ObjectiveRecurrent rupture of Achilles tendon is a severe complication after primary repair.The optimal treatment remains controversial.This study was in aiming to explore the risk factors of recurrent ruptures of Achilles tendon,to evaluate the indication,outcome and complications of reconstructing Achilles tendon recurrent ruptures by V-Y advancement flap and Flexor Hallucis Longus tendon (FHL) transfer.MethodsWe retrospectively studied 16 cases who underwent reconstruction of Achilles tendon recurrent ruptures from Mar,2006 to Jan,2010.Among them there were 12 males and 4 females with the mean age of 50.9 years(35-72 years).The period of time between recurrent rupture and primary operation was 6-49 weeks(ave.21.8 weeks).The follow-up interval was 6-52 months (ave.27.5 months).During operatin,4 cases with a rupture gap less than 4 cm had received V-Y advancement flap and 12 cases with a rupture gap more than 4 cm had received FHL transfer.At the time of follow-up,all patients were assessed with the American Orthopaedic Foot and Ankle Society(AOFAS) Ankle-Hindfoot Scale and Leppilahti Achilles Tendon Repair score.ResultsThe average AOFAS score had increased from 70.2±8.5 preoperatively to 92.4±6.1postoperatvely.Leppilahti Achilles Tendon Repair score had increased from 74.8±6.2 preoperatively to 91.7±4.8 postoperatvely.MRI of Achilles tendon showed even signal without signs of tear.ConclusionV-Y advancement flap could repair a rupture gap within 4 cm,FHL transfer is suitable for rupture gap over 4 cm in reconstruction of Achilles tendon recurrent ruptures.

ObjectiveTo evaluate effect of periarticular osteotomy in the treatment of asymmetrical ankle arthritis.MethodsSixty-five patients with asymmetrical ankle arthritis were treated with periarticular osteotomy between February 2005 and May 2011,including 43 females and 22 males,aged from 35 to 74 years (mean,55.5 years).According to the Takakura classification of ankle arthritis,there were 29 patients in grade 2,32 in grade 3 and 4 in grade 4.Supramalleolar tibial osteotomy were performed in 20 patients,supramalleolar tibial and fibular osteotomy in 12,supramalleolar osteotomy combined with calcaneal osteotomy in 30 patients,and supramalleolar tibial and fibular osteotomy combined with calcaneal osteotomy in 3patients.Forty three patients underwent ligament reconstruction procedures.Based on radiographs,the tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were compared before and after operation.AOFAS-AH score was used to evaluate the function of the ankle.ResultsFifty-nine patients were followed up for an average of 35.7 months (range,7 to 94 months).Bone healing was observed in all patients,and the average healing time was 7 to 8 weeks.The average AOFAS-AH score was improved from 49.7 points preoperatively to 78.6 points 12 months postoperatively.Tbe average TAS and TLS was improved from 86.1° and 70.0° preoperatively to 93.9° and 81.5° 6 months postoperatively,respectively.Delayed wound healing occurred in 5 patients,which was resovled after nursing care.Forty-two patients felt excellent about results,15 felt good and 2 fell fair.ConclusionPerarticular osteotomy is a sound method in the treatment of asymmetrical ankle arthritis,based on chosing proper patients.The procedure can decrease the contact pressures on the degenerated cartilage and prolong the life span of the ankle.

Objective To discuss the pathomechanism of medial ankle instability after medial ligament injury. Methods The study involved 15 patients including eight males and seven females, at average age of 40 years (range 22-58 years). There were two patients with acute ankle sprain, three with chronic ankle injury, three with congenital pes planus, five with posterior tibial tendon dysfunction, one with pronation external rotation ankle fracture and one with old avulsion medial malleolus. All patients were treated surgically with deltoid ligament repair, when eight patients further received calcaneal lengthing osteotomy, five received medial cuneiform close wedge osteotomy and one received medial shift calcaneal osteotomy. All patients were followed up for 7-56 months. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was used for pre- and post-operative evaluation of the function. All data were analyzed using t test. Results The clinical data of one patient was excluded from the statistical analysis because AOFAS ankle-hindfoot scale could not be applied for evaluating the acute ankle fracture. The AOFAS ankle-hindfoot scale was 42.4 + 10.6 before surgery and 89.8 +6.2 at the final followup for 14 patients (P＜0.05). Conclusions Deltoid ligament is an important anatomical structure.More attention should be paid to its repair under following aonditions: ( 1 ) the injury of the deltoid ligament involves tibiospring and tibionavicular ligament; (2) patients have congenital pes planus and posterior tibial tendon dysfunction; (3) patients present with ankle fractures and have history of repeated ankle sprain.

