Objective To improve bone knife spinous lamina osteotomy replantation complex treatment of lumbar spinal stenosis patients.Methods Retrospective analysis from January 2014 to January 2015,the clinical data of 56 patients with lumbar spinal stenosis disease,all patients were taken modified osteotome bone cutting composite lamina spinous process and implant treatment,through follow-up,the CT,preoperatie and follow-up sessions at the end of the measurement of vertebral canal sagittal diameter,spinal canal diameter,to observe the prognosis and complications,and according to the Japanese orthopaedic society of low back pain score standard(Japanese orthopaedics asso ciation,JOA),the rate of good evaluation of clinical curative effect.Results This group of 56 patients with lumbar spinal stenosis disease,the last follow-up,vertebral canal sagittal diameter,spinal canal diameter,than preoperative significantly increased;JOA score was obviously improve the preoperative;The t test,statistically significant difference(P<0.05);The rate of good clinical curative effect was 96.43%;Follow-up period,all patients by CT review that lamina in situ fusion rate was 100%,no lumbar spinal instability,secondary lumbar spinal stenosis,composite lamina spinous complications such as shift,subsidence,fall off;6 months basic achieve bony healing.Conclusion The modified bone knife spinous lamina osteotomy replantation complex therapeutic effect of lumbar spinal stenosis precise,effective reconstruction of posterior structure stability,integrity,reduce complications,the prognosis is good,worthy of clinical use.

Three-dimensional (3D) printing technique has been improving the industrial process from uniform pipeline production procedure in manufacture into individualized production with distributed network. 3D printing technique also provokes these changes in the field of medicine, especially in orthopedics, stomatology and radiology. The role of 3D printing technique has been increasingly highlighted in tumor radiotherapy. Current studies and application mainly focus on personalized tissue compensato (bolus), brachytherapy (high-dose post-loading and particle implantation therapy), 3D printing personalized phantom and individualized fixtures, etc. In this article, research progresses on the application of 3D printing technique in radiotherapy at home and abroad were reviewed.

BACKGROUND:Currently, what we know about exosomes is that it can be produced by a variety of cel s and transfer a variety of materials, producing subsequent function of regulation.
OBJECTIVE:To review the function of exosomes in mesenchymal stem cel differentiation, in order to provide reference for further in-depth study.
METHODS:With the key words of“exosome, mesenchymal stem cel , differentiation”in Chinese and English, respectively, a computer-based search was performed for articles published in CNKI, Medline and Embase databases from January 2001 to September 2016. After the initial screening, the reserved articles were further detailed, summarized and concluded.
RESULTS AND CONCLUSION:Exosomes are a kind of vesicles 40-100 nm in diameter, which can be secreted by a variety of cel types, containing functional products, such as functional protein, gene product, lipid and so on. As a bridge of adjacent cel s transferring functional products, exosomes are becoming an issue of concern in the microenvironment for cel interaction. In the differentiation of mesenchymal stem cel s, exosomes also play an indispensable role via pathway regulation.

BACKGROUND:Lisfranc injury is rarely seen in clinical practice, with a low incidence and a high misdiagnosis rate. At present, open reduction and internal fixation is the major treatment, but there is little evidence available on the long-term fol ow-up fol owing injury and foot motor functions fol owing surgery. OBJECTIVE:To evaluate the change of foot functions after metal graft internal fixation in patients with Lisfranc injury. METHODS:Eighteen patients with Lisfranc injury were treated with internal fixation of metal grafts, such as Kirschner wire, screws and steel plate. At 6-8 weeks postoperatively, patients began to walk with crutches. After 1 year fol ow-up, the Footscan balance system and AOFAS scores were applied to evaluate the foot stability and function of patients. RESULTS AND CONCLUSION:After 1 year of internal fixation, al bone fractures were healed, the peak pressure of affected foot in the fourth metatarsal (M4) and the fifth metatarsal (M5) was significantly increased (P<0.05), and the impulse in the fifth metatarsal (M5) and mid-foot bottom (MID) was higher than the contralateral side (P<0.05). The AOFAS score of affected foot was 87.26 ± 21.13 points, the rate of excellent and good efficacy accounted for 88.9%. Internal fixation can rebuild Lisfranc complex stability, the body weight is transferred from the inside to the outside in the front foot, and the remaining pressure did not change significantly, thus the foot function is recovered satisfactorily.

