[Objective]To retrospectively analyze the therapy comparison between the unilateral hinged external fixator assisting the internal fixation, soft tissue repair and reconstruction and routine surgery for elbow instability of fracture dislocation.[Method]A total of 117 cases of elbow fracture dislocation were collected from Jan. 2001 to Jun. 2005. Some patients were treated by unilateral hinged external fixator, and others were treated by routine surgery and casting external fixation.The JOA assessment was applied for the pain, function, arc of motion, articular instability and deformity of elbow joint before surgery and after operational follow-up. [Result]Eighty-six cases were followed up by telephone and mail appointment.The average follow-up time was 18.6 months (from the range of 8 months to 30 months).The function and arc of motion of two group patients were assessed by JOA in post-operational follow-up, showing statistical significant difference (P0.05). The total assessment score between two groups indicates statistical significant difference.[Conclusion]The operation in combination with unilateral hinged external fixator for treating elbow instability of fracture dislocation will enhance lateral stability of elbows, guaranteen early safe elbow function exercises, facilitate stable environment for ligaments healing,suggesting a good subsidiary operational method.

Objective To explore the atypical ultrasonic appearances of breast fibroadenoma and analyze the cause of mis diagnosis.Methods A total of 493 lesions in 485 patients of breast fibroadenoma detected by ultrasound examination andconfirmed by pathology were retrospectively analyzed.Atypical appearances were analyzed and misdiagnosis rate were cal-culated.Statistical methods were taken to compare the misdiagnosis rates in lesions with various atypical appearances andthose with none or single atypical appearance.Misdiagnosis rates in lesions with different sizes and pathological types wereanalyzed statically.Then misdiagnosing causes were analyzed.Results A total of 404 lesions were diagnosed correctly,in-cluding 99 lesions with atypical appearances,and the other 89 lesions were misdiagnosed,which showed atypical appear-ances.The misdiagnosis rate of lesions with ≥2 atypical features was higher than that with none or single atypical feature(x2 =256.40,P＜ 0.05).Large lesions (maximum diameter＞ 3 am) showed higher misdiagnosis rates than small ones(maximum diameter ≤3 cm,x2=6.73,P＜0.05),and complex fibroadenoma lesions also showed higher misdiagnosisrate than simple ones (x2 =188.01,P＜0.05).Conclusion The lesions with various atypical appearances,large size andcomplex fibroadenoma in pathology are easy to be misdiagnosed.

BACKGROUND:Hypoxia inducible factor-2 α(HIF-2α)is one of the key regulators in articular cartilage degeneration and endochondral osteogenesis. OBJECTIVE:To review the regulatory mechanism and application development of HIF-2α in articular cartilage degeneration. METHODS:A computer-based retrieval of PubMed and CNKI databases was performedforrelevant literatures published from January 1990 to October 2015 ,using the key words of “hypoxia inducible factor-2α; osteoarthritis; cartilage” in Chinese and English, respectively. RESULTS AND CONCLUSION:HIF-2α is a transcription factor encoded by the Epas1 gene, which is one of the key regulators in articular cartilage degeneration and endochondral osteogenesis by directly regulating the expressions of various catabolic genes to strengthen cartilage destruction in osteoarthritis. It has been reported that HIF-2α acts on the chondrocytes by regulating the expressions of Wnt/β-Catenin, nuclear factor-κ B, and interleukin-6.

Long non-coding RNA( LncRNA) is an RNA molecule that is longer than 200 nucleotides and is not translated into a protein.LncRNA DANCR has been identified in hepatocellular carcinoma ( HCC) and markedly increased stemness features of HCC cells to promote tumorigenesis.Recent studies show that DANCR contributes to the differentiation and proliferation of synovium-derived mesenchymal stem cell ( SMSCs) and may be as a key point for this process.This article reviews the role of long non-coding RNA DANCR in enhancing chondrogenic differentiation and proliferation of human SMSCs.

