OBJECTIVETo study on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty (TKA) the rotational alignment reference bony landmarks of the proximal tibial component on magnetic resonance image (MRI) were measured.

METHODSFrom January 2010 to December 2013, 80 normal knees of Chinese volunteers including 35 males and 45 females with an average age of (35.4±6.1) years were reviewed. The images of the knees were obtained by MRI. The surgical epicondylar axis (STEA) was identified in the femoral transverse sections and then was projected to the side of tibia, forming the SETA'. A line connecting the medial border of the patellar tendon and the middle of the posterior cruciate ligament insertion (Akagi line) and its vertical line (AK), as well as a line connecting the medial 1/3 of the patellar tendon and the middle of the posterior cruciate ligament insertion and its vertical line (AP), were identified in the tibial transverse sections. The angles were measured between the AK, AP and STEA'.

RESULTSThe angle between AK and STEA' was (0.59±2.07)°, and there was no significant difference between the two lines (t=-2.54, P=0.13). The mean angle between AP and STEA' was (3.21±2.04)°, and there was a significant difference between the two lines (t=14.05, P<0.05). There was a significant difference between the AK and AP (t=-11.68, P<0.05).

CONCLUSIONThe reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in TKA is good.

Adolescent ; Adult ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Rotation ; Tibia ; surgery

The effect of pioglitazone on mRNA expression of advanced glycosylation end products(AGE) receptor(RAGE)was observed in renal cortex of streptozotocin-induced diabetic rats.The RAGE mRNA expression was significantly raised in diabetic control group as compared with that in the normal control group(P

The aim of this study was to detect the localization and level of tyrosine phosphorylated proteins during in vitro capacitation of guinea pig sperm. Sperm from mature guinea pigs were incubated in modified TALP under 5% CO_2 in air at 37 ℃. The capacitation effect was assessed by chlortetracycline (CTC) staining. Western blotting and indirect immunofluorescence were used to analyze the level and localization of tyrosine phosphorylation. The results showed that guinea pig sperm underwent a time-dependent increase in protein tyrosine phosphorylation during the in vitro capacitation and the percentage of protein tyrosine phosphorylated sperm increased from 36% to 92% from the beginning of incubation to 7h incubation. Also, there was a shift in the site of phosphotyrosine-specific fluorescence from the head of sperm to both the head and the flagellum of sperm. Moreover, there were three proteins phosphorylated in this experiment. After 0 to 0.5h incubation, the protein of 40kDa was detected by anti-phosphotyrosine monoclonal antibody, and the intensity of this protein increased in the following incubation. Then, after 1h incubation, another protein of 80kDa was found and the level of this protein reached the highest point at 3h. Also, in 3h incubation, a protein of 45kDa was detected and the intensity of this protein increased in the following incubation.

OBJECTIVETo evaluate the efficacy and safety of etanercept plus Tripterygium wilfordii polyglycoside (TWP) in elderly patients with active rheumatoid arthritis (RA).

METHODSTotally 46 elderly patients with active RA were randomly assigned to the treatment group (22 cases) and the control group (24 cases). All patients received subcutaneous injection of etanercept, 25 mg each time, twice per week. The dosage was reduced to once per week 3 months later. Patients in the treatment group took TWP Tablet (10 mg each time, three times per day), while those in the control group took methotrexate (MTX), 10 mg each time, once per week. The whole course lasted for 24 weeks. Patients' rest pain, tender joint number, swollen joint number, health assessment questionnaire (HAQ), patients' global assessment, physicians' global assessment, erythrocyte sediment rate (ESR), C reactive protein (CRP), rheumatic factor were assessed at week 0, 4, 8, 12, and 24. The curative effect was statistically evaluated by the United States Institute of Rheumatology ACR20, ACR50, and ACR70 improvement criteria. Meanwhile, any adverse event was recorded and evaluated.

RESULTSTotally 41 completed the trial, and 5 dropped off (3 in the treatment group and 2 in the control group). Compared with the control group, there was no statistical difference in ACR20, ACR50, or ACR70 in the treatment group (P > 0.05). Compared with before treatment in the same group, there was some improvement in tender joint number, swollen joint number, visual analogue scale (VAS) for patients' global assessment, VAS for physicians' global assessment, ESR, CRP, and HAQ between the two groups, showing statistical difference (P < 0.05). Compared with the control group in the same phase, there was no statistical difference in the treatment group (P > 0.05). There was no statistical difference in the occurrence of adverse events between the two groups.

