BACKGROUND: The characteristics of cervical anatomy and pedicle screw, operational specification, and individual screw implantation are the key factors of a successful implantation treatment.OBJECTIVE: This study was designed to investigate the cervical pedicle screw and host response as well as the recovery of spinal nerve functions during the surgery and follow-up period of cervical spine fracture-dislocation.DESIGN: A case analysis.SETTING: Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Lianning Province, China.PARTICIPANTS: A total of 41 patients with cervical spine fracture-dislocation, who have complete follow-up data, were admitted to the Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA between February 2002 and February 2006. Of the included patients, 18 were complicated by spinal cord injury (according to Frankel classification system, 6 were graded as A, 1 as B, 4 as C, and 7 as D.METHODS: Forty-one patients with cervical spine fracture-dislocation were treated by implanting a screw through the cervical pedicle and fixing it. Prior to surgery, all patients were subjected to X-ray, CT and MRI examinations. According to measurements, each cervical pedicle screw was individually implanted. The entire surgery was accomplished by Xiang Liang-bi, chief physician, whose qualification corresponds to the responsibilities.MAIN OUTCOME MEASURES: Material and host response during and after screw implantation as well as in the follow-up period. Recovery of spinal nerve function after screw implantation.RESULTS: All patients were followed up for 6-12 months and all incisions were healed primarily. Material and host response during the process of screw implantation: A total of 218 screws were implanted. After initial implantation, 12 screws were loosened, and such a phenomenon disappeared in 11 screws by adjusting inserting point and inserting direction or/and increasing screw diameter or length. The remaining 1 screw was stabilized by increasing the fixed segments. After drilling, poles of 10 screws bled much and treated by hemostasis. C1-2 venous plexus hemorrhage was caused in 3 patients and stopped by compression, and Apofix internal fixation was used in 1 of 3 patients due to unclear surgical visual field. Material and host response after surgery and during the follow-up: A total of 218 screws were inserted. Of the 218 screws, 196 were in correct position, and 22 were deviated to different degrees. Deviation of 1 screw caused injury to nerve root and that of another screw led to injury to blood vessel. Thirty-eight patients acquired satisfactory reduction and bone union. Three patients presented with symptoms of nerve root irritation due to incomplete reduction in the old fracture-dislocation. Among the 3 patients, 1 was subjected to anterior approach due to screw removed, and neither injury to vertebral artery, spinal cord, and nerve root nor internal fixation destroy was found in any other patients. Recovery of spinal nerve function after implantation: Among the 18 patients complicated with spinal cord injury, 6 patients, who were assessed as grade A spinal cord injury, did not exhibit improvement in spinal cord function, while the remaining 12 presented with 1 or 2 grades of improvement.CONCLUSION: There is a lower probability for biocompatibility reaction, and spinal nerve function recovers better after implantation of cervical pedicle screw. So implantation of a cervical pedicle screw system is an effective and relatively safe method for treatment of cervical spine fracture-dislocation.

Objective To discuss the effect of the calcaneocuboid joint arthrodesis on the weight- bearing area of subtalar joint and its clinical significance.Methods Twelve fresh-frozen cadaver foot specimens were used for determination of weight-bearing area of the subtalar joint on foot and ankle neutral position,dorsiflexion,plantoflexion,adduction,abduction,inversion and eversion motion by means of pressure sensitive film before and after calcaneocuboid joint arthrodesis under weight loading.Results Weight-bearing area of the subtalar joint averagely increased for (32.54?7.45)% in all positions after calcaneocuboid joint arthrodesis,with statistical significance (P＜0.05).Conclusion Weight-bear- ing area of the subtalar joint increases after calcaneocuboid joint arthrodesis,which contributes to decrea- sing the pressure and increasing the stability of the subtalar joint.

