Objective To evaluate the recent clinical outcomes of fixing posterior acetabular wall fractures combining the AO mini plate with reconstruction plate.Methods From Jan 2009 to Jul 2013,28 patients with posterior acetabular wall fracture were fixed by the AO mini-steel plate combined with reconstruction plate,including 17males and 11 females with the mean age of 45.8 years (range,18-65).After admission,reduce the dislocation of hip joint immediately,and take femoral condyle or tibial tubercle traction.Preoperative and postoperative anteroposterior and Judet oblique radiographs,acetabular CT scan and three-dimensional reconstruction imaging were routine taken.Using Kocher-Langenbeck approach,intraoperative,try to protect the soft tissue attached on the small fragments,and reduct the fracture.Cutting the mini plate into proper length with reconstruction plate fix to its surface crossover.The functional outcomes were evaluated by the modified Merle d'Aubigné and Postel clinical grading system.The radiographs were graded according to the Matta/Judet criteria.Results Twenty-three patients are followed up 13 months(82.2％),and 5 cases lost in 12 weeks (17.8％).By the Matta/Judet criteria,22 cases achieved excellent reduction,4 good reduction and two fair reduction,with a good and excellent rate of 92.8％.By the modified Merle d'Aubigné and Postel criteria,functional recovery of the affected hip six month post-operation was rated as excellent in 15 cases,good in 5 cases,fair in 2 cases and poor in one case.with a good and excellent rate of 87.9％.One case occurred femoral head necrosis.In 2 patients 2 years after surgery developed traumatic arthritis.Two patients had heterotopic ossification after six month operation.One patient with injury to the sciatic nerve recovered 3 months post-operation.Conclusion Using the AO mini plate combined with reconstruction plate can fix the acetabular posterior wall fractures stably.The technique meet the requirements of patients with early functional exercise,which provides an effective method of internal fixation.

Objective To investigate mutation patterns in core promoter(CP)region of hepatitis B virus(HBV).Methods HBV DNA was extracted from sera of patients with chronic HBV infection.The CP sequence was amplified by polymerase chain reaction(PCR)and cloned into pMD19 T vector.The positive clones were then sequenced.The sequences were compared with known HBV genome in GenBank to identify the mutation sites and patterns of patients with chronic HBV infection.Results There were 74 clones from 21 patients with chronic HBV infection which were sequenced.The sequence comparisons showed that there was a 234-nucleotide deletion in CP region of HBV genome in 54 clones and a 245-nucleotide deletion in one clone.These deletion regions included CP,HBeAg initiation codon and direct repeat sequence(DR)Ⅰ regions,which named CP deletion(CPD).A1585T replacement mutation was also found in HBV strain with CPD,which indicated that there was linkage between these two mutations.Conclusions A novel mechanism of HBeAg negative chronic hepatitis B is observed,which includes deletions of CP and HBeAg initiation codon.Meanwhile,a simple and useful PCR method is developed to detect CPD.

Objective To investigate the effect of high viscosity bone cement in percutaneous vertebroplasty to treat osteoporotic vertebral compression fracture(OVCF) and veterbral metastasis tumor(VMT) .Methods 102 cases of OVCF(OVCF group) and 16 cases of VMT(VMT group) in our hospital from March 2010 to December 2012 were performed percutaneous vertebroplasty under local anesthesia ,through the vertebral pedicle approach by conducting puncture at bilateral vertebral pedicle into the vertebra , 3-6 mL high viscosity bone cement was injected to each vertebra .The pain intensity was detected by the McGill pain questionnaire score before operation ,on postoperative 3 d ,1 month and 6 -18 months last follow-up .The preoperative and postoperative MPQ scores were statistically analyzed .Results Postoperative patients′s back pain was significantly alleviated or disappeared .Compared with before operation ,the MPQ scores on postoperative 3 d ,in 1 month and 6 -18 months last follow-up in the OVCF group and the VMT group were significantly decreased(P<0 .05) .The postoperative CT scanning revealed that the cement leakage rates in the OVCF group and the VM T group were 11 .76% and 6 .25% respectively .But no complications of bone cement toxicity ,pulmo-nary embolism ,infection and nerve damage occurred .Conclusion High viscosity bone cement injection has the advantages of strongly controllable injection due to high viscosity ,low bone cement leakage and high surgical safety ,which is suitable for the treatment of OVCF and VM T .

