Objective To compare treatments of intra-articular calcaneal fractures with and without bone graft in foot and ankle surgery.Methods A comprehensive search was conducted on line for all English research articles published from January 1990 through December 2010 dealing with open reduction and internal fixation with and without bone graft for intra-articular calcaneal fractures.Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest.Meta-analytic pooling of group results across studies was performed for the 2 treatments.Results The systematic review identified 32 qualified primary studies with 1281 fractures.No significant differences were found in postoperative infection, osteoarthritis or subtalar fusion between the 2 treatments ( P ＞ 0.05) .The average full weight-bearing time in bone graft treatment was significantly lower (5.4 weeks) than in non-graft treatment (10.5 weeks) .The mean B(o)hler angle was significantly larger and long-term loss of collapse significantly lower in bone graft treatment than in non-graft treatment.The bone graft treatment had a lower American Orthopaedic Foot and Ankle Society (AOFAS) score (71.4 points vs.80.5 points) but a higher Creighton score (89.9 points vs.81.0 points) compared with non-graft treatment.Pooled mean results showed no significant differences in the weighted excellent-to-good rate between the 2 treatments (excellent 35%, good 40%, fair 21% and poor 4% for the bone graft treatment versus excellent 34%, good 42%, fair 14%, and poor 10% for the non-graft treatment).Conclusions Open reduction and internal fixation with bone graft for intra-articular calcaneal fractures may lead to better reduction of B(o)hler angle and early return to full weight-bearing without increased risk of postoperative infection.However, since more cases of joint depression and comminuted fracture have been included in the bone graft group in the present study, a prospective controlled comparative study with a large scale of samples is still needed.

Objective To understand the characteristics of subtalar joint motion and to probe a new method in evaluating the subtalar joint. Methods Eight fresh frozen adult shank-foot specimens with calcaneus marked were placed in a Cartesian coordinate system. The motion of the subtalar joint was obtained through matrix translation and Euler equation. Comparatively, the same specimens were underwent CT scan and established three dimensional reconstruction through the radiographic method. Results Both the mechanical and the radiographic methods had no significant difference in reflecting the motion of subtalar joint in coronal and transversal plane. Conclusion To evaluate the motion of subtalar joint with mechanical method was more precise, economic and easier to perform. Although the radiographic method had considerable discrepancy among examiners, as a non-invasion examination, it needs further research.

[Objective]To explore displacement and plantar pressure distribution of the forefoot before and after the plantar fascia and other plantar ligaments were sectioned.[Method]Seven fresh adult cadaveric feet were tested with the main plantar ligaments exposed,including the plantar fascia,spring ligament,short plantar ligament and long plantar ligament.The displacements of the metatarsals were recorded and calculated with digital speckle correlation measurement(DSCM),also F-scan insoles were put under the plantar aspect of the feet when the speciments were loaded to 700N vertically.The special shifts and plantar pressure data of the metatarsals was collected and stored before and after the main plantar ligaments were sectioned.[Result]The transverse movements of the metatarsals did not change significantly,the same as their vertical displacements except the first metatarsal after the plantar fascia was sectioned,while the peak pressure shifted laterally.When the four major plantar ligaments were all injured,all of the above changed significantly.[Conclusion]The plantar fasciotomy will not consequentially lead to collapse of the forefoot structure.But the redistribution of the plantar pressure and the compensation of other ligaments may result in later complication.

Objective To investigate the properties of hind foot motion and it's changes in ankle or subtalar joint arthrodesis. Methods Eight fresh frozen adult leg-foot specimens were mounted in a coordinated system, a Steinmann pin was perforated across the calcaneus as a marker. The displacements of the marked points in the coordinated system were recorded when subtalar or ankle joint was fixed respectively. Through matrix translation and Euler equation, the angle of the calcaneus rotation were calculated, representing the motion of the subtalar and ankle joints in different condition, Statistical analysis were also taken between different conditions. Results Three dimensional (3-D) motion was observed in hind foot motion. The range of motion with ankle joint fixation was: inversion 15.99??2.81?, eversion 8.62??1.90?, dorsiflexion 3.70??1.00?, plantar flexion 5.87??1.39?, adduction 7.64??2.04?, and abduction 3.99??1.78?. When subtalar joint was fixed, they were: 7.13??1.07?, 5.52??0.85?, 17.09??2.87?, 30.75??5.04?, 10.77??1.56?, and 6.54??1.88? respectively. While they were 22.62??3.21?, 40.88??5.77?, 18.87??3.89?, 9.12??2.05?, 17.48??2.26? and 11.47??2.29?, when no joint was fixed. Arthrodeses of ankle or subtalar joint would affect the hindfoot motion significantly (P

[Objective]To discuss the operative treatment for adult flatfoot deformity with severe pain.[Method]From August 2002 to October 2004,operative treatment for 12 cases of unilateral adult flatfoot deformity with severe pain underwent operative treatment,which included 7 males and 5 females with an average age of 35 years(range,20 to 56 years),left side was involved in 8 cases,and right side was affected in 4 cases.According to etiological factor,stageⅡ~Ⅲ posterior tibial tendon dysfunction were 6 feet,congenital flatfoot were 3 feet,neurological flatfoot were 2 feet and postoperative equinovarus was 1 feet.Every case received special operative treatment,for instance lateral column lengthening,medial displacement calcaneal osteotomy,arthrodesis,repair posterior tibial tendon,sping ligament reefing,FDL tendon transfer and so on.All patients were fixed with plaster cast at inversion position for 4~6 weeks,then changed to plaster splint fixing at neutral position for 4 weeks.Functions of ankle and foot were evaluated before and after operation.[Result]All patients were followed up for an average of 22 months(ranged,16 to 28 months).The total excellent and good rate was 83.3% according to Marryland foot score.The specific index of X-ray improved obviously(P