Objective To investigate the expression of Mta-1 in bladder transitional cell carcinoma (BTCC)and to analyze its correlation with the clinical staging,pathologic grading,metastasis and recur- rence,and to explore the possible molecular mechanisms.Methods Samples of 42 cases of BTCC and 12 normal bladder mueosa tissues were examined with immunohistochemical analysis for the expression of Mta- 1,ER,u-PA and PAI-1.Endothelial cells were stained by anti-CD34,and microvascular density(MVD)of carcinoma tissue was calculated.The correlation of Mta-1 expression with the invasion,metastasis,angiogene- sis and recurrence of BTCCs was analyzed;and the correlation of Mta-1 expression with ER,u-PA,PAI-1,and MVD was also analyzed.Results The positive rate of Mta-1 expression in BTCCs was 73.8%(31/42) , while it was 0.0% in normal bladder mucosa tissues(P＜0.01).The expression level of Mta-l increased with the higher clinical stages and pathologic grades of BTCCs;it was higher in recurrence group(100.0% , 15/15)than in non-recurrence group(59.3%,16/27),and high in metastasis group(100.0%,14/14) than in non-metastasis group(60.7%,17/28)(P＜0.05).The expression level of ER increased with the lower clinical stages and pathologic grades of BTCCs;the positive rate of ER expression was 0.0% in 14 ca- ses with metastasis and was 53.6% in 13 of 28 cases without metastasis(P＜0.05);and the rate was 6.7% in 1 of 15 cases with recurrence and 44.4% in 12 of 27 cases without recurrence(P＜0.05).Negative cor- relation was found between Mta-1 and ER expression(r=-0.739,P＜0.01).The positive rate of u-PA ex- pression(59.5%,25/42)was significantly higher in BTCCs than that in normal bladder mucosa tissues (16.7%,2/12)(P＜0.05).Positive correlation was found between u-PA and Mta-1 expression(r= 0.875),while negative correlation was found between u-PA and PAI-1 expression(r=-0.535).The posi- tive rate of PAI-1 expression in normal bladder mucosa tissues(50.0%,6/12)was significantly higher than that in BTCCs(19.0%,8/42)(P＜0.05).In addition,negative correlation was found between PAI-1 and Mta-1 expression(r=-0.706).And positive correlation was found between MVD in BTCCs marked by an- ti-CD34 and Mta-1 expression(r=0.683).Conclusions Mta-1 is highly expressed in BTCCs,and it correlates closely with tumor pathologic grades,clinical stages,recurrence and metastasis.Mta-1 up-regulates the expression of u-PA and down-regulates that of PAI-1,which is associated with invasion and metastasis and acts as an angiogenic mediator in BTCCs.A negative correlation is found between Mta-1 and ER in inva- sion and metastasis of BTCCs.

ObjectiveTo explore the effect of the calcium phosphate cement (CPC) /calcium polyphosphate fiber (CPPF) composites mixed with different proportion of minimal morselized bone on repair of bone defect in vivo. MethodsA total of 36 New Zealand white rabbits were completely randomly designed into A, B, C, D groups and their bilateral radial bone defect model was prepared. The minimal morselized bone (300-500 μm in diameter) was made from the iliac of those rats. The CPPF and CPC were evenly mixed into CPC/CPPF composites which were divided into four groups in accordance with the CPPF weight O, 10％, 30％ and 50％ in CPC/CPPF composite. The CPC/CPPF composites of the four groups was mixed with the minimal morselized bone with ratio of 6:4 and then the mixture was implanted the bone defect of the rabbits in four groups. The gross, X-ray and histological observations were done at four and eight weeks. The biomechanical test was performed at eight weeks. Results When CPPF occupies 30％ of the CPC/CPPF composite, the maximum compressive load and bending loads were better than those in the other groups ( P ＜ 0.05 ), when the histological observation showed the most tight link between the artificial composite and the bone interface and the closest similarity between material degradation rate and the ossification rate, with the best osteogenesis and the optimal ratio.ConclusionThe repair of bone defect can attain the optimal outcome through adding a certain ratio of minimal morselized bone into the CPC/CPPF to adjust the degradation rate of composites.

OBJECTIVETo explore the technique and therapeutic effect of bridge wire splint fixation with ankle dorsiflexion for the treatment of femoral shaft fractures in young children. Methods:From June 2006 to June 2012,45 young children with femoral shaft fractures were treated by bridge wire splint fixation with ankle dorsiflexion,which was designed according to arch bridge mechanical principle and structure. There were 31 males and 14 females with an average age of 3.2 years old ranging from 8 months to 5.5 years old; 14 cases were upper 1/3 femoral fractures,26 cases were middle 1/3 femoral fractures,5 cases were lower 1/3 femoral fractures; 20 cases were transverse fractures, 14 cases were oblique fractures,6 cases were spiral frac- tures, and 5 cases were comminuted fractures. X-ray, follow-up imaging changes,clinical curative effect and complications were assessed.