BACKGROUND: A number of studies have shown that long non-coding RNA DANCR can play an important role in various pathophysiological processes through Wnt/β-catenin signaling pathway.OBJECTIVE: To explore the effect of long non-coding RNA DANCR on the proliferation and chondrogenesis of synovium-derived mesenchymal stem cells.METHODS: Passage 3 synovium-derived mesenchymal stem cells were obtained and transfected with pcDNA3.1-GP (control) and pcDNA3.1-GP(DANCR Homo) (experimental). Cell viability was estimated at 1, 2, 3, 4, 5, 6 and 7 days after DANCR transfection. The passage 3 cells were cultured in the chondriogenic medium for 14 days. And the chondrogenesis potential of cells was examined by toluidine blue staining. The chondrogenic-specific marker genes Aggrecan, Type II collagen (Col2) and Sox9 were determined by Real-time PCR.RESULTS AND CONCLUSION: The synovium-derived mesenchymal stem cells exhibited S-shaped curves in the two groups, with cell arrest at 1-2 days and rapid proliferation beginning at 3 days. Cell counting kit-8 assay and toluidine blue staining showed overexpressing DANCR significantly promoted proliferation in synovium-derived mesenchymal stem cells. The aggregates from synovium-derived mesenchymal stem cells in the experimental group had a greater amount of toluidine blue staining than the control group. In addition, we detected the higher expression of chondrogenic specific marker genes, such as Col2, Sox9 and Aggrecan, in the experimental group than the control group at 14 days after chondrogenic induction (P < 0.05). These results demonstrate that long non-coding RNA DANCR could enhance chondrogenic differentiation and proliferation of human synovium-derived mesenchymal stem cells and increase the expression of chondrogenic specific marker genes.

Objective To probe the characteristic ultrasonic appearances of hepatic adenoma.Methods The appearances of color Doppler flow imaging(CDFI)and contrast-enhanced ultrasound(CEUS)in 10 cases of hepatic adenoma were analyzed.Results Rich blood flow signals were found in all the hepatic adenoma lesions on CDFI.Large blood flow signals were detected in the periphery of all tumors.On CEUS,peritumoral feeding vessels displayed in early arterial phase and homogeneous enhancement in arterial phase was observed in all the 4 cases.The tumor capsule was enhanced continuously in all cases.One case with isoechoic enhancement in delayed phase was found the contrast agent wash out in portal phase.The other 3 cases showed the‘fast-in and slow-out'appearance.which was iso-echoic enhancement in portal phase and slightly hyperechoic enhancement in delayed phase.Conclusions The rich blood flow signals,early displaying of peritumoral feeding vessels,homogeneous enhancement in the arterial phase and continuously enhanced tumor capsule on CEUS are the distinctive appearances of hepatic adenoma.

Objective To prepare a sustained-delivery of paclitaxel-loaded thermosensitive hydrogel for the treatment of breast cancer by ultrasound-guided intratumoral injection,and probe the antitumor effect and mechanism of the new method. Methods Paclitaxel-loaded thermosensitive hydrogel was prepared. A total of 40 rats bearing subcutaneous breast tumor were randomized into 4 groups. Each group of rats were administered ultrasound-guided intratumoral injection of different agents as follows: salin, thermosensitive hydrogel, paclitaxel injection and paclitaxel-loaded thermosensitive hydrogel. The tumor nodules were scanned by high frequence ultrasound. The rats were sacrificed on the 14th day,and then the tumors were stripped to calculate the growth inhibitory rate. Histological examinations were undergone and RT-PCR was performed for the detection of bcl-2 and bax expression. Results Greater decrease in average tumor weight was found in paclitaxel-gel group [(16. 04 ± 2. 82)g], compared with that in paclitaxel group [(27.45 ±5.13)g, P ＜0. 05],and tumor growth inhibitory rate in the group was 62.77 %. In this group, blood flow signals reduction was detected on ultrasound and extensive necrosis was found in histological examination. In addition,down-regulation in bcl-2 mRNA expression and up-regulation in bax were found. Conclusions Ultrasound-guided percutaneous intratumoral injection of paclitaxel-loaded thermosensitive hydrogel may provide an effective method for breast tumor ablation therapy. The mechanism may be related to the inhibition of proliferation and induction of apoptosis.

