Objective To investigate the clinical effectiveness of autologous platelet-rich-plasma (PRP) combined with iliac autograft in reconstruction of bony defective nonunion of humeral condyle.Methods The 27 patients who had been admitted to our department from January 2004 to June 2015 for bony defective nonunion of humeral condyle were analyzed retrospectively.Of them,15 underwent reconstruction with PRP combined with iliac autograft (experimental group) and 12 reconstruction with only iliac autograft (control group).The preoperative demographic data of the 2 groups were not significantly different (P ＞ 0.05).The 2 groups were compared in terms of operation time,hospital stay,bony union time,range of motion of the elbow,and modified Cassebaum scoring.Results The patients were followed up for 12 to 90 months (average,24.6 months).No such complications were observed as displacement of bone blocks,loosening or breakage of implants,re-nonunion,malunion,delayed ulnar neuritis,or olecranon nonunion.There were no statistic differences between the 2 groups regarding operation time,hospital stay,range of motion of the elbow and modified Cassebaum scoring (P ＞ 0.05).The clinical healing time (4.2 ± 1.3 months) and bony healing time (4.8 ± 1.4 months) for the experimental group were significantly shorter than for the control group (6.0 ± 1.1 months and 6.2 ± 1.0 months,respectively) (P ＜ 0.05).Conclusion Autologous PRP combined with iliac autograft can speed up the healing of bony defective nonunion of humeral condyle,promoting functional recovery of the elbow.

Child ; Hemofiltration ; Humans ; Male ; Paraquat ; poisoning ; Poisoning ; therapy ; Treatment Outcome

Objective To evaluate simple and practical methods to repair deep wounds in the foot near the ankle joint.Methods 128cases of deep wounds near ankle jo int with exposed bone and tendons fro mJan 1990to Jan 2002were reviewed .Altogether 13types of microsurgical flaps were applied in these cases and obtained satisfactory results.Timing of sur gery:53cases of primary repair,28c ases of secondary repair,47cases of delayed repair.Results26cases of reverse skin avultion were repaired by venous anastomosis in a valsed flaps,of which19survived completely,and 7underg one partial necrosis.There were 19f ree tissue flap grafts in which 13sur vived,3failed and 3undergone partial necrosis and infection.All pedicle tissue flap grafts amounted to 83cases wi th only3partial necrosis in 58cases of sura l nerve flaps graft,and 1total necro sis in 25other types of flap grafts.Con-clusion Sural nerve flaps graft is a reliable method to repair deep wounds with exp osed bone and tendons near the ankle joint.It is easy to perform with excellent abrasion resistance and little effect on the donor limb.

Objective To introduce a new technique of talocalcaneal joint fusion with trephine and evaluate its clinical effects. Methods From June 1997 to October 2001, 18 cases complained of pain, weakness, limited range of motion and tenderness of ankle were treated with subtalar joint fusion. Of 18 cases, there were 12 males and 6 females with an average age of 47 years (range, 35 to 59 years). The lesions of subtalar joint were identified as traumatic osteoarthritis in 8, degenerative osteoarthritis in 5, congenital bone bridge in 2, rheumatoid arthritis in 2 and refractory inflammation of tarsal sinus. The AP and lateral view X-ray films were taken to measure the width and length of sutalar joint and talocalcaneal angle so as to choose the trephine of appropriate diameter (?11.5 mm, 12 mm, 13 mm )and guide the direction and length of osteotomy. Posterolateral approach was used in 14, and anterolateral approach in 4 depending on the location of lesion at subtalar joint. The trephine was inserted into subtalar joint slowly, the bone block inside the trephine was removed, rotated to 90?, then reimplanted in situ in 14 cases; Autograft of iliac crest was harvested and implanted by trephine in 4. Results All of the affected feet were immobilized with a cast postoperatively for 12 to 16 weeks. The patients were followed up for an average of 25 months ranging from 5 months to 4 years. All the wounds healed well at 2 weeks, the callus appeared at 4 weeks, and the bony fusion was obtained at 16 weeks displayed by postoperative X-ray films. The scores of ankle pain by VAS measurement were improved from preoperative 83.8 to postoperative 32.5. There were no severe complications, only 1 case suffered from dropping foot and recovered 10 months later, and 1 case complained of discomfort of foot. Conclusion Subtalar joint fusion with trephination is an effective procedure with many advantages such as: minimal invasive surgery, easy to perform, higher fusion rate and preserving mechanical stability of hind foot.