RESULTSForty-five patients were followed up for 6 to 21 months (averaged 12 months). All fractures were reached clinical bone healing after 5 to 7 weeks (averaged 6 weeks) fixation. Seven cases appearred limb soft tissue complications, including buttocks bedsore,dorsal foot and Achilles tendon epidermal necrosis, and healed after dressing and removal of external fixation. During follow-up,the original overlap angle and lateral displacement were remodeled, and limbs were restored to the normal line of force and bone structure. According to Flynn standard, 35 cases got excellent results, 8 cases good, 2 cases fair.

CONCLUSIONThe bridge wire splint fixation with ankle dorsiflexion for the treatment of femoral. shaft fractures in young children (less than 6 years old) is safe,feasible, simple,and has raliable effect, which can be applied in primary hospitals.

Ankle ; surgery ; Bone Wires ; Child ; Child, Preschool ; Female ; Femoral Fractures ; surgery ; Femur ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Infant ; Male ; Treatment Outcome

OBJECTIVE: To explore the effect of LRRC4, a glioma suppressive gene, on blocking U251 cells in G0/G1 by MAPK signaling pathway. METHODS: LRRC4 was transfected into U251 cells, and at 24 hour of post-transfection, cells were split at a 1:3 dilution, challenged with 500 microg /mL G418 and formed a stable transfected clone pool. RT-PCR, Northern blot and Western blot were used to identify the stable transfectants. ERK, JNK and P38 expression changes were analyzed by Western blot. FACS analysis, Luciferase reporter gene assay and Western blot were used to detect the cell cycle and cyclin D1. RESULTS: LRRC4 down-regulated the expression of phosphorylated ERK2 and up-regulated the expression of total protein JNK2 (a key molecule of MAPK signaling pathway) and phosphorylated c-Jun. LRRC4 decreased the expression of mutation P53, cyclin D1 activation and its expression. U251 cells were blocked in G0/G1 by LRRC4. CONCLUSION LRRC4 can decrease JNK2, up-regulate the phosphoralated c-Jun, down-regulate mutant P53 and cyclin D1, and therefore block U251 cells in G0/G1.
Blotting, Northern ; Blotting, Western ; Cell Line, Tumor ; Cyclin D1 ; metabolism ; Flow Cytometry ; G1 Phase ; genetics ; physiology ; Glioma ; genetics ; metabolism ; pathology ; Humans ; Luciferases ; genetics ; metabolism ; MAP Kinase Signaling System ; genetics ; physiology ; Mitogen-Activated Protein Kinase Kinases ; metabolism ; Nerve Tissue Proteins ; genetics ; metabolism ; physiology ; RNA, Messenger ; biosynthesis ; genetics ; Recombinant Fusion Proteins ; genetics ; metabolism ; Resting Phase, Cell Cycle ; genetics ; physiology ; Reverse Transcriptase Polymerase Chain Reaction ; Transfection

OBJECTIVETo study the bone state with ultimate stress by examining biomechanical distribution of upper femur in Chinese, in order to accumulate more experiences for clinical work.

METHODSTotally 60 Chinese femurs from fresh cadavers were randomly divided into two groups. All the femurs were cleaned, and the body age ranged from 36 to 72 years old, averaged 56.4 years, including 41 from males, and 19 from females. These two groups underwent mechanical stress and bending stress tests. Special mechanical laboratory and machines were used to get the information. Results about the loading value at each testing point under stress were collected.

RESULTSThe four faces of the upper femur suffered different stress under external forces. The bone on upper femur can tolerate more mechanical stress than bending stress. Medial and lateral region of the femur neck and the rear side of the small tuberosity section were themain position enduring the vertical stress. The rear position of the base femur neck and the small tuberosity section were the main regions enduring the bending stress. Those main positions had strong cancellous bones. The intertrochanteric fracture fixation and artificial femoral stems were designed depending on this biomechanical basis.

CONCLUSIONAccording to our experiment result, doctors need to chose more effective fixations for upper femur fracture, and femoral stems for the patients. More information should be collected by further researches.

Adult ; Aged ; Biomechanical Phenomena ; Female ; Femur ; chemistry ; Humans ; Male ; Middle Aged ; Stress, Mechanical

OBJECTIVETo investigate the value of urinary S100B protein and lactate/creatinine ratio determination in early identification of neonatal hypoxic-ischemic encephalopathy (HIE).