BACKGROUND:Over-expression of serum interleukin-6 and interleukin-8 may be involved in tourniquet-induced limb ischemia-reperfusion injury to the lung ventilation function. OBJECTIVE:To evaluate the tourniquet effect on serum interleukin-6 and interleukin-8 levels of the rat limb within the safety time limit. METHODS: Sixty rats were randomly divided into control and experimental groups, 30 rats in each group. Rats in the control group had no ischemic preconditioning and were directly subjected to stop bleeding for 2, 3, 4 hours; rats in the experimental group were subjected to ischemic preconditioning (short-time hemostasis for several times within 1 day before ischemia-reperfusion injury), and then underwent 2-, 3-, 4-hour hemostasis at the 2nd day. At 1, 3, 7, 14 days after the recovery of limb blood flow, blood samples were extracted to detect serum interleukin-6 and interleukin-8 levels using ELISA method. RESULTS AND CONCLUSION:The levels of interleukin-6 interleukin-8 showed an increasing and decreasing trend in the two groups, which both reached the peak at the 3rd day (P< 0.05). The levels of interleukin-6 in the experimental group was significantly higher than that in the control group at 1, 3, 7, 14 days (P < 0.05), and only at 7 days, the level of interleukin-6 in the rats undergoing 3-hour hemostasis was significantly lower than that in the control group (P< 0.05). At 7 days, the level of interleukin-8 in the rats undergoing 3-hour hemostasis was lower than that in the control group, but there was no significant difference (P > 0.05), and at 3, 7, 14 days, the level of interleukin-8 in the rats undergoing 4-hour hemostasis was significantly higher than that in the control group (P< 0.05). At 1 and 3 days, the levels of interleukin-6 and interleukin-8 in the experimental group had an increasing trend with the bleeding time and ranked as folows: 2-hour hemostasis < 3-hour hemostasis < 4-hour hemostasis, and there was a significant difference; while in the control group, there was also an increasing trend in the levels of interleukin-6 and interleukin-8, but there was no statistical difference. These findings indicate that the tourniquet preconditioning treatment is preferred at 3 days after limb ischemia-reperfusion injury, when the inflammatory response was the most obvious in rats, and this treatment can dramaticaly reduce inflammatory response. Additionaly, the inflammatory become more obvious with the bleeding time.

BACKGROUND:There remains controversy that whether patel ar resurfacing in total knee arthroplasty and whether patel ar chondromalacia has influence on clinical outcomes.
OBJECTIVE:To evaluate anterior knee pain, clinical function and effects of patel ar chondromalacia on clinical outcomes after total knee arthroplasty without patel ar resurfacing for degenerative osteoarthritis.
METHODS:Clinical data of 162 patients (162 knees) with degenerative osteoarthritis undergoing total knee arthroplasty without patel ar resurfacing from June 2008 to February 2010 were retrospectively analyzed. Outerbridge classification was used for patel ar chondromalacia, Visual Analogue Scale for anterior knee pain, and the Knee Society clinical scoring system for clinical function.
RESULTS AND CONCLUSION:The incision of al patients reached stage-I healing. The patel ar chondromalacia:grade I in 18 patients, grade II in 36 patients, grade III in 62 patients, and grade IV in 35 patients. At the final fol ow-up, there were six (4.0%) patients with anterior knee pain, including four cases of mild pain and two cases of moderate pain, no severe pain. The mean Knee Society clinical scoring system scores and patel ar score were obviously elevated. Outerbridge classification did not affect the incidence of anterior knee pain after replacement (χ2=0.42, P=0.94), the Knee Society clinical scoring system score (knee score:F=1.83, P=0.14;functional score:F=0.56, P=0.64) and partel ar score (F=0.78, P=0.51). These data suggested that total knee arthroplasty without patel ar resurfacing for degenerative osteoarthritis can obtain satisfactory clinical outcomes, and the patel ar chondromalacia may not affect the clinical outcomes.