CONCLUSIONSEtanercept plus TWP could achieve equivalent therapeutic effect to that of Etanercept plus MTX. The two regimens could improve clinical signs, symptoms, and QOL related to RA. They were well tolerated in the treatment of elderly patients with active RA.

Aged ; Antirheumatic Agents ; therapeutic use ; Arthritis, Rheumatoid ; drug therapy ; Drug Therapy, Combination ; Etanercept ; Female ; Glycosides ; therapeutic use ; Humans ; Immunoglobulin G ; therapeutic use ; Male ; Middle Aged ; Receptors, Tumor Necrosis Factor ; therapeutic use ; Treatment Outcome ; Tripterygium ; chemistry

OBJECTIVETo evaluate the safety and reliability of percutaneous internal fixation for pelvic ring injuries with cannulated screws.

METHODSForty-eight patients (21 male and 27 female, aged from 17 to 61 years with an average age of 38 years) with unstable pelvic ring injuries were treated with closed reduction and percutaneous cannulated screws fixation under C-arm fluoroscopic guidance. According to Tile's classification, the patients were classified into type B1 in 4 cases, B2.1 in 8, B2.2 in 10, B3 in 4, C1 in 11, C2 in 7 and C3 in 4. Among them, 39 patients were treated with anterior and posterior fixation, 4 were treated with anterior fixation, and 5 were treated with posterior fixation alone. Anteroposterior, inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities, and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.

RESULTSThe average operative time was 55 minutes (range, 15 to 95 minutes), and the average intraoperative blood loss was 60 ml (range, 15 to 150 ml), no patient accepted blood transfusion during or after operation. All 48 patients were inserted 157 cannulated screws (mean 3.3, range 2 to 8 per patient). Forty-two patients (135 screws) underwent postoperative pelvic CT scan and 91.11% (123 screws) of them was considered in optimal location; 7 screws penetrated the wall of pelvis and acetabulam because of overlength (<0.5 cm) or deviation, 5 screws interfered with the sacral canal or foramen. Fortunately, these 12 screws did not cause any symptom to the patients. The average follow-up period was 13 months (range 8 to 49 months), the displacement of injured pelvis was satisfactorily corrected in 45 patients (93.75%) and the fractures were healed at one stage. Among all patients, 40 cases (83.33%) had returned to their original works, 4 were still in the process of recovery at the last follow-up and the other 4 were unemployed as sciatic nerve injury or amputation. According to Lindahl improved standard of functional assessment of pelvic injury, the result was excellent in 35 cases, good 10 and fair 3, the average score was 78.7.

CONCLUSIONWith better understanding of the pelvic anatomy, and under C-arm fluoroscopic guidance, treatment of closed reduction and percutaneous cannulated screw internal fixation for unstable pelvic ring injuries is a safe, reliable and feasible method. The clinical outcome is satisfactory.

Adolescent ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Pelvic Bones ; injuries

BACKGROUND:Percutaneous vertebroplasty and percutaneous kyphoplasty have become the mainstream clinical methods for the treatment of vertebral compression fractures. However, both of them have several shortcomings such as bone cement leakage, spinal stenosis, nerve compression, pulmonary embolism and other issues. OBJECTIVE:To verify the possibility of bone filing mesh container prepared by polyethylene terephthalate for the treatment of vertebral compression fractures. METHODS:The biological properties of bone filing mesh container were examined according to GB/T16886. After sample aging test, the tensile properties of the aged samples and the fresh prepared samples were compared. The expansion and bone cement leakage were evaluated by injecting bone cement into the bone filing mesh container and measuring the pressure. The initial strength and stiffness of the fresh pig vertebrae with calcium phosphate cement injection or with bone filing mesh container filed with calcium phosphate cement were compared. The in vivo bone tissue growth was periodicaly observed after the lumbar vertebra of 4-month-old pigs was implanted with the bone filing mesh container that was then ful of bone cement. RESULTS AND CONCLUSION: The bone filing mesh container had good biocompatibility. Bone filing mesh containers after 2-year storage had the same tensile strength to the fresh bone filing mesh containers. At ambient conditions, after bone cement injection, bone filing mesh containers could be expanded at 5-10 atm and therefore could play the role of uplift; at 7-10 atm, bone cement could leak out from the bone filing mesh container and enter into the interspace between surrounding bone tissues, thus playing the role of adhesion and fixation. The vertebrae after bone cement injection with or without bone filing mesh containers had the same initial strength and stiffness and exhibited bigger initial strength and stiffness than untreated vertebrae. Thein vivo animal experiments proved that bone filing mesh container had no obvious effect on the vertebrae. These findings indicate that the bone filing mesh container can be used to restore the height and strength of the fractured vertebrae. Moreover, it may eliminate bone cement leakage and therefore increase the surgery safety.