Objective To investigate the role of hypoxia inducible factor(HIF)-prolyl hydroxylase 1 (HPHl)and factor inhibiting HIF-1(FIH-1)in placentas in the pathogenesis and development of severe pre-eclampsia.Methods RT-PCR and western blot analyses were used to detect the HPH1 and FIH-1expression levels in placentas of 34 patients with severe pre-eclampsia and 24 cases of term pregnancy (normal pregnancy group)and their correlations with symptoms were analyzed.Results (1)The HPHI mRNA and protein expression levels in placentas of severe pre-eclampsia group were 0.40±0.04 and 59.5±3.4 separately,significantly lower than those of normal pregnancy group,0.84±0.12 and 71.6±1.7(P<0.01).The FIH-1 mRNA and protein expression levels in placentas of severe pre-eclampsia group wereQ 31 ±0.05 and 45.6±2.4 separately,significantly lower than those of normal pregnancy group,0.43±0.04 and 54.9±2.1(P<0.01).(2)The mRNA and protein expression levels of HPH1 and FIH-1 in severe pre-eclampsia group were all negatively correlated with mean arterial pressure(MAP)[the Spearman correlation coefficient was-0.854(P<0.01)],urinary protein per 24 hours[the Spearman correlation coefficient was-0.936(P<0.01)1 and the occurrence of fundus oculi artery spasm[the Spearman correlation coefficient was-0.854(P<0.01)].(3)rrhe expression of HPHl mRNA in placentas of all the 58 cases WBB 0.58±0.27.higher than the expression of FIH-1 mRNA,which was 0.39±0.10.There was a positive correlation between them.The pearson correlation coefficient was 0.686(P<0.01).The expression of HPH1 protein in placentas of all the 58 cases was 64.5±6.7,higher than the expression of FIH-1,which was 49.4±5.2.There was a positive correlation between them.The Pearson correlation coefficient was 0.947(P<0.01).Conclusion The expression imbalance of HPH1 and FIH-1in palcenta may play an important role in the pathogenesis and development of severe pre-eclampsia through inhibiting HIF-1a.

Objective To evaluate different expressions of high mobility group box 1(HMGB1)and receptor for advanced glycation end products(RAGE)in placentas and their relationship with preeclampsia.Methods Fifteen early-onset pre-eclaraptic women(early-onset pre-eclampsia group),22 late-onset pre-eclamptic women(late-onset pre-eclampsia group)and 12 normotensive women(control group)in the third trimester were recruited at the Shengjing Hospital of China Medical University from March 2006 to March 2007.The localization and levels of HMGB1 and RAGE in placentas of the three groups were detected by the strept avidin biotin-peroxidose method.Results (1)Immunoreactivities to HMGB1:positive immnnostaining for HMGB1 was observed in trophoblast,macrophages,decidual cells,vascular muscle cells,endothelial cells and placental mesenchymal cells in the placentas from the pre-eclamptic women,while a low level of immunoreactivities was observed in the placentas from healthy pregnancies;the staining was observed within both the nuclei and the cytoplasm,mainly in the cytoplasm.The cytotrophoblast,especially the nuclei was extensively positive for HMGB1 in early-onset pre-eclampsia. (2)Immunoreactivities to RAGE:positive immunostaining for HMGB1 was observed in syncytiotrophoblast,macrophages and endothelial cells in the placentas from the preeclamptic women,while a low level of immunoreactivities was observed in the placentas from healthy pregnancies:the staining was in the cytoplasm and(or)cell membrane.The trophoblast was extensively positive for RAGE in early-onset pre-eclampsia.(3)Positive rate of HMGB1 expression:the expression of HMGB1 in early-onset group(73%,11/15)and late-onset group(64%,14/22)was significantly higher than that in normal group(17%,2/12;P<0.05),but no significant difference was found in early-onset group and late-onset group(P>0.05).(4)Positive rate of RAGE expression:the expression of RAGE in early-onset group(80%,12/15)and late-onset group (82%,18/22)was significantly higher than that in normal group(25%,3/12;P<0.05),but no significant difference was found in early-onset group and late-onset group(P>0.05).Conclusions The increased expression of HMGB1 and RACE in the placenta may play an important role in the pathogenesis of pre-eclampsis.The different locations may be associated with the occurrence of different onset types of pre-eclampsia.

