OBJECTIVETo study the related risk factors for surgical site infection following Pilon fracture surgery. METH ODS: The data of 561 patients with Pilon fractures treated with open reduction plate osteosynthesis at our institution's trauma centre were collected from January 2006 to December 2012. All the patients were divided into two groups: infection group and non-infection group. In the infection group, there were 23 males and 10 females, ranging in age from 21 to 69 years old, with an average of (45.50±4.40) years old. In the non-infection group, there were 296 males and 232 females, ranging in age from 16 to 76 years old, with an average of (43.50±7.19) years old. The possible risk factors such as age, gender, smoking, diabetes, alcohol abuse, open fractures, compartment syndrome and operative time were studied. The multivariate Logistic regression model was used to analyze the risk, factors.

RESULTSThe infection rate of surgical site after Pilon fracture surgery was 5.88%. There were significant statistical differences between infection group and non-infection group in operative time, open fractures and compartment syndrome. However, multivariate Logistic regression analysis revealed that only operative time was significantly associated with surgical site infection (P=0.005, OR=44.92).

CONCLUSIONOperation time is an independent predictor for post-operative surgical site infection of Pilon fracture treated with open reduction plate osteosynthesis. Though open fracture and compartment syndrome could increase the surgical site infection rate, they could not not be considered as independent predictors.

Adult ; Compartment Syndromes ; complications ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Operative Time ; Risk Factors ; Surgical Wound Infection ; etiology ; Tibial Fractures ; surgery

OBJECTIVETo evaluate a surgical technique and outcome and illustrate its important of open reduction and internal fixation for fractures of posterior malleolus.

METHODSFrom Jan. 2004 to Jan. 2008, 25 cases were treated with open reduction and internal fixation involving 17 males and 8 females with an average age of 34 years (ranged from 21 to 67 years old). According to Lauge-Hansen classification: 13 cases of type pronation-external rotation (IV), 7 and 5 cases of type supination-external rotation (III and IV). Twenty cases were treated with screw, 5 cases were treated with gypsum. To evaluate the outcome of operation with X-ray.

RESULTSAfter seven months to three years followed-up, clinic therapeutic effect of each patient was evaluated according to the Leeds scoring system, the results were excellent in 21 cases and good in 2. As compared with the uninjured side on the evaluation of the activity range of ankle joint, there were no significant difference in back-extend and plantar flexion.

CONCLUSIONIn order to obtain ankle joint satisfactory result, open reduction and rigid internal fixation must be adopted in the fracture of posterior malleolus.

Adult ; Aged ; Ankle Injuries ; surgery ; Female ; Fracture Fixation, Internal ; Fracture Healing ; physiology ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Rotation ; Treatment Outcome

ObjectiveTo investigate the relationship between metastasis-associated gene 1 ( MTA1 )expression and invasive and metastatic ability of cervical cancer cell. MethodsThree kinds of plasmids pcDNA3( control group), pcDNA3-MTA1 ( MTA1 group) and pSilencer3. 1-MTA1-siRNA ( MTA1-siRNAgroup) were transfected into human cervical cancer cell line CaSki cells. Reverse transcription (RT)-PCR and western blot were used to detected MTA1 mRNA and protein expressions. The effects of MTA1 expression on CaSki cell growth and proliferation, cell migration, adhesion and invasion, and cell cycles were tested by methyl thiazolyl tetrazolium (MTT), clone formation experiment, wound-healing assay, transwell assay, adhesion assay and flow cytometry, respectively. In animal experiment, three groups of cells were inoculated to BALB/c nude mouse subcutaneously to observe tumor formation ability. ResultsCompared with control group, MTA1 mRNA and protein were significantly overexpressed in MTA1 group, while MTA1-siRNA group showed lower MTA1 expression. Compared with control group, MTA1 group showed significantly accelerated cell growth; while MTA1-siRNA group showed decreased cell growth since the second day (P＜0. 05). Clone formation number in control, MTA1 and MTA1-siRNA group were 133 ±6, 169 ± 10 and 57 ±5,respectively. MTA1 group showed accelerated cell formation, while MTA1-siRNA group showed the reverse effect compared with that in control group(P ＜ 0. 05 ). At 24, 48 and 72 hours after wounding, the healing ability of MTA1-siRNA group significantly lagged behind that in the control group, while MTA1 group showed accelerated cell healing ability. The adhesion rate of control, MTA1 and MTA1-siRNA group were (69. 3 ± 3. 6) ％, ( 80. 4 ± 5. 6 ) ％ and ( 39. 2 ± 7.4 ) ％ separately at 90 minutes after cell seeding. In contrast with control group, MTA1 group promoted the adhesion of CaSki cell to matrigel matrix, while MTA1-siRNA group inhibited the adhesion process (P ＜0. 05 ). In the migration assay, the number of cells migrated to the bottom side of the membrane in control,MTA1 and MTA1-siRNA group were 153 ± 17,247 ± 38 and 82 ± 10, respectively. The number of cells in the invasion assay were 231 ± 19,354 ± 36 and 76 ± 7, respectively. Compared with the control group, MTA1 group significantly increased the migration and invasion ability, while MTA 1-siRNA group showed lower cell migration and invasion ability (P ＜ 0. 05 ). In cell cycle experiment, no significant differences of cell proportions including G1, S and G2 stage were found among three groups (P ＞ 0.05).In animal experiment, compared with control group,MTA1 group showed accelersted tumor formation and growth,whilethe MTA1-siRNA group showed the reverse effect ( P ＜ 0. 05 ). ConclusionsMTA1 may play its roles to promote cervical cancer cell invasion, migration, adhesion, as well as cell growth and colony formation, while RNA interference against MTA1 may decrease the malignant phenotypes. This study shows that it will be an effective beginning to explore metastasis mechanisms and cancer gene therapy strategy targeting MTA1 in cervical cancer.

