BACKGROUND:Exosome, a kind of cystic vesicle with bilayer structure, is widely distributed in the body fluids. Exosomes are involved in various cel ular communications, and its contents including proteins, short chain peptides, DNA, RNA, phospholipids, and miRNA are resistant to degradation.
OBJECTIVE:To clarify the characters of exosomes, and to investigate the possibility of exosomal miRNAs as biomarkers for different diseases to provide a new strategy for clinical diagnosis.
METHODS:A computer-based search of CNKI and PubMed databases was performed by the first author for articles related to exosomal miRNAs. The keywords were“exosome, microvesicles, extracel ular vesicles, miRNA, biomarker, early diagnosis, progrosis”in Chinese and English, respectively. Total y 50 eligible articles were included in result analysis.
RESULTS AND CONCLUSION:After reviewing researches of exosomes in different diseases, we can confirm that exosomes broadly participant in physiological and pathological process of various system diseases. The abnormal expression of exosomal micro-RNAs has been identified in many studies, indicating the exosomal micro-RNAs have a great potential to be biomarkers for disease diagnosis. Further studies should focus on extracting the contents of exosomes, the pathogenesis of exosomes is involved in and screening the appropriate exosomal miRNAs for early diagnosis.

Tibial plateau fracture,one of the most common fractures,includes simple and complicated fractures.Inappropriate treatment could result in pain and deformity,which has a bad effect on patient life.With the development of the surgical technique,a lot of methods could be selected when an orthopedist deals with these fractures.X-ray,one of the most common assistant examination,is the preferred method for tibial plateau fracture and could diagnose most of these fractures.Due to high resolution,CT scan could find these micro-fractures which X-ray cannot find and it could supplement the Schatzker type.MRI could find ligament,meniscus and arthrodial cartilage injury.Surgical approach includes anterolateral approach,medial approach,posteromedial approach,post approach,anterior approach.Anterolateral approach could be used for most of tibial plateau fractures.Posteromedial approach is used for medial plateau fracture involving post plateau fracture or post plateau fracture alone.Common plate,locking plate,dual plate and external fixation are commonly used fixation method.Dual plate is often used for complicated tibial plateau fracture.However,how to make accurate diagnosis and choose appropriate fixation is crucial for patients.We will summarize the application of X-ray,CT scan and MRI in diagnosis of tibial plateau fracture.Commonly used approaches to the proximal tibia,which together allow for the treatment of any proximal tibia fracture,will be described in this article.

[Objective]To evaluate a preliminary outcome of volar surgical treatment of dorsally displaced fractures of distal radius with open reduction and internal fixation with T shape locking compression plate(TLCP).[Method]From Sept.2003 to Nov.2005,9 cases with dorsally unstable distal radius fractures were treated with open reduction and internal fixation with T-LCP.This study involved 3 males and 6 femals with an average age of 63.5 years(ranged from 52 to 74 years old).According to AO classification: 2 cases of types B2;1 case of type B3;2 cases of type C1;3 cases of type C2;1 case of type C3,all of them were closed fractures of distal radius.The fractures of 9 cases were fixated with T-LCP by volar approach and dorsal soft tissues were not dissected during the operation.The Osteosets and the artificial bone substitute were implanted into bone defects if they were large enough.[Result]Nine cases were followed up for 6 to 17 months and the average time was 10.7 months.The X-ray pictures showed that unions have been achieved in all patients and a mean healing time was 7 weeks.The Osteosets were implanted into large bone defects in one case.No complication was found as infection,non-union,loosing of nails,syndrome of wrist,and medium neuritis.The functional recovery was achieved from 6 to 29 weeks with an average time of 12.5 weeks after operation.Passive wrist motion,active finger motion and forearm rotation were encouraged immediately after surgery.Active wrist motion was suggested in 7 days postoperatively.The clinical outcomes were evaluated according to modified Mcbide grading system.There were 7 excellent,1 good and 1 fair,the satisfactory rate was 88.9%.[Conclusion]The volar fixation of T-LCP for dorsally displaced fractures of distal radius has a good clinical outcome.It allows the patients to begin early exercise.

