Incidence of ankle fractures is relatively high.Malunited ankle fractures result from inappropriate nonoperative treatment and incorrect surgery as well.It is not difficult to diagnose a malunited ankle fracture when taking history,symptoms and imaging examinations into consideration.Orthopaedic surgeons used to do ankle fusion for this kind of patients as the effect of reconstructive surgery is not clear.This article summarizes the diagnostic and therapeutic methods for ankle fracture malunion based on the articles from 1976 to 2015.More detailed therapeutic methods for deformities involving lateral malleolus,tibiofibular syndesmosis,medial malleolus and posterior malleolus are also reviewed.

BACKGROUND:3D bioprinting has been used to print a variety of tissues including skin,vascular tissues,liver,cartilage,cardiac tissues,ear,and adipose tissues.OBJECTIVE:To review the application of 3D bioprinting technology in printing tissues or organs and its research progress in oral medicine.METHODS:A computer-based retrieval of PubMed and CNKI was performed to search articles concerning the application of 3D bioprinting technology in printing tissues,organs and stomatology which were published from 2006 to 2016,using the keywords of 3D bioprinting,3D pinting,organs,tissues,tissue engineering,stomatology,oral,cranio-maxillofacial in English and Chinese,respectively.RESULTS AND CONCLUSION:Direct cell-bioprinting is still in its early stage,even though 3D bioprinting has been applied to print various tissues such as skin,vascular tissues,liver,cartilage and cardiac tissues,etc.Although additive manufacturing technology has been widely used for printing different scaffolds of tissues and organs nowadays,there are no successful bioprinted tissues with biological functions in clinical practice.Even in oral medicine,most of the studies still remain in the stage of printing biological scaffolds.It is a long way to solve the problems such as source of cells,materials of biological scaffolds and types of extracellular matrix in the future,due to the complexity of human organism structure and the function expression of various tissues and organs.

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.

Objective To evaluate the effect of isoflurane or sevoflurane inhalation before and after gestation on the offspring brain development. Methods Thirty female adult Sprague Dawley rats were randomly assigned into 5 groups(n=6 each):control group(group C),group that ex?posed to isoflurane with the concentration of 1.6%for 6 hours before gestation(group BI),group that exposed to isoflurane with the concentration of 1.6%at the 6th,10th,14th and 18th day for 6 hours(group PI),group that exposed to sevoflurane with the concentration of 2.4%for 6 hours before gestation(group BS),and group exposed to sevoflurane with the concentration of 2.4%at the 6th,10th,14th and 18th day for 6 hours after gestation (group PS). Twelve offspring rats from pregnant rats in each group were chosen on the day of birth(T1),and 7th,14th and 28th days after birth(T2, T3 and T4)and sacrificed,and the hippocampi were then isolated. Hematoxylin and eosin stain were adopted to observe the tissue pathological change. Electron microscope was used to observe the neuron ultrastructure change of hippocampus. Immolunohistochemistry was used to detect cas?pase?3,the expression of growth associated protein?43(GAP?43)and neuronal nitric oxide synthase(nNOS). Results Compared with group C, no significant change was found in caspase?3,GAP?43 and nNOS expression in offspring rat hippocampus in groups BI and BS(P>0.05),and no damage change in hippocampal was seen by HE staining and electron microscopy. In group PI and PB,the expression of caspase?3 was significantly up?regulated,the expression of GAP?43 and nNOS was down?regulated at T1 to T3(P<0.01),and structural changes in cell were seen by electron microscopy. In group PI,significant pathological changes in hippocampal were seen by HE staining at T1 to T3. Compared with group PI,the expres?sion of GAP?43 and nNOS was significantly up?regulated(P<0.01),and the expression of caspase?3 was down?regulated at T1 to T3(P<0.01). Conclusion Isoflurane or sevoflurane inhalation before gestation does not affect the offspring brain development,while isoflurane or sevoflurane in?halation after gestation can induce transient abnormal change of offspring brain development,and isoflurane′s toxicity was greater than sevoflurane.

OBJECTIVETo compare the efficacy between the reducing technique with consciousness conduction involved and the reducing technique by needle rotation of acupuncture in the treatment of lunbar strain of cold damp pattern.

METHODSOne hundred and eight patients were randomized into group A and group B, 54 cases in each one. Ashi points were the main points in the two groups. In the group A, the reducing technique with consciousness conduction involved was applied to ashi points. In the group B, the reducing technique with needle rotation was adopted. Cupping and the irradiation specific electromagnetic wave apparatus (TDP) were used in the two groups as the adjuvant therapy. The treatment was given once every two days, and 10 treatments made one session. The treatment stopped till pain disappeared. The efficacy was evaluated in 1 session of treatment. The numerical rating scale (NRS) and the Oswestry disability index (ODI) were observed before and at the end of treatment. NRS of acupuncture itself was observed at the end of treatment. The recurrence rate was compared between the two groups.

RESULTSThe curative and remarkably effective rate was 87.0% (47/54) in the group A, better than 63.0% (34/54) in the group B (P < 0.01). After treatment, NRS and ODI scores were all reduced as compared with those before treatment in the two groups (both P < 0.01). The results in the group A were better than those in the group B (both P < 0.01). Three months after treatment, the recurrence rate was 3.8% (2/52) in the group A, better than 17.7% (9/51, P < 0.05) in the group B. Pain induced by acupuncture itself was mild in the two groups and NRS score in the group A was lower than that in the group B (P < 0.01).