Objective To summarize the enperience of medical rescue and rdlief work in flood disaster at over seas. Method From August,26 to September14, 2010, China's international medical rescue team urgently ordered by the Chinese gevernment for the first time went to join the Pakistan flood disaster medical relief mission to carry out international humanitarianism rescue work. Aiming directly at infectious diseases prevention and treatment after flood disaster, organized medical rescue team from the hospital; consummated medical rescue plan; equipped with medical materials; established medical profession safety regulation. Results Through 18 days hard working,China's international medical rescue team received 11 243 persons, and treated 11020 patients. Conclusions China is one of the first countries to join the Pakistan flood disaster medical relief mission.

Objective To investigate the effects of SPARC (secreated protein acidic and rich in cysteine) and its peptide on proliferation, apoptosis and cell cycle of human mesangial cells cultured in vitro, and explore the possible mechanism. Methods Mesangial cells were incubated in the media with various concentrations of SPARC and its peptide cultured in vitro. Cell proliferation was assessed by MTT colorimetric assay. Cell cycle and apoptosis index were analyzed by flow cytometry. The expression of cyclinD1 and p21Wafl proteins in response to SPARC and its peptide in HMC was determined by Western blot. Results Various concentrations of SPARC and its peptide could significantly inhibit the proliferation of mesangial cells in dose- and time-dependent manner, regulate the cell cycle at phrase G-0/G1 increased while cells phrase S reduced, and could also induce apoptosis. Under the stimulation of SPARC and its peptide, the expression of cyclinDl in HMC decreased markedly meanwhile the expression of p21Wafl increased significantly. Conclusions SPARC and its peptide can effectively inhibit HMC proliferation and regulate cell cycle progression. The mechanism may be mediated by inhibiting cyclinDl and stimulating p21Wafl expression, subsequently blocking cells passing through G-S check point, which will be useful for treating mesangial proliferative glomerulonephritis.

Objective To clarify the pathologic change of the motor neuron on spinal cord ischemia reperfusion injury delayed paraplegia. Methods The infrarenal aorta of White New Zealand rabbits (n=24) was occluded for 26 minutes using two bulldog clamps. Rabbits were killed after 8, 24, 72, or 168 hours (n=6 per group), respectively. The clamps was placed but never clamped in sham-operated rabbits (n=24). The lumbar segment of the spinal cord (L5 to L7) was used for morphological studies, including hematoxylin and eosin staining, the expression of bcl-2 and bax proteins in spinal cord was detected with immunohistochemistry. The apoptotic neurons in spinal cord were measured with terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end-labeling of DNA fragments (TUNEL) staining. Results Delayed paraplegia occurred in all rabbits of ischemia reperfusion group at 16-24 hours, but not in sham groups. Motor neurons were selectively lost at 7 days after transient ischemia. After ischemia, the positive expression of bcl-2 protein were in the sham controls but decreased significantly as compared with that of the IR group (P＜0.01), especially in 72 hours reperfusion. The positive expression of bax protein were also in the sham controls, but increased in the IR group, especially in 72 hours reperfusion; In addition, TUNEL study demonstrated that no cells were positively labeled until 24 hours after ischemia, but nuclei of some motor neurons were positively labeled at peak after ischemia reperfusion at 72 hours. Conclusion Spinal cord ischemia in rabbits induces morphological and biochemical changes suggestive of apoptosis. These data raise the possibility that apoptosis contributes to neuronal cell death after spinal cord ischemia reperfusion.

