Anterior shoulder instability is a very difficult issue to treat,especially with glenoid bone defect.When the defect is small,there is little influence on shoulder instability.The larger the defect is,the more influence there will be.Most authors agree that glenoid bone reconstruction should be considered when glenoid bone defect is more than 20％-25％.In this condition soft tissue procedures alone are not enough to provide stability to the shoulder.To date,there is still not an ideal typing of glenoid bone defect.There are many methods of assessing the size of bone defect.Pico system is one of the most common methods,as it is easier and more precise.Numerous surgical procedures have been described to address the bone defect.The Bristow procedure,the Latarjet procedure and the Eden-hybinette procedure are effective and most popular around the world.The Latarjet procedure can provide more bone blocking than the Bristow procedure,and is more popular.The Eden-hybinette procedure dose not need coracoid transfer and then has no damage of normal anatomical structure.But it also lack the hanging effect of the conjoint tendon.After all,each procedure has its advantage and disadvantage in treating anterior shoulder instability associated with glenoid bone defect and should be chosen depending on the characteristics of each patient and the preference of each surgeon.Furthermore,more new and effective treatments are still needed.

Objective to investigate the curative effect of activated vitamin D3 combined with IFN-α on CCl4-induced hepatic fibrosis in BALB/c mouse model. Methods the experimental mice received 100 μL of 10% CCl4 intraperitoneally to induce a model of hepatic fibrosis,and the nor-mal control group were administrated with same volume of 0.9% saline(n = 6). the experimental mice then were randomly divided into four treat-ment groups and treated for six weeks:saline therapy group(0.9% saline,100 μL/mouse,n = 6),IFN-α therapy group(IFN-α 800 U/mouse,n =6),1,25-(OH)2D3 therapy group(50 μg/kg,by gavaged,n = 6)and combined treatment therapy group(combined treatment,n=6). Hepatic inju-ry and hepatic pathology were examined by HE staining and Masson staining. Interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(tNF-α),transforming growth factor-β(tGF-β)and Smad3 were determined by real-time PCR and ELISA. Results Inflammatory cell infiltra-tion and periportal collagen deposition were significantly reduced in all the therapeutic group expect saline therapy group assessed by HE and Masson staining. the IFN-α therapy group,1,25-(OH)2D3 therapy group and combined treatment therapy group displayed significant decrease in Col1α1, IL-6,tNF-α,tGF-β and Smad3 expression and increase in IL-10 expression in liver tissue(P < 0.05). Conclusion the effect of 1,25-(OH)2D3 combined with IFN-α therapy is similar to separated treatment.

Objective To comparative evaluation the application value of high frequency ultrasound (HFU)and magnetic reso-nance imaging (MRI)in the diagnosis of rotator cuff tears(RCT).Methods 86 patients of unilateral RCT confirmed by shoulder ar-throscopy were chosen.The detection rate by HFU and MRI before the surgery was compared.Shoulder arthroscopic finding was as the evaluation standard,the accuracy of HFU and MRI in the diagnosis of RCT was calculated which included:total (full and partial) RCT,full RCT,partial RCT.Chi-square test was used to compare the accuracy rate.Results Among 86 patients,30 patients with full RCT and 56 patients with partial RCT were detected by shoulder arthroscopy,in which 28 patients with full RCT and 43 patients with partial RCT were found by HFU,and 28 patients with full RCT and 5 1 patients with partial RCT were found by MRI respec-tively.The accuracy of HFU and MRI in the diagnosis of total,full,partial tear RCT were 82.6%,93.3%,76.8% and 91.9%,93.3%, 91.6% respectively.There was no significant difference between HFU and MRI in diagnosing total and full RCT(P >0.05),the ac-curacy on HFU in diagnosing partial RCT was slightly lower than that on MRI (P <0.05).Conclusion Both HFU and MRI have relatively high accuracy in diagnosing full RCT,HFU is slightly lower than MRI in diagnosing partial RCT.