OBJECTIVETo investigate clinical results of percutaneous reduction and hollow screw internal fixation for the treatment of calcaneal fractures, and to compare therapeutic effects between close reduction hollow screw internal fixation and open reduction plate internal fixation.

METHODSFrom August 2007 to May 2010, 53 patients with calcaneal fractures were retrospectively analyzed. All the patients were divided into two groups, 25 patients in group A (PR group) treated with percutaneous reduction and hollow screw internal fixation, including 17 males and 8 females, with an average age of (39.4 +/- 9.9) years. While 28 patients in group B (OR group) treated with open reduction and plate internal fixation, including 18 males and 10 females, with an average age of (38.6 +/- 10.2) years. According to Sanders classification, there were 18 patients with type II fractures, 29 patients with type III and 6 type IV. In both groups, operative time, blood loss, postoperative complications and radiology were recorded. Functional recovery was evaluated by Maryland score.

RESULTSAll the patients were followed up, and the duration ranged from nine months to thirty-five months (averaged 20.4 months). There were no significant differences in sex, age, fracture type, fracture classification, initial Böhler angle, or late complications between the two groups. But significant difference can be seen between operative time, blood loss, and skin complications (in group A no nonunion and skin complications occurred, but subtalar posttraumatic arthritis occurred in 1 case; in group B, 3 patients had complications of skin necrosis, 1 patient suffered from a delayed union due to large defect filled with artificial bone, and 1 patient got subtalar posttraumatic arthritis). No difference were found in the latest X-ray film. According to Maryland score, in group A, 8 got an excellent result and 12 good. In group B, 10 got an excellent and 14 good. There were no significant differences between the two groups in Margland score.

CONCLUSIONThe results of this study suggest that in comparison with open reduction, percutaneous reduction and hollow screw internal fixation minimizes complications and achieves good results. Further study of this technique is needed.

Adolescent ; Adult ; Aged ; Bone Screws ; Calcaneus ; surgery ; Case-Control Studies ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

BACKGROUNDAstrocyte swelling is an important consequence of hepatic encephalopathy, and aquaporin-4 has been reported to play a vital role in this swelling. Ammonia causes astrocyte swelling and is also known to modulate aquaporin-4 expression in the astrocyte foot processes. The purpose of this study was to explore the mechanism of ammonia-induced aquaporin-4 expression, which has been suggested to involve the p38 mitogen-activated protein kinase pathway.

METHODSWe exposed cultured astrocytes to ammonium chloride, an in vitro model of hepatic encephalopathy. The purity of cultured astrocytes was evaluated by fluorescent glial fibrillary acidic protein labeling; cell morphology was assessed by light microscopy; the expression of aquaporin-4, phospho-p38, and p38 were detected by Western blotting analysis. Statistical analysis was performed by one-way factorial analysis of variance, and the relationship between variables was calculated by linear regression using SPSS version 13.0 program for Windows (SPSS, Chicago, IL, USA).

RESULTSThe purity of cultured astrocytes was (96.6 +/- 1.4)%. Astrocytes swelled significantly when exposed to 5 mmol/L ammonium chloride for 24 hours as compared to non-exposed astrocytes. Co-treatment with 10 micromol/L SB203580 (an inhibitor of p38) attenuated the degree of ammonium chloride induced astrocyte swelling. Western blotting analysis revealed that the expression levels of phospho-p38 and aquaporin-4 in ammonium chloride treated cells were significantly increased relative to the control group (P < 0.001); SB203580 co-treatment inhibited the increased expression of phospho-p38 and aquaporin-4 relative to the ammonium chloride treated group (P = 0.002 and P = 0.015 respectively). The phosphorylation of p38 and upregulation of aquaporin-4 were highly correlated (r = 0.909). There were no significant differences in total p38 expression among the groups (P = 0.341).