To explore the efficacy and feasibility of interstitial chemotherapy using thermosensitive gel-coated ricin in hepatoma H22-bearing mice.

Objective To evaluate the effectiveness and feasibility of riein-loaded thermosenaitive hydrogel in percutaneous intratumoral injection for treatment of hepatic carcinoma. Methods BALB/c-nu mice were inoculated subcutaneously in the right flank with human liver cancer cell line HepG2. A total of 32 male mice bearing subcutaneous hepatic carcinoma (7-10mm in diameter) were randomized into 4 groups. Each group of mice were administered percutaneous intratumoral injection of different agents as follows: salin, thermosensitive hydrogel,ricin, ricin-loaded thermosensitive hydrogel. The tumor volume was totally measured 3 times by high frequency ultrasound once a week. One mouse of each group was sacrificed to perform tumor histopathological examination on 7th day, 14th day, respectively, and survival time of the remaining mice was recorded. Results After intratumoral therapy,tumor volume in ricin group was smaller than that of saline group on 7th day, 14th day and 21st day( P<0.01 ),and mice got a life-prolonging rate of 36.8%. In ricin-loaded thermosensitive hydrogel group,obvious necrosis occurred in tumors treated since 5th day, and the tumor almost regressed on 21st day. Histopathological assay showed serious necrosis with a large number of leucocyte infiltration in tumor. All the remaining mice treated with riein-loaded thermosensitive hydrogel survived at the end of experiment sans tumor recurrence. Conclusions Percutaneous intratutnoral injection of ricin-loaded thermosensitive hydrogel could completely ablate hepatic carcinoma,which may provide an effective and feasible method for tumor ablation therapy.

Objective:To compare anatomical locking plate fixation with versus without reconstruction of the coracoclavicular ligament in the treatment of acute and old Neer Ⅱb unstable distal clavicle fractures.Methods:From January 2015 to November 2020, 80 Neer Ⅱb distal clavicle fractures were treated at Department of Orthopaedics, The First Hospital Affiliated to China Pharmaceutical University. There were 49 males and 31 females, aged from 32 to 78 years (average, 47.8 years). Of the 50 fresh fractures, 25 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group A) while the other 25 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group A). Of the 30 old fractures which had not got united over 3 weeks after injury, 15 were treated by internal fixation with anatomical locking plate of distal clavicle plus reconstruction of the coracoclavicular ligament with suture anchor (reconstruction group B) while the other 15 by only internal fixation with anatomical locking plate of distal clavicle (non-reconstruction group B). At 1, 3 and 6 months postoperatively, Constant-Murley scale and visual analogue scale (VAS) were used to evaluate shoulder function and pain. X-ray follow-ups were conducted to measure the coracoclavicular distance and observe fracture union and complications at the last follow-up.Results:All the 80 patients were followed up for 6 to 24 months (average, 13.8 months). For reconstruction group A and non-reconstruction group A, respectively, the union time for fresh fractures was (11.7±2.8) weeks versus (13.4±1.3) weeks, the rate of coracoclavicular distance increase 12.7%±6.2% versus 14.2%±8.0%, the Constant-Murley score 92.2±4.4 versus 90.9±5.7, showing no statistically significant difference between the 2 groups (all P>0.05). For reconstruction group B and non-reconstruction group B, respectively, the union time for old fractures was (12.8±1.9) weeks versus (19.4±6.7) weeks, the rate of coracoclavicular distance increase 12.3%±6.7% versus 21.5%±13.1%, the Constant-Murley score 93.0±5.9 versus 83.5±8.5, showing statistically significant differences between the 2 groups (all P<0.05). Conclusions:For fresh Neer Ⅱb distal clavicle fractures, simple anatomical locking plate fixation can achieve satisfactory curative efficacy without additional reconstruction of the coracoclavicular ligament. However, for old Neer IIb distal clavicle fractures, additional reconstruction of the coracoclavicular ligament can better maintain the stability of the acromioclavicular joint, reduce the risk of internal fixation failure, and achieve better outcomes.