criterion, the result was excellent in 56 pateints, good in 19, fair in six and poor in one, with excellence rate of 91％. Conclusions The locking compression plate can provide firm fixation and allow early functional exercise and hence is suitable for unstable distal radius fracture especially the osteoporosis patients with comminuted compression fracture.

Objective To discuss the clinical features of Traumatic Spinopelvic Dissociation(TSD) and to evaluate the clinical results treated by lumbopelvic fixation by retrospective case study.Methods From July 2008 to December 2012,twelve patients of Traumatic Spinopelvic Dissociations were surgically treated at our department in Tianjin Hospital.There were 8 males and 4 females with a mean age of 34.6±9.2 years(range,18-50 years).The causes of injuries were fall or jump from height (11 patients) and traffic injury (1 patient).All the fractures were closed injuries and associated injuries in different degrees were noted in all the patients.The sacral fractures were classified according to fracture shape,with 4 cases of U shape,6 cases of H shape and 2 cases of Y shape.The transverse part of the sacral fractures were classified by Roy-Camille classification,and there were 6 cases of type Ⅱ and 6 cases of type Ⅲ.All the 12 patients were surgically treated by lumbopelvic fixation of a posterior approach,and 6 patients with significant neurological impairments were performed with sacral decompression via the same approach.The clinical results were evaluated by Majeed functional evaluation and the neurological impairments were evaluated by Gibbons score.Results All the patients were followed up on an average of 15.5±6.3 months (range,12-36 months).The diagnosis of the TSD were missed or delayed in 9 of the 12 patients.There were different neurological impairments in all the 12 patients.All the fractures healed in a mean time of 4.8±2.8 months(range,4-8 months).Clinical outcome was rated excellent in 4 patients,good in 4 patients,fair in 2 patients,and poor in 2 patients,according to the Majeed functional evaluation,and the excellent and good rate was 66.7％ (8/12).The neurological injuries were recovered completely or partially in sensation and motion in 11 of all 12 patients (91.7％).For the neural decompression patients,the neurological injuries were recovered completely or partially in sensation and motion in 5 of all 6 patients (83.3％).At last follow up,the average Gibbons score improved from 3.25 preoperatively to 1.67 postoperatively,with significant difference.Conclusion TSD is a rare high-energy injury pattern.It has a high rate of associated injuries and neurological impairments.The correct diagnosis of the injury pattern is easy to be missed or delayed.Surgical procedure of lumbopelvic fixation via post approach should be considered as the method of choice.Early neural decompression for the patients with obvious indications could be helpful in overall neurological and functional recoveries.

BACKGROUND:Epidural scar after laminectomy is one important reason for the secondary spinal stenosis, and local application ofSanqi sodium hyaluronate gel can prevent epidural scar adhesion after laminectomy. OBJECTIVE: To study the effects ofSanqisodium hyaluronate gel on α-smooth muscle actin expression in the process of rabbit's epidural scar formation. METHODS: In this study, there were ninety-six rabbits which were randomized into four groups and given 0.5 mL normal saline, 0.5 mLSanqi concentrated solution, 0.5 mL sodium hyaluronate and 0.5 mLSanqisodium hyaluronate gel around the dura. At 1, 2, 4, 8 weeks after treatment, immunohistochemistry staining was employed for analysis of α-smooth muscle actin expression. RESULTS AND CONCLUSION:At the end of weeks 1 and 2, the expression of α-smooth muscle actin antibody in the normal saline group was significantly higher than that in the other three groups (P < 0.01 orP < 0.05), but there were no significant differences among the Sanqi, sodium hyaluronate andSanqisodium hyaluronate gel groups (P> 0.05). At weeks 4 and 8, the expression of α-smooth muscle actin antibody in theSanqi sodium hyaluronate gel group was significantly lower than that in the other three groups (P < 0.01 orP < 0.05), and there was no significant difference among the latter three groups (P > 0.05). These findings suggest thatSanqi sodium hyaluronate gel can inhibit the expression of α-smooth muscle actin, and thus ease scar contracture.