CONCLUSIONSAmmonium chloride induced upregulation of aquaporin-4 in astrocytes is regulated by the p38 mitogen-activated protein kinase pathway. Inhibiting p38 activation prevented ammonium chloride induced aquaporin-4 protein upregulation.

Ammonium Chloride ; pharmacology ; Animals ; Aquaporin 4 ; genetics ; metabolism ; Astrocytes ; drug effects ; metabolism ; Blotting, Western ; Cells, Cultured ; Enzyme Inhibitors ; pharmacology ; Imidazoles ; pharmacology ; Phosphorylation ; drug effects ; Pyridines ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; drug effects ; p38 Mitogen-Activated Protein Kinases ; antagonists & inhibitors ; metabolism

Objective To investigate the effect of ankyrin-repeat domain-containing protein 22(ANKRD22)on the proliferation,invasion,and migration of human hepatoma cells and its molecular mechanism.Methods The TCGA database was used to analyze the expression level of ANKRD22 in normal liver tissue and hepatocellular carcinoma tissue and its association with prognosis.Western Blot and qRT-PCR were used to measure the expression of ANKRD22 in human normal liver cells(L-02)and human hepatoma cells(Huh7,HepG2,MHCC-97H,SK-HEP-1,and SMMC-7721);CCK-8 assay,EdU,wound healing assay,and Transwell assay were used to observe the effect of ANKRD22 on the proliferation,invasion,and migration of hepatoma cells;Western Blot was used to investigate the association of ANKRD22 with cyclins and EMT-related proteins;KEGG and ssGSEA analyses were performed to investigate the mechanism of action of ANKRD22 in hepatoma cells,and related experiments were conducted for validation.The independent-samples t-test was used for comparison of continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups.Results In the TCGA database,the expression level of ANKRD22 in hepatoma tissue was significantly higher than that in normal liver tissue(t=5.083,P<0.05),and the patients with a high expression level of ANKRD22 had longer overall survival and disease-related survival than those with a low expression level of ANKRD22(P<0.05).The expression level of ANKRD22 in various human hepatoma cell lines was higher than that in human normal liver cells(all P<0.05).Cell proliferation assay showed that the ANKRD22 overexpression group had significantly higher EdU positive rate and proliferation rate than the Vector group(t=19.60 and 6.72,both P<0.001),and compared with the si-NC group,the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower EdU positive rate and proliferation rate(all P<0.001).Compared with the Vector group,the overexpression group had significantly higher expression levels of Cyclin E1,Cyclin D1,CDK7,and CDK4(t=3.54,4.95,6.34,and 5.19,all P<0.01),and the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower expression levels than the si-NC group(all P<0.001).The overexpression group had a significantly lower expression level of P27 than the Vector group(t=6.12,P<0.001),and the si-ANKRD22#2 group and the si-ANKRD22#3 group had a significantly higher expression level than the si-NC group(both P<0.001).Invasion and migration experiments showed that compared with the Vector group,the ANKRD22 overexpression group had significantly higher migration rate and number of crossings through the membrane(migration group and invasion group)(t=5.01,25.60,and 3.67,all P<0.05),and compared with the si-NC group,thesi-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower migration rate and number of crossings through the membrane(migration group and invasion group)(all P<0.01).The overexpression group had significantly higher expression levels of N-cadherin,Vimentin,and Snail than the Vector group(t=12.13,8.85,and 13.97,all P<0.001),and the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower expression levels than the si-NC group(all P<0.001);the overexpression group had a significantly lower expression level of E-cadherin than the Vector group(t=4.98,P<0.01),and the si-ANKRD22#2 group and the si-ANKRD22#3 group had a significantly higher expression level than the si-NC group(both P<0.001).The KEGG enrichment analysis and the ssGSEA analysis showed that ANKRD22 was associated with the PI3K/AKT/mTOR signaling pathway in hepatocellular carcinoma,and the overexpression group had significantly higher expression levels of p-AKT/AKT,p-PI3K/PI3K,and p-mTOR/mTOR than the Vector group(t=12.21,3.43,and 9.75,all P<0.01),and the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower expression levels than the si-NC group(all P<0.001).Conclusion ANKRD22 is highly expressed in hepatoma cells and can promote the proliferation,invasion,and migration of hepatoma cells and the activation of the PI3K/AKT/mTOR signaling pathway.

