OBJECTIVEThis study investigates the effect of temporomandibular joint osteoarthritis (TMJOA) on different stages of condylar three-dimensional position and provides a theoretical basis for clinical application.

METHODSThe cone beam computed tomography (CBCT) images of 108 TMJOA patients were analyzed and divided into four stages based on the stage standard of osteoarthrosis X-ray performance proposed by Xuchen Ma in 2005. A total of 28 defect-free temporomandibular joint disorders were used as the control group. Differences in condylar position and condylar axis horizontal angle were evaluated and compared.

RESULTSNo significant differences were found in terms of sagittal relationship, but condylar axis horizontal angle showed a significant difference (F = 3.872, P = 0.005). The horizontal angle values of stage 1 in the TMJOA group were lower than those in stages 2 and 3 (P = 0.027, P = 0.000), whereas the horizontal angle values of stage 2 and control groups were lower than those of stage 3 group (P = 0.004, P = 0.047).

CONCLUSIONCondylar horizontal angle differed in each stage of TMJOA, but no significant difference between the parasagittal positions of the condyles was observed in each stage.

Case-Control Studies ; Cone-Beam Computed Tomography ; Humans ; Mandibular Condyle ; Osteoarthritis ; diagnostic imaging ; Temporomandibular Joint ; diagnostic imaging ; pathology ; Temporomandibular Joint Disorders ; diagnostic imaging

Objective To establish a mice model of cisplatin-induced ototoxicity and to investigate the effect of cisplatin on the expression of caspase-3 in mouse cochlea.Methods Totally 69 Kunming mice were randomly divided into control group,cisplatin 2.5mg/(kg?d) group,cisplatin 3.5mg/(kg?d) group and cisplatin 4.5mg/(kg?d)group.Mice were injected intraperitoneally for 5 days.Auditory brainstem response(ABR) was measured to observe the change of hearing.Envision method of immunohistochemistry was applied to detect the expression of caspase-3 in cochlea.Results The weight and hearing of mice in different dose cisplatin groups were declined significantly as compared with those in control group(P

Objective To explore the application value of carpal shoot through view in the palmar plating of distal radius fractures.Methods From March 2015 to May 2016,there were 62 acute distal radius fractures received various operation in our department,in which 48 patients were only performed volar locked plating.Among these 48 cases,there were 21 males and 27 females,with ages ranging from 17 to 75 years (mean 43.6±10.6 years).There were 15 cases of type A,11 cases of type B and 22 cases of type C distal radial fractures according to AO/OTA classification.All the operations were performed through modified Henry's approach between the radial artery and flexor carpi radialis.Once achieved satisfactory reduction,we performed rigid fixation of distal radius using anatomical locking plates.In all cases,bicortical drilling was performed.Screw lengths selected measured 1 to 2 mm less than the depth gauge number avoiding dorsal cortex penetration.After plate fixation of these 48 cases,standard posteroanterior and lateral radiographs were taken followed by the carpal shoot through view.To obtain carpal shoot through view,the patient's forearm was maximally supinated,the elbow flexed about 60°-70°and the wrist maximally dorsiflexed.The image intensifier beam is directed over the base of the thenar eminence.Compare the ratio of dorsal protrusion between standard view and carpal shoot through view,then statistical analysis was performed.After operation,CT scan was routinely taken to further test the effectiveness of carpal shoot through view.Results Five cases were detected dorsal cortex screw protrusion using standard posteroanterior and lateral views (10.4％,5/48).There were totally 16 cases (including the former 5 cases) of dorsal screw penetration uncovered by the carpal shoot through view(33.3％,16/48.Statistically significant difference was existed between the two fluoroscopy methods.Additionally,in 2 cases,a screw had penetrated the distal radioulnar joint (DRUJ),which was only apparent on the shoot through view.All the improper screws were exchanged and again were verified by the carpal shoot through view.The overall screw exchange rate was 37.5％ (18/48).Conclusion Compared with standard AP and lateral fluoroscopy,the carpal shoot through view can reliably reveals dorsal screw penetration.Meanwhile,it provides excellent visualization of DRUJ.

Objective: To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results. Methods: From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months. Results: Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively. Conclusion Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.

