Objective To investigate the relationship between Oxfordshire community stroke project(OCSP) classification and imaging classification in acute cerebral infarction. Methods Two hundred and thirty-six patients with acute cerebral infarction were retrospectively evaluated with OCSP classification and imaging characteristics. Results According to OCSP classification,of all the 236 patients with acute cerebral infarction,28(11.9%) experienced total anterior circulation infarction(TACI),71(30.1%) partial anterior circulation infarction(PACI),94(39.8%) lacunar infarction(LACI),and 43(18.2%) posterior circulation infarction(POCI).The consistency was found in 171 cases(72.5%) between the OCSP classification and imaging classification,with the accuracy of 76%(25/33) for TACI,81%(34/42) for PACI,71%(81/114) for LACI and 66%(31/47) for POCI. Conclusion OCSP classification can predict the location and size of cerebral infarction with a high accuracy,and is well consisted with the imaging findings.

BACKGROUND: The proliferation and differentiation of mesenchymal stem cells (MSCs) lack of regulatory functions. Following combining with suitable vectors, MSCs cannot highly effectively proliferate and differentiate, which are keys to prevent MSCs entering the clinic. It is of great importance to effectively regulate the differentiation of stem cells into osteoblasts using pulse electromagnetic field.OBJECTIVE: To investigate the differentiation of mouse MSCs into osteoblasts in vitro following stimulation of pulse electromagnetic field.DESIGN, TIME AND SETTING: The cytological in vitro controlled study was conducted at the Laboratory of Department of Orthopaedics, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology from May 2004 to October 2007.MATEIRALS: Totally 20 BALB/C mice were supplied by the Experimental Animal Center of Tongji Medical College. Pulse electromagnetic field deviser was designed and made by the Department of Electric Machine, Naval University of Engineering.METHODS: Mouse bilateral femur was sterilely isolated. BMSCs were harvested by the Percoll density gradient centrifugation,and purified and proliferated by the adherent method. Cells at the third passage (2×10~7/L) were incubated in a 6-well plate, and then divided into 4 groups. Cells in the blank control group were incubated in the complete medium. Cells in the pulse electromagnetic field underwent pulse electromagnetic field radiation of 50 Hz, sinusoidal wave, and 1 mT, twice a day, once 30 minutes, with an interval of 12 hours, totally 10 days. Cells in the osteogenic induction group were incubated in the complete medium, supplemented with dexamethasone, sodium glycerophosphate and VitC. Cells in the pulse electromagnetic field + osteogenic induction group were subjected to the same pulse electromagnetic field radiation and then incubated in the complete medium.MAIN OUTCOME MEASURES: The differentiation of BMSCs was measured.RESULTS: Results of alkaline phosphatase staining showed that cells were negative in the blank control group, but weakly positive in the pulse electromagnetic field group, positive in the osteogenic induction group, and strongly positive in the pulse electromagnetic field + osteogenic induction group 10 days following intervention. Compared with the blank control group,absorbance value of type I collagen immunohistochemistry was significantly greater in the osteogenic induction group, pulse electromagnetic field + osteogenic induction group (P < 0.05, P < 0.01).CONCLUSION: Pulsed electromagnetism fields of 50 Hz, waves of sine, with the intensity of 1 mT could promote alkaline phosphatase and type I collagen expression and enhance the differentiation of mouse BMSCs into osteoblasts in vitro.

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.

We investigated the development of an injectable, biodegradable hydrogel composite of poly(trimethylene carbonate)-F127-poly(trimethylene carbonate)(PTMC11-F127-PTMC11 )loaded with bone morphogenetic protein-2 (BMP-2) derived peptide P24 for ectopic bone formation in vivo and evaluated its release kinetics in vitro. Then we evaluated P24 peptide release kinetics from different concentration of PTMC11-F127-PTMC11 hydrogel in vitro using bicinchoninic acid (BCA)assay. P24/ PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine and ectopic bone formation of the implanted gel in vivo was detected by hematoxylin and eosin stain (HE). PTMC11-F127-PTMC11 hydrogel with concentration more than 20 percent showed sustained slow release for one month after the initial burst release. Bone trabeculae surround the P24/ PTMC11-F127-PTMC11 hydrogel was shown at the end of six weeks by hematoxylin and eosin stain. These results indicated that encapsulated bone morphogenetic protein (BMP-2) derived peptide P24 remained viable in vivo, thus suggesting the potential of PTMC11-F127-PT- MC11 composite hydrogels as part of a novel strategy for localized delivery of bioactive molecules.
Animals ; Biocompatible Materials ; chemistry ; Bone Morphogenetic Proteins ; pharmacology ; Bone and Bones ; drug effects ; Dioxanes ; chemistry ; Drug Delivery Systems ; Hydrogels ; chemistry ; Osteogenesis ; drug effects ; Peptides ; Prostheses and Implants ; Rats