Objective To investigate the effectiveness of simple peritoneal lavage combined with venous-venous hemofiltration therapy for severe acute pancreatitis (SAP). Methods Needles were inserted into abdominal cavity and tee was connected, then normal saline was administrated and discharged, followed by lidocaine, dexamethasone and antibiotics once daily until bloody peritoneal drainage became clear. At the same time venous-venous hemofiltration was used. Results 61 SAP patients were randomly divided into peritoneal lavage + hemofiltration group (treatment group, n =31) and control group (n = 31). The time to abdominal pain relief, abdominal distention relief, nausea and vomiting disappearance, peritoneal irritation disappearance was (1.5 ±0.3)d,(2.7 ±0.3)d, (1.9 ±0.3)d, (1.5 ±0.2)d, and the time to cure was (11.0 ±2.0)d in the treatment group, which was significantly shorter than that in the control group [(3.9 ± 0. 3) d, (4.5 ±0.6)d, (3.7 ±0.2)d, (5.3 ±0.4)d, (18.0 ±2.5)d, P＜0.05]. At the 1st day of treatment, serum ALT,AST was significantly lower than that in the control group; at the 3rd day of treatment, the serum and urine amylase and serum levels of TNF-α, IL-6 and IL-8 level were significantly lower, but the serum level of IL-10,HCO3-was significantly higher than that in the control group (P ＜ 0.05 or ＜ 0. 01); at the 5th day of treatment, the serum Bun and Cr level were significantly lower than those in the control group (P ＜ 0. 05).Conclusions Simple peritoneal lavage combined with venous-venous hemofiltration therapy can effectively eliminate the inflammatory factors, which is more rational and effective for the treatment of severe acute pancreatitis.

Objective To evaluate the clinical effect of talonavicular arthrodesis and the influence of adjacent joints use trephine percutaneous osteotomy in the treatment of talonavicular arthralgia.Methods From June 1999 to June 2009,24 patients were performed talonavicular arthrodesis due to a variety of painful disorder of talonavicular joint with trephine percutaneous osteotomy.There were 13 males and 11 females,with an average age of 45 years(range,37-72 years).The indications for the procedure included 15cases with posttraumatic arthritis,6 cases with rheumatoid arthritis,and 3 cases with degenerative arthritis.AOFAS system and visual analogue scale(VAS)were used to evaluate the change of function and arthralgia.Graves score system was used to evaluate the influence of adjacent joints.Results All patients were followed up 10-120 months,with the mean of 48 months.Only one case suffered skin brim necrosis of incision and got delayed healing after 3 weeks.The average AOFAS ankle-hind foot score improved from 45.2 points preoperatively to 84.5 points postoperatively.The excellent and good rate was 87.5%.VAS pain scores decreased from 8.1 to 2.4 postoperatively.Twenty-three patients were satisfied and one dissatisfied with the results.Postoperative radiology showed the union evidence in 23 patients at 6 months postoperatively(successful fusion rate of 95.8%).One joint nonunion occurred and required revision arthrodesis with iliac crest bone graft.There was an increase of Ⅰ grade in arthritic scores for 8 cases and Ⅱ grade for 1 case.Conclusion Talonavicular arthrodesis with trephine percutaneous osteotomy has the advantages of low trauma,high successful fusion rate and can acquire satisfactory clinical effect in the treatment of painful malalignment of talonavicular joints.

AIM: To study the effect of calcium sensing receptor (CaSR) on icariin (ICA) induced mouse embryonic stem cells ( mESCs) to differentiate into cardiomyocytes in vitro.METHODS:mESCs were cultured to embry-oid bodies ( EBs) by direct suspension method and the differentiation of EBs into cardiomyocytes was induced by ICA.The expression of cardiac specific proteinsα-actinin and cardiac troponin-I ( cTnI) was analyzed by Western blot and immuno-fluorescence.The differentiation rate was determined by flow cytometry.The ultrastructure of the derived cardiomyocytes was further characterized by transmission electron microscopy.The expression of cardiac-specific transcription factors Nkx2.5 and GATA-4,as well as CaSR was detected by Western blot.RESULTS: After induction with ICA, the positive characteristics of myocardial cells appeared in the EBs cultured for 2 d.The expression of cardiac-specific sarcomeric pro-tein actinin (α-actinin) and cTnI showed an overall upward trend by Western blot in different phases of ICA induced differ-entiation.The expression of CaSR, Nkx2.5 and GATA-4 was the highest at an early stage of ICA-induced differentiation. Neomycin (an activator of CaSR) up-regulated CaSR, NKx2.5 and GATA-4 expression in the EBs at early stage of ICA-in-duced differentiation, all of which were reversed by NPS2390 ( an inhibitor of CaSR) .CONCLUSION:CaSR is function-ally expressed in mESC-derived cardiomyocytes, and activation of CaSR is involved in the differentiation of mESCs into car-diomyocytes by facilitating the expression of NKx2.5 and GATA-4.

