Objective To investigate the prognostic outcome of open reduction and internal fixation(ORIF)with radial head resection in treatment of comminuted radial head fractures so as to discuss the corresponding operation options.Methods A series of 23 patients with Mason type Ⅲ or Ⅳ radial head fractures were enrolled in the study including 11 males and 12 females.Eight patients(three with Mason type Ⅲ and five with Mason type Ⅳ)underwent radial head resection and 15(seven with Mason type Ⅲ and eight with Mason type Ⅳ)received open reduction and internal fixation including nail and plate fixation in eight and screw and K-wire fixation in seven.The outcomes were assessed in regard of range of motion,radiographic findings,visual analogous scale(VAS)of pain,patient satisfaction degree,disabilities of the arm,shoulder and hand score system(DASH)and the Broberg & Morrey elbow performance score system.Results The follow-up period ranged from 12 to 65 months(mean 35 months),which showed fracture healing in all patients,with no traumatic arthritis happened.The mean range of flexion and extension arc at the elbow of ORIF group and resection group was 132°and 79.4°(P＜0.01)and the patient satisfaction was 9.1 and 8.0(P ＜0.05)respectively.According to the Broberg & Money elbow performance score system,the score was average 93.9 in the ORIF group,with excellent result in nine patients,good in five and fair in one,while the score was average 80.6 in the resection group,with excellent result in two patients,good in two and fair in four.There was statistical difference between two groups(P ＜0.01).The DASH score of the ORIF and resection group was 2.9 and 18.1 respectively(P＜0.05).Conclusions ORIF has better elbow motion,elbow function,daily living and satisfactory outcomes than radial head resection and is recommended for treatment of Mason type Ⅲ or Ⅳ radial head fractures for repair of the radial head as far as possible.

Objective To observe the clinical effects of double support plate via posteromedial approach in the treat?ment of tibial plateau fracture of posterior column. Methods A total of 21 cases of tibial plateau fracture in closed posterior column with an average age of 34.6 (range, 21 to 56) years old were treated using double support plate through posteromedial approach from January in 2010 to January in 2013(16 males and 5 females). Among all, 4 cases were combined with lateral column fracture and 17 cases were three column fracture. Wound healings were observed after operation. X-ray examina?tions were performed at 2 weeks, 3 months, 4 months, 6 months and 12 months after operation as well as at last follow up. The averaged healing time was calculated. Changes of tibial plateau angle and posterior slope angle were compared between time points at 2 weeks after operation and at last follow up. Rasmussen knee score criteria was employed to assess knee joint recovery. Results The mean follow-up was (18.2 ± 1.8) months. No infection was reported. The average fracture healing time was 3.8(3.8±0.6)months. There was no significant difference between tibia plateau angle and posterior slope angle be?tween time points at 2 weeks after operation and at last follow-up (P<0.05). According to Rasmussen knee score criteria at last follow-up, 13 cases were graded as excellent, 6 cases as good, and 2 case as fair, with an excellent and good rate of 90.5%. Conclusion With posteromedial approach, the fractures of medial column, posteromedial and posterolateral of pos?terial column can be exposed well. Using double support plates to fix posteromedial and posterolateral of posterior column fracture can effectively prevent loss of reduction and the function of knee recovered well postoperatively.

Objective To discuss feasibility and clinical effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of unstable anterior pelvic ring fractures.Methods A retrospective study was carried out on data of eight patients with pelvic fractures,including five males and three females at age of 21-57 years (average 38 years).All fractures were identified as unstable type according to Tile classification.MIPPO was performed for all patients after closed reduction.Reduction effect was analyzed according to Matta radiological evaluation criterion.Results All patients were followed up for 3-5 months (average 4.1 months),which showed reduction of anterior pelvic ring in eight patients including satisfactory reduction in five patients and good reduction in three.Fractures in all patients obtained bony union without complications like vascular nerve injury,wound infection,intraoperative massive hemorrhage,deep venous thrombosis or postoperative long-term pain.Conclusion MIPPO has advantages of reduced bleeding,few soft tissue complications,low infection rate and easy removal in treatment of anterior pelvic ring fractures and thereby is a promising surgical method.

Objective To observe the clinical effect of arthrodesis in treating severe hallux rigidus. Methods Totally 30 patients (30 feet) with severe hallux rigidus treated by arthrodesis from January in 2010 to January in 2013 were retrospec?tively analyzed. AOFAS and VAS scoring system were employed to evaluate the clinical curative effect including acquiring the fusion rate, the time to fusion and the incidence rate of hallux valgus. Forefoot-plantar pressure values before and after operation were measured by Plantar pressure measurement system. Results The mean follow-up time was 18 months. AO?FAS score was raised from (48.2±7.6) to (72.8±6.2) after operation (P<0.01). VAS score was also increased from (1.7±0.7) to (8.3 ± 1.1) after operation (P<0.01). The average healing time of knitting was 12.1 weeks. None was non-union and devel?oped to hallux valgus. The forefoot-plantar pressure returned to normal postoperatively from abnormal laterally distribution.Conclusion The surgical strategy of arthrodesis is proved to be effective in treating severe hallux rigidus, in terms of capa?bility of relief from pain, recovery of forefoot-plantar pressure distribution, low incidence of complication.

