Objective To investigate the effect of MHA-bBMP implantation combined with limited contacted titanium net duct fixation on femoral shaft bone defect in rabbits.Methods A total of 48 rabbits were divided into experimental group(treated with bionic bone MHA-bBMP plus titanium net duct) and control group(treated with iliac autograft plus titanium net duct).The rabbit femoral shaft bone defect model was established by cutting 10mm bone fragment off.After operation,bionic bone MHA-bBMP/iliac autograft was implanted into the bone defect area and fixed with limited contacted titanium net duct.The general condition,serum alkaline phosphates,X-ray,histopathologic and electron microscopic examinations were performed.Results The fixation stability of titanium net duct in the two groups was good.The bone defect in the two groups was repaired.The phosphates,X-ray,histopathologic and electron microscopic examinations in the two groups were not significantly different.Conclusion The limited contacted titanium net duct can provide a reliable fixation effect on the graft and bone defect ends.Induction bone formation activity of MHA-bBMP is comparable to the iliac autograft.

Objective To evaluate clinical effect of expandable intramedullary nail in unreamed treatment of tibia fracture.Methods 31 patients with proximate tibia fracture were treated with expandable intramedullary nail and unreamed.Among those patients,4 cases were compound fracture,27 cases were closed fracture;16 cases were AO/ASIF type A,4 cases were type B and 11 cases were type C.The following-up of 9 months to 5 years(average 2 years) performed after operation.Results The fractures of 30 patients healed up and patients' functions recovered.1 case with comminuted and multiple fracture got delayed union.Conclusion Expandable intramedullary nail is an utility and satisfactory method to treat proximate tibia fracture.

Objective To explore the pathological changes of the femoral head bone metabolism induced by diabetes mellitus.Methods Seventy rabbits were divided into the control group and experiment group randomly. The control group were injected with saline; while the experiment group were injected with Alloxan through ear-edge vein quickly to establish the immediate diabetes mellitus model. The histopathology, ultrastructure, biochemistry, hemorrheology, and platelet function of all animals of two groups were detected in different periods.Results In the experiment group, 2 animals' bone trabecula were found disorder and vacant bone lacuna was 14% in the 4th week; in the 8th week, 3 animals' part bone trabecula were found breakage, defluxion, vacant bone lacuna was 28%; in the 12th week, 5 animals' bone trabecula were found breakage, defluxion obviously, vacant bone lacuna was 56%. Under TEM, there was some lipid droplet in bone cells, bone cellular necrotized at different levels. Myelosis decrease, the number and diameter of adipose cell increased. In the 8th and 12th week, the content of serum calcium decreased and that of serum phosphorus increased in the experiment group compared with the control group ( P<0.05, P<0.0l), and the product of calcium and phosphorus of the experiment group in the 12th week was lower than that of the control group (P<0.05).Conclusion DM can cause osteoporosis. Capillary fracture happens in the arch bridge structure of femoral head under machine press while being pressed. Along with the course of DM process, capillary fracture accumulates, bone under cartilage compress and collapse. It can oppress bone capillary to cause ischemia. All factors result in the basic pathology and the primary pathogenesy of the femoral head.

Objective To investigate the efficacy ,safety and compliance of mesalazine sustained‐release (SR) granules taking once daily or multi‐times daily in the treatment of patients with mild to moderate active ulcerative colitis .Methods Sixty patients with mild to moderate active ulcerative colitis were divided into group A ,B and C with 20 patients in each group .Group A received mesalazine SR granules 4 g once daily ,Group B with 2 g each time and twice daily ,Group C with 1 g each time and four times daily . The total course was eight weeks . The vital signs ,Mayo score ,compliance and adverse effects of patients were monitored at 0 ,4th ,8th weeks .At 0 and 8th weeks ,colonoscopy were performed . The parameters of efficacy assessment were clinical complete remission rate , clinical remission rate , efficacy rate ,mucosal healing rate ,remission time and safety .The F test ,t test or Chi‐square test was performed for comparison among groups .Results The clinical complete remission rate of group A ,B and C was 20% (4/20) ,10% (2/20) and 10% (2/20) ,respectively .The clinical complete remission rate was 70% (14/20) ,65% (13/20) and 70% (14/20) ,respectively .The efficacy rate was 95% (19/20) ,85%(17/20) and 90% (18/20) ,respectively .The mucosal healing rate was 70% (14/20) ,60% (12/20) and 50% (10/20) ,respectively .The side effects rate was 20% (4/20) ,15% (3/20) and 20% (4/20) .There was no significant difference between groups (all P > 0 .05) .The remission time of group A and B was (15 .4 ± 3 .7) days and (15 .6 ± 2 .9) days ,which were both shorter than that of group C (18 .4 ± 3 .6) days ,and the differences were statistically significant (t= 2 .661 and 2 .710 ,both P< 0 .05) .There was no significant difference among three groups in gender ,disease course , severity , location and clinical remission rate of sub‐groups .Conclusions The efficacy and safety of mesalazine SR granules taking once daily or multi‐times daily are similar in the treatment of patients with mild to moderate active ulcerative colitis .Once daily have better compliance than other regimens .