Objective To prepare P24/PTMC11-F127-PTMC11 hydrogel,to study the in vitro release profile and to observe ectopic bone formation in p24 peptide incorporated PTMC11-F127-PTMC11 hydrogel.Methods Corresponding weight powder of p24 peptide was infunded into tubes of PTMC11-F127-PTMC11 solution with concentrations of 16％,20％ and 25％.Release profiles of P24 peptide in different concentration PTMC11-F127-PTMC11 hydrogel were measured in vitro by BCA assay.P24/PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine,and the implanted gel was detected by hematoxylin and eosin stain (HE).Results PTMC11-F127-PTMC11 hydrogel showed sustained slow release for the whole process after the initial burst release.With the increase of concentration in PTMC11-F127-PTMC.hydrogel,the initial burst release was reduced significantly.Ectopic bone formation was observed by computed tomography in p24 peptide incorporated PTMC11-F127-PTMC11 hydrogel after four weeks.Bone trabeculae surround the P24/PTMC11-F127-PTMC11 hydrogel was observed at forth week by hematoxylin and eosin stain.The bone trabeculae became thicker from sixth week.Conclusion Delayed release of peptide from the hydrogel was mainly controlled by disintegration of hydrogel and a satisfactory release profile was observed.These results suggest that the p24-loaded PTMC11-F127-PTMC11 hydrogel remmns active of p24 at the implanted site,continuously induce differentiation of osteoblast precursor cells into osteoblasts,and activate osteoblasts to promote ectopic calcification.

Objective To evaluate the clinical outcome of lateral malleolar's anatomical hook-plate in treating ankle fracture including distal fibular fracture. Methods Nineteen patients of ankle fracture including distal fibular fracture were treated from January 2006 to January 2009. There were 12 males and 7 females with an average age of 36 years (range, 18-72 years). The fractures were classified by Danis-Weber system. There were A type in 8 cases, B type in 11 cases. The average time of duration between injury and operation was 6 days (ranged from 6 hours to 16 days). The distal fibular fracture were treated with lateral malleolar's anatomical hook-plate. The medial malleolus was fixed with cancellous bone screw. The posterior malleolus was fixed with screw or plate according to the pattern of fracture. Results The mean follow-up period was 18.8 months with a range from 6 to 32 months. No obvious fracture line could be seen on the radiographs 4-6 weeks after operation. Bone healing was achieved in 10 cases 12 weeks after operation and in 9 cases 20 weeks after operation. All surgical incisions healed adequately. There were no instances of infection, instability of ankle and other complications. According to Mazur ankle joint scoring scale system, the fiual result was scored from 67 to 92 (average 86.3). There were excellent in 12 cases, good in 4, fair in 2,and poor in 1 case. The excellent and good rate was 84.2%. Conclusion The lateral malleolar's anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus, with advantage of restoring anatomic structure, joint activity effectively and firm fixation.

Objective To investigate the clinical effects of tibiotalocalcaneal arthrodesis (TTCA) using a retrograde intramedullary nail with a valgus curve.Methods At our department,22 patients underwent TTCA using a retrograde intramedullary nail with a valgus curve from June 2009 to January 2014 and were available for complete follow-up.They were 12 men and 10 women,aged from 46 to 79 years (average,62.2 years).There were 3 cases of primary ankle osteoarthritis,9 ones of traumatic arthritis,one of ankle arthritis secondary to severe talar avascular necrosis,3 ones of progressive subtalar arthritis following failed ankle replacement,5 ones of progressive subtalar arthritis following failed ankle arthrodesis,and one of arthritis secondary to equinovarus.The outcome measurements included the American Foot and Ankle Society (AOFAS) ankle-hindfoot scale,EQ-5DTM functional score,radiologic assessment and clinical examination.Results The mean follow-up was 21.3 months (range,from 14 to 38 months).A plantigrade foot and bony union were achieved in all the patients after a mean time of 3.9 months (range,from 2.4 to 6.2 months).Postoperative radiologic results showed a good hindfoot alignment in all the patients.Superficial infection occurred in one patient and loosening of the distal screw in another who asked for removal.The mean postoperative EQ-5DTM functional score and AOFAS ankle-hindfoot score were 69.3 (range,from 20 to 90) and 69.9 (range,from 45 to 85),respectively.Conclusion TTCA using a retrograde curved intramedullary nail may lead to solid fusion and good hindfoot alignment.