BACKGROUND:Since damage control theory system was founded, this theory in the orthopedics has been applied gradualy, especialy in elderly hip fracture surgery that reduces the negative impacts due to inflammatory responses. OBJECTIVE:To explore whether flurbiprofen axetil can reduce inflammatory responses in rats with hip fractures based on the damage control theory. METHODS: Forty-nine healthy Sprague-Dawley rats weighing 250-300 g were randomly divided into four groups:control group (n=7), immediate internal fixation group (n=14), flurbiprofen axetil group (n=14), damage control group (n=14). Rats in the control group moved freely in the cages. Rats in the other three groups were intraperitonealy injected with composite anesthetics to make unilateral hip fracture models, and then respectively given internal fixation immediately after fracture, flurbiprofen axetil injection and delayed internal fixation, and delayed internal fixation. Levels of serum C-reactive protein, interleukin-6 and tumor necrosis factor-α were determined and analyzed before fixation, immediately after internal fixation and at 4, 8, 12, 24, 48 hours after internal fixation in different groups. RESULTS AND CONCLUSION:Postoperative serum levels of C-reactive protein, interleukin-6, tumor necrosis factor-αwere al increased in different groups. The level of C-reactive protein reached the peak at 24 hours after internal fixation. Flurbiprofen axetil injection had no significant influence on the level of C-reactive protein in rats with delayed internal fixation (P=0.51). Interleukin-6 levels were stil increased at 48 hours after internal fixation, but flurbiprofen axetil reduced the level of interleukin-6 significantly in rats with delayed internal fixation (P < 0.01). The tumor necrosis factor-α level peaked at 4 hours after internal fixation, and flurbiprofen axetil injection could significantly reduce the level of tumor necrosis factor-α in rats with delayed internal fixation (P < 0.01). These findings indicate that flurbiprofen axetil as a new non-steroidal anti-inflammatory drug can reduce the inflammatory response in rats with hip fractures after internal fixation, and also can aleviate the inflammatory response of rats undergoing delayed operation under the guidance of damage control theory.

Objective To synthesize 99Tcm-TP5-3 and evaluate its biodistribution and kinetics as a molecular probe for the detection of apoptosis,and evaluate tumor apoptosis after a single dose of paclitaxel chemotherapy in MDA-MB-231 breast tumor model.Methods TP5-3 was labeled with 99Tcm directly,and analyzed with HPLC.The radioactivity in tissues was measured and expressed as ％ID/g and T/NT (tumor/muscle).The mice bearing MDA-MB-231 breast tumor were divided into two groups:the treatment group which was given a single dose of paclitaxel (40 mg· kg-1,via tail vein),and the control group which was injected with the same volume of normal saline.After therapy,99Tcm-TP5-3 was injected via tail vein in both groups (100 μ1 for each mouse).MicroSPECT/CT was performed at 3 h postinjection.Radioactivity in different tissues was determined after imaging.Apoptotic cells were measured with flow cytometry.The morphological changes of the apoptotic cells were observed by light microscopies.One-way analysis of variance,two-sample t test and linear correlation analysis were used to analyze the data.Results The radiolabeling efficiency was ＞ 95％ and the radiochemical purity of 99Tcm-TP5-3 was (96.0± 1.5)％ at room temperature for 4 h.The predominant uptake was found in the kidneys at 30 min postinjection ((8.48± 1.07) ％ID/g),with rapid tracer clearance from the circulation.By comparison with activity at 5 min postinjection ((13.74± 4.21) ％ID/g),85％ of the initial activity reduced in blood at 4 h ((2.07±0.35) ％ID/g; F=11.310,P＜ 0.05).99Tcm-TP5-3 was mainly accumulated in the kidneys,liver and stomach,and excreted via the kidneys.T/NT in the treated group was 4.21±0.06,which was significantly higher than that of the control group (1.57±0.67; t =12.820,P＜0.05).The radioactivity of tumor tissue in the treatment group was much higher than that in the control group (4.82±0.54) ％ID/g vs (1.44±0.38) ％ID/g,t=0.679,P＜0.05).The tumor uptake of 99Tcm-TP5-3 in the treatment group positively correlated well with the apoptotic cells (r =0.985,P＜0.05).Histopathology further confirmed that a large number of apoptosis had occurred in the tumor after paclitaxel treatment.Conclusion 99Tcm-TP5-3 appears to have potential to be a useful molecular probe for imaging tumor cell apoptosis.

