[Objective]To explore the operative methods and curative effect of the damage of the deltoid ligament.[Method]From April 2002 to April 2005,all 40 cases with ankle fractures were treated by open reduction and firm internal fixtion,by repairing of the deltoid ligament and restoration of stability of medial and lateral structures of ankle joint.If separation of the tibio-fibular joint was still unstable,transverse internal fixtion was adopted with one cortical bone screw.[Result]All cases were followed up from 6 months to 3 years with an average of 18 months,and were evaluated according to the criteria of QI Bin:the results showed excellent in 30 cases,fair in 8 cases and poor in 2 cases,the rate of excellent results was 75%.[Conclusion]The authers emphasized that,in order to obtain satisfactory result,open anatomical reduction and rigid internal fixtion must be adopted in the fractures,the deltoid ligament should be treated properly.

Objective To investigate the effect of Lokomat gait training rehabilitation robot on joint motion and lower limb function in hemiplegic patients after stroke.Methods Forty hemiplegic patients after stroke were randomized equally into a robotic group and a control group (20 cases in each group).The robotic group received robotic rehabilitation therapy in addition to routine rehabilitation training,while the control group was only given instructions for routine rehabilitation training.All the patients were assessed at the beginning of the training and at the end of 4,8 and 10 weeks of treatment.The Fugl-Meyer Assessment of lower extremities (FMA),range of motion (ROM) in hip and knee,force and tone of bilateral hip/knee flexors and extensors were used to evaluate stepping function before training,and after 4,8 and 10 weeks of treatment.Results There was no significant difference between the 2 groups with regard to FMA scores,the ROM in hip and knee,as well as force and tone of bilateral hip/ knee flexors and extensors (P ＞ 0.05).After treatment,the robotic group was significantly improved with all the evaluation indexes when compared to its baseline values (P ＜ 0.05).It was also shown that the robotic group improved to a significantly greater extent than the control group (P ＜ 0.05).Pearson's correlation analysis demonstrated a positive relationship between the ROM of knee or hip and lower limb function (P ＜ 0.05).Conclusions The Lokomat gait training rehabilitation robot can improve the lower extremities functions,as indicated by increase of ROM and muscle strength as well as decrease in muscle spasticity in hemiplegic patients after stroke.

[Objective]To investigate the clinical features,reasons of missed diagnosis and treatment for ipsilateral fractures of femoral neck and shaft.[Method]Twelve cases of ipsilateral fractures of femoral neck and shaft treated from 1999 to 2005 were retrospectively reviewed.Seven cases' neck fractures were diagnosed separately before operation,2 cases' were diagnosed during operation and 3 were diagnosed after operation.Among the 12 cases,3 cases were treated with reconstructive intramedullary nail to fix both shaft and neck fractures;2 cases were treated with DHS to fix both shaft and neck fractures;1 case was treated with retrograde interlocking intramedullary nail to fix shaft fracture and with canulated screws to fix neck fracture;2 cases were treated with interlocking intramedullary nails and canulated screws;1 case combined supracondylar fracture of femur,was treated with LISS-DF to fix shaft and supracondylar fracture,canulated screws to fix the neck fracture;the neck fractures were found in 3 cases after shaft fixation with plate,then fixed with canulated screws.[Result]All cases were followed up for 1~6 years,with an average of 3.4 years.All femoral shaft fractures were united and 11 neck fractures were united,1 neck fracture was malunion,1 case was osteonecrosis of femoral head.[Conclusion]The ipsilateral fracture of femoral neck and shaft is rare,and the neck fracture is easy to miss diagnosis.The orthopaedic surgeons should consider the femoral neck fractures by analyzing the mechanism of high energy injury patient with femoral shaft fracture.Pelvic X-ray should be taken conventionally or CT scan when necessary.The surgical treatment for ipsilateral fractures of femoral neck and shaft depends on the position of femoral shaft,and the situation of femoral neck.