Objective To compare the effects of UVA irradiation on cell morphology,quantity and expression of inducible nitric oxide synthase (iNOS) mRNA and protein in human fibroblasts versus a kerati- nocyte cell line HaCaT.Methods Human fibroblasts and HaCaT cells were cultured and irradiated by 5 J/cm~2 UVA.Then,at 24,48 and 72 h after the stimulation,the cell morphology was observed under an in- verted microscope,and iNOS mRNA and protein were measured by RT-PCR and immunohistochemistry method,respectively.Results After the irradiation,human fibroblasts showed shrinkage at the three time points,the quantities of the cells began to decrease significantly at 24 h (P

Objective To observe the curative effect of captopril and metoprolol in the treatment of chronic Keshan disease (CKD). Methods One hundred and ninty-five patients with CKD chosen from Juxian, Wulian, Yishui, Pingyi, Sishui and Zoucheng in Shandong Province were randomly assigned to control group, captopril group and metoprolol group according to NYHA cardiac functional grading. All cases were given diuretics, digitalis and vasodilating agents as routine treatment. On this basis, captopril and metoprolol was administered in captopril group and metoprolol group respectively. After 12 months of follow-up visit, the causes of cardiac death, hospitalization status and the changes of heart size, electrocardiogram, blood pressure and heart rate were all observed. Results It was found that the mortality of captopril group and metoprolo] group was 4.76% (3/63), 5.00% (3/60) respectively, both lower than the control group 10.61%(7/66). But this difference had no statistically significance(P=0.39). Besides, the hospitalization days of each year in captopril group and metoprolol group was respectively (19.12± 20.35) and(18.86±21.52)days, much more reduced than in the control group[(21.45±21.74)days, q=3.17, 3.38, P<0.05]. The detection rate of cardiothoracic ratio decreased in captopril group and metoprolol group [45% (27/60) and 40.4% (23/57)] After treatment showed more pronounced amelioration than the control group [18.6% (11/59), χ2=9.51,6.59, all P<0.0125], still the detection rate of cardiomegaly and invariability had no significant difference among three groups (χ2=2.50,4.75, all P>0.05). The elimination coefficient of ectopic rhythm in metoprolol group [56.5% (13/23)] was pronounced higher than the control group and captopril group [23.8% (5/21), 22.7% (5/22)], but differences had no statistically significance(P=0.0358,0.0331, all P>0.0125). Significant differences were found in systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) in three groups prior and post-treatment(F=47.51,44.23,80.66, all P<0.01). The interaction of therapy and treatment time had influence on SBP and HR (F=3.19,37.44, all P<0.05), but had no influence on DBP(F=2.21, P> 0.05). There was no difference in SBP, DBP or HR among three groups before treatment(F=0.28,0.57,1.80, all P>0.05). After treatment, SBP and DBP in captopril group, metoprolol group and the control group[(109.0±10.9), (112.2±12.8), (114.7±13.2)mm Hg, (69.3±7.2), (72.1±9.5), (73.3±9.3)mm Hg] were all lowered compared with pre-treatment[ (117.1±13.4), (119.0±14.4), (117.6±14.1)mm Hg and (74.2±10.2), (76.3±10.8), (75.4±11.1)mm Hg, t=4.79,4.47,2.08,5.12, 4.32,2.15, all P<0.05]. HR was reduced in metoprolol group, being [(66.2±7.7), (75.9±11.5)times/min] before and after treatment(t=10.81, P<0.01), while it remained unchanged in captopril group and control group[(70.6±8.0), (72.6±10.5) times/min and (71.9±10.4), (73.8± 12.2)times/min, t=1.77,1.74, all P>0.05]. After treatment, both SBP and DBP of captopril group were significantly lower than that in the control group (q=3.52,3.56, all P<0.05); HR was reduced in metoprolol group, lower than that in captopril group and control group(q=5.44,3.73, all P<0.01). Conclusions Having a tendency of depressing mortality, captopril and metoprolol can reverse or delay myocardial remodeling and reduce admission rate in a safe,reliable and economic way, and are worth to be widely used in the treatment of chronic Keshan disease.

