Objective To observe the effect of continuous elastic outside distraction on the expression of basic fibroblast growth factor (bFGF) and transforming growth factor-beta 1 (TGF-β1) in the female porcine nipples,and to further investigate the mechanism of continuous elastic outside distraction stimulation on the proliferation of supporting tissue in nipples.Methods Three female minipigs were employed,each of them had 12 nipples.Four nipples of each minipig were used as control group,while the other eight nipples were continuously distracted with prefabricated instruments.One nipple without distraction and two distracted nipples of each minipig were excised at 2,4,8,and 12 weeks after operation under general anesthesia respectively.The excised nipples were prepared for immunohistochemical staining to observe the expression of bFGF and TGF-β1.Image analysis software was employed for quantitative analysis.Results bFGF and TGF-β1 expression of control groups was weaker than those of the distracted groups at any time (P＜0.01).The expression of bFGF increased gradually after tracted and reached the peak at 4 weeks.There was significant difference (P＜0.05) in the expression of bFGF between 4 weeks and 12 weeks groups.The expression of TGF-β1 was increased to the peak after 2 weeks.The expression of TGF-β1 between 8 weeks and 12 weeks groups and 2 weeks group had statistical significance (P＜0.05).The expression of bFGF and TGF-β1 had a positive correlation during the traction.Conclusions Continuous elastic outside distraction can promote female minipig nipple to synthesis and secretion of b-FGF and TGF-β1.

Objective To evaluate the short?term functional outcome of Multiloc Proximal Humeral Nails (PHN) in the treatment of proximal humeral fractures, by retrospectively reviewing the function and complications of our institutional experi?ence. Methods 15 patients were treated operatively for displaced proximal humeral fractures using the Multiloc PHN. Fractures were classified according to Neer's classification. Male 4 cases, female 11 cases, with a mean age 63.7 years (58-73 years), and the mean follow?up was 5.2 months (3-10 months). A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the rating scale of the American Shoulder and Elbow Surgeons (ASES) and Constant Score, Visual Analogue Scale (VAS) scores. Results 15 patients completed the follow?up more than 3 months, the operation time was 145.3minutes (70-200 min), the blood loss was 189.3ml (50-310 ml). The union rate was 100%(mean time to union: 2.5 months). The ASES score was 83.1 and Constant Score was 81.7 , while the VAS was 1.7. The Constant score 87 (85, 92) and ASES 90 (83.5, 100) were higher for 5 cases without calcar screw than those of the other 10 cases using the calcar screw whose Constant 83 (77, 90), ASES 85 (73, 95). The average Constant score 88 (78, 92) and ASES score 91.5 (75, 100) were higher in 7 cases with 1 screw?in?screw than those with more than 2 screw?in?screw in 8 cases whose Constant 80.5 (74, 88.5), ASES 81.8 (73, 92.5). There were no complications such as hardware failure, protruded screws, infection, nonunion, avascular necrosis of humeral head or impingement syndrome, but 1 patient suffered from elbow stiff?ness (complication rate:6.7%). Conclusion The Multiloc proximal humeral nail is an effective implant for stabilisation of dis?placed proximal humeral fracture with a good short?term functional outcome. Its advantages are short operation time, small inci?sion, less trauma, less blood supply and less complications. The shoulder pain history and or with intraoperative findings of rotator cuff injuries, may have a negative impact on the prognosis.

Objective To explore the procedures of reconstruction emergency for skin and soft tisue defects due to trauma with local flap based on plastic surgical principles and techniques.Methods Thirty-two patients with facial defects caused by tramua were treated.After strict debridement of the wound of the skin and soft tissue,the flaps were designed according to the wound condition with plastic surgical principles.Subcutaneous SMAS pedicle flap,V-Y advancement flap,orbicularis flap,nasolabial groove flaps and others were chosen for wound repair,to suture and close the wound meticu lously.Results All of 32 treated cases,the wounds were primary healing.After 6-18 months follow-up,there was no obvious scar formation or functional problems.Second stage reconstruction was not needed since the cosmetic effect was perfect.Conclusions It is a satisfactory and effective method to emergently treat the skin and soft tissue defects after facial trauma with local flap based on the plastic surgical principles,which is well worth popularizing in clinic.