Gastric emptying time of liquid meal was detected by using ultrasonography in 28 gas tric ulcer patients with continual or recurrent dyspepsia symptoms after the ulcer healing. Sixteen out of 28 patients (57.1%) with a delay of gastric emptying time (T1/2) were randomly divided into two groups: 8 cases were treated with cisapride 5 mg three times a day and 8 cases with cis apride 10 mg three times a day respectively. The results showed that cisapride could relieve the symptoms with the effective rate being 68.8% in the two groups. T1/2 in the patients after treat ment with cisapride was significantly shorter than before treatment (P＜0.001). It was concluded that there is a delay of T1/2 in some patients with gastric ulcer healing. Cisapride could promote gastric empty of liquid meal and relieve the symptoms efficiently. The effect of lower dose of cis apride is similar to that of higher dose.

Gastric emptying time of liquid meal was detected by using ultrasonography in 28 gas tric ulcer patients with continual or recurrent dyspepsia symptoms after the ulcer healing. Sixteen out of 28 patients (57.1%) with a delay of gastric emptying time (T1/2) were randomly divided into two groups: 8 cases were treated with cisapride 5 mg three times a day and 8 cases with cis apride 10 mg three times a day respectively. The results showed that cisapride could relieve the symptoms with the effective rate being 68.8% in the two groups. T1/2 in the patients after treat ment with cisapride was significantly shorter than before treatment (P＜0.001). It was concluded that there is a delay of T1/2 in some patients with gastric ulcer healing. Cisapride could promote gastric empty of liquid meal and relieve the symptoms efficiently. The effect of lower dose of cis apride is similar to that of higher dose.

Objective:To investigate the advantages and disadvantages and clinical effects of integrated acetabular quadrilateral surface buttress plate in the treatment of acetabular both column fractures.Methods:From September 2017 to March 2019, 14 patients with acetabular both column fractures were treated with integrated quadrilateral acetabular buttress plate and were followed up. The clinical data were retrospectively analyzed. There were 10 males and 4 females with an average age of 53.2 years (range, 26-75 years). Fracture classification were both column fractures according to the Letournel-Judet classification system, including 11 cases of combined posterior wall without posterior dislocation. The time from injury to operation was 8-19 days, with an average of 10.3 days. All operations were performed with a supra-ilioinguinal approach. After satisfactory reduction, the integrated acetabular quadrilateral surface buttress plate was used to fix the anterior and posterior column and quadrilateral fractures at the same time. After operation, Matta criteria was used to evaluate the quality of fracture reduction on postoperative images, and modified Merle d'Aubigné-Postel score to evaluate hip joint function.Results:The average operation time was 180 min (range, 120-320 min), and the intraoperative average blood loss was 980 ml (range, 700-1 600 ml). Operations were performed successfully with none intraoperative reshaping conducted, and the plate could fit into the bone surface well. All 14 patients were followed up with an average of 15.6 months (range, 9-20 months). During the follow-up, all fractures healed with an average of 3 months (range, 2.5-5 months). The reduction quality evaluated by the Matta criteria were 7 anatomical, 5 satisfactory, and 2 unsatisfactory, with an excellent and good rate of 85.7% (12/14). The hip joint function at the last follow-up was in accordance with the modified Merle d'Aubigné-Postel score was 12-18 points, with an average of 16.9 points, of which 8 excellent, 4 good, and 2 fair. The excellent and good function rate was 85.7% (12/14). During the operation, 1 patient had a rupture of about 1 cm of the peritoneum during the separation of the spermatic cord, which was immediately sutured and repaired. One patient had obturator nerve paralysis after the operation, without special treatment, and the paralysis symptoms were relieved during the 6th-month follow-up. There were no other operation-related complications.Conclusion:For both-column fractures characterized by central dislocation of the femoral head, the integrated acetabular quadrilateral buttress plate can simultaneously fix the anterior and posterior columns and quadrilateral surface at the same time. Satisfactory reduction and functional outcomes could be achieved by the novel plates.