OBJECTIVETo compare therapeutic effects between clavicular hook plate and tension band fixation for the treatment of Allman type II to III sternoclavicular joint dislocations.

METHODSA retrospective survey was analyzed from May 2000 to September 2008. A total of 31 patients with Allman type II to III sternoclavicular joint dislocations were followed up. Sixteen patients were fixed with the clavicular hook plate (Group A) including 11 males and 5 females, with a mean age of (37.4 +/- 7.3) years. Fifteen patients were treated with tension band fixation (Group B) including 9 males and 6 females, with a mean age of (35.6 +/- 5.1) years. The indexes of intra-operation and during the hospital stay, the clinical outcomes and postoperative complications were statistically compared.

RESULTSAll the patients were followed up for 12 to 37 months, with an average of 20 months. There was no significant differences in data of operative time, blood loss and length of incision between the two group (P > 0.05); however, the economic cost was significantly much more in Group A (P < 0.01). Also, there was statistically difference in the incidence of complications between the two groups (P = 0.023), which were 2 patients in Group A and 8 patients in Group B. According to Rockwood evaluation criteria, in group A, 13 patients got an excellent result, 2 good and 1 poor; in group B, 10 patients got an excellent result, 3 good, 1 poor and 1 bad. There were no statistical difference in good and excellent rate.

CONCLUSIONThe clavicular hook plate for the treatment of Allman type II to III sternoclavicular joint dislocation is believed to be as good as tension band fixation, but there are fewer complications and in favor of early exercise.

Adult ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; surgery ; Male ; Orthopedic Fixation Devices ; Sternoclavicular Joint ; injuries

OBJECTIVETo investigate the effect of Lianggesan on the expression of signal transducer and activator of transcription 1 (STAT1) in rats with lipopolysaccharide (LPS)-induced acute lung injury and explore the possible mechanisms of the therapeutic effects.

METHODSEndotoxemia was induced in Wistar rats by intravenous injection of LPS (5 mg/kg). The rats were randomly divided into 6 groups, namely the control group, acute lung injury group (LPS group), 3 Lianggesan groups treated at different doses, and LPS+DEX treatment group. Each group, except for the control group, was further divided into 5 subgroups and examined at 1, 2, 4, 8 and 16 h after LPS injection. Western blotting was used to detect the protein expression of STAT1 and p-STAT1 in the lung tissue.

RESULTSIn LPS group, the expression of STAT1 began to increase at 1 h following LPS injection, reaching the peak level at 4 h; the peak expression of p-STAT1 occurred at 2 h after LPS administration (P<0.01). Compared with LPS group, the 3 Lianggesan groups and DEX group showed significantly decreased expressions of STAT1 and p-STAT1 at 2, 4 and 8 h after LPS injection (P<0.05 or 0.01).

CONCLUSIONAbnormal expression of STAT1 occurs in the lung tissue in the event of ALI. Lianggesan can relieve LPS-induced acute lung injury in rats by decreasing the expression of STAT1 and p-STAT1.

Acute Lung Injury ; chemically induced ; drug therapy ; metabolism ; Animals ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Lipopolysaccharides ; Lung ; metabolism ; Random Allocation ; Rats ; Rats, Wistar ; STAT1 Transcription Factor ; genetics ; metabolism