BACKGROUND:There is no clear understanding about the effect of let-7f and interleukin-6 (IL-6) on the proliferation of bone marrow mesenchymal stem cels and their relationship.
OBJECTIVE: To explore the effects of expression levels of let-7f and IL-6 on the proliferation of bone marrow mesenchymal stem cels and their relationship.
METHODS:(1) LV-rno-let-7f-up and LV-rno-let-7f-down were constructed and transfected into bone marrow mesenchymal stem cels of Sprague-Dawley rats, respectively. Then, there were four groups in the study: transfection upregulation group transfected with LV-rno-let-7f-up), transfection inhibition group (transfected with LV-rno-let-7f-down), negative control group (transfected with FU-RNAi-NC-LV), and untransfected group. The expression level of let-7f in each group was detected by qRT-PCR. The proliferation ability of cels and expression levels of IL-6 when let-7f expression was at different levels were detected by MTT, flow cytometry and ELISA. The expression of Cyclin D1 at mRNA and protein levels was detected by qRT-PCR and western blot, respectively. (2) To predict the potential target gene of let-7f, the wild-type/mutant IL-6 3’UTR reporter gene vectors were constructed, and cotransfected with let-7f/let-7f inhibitor respectively into the 293T cels to measure the luciferase.
RESULTS AND CONCLUSION: Compared with the negative control group, the proliferative and cloning capacities of cels in the transfection upregulation group were higher; the number of cels was significantly decreased at G1 stage and increased at S stage, and the apoptotic cels were reduced in number (P < 0.05). However, the transfection inhibition group had opposite results. The expression level of IL-6 in the transfection upregulation group was lower than that in the untransfected group and negative control group (P < 0.05); while in the transfection inhibition group, the expression level of IL-6 was significantly increased (P < 0.05). The expression of Cyclin D1 at mRNA and protein levels was up-regulated in transfection upregulation group (P < 0.05) and down-regulated in the transfection inhibition group (P < 0.05), but there was no significant difference between the negative control group and untransfected group (P > 0.05). Luciferase activity of cels transfected with wide-type IL-6 3’UTR and let-7f was significantly reduced (P < 0.05). These findings indicate that up-regulation of let-7f can promote the proliferative and cloning capacities of bone marrow mesenchymal stem cels and reduce cel apoptosis, but downrelation of let-7f exhibits an inhibitory effect. Overexpression of IL-6 can suppress the proliferation of bone marrow mesenchymal stem cels, which is considered to be a target gene of let-7f, and let-7f may suppress the expression of IL-6 to promote the cel proliferation.

Objective:To evaluate the protective effects of hydrogel implantation in prostate cancer patients for radiotherapy.Methods:A search was performed in PubMed, Web of Science, Cochrane Library, Embase, CNKI and VIP to collect controlled clinical research literature concerning hydrogel implantation in prostate cancer for radiotherapy. The Revman 5.3 software was used to perform meta-analyses of rectal V70, rectal D2 cm 3, rectal toxicity effects and bowel symptoms. Results:The review included ten controlled clinical trials involving 1 360 patients (690 in the hydrogel group and 670 in the control group). The result of Meta-analysis showed that the rectal V70 and rectal D2 cm 3 of prostate cancer patients in the hydrogel group were significantly lower than those in the control group( MD=-4.5, 95% CI -7.11 to -1.90, P<0.001; MD=-19.78, 95% CI -25.92 to -13.63, P<0.001), early and late G1 rectal toxic effects in the hydrogel group were significantly lower than those in the control group ( OR=0.64, 95% CI 0.45-0.90, P=0.01; OR=0.28, 95% CI 0.13-0.60, P=0.001)and the late bowel quality of life in the hydrogel group was significantly improved compared with the control group( MD=5.13, 95% CI 3.29-6.98, P<0.001). However, there were no statistically significant differences in early and late ≥G2 rectal toxic effects( OR=0.46, 95% CI 0.17-1.25, P=0.13; OR=0.44, 95% CI 0.09-2.17, P=0.31)and the early bowel symptoms( MD=2.30, 95% CI -1.31-5.91, P=0.21)between the two groups. Conclusions:Hydrogel implantation inprostate cancer for radiotherapy can reduce rectal V70 and rectal D2 cm 3, lower the early and late G1 rectal toxic effects, and reduce improve the late bowel symptoms.