Many studies have shown that the embolism caused by vulnerable atherosclerotic plaque is one of the major causes of ischemic stroke. However, there is still not a simple and precise method to identify the vulnerable plaques yet. This article reviews the various methods for detecting vulnerable plaques from the aspects of serology and imaging.

BACKGROUND: Scoliosis is a kind of commonly seen spinal deformity, and as a recommended therapy,autologous bone graft has obtained satisfactory outcomes, but there are still some limitations.OBJECTIVE: To observe the therapeutic effect of allogeneic bone and autologous iliac bone graft for scoliosis.METHODS: Ninety-two patients with scoliosis received posterior pedicle screw fixation and selective spinal fusion:46 cases for autologous bone transplantation (control group), and the others for allogeneic bone transplantation (observation group). The clinical indexes, Cobb angle loss rate, bone graft fusion and adverse reactions in the two groups were evaluated postoperatively.RESULTS AND CONCLUSION: The recovery time of the initial body temperature, white cell count and erythrocyte sedimentation rate returned to normal as well as drainage time in the control group were significantly shorter than those in the observation group (P < 0.05). There was no significant difference in the Cobb angle loss rate between groups at 3,9 and 15 months postoperatively (P > 0.05). The bone graft fusion rate showed no significant difference at 3, 6, 13 and 24 months postoperatively (P > 0.05). The screw loosening, ruptured and broken robs occurred neither in control group nor in the observation group. The incidences of pain and infection in the control group were significantly higher than those in the observation group (P < 0.05). These findings suggest that both allogeneic bone and autologous iliac bone graft can achieve satisfactory efficacy in the treatment of scoliosis.

Objective To investigate the protective effect of green tea-based cream at different con- centrations on photoaging and photo-immunosuppression. Methods Twenty healthy female volunteers were enrolled into this study with informed consent. Green tea-based cream with a mass fraction of 2%-5% (pre- pared by adding green tea extracts to an emollient formulation), excipient or green tea extracts alone were applied to six unexposed sites on the back of these volunteers. Thirty minutes later, these treated sites were subjected to solar-simulated ultraviolet irradiation (ssUVR) with a 1.5-fold minimal erythema dose once a day for 4 days. At 6, 24 and 48 hours after the last irradiation, green tea-based cream were applied repeatedly to the corresponding sites. Biopsy specimens were obtained from the seven sites 72 hours following the last irradiation, and immunohistochemical staining was performed to detect cytokeratin 5/6 and 16 expression, as well as the densities of CDla- or HLA-DR-positive cells. Resttlts Green tea-based cream at a mass fraction of 2% to 3% could effectively prevent ssUVR-induced obvious erythema and hyperpigmentation. The posi- tivity (+) rates plus strong positivity (++) rates reached 50% and 25% for CK5/6 in the sites treated with ssUVR only and those irradiated and protected with green tea cream at a mass fraction of 3%, respectively, 69% and 31% in the sites treated with ssUVR only and those irradiated and protected with green tea-based cream at a mass fraction of 2%, respectively. Compared with the control site without irradiation or protec- tion, a decrease over 75% was noticed in the density of epidermal CD1a- or HLA-DR- positive Langerhans cells in the irradiated sites without protection, and green tea-based cream, especially those at a mass fraction of 3%, could effectively inhibit the density decrease. Conclusion Green tea extracts could effectively pro- tect skin from photoaging and photo-immunosuppression with the optimal mass fraction at 2% or 3%.

Objective:To study the value of 3D print technique in the reconstruction of the defects and malformations of oral and maxillofacial bone.Methods:6 cases with defects and malformations of oral and maxillofacial bone were examined by CT scanning,treated by the implantation of 3D printed implants.Results:Before operation,3D printed model clearly showed the status of the defects and malformations for the precious preoperative implant shaping.The implants for the reconstruction were prepared by 3D print techinique.Perfect reconstruction of the defects was achieved.Conclusion:3 D printing technology exerts promising values in the precious and effective reconstruction of the defects and malformations of maxillofacial bones.

