There is a long path to go on the course of Chinese medical supply reform program.With the development of medicare system,the use of Internet + to promote Chinese medical supply reform program and to provide usefulsolutions to the present medicare problems in China could be very difficult.

Objective To investigate the clinical value and relating problems in treating complex fractures of proximal humerus by using replacement of humeral head prosthesis. Methods There were 23 cases (10 males and 13 females, age range 43-76 years, mean 58.6 years) with complex fractures of proximal humerus. According to Neer classification, 4 cases had three-part fracture, 17 four-part fracture, 2 cleavage fracture of humeral head, 18 fresh fracture (within 2 weeks after injury) and 5 old fracture, which were all treated with replacement of humeral head prosthesis. Results Follow-up study for a mean period of 15.6 months was conducted in all the cases. No flexible prosthesis, prosthesis dislocation, infection, nerve damage or periprosthesis fractures occurred. According to scoring system modification for hemiarthroplasty (SSMH) of UCLA (Los.Angeles, California, USA), the average score was 26.3. Score was above 27 (excellent) in 3 cases and 24-27 (good) in 18 with an excellence rate of 91.3%, score was 18-24 (moderate) in 2 but no one had score less than 18. Average score was 9.5 in pain, 8.6 in function and 8.2 in muscle power and motion in 23 cases. Conclusions Replacement of humeral head prosthesis is a preferable method for treating the complex fractures of proximal humerus, with significant effect in relieving the pain in the shoulder joint posterior to trauma. It is key to a satisfactory curative effect to correctly select the indication, clearly master the local anatomy, grasp the operation technique and give early and reasonable postoperative rehabilitation treatment.

Objective To observe and compare the short-time outcome in meniscal lesions with radiofrquency coblation technology or normally mechanical technology under the arthroscopy. Methods Thirty-eight patients with mentisci injury was selected, and divided into radiorfequency and normal group according to the standards. The patients in former group were treated with menisci reformation by radiofrequency, while in later group by menisci parthial excision. Some criteria were analysised and evaluated by comparison of operation-time, post-operation effusion of joint and improvement on the degrees of flexion and extension, clinical symptoms, functional restoration of knee joint of both groups. Results The average operation-time in radiofrequency group was less than that of normal group apparently. It was less possible for effusion of joint happened in the radiofrequency group after operation. The improvement on the degrees of flexion and extension and functional restoration of joint in the radiofrequency group exceeded in another group. Conclusion The radiofrequency under the arthroscopy is simper and less leading the surrounded tissue injury with more excellent functional restoration fo knee joint, also it has more advantage than the normal menisci partial excision mechanically.

[Objective]To explore a method for isolating and culturing bone marrow mesenchymal stem cell(BMSCs) in vitro,and improve the cellular conglutination ability of biomaterial poly-lactide-co-glycolic acid(PLGA),and observer the adhesion of BMSCs cultured on PLGA modified with Ⅱ collagen.[Method]BMSCs were isolated and cultured in vitro.The cell exterior antigen,cell livingness and cell cycle were analyzed by flow cytometry method,and cellular configuration was observed continually under invertd phase-contrast microscope.PLGA was made by phase separation,and was modified with Ⅱ collagen.The third era BMSCs were cultured on PLGA,and its adhesion with biomaterial was observed scan electron microscope.[Result]BMSCs could be isolated and cultured in vitro,and express CD29,CD44,CD106,but not express CD34,CD45.The cell livingness was 88.96%,cells in G0-Glperiod are 90.32%.The cell morphology was spindle.The average diameter of PLGA modified with Ⅱ collagen was 100 ?m,and PLGA has good adhesion with BMSCs.[Conclusion]BMSCs could be cultured stability in vitro for long time,and is good seminal cell of tissue engineering.Ⅱ collagen can improve the cellular adhesion of PLGA,PLGA modified with Ⅱ collagen is the good biomaterial of tissue engineering.