Objective To investigate the expression patterns of major bone growth factors and bone morphogenetic protein-2 (BMP2) in the distracted calluses following transfected gene during mandibular distraction osteogenesis in a rabbit model.Methods Bilateral mandibular osteotomies were performed in New-Zeland rabbits.After a latency of 3 days,the mandibles were elongated using distractors for 7 days.After the completion of distraction,the rabbits were randomly divided into 5 groups.Three animals each were sacrificed at the end of the delay phase,at 7,14,and 28 days after completion of distraction,respectively.The lengthened mandibles were harvested and processed for immunohistochemical detection of BMP2 expression,the mean optic densities and integral optical density of BMP2 positive cells were measured by computerized image analyzer.Results Elevated cellular expression of BMP2,in the distraction gap,was observed following mandibular distraction.BMP2 staining was mainly located in inflammatory cells,and the connective tissues arrounding the new bone.Their strongest expression was the 7th day,some of those growth factors expressed weakly or negatively.Conclusions Electroporation-mediated gene transfection can promote BMP2 expression effectively,which plays an important role in cell differentiation and proliferation during distraction osteo genesis.The BMP2 stimulates extracellular matrix synthesis,induces the proliferation and differentiation of fibroblasts and osteoblasts,which then promotes the new bone formation and repair.

Objective To investigate the effect of gene therapy which was mediated by electroporation on the expression of basic fibroblast growth factor (bFGF) duning mandible distraction.Methods Bilateral mandibular osteotomies were performed in New-Zealand rabbit.After a latency of 3 days,the mandibles were elongated using distractors with a rate of 0.8 mm/d for 7 days.The rabbits were randomly divided into 5 groups:2 μtg recombinant plasmids pIRES-hVEGF165-hBMP2,pIRES-hBMP2,pIRES-hVEGF165,pIRES and normal saline (NS) were injected into the distraction area of groups A,B,C,D and E,after completion of distraction,respectively.The lengthened mandibles were harvested and processed for immunohistochemical detection of bFGF,and the mean optic densities and integral optical density of bFGF positive cells were measured by computerized image analyzer.Results bFGF mainly located in fibroblasts,giant monocytes,polynuclear phagocytes,osetocytes,and osetoblasts in the connective tissue around bone tissue.The strongest expression was observed at the 7th day,and weakened at 14th day of consolidation stage,there were no significant difference among groups A,B and C,at the 7th day of consolidation.However,there were significant differences between gene therapy groups (A,B and C) and control groups (D and E) (P＜0.01).Conclusions Gene therapy can enhance and prolong the expression of bFGF in distraction gap,which promotes the cell differentiation and proliferation,extracellular matrix synthesis and new bone formation during distraction osteogenesis.This is probably one of the molecular mechanisms of the gene therapy promoting new bone formation in distraction gap.

Objective To explore the effect of elastic outside distraction on microvessel density and to illustrate the mechanism correcting inverted nipples. Methods Three female 3-month-old minipigs,with 12 nipples each,were employed.4 nipples of each minipig were remained without distraction were control group,and the other 8 nipples were continuously distracted with inverted nipple correction instruments.Corresponding nipples were excised at 2,4,8 and 12 weeks after traction.The excised nipple specimens were employed with immunohistochemical staining to detect the expression of vascular endothelial cells growth factor (VEGF) and CD34 in those tissues,and the percentageof positive cells and microvessel density (MVD) changes were counted.Results The expression of CD34 and VEGF in the experimental groups increased at 2 weeks after tracted,and reached at the peak at 4 weeks,then gradually decreased during 8 to 12 weeks after tracted.While those were weakly positive in control group.Compared with the control group,the integral optical density of VEGF-positive cells and MVD were significantly different (P＜0.01),and there was a significantly positive correlation between MVD and VEGF.Conclusions Continuous elastic outside distraction can promote the expression of VEGF and CD34 in female minipig nipple and enhance angiogenesis,which increases oxygen supply locally,and therefore those local tissue proliferation may be one of key mechanisms of correcting the inverted nipple by continuous elastic outside distraction.