CONCLUSIONAcupuncture with the consciousness conduction involved is superior to the reducing technique with needle rotation in the treatment of lumbar strain of cold damp pattern, in which, pain induced by acupuncture itself is much milder than that induced by the reducing technique with needle rotation.

Acupuncture Therapy ; methods ; psychology ; Adult ; Aged ; Back Muscles ; injuries ; Consciousness ; Female ; Humans ; Male ; Middle Aged ; Myalgia ; therapy ; Sprains and Strains ; therapy ; Young Adult

By analyzing the articles in Huangdi Neijing (Inner Canon of Yellow Emperor), combined with the verification of consciousness in vitro in clinic and modern science, it is found Huangdi Neijing has made special requirements of treating spirit for physicians using spirit-qi acupuncture. The physicians consciously use different methods to motivate the spirit of physician and patients, especially patients, to transform it to the physiological effect of patients, which could minimize the psychological factors that make negative influence on treatment; also the psychotherapy is considered as the most important principle of treating spirit. The reinforcing and reducing methods in later generations, mainly lifting-thrusting twirling method, unintentionally lead patients into a basic or strong status of treating spirit or keeping spirit during the process of achieving stimulation and needle sensation. To partially perform the special role of treating spirit for physicians in Huangdi Neijing on patients could cause the chages including patient-based using spirit to move qi. It not only inspires the body's natural resistance to disease and self-healing, but also motivates the self-protection mechanism of keeping spirit.
Acupuncture Therapy ; history ; instrumentation ; methods ; Books ; history ; China ; History, Ancient ; Humans ; Medicine in Literature ; Needles ; Qi

By analyzing the acupuncture taboos in Neijing (Internal Classic) on clinical application of mind conduction of acupuncture therapy in going against the actual situation, astronomy and others, it is found that the relevant acupuncture taboo implies many subtle mysteries of human body, qi, mind and astronomy, which have not been discovered yet in modern science and are very significant in qi protection. In Neijing, the acupuncture physicians have been highly required in the mind treatment, in which, accurately regulating qi circulation is the target in the treatment. The mind conduction is used for qi circulation to accomplish accurately the reinforcing or reducing in the deficiency or excess condition. All of the taboos are provided to normalize the accuracy of reinforcing and reducing technique of acupuncture therapy and avoid the damage of qi in human body. Hence, those taboos must be obeyed so as to prevent from serious consequence and ensure the safety of this acupuncture therapy.
Acupuncture Therapy ; history ; psychology ; Books ; history ; China ; History, Ancient ; Humans ; Medicine in Literature ; Mind-Body Therapies ; history ; psychology

Objective To evaluate primary open reduction and wire-pin fixation for total dislocation of talus.Methods A retrospective study was conducted of the 12 patients who had been admitted into our hospital from October 2009 to December 2013 for total talar dislocation without fracture of the talar neck or body and had been available for complete follow-up.They were 10 males and 2 females.Their range of age was from 17 to 56 years (average,34.2 years).The total dislocation was open in 4 cases and close in 8.All of them underwent primary open reduction and wire-pin fixation.The functions of ankle joint and hindfoot were evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results The follow-up time ranged from 22 to 72 months (average,35.6 months).Postoperatively,one case suffered skin necrosis and another superficial infection,both of whom responded to skin flap transferring after debridement.Traumatic arthritis of the talotibial or subtalar joint was found more or less in 7 cases,one of whom complained of severe pain but refused the subtalar arthrodesis advised.Their AOFAS scores at the final follow-up ranged from 42 to 96 points (average,72.2 points).Five cases developed avascular necrosis of the talus,but no talar collapse happened.Conclusions Primary open reduction and wire-pin fixation is effective for treatment of close total talar dislocation and open total dislocation of Gustilo type Ⅲ A or below.Although avascular necrosis and traumatic arthritis are common postoperative complications,satisfactory functions can be achieved if there is no collapse,severe pain or infection.

Objective To analyze and summarize the clinical characteristics of patients with spontaneous hemor -rhage of hepatic adenoma in glycogen storage disease type Ⅰa.Methods Reporting 1 case in our hospital and making a summary about general situation , category, etiology, diagnosis and treatment of the hemorrhage of hepatic adenoma with glycogen storage disease type Ⅰa through checking literatures .Results The patient was a 27 year old male who had been diagnosed as glycogen storage disease for 14 years, as well as was first found hepatic adeno-ma at the age of 17 .He once was diagnosed as intra-adenoma bleeding with persistent abdominal pain and dizziness and was underwent selective hepatic artery embolization at the age of 22.Hepatic adenoma in glycogen storage dis-ease typeⅠa generally appeared at the age of puberty .One common complication of this disease was hemorrhage of hepatic adenoma , which can be found by ultrasonography and CT .Clinical management includs observation , selec-tive hepatic artery embolization , radiofrequency ablation , surgical resection and liver transplantation .Conclusions Glycogen storage disease type Ⅰa is an autosomal recessive genetic disease with hepatic adenoma as a common complication of GSD Ⅰa, serious liver adenoma's hemorrhage can be life threatening , the radiological examination can be helpful to detect hepatic adenoma .Then appropriate intervention can improve the life quality and prognosis .

The etiology of osteoporosis is complex, and some inflammatory factors have been found to play a role in pathogenesis of osteoporosis.This paper focuses on the advance in the potential role of inflammatory factors in the pathogenesis of osteoporosis.