Objective To evaluate the clinical efficacy of AF (atlas fixator) internal fixation in treatment of thoracolumbar fracture and dislocation. Methods 42 cases of thoracolumbar fracture were treated by posterior AF internal fixation. Prior to surgery, anteroposterior and lateral radiographs, and CT scan through bone windows were done for all the patients. During surgery, all the pedicle screws were inserted by Mergerls method and proper insertion was confirmed by radiographs. Results The follow ups of 39 patients averaged 21 months (ranging from 6 to 29 months). After surgery, the correction of anterior vertebral body height averaged 40.2%, and of Cobbs angle 23.2?. 12 cases of incomplete spinal cord injury had significant improvement and 2 ones of complete spinal cord injury had no improvement. Conclusion The AF screw is especially helpful in reconstruction of stability of thoracolumbar region after posterior decompression and reduction, because it results in simplicity, safety, less fixation segments, and little invasion or bleeding.

Objective To investgate the value of various parameters obtained from monoexponential, biexponential, and stretched exponential diffusion?weighted imaging models in the differential diagnosis of breast lesions. Methods A retrospective study performed in 54 patients with pathologically confirmed malignant tumors(n=30), benign lesions(n=34) and normal fibroglandular tissues (n=30). All patients underwent T1WI, T2WI, dynamic enhancement and diffusion weighted MRI with multi?b values at a 3.0 T magnetic resonance imaging unit. All parameters were measured at a workstation. ADC was calculated by using monoexponential analysis(b=0, 800 s/mm2). Slow apparent diffusion coefficient (ADC?slow), fast apparent diffusion coefficient (ADC?fast), and perfusion fraction (f) were calculated using the biexponential model. Distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) were obtained from diffusion?weighted images using the stretched exponential model. All parameters were statistically compared among normal fibroglandular tissues, benign lesions and malignant tumors using Kruskal?Wallis rank sum test. Mann?Whitney U test were used for further comparisons between specific group pairs. ADC values were compared with ADC?slow and DDC for different groups by paired Wilcoxon test. Correlations between ADC?value, ADC?slow and DDC were assessed by using Spearman rank correlation coefficient. Receiver operating characteristic curve was used to analyze and compare the ability of these parameters in differentiation of benign and malignant breast lesions. Results The ADC, ADC?slow, f, DDC and α values were significantly different among the normal fibroglandular tissues, benign tumors and malignant tumors (P<0.05). Further differential comparisons of the four parameters between each pair showed that the ADC, ADC?slow, f, DDC and α values were significantly lower in malignant tumors than both in normal fibroglandular tissues and benign tumors(P<0.016 7). The ADC values of normal fibroglandular tissues, benign tumors and malignant tumors were significantly higher than ADC?slow and DDC (P<0.05). The f and DDC had higher area under the receiver operating characteristic curve (0.688 and 0.657 respectively). The optimal cutoff values for ADC, ADC?slow, f, DDC and α were 1.235 × 10-3mm2/s, 0.428 × 10-3mm2/s, 57.8%, 1.175 × 10-3mm2/s and 0.721, respectively. Theαvalue showed higher specificity (65.5%) and the f value had higher sensitivity (82.9%). Conclusion The parameters derived from biexponential and stretched exponential DWI could be helpful for differentiation between benign and malignant breast tumors.

BACKGROUND:Micro-fracture surgery method is simple, easy to operate, which is an effective way to treat articular cartilage defects, but there are stil some problems such as regenerated fibrocartilage and regenerated cartilage degradation. Scholars have focused on the use of various methods to improve the micro-fracture effect on repairing cartilage defects.
OBJECTIVE:To explore the effects of micro-fracture enhanced by autologous bone marrow mesenchymal stem cells extracellular matrix (aBMSC-dECM) scaffold for treating cartilage defects in minipig models.
METHODS:Bone marrow was extracted from the minipigs and bone marrow mesenchymal stem cells were obtained. aBMSC-dECM membranes were col ected. Cross-linking and freeze-drying technology were used to make the three-dimensional porous aBMSC-dECM scaffold. Ful thickness cartilage defects, 2 mm in depth and 6 mm in diameter, were created on the femoral condyles and trochlea grooves of the two knees of the minipigs. The right knees were treated with micro-fracture as control and the left were treated with micro-fracture enhanced by aBMSC-dECM scaffold. Six months later, histological examination and Wakitani score were used to evaluate the cartilage regeneration, and glycosaminoglycans and DNA contents in the regenerative tissue were determined.
RESULTS AND CONCLUSION:After 6 months, the tissue treated by micro-fracture enhanced by aBMSC-dECM scaffold got better surface and integrated with the surrounding cartilage. Safranin O and fast green staining and Masson staining showed that the regenerated cartilage of the left knee, with abundant matrix and dense bone trabeculae, was better than that of the right. Wakitani score of the left knee was higher than that of the right. Glycosaminoglycans content of the left knee was much more than that of the right, while the DNA content was lower in the left knee than the right knee. Better results were observed in the left knee undergoing micro-fracture enhanced by aBMSC-dECM scaffold, and improvements in the femoral condyles and trochlea grooves showed no differences.