OBJECTIVETo establish osteoblast apoptosis model induced by gingipains, and to examine the expression of pro-apoptotic protein Bcl-2 interacting mediator (Bim), Bcl-2 associated X protein (Bax) and Bcl-2 antagonist/killer (Bak).

METHODSGingipain and gingipain acticity were extracted and measured. Mouse osteoblast cell line MC3T3-E1 cells were cultured in the presence of 0.453, 0.906, 1.812 U/L gingipains for 0, 16, 24 and 48 h. Apoptosis was examined by 4',6-diamidino-2-phenylindole (DAPI) staining or annexin V/propidine iodide (PI) staining.Protein expression of Bim, Bax and Bak was determined by Western blotting after osteoblasts were cultured with 1.812 U/L gingipain for 0, 4, 8, 16, 24 and 48 h. Osteoblasts were cultured with 1.812 U/L gingipain which had been inhibited with N-alpha-tosyl L-lysyl-chlorom ethylketone (TLCK). Western blotting was used to detect Bim expression and DAPI staining to measure apoptosis.

RESULTSArginine-specific proteinases (Rgp) activity was (18.11 ± 2.11) U/L and specific proteinases (Kgp) was (1.02 ± 0.25) U/L. Percentage of osteoblast apoptosis induced by 1.812 U/L gingipain rose to (6.31 ± 0.37)% after 16 h, and reached (11.20 ± 0.35)% at 24 h and (10.80 ± 0.46)% after 48 h with DAPI staining. Annexin V/PI staining supported the result from DAPI staining.Bim protein level increased during osteoblast apoptosis, the relative fold rose to (0.31 ± 0.03) after 4 h (about 2 fold compared to control), peaking at 24 h (0.57 ± 0.05, 3-4 fold compared to control). Proteinase inhibitor TLCK effectively blocked the activity of gingipain and inhibited up-regulation of Bim induced by gingipains from (0.58 ± 0.04) to (0.14 ± 0.03). The percentage of osteoblast apoptosis decreased from (11.20 ± 0.35)% to (4.31 ± 0.38)% in the presence of TLCK. Expression of Bax remained unchanged when cells were cultured with or without gingipains. Bak was under the detectable level in MC3T3-E1.

CONCLUSIONS1.812 U/L gingipains induced osteoblast apoptosis. Protein expression of Bim was up-regulated during cell apoptosis and was down-regulated when gingipain inhibited with TLCK, suggesting that Bim was involved in osteoblast apoptosis induced by gingipain. Inhibition of Bim protein expression protected osteoblast from apoptosis.

Adhesins, Bacterial ; pharmacology ; Animals ; Apoptosis ; drug effects ; Apoptosis Regulatory Proteins ; metabolism ; Bcl-2-Like Protein 11 ; Cell Line ; Cysteine Endopeptidases ; pharmacology ; Humans ; MCF-7 Cells ; Membrane Proteins ; metabolism ; Mice ; Osteoblasts ; cytology ; metabolism ; Proto-Oncogene Proteins ; metabolism ; Tosyllysine Chloromethyl Ketone ; pharmacology ; bcl-2 Homologous Antagonist-Killer Protein ; metabolism ; bcl-2-Associated X Protein ; metabolism

Objective To investigate the relationship of folates,vitamin B_(12) with tan phosphorylation and the possible mechanism in Alzhcimer's disease (AD).Method Tau protein phosphorylation was examined in hippocampns of rats of two months old and forty months old treated or untreated by folates and vitamin B_(12) using Western blot and immunohistochemistry with phosphorylation dependent and independent tau antibodies.Results We found that tau phosphorylation in aged rat brain showed a significant higher level than that in the two-month olds.Folates combined with vitamin.B_(12) could decrease tau phosphorylation by 27% at the site of Ser396/404 of hippoeampus in aged rats.Conclusion It suggests folates and vitamin B_(12) may play an important role in preventing the neurodegenerative change via effeeting tau phosphorylation in AD brain.