Objective To study the feasibility of adopting temporary revascularization during the course of limb replantation in order to shorten ischemia time and accelerate functional restoration of the severed limb. Methods Temporary revascularization was firstly established with various kinds of canals before the routine replantation was conducted. A statistical comparison of objective indexes was carried out between the revascularization method and the routine method. Results The method of adopting temporary revascularization during the course of limb replantation resulted in more satisfactory clinic effects than the routine method. Conclusion Temporary revascularization during the course of limb replantation plays an important role in accelerating functional restoration of the severed limb, and therefore is practically recommendable in clinics.

Objective To review the efficacy of different rehabilitation training on walking locomotion for chronic incomplete spinal cord injury (SCI) by Meta-analysis. Methods PubMed, CNKI, Wanfang Database, and Google academic search were applied to search for clinical trials on chronic incomplete spinal cord injury to review the efficacy of gait training. Meta-analysis was to assess the clinical trials by Rev-Man 4.2. Results Gait training improved the walking speed for chronic incomplete spinal cord injury. The efficacy of partial body weight support treadmill training combined with functional electrical stimulation was confirmed. The efficacy of artificial aided training and robot-aided training remained uncertain. Conclusion Gait training was effective to improve walking ability for chronic incomplete spinal cord injury, but the evidence was insufficient.

BACKGROUND:The tensile and stress-relaxation mechanical properties of sciatic nerve injury after repaired with autologous nerve and poly(lactic acid-glycolic acid) (PLGA) scaffold are rarely reported. OBJECTIVE:To analyze the tensile and stress relaxation characteristics of sciatic nerve injury after the transplantation of autologous nerve and PLGA scaffold. METHODS:Sixty sciatic nerves were extracted from the fresh cadavers dead within 24 hours, processed into 35 mm samples, and were then randomly divided into three groups. The nerve samples in control group received no intervention;the nerves in artificial and autologous groups were modeled into 20 mm defects, followed by repaired with PLGA scaffold and autologous nerve, respectively. Afterwards, the tension and stress-relaxation tests were performed in each group. RESULTS AND CONCLUSION:The stress in each group descended fast at the first 600 seconds, then descended slowly and was closed to the horizontal level until 7200 seconds, and the stress-relaxation curves in each group were in logarithmic decrease. The order of the elastic limit load, elastic limit stress, maximum load, maximum stress, elastic limit strain and maximum strain during tension was as follows:control group>artificial group>autologous group (P<0.05). Our results indicate that the PLGA scaffold holds good tension and stress-relaxation properties, which meets the mechanical requirements of the biomaterials used for sciatic nerve repair.

Objective To investigate the impact of LY294002 on the proliferation of cancer stem cell-enriched spheroid cells from human hepatocellular carcinoma via regulating phosphatidylinositol-3-kinaseprotein kinase B(PI3K-Akt)signaling pathway. Methods The cancer stem cell-enriched spheroid cells were genera-ted by culturing HepG2 cells in serum-free medium. LY294002(10,20,30 μmol/ L),an inhibitor of PI3K-Akt signaling pathway,was used in the experimental groups,without used in the control group. The impact of LY294002 on the spheroid cells proliferation was confirmed by cell counting kit(CCK-8 kit). The expression of Akt was tested by Western blotting. The expression of PI3K-Akt signaling pathway downstream genes such as decoy receptor 3(DcR3),mammalian target of rapamycin(mTOR),B-cell lymphoma(Bcl)-2 and Cyclin D1 were tested by real-time PCR. Results 30 μmol/ L LY294002 could inhibit the proliferation of spheroid cells, and significant difference in the absorbance(A value)was observed between the experimental group and control group[(0. 14 ± 0. 03)vs(0. 56 ± 0. 01),t = - 8. 915,P = 0. 000]. The expression level of phosphorylated Akt protein increased[(0. 57 ± 0. 08)vs(0. 16 ± 0. 42),t = 6. 027,P = 0. 026]. The mRNA of DcR3 [(0. 38 ± 0. 08)vs 1,t = 13. 060,P = 0. 006],mTOR[(0. 37 ± 0. 04)vs 1,t = 30. 363,P = 0. 001],Bcl-2 [(0. 26 ± 0. 04)vs 1,t = 33. 554,P = 0. 001]and Cyclin D1[(0. 10 ± 0. 02)vs 1,t = 63. 528,P = 0. 000] decreased. Conclusion LY294002 could inhibit the proliferation of cancer stem cell-enriched spheroid cells from human hepatocellular carcinoma via inhibiting PI3K-Akt signaling pathway.