0.05],significantly higher than stage Ⅲ,Ⅳ[60%(6/10),50%(5/10);P

OBJECTIVETo study the efficacy of Xiaoyao Powder (XYP) combined with interferon alpha (IFN-alpha) in treating HBeAg positive chronic hepatitis B (CHB) patients and the effect on their quality of life (QOL).

METHODSTotally 193 patients with HBeAg-positive CHB confirmed by liver biopsy were randomly assigned to 2 groups, Group A (94 cases) and Group B (99 cases). IFN-alpha1b was subcutaneously injected to patients in Group A at the dose of 50 microg, thrice per week. Those in Group B additionally took XYP. The therapeutic course for all was 24 weeks. Clinical efficacy was observed by assessing ALT restoration rate, HBeAg negative rate, HBeAg conversion rate, HBV DNA negative rate, complete response rate, partial response rate, and symptoms integral. The evaluation of QOL was performed by using chronic liver disease questionnaire (CLDQ) score. Adverse reaction occurrence rate was observed in the two groups.

RESULTSBetter effects were obtained in Group A on ALT restoration rate, HBeAg negative rate, HBV DNA negative rate, complete response rate, partial response rate, TCM symptoms integral, the total effective rate of TCM sysmptoms, CLDQ score, and adverse reaction rates, showing statistical difference when compared with Group B (P < 0.05, P < 0.01).

CONCLUSIONXYP could elevate the efficacy of TCM symptoms of HBeAg-positive CHB patients and anti-viral effect, improve their QOL, and reduce adverse reaction of IFN-alpha.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Quality of Life ; Treatment Outcome

Objective To evaluate the effects of dietary intervention with low glycemic index (LGI) and low glycemic load (LGL) on dietary knowledge and dietary modification of patients with type 2 diabetes mellitus (T2DM).Methods This study was a cluster randomized controlled study.From June to September 2010,105 T2DM patients were randomly sampled from 3 residential areas (n =35 in each) in Jin Pen Ling community,Changsha,Hunan province and divided into three groups with a random number table:whole-day dietary intervention group (group A,n =35),breakfast dietary intervention group (group B,n =35),and control group (group C,n =35).Interventions included 3-month health education and dietary intervention.Dietary knowledge,dietary oils,glycemic index (GI),and glycemic load (GL) of the three groups were compared before and after intervention.Results Before intervention,all the three groups showed a low level of knowledge about GI (57.7 ％),and high levels of average GI value of each meal (69.71 ± 8.55),GL value per day (132.45 ± 16.25),and daily cooking oil intake [(39.95 ± 20.64)g].The average knowledge level about GI increased after intervention in both group A (96.3％ vs.57.1％,P ＜0.05) and group B (94.5％ vs.60.5％,P＜0.05),but not in group C (54.8％ vs.55.3％,P＞0.05).The reduction of daily cooking oilintake in group A was larger than those in group B and group C [(7.81 ± 3.91) g vs.(-5.12 ± 1.37) g,(7.81 ± 3.91) g vs.(-3.45 ± 5.95) g,both P ＜ 0.05];so was the average GI value of each meal [group A,(5.95±2.27);groupB (-0.85±1.87);groupC,(-2.87±1.93);allP＜0.05].The changes of GL values in group A (11.31 ±4.31) was better than in group B (1.23 ±27.82) and group C (-0.43 ± 18.40)(both P ＜0.05).Conclusions The average GI value,GL value,and daily cooking oil intake of T2DM patients were all at a high level before intervention,while the level of knowledge about GI was at a low level.Health education providing GI knowledge may effectively improve the knowledge about GI in T2DM patients,while LGI and LGL dietary intervention may promote diet modification.Whole-day dietary intervention may be more effective than breakfast intervention.