AlM: To silent hypoxia inducible factor-1α ( HlF-1α) gene in malignant melanoma of the choroid cell by small interference RNA ( siRNA ) and investigate its effect on the expression of matrix metalloproteinase-2 ( MMP-2 ) in the choroid cell line human uveal melanoma cell (OCM-1) in hypoxia environment.METHODS:OCM-1 cells cultured on culture flask were divided into normal group and hypoxia group. Hypoxia group were divided into five groups: simple hypoxic group, and interference group, and negative control group, and positive control group, and liposome group. Normal group cells were cultured on DMEM culture flask with 10% FBS, 100U/mL penicillin, 100μg/mL streptomycin as well as high concentration of glucose. The cells were maintained at 37℃ in a humidified 5% CO2 incubator. Cells in good condition were selected for experiment. For hypoxia group, chemical hypoxia inducer CoCl2 was added into nutrient medium at the concentration of 100μmol/L to simulate hypoxia microenvironment. We designed and synthesised siRNA ( siRNA + negative control+positive control ) , the target sequences of the HlF-1α to transfect hypoxic malignant melanoma of the choroid cell. SiRNA including HlF-1α siRNA, β-actin siRNA and negative control group synthesized in vitro transfected hypoxic OCM - 1 cell through Lipofectamine2000. The expression of HlF-1α, MMP-2 gene and the protein were detected by RT-PCR and Western blot. RESULTS: Compared with the normal group, the expression of HlF-1α mRNA was not obviously changed (P>0. 05), but the expression of HlF-1α protein and MMP- 2 mRNA protein was significantly higher ( P<0. 05) . Compared with the other hypoxia groups,β-actin mRNA expression of positive control group decreased ( P< 0. 05 ) , which proved successful transfection. The expression of HlF-1α mRNA and the expression of its protein and both MMP-2 mRNA and its protein was significantly lower ( P < 0. 05 ). The negative control group, liposome control group had no significant difference in the detection of factors (P>0. 05).CONCLUSlON: Hypoxia status may upregulate the HlF-1α in OCM-1 cells by increasing the expression of protein. Hypoxia can also inactivate MMP-2, resulting in upregulation of MMP-2 RNA and the expression of its protein. The expression of HlF-1α and MMP-2 mRNA can be down-upregulated by transfecting OCM-1 with HlF-1α siRNA.

ObjectiveTo investigate the application of intraoperative Computed Tomograph (CT) using in surgery for complex acetabular fractures.MethodsFrom June 2008 to December 2010,14 patients (9 males,5 females; with the mean age of 45.1 years; range,28-62 years) with complex acetabular fractures were operated using intraoperative CT.Preoperative radiotherapy and CT scan were adopted to evaluate the fractures.Three dimensional reconstruction based on CT scan was used to mimic surgery.The surgery approach and the type of internal fixators were noted.Intraoperative C-arm and CT scan were used to evaluate the fractures reduction respectively.Decision of additional reduction was made by surgeons according to above mentioned methods respectively and the results were noted.Comparing to preoperative design,the change of surgery plan were noted.Overall time,frequency and radiation dose of intraoperative CT scan were also noted.ResultsAll patients in this study received average 2.7 times of intraoperative CT scan.Mean time of CT scan was 40.4 min and the overall dose of radiation was 47.2 mGy.Decision of additional reduction was made in 3 cases according to C-arm radiography and 4 cases according to CT scan (above mentioned 3 cases were included).The change of surgery plan was made in one case.In postoperative radiography evaluation according to Matta's score system,anatomical reduction were achieved in 8 cases,imperfect reduction in 3 cases and poor reduction in 3 cases.ConclusionIntraoperative CT scan increases the radiation time and dose of patients dramatically.When used to evaluate fracture reduction intraoperatively,it can't take the advantage of traditional C-arm radiography.When delicate preoperative plan is made with radiography and three dimensional reconstruction based on CT data,the efficiency of intraoperative CT scan for complex acetabular fractures are to be discussed.

Objective To observe the electrocardiogram changes of threatened crowds in Keshan disease (KSD) endemic area in Shandong province. Methods In 2008,inhabitants from 21 villages of Zoucheng,Sishui,Tengzhou, Yishui, Pingyi, Wulian, Juxian and Qingzhou regions were selected as subjects undergoing electrocardiogram. No less than 100 people were chosen from each village and the examination rate was not lower than 85%. Results Among the 3378 inhabitants investigated,460 cases showed abnormal electrocardiogram and the total incidence of abnormal electrocardiogram was 13.62% (460/3378). The relatively high incidence was T-wave changes,QRS low voltage and ST-T changes,the detection rate being respectively 2.69% (91/3378), 1.92% (65/3378) and 1.72% (41/3378). The highest incidence of abnormal electrocardiogram (26.76%,55/213),the intermediate(21.50%,43/200) and the lowest(5.50%,12/218) was respectively found in Pingyi,Qingzhou and Sishui. Conclusions The threatened crowds in KSD endemic area in Shandong province are still in a state of high abnormal electrocardiogram detection,and electrocardiogram is of great value in the evaluation of KSD patients.