[Objective]To discus clinic value of fixation by vertebral pedicle screw system and vertebroplasty using injectable graft for thoracolumbar vertebrae fractures.[Method]Fifteen cases of thoracolumbar vertebrae fractures(7 cases with compress fractures,8 cases with burst fractures) were treated with fixation by vertebral pedicle screw system and vertebroplasty using injectable graft.[Result]The group was followed up for average 9.6 months,no case showed internal fixation device loosening or breaking,nor were chronic lumbar pain seen in this group.No case had lost the anterior height of body of spine.All injected grafts were Abs orbed within 3 months postoperatively.According to Frankels grading,there were 4 cases in Grades B,6 cases in Grade C and 2 cases of Grade D preoperatively,but 3 cases of Grade C,5 cases of Grade D and 4 cases of Grade E postoperatively in 12 cases with incomplete paraplegia,with a statistically significant difference(x~2 =21.000,P=0.000

Protein arginine methyltransferases ( PRMTs) play crucial roles in the methylation of a series pro-tein substrates.PRMT5 is a type Ⅱ methyltransferase that symmetrically methylates arginine residues of histone and non-histone substrates, thereby regulating a variety of cellular processes through epigenetic control of target gene expression or post-translational modification of signaling molecules.Recently, accumulated evidence has suggested that PRMT5 may function as an oncogene.This review is aimed to summarize the oncogenic role of PRMT5 and its regulatory mechanisms in tumors.

BACKGROUND:Studies have shown that Wnt signaling pathways play an important role in the osteogenic differentiation of mesenchymal stem cells.
OBJECTIVE:To review the mechanism and regulation of the Wnt signaling pathways, as wel as Wnt signaling pathway effects on osteogenic differentiation of mesenchymal stem cells.
METHODS:A computer-based search of PuMed database and CNKI database from September 1998 to March 2013 was performed to search related articles. The key words of“Wnt, mesenchymal stem cells, Wnt signaling pathways, osteoblastic differentiation, canonical wnt signaling pathway, non-canonical signaling pathway”in English or Chinese were used to search the articles in the title and the abstract. A total of 31 articles were included to review.
RESULTS AND CONCLUSION:Wnt signaling pathways play a critical role in the osteogenic differentiation of mesenchymal stem cells. Canonical Wnt signaling pathway, non-canonical Wnt signaling pathway, and their mutli-factors were involved in regulating the proliferation and differentiation of mesenchymal stem cells. The osteogenic differentiation of mesenchymal stem cells can be promoted effectively via specific induction of Wnt signaling pathways. Wnt11, FZD6, sFRP2, sFRP3 and Ror2 expressions increase, while Wnt9a and FZD7 decreases during the regulation. However, the relations of factors in Wnt signaling pathways and how to use the mechanism of Wnt signaling for promoting mesenchymal stem cells faster, more accurate differentiation need further studies.

AIM: To determine whether the viartrils could provide a beneficial effect on the prevention of early/middle stage osteoarthritis(OA) and affect the proliferation of chondrocytes. METHODS: An OA model was produced with severing the anterior, posterior cruciate ligaments of the knee in 24 adult New Zealand rabbits. The animals were then randomly divided into viartrils group and control group. After surgical operation, viartrils (mainly contains glucosamine sulphate) 2 pills per day were administered to the animals in viartrils group. The animals were sacrificed and specimens were taken from the weight-bearing portion of the femoral condylar seven weeks after operation. Each case was evaluated according to a modified histological-histochemical grading system(HHGS) using HE and safranin O/fast green staining slides, and immunohistochemical method was used to detect the proliferation of chondrocytes in articular cartilage. RESULTS: The method of severing the anerior, posterior cruciate ligaments of the knee could successfully induce the early/middle stage model of OA. The pathological remark in control group was significantly higher than that in the viartrils group (P