Objective To evaluate the curative effect of stress urinary incontinence (SUI) with Tconsling suspension surgery. Methods From May 2010 to September 2011,we treated 9 cases SUI with T-consling suspension surgery.The average age was 51 years (range 45 -63 years).They all suffered from stress incontinence 1 -5 years. Urodynamic test were performed preoperatively and stress urinary incontinence was confirmed.Abdominal leak point pressures is between 75 - 103 cm H2O (average 87 cm H2O),and no obvious cystocele vaginalis and others pelvic organ prolapsed disease were detected.Operation was done by transvaginal front wall incision to place T-consling suspension tape beneath the middle urethra.Results Operation time were between 15 to 25 mins,with 17 minutes on average.EBL was 5 - 30 ml.Urinary catheters were drawn 3 -4 d postoperatively.In 9 cases,8 were cured,one improved.The improved case had leakage when abdominal pressure increases,but became less significant,and the other cases had no leakage when abdominal pressure increases.The short-term cure rate was 89％. Conclusions The Tconsling suspension is safe,effective and easy to perform for the treatment of SUI,however,longer follow-up and more cases are necessary to confirm the long-term effects of this procedure.

Objective:To determine the relationship between uric acid (UA) and mild cognitive impairment (MCI), and its potential effect on inflammation.Methods:450 patients with MCI diagnosed by neuropsychological scale and 450 controls with normal cognitive function were included. All subjects were≥60 years old. There were 184 obese subjects in MCI group and 199 obese subjects in control group.Results:A correlation between increased serum UA level and decreased risk of MCI was found in all MCI patients and non-obese MCI patients ( OR: 0.60, 95% CI 0.45-0.78; OR: 0.42, 95% CI 0.29-0.62), but not in obese MCI patients ( OR: 0.86, 95% CI: 0.54-1.35). The levels of UA and hypersensitive C reactive protein (hs-CRP) in obese patients with MCI were higher than those in non-obese patients ( P<0.01). There was a linear positive correlation between serum UA and hs-CRP levels in obese patients with MCI ( r=0.505, P<0.01), but not in non-obese MCI patients ( r=0.053, P=0.385). Conclusion:A significant correlation between lower serum uric acid levels and higher risk of MCI in non-obese subjects was found. Inflammation caused by obesity may weaken this relationship.

Objective To evaluate distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column.Methods A retrospective study was conducted of the 18 patients who had been treated surgically at Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital between May 2014 and March 2017 for Lisfranc injury complicated with compressive fracture of lateral foot column.They were 10 males and 8 females,with an average age of 38.4 years (from 25 to 65 years).The injury involved the right foot in 11 cases and the left foot in 7.Their concomitant injuries were 12 compressive cuboid fractures and 6 compressive fractures of the calcaneal anterior process.According to the Chiodo-Myerson classification,there were 13 cases of three-column injury,3 ones of middle-lateral column injury and 2 ones of medial-lateral column injury.All the injuries were closed.After the condition of foot soft tissues permitted,open reduction assisted by a distractor and internal fixation with a mini locking plate was performed.Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores and visual analogue scale (VAS) at the final follow-ups and complications during follow-up.Results The 18 patients were followed up for one to 4 years (average,2 years).Their AOFAS hindfoot-ankle scores ranged from 55 to 96 points (average,80.4 points);their VAS ranged from 0 to 6 points (average,1.5 points).Radiographic evidence of degeneration was noted in 10 patients.Of them,2 reported persistent pain which was cured by arthrodesis after conservative therapy failed and one presented with symptoms of injury to sural and cutaneous nerves which disappeared after oral administration of neurotrophic drugs for half a year.No such complication as skin necrosis,infection or implant failure occurred in other patients.Conclusion Open distractor-assisted reduction and internal fixation of lateral foot column with a mini locking plate,combined with bone graft if necessary,is an effective treatment for Lisfranc injury complicated with compressive fracture of lateral foot column,because it can effectively restore the alignment of lateral column and result in satisfactory therapeutic effects.

Objective To evaluate the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation.Methods From February 2014 to June 2017,15 patients (15 feet) with intra-articular calcaneal fracture associated with peroneal tendon dislocation were treated at Department of Foot and Ankle Surgery,Orthopaedics Hospital of Zhengzhou.There were 9 males (9 feet) and 6 females (6 feet),and 8 left feet and 7 right feet.The patients were aged from 20 to 55 years (average,42.5 years).After reduction of calcaneal fractures,titanium plates and screws were used for fixation.The bone canal was established on the lateral malleolus,and the torn superior peroneal retinaculum was fixed to the lateral malleolus by suture after reduction of the peroneal tendon.The ankle joint was immobilized with a plaster brace in the metatarsal flexion for 6 weeks.The postoperative outcomes were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS);complications were recorded.Results All the 15 patients were followed up for 12 to 36 months (average,20.5 months).All the calcaneal fractures fully healed and no re-dislocation of the peroneal tendon occurred.The AOFAS hindfoot-ankle scores ranged from 80 to 95 points,averaging of 87.4 points;the VAS scores ranged from 0 to 5 points,averaging 1.5 points.Delayed wound healing was observed in one case but primary healing was achieved eventually with regular dressing change.Another case presented with symptoms of injury to the cutaneous branch of the sural nerve which disappeared after oral administration of neurotrophic drugs for 6 months.Another case suffered from subtalar arthritis accompanied by persistent pain which disappeared after subtalar arthrodesis.No other complications were observed in the other patients.Conclusion In the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation,the peroneal tendon dislocation should be treated simultaneously with the intra-articular calcaneal fracture to achieve satisfactory clinical outcomes.