BACKGROUND:Studies have shown that arthroscopic al-inside technology for meniscus repair has achieved good outcomes, and arthroscopic suture combined with sodium hyaluronate has an important role in the cartilage repair. OBJECTIVE:To observe the therapeutic effect of arthroscopic al-inside suture repair combined with sodium hyaluronate injection in the repair of discoid meniscus tears. METHODS:Twenty-two patients with discoid meniscus injury were subjected to arthroscopic al-inside suture repair combined with sodium hyaluronate injection. Al cases were confirmed to have attached edge relaxation or longitudinal crack in operation. After repair, effective rehabilitation training was done. RESULTS AND CONCLUSION:The operations for the 22 cases were al successful and there was no complication. Al patients were fol owed up for over 18 months. According to Ikenchi’s method (Lysholm knee score criterion), 11 cases were rated excel ent, 8 were rated good, and 3 were rated fair, with an excel ent/good rate of 86.36%. It is demonstrated that the al-inside suture repair under the guide of arthroscopy in discoid meniscus cases can remain the most appropriate anatomical structure of the meniscus that can play an effective function, and has the advantage of minimal invasion. Arthroscopic al-inside suture repair combined with intra-articular injection of sodium hyaluronate and standard rehabilitation training result in a lower complication rate and effectively promotes the meniscus repair.

BACKGROUND: Many experiments indicate that the angiogenesis of tissue engineered bone graft plays a key role in the osteogenesis.OBJECTIVE: An experimental pattern was set up designed to prepare a kind of vascularized engineered-bone graft for repairing rhesus tibia defects and analyze the relation of angiogenesis and osteogenesis in vivo by rontgenographic and morphological approaches.DESIGN: Random controlled animal experiment.SETTING: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University.MATERIALS: The composite graft was constructed by seeding the induced bone marrow stem cells (BMSCs) on to a beta-tricalcium phosphate(3-TCP) scaffold in vitro, a circular cylinder (20 mm × 8 mm diameter) with a slit (width 2 mm and length 3 mm ) open to both ends and slot. Porosity 60% and pore diameter 100-150 μm. Twenty-nine healthy rhesuses aged 4-5 years and weighted 3.5-5 kg were adopted without gender limitation.METHODS: The experiment was conducted in the Department of Orthopaedics and Traumatology, Nanfan Hospital, Southern Medical University from October 2003 to July 2005. ①Bone-periosteum defect of 20 mm was made in the middle part of right tibia of the 27 rhesuses, and randomly divided into 3 groups equally. ②The defect gaps in fascia-blood vessel group (A) were plugged with in vitro engineered composites constructed by bone marrow stem cells and 3-TCP scaffold, which were totally hugged by a sheet of pedicled deep fascia and additionally a corresponding portion of saphenous artery and veins. The gaps in fascia group (B) and control group(C), however, were inserted with fascia-coated tissue engineered bone and tissue engineered bone only, respectively. Furthermore, two rhesuses without filling materials on the defect were picked up as blanks fixed by steel pins. ③The angiogenesis and osteogenesis for each treatment was assessed by radioactive imaging, roentgenographic analyses, blocking density and vaso-area image analysis at time intervals of 4, 8 and 12 weeks postoperative.MAIN OUTCOME MEASURE: The score of radioactive imaging,roentgenographic, morphological and vaso-area image analyses RESULTS: Totally 29 rhesuses were involved in the result analysis.① General observation of samples: In group A, all the surfaces of the implanted material and the central part were wholly wrapped up or replaced by bonelike tissues which were hard and could not be broken. And 2/3 materials had been absorbed; In group B and C, partial materials of the medial surface and the front were not coated or replaced by bonelike tissues, which could be broken with force, and 1/3 material had been absorbed.②Histological observation of scaffolds: With time passing, the scaffold materials were absorbed to different degrees in group A, B and C, among which, group A was most significant; Under the microscope, the implanted materials at 12 weeks were completely coated with the bonelike tissues, while the blood vessels structures in the materials were mostly alveoli alike and multi-braches. In group B, most of the materials at 12 weeks were wrapped up by the new bone, and few blood vessels could be seen in the center of the materials. In group C, the implanted materials at 12 weeks were slightly absorbed. The new bone and the vascular structures were both increased a little, but still very few.③Analyses of vaso-area: The vaso-areas of both central and peripheral parts in group A were significantly bigger than those of group B and C (P ＜ 0.05). Furthermore, it tended to increase with the time.④X-rays observation: At 12 weeks, group A's images presented obviously decreased density which was lower than that of the normal bone in individual areas and the continual bony callus manifested. Whereas group B and C's images showed slightly decreased density and the continual bony callus appeared on the sections. ⑤The roentgenographic scores of bone defects: The results indicates that the scores of group A was better than those of group B and C at 4, 8 and 12 weeks, respectively (P ＜ 0.05).CONCLUSION: ①This study shows that a feasible and effective angiogenesis approach of tissue engineered bone can accelerate osteogenesis in vivo. ②The absorption level is positively related to local angiogenesis.