Objective To investigate the relationship between changes in the liver computed tomography (CT) images and the postmortem interval (PMI) of rabbits 129 h after their death due to hemorrhagic shock. Methods CT scanning was used to investigate the hemorrhagic shock death model in 23 rabbits to identify the postmortem cerebral changes from 0 h to 129 h after death. Results The liver or lumbar area in the liver window showed the following characteristic changes: from unchanged, to rapid shrinkage, to slow shrinkage; the mean CT values of the liver initially increased and subsequently decreased. The regression equations for the relationship between the two indices and PMI were established by surgery, and they all had statistical significance (P ＜ 0. 01). Conclusion CT scanning can accurately show changes in the rabbit liver after death. The mean CT value of the liver tissue is more sensitive for inferring early PMI. Furthermore, the liver area/lumbar area ratio parameters are more sensitive for inferring mid-late PMI.

Objective To evaluate the efficacy and safety of 3D printing patient-specific external guide template in assisting minimally invasive screwing for treatment of pelvic and acetabular fractures.Methods The clinical and follow-up data of 39 pelvic or acetabular fractures were retrospectively analyzed which had been treated from June 2016 to February 2018 at Department of Orthopaedics,Wuhan Union Hospital.The patients were divided into a template group and a freehand group.In the template group,there were 14 men and 7 women with an age of 46.3 ± 18.2 years and 17 pelvic fractures and 4 acetabular fractures;in the freehand group,there were 12 men and 6 women with an age of 43.8 ± 12.2 years and 14 pelvic fractures and 4 acetabular fractures.The 2 groups were compared in terms of operation time,fluoroscopic frequency,guide wire adjustments,fracture reduction,screw penetration rate,function evaluation and adverse events.Results All the 39 patients were followed up for 9 to 13 months (average,11.6 months).A total of 42 screws were placed in the template group and 35 screws in the freehand group.The values of operation time (43.8 ± 22.2 min),fluoroscopic frequency (29.6 ± 10.7 times) and guide wire adjustments (1.8 ± 1.2 times) in the external guide template group were all significantly lower than those in the freehand group (73.8 ±22.6 min,54.6 ± 16.5 times and 9.8 ±2.8 times,respectively) (P ＜0.05).There were no significant differences between the 2 groups in screw penetration rate,rate of satisfactory reduction,Majeed scores for pelvic function or modified Merle d'Aubigné scores at the last follow-ups (P ＞ 0.05).One case in the freehand group experienced numbness after operation on unilateral dorsi pedis which disappeared at 3-month follow-up.Conclusion The 3D printing patient-specific external guide template can reduce fluoroscopic frequency,save operation time and improve accuracy of screw insertion,providing a new means for minimally invasive treatment of pelvis and acetabular fractures.

【Objective】 To investigate the clinical characteristics and molecular genetic mechanism of 46,XY complete gonadal dysplasia (46,XY CGD) caused by a new mutation of NR5A1 gene. 【Methods】 The clinical data of a female patient with 46 XY karyotype were retrospectively analyzed, and the whole exon group and mitochondrial group genes were detected. 【Results】 The clitoris was hypertrophic. The patient had both urethral orifice and vaginal orifice, and there was no common passage between them. Ultrasonography showed an unclear primordial uterus and bilateral ovaries. The gonad biopsy showed poorly developed testicular tissue. Karyotype was 46,XY. The detection of whole exon group and mitochondrial group genes indicated a new heterozygous missense mutation in NR5A1 gene on chromosome 9, and the variation information was c.205C>T:p. Arg69Cys. The mother did not carry the gene mutation. 【Conclusion】 The clinical manifestations of 46,XY CGD are diverse. NR5A1 gene mutation is one of the important causes, which provides a basis for the clinical diagnosis and pathogenesis of the disease.