Objective To investigate the safety and feasibility of en-bloc resection of a primary sacral chordona based on a 3-dimensional printing model.Methods 31 patients with primary sacral chordoma underwent en-bloc resection via a onestage posterior approach or combined anterior and posterior approaches in our oncology department from January 2013 to December 2014.They comprised 21 males and 10 females of mean age (49.2±12.5) years (range,26-67 years).Preoperative 3-D printing models were created by 3D printing technology,it included tumor tissue,the around vascular and nerves involved in sacral chordoma.The sacral chordomas were en-bloc resection with decompression and internal fixation.Results With the mean (29.0±6.8)months follow-up (range from 19 to 41),all patients underwent en bloc excision via 26 cases with posterior approach,5 cases combined posterior and anterior approaches in one stage.The mean operative time and estimated blood loss were (275.0±58.1) min and (3 250.0±1 304.4) ml,respectively.The visual analogue scale (VAS) score was (5.6±1.9) in average (range from 3 to 9) at preoperation,and (2.0±1.5) at post-operation,which was significantly lower than that of preoperation,and the pain was relief obviously.There were 13 cases in grade C,11 cases in grade D,7 cases in grade E of American Spinal Injury Association (ASIA) grade neurological function before surgery,compared with the pre-operation,there were 5 cases in grade C,6 cases in grade D,20 cases in grade E of post-operation,which was significantly improved.MSTS (Musculoskeletal Tumor Society) 93 score was 6-29 points (20.0％-96.7％) at the follow-up 3 months after surgery,with the average of (19.8 ± 5.8) points,which excellent in 8 cases,good in 14 cases,general in 5 cases,poor in 4 cases.Two cases of dysporia for the reasons of resecting on one side of the S1,2 nerve roots involved by the sacral chordoma,after sacrificing the nerve root of complete tumor resection,the urine left dysfunctional,while the pain of other 29 patients were thoroughly relief after surgery.The ones were relieved with the disturbance of sensation of the perineum before the operation.2 cases were recovery of leakage of cerebrospinal by the drainage of lumbar cistern with normal temperature.One hypostatic pneumonia patient was cured by anti-inflammatory.One with the urinary infection got better by the effective bladder irrigation,which had diabetics mellitus with the bladder stoma before.1 case of skin necrosis due to vascular thrombosis before operation,recevied flap translocation half month after surgery,got recovery 3 months later.Only one underwent tumor resection for the recurrence at 15 months follow-up.Conclusion It is feasible and safe to perform en bloc resection of primary sacral chordoma.This is the most effective means of managing method of the marginal resection of the tumor.Preoperative 3-D printing modeling enables better anatomical understanding of the relationship between the tumor,and can avoid vascular and nerves tissue injury,which can also assist in planning the surgical procedure,and be worth recommendation.

OBJECTIVETo investigate the effect of early allergen exposure on later development of allergic rhinitis in mouse.

METHODSTwenty-four BALB/c neonates were randomly divided into 4 groups (low-dose group, high-dose group, negative control group and positive control group), each group had 6 mice. The mice were administered ovalbumin (OVA) by subcutaneous injection on day 1, 5, 12 after birth (10 μg OVA in 0.05 ml saline for low-dose group, 1000 μg OVA in 0.05 ml saline for high-dose group, only saline for negative and positive control group). Then the mice were sensitized and intranasally challenged with OVA (saline without OVA was used in negative control group) after 6 weeks. Symptoms, histopathological changes of nasal mucosa were observed, OVA-IgE in serum was examined, cytokines IL-4, IL-5 and IFN-gamma were detected in the supernatant of cultured splenic mononuclear cells.

RESULTSCompared to the positive control group, symptoms and nasal mucosa histological changes of high-dose group was indistinctive. The level of OVA-IgE and cytokines IL-4, IL-5 (x(-) +/- s) in high-dose group [(265.11 +/- 26.29), (446.39 +/- 72.83) and (171.24 +/- 15.66) pg/ml, respectively] were significantly lower than those in positive control group [(665.85 +/- 43.15), (1113.45 +/- 30.47), (255.36 +/- 30.96) pg/ml, respectively, t value were 0.000, 0.000 and 0.009, respectively, all P < 0.05]. The level of IFN-γ in high-dose group [(319.74 +/- 56.30) pg/ml] was significantly higher than those in positive control group [(170.02 +/- 14.50) pg/ml, t = 0.000, P < 0.05]. There was no significant difference of the results between the low-dose group and positive control group.

CONCLUSIONSNeonatal immunization with high-dose OVA inhibited the future allergic rhinitis symptoms, nasal histological changes, serum OVA-IgE levels and Th1/Th2 cytokine imbalance, resulting in the protective effect.

Allergens ; immunology ; Animals ; Animals, Newborn ; Dose-Response Relationship, Immunologic ; Immunoglobulin E ; blood ; Interferon-gamma ; analysis ; Interleukin-4 ; analysis ; Interleukin-5 ; analysis ; Mice ; Mice, Inbred BALB C ; Nasal Mucosa ; immunology ; Nasal Provocation Tests ; Ovalbumin ; immunology ; Rhinitis, Allergic, Perennial ; immunology ; prevention & control