Objective To compare the impact of the sirolimus and tacrolimus on the tumor recurrence after liver transplantation due to HCC beyond Milan criteria.Method Sixty-one liver transplantation recipients due to HCC beyond Milan criteria,between Jan.2008 and Apri.2012,were randomized,with the informed consent,into two different immunosuppression groups: sirolimus group (n=30) and tacrolimus group (n=31).In tacrolimus group,tacrolimus was used as the basic immunosuppressant,methylprednisolone was discontinued within one month postoperatively,and mycophenolate mofetil was used within the dosage of 1.5 g/d accordingly.In sirolimus group,the immunosuppresive scheme was the same as that of the tacrolimus group within postoperative one month,and from that,tacrolimus was transferred to sirolimus.No antineoplastic agents were given before tumor recurrence.The tumor recurrence rate and the survival rate of the recipients were compared between the two groups.Result The median follow-up duration was 35.2 months (10.3～ 60.2).The tumor recurrence rate at postoperative year 1,2,3 and 4 in the sirolimus group (13.3％,36.7％,43.3％ and 53.3％) was significantly lower than that in the tacrolimus group (38.7％,67.7％,74.2％ and 77.4％),P ＜ 0.05 for all.The one-year survival rate in the recipients postoperation had no significant difference between sirolimus group and tacrolimus group (90.0％ vs.87.1％,P=0.438).The 2-,3-and 4-year survival rate in the recipients was significantly higher in the sirolimus group (53.3％,33.3％ and 20.0％) than that in the tacrolimus group (41.9％,22.6％ and 9.7％),P ＜ 0.05 for all.The liver function and renal function of the recipients at the postoperative year 1,2,3 and 4 showed no significant difference between the two groups,P＞0.05.Conclusion In comparison with tacrolimus,sirolimus could significantly reduce the tumor recurrence rate and increase the survival rate for the liver transplant recipients due to HCC beyond Milan criteria.

BACKGROUND:There are reports concerning differentiation of adipose-derived mesenchymal stem cells(ADSCs)into chondrocytes using gene transfection technique.However,the transfection of adenovirus and adeno-associated virus into ADSCs is various.It is controversial whether adeno-associated virus(AAV)can transfect ADSCs.OBJECTIVE:To observe the enhanced green fluorescent protein(EGFP)expression following Ad5-EGFP and rAAV2-EGFP transfection into ADSCs,and investigate the cell proliferation ability following transfection.METHODS:ADSCs were isolated from the adipose tissue,which was from 6-month-old New Zealand albino rabbit back and neck by mechanical digestion and enzyme digestion,then ADSCs were cultured and amplified in vitro.ADSCs were infected with Ad5-EGFP and rAAV2-EGFP,and the EGFP expression was observed.A total of 2 μL sodium butyrate(1 mol/L)was added into the medium after rAAV2-EGFP transfection.MTT assay was used to detect the gene transfection effects on reproductive activity of ADSCs.RESULTS AND CONCLUSION:ADSCs isolated and cultured in vitro were flat,long-spindle and amplified stabry.The cell morphology was uniform.Many green fluorescent cells were observed in Ad5-EGFP and rAAV2-EGFP groups.Transfection efficiencies were about 88% and 83%.Adenovirus and adeno-associated virus vector can be transfected with ADSCs,and transfection efficiency is high.Adeno-associated virus needs sodium butyrate to increase its level of gene expression.

Aim To investigate the effects of starfish saponins(Sfs) on insulin signaling pathway in orotic acid-induced NAFLD rats.Methods 1% orotic acid was used to establish NAFLD model in male Wistar rats for six weeks.The NAFLD rats were randomly divided into two groups(eight rats in each group) and then fed with the corresponding diets: Model group(1% orotic acid)and Sfs group(1% orotic acid containing 0.04% starfish saponins).After starfish saponins feeding for 8 weeks, hepatic lipids content, liver function indices and relevant protein expression in muscle insulin signaling pathway were measured.Results Compared with model group, starfish saponins reduced hepatic lipids content and improved liver functions.In addition, it effectively ameliorated insulin resistance by improving insulin signaling pathway and improved glucose uptake in muscle.Conclusion The amelioration effect of starfish saponins on impaired insulin signaling pathway in muscle is observed in orotic acid-induced NAFLD rats.

AIM: To explore the role of TGF-?_1 and signaling transduction molecule, Smad4, in the development of glomerulosclerosis. METHODS: Expression levels of TGF-?_1, Smad4, collagen Ⅰ proteins were evaluated by immunohistochemistry in renal biopsies from 38 cases with a spectrum of glomerulonephritis, and compared with 20 normal kidney tissue with image analysis system. After stimulation with TGF-?_1, expressions of endogenous Smad4 and collagen Ⅰ mRNA and proteins and its modulation by TGF?_1 were evaluated by RT-PCR and Western blotting analyses in cultured human mesangial cells. RESULTS: All types of proliferative and sclerotized glomerulonephritis showed an increased expression of TGF-?_1, Smad4 and collagen Ⅰ ompared with the 20 normal kidney tissue in glomerular (P