BACKGROUND: With further understanding of deep venous thrombosis(DVT)following total hip replacement,reduction and prevention of DVT has become hot topic in clinical studies.The reports of DVT formation factors remain controversial due to small samples,little statistical significance,confusion of basic experimental and clinical results and lacks of science.OBJECTIVE: To explore the causes and factors for the early DVT following total hip replacement and summarize measures to prevent and treat early DVT to reduce incidence of complications.METHODS: A total of 1780 cases of primary total hip replacement operation were analyzed retrospectively.The statistical indexes included sex,age,body mass,other system disease,previous hip joint operation,anesthesia,operative time,prosthetic fixation,blood transfusion,postoperative functional exercise,antithrombotics,and complication.Standardized database was built and analyzed by SPSS(version 13).Regression analysis was performed using Binary Logistic Regression.RESULTS AND CONCLUSION: Of 1780 cases,136 had DVT.Age,other system diseases,anesthesia,prosthetic fixation,blood transfusion,postoperative functional exercise and antithrombotics were correlated with early DVT(P < 0.05).Old age,hypertension or diabetes,general anesthesia,fixation of bone cement,whole blood transfusion were the risk factors for early DVT following total hip replacement,while postoperative functional exercise and antithrombotics were the protective factors for DVT.The incidence rate of early complications can be reduced by the methods such as dealing with perioperative treatment carefully,effectively controlling the chronic diseases,efficient evaluation before surgery,precise manipulation,and the postoperative prophylactic treatment and nursing.

BACKGROUND: The skill to culture osteoblasts primarily has been well developed. However, trypsinase can affect membrane protein of osteoblasts if the time of digestion is long. Therefore, it is of great significance to select an ideal method to avoid the damage from trypsinase to cells as possible when culturing osteoblasts.OBJECTIVE: To explore a novel method to isolate and culture SD rat osteoblasts in vitro, and identify the functions of the cells.DESIGN: Observational study.SETTING: Department of Orthopaedics, First Affiliated Hospital of Jinan University.MATERIALS: This experiment was carried out in the Department of Orthopaedics, First Affiliated Hospital of Jinan University from March to May in 2007. Eight SPF 24-hour old SD rats were used in the experiment. The rats, irrespective of gender, were provided by the Experimental Animal Center of Nanfang Medical University. The experimental animals were disposed according to ethical criteria. The main reagents were detailed as follows: collagenase Ⅱ (Sigma Company);trypsin (Sigma Company); alkaline phosphatase (ALP) kit (Nanjing Jiancheng Biological Products Company); SABC-1021(Wuhan Boster Biotechnology Company).METHODS: 24-hour old SD rats were chosen for experiment. The newly born SD rats were sacrificed by anesthesia and the cranial bones of the rats were obtained cleanly, erased completely of the periosteum and cut to blocks of I mm3. The cranial bones were digested by 0.25 % trypsinase for 20 minutes, then by 0. 1% type Ⅱ collagenase for 60 minutes. The digestive time of trypsinase was controlled in the process of digestion to avoid to harm the cells. The liquid was gathered and centrifuged. The cells were cultured in culture flask and were purified by many times adhered.MAIN OUTCOME MEASURES: Morphology observations under the inverted phase contrast microscope, transmission electron microscope, and scanning electron microscope were performed. The phenotype, calcium tuberculation and the expression of alkaline phosphatase were studied with alizarin red staining and modified Gomori Ca-Co assays respectively.The cells were also evaluated with collage Ⅰ immunohistochemical staining.RESULTS: The cultured cells had active proliferation ability. Cells showed multi-angle or fusiform shape. Nucleus was immature and organell was plentiful. Therefore, they had typical morphological characters of osteoblasts. Moreover, they showed the osteoblastic phenotypes such as their synthesis of alkaline phosphatase, collage Ⅰ and formation of calcium tuberculations.CONCLUSION: The cells cultured by our modified enzymatic digestion method had typical morphological and biological characteristics of osteoblasts.