Objective To assess the efficacy and safety of fluvastatin sodium extended-release tablets (fluvastatin XL) 80 mg once daily compared to fluvastatin sodium immediate-release capsules (fluvastatin IR) 40 mg twice daily in Chinese hyperlipidemic patients with moderate or high cardiovascular risk.Methods In this multi-center,randomized,double-blind,double-dummy,active-controlled,parallel-group study,after 6-week open-label treatment with fluvastatin IR 40 mg once daily,patients who did not reach their lipid goals were randomized to 12-week double-blind treatment with fluvastatin XL 80 mg once daily or fluvastatin IR 40 mg twice daily.Results (1) There were 218 patients enrolled in each group.At the study endpoint,no statistical difference was found in the mean percent change from baseline for LDL-C with-8.69％ [from (3.504 ±0.060) mmol/L to (3.153 ±0.065) mmol/L] in the fluvastatin XL group and-7.89％ [from (3.491 ±0.050) mmol/L to (3.181 ±0.060) mmol/L] in the fluvastatin IR group (P ＞ 0.05).The 95％ CI for difference between the two groups in adjusted mean percent change from baseline was (-4.70％-3.09％),which was within the pre-specified non-inferiority margin.In the fluvastatin XL group,the proportion of patients with moderate cardiovascular(CV) risk and high CV risk achieving their LDL-C treatment goals at endpoint was 50.0％ and 31.5％ respectively,while the proportion was 42.5％ and 24.5％ respectively in the fluvastatin IR group.No significant difference was found between the two groups in the proportion of patients who reached their lipid goals and the changes from baseline with other lipid parameters.(2)Similar safety profiles were observed in the two treatment groups,with 21.1％ adverse event (AE) (8.3％ study-drug related AE) in the fluvastatin XL group and 17.0％ AE (6.3％ study-drug related AE) in the fluvastatin IR group.Conclusion The efficacy of fluvastatin XL 80 mg once daily is comparable to fluvastatin IR 40 mg twice daily in Chinese hyperlipidemic patients with moderate or high cardiovascular risk and both treatments are safe and well-tolerated.

Objective To find out factors related to avascular necrosis (AVN) of femoral head through a retrospective study of patients with femoral neck fractures treated with cannulated screws.Methods Two hundred and thirty cases of femoral neck fracture whn had been treated with cannulated screws in our department from August 1994 to October 2003 were analyzed statistically.Six factors of patient,age,gender,fracture type (Garden clas- sification),reduction method (close or open),the quality of reduction (Garden Index) and time interval from injury to surgery were analyzed statistically with rank sum test and logistic multiple regression.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence: fracture type,quality of reduction,reduction method,time interval from injury to surgery and age.Gender was found to have little impact on the prognosis of femoral neck fracture (P＞0.05).Conclusions Fracture displacement is the most critical factor that influences the prognosis.Anatomical reduction (close or open) must be achieved to re- duce the risk of AVN.Timing of surgery shows its importance.High age will not lead to an increased incidence of AVN.

BACKGROUNDA bioactive compound from Paecilomyces tenuipes (BCPT) has an inhibitory effect on monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B) in vitro and in vivo, which indicates BCPT may be a potential antidepressant. In this study we aimed to study the antidepressant effects of BCPT in the chronic unpredictable stress (CUS) model in rats and explore underlying mechanisms in the hypothalamic-pituitary-adrenal (HPA) axis.

METHODSThe antidepressant effects of BCPT were studied in the chronic unpredictable stress model in rats. Animals were housed isolated, except the control group. Rats were exposed daily to different random stressors from day 1 to 21. Awarding response was detected by calculating the 24-hour consumption of sucrose water. Cortisol (CORT) and adrenocorticotropic hormone (ATCH) contents in serum and arginine vasopressin (AVP) contents in the pituitary body were detected by radio immunoassays. Total RNA of hippocampus or hypothalamus was extracted and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for the measurement of corticotrophin releasing hormone (CRH) mRNA or mineralocorticoid receptor (MR) mRNA and glucocorticoid receptor (GR) mRNA levels. Statistical analyses were performed using one way analysis of variance (ANOVA) followed by Student-Newman-Keuls (SNK) test.

RESULTSChronic unpredictable stress resulted in reduction of sensitivity to reward and abnormality in the HPA axis in the animal model. BCPT improved the reward reaction as measured by increasing sucrose consumption, remarkably reduced serum CORT and ACTH levels and the AVP content in the pituitary body in the CUS-treated rats, decreased the expression of CRH mRNA, enhanced the expression of hippocampus MR mRNA, GR mRNA and decreased the ratio of MR/GR.

CONCLUSIONSBCPT has potentially antidepressant-like activity and normalized the HPA axis hyperactivity in a CUS model of depression in rats. This may be an important mechanism of its antidepressant effect.

Animals ; Antidepressive Agents ; pharmacology ; Chronic Disease ; Corticotropin-Releasing Hormone ; genetics ; Hydrocortisone ; blood ; Hypothalamo-Hypophyseal System ; drug effects ; physiology ; Male ; Monoamine Oxidase Inhibitors ; pharmacology ; Paecilomyces ; chemistry ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Receptors, Glucocorticoid ; genetics ; Receptors, Mineralocorticoid ; genetics ; Stress, Psychological ; physiopathology ; Sucrose ; administration & dosage