Objective To investigate the value of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma.Methods The clinical data of 10 patients with hilar cholangiocarcinoma who were admitted to Chenggong Hospital of Xiamen University from January 2012 to September 2012 were retrospectively analyzed.The two-dimensional computed tomography images were converted to three-dimensional images with the three-dimensional visualization system,and then the volume of liver and tumor size,volume of liver to be resected,remnant liver volume were measured.Surgical procedure was planned based on the three-dimensional images,and the difference between the actual and planned surgical procedures was analyzed.The correlation between actual liver resection volume and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.Results The mean liver volume,tumor size,predicted liver resection volume and remnant liver volume of the 10 patients detected by the three-dimensional visualization system were (1496 ± 162) ml,(67 ± 18) ml,(335 ± 241)ml and (1140 ± 197)ml,respectively.The average error rate of predicted liver resection volume was 6.4％.Surgical plan was made in accordance with the principle of curative hepatectomy,including 4 cases of left semihepatectomy,2 cases of right semihepatectomy,3 cases of partial liver resection and 1 case of palliative liver resection.The coincidence rate between the planned and actual surgical procedures was 9/10.R0 resection was performed on 7 patients,R1 resection on 1 patient and palliative resection on 2 patients.One patient received restrictive portal vein arterialization.Preoperative evaluation of the anatomy of blood vessels,bile ducts and tumors based on three-dimensional images was confirmed with operative findings.The accuracy of tumor typing by the three-dimensional visualization system was 8/10.The actual liver resection volume was (325 ± 258) ml,which was positively correlated with the predicted liver resection volume (r =0.902,P ＜ 0.05).Conclusion The three-dimensional visualization system is helpful in the treatment of hilar cholangiocarcinoma.

Objective To investigate the indication of approach,type of fixation and the clinical outcome of minimally invasive internal fixation for treatment of pelvic anterior ring injury.Methods From January 2012 to August 2016,data of 32 patients with 44 pelvic anterior ring injuries who had been treated with minimally invasive internal fixation were retrospectively analyzed.There were 22 males and 10 females with an average age of 38.2 years old (range,20-65 years).14 patients were injured by traffic accident,12 patients by falling and 6 patients by crush injury.There were 4 cases of pubic symphysis diastasis,27 fractures of anterior ring which included 12 billatral fractures and 1 combined vertical displacement of pubic symphysis associated with pubic fracture.According to AO classification,there were 3 cases in A2.3,3 cases in B1.2,4 cases in B2.2,4 cases in B2.3,2cases in C1.1,1 case in C1.2,5 cases in C1.3,4 cases in C2,6 cases in C3.There were 25 patients associated with other injuries,including brain injury in 2,thoracic injury in 17,abdominal injury in 8,urogenital system injury in 5,lumbosacral nerve plexus injury in 4 and the extremity or lumbar fracture in 19.The average period from injury to operation was 9.2 d (range,5-32 d).4 patients who had the pubic symphysis diastasis,3 had pelvic anterior ring fracture medial obturator foramen and 1 combined vertical displacement of pubic symphysis associated with pubic fracture were reduced by modified Pfannenstiel incision and fixed with cannulated screws,while 36 patients with fractures of lateral obturator foramen were reduced by modified Pfannenstiel incision associated with small ilial crest incision and fixed with locking reconstruction plates,and 25 patients received the fixation of pelvic posterior ring injury simultaneously.Results The average time of operation was 44.5 min (range,30-65 min),and the average amount of blood loss intraoperative was 56.2 ml (range,20-150 ml).All patients were followed up successfully,with an average time of 28.2 months (range,16-42 months).All the fractures were healed with an average time of 4.5 months (range,3-9 months).According to Matta standard of reduction assessment,30 fractures' reduction were excellent,12 were good and 2 were fair,which the rate of satisfaction was 95.5％ (42/44).Neither reduction loss or fixation failure nor infection occurred,and the occurrence rate of complication was 9.1％ (4/44),including one patient with fatal liquefaction and was cured 3 weeks after wound dressing,one patient with lateral femoral cutaneous nerve injury who was cured within 3 months by oral drug and 2 patients who complained discomfort of inguinal area because of the fixation prominence and were lessened by physical therapy.Conclusion Minimally invasive internal fixation can be recommended for treatment of pelvic anterior ring injury because of the advantages of less damage,safer manipulation,less complications and good prognosis.