Objective To obtain and anlysis the diffuse idiopathic skeletal hyperostosis(DISH) related miRNAs under 3-D adhesion for cell culture.Methods From January 2012 to January 2014,4 ossific ligamenta flava tissues were obtained from DISH patients and 4 normal ligamenta flava tissues were obtained from trauma patients surgically.Fibroblasts were separated by using collagenase technique and then cultured on human acellular amniotic membrane (HAAM).Each sample was identified by immunofluorescence before harvested.Total RNA was extracted and then quantified by microfluidics analysis.The small RNAs (＜300 nt) were isolated by using a YM-100 Microcon centrifugal filter.μParafloTM MiRNA microarray assay was performed using a service provider to identify miRNAs whose expression was significantly different between the two groups.Part of differential expression miRNAs were verified by qRT-PCR.Targets of miRNAs were obtained using PicTar 2005,miRanda v5,TargetScan 5.1,their function were analyzed by using Gene Ontology.Functional pathway analysis of miRNAs was performed using KEGG Pathway Analysis.TRANSFAC 7.0 public and Patser were used to get the distribution of transcription factor binding sites.Results When grown on HAAM,fibroblasts kept their morphology,distributed in the way of cluster,lived in multi-level of HAAM,and established linkage.Collagen Ⅰ and Ⅲ were tested positive in normal group cells.Collagen Ⅰ,Ⅱ,Ⅲ and Osteocalcin were tested positive in DISH group cells by immunefluorescence.In total 15 miRNAs showed differential expression,12 were up-regulated and 3 were down-regulated.The result of qRT-PCR was consistent with MiRNA microarray assay.Totally 67 target genes were predicted which participated in cell differentiation,cell adhesion,mineralization et al,and had function in regulating MAPK,Wnt,TGF-β,Focal adhesion signal pathway et al.In total 10 transcription factors were predicted in differentially expressed miRNAs.Conclusion HAAM can provide fibroblasts with 3D adhesion growth,Some differentially expressed miRNAs may participate in the pathogenesis of DISH.

ay of the anatomical features of the SN and clinical diagnosis of diseases related to the nerve.

Objective:To study the relationship between pregnancy outcomes and blood glucose index at different time points in 75 g oral glucose tolerance test (OGTT).Methods:A total of 403 pregnant women who receiveda 75 g OGTT were enrolled.Pregnant women were divided into three groups:group A with one abnormal blood glucose level (group A1:abnormal fasting glucose level;group A2:abnomal 1 hour glucose level;group A3:abnormal 2 hour glucose level), group B with two abnormal blood glucose level (group B1:abnormal fasting and 1 hour glucose level;group B2:abnormal fasting and 2 hours glucose level;group B3:abnormal 1 hour and 2 hours glucose level), and group C with abnormal blood glucose level in all three time points.Retrospective analysis of general information and pregnancy outcomes of pregnant women.Results:There were significant differences in A, B and C groups when comparing the incidence of hypothyroidism, hypertensive disorders of pregnancy, cesarean section rate, neonatal body mass index (BMI), chest circumference, macrosomia preterm birth and transfer to Neonatal Intensive Care Unit (P＜0.05), and the incidence of adverse outcomes in group C was higher than that in group A and B.The neonatal body mass index, chest circumference and fetal distress rate and cesarean section rate in the A2 group were significantly higher than those in the A1 and A3 groups (P＜0.05).The incidence of macrosomia and cesarean section in group B3 was lower than that in group B1 and B2 (P＜0.05).Conclusions:The maternal and neonatal adverse outcomes would increase if the abnormal glucose level was detected in all three time points in 75 g OGTT.When the fasting and 1 or 2 hour blood glucose level were abnormal, the incidence of neonatal macrosomia would increase.There could be a correlation between 1 hour blood glucose level and neonatal body mass index.