Objective To evaluate Evans lateral lengthening calcaneal osteotomy(E-LLCOT) in the treatment oftalocalcaneal coalitions (TCCs) with forefoot abduction deformity in the teenagers.Methods From February 2014 to August 2018,11 teenaged patients (14 feet) were treated at Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital for TCCs with severe forefoot abduction deformity.They were 6 males (8 feet) and 5 females (6 feet),aged from 13 to 17 years (average,15 years).Their diseases involved bilateral feet in 3 cases and unilateral foot in 8,the left foot in 7 cases and the right in 7.All patients underwent TCCs resection followed by E-LLCOT.Their talonavicular coverage angles (TCA) and talar-second metatarsal angles (T2-MT) on the anteroposterior film and talar horizontal angles (TH) and talar-first metatarsal angles (T1-MT) on the lateral film were measured preoperatively and at the last follow-up.The foot functions were evaluated preoperatively and at the last follow-up using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS).Results All the 11 patients were followed up for 12 to 24 months (average,16.5 months).The mean preoperative TCA (22.3°,from 20° to 26°) was improved to 10.5° (from 8° to 13°) at the last follow-up;the mean T-2MT was improved from preoperative 17.6° (from 16° to 20°) to 6.5° (from 5° to 11°) at the last follow-up;the mean TH on the lateral view was improved from preoperative 35° (from 25° to 40°) to 17.5° (from 16° to 21°) at the last follow-up;the mean T-1MT was improved from preoperative 15.5° (from 10° to 22°) to 3.5° (from 2° to 6°) at the last follow-up;the mean AOFAS score was improved from 56.5 (from 50 to 62) preoperatively to 90.6 (from 75 to 95) at the last follow-up;the mean VAS score was improved from 6.0 (from 5 to 7) preoperatively to 2 (from 0 to 3) at the last follow-up.Conclusion For TCCs with severe forefoot abduction deformity in the geenagers,E-LLCOT after TCCs resection can effectively correct deformity,relieve pain and achieve significant functional and radiographic improvements.

Objective:To analyze the therapeutic effect of ankle arthrodesis with reverse proximal humerus internal locking system plating plus cannulated screwing via the transfibular approach in the treatment of end-stage ankle arthrosis.Methods:From April 2014 to January 2018, 19 patients (19 ankles) with end-stage ankle osteoarthritis were treated at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital by ankle arthrodesis with reverse PHILOS plating plus cannulated screwing via the transfibular approach for multi-plane fixation. They were 9 men and 10 women, aged from 36 to 65 years (average, 46.7 years). The disorder was further diagnosed as traumatic arthritis in 9 cases, as osteoarthritis in 6, as talar necrosis in 2 and as equinovarus in 2, and affected the left ankle in 11 cases and the right in 8. All cases belonged to stage Ⅲ osteoarthritis according to the Morrey-Wiedeman imaging classification. Their American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), joint fusion and complications were observed preoperatively and at the last follow-up.Results:All the 19 patients were followed up for 18 to 62 months (average, 31.5 months). Their AOFAS scores were improved from preoperative 46.3±2.1 to 81.6±0.9 at the last follow-up, and their VAS was reduced from preoperative 7.1±0.2 to 2.0±0.2 at the last follow-up, showing significant differences ( P<0.001). All their ankle joints obtained bony fusion after 9 to 14 weeks (mean, 11.5 weeks). No implant loosening or breakage was observed. All the patients were satisfied with their operative results at the last follow-up. Dorsal lateral foot numbness was observed in one patient who became asymptomatic after neurotrophic medication for 3 months. Lateral distal wound dehiscence happened during removal of stitches at 2 weeks after operation in another patient but healed after debridement. The last follow-up found subtalar joint degeneration in 2 cases and talonavicular joint degeneration in one but no clinical symptoms in the 3. Conclusion:Ankle arthrodesis with reverse PHILOS plating plus cannulated screwing via the transfibular approach is a fine treatment for end-stage ankle arthrosis, because it leads to reliable fixation, short fusion time, alleviated pain and improved ankle function.