Objective To investigate the clinical prediction value of chemokine CCL21 level for acute coronary syndrome.Methods Totally 212 patients receiving coronary arteriography were divided into acute myocardial infarction group(AMI,n=72),unstable angina pectoris group(UAP,n=76),and stable angina pectoris group(SAP,n=64).The serum level of chemokine CCL21 was detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA)and the pathological changes of coronary artery were measured by Gensini scoring system.All patients were followed up for six months and the cardiovascular adverse events were recorded.Results The serum level of CCL21 was(169.72±14.64)ng/L in AMI group,(154.42±16.50)ng/L in UAP group,and(143.87±9.80) ng/L in SAP group,with statistically significant differences (F =99.818,P =0.000).Serum levels of CCL21 in ACS group and SAP group were positively correlated with Gensini score(r=0.474,P =0.000;r=0.350,P=0.049).Binary Logistic regression analysis revealed that chemokine CCL21 was an independent risk factor for predicting acute coronary syndrome (OR =1.049,P =0.022).The CCL21-judged area under the ROC curve in acute coronary syndrome group was 0.887 ± 0.028 (P =0.000),with diagnostic point of serum level of chemokine CCL21 at 159.15 ng/L,sensitivity of 0.635,specificity of 0.981.Serum level of CCL21 was higher in the patients with cardiovascular adverse events than in the patients without cardiovascular adverse events[(168.57±7.24)ng/L vs.(156.92± 6.53) ng/L],with statistically significant difference (t =16.100,P =0.000).Conclusions Serum level of chemokine CCL21 reflects the severity degree of coronary artery disease.The chemokine CCL21,as an independent and effective marker,can predict acute coronary syndrome.

To determine the effect of straight-leg-raising (SLR) movement on epidural fibrosis after laminectomy, 40 adult New Zealand rabbits were selected as laminectomy models in the study. They were divided into 2 groups: a SLR group (group S) and a control group (group C) randomly, with each group having 20 animals. All rabbits were subjected to total laminectomy in the site of S1. Every 5 rabbits in each group selected randomly were killed at the 1st, 2nd, 4th, and 8th week after the surgery. Segments of spines from L7 to S2 were removed en bloc. After gross evaluation, specimens were sliced up. The slices were stained by HE and Masson's trichrome methods respectively for histological examination. Our results showed that formation process of scar in group S was retarded as compared with that of group C at the time of the 2nd-week, but there was no statistical difference between groups in the adhesion degree (P> or =0.05). At the 4th and 8th week, the epidural fibrosis of group S was more serious than that of group C. Since the 2nd-week, the area of scar in group S was larger than that of group C. The number of fibroblasts and inflammatory cells in group S were larger than those of group C at early stage. But in later stage, there was no statistical significance between the two groups. It is concluded that SLR movement after laminectomy may promote the formation of epidural fibrosis and retard the maturity of scar. SLR movement can also aggravate scar adhesion.

Little is known about whether tamoxifen (TAM) can affect resting state microglia apoptosis and about the cellular mechanism that may account for this. To explore this question, we incubated the microglia cell line BV-2 cells with TAM at different concentrations. Cell viability was assessed by the MTT assay, and flow cytometric analysis was performed to detect the cell apoptosis rate. Furthermore, mitochondrial membrane potential (Δψm) was tested by flow cytometry, and Bax, Bcl-2, Fas, and Fas-L expression was detected by Western blot. The results demonstrated that TAM decreased cell viability and induced apoptosis of BV-2 cells in a concentration- and time-dependent manner. In addition, disruption of Δψm was followed by up-regulated expression of pro-apoptotic Bax, Fas and Fas-L, and down-regulated expression of anti-apoptotic Bcl-2. These results indicate that TAM may induce apoptosis of BV-2 cells through both mitochondria- and death receptor-mediated pathways.