Objective To investigate the fixation sequence,key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor.Methods From October 2015 to January 2017,5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department.They were 4 men and one woman,aged from 23 to 65 years (mean,45.5 years).The femoral fractures were type A in 2 cases,type B in 2 cases and type C in one case according to AO/OTA classification.The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification.After the tibial plateau fractures were first fixated,Kirschner wires were inserted via the femoral condyle and distal tibia.A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation.Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing.The bone traction was completed via the femoral condyle and anterior superior iliac spine.The operative time,bone union time,knee functional recovery and hospital stay were recorded.Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months).No delayed union,nonunion or malunion happened of either femoral or tibial plateau fractures.The healing time for femoral fractures ranged from 4 to 8 months,averaging 5.5 months;the union time for tibial plateau fractures ranged from 10 to 14 weeks,averaging 12.0 weeks.The knee flexion averaged 110° (from 95° to 130°).The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstr(o)m & Olerud criteria.The average hospital stay was 18 days(from 13 to 32 days).Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage,leading to fine functional recovery of the knee and greatly reduced hospital stay in particular.

OBJECTIVE：To investigate the anti- hepatic fibrosis （HF）effects of Qiwei qinggan powder and explore its possible mechanism. METHODS ：Male Wistar rats were randomly divided into blank group ，HF model group ，Qiwei qinggan powder low-dose，medium-dose and high-dose groups [ 135，270，405 mg/（kg·d），by total amount of crude drugs] ，with 12 rats in each group. Except for blank group ，other groups were given 50％ CCl4-peanut oil solution intragastrically （2 mL/kg，twice a week ，for consecutive 8 weeks） to induce HF model. At same time ， blank group and model group were given constant volume of 0.5％ CMC-Na solution intragastrically ；administration groups were given relevant medicine intragastrically ，once a day ，for consecutive 8 weeks. General situation of rats were observedand liver morphology was observed after last administration and hepatic indexes were detected. The contents of liverfunction indexes （ALT，AST，ALP，HYP）in serum and the expression of α-SMA in hepatic tissue were determined ， and HE and Masson staining were performed to observe the histopathology. Using the difference multiple of expression quantity as the index ，TMT technology was used to screen the differentially expressed protein in medicine group （combining the liver tissue samples of Qiwei qinggan powder groups ）and HF model group. Uniprot-GOA database and KAAS ，KEGG mapper online tools were used to analyze GO and KEGG pathway enrichment. RESULTS ：The rats in the blank group were in good health ；the liver was bright red and smooth ，the liver lobules were intact ，no degeneration and necrosis ，inflammatory cell infiltration or fibrous tissue proliferation was found. Compared with blank group ，the rats in HF model group had poor diet ，depressed spirit ，disordered and lusterless fur ；the liver was dark red or yellow with rough surface ，hard texture ，inflammatory cell infiltration ，fiber tissue destruction ，bridge connection and so on ；the hepatic index ，the contents of liver function indexes and the expression of α-SMA were increased significantly （P＜0.05）. Compared with HF model group ，above symptoms of rats were improved to different extent in different dose groups of Qiwei qinggan powder ；hepatic index in Qiwei qinggan powder low-dose group ，the content of ALP in high-dose group ，the contents of ALT，AST and HYP and the expression of α-SMA in different dose groups were decreased significantly （P＜0.05）. A total of 42 differentially expressed proteins related to HF were screened ，of which 15 were up-regulated and 27 were down-regulated in expression，including fatty acid binding protein 4（FABP4），cholesterol 7α-hydroxylase（CYP7A1）. The results of enrichment analysis showed that the differentially expressed proteins were mainly enriched in extracellular space ，blood particles and other cell parts，involving the molecular functions of oxidoreductase activity and fatty acid binding ，the biological processes of the regulation of heterotypic cell adhesion ，protein activation cascade ，as well as retinol metabolism ，arachidonic acid metabolism ，PPAR and other signal pathway. CONCLUSIONS ：Qiwei qinggan powder can reduce the hepatic index ，ALT，AST，ALP and HYP contents in serum ，down-regulate the expression of α-SMA，improve the degree of inflammation and fibrosis of liver tissue ，and have a certain protective effect on rats. The anti-HF mechanism of it involves multiple targets and signal pathways ，such as FABP 4， CYP7A1 and PPAR.