OBJECTIVE To evaluate the sterilization steps and effects of low temperature plasma on heat-resistant items. METHODS Low temperature plasma sterilization was adopted to operate according to standard procedures including pre-sterilizaing, packaging, sterilization, unloading and storageing. RESULTS Low temperature plasma had the features of reliable sterilization effect, easy to monitor, short time needed, and high utilization rate which could greatly increase the number of surgery and have a long term storage. CONCLUSIONS Low temperature plasma sterilization is a kind of fast, safe and effective way of sterilization by which the sterilization quality is guaranteed and the hospital infection rate is reduced greatly to meet the clinical demands to sterile items.

The mandibular canine usually has a single-root with a single canal. A case of a patient who has a mandibular canine with two well-defined roots and two root canals was reported. Size of the lingual root and buccal root was equal. The buccal root length was 24.5 mm. The lingual root length was 23.0 mm. Clinicians should be aware of the anatomical variation that exists in mandibular canines in practice.

To establish a murine carotid artery transplantation model for the study of the chronic rejection, 80 rats were divided into two groups, an allotransplant (ACI-Lewis) group and an isotransplant (Lewis-Lewis) group (control group). The donor carotid artery and the recipient carotid artery were anastomosed by using a polyethylene cuff (internal diameter: 0.7 mm, length: 3 mm).The pathological changes of carotid artery transplant were observed 14, 28 and 56 days after the transplantation. The results showed that the model was successfully established in 95% of the animals. The chronic rejection-associated arteriosclerosis was induced 28 days after the transplantation. The new chronic rejection model of carotid artery by using cuff technique caused fewer traumas and was easy to make. The pathological changes of the transplant mimicked the chronic rejection-associated arteriosclerosis found in human transplant.
Anastomosis, Surgical/methods ; Arteriosclerosis ; Carotid Artery, Common/*transplantation ; Delayed Graft Function ; Graft Rejection/*pathology ; Models, Animal ; Polyethylene ; Rats, Inbred ACI ; Rats, Inbred Lew

Objective:To explore the regulatory role of exosomes in calcification of rat vascular smooth muscle cells (VSMC) induced by high phosphorus.Methods:VSMC (A7r5 cells) were cultured in vitro and randomly divided into three groups: normal phosphorus group (0.9 mmol/L), high phosphorus group (2.6 mmol/L) and high phosphorus exosomes induction group (i.e. the exosomes extracted from high phosphorus group were added to VSMC in normal culture). Until the 7th day of culture, the culture medium of normal phosphorus group and high phosphorus group obtained during the change of cell culture medium was collected, and the precipitate was obtained by ultracentrifugation and suspended by phosphate buffered saline. The protein content of the precipitate was determined by BCA protein quantitative method. The precipitates were identified. The structure and size of exosomes were observed by transmission electron microscope. The exosomes marker proteins tumor susceptibility gene 101 protein (TSG101) and CD9 were detected by Western blotting. The miRNA in exosomes was extracted, and the expression of related miRNA (miR-30b, miR-204, miR-211) were observed by real-time quantitative PCR. After 7 days of cultivation, the exosomes uptake process of VSMC in high phosphorus exosomes induction group was observed. The calcium deposition was detected by Alizarin stain, and the calcium content was detected by O-cresol complex copper. The content of alkaline phosphatase was detected by colorimetry. The protein expression of Runx2 was quantified by Western blotting. Results:(1) The precipitate obtained by ultracentrifugation of the cell culture fluid was identified as exosomes by electron microscopy morphology. Western blotting confirmed that the expression of the exosomal marker proteins TSG101 and CD9 were positive. (2) The exosomes were rich in miRNAs. The expression of miR-30b, miR-204, miR-211, which negatively regulated the transcription of Runx2, was significantly down-regulated in the high-phosphorus group compared with the normal group ( P<0.05). (3) After culturing rat VSMC with high phosphorus for 7 days, calcium salt deposition was obvious. Compared with the normal phosphorus group, calcium content and alkaline phosphatase activity were significantly increased (both P<0.05), and Runx2 expression was also significantly increased ( P<0.05). (4) Added the obtained high-phosphorus exosomes to the normal cultured VSMC, the exosomes could be taken up by VSMC and successfully induced VSMC calcification. The levels of cell calcification indicators and Runx2 expression were significantly increased. Conclusions:High phosphorus induces calcification of VSMC and promotes the increase of Runx2 expression. The mechanism may be realized by releasing exosomes from VSMC to transmit cell signals.

Objective To observe the effect of fluvastatin on urinary albumin excretion rate(UAER)of microalbuminuria in type 2 diabetes patients.Methods Type 2 diabetes patients with mieroalbuminuria were randomly divided into fluvastatin goup(n=126)and control group(n=129).Fluvastatin group was given fluvastatin 40 mg each night.Follow up was conducted for 1.5 years.The UAER and glomerular filtration rate(GFR)as well as blood lipid level before and after therapy were compared.Results UAER in fluvastatin group was significantly lower than that in control group[(59.6±10.5)vs(87.5±12.3)mg/min,P＜0.05]before therapy[(104.4±25.2)vs(110.6±19.7)mg/min,P＜0.05],which was independent of its lowering-lipid effect.But GFR had no signifimicroalbuminuria which is independent of lowering-lipid effect in type 2 diabetic nephropathy patients and delay the progress of diabetic nephropathy.