Objective To explore the correlation of serum matrix metalloproteinase-2 (MMP-2) and tissue metalloproteinase inhibitor-2 (TIMP-2) levels to carotid atherosclerosis plaque vulnerability in patients with anterior circulation infarction. Methods Sixty patients with anterior circulation infarction and 38 healthy volunteers were enrolled in this study. Color Doppler ultrasonography of the carotid artery was performed to determine the carotid intima-media thickness (IMT), Crouse plaque integral (CPI) score, and the total carotid plaque area (CPA). According to the nature of the carotid atherosclerosis plaque defined by ultrasonography, the patients were divided into vulnerable plaque (VP) group (33 cases), stable plaque (SP) group (27 cases), and no plaque (NP) group (38 cases). Serum MMP-2 and TIMP-2 levels were detected in these subjects using enzyme-linked immnosorbent assay (ELISA). Results Ultrasonography showed significantly greater/MT, CPI and CPA in VP group than in SP and NP groups (P<0.05). Serum MMP-2 level was significantly elevated in VP group as compared with that in SP and NP groups (P<0.05). Serum TIMP-2 level was significantly lower in VP group than in SP and NP groups (P<0.05). In VP group, serum MMP-2 level and MMP-2/TIMP-2 ratio were found to positively correlate to IMT, CPl and CPA (r=0.961, 0.966, and 0.804 for MMP-2, respectively, P<0.05;r=0.625, 0.709, and 0.651 for MMP-2/TIMP-2 ratio, respectively, P<0.05), while TIMP-2 was inversely correlated to IMT, CPI and CPA (r=-0.944, -0.996, and -0.859, respectively, P<0.05). Conclusion Serum MMP-2 and TIMP-2 levels and MMP-2/TIMP-2 ratio are closely correlated to carotid atherosclerosis plaque vulnerability.

Background: The angiography with micro-computed tomography (micro-CT) has been proved its great advantages on investigating the intra-osseous vascularity of carpal bones. But few researches have focused on the intra-hamate vascularity. This study aimed to illustrate the intra-osseous arteries of the hamate and the relationship between the intra-hamate vascularity and the avascular risk of different types of hamate fractures. Methods: Six normal cadaveric hamates were investigated with red lead (Pb₃O₄) micro-CT angiography. The intra-osseous arteries of specimens were clearly enhanced and the three-dimensional model was reconstructed. In order to study the features of the arterial entrances and intra-hamate vascularity, the diameters, quantities, locations of enhanced arteries, and the locations of transversal/proximal pole fracture lines on the body of the hamate were statistically compared. Besides, in order to analyze the relationship between intra-hamate vascularities and different hamate fractures, 127 cases of hamate fractures who presented in our hospital from March 2003 to June 2017 were retrospectively studied. Results: A total of 94 cases were followed up (range: 4-37 months; mean: 12.4 months) effectively. The overall union rate of hamate fractures was as high as 92.6% (87 of 94 cases), while non-union of fracture on hamate hook was more common (P = 0.031). The arterial entrances were located around the dorsal, volar, radial, ulnar non-articular surfaces of the hamate body and the hook of the hamate. Generally, there were one to two trunk arteries on the volar non-articular surface and one to three trunk arteries on the dorsal non-articular surface. They formed one or two arterial arches, from which some branches were emitted and supplied the proximal parts. The intra-osseous vascularities of the hamate body were generally located in the radial part. The blood supply of the hook was mainly from the volar non-articular surface in most specimens. Hamate fractures could be classified into four types: fractures of the transversal/proximal pole, medial tuberosity, dorsal coronal of the hamate body, and fractures of the hamate hook. Conclusions This study showed new features of intra-hamate vascularity and the results will guide surgeons to reduce the vascular damage during the hamate fracture operations. The fracture lines of different types of hamate fractures may disrupt the intra-hamate arteries. The intra-hamate vascularities will have different influences on the avascular risks of different hamate fractures.

BACKGROUNDThe etiology of Kienböck's disease is controversial, and the blood supply is a possible pathogenic factor. The red lead (Pb3O4) angiography with micro-computed tomography (micro-CT) of lunate to investigate intralunate arteries has rarely been reported. This study aimed to investigate a new, reasonable, and simplified technique to study the intraosseous arterial pattern of normal lunates.

METHODSThis study investigated the intraosseous arterial pattern of six normal cadaveric lunates through Pb3O4injection and three-dimensional reconstruction with micro-CT. The intraosseous arteries of all specimens were clearly enhanced. The data of enhanced arteries and nutrient foramina were shown as median (Q1, Q3) and analyzed with Wilcoxon signed-rank test.

RESULTSThe mean number of total nutrient foramina was 2.00 (1.75, 2.00) on the palmar side and 3.50 (2.50, 4.25) on the dorsal side. The number with enhanced arteries on the palmar side was 1.00 (0.75, 2.00) and on the dorsal side was 3.50 (1.75, 4.00). There were no significant differences between the number of nutrient foramina on the palmar and dorsal sides of the lunates, no matter the total number or enhanced arteries. The intraosseous arterial pattern in normal lunates can be classified into three types: the dominate stems from the palmar side, from the dorsal side, and from both sides with anastomosis.

CONCLUSIONSThe Pb3O4angiography with micro-CT is a simplified, quicker, and reliable method to study intraosseous arteries.