Objective To investigate the expression and clinical significance of myeloid cell leukemia-1 (MCL-1) and F-box and WD repeat domain-containing 7 (FBW7) in breast cancer polyploid induced by spindle poisons. Methods (1) Nocodazole spindle poison was used to treat breast cancer cell MDA-MB-231. The morphological changes of cells were ob?served under microscope, and cells were harvested in 0, 6, 12, 24, 48 and 72 h. The cell cycle and DNA-ploidy changes were examined by flow cytometry. The expressions of FBW7 and MCL-1 proteins were detected by Western blot assay. (2) A multikinase inhibitor (Sorafenib) with Nocodazole or Taxol was used to treat MDA-MB-231 cells. MCL-1 protein expression was detected by Western blot assay after 48 h treatment. The cell cycle and DNA-ploidy changes were examined by flow cy?tometry after 48 h treatment. MTT method was used to observe cell proliferation after 48 and 72 h treatment. Results (1)Af?ter treatment by Nocodazole, polyploid characteristics of large cell size and nucleus were appeared. The percentages of octa?ploid were (0.8±0.2)%, (8.5±2.3)%, (7.8±2.0)%, (9.9±0.9)%, (28.2±0.8)%and (35.1±4.9)%after 0, 6, 12, 24, 48 and 72 h treatment, showing the increasing trend in turn (P<0.001). The number of polyploidy (tetraploid and octaploid) cells was as high as (97.6±0.7)%after 48 h treatment. The expression level of FBW7 protein was decreased significantly but the expres?sion of MCL-1 protein was increased significantly after 48 h treatment. (2) After 48 h treatment, the expression level of MCL-1 protein, polyploidy percentage and cell proliferation decreased significantly in Nocodazole+Sorafenib group and Taxol+Sorafenib group compared with those of Nocodazole group and Taxol group (P<0.05). Conclusion The lower expression of FBW7 protein and over-expression of MCL-1 protein are correlated with the formation of breast cancer polyploidy. Sorafenib can reduce polyploid tumor cells by inhibiting MCL-1 protein expression.

Objective To investigate the effect of creatine phosphate sodium on postoperative fatigue syndrome (POFS) in gastric carcinoma patients. Methods Nighty cases of radical resection in gastric cancer were randomly divided into control group (n=45) and treatment group (n=45).Normal saline (100 mL) and phosphocreatine sodium (2 g) was admin-istrated intravenously after anaesthesia induction in treatment group while only normal saline was given in control group . After operation, the two groups of patients were all treated with enteral and parenteral nutrition. General performance was ob-served in both groups. Fatigue score (VAS score) was measured on the day before the operation,the first,third and fifth day after operation. Body weight, triceps skinfold thickness (TSF), mid upper arm circumference (AMC), plasma total protein (TP), plasma albumin (ALB) and prealbumin (PA) were examined at the same time. Results The total effective rate of the control group and the study group were 73.3%and 95.6%respectively and the difference was of statistically significant. Fa-tigue scores (VAS score) was significantly difference in both groups pre- and post-operation time points, also between 2 groups. Body mass, TSF and AMC in time points postoperation were all lower than those in the time point of preoperation. TP, ALB and PA of two groups in postoperative time points were significantly different compared with those in preoperative time point. The above indexes were all decreased with postoperation time, and these indexes in treatment group were signifi-cantly better than those in control group. Conclusion Creatine phosphate sodium can alleviate postoperative fatigue, im-prove nutritious status and promote early rehabilitation of patients.