Objective To measure the extent of malrotation of femur fractures with CT scan after fixation with interlocking intramedullary nailing , and to discuss the methods which can help to correct the malrotation of femur fracture during the operation. MethodWith CT scan, the anteversion of femur fracture after the close reduction and fixation with interlocking intramedullary nailing in 56 cases was measured, and the difference of anteversion between the fracture side and the contralateral side was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion meaned external rotation. According to AO classification system, the type A of infratrochanteric fractures happened in 9 cases, type A of femoral shaft fractures happened in 12 cases, type B in 15 cases,type C in 7 cases,and 13 cases of femoral supercondyle fractures were type A. ResultThe results of measurement showed that the femoral anteversion after fixation with interlocking intramedullary nailing was changed in all patients. The anteversion of the femoral shaft fracture ranged from 13.35?to 47.21?. The aneversion of infrotrochanteric fractures ranged from -7.12?to 36.35?, and the supercondyle fracture of femur from -11.10?to 39.22?. For the extent of malrotation of distal femoral fracture, the internal rotation was more obvious than the external rotation. The number of Internal rotation cases accounted for 60.71%, and the external cases accounted for 39.29%. The maximum internal malrotation happened in femoral shaft fracture, from 1.37?to 29.82?with average malrotation 12.34?. and the minimum internal malrotation happened in infratrochanteri fracture, from 0.81?to 23.21?,with the average malrotation 8.32?. The medium internal malrotation was femoral supercondyle fracture, from 1.72?to 27.11? with the average malrotation 8.38?. The maximum external malrotation happened in femoral shaft fracture, from 1.11?to 21.12?with the average of them 9.33?. The minimum external malrotation happened in infratrochanteri fracture, from 1.31?to 16.23?with the average 7.71?. The medium external malrotation was seen in femoral supercondyle fracture, from 0.97?to 17.96?with average 8.22?. For these three parts of femoral fracture, the partnership T test was done between the fracture side and the contralateral side, the results showed that there were significant differences among of them,P

Objective To explore the effect and methods of hip prosthesic replacement of comminuted interochanteric fracture of femur in the eldly.Methods We adopted bone cement hip prosthesic replacements to treat interochanteric fracture of femur in the the eldly.There were 34 cases,with male 11 cases and female 23 cases,aged 74 ～90years old.The fracture was classified according to Evans,with Ⅰa 4 cases,EvansⅠb 12 cases,EvansⅠc 7 cases,EvansⅠd 8cases and EvansⅡ 3 cases.Results All 34 cases got operation successfuly,with the follow-up time of 7 to 48 months postoperatively for all 34 cases.The average hospital stay of the patients was 21 days.The average time to ambulation was 13 days.The incidence rate of the hip joint was 10 percent.Conclusion Bone cement twin exceedingly prosthesic replacement for interochanteric fracture in the the eldly has advmtages of early full weight-bearing and rapid rehabilitation.

Objective To study the clinical effect and necessity of removing internal fixation after treatment of acromioclavicular dislocation (Tossy Ⅲ ) with AO clavicular hook plate. Methods From October 2001 to October 2004, 31 patients with acromioclavicular dislocation (Tossy Ⅲ ) were treated with AO clavicular hook plate and were followed up. All of their broken acromioclavicular joints were sutured and the clavicular insertions of deltoid and trapezius muscles were repaired. The coracoclavicular ligaments were sutured for only 9 patients. Their shoulder functions before and after taking out of the internal fixation were assessed by Constant and Murley evaluation and compared. Results 24 patients were followed up from 4 to 40 months after operations (averaging 22 months). There were no loosening or breakage of internal fixations. The plates were removed 12 to 27 months postoperatively (averaging 18 months) in only 9 patients. No redislocation occurred after taking out of the plates. The scores of shoulder joint function were 76.5? 8.6 and 99.5? 1.0 (P