Objective To investigate the effect of Glycyrrhizin combined with puerarin on serum Leptin and insulin resistance in non-alcoholic fatty liver disease(NAFLD) patients.Methods One hundred and twenty patients with NAFLD were randomized into 4 groups,which were control group,compound Glycyrrhizin group,puerarin group,combined group,and each group was 30 cases.Patients in control group were received the regular liver protecting therapy including vitamins,amino acids,glucurolactone,in compound Glycyrrhizin group were given 60 ml compound glycyrrhizin solution (iv),in puerarin group were given puerarin at dose of 400 mg by intravenous infusion,and in combined group were given both compound glycyrrhizin and puerarin combination.All treatment period was 4 weeks.The levels of serum serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total cholesterol (TC),triglyceride (TG),leptin (LP),fasting blood glucose (FBG) and insulin(INS) were measured,and the insulin resistance index(IRI) was calculated.The liver CT image of patients were performed by Germany Siemens dual source CT instrument.Results The levels of serum ALT,AST,TC,TG,LP and IRI in control group at before and after treatment were ((83.08 ± 115.68) U/L vs.(43.32 ±11.72) U/L,(52.12±15.62) U/Lvs.(36.08 ±7.28) U/L,(6.20±1.30) mmol/Lvs.(5.60 ±0.70) mmol/L,(2.70 ±0.50) mmol/L vs.(2.10 ±0.40) mmol/L,(14.63 ±3.26) μg/L vs.(7.61 ± 2.46) μg/L,(7.9 ± 1.8) vs.(7.0 ± 1.2)),and the difference were statistically significant (t =12.828,4.244,16.648,21.442,3.341,16.152 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and IRI in compound glycyrrhizin group after treatment were ((43.28 ± 11.06) U/L,(37.28 ± 7.22) U/L,(5.70± 0.80) mmol/L,(2.20 ± 0.50) mmol/L,(7.89 ± 2.26) μg/L,(7.1 ± 1.6) respectively,significant different from before treatment ((83.06 ± 14.38) U/L,(51.68 ± 15.48) U/L,(6.30 ± 1.50) mmol/L,(2.60 ± 0.40) mmol/L,(15.13 ± 3.87) μg/L,(7.8 ± 2.2) respectively,t =8.893,4.225,16.520,24.708,6.353,21.137 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in puerarin group after treatment were (44.26 ± 9.68) U/L,(36.86 ± 6.88) U/L,(5.60 ± 0.70) mmol/L,(2.26 ± 0.48) mmol/L,(6.89 ± 2.18) μg/L,(7.0 ± 1.8) respectively,significant different from that before treatment ((82.68±14.36) U/L,(50.06±15.23) U/L,(6.20±1.60) mmol/L,(2.70±0.52) mmol/L,(15.68 ±3.26)μg/L,(7.7 ±2.8) respectively,t =7.087,8.138,18.159,7.244,7.470,32.283 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in combined treatment group after treatment were (22.28 ± 9.38)U/L,(28.48 ± 9.06) U/L,(5.00 ± 0.60) mmol/L,(1.70 ± 0.40) mmol/L,(4.63 ± 2.36) μg/L,(6.20± 1.6) respectively,significantly different from that before treatment ((84.62 ± 14.88) U/L,(49.12 ± 16.56)U/L,(5.70 ± 1.60) mmol/L,(2.78 ± 0.50) mmol/L,(14.78 ± 3.68) μg/L,(7.6 ± 2.1),t =14.255,11.272,8.371,9.941,8.102,37.626,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI of patient were no significant difference before treatment,but after treatment,these indexes in combined therapy group were the lowest among 4 groups (P ＜ 0.05).And there were no significant difference among control group,compound glycyrrhizin group,puerarin group (P ＞ 0.05).Conclusion Compound glycyrrhizin combined with puerarin is proved to be an effect treatment method for NAFLD through decreasing serum leptin,improving insulin resistance.