Objective To evaluate the clinical outcomes of primary repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures.Methods From August 2007 to November 2011,16 cases of Mason-Johnston type Ⅳ radial head fractures were treated by open reduction and screw or plate fixation combined with simultaneous repair of ruptured capsular ligaments with suture anchors.There were 11 men and 5 women with a mean age of 31.6 years (range,18-52 years).Totally,left side was involved in seven cases and right side in nine； dominant side was involved in 13 cases and non-prominent side in three.Time from injury to operation averaged 6.2 days (range,2-11 days).Nine cases of partial articular fractures with 2 or 3 fragments were treated with 1.5 mm or 2.0 mm AO miniscrews and seven cases of complete articular fractures with 2-4 fragments were treated with 2.0 mm AO mini plastic plates and screws after reduction.Active and assisted functional exercise was instructed in the early period after surgery.Visual analogue scale (VAS) and Broberg-Morrey elbow performance were measured for function assessment at the latest follow-up.Results Follow-up averaged 22.6 months (range,12-38 months),which showed primary wound healing without infection.All fractures achieved bony union at an average of 4.8 months (range,3.3-6.2 months).Ten out of the 16 cases,four of partial articular fractures and six of complete articular fractures,had slight but asymptomatic ossification in the medial and lateral collateral ligament attachment.There were two excellent,six good and one fair results in partial articular fracture group,with excellent-good rate of 89％ as well as one excellent,four good and two fair results in complete articular fracture group,with excellent-good rate of 72％.Moreover,the total excellentgood rate reached 81％.Range of motion in extension,flexion and rotation,Broberg-Morrey score and VAS presented statistical differences between partial and complete articular fracture groups (P ＜ 0.05).Conclusion Primary management of bony and ligamentous components to treat Mason-Johnston type Ⅳ radial head fractures brings timely three-dimensional stability of the elbow joint,favors early functional exercise and further decreases incidence of postoperative complications,such as elbow stiffness,pain and heterotopic ossification.

ObjectiveTo analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus.MethodsThe study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.ConclusionsAlthough the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients.

AIM:To assess the protective role of melatonin(MEL)in a rat model of oleic-induced acute lung injury.METHODS:Twenty-four rats were randomly allocated to three groups as follows:saline(NS)injection group,oleic acid(OA)injection group and MEL plus OA injection group,the lavage protein,lung wet-to-dry weight ratio,malondialdehyde(MDA)content,superoxide dismutase(SOD)activity and lung histopathology were examined.RESULTS:(1)Injection 0.15 mL/kg of OA led to a severe acute lung injury(ALI),characterized by significantly increasing in lavage protein,lung coefficient(P＜0.01),and by histopathological alterations which presented hemorrhage,edema.thickened alveolar septum and the existence of inflammatory cells in alveolar spaces;(2)Infusion of MEL(20 mg/kg,intraperitoneally for 60 min before the oleic acid)markedly alleviated above-mentioned symptom induced by OA,consistent with decrease of MDA level(P＜0.01) and the increase of SOD activty(P＜0.01).CONCLUSION:Pre-treatment with MEL can attenuate the OA -induced ALI in rats via cleaning and preventing the formation of free radicals and further lessening the increase of alveolocapillary membrane permeability,these data suggest that MEL may be effective in the prevention of ALI.

Objective To explore the characteristic of ACE gene I/D polymorphism in Han broad jumpers .Methods Distribu‐tion of ACE gene I/D polymorphism for broad jumpers was analyzed by PCR ,DNA sequencing ,Hardy‐Weinberg and SPSS ,and the results were compared with that of normal people .Results There were II ,DD and ID in gene ACE 16 ,and the Hard‐Weinberg re‐sults showed that the subjects were group representative .The ACE DD genotype and D allele in broad jumpers was statistically higher than normal controls (P<0 .05) .Conclusion The results suggest that ACE DD genotype and D allele are associated with training sensitivity of broad jumpers and could be the molecular marker for athletes choosing genetically .