Objective To evaluate the preliminary outcome of surgical treatment of unstable distal radius fractures caused by osteoporosis in the elderly patients with open reduction and internal fixation with T-shaped locking compression plates(T-LCP).Methods From June 2003 to may 2005,13 elderly cases of comminu ted unstable distal radius fractures caused by osteoporosis were treated with op en reduction and T-LCP internal fixation.They were four males and nine females,with an average age of 74 years old(ranging from 67 to 81).According to AO classification,two cases belonged to types B2,three to type B3,two to type C1,five to type C2 and one to type C3.All of them were closed fractures.They were fixated with T-LCP through the volar approach and their dorsal soft tissues were not dissected during the operation.Osteoset,the artificial bone substitute,was implanted in one case of large bone defect.The postoperative functional recovery ranged from 6 to 30 weeks with an average of 12.3 weeks.Passive wrist motion,active finger motion and forearm rotation were encouraged immediately after surgery.Active wrist motion was suggested seven days postoperatively.Result s The 13 cases were followed up for 4 to 22 months,with an average time of 13.2 months.The X-ray pictures showed that one-stage union was achieved in all the patients,with a mean healing time of seven weeks.No such complications were found as infection,non-union,loosing of nails,carpal tunnel syndrome or medium neuritis.Their clinical outcomes were evaluated according to the modified Mcbride grading system.Nine were rated as excellent,three as good and one as fair,with their good-excellent rate being 92.3%.Conclusions T-LCP can ensure a good fixation in the treatment of unstable distal radius fractures caused by osteoporosis in elderly patients,allow the patients to do early exercise,and achieve satisfactory clinical outcome.

[Objective] To compose carbonated hydroxyapatite cement with chemica l materials,and by adding the pore agent to develop a new bone substitute,which can be solidified in situ to form porous carbonated hydroxyapatite.[Method](1)A new type of carbonated hydroxyapatite cement(CHC)was prepared.The powder of cement was composed of calcium carbonate,tricalcium phosphate and calcium phosphate dibasic.The liquids were prepared by 0.2mol/L sodium phosphate buffer,solide phase to liquid phase was 1g to 0.4 ml;(2)To prepare an in situ setting porous carbonated hydroxyapatite cement,add the pore agent into the powder of cement,pore generate CO2 during situ setting of cement;(3)The chemcial composition,chemcial constitution mechanical property,setting time,interval porosity of the PCHA were tested.and then the physio-chemical character,manipulatity,histocompatibility were evaluated.[Result]Addition of pore agent could succeed to prepare a new bone substitute which could set in situ and transform into porous carbonated hydroxyapatite.The setting time was 13~15 minutes which was suitable to clinical application.The pore size and porosity character could be controlled by adjustment of the component.The checking results demonstrated that the self-setting composition of this cement was carbonated hydroxyapatite which was similar with the mineral phase of natural cancellous bone,the carbonic acid radical was 5.6% in the solidify production.Contain of the porosity was 36% with interconnect pore,the compressive strength was 5.6?2.2 MPa which was equal to strength of cancellous bone,and the cytotoxicity tests showed an exellent biocompatibility.[Conclusion]The porous carbonated hydroxyapatite cement is a good bone substitute which seems to be the cancellous bone with good porosities,exellent biocompatibility.

[Objective]To evaluate curative effects of Osteoset~ synthetic bone transplants and internel fixations on calcaneus fracture.[Method]Twenty-three patients with calcaneus fracture,who were treated by Osteoset~ synthetic bone transplants and internel fixation,were followed up by plain X-Rays and JOA functional questionnaires.Fracture patterns were based on Sanders methods.[Result]A series of 23 patients,7 of which were sanders Ⅱ,15 were sanders Ⅲ,3 were sanders Ⅳ,were treated with ORIF and Osteoset~ implants.The preoperative Blher's angle was 4.8 degrees(standard deviation 6.6 degrees).Blher's angle increased to a mean of 26.8 degrees(SD 8.6 degrees) postoperatively.In the first 3 months after surgery,a mean decrease in the Blher's angle of 0.4 degrees(SD 2.27 degrees) occurred.One month after surgery osteoset synthetic bone transplants,which was replaced by new bone,were gradually absorbed and degraded.JOA questionnaires suggested that the whole effective rate was 92 percent.[Conclusion]Osteoset synthetic bone transplants and internel fixations has good therapeutic effects on patients with comminuted calcaneus fracture.Osteoset~ synthetic bone has the same effects as autogenous bone.