Cerebral blood flow autoregulation is physiologically protective mechanism to maintain the stability of cerebral blood flow.Once autoregulation is impaired, the cerebral blood flow fluctuates with blood pressure, leading to the risk of brain ischemia or cerebral hyperemia.Multiple research results indicate that cerebral blood flow can be monitored indirectly and continuously with transcranial Doppler, near infrared spectroscopy or ICP.The correlation coefficient calculated by the surrogate for cerebral blood flow and blood pressure is used to judge cerebral blood flow autoregulation.When the correlation coefficient is close to 1, cerebral blood flow will be passively fluctuated by blood pressure, indicating autoregulation is impaired.When the coefficient is less than 0, cerebral blood flow will not be changed with blood pressure, indicating autoregulaiton is intact.The status of autoregualtion is closely associated with mortality or poor neurological outcomes in patients with cardiac surgery underwent cardiopulmonary bypass, liver transplantation patients or patients with deep trendelenburg position for long time or beach chair position.Continuous monitoring of cerebral blood flow autoregulation can identify the lower or the upper limit of autoregulation, and provide information to individualize the perioperative management of blood pressure.

Objective To explore the influence of adefovir dipivoxil on HBV specific CTL in patients with chronic hepatitis B (CHB). Methods 10 mg adefovir dipivoxil (Zhengda Tianjing Pharmaceutical Company) was used for CHB patients with positive HBV DNA (HBV DNA ≥ 1 × 104 copies/ml) ,ALT ＞ 2 × upper limit of normal value (ULN) and positive human leucocyte antigen (HLA)-A2,orally,once a day for 3 months. Real time fluorescent quantitative PCR was used to determine HBV DNA and flowcytometer was used to determine HBV specific CTL. Results After treatment with adefovir dipivoxil for 3 months, HBV specific CTL (0. 52 ± 0. 11 )% was higher than that before treatment(0. 34 ± 0. 14 )% , t =6.78 P ＜0. 01, HBV DNA of 28 cases turned to negative ( ＜ 1 × 103copies/ml) (62. 22% ). HBV DNA of 17 cases failed to turn negative 3 months after treatment,but their HBV DNA level was lower [(4. 18 ±0.4)log 10 copies/ml] than that before treatment [(6. 23 ± 0. 73 ) log 10 copies/ml], t = 9.99, P ＜ 0.01.Conclusion adefovir dipivoxil can improve HBV specific cellular immunity in patients CHB.

Objective To determine the epidemiological features of hand-foot-and-mouth disease (HFMD) outbreaks and the genetic characteristics of enterovirus type 71 (EV71) isolates from patients in Lianyungang, Jiangsu province in May, 2008. Methods Epidemiological, microbiological, cellular and molecular methods were performed to investigate pathogens and to describe the homogeneity of isolated strains. Results 21 cases were reported in this HFMD outbreak with the attack rate as 20.0%. 3 EV71 virus strains were isolated from 10 stool samples. The nucleotide and amino acid homogeneity of these 3 Jiangsu strain with Anhui Fuyang strains were 97.9%-100.0% and 99.7%-100.0%, respectively. These 4 Jiangsu strains were within genotype C sub-geno group C4 in phylogenetic tree. Data from the follow-up study showed that shedding of EV71 and Coxsackie A 16 virus (CA 16) in the latent period appeared in the outbreak of HFMD. Human beings could be infected by both EV71 virus and CA16 at the same time and could also carry the two viruses. We also discovered that EV71 virus could be expelled out of the human body through stool in the fast week and last for 10 weeks. Conclusion The recently identified EV71 isolates from this HFMD outbreak belonged to sub-geno group CA. Facts as: the release of viruses in the latent period, co-infection or coexisting of two viruses at the same time and super long period of expulsion of toxin exist in EV71 and CA16 did exist.