BACKGROUND: At present, genetic recombinant technique has been utilized to express recombinant human bone morphogenetic protein-2 (rhBMP-2)and to induce either orthotopic or ectopic regenerated bone successfully. But,because that osteoblastic activity induced by rhBMP-2 is lower than that by natural BMP-2, the perfect vectors have not been discovered yet.OBJECTIVE: BMP recombinant adenovirus (rAdV) was constructed so as to provide feasible vector for the basic treatment of bone defect.DESIGN: Single sample was designed in the experiment.SETTING: Experimental Center of Molecular Biology in First Hospital of Xi'an Jiaotong University.MATERIALS: PACCMV-PLPA plasmid, PJM17 plasmid, 293-cell line.METHODS: The experiment was performed in Experimental Center of Molecular Biology in First Hospital of Xi'an Jiaotong University from September 2001 to June 2002. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was used to clone the whole-length gene of BMP-2 and construct AdV vector. DNA-calcium phosphate coprecipitation was used to transfect accessory plasmid PJM17 into 293cell and homologous recombination was used to construct rAdV. The titer was assayed and CsC1 density gradient centrifugation and purification were applied.construction of rAdV.binant plasmid is named as pGEM-T/hBMP2, (3 015+1 213)bp in size.It was indicated in agar gel electrophoresis that the practical value was in BMP2 shuttle plasmid: The plasmid was about 10 Kbp in size. Since PACCMV-PLPA plasmid multiclone sites belonged to PUC plasmid series,EcoR Ⅰ enzyme digestion was used to linerarizate recombinant plasmid,10 Kbp in size. 8.8 Kb and 1.2 Kbp visible fragments were obtained durtion of rAdV: PCR technique was used to identify rAdV. The target fragment 1.2Kbp that was amplified by BMP2 specific primer of the whole length was in conformity completely with the theoretic value.CONCLUSION: Successful construction of BMP2 rAdV lays a foundation for the feasible genetic treatment with vector of bone defect.

Objective To study on the different results of a minimally invasive method to reconstruct the ligaments of the lateral ankle using semitendinosus tendon autograft and tendon allograft.Methods Data of 68 patients with chronic ankle instability who had undergone lateral ligament reconstruction from September 2006 to June 2011 were retrospectively analyzed.In the group of semitendinosus autograft,there were 32 patients (19 males,13 females) with an average age of 32.4 years old.Semitendinosus was harvested through 2 small knee incisions.While in the group of tendon allograft,there were 36 patients (22 males,14 females) with an average age of 34.2 years old.For the ankle reconstruction,4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip,the talar neck,and the middle of the calcaneus.Anatomical reconstruction of the anterior talofibular ligament and calcaneofibular ligament was then performed through these small incisions.AOFAS questionnaires were used to measure clinical outcomes,donor site morbidity and patients' satisfaction.Preoperative and postoperative stress tests were performed and radiographic parameters were measured.Results The average operation time of the autograft group 85.5 ± 11.5 min was significantly longer than that in the allograft group 58.1±10.2 min,but the fever days in the latter 5.5±1.5 d was significantly longer than in the former 2.5±1.2 d.In autograft group,23 patients got followed up,and the mean period of follow-up was 33.5±6.7 months.The mean AOFAS score increased from 62.3±8.2 to 95.1 ±7.5.In allograft group,26 patients got followed up,and the mean period of follow-up was 28.5±6.7 months.The mean AOFAS score increased from 60.2±8.4 to 94.8±5.5.There were 5 patients (3 of autugraft group and 2 of allograft group) with residual instability on uneven ground.One case of the autologous group had instability in daily life.No patient presented weakness or disability in the donor site.The satisfaction level of the autograft group was excellent in 16,good in 5 and bad in 2.Significant improvement in stress radiographic parameters was noted for the talar tilt angle,with reduction from a mean of 14.0° to 3.8°; anterior talar displacement reduced from a mean of 12.3 to 4.6 mm.The satisfaction level of the allograft group was excellent in 17,good in 5 and bad in 4.The talar tilt angle reduced from 13.0° to 3.6°; anterior talar displacement reduced from 11.5 to 4.3 mm.Conclusion There is no differences in efficacy could we found in using these 2 kinds of materials.The process of healing and rehabilitation of tendon autograft is slightly faster than the tendon allograft,but the allograft tendon has many advantages such as limited injury,simple procedure andavoiding of donor site morbidity.