Objective To analyze the mammographic features and pathological characteristics among different molecular subtypes of breast cancer.Methods The results of 210 cases breast cancer identified by postoperative pathology were collected and classified to three groups;Luminal,HER-2(+)and TNBC(triple negative breast cancer)by molecular subtypes.Three groups'mammograph-ic features and pathological characteristics were compared.Results 210 cases included 147 Luminal cases,30 HER-2 (+)cases and 33 TNBC cases.There were statistically significant difference between tumor grading and lymph node metastasis (P <0.05).Three groups had statistically significant difference among mass number,mass margin and calcification incidence(P <0.05),and had no sta-tistically significant difference between mass size and shape(P >0.05).The mammographic features of Luminal molecules subtypes showed more mass with burr,HER-2(+)molecules subtypes showed no fixed features but more calcification incidence than other groups,TNBC molecules subtypes showed merely mass with clear margin and less calcification.Conclusion The mammographic fea-tures and pathological characteristics of different molecular subtypes of breast cancer are significant differences.

ObjectiveTo study the effect of hydrogen peroxide (H2O2) in inducing apoptosis of typeⅡalveolar epithelial cell (AECⅡ) after overexpression by adenoviral transfection of micro RNA-21-5p (miR-21-5p), and to explore the mechanism of its anti-apoptosis.Methods Subculture AECⅡ were randomly divided into four groups: normal control group (normal saline), H2O2 challenge group ( 0.5 mmol/L H2O2), miR-21-5p overexpression group (miR-21-5p adenovirus+ 0.5 mmol/L H2O2), miR-21-5p negative transfection group (adenovirus void+0.5 mmol/L H2O2). Transmission electron microscopy and flow cytometry were used to detect apoptotic morphology and early apoptotic rate. Real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of miR-21-5p in AECⅡ, and Western Blot was used to detect the protein expressions of Bcl-2, Bax, and caspase-3 at the highest transfection efficiency at different time points (6, 12, 24, 48 hours).Results ① AECⅡ identification: fluorescence microscopy showed the presence of characteristic structure of AECⅡ, i.e. microvilli and osmiophilic lamellar bodies.② Apoptotic morphology: transmission electron microscopy showed cytoplasmic retraction, chromatin condensation, margination, lack of cell surface microvilli, and emptying of osmiophilic lamellar bodies in AECⅡ.③ The expression of miR-21-5p in AECⅡ: the highest transfection efficiency was found at 48 hours. The expression of miR-21-5p in miR-21-5p overexpression group was significantly higher than that of the normal control group, H2O2 challenge group and miR-21-5p negative transfection group (A value: 1.54±0.02 vs. 1.02±0.02, 0.56±0.03, 0.58±0.02, allP< 0.05).④ The rate of early apoptosis: compared with normal control group, the early apoptotic rates in H2O2 challenge group, miR-21-5p negative transfection group and miR-21-5p overexpression group were gradually elevated with the prolongation of injury time. The early apoptotic rate in miR-21-5p overexpression group was significantly lower than that of the H2O2 challenge group and miR-21-5p negative transfection group at all time points except 6 hours [12 hours: (10.73±2.80)% vs. (16.26±0.59)%, (16.04±0.70)%; 24 hours:(16.00±3.44)% vs. (23.29±2.78)%, (23.58±2.31)%; 48 hours: (31.30±3.55)% vs. (50.53±2.17)%, (49.41±1.97)%, allP< 0.05]. There was no significant difference in early apoptotic rate between miR-21-5p negative transfection group and H2O2 challenge group at each time point.⑤ Protein expression: the expressions of Bax and caspase-3 in miR-21-5p overexpression group were significantly lower than those of the H2O2 challenge group and miR-21-5p negative transfection group [Bax (A value): 0.07±0.01 vs. 0.18±0.01, 0.13±0.01; caspase-3 (A value): 0.07±0.01 vs. 0.23±0.01, 0.12±0.01, allP< 0.05], and Bcl-2 protein expression was significantly higher than that of the H2O2 challenge group and miR-21-5p negative transfection group (A value: 0.26±0.01 vs. 0.06±0.01, 0.10±0.01, both P< 0.05).Conclusions① miR-21-5p has the function of anti-apoptosis of AECⅡ.② Adenoviral vector is a successful gene transfer vector when transfected with AECⅡ.③ The anti-apoptosis of AECⅡ by miR-21-5p may be associated with reduced Bax and caspase-3 protein levels and raised expression levels of Bcl-2 protein.

