Treatment of scaphoid nonunion after failed surgery for acute scaphoid fracture presents a unique challenge.Prior surgery complicates evaluation of the patient and increases the technical difficulty of future procedures.Healing of nonunion is crucial to prevention of carpal collapse and progressive arthritis.It is required to identify whether the technical factors or treatment methods led to the failure of primary surgery.CT is important for confirming nonunion and planning revision surgery.Several studies have described the use of bone grafts and fixation devices for scaphoid nonunion repair,including nonvascularized and vascularized bone grafts,screws,pins,and plates.Satisfactory healing rates have been achieved using nonvascularized bone grafts supplemented with screw or wire fixation,especially in the absence of bone necrosis.Although vascularized grafts require high demanding surgical skills,they improve the odds of union in the setting of osteonecrosis.

BACKGROUND:The main change of knee osteoarthritis is cartilaginous degeneration and secondary bone hyperplasia. The mechanism of these pathological changes is unclear, but some experiments have proved that the onset of knees osteoarthritis is closely related to inflammatory substances.
OBJECTIVE:To discuss the role of inflammatory substances in the pathogenesis of knee osteoarthritis.
METHODS:According to diagnostic criteria set by the American Colege of Rheumatology, we selected 60 knee osteoarthritis patients as experimental group, and another 60 patients undergoing the operative treatment of traumatic amputation or meniscus injury (except knee injury) as control group. After extracting synovial fluid samples from two groups, ELISA assay method was used to detect the levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor α, basic fibroblast growth factor, and osteopontin. The nitric oxide level in the synovial fluid was detected with nitric oxide detection kit. The content of lipid peroxidase was detected using TBA fluorescence method.
RESULTS AND CONCLUSION:We found higher levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor α, basic fibroblast growth factor, osteopontin, nitric oxide, and lipid peroxidase in knee osteoarthritis patients, and these levels were positively correlated with knee osteoarthritis. These inflammatory substances are realy involved in the inflammation process of knees osteoarthritis.

OBJECTIVE: To compare the influence of traditional Chinese compound recipes (TCCRs) with different efficacy on body weight, tumor weight and immune function in H22 cancer-bearing mice. METHODS: H(22) cancer-bearing mice were chosen to observe the effects of TCCRs with different efficacy on tumor growth inhibition and detect the proliferation function of T lymphocytes, the activity of natural killer (NK) cells, the changes of T lymphocytes and the content of interferon-gamma (IFN-gamma)and interleukin-4 (IL-4). RESULTS: Tumor weight of H(22) cancer-bearing mice in Yidu Gongdu Recipe (YDGDR, a compound traditional Chinese herbal medicine using poison as an antidote for poison)-treated group was obviously lighter than that in the other TCCR-treated groups and the tumor inhibition rate in YDGDR-treated group was 65.76% (P<0.01). The tumor inhibition rates in other TCCR-treated groups were ranged from 10.1% to 17.1% . Body weight of mice in YDGDR-treated group was obviously decreased and depilation was observed at the same time. Pelage of mice in Fuzheng Peiben Recipe (FZPBR, a compound traditional Chinese herbal medicine for supporting the healthy energy)-treated group grew well, and behavior of the mice was active. Stimulation index (SI) of T lymphocyte transformation in YDGDR-treated group was obviously increased (SI=4.34, P<0.01), which showed the proliferation function of T lymphocyte was very strong. The SI of T lymphocyte transformation in the other groups was less than three, which showed the proliferation function of T lymphocytes was not significant. Compared with normal saline (NS)-treated group, percentages of NK cells in Qinre Jiedu Recipe (QRJDR, a compound traditional Chinese herbal medicine for clearing away heat and toxic substances)-treated, Huxue Huayu Recipe (HXHYR, a compound traditional Chinese herbal medicine for activating blood circulation to dissipate blood stasis)-treated and YDGDR-treated groups were obviously increased and 5.05, 4.07 and 5.17 times more than the NS-treated group, respectively (P<0.01). The activity of NK cells wasn't increased in the FZPBR-treated and HXHYR-treated groups. The production of IFN-gamma induced by T cells in YDGDR-treated group was obviously raised (P<0.05), and the production of IL-4 induced by T cells in QRJDR-treated, HXHYR-treated, Huatan Sanjie Recipe (a compound traditional Chinese herbal medicine for eliminating phlegm and resolving masses)-treated and YDGDR-treated groups was also raised obviously (P<0.01). CONCLUSION: YDGDR has a good effect of inhibiting tumor growth and can reinforce cellular and humoral immune function in tumor-bearing mice. FZPBR can strengthen the body.

OBJECTIVE: To investigate the mechanisms of tumor inhibiting and immunoloregulation of Mylabris Mixture on H22 cancer-bearing mice. METHODS: H22 cancer-bearing mice were chosen to observe the effects of tumor inhibiting and detect the proliferation function of T lymphocytes, the toxicity function of NK cells, the changes of T lymphocytes and the contents of interferon-gamma and interleukin-4. RESULTS: Mylabris Mixture could obviously inhibit the growth of H22 cancer in mice, and the tumor inhibition rat was 65.76%. The stimulation index of T lymphocyte transformation and percentage of NK cells in Mylabris Mixture-treated group were obviously higher than those in the normal control group. The subpopulation proportion of T lymphocytes in Mylabris Mixture-treated group was changed more than the normal control group. The production of interferon-gamma and interleukin-4 by T lymphocytes obviously increased in Mylabris Mixture-treated group (P<0.05, P<0.001). CONCLUSION: Mylabris Mixture has the effect of inhibiting the growth of tumor constitution, and regulating immunological function on mice with tumor. Its mechanisms include the reinforcement of T lymphocyte immune function, NK cell killing function and humoral immune function.

Objective:To explore the cost-effectiveness of alfacalcidol and cinacalcet for the treatment of secondary hyperparathyroidism in dialysis patients compared with parathyroidectomy.Methods:A total of 60 patients with secondary hyperparathyroidism treated at the Third People's Hospital of Chengdu from 2011 to 2020 were studied, patients were randomly divided into three groups: cinacalcet group, alfacalcidol group and parathyroidectomy group, with 20 cases in each group.Result:The improvement rate of bone pain and skin pruritis in parathyroidectomy group were higher than that in cinacalcet group and alfacalcidol group ( χ2=16.282, P<0.001; χ2=12.823, P=0.002). After 12 months of treatment, iPTH in the parathyroidectomy group and the cinacalcet group was significantly lower than that in the alfacalcidol group ( HR=1.36, 95% CI: 1.00-1.72, P<0.001; HR=1.27, 95% CI: 0.91-1.63, P<0.001); Serum calcium in the parathyroidectomy group was significantly lower than that of the other two groups ( HR=0.18, 95% CI: 0.12-0.24, P<0.001; HR=0.14, 95% CI: 0.08-0.20, P<0.001). The cost of complications management in the parathyroidectomy group was the lowest ( H=40.534, P<0.001), with bone pain being the most cost concern ( H=38.494, P<0.001). Patients with iPTH>2 800 pg/ml had the highest costs than with 800~1 800/ml and 1 800~2 800/ml ( H=43.798, 37.260, P<0.001). Conclusion:Surgical treatment should be the first choice for patients with secondary hyperparathyroidism, especially for patients with iPTH>2 800 pg/ml and bone pain.