Objective: Purpose To introduce the treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with endobutton CL bone-tendon-bone (BTB), and discuss its clinical effects. Methods: From January 2010 to August 2013, 21patients (male 15, female 6) with mallet finger deformity were retrospectively studied. The average age of patients was 31.3±5.3 years. The time from injury to surgery was 5.2±2.1 d. Extensor tendons were ruptured at the terminal insertion in all patients, and there were no avulsion fracture at the base of the distal phalanx.. the terminal extensor tendon insertion Awere surgical reconstructed with Endobutton CL BTB, via a dorsal S-shaped incision of distal interphalangeal joint. Dorsal base of the distal phalanx was drilled a hole and then the tendon suture line with Endobutton CL BTBwas inserted from the ventral finger to the dorsal base of the phalanx to suture the proximal extensor tendon. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up: the active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total active ranges of motion of the finger were recorded. Finger function was evaluated according to the total active range of motion (TAM) system of the American Association of hand Surgeons. Results: All 21 cases were followed up and the follow-up period was 8 to 24 months, with an average of 18.6±5.1 months. The operation time of the patients was 20-40 min, with an average of 29.6±10.3 min. The intraoperative blood loss was 5-10ml, with an average of 7.5±2.6 ml. Mallet finger deformities were all corrected postoperatively. One case presented with limited dorsal extension with elongation of -20°. According to the Crawford evaluation standard, there were 18 excellent patients and 2 good patients, with the excellent and good rate was 95.2% (20/21). The degrees of active joint activity were: 91°±7° of the metacar-pophalangeal joint, 92°±4° of the proximal interphalangeal joint, 82°±8° of the distal interphalangeal joint, and 259°±15° of total active activity. The TAMs of the healthy side were 259°±15°, and the TAMs of the affected side were 268°±12°, the difference was statistically significant (t=2.147, P=0.038). Accorrding to TAM system assessment criteria: excellent in 18 patients, good in 2 patients, and the excellent and good rate was 95.2% (20/21). One case presented with dorsal extension limitation, one case suffered from discomfort of grip because of scar in ventral side of the finger. The postoperative dorsal extension was limited in 3 cases, and the postoperative dorsal extension function was gradually restored 6 months later. Conclusion The treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB was effective and easy-operating. Postoperative patients can perform early finger function exercise, satisfactory results, worthy of clinical promotion and application.

OBJECTIVETo investigate the clinicopathologic features of mantle cell lymphoma (MCL) and the significance of immunostaining for cyclin D1 in diagnosis.

METHODSClinicopathologic observation and immunohistochemical staining for CD20, CD45RO, cyclin D1, bcl-2, Ki-67, CD5 for 8 cases of mantle cell lymphoma were performed.

RESULTSThe 8 cases of mantle cell lymphoma consisted of 6 males and 2 females, aged from 43 to 78 years (mean 57 years). Histopathologically, MCL demonstrated architectural destruction by a vaguely nodular monomorphic lymphoid proliferation with vaguely nodular, diffuse or mantle zone growth patterns. Analogous to centrocytes, the lymphoma cells with slightly to markedly irregular nuclear contours showed moderately dispersed chromatin and a low mitotic figure. Three cases were transformed into highly aggressive blastoid variants. The tumor cells were positive for CD20, CD5, bcl-2 and cyclinD1 in all 8 cases and negative for CD45RO.

CONCLUSIONSThe clinicopathological features and special immunophenotypes were present in mantle cell lymphoma. This tumor can be differentiated from other small B-cell lymphomas on the basis of histopathologic features and positive cyclin D1 immunophenotype. The blastoid variant should also be differentiated from other variants.

Adult ; Aged ; Cyclin D1 ; analysis ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; analysis ; Lymphoma, Mantle-Cell ; diagnosis ; pathology ; Male ; Middle Aged ; Prognosis

OBJECTIVETo study the relationship between immunoglobulin variable heavy chain (IgVH) gene mutation status and clinical features, pathologic findings and biologic behavior of mantle cell lymphoma (MCL).

METHODSIgVH gene was amplified in 60 cases of MCL with FR1-JH and FR2-JH primers in BIOMED-2. The sequence was determined by cloning. The IgVH somatic mutational status was analyzed using NCBI's Ig-Blast tool. The relationship between IgVH gene mutation status and clinicopathologic features was also analyzed.

RESULTSForty percent (24 cases, 28 functional Ig genes) of the MCL cases displayed somatically mutated VH genes (defined as > 2% mutated), whereas 60.0% (36 cases, 40 functional Ig genes) showed unmutated VH genes. The most widely used genes were VH3-21 (27.9%) and VH4-34 (19.1%). The former were mainly used by unmutated cases, while the later mainly by mutated cases.Intraclonal heterogeneity was noted in 19 cases. There was no correlation of VH mutation status and specific VH gene with survival (P > 0.05).

CONCLUSIONSMCL comprises at least two subsets that do not correlate with morphology: one with unmutated VH genes and one with mutated VH genes. The biased use of VH3-21 and VH4-34 is noted. The nonrandom usage of IgVH segments suggests specific antigens may play a role in the pathogenesis and progression of MCL subsets. There is no correlation of IgVH mutation status and specific VH gene with survival.

DNA Primers ; Female ; Genes, Immunoglobulin Heavy Chain ; genetics ; Humans ; Immunoglobulin Variable Region ; genetics ; Lymphoma, Mantle-Cell ; genetics ; mortality ; pathology ; Male ; Mutation ; Prognosis