BACKGROUND:Numerous studies have shown that air wave pressure therapy plays an important role in prevention of deep venous thrombosis of lower limb after a major operation on the hip.
OBJECTIVE:To explore the efficacy of air wave pressure therapy on deep vein thrombosis of the lower extremity in patients with total knee arthroplasty.
METHODS:A total of 80 patients with total knee arthroplasty were randomly divided into experimental group and control group. Patients in the control group were treated only with conventional method to help the patient massage the lower extremity by the nurse and combined with active functional exercise;patients in the experimental group were treated with air wave pressure therapy at 2 days postoperatively, and were also treated with conventional method to help the patient massage the lower extremity by the nurse and combined with active functional exercise. Swel ing index, coagulation index and the number of patients with deep venous thrombosis of the lower extremity were recorded in both groups.
RESULTS AND CONCLUSION:At 2 weeks after treatment, swel ing index, coagulation index and the number of patients with deep venous thrombosis of the lower extremity were significantly reduced in the experimental group, and its effects were significantly better than those in the control group (P<0.05). Early use of air wave pressure therapy after total knee arthroplasty can al eviate limb swel ing effectively and have obvious advantages in improving coagulation index and blood coagulation condition and in preventing deep vein thrombosis of the lower extremity after total knee arthroplasty.

BACKGROUND:The most effective method for the treatment of acetabular fracture is open reduction and internal fixation, however, this treatment for some special types of acetabular fracture cannot get satisfactory prognosis, and is prone to complications, such as traumatic coxarthrosis and avascular necrosis of femoral head. OBJECTIVE:To evaluate the curative effect of open reduction and internal fixation and total hip arthroplasty in the treatment of special acetabular fracture. METHODS:Twelve cases of acetabular fracture were included, including seven cases of traffic accident wound, three cases of crush injury, and two cases of fal ing injury. The type of bone fracture:two cases of posterior wal fracture, two cases of posterior column and posterior wal fracture, one case of T shaped fracture, five cases of transverse and posterior wal fracture, and two cases of acetabular roof sexual fracture. Complications:one case was femoral head centric dislocation, five cases were latter dislocation, and three cases were caput femoris fractures. Before injury, three cases had coxarthrosis, and two cases were avascular necrosis of femoral head. Al the cases were treated with open reduction internal fixation and total hip arthroplasty, of which nine cases were treated with biological prosthesis, and three cases were treated with bone cement prosthesis. The time from hospitalization to surgery was 3-15 days, and average was 6 days. The patients were fol owed-up once every 2 months in 1 year after replacement, and the Harris score was used to evaluate the hip function recovery. RESULTS AND CONCLUSION:No surgical site and deep wound infection, joint dislocation, lower limb deep vein thrombosis, and death were found in these 12 cases. Among them, 11 cases were fol owed-up for a longtime;the fol ow-up was lasted for 6-82 months. The acetabular fracture was healed at 6-16 months after reduction without prosthesis loosening and sinking. The hip function was evaluated during final fol ow-up according to the Harris score:excellent in eight cases, good in two cases, poor in one case, and the excellent and good rate was 91%. Open reduction internal fixation and one-stage total hip arthroplasty can avoid long-term bed, get out of bed as soon as possible, and reduce complications, thus reconstruct the hip joint painlessly and good functional y.