BACKGROUND: Recent studies have demonstrated that sterol regulatory element binding protein-2 (SREBP-2) plays a key role in osteoarthritis, but its exact pathogenesis remains incompletely understood yet. OBJECTIVE:To investigate the expression of SREBP-2 in the process of interleukin-1β-induced articular chondrocyte degenerationin vitro. METHODS: Articular chondrocytes obtained from C57BL/6J mice were culturedin vitro. After the second passage, cels were randomly divided into four groups: control group, and three experimental groups treated with 10 μg/L interleukin-1β for 24, 48 and 72 hours, respectively. RESULTS AND CONCLUSION:The cels became hypertrophic after being stimulated by interleukin-1β, and the staining of colagen X was positive at 72 hours. MTT assay demonstrated that the cel activity after stimulation with interleukin-1β decreased with time. Results of RT-PCR showed that the expression of SREBP-2 and SREBP cleavage activating protein mRNA was significantly increased after stimulation with interleukin-1βas compared with the control group and increased with time. On the contrary, the expression of aggrecan and colagen II mRNA was decreased with time. It is revealed that interleukin-1β could inhibit the proliferation of regular chondrocytes and the expression of its extracelular matrix, and furthermore, induce chondrocyte hypertrophy. The expression of SREBP-2 showed a negative relationship with key cartilage genes during this interleukin-1β-induced degeneration.

Effect of interleukin-6 receptor (IL-6R) antibody on polymethyl methacrylate (PMMA) bone cement-mediated expression of osteoprotegerin (OPG) and receptor activator of nuclear factor-kappaB ligand (RANKL) in synovial fibroblasts was investigated. Synovial tissue obtained from total knee arthroplasty was digested and cultured. Inverted microscope was employed to observe the synovial cells and immunocytochemistry (SABC method) staining was used to identify synovial fibroblasts. This experiment was divided into three groups according to different culture media: PMMA group (75 μg/mL PMMA bone cement particles), IL-6R antibody group (10 ng/mL IL-6R antibody+75 μg/mL PMMA bone cement particles), and control group (no IL-6R antibody or PMMA bone cement particles). Influence of IL-6R antibody and PMMA on proliferation of synovial fibroblasts was measured by cell counting kit-8 (CCK-8). ELISA method was used to measure OPG and RANKL levels in culture solution. Fluorescence quantitative real-time PCR (FQ-PCR) was used to detect the expression of OPG and RANKL mRNA. After three consecutive passages, more than 95% of the primary synovial cells became long spindle fibroblast-like cells. SABC staining results showed that the fibroblast-like cells were negative for anti-CD68 antibody and positive for anti-vimentin antibody, with brown madder stained. CCK-8 test demonstrated that the absorbance (A) value at 450 nm was significantly lower in IL-6R antibody group than in PMMA group and control group (P<0.01), but there was no statistically significant difference in A value at 450 nm between the control group and PMMA group (P>0.05). Results of ELISA indicated that the expression of OPG was significantly higher in IL-6R antibody group than in PMMA group and control group (P<0.01). The expression of RANKL was inhibited (P<0.05), and the ratio of OPG/RANKL was significantly increased in IL-6R antibody group as compared with PMMA group and control group. There was no significant difference in the expression of OPG between control group and PMMA group (P>0.05), but the expression of RANKL was higher in PMMA group than in control group (P<0.05), and there was a significant difference in the ratio of OPG/RANKL between them (P<0.05). Results of FQ-PCR revealed the expression of RANKL mRNA was significantly inhibited (P<0.01) and the expression of OPG mRNA was significantly increased (P<0.01) in IL-6R antibody group as compared with PMMA group and control group. The expression of RANKL mRNA was higher in PMMA group than in control group (P<0.05), but the expression of OPG mRNA had no significant difference between them (P>0.05). IL-6R antibody could significantly increase the expression of OPG, but inhibit the expression of RANKL, which might provide a theoretical basis of molecular biology for the prevention and treatment of aseptic loosening of prosthesis.