METHODSThe levels of urinary S100B protein and urinary lactate/creatinine ratio were detected in 58 full-term newborn infants with HIE on the first, second and third day after birth. The severity of clinical manifestations, including the degree of encephalopathy, was assessed within 7 days after birth. Twenty five normal neonates were enrolled into the control groups.

RESULTS(1) The urinary S100B level of HIE neonates was significantly higher in samples collected throughout the monitoring period than those of the normal control groups (all P < 0.001). The urinary lactate/creatinine ratio of the HIE neonates was also significantly higher than that of normal control groups within the first day (P < 0.001). (2) A significantly positive correlation was found between the level of urinary S100B protein within three days and the urinary lactate/creatinine ratio within the first day and between the level of urinary S100B protein within three days and clinical degree (P < 0.05). (3) When S100B concentration was 0.47 microg/L and urinary lactate/creatinine ratio was 0.55, the sensitivity and specificity of detecting the third day urinary S100B alone, were respectively 90.4%, 91.9%. Detecting it associated with the first day urinary lactate/creatinine ratio could increase the sensitivity and specificity (respectively 98.8% and 97.4%) for predicting development of HIE.

CONCLUSIONOn the basis of clinical manifestations of asphyxic neonatals, detecting the level of urinary S100B within three days and the first day urinary lactate/creatinine ratio may be of important value in early diagnosis and grading of HIE.

Apgar Score ; Asphyxia Neonatorum ; complications ; Creatinine ; urine ; Early Diagnosis ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; etiology ; urine ; Infant, Newborn ; Lactic Acid ; urine ; Male ; Nerve Growth Factors ; urine ; S100 Calcium Binding Protein beta Subunit ; S100 Proteins ; urine ; Tomography, X-Ray Computed

Cell Line ; Cytochrome P-450 CYP1A1 ; drug effects ; metabolism ; Hepatocytes ; cytology ; metabolism ; Humans ; Microsomes, Liver ; drug effects ; metabolism ; Quercetin ; pharmacology

OBJECTIVETo compare clinical effects between bridge wire splint fixation and traditional Bryant traction for the treatment of femoral shaft fractures in children.

METHODSFrom June 2006 to June 2009,38 children with femoral shaft fractures were treated with bridge wire splint fixation and Bryant traction. In bridge wire splint group, there were 15 males and 6 females, ranging in age from 8 months to 5.3 years, with an average of (2.3 +/- 0.6) years. According to fracture site classification, 5 patients were upper 1/3 femoral fractures, 9 patients were middle 1/3 femoral fractures,and 7 patients were lower 1/3 femoral fractures. In Bryant traction group,there were 10 males and 7 females, ranging in age from 10 months to 3.2 years, with an average of (2.2 +/- 0.4) years. According to fracture site classification, 4 cases were upper 1/3 femoral fractures, 10 patients were middle 1/3 femoral fractures, 3 patients were lower 1/3 femoral fractures. The clinical features, X-ray healing time,weight-bearing time and complications of the two groups were compared.

RESULTSComparison of fracture healing time: bridge wire splint group was (6.0 +/- 0.3) weeks and Bryant traction group was (6.2 +/- 0.4) weeks; the time of weight-bearing in bridge wire splint group was (6.1 +/- 1.0) weeks and in Bryant traction group was (6.4 +/- 1.2) weeks; there was no significant difference between two groups. There was a significant difference in soft tissue complication between bridge wire splint group occurred in 3 cases and 13 cases in Bryant traction group. According to the criteria of clinical efficacy,in Bryant traction group, 12 patients got an excellent result, 4 good and 1 fair; in bridge wire splint group, the data were 17, 3 and 1 respectively,and there was no significant difference between the two groups.

CONCLUSIONBoth of bridge wire splint fixation and traditional Bryant traction for the treatment of femoral shaft fractures in children have good efficacy. Compared with Bryant traction,bridge wire splint fixation is simple, safe and has reliable effect.

Child, Preschool ; Female ; Femur ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Fracture Fixation ; adverse effects ; instrumentation ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Infant ; Male ; Postoperative Complications ; Splints ; Time Factors ; Tomography, X-Ray Computed ; Traction ; methods ; Treatment Outcome ; Weight-Bearing