Objective To explore the relationship between gastric juice pH and hospital-acquired pneumonia ( HAP) , the gastric bacterial colonization and etiology of HAP in neurologic intensive care unit patients by monitoring gastric juice pH value.Methods From October 2014 to May 2015, consecutive seventy-two tube feeding patients admitted in the Department of Neurology Intensive Care Unit in Xijing Hospital were enrolled in this research.The type and concentration of pathogens from gastric contents were collected, while samples from upper respiratory tract and pharynx were detected dynamically at the same time.Results (1)The group with new onset HAP was higher in gastric juice pH (6.4(5.4,6.4) vs 5.4 (2.5, 6.4), Z=-2.37, P=0.01); (2) The isolation rate of colonized bacteria in gastric cavity was associated with the pH of gastric juice , achieving 60.8% ( 42/69 ) in HAP group; ( 3 ) When the gastric juice pH was >4, the isolation rate of Gram-negative bacilli in gastric cavity obviously increased (63.6%(28/44) vs 35.7%(10/28),χ2 =5.323, P=0.021); (4)The same pathogens were found in stomach-pharynx-upper respiratory tract in 7 cases ( 17.5%) of the total 40 HAP patients.Conclusion Increased gastric juice pH was associated with gastric colonization , especially Gram-negative bacilli , and may lead to a higher incidence of new onset HAP in patients on enteral feeding.

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combination use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively analyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some previous studies were not reliable.

OBJECTIVETo analyze the location, early diagnosis and treatment of osteofascial compartment syndrome (OCS).

METHODSThere were 38 males and 29 females with age range of 8 - 69 years (mean 38.1 years). All 67 cases were suffered from Wenchuan earthquake happened in May 12th, 2008, of which 34 focuses with tibia-fibular fracture, 9 focuses with femoral fracture, 4 focuses with humeral fracture, and 13 focuses with radius and/or ulna fracture. The occurred place of OCS involves calf (41 focuses), legs (25 focuses), hands (2 focuses), feet (3 focuses), hip (19 focuses), forearms (15 focuses) and upper arms (10 focuses). The clinical symptoms and characteristics were closely observed and treated with decompression posterior to conservative treatment or with prompt open decompression.

RESULTSOf 67 cases (115 focuses), 82 focuses with secondary suture won satisfactory recovery of blood circulation and extremity function, 23 wounds were closed with secondary suture and skin grafting, 5 limbs were amputated due to avascular necrosis and 2 cases died (5 focuses OCS). Of 115 focuses 11 focuses obtain part function, 7 focuses lost join function.

CONCLUSIONSThe proportion of some rare parts' pathogenesis of osteofascial compartment syndrome caused by the earthquake rises. Early diagnosis, close observation and open decompression are important for treatment of osteofascial compartment syndrome.

Adolescent ; Adult ; Aged ; Child ; Compartment Syndromes ; diagnosis ; etiology ; surgery ; Decompression, Surgical ; Early Diagnosis ; Earthquakes ; Female ; Humans ; Male ; Middle Aged ; Wounds and Injuries ; complications