OBJECTIVE To investigate the effect and mechanism of morin on alveolar bone resorption in periodontitis mice based on the silent information regulator 1 （SIRT1）/peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）/nuclear factor-erythroid 2-related factor 2 （Nrf2） pathway. METHODS The mice were randomly divided into control group， model group， morin group （40 mg/kg）， SRT1720 （SIRT1 activator） group （5 mg/kg）， and morin+EX527 （SIRT1 inhibitor） group （40 mg/kg morin+7.5 mg/kg EX527）， with 18 mice in each group. Except for control group， mice in other groups were subjected to silk ligation to establish periodontitis model. After successful modeling， mice in each group were treated with corresponding medicinal solutions or normal saline intragastrically or intraperitoneally， once a day， for two consecutive weeks. After the last medication， serum levels of tumor necrosis factor-α （TNF-α）， interleukin （IL）-1β， IL-6 and IL-10 were measured. The distance between the cementoenamel junction and alveolar bone crest was determined， and bone volume fraction and bone mineral density were calculated. Pathological changes of periodontal tissue were observed， and the number of osteoclasts was measured. mRNA expressions of receptor activator of nuclear factor-κB ligand （RANKL） and osteoprotegerin （OPG） in periodontal tissue， the levels of malondialdehyde （MDA） and superoxide dismutase （SOD） as well as protein expressions of SIRT1， PGC-1α， and Nrf2 were determined. RESULTS Compared with model group， the alveolar bone resorption and inflammatory cell infiltration in the periodontal tissues of mice were improved in morin group and SRT1720 group. The serum levels of TNF-α， IL-1β and IL-6， the distance between cementoenamel junction and alveolar bone crest， the number of osteoclasts in periodontal tissue， RANKL mRNA expression and the MDA level were decreased， shortened and reduced significantly （ P ＜0.05）； however， serum level of IL-10， bone volume fraction and bone mineral density， OPG mRNA expression in periodontal tissue， SOD level and protein expressions of SIRT1， PGC-1α and Nrf2 were increased significantly （ P ＜0.05）. Compared with morin group， the above pathological changes were significantly aggravated in the morin+EX527 group； and the levels of quantitative indicators were markedly reversed （ P ＜0.05）. CONCLUSIONS Morin may inhibit alveolar bone resorption in periodontitis mice by activating the SIRT1/PGC-1α/Nrf2 pathway to reduce inflammatory reaction and oxidative stress.

Objective:To explore the clinical efficacy of double traction-assisted reduction internal fixation and open reduction internal fixation in treating tibial plateau fractures.Methods:Data of patients with tibial plateau fracture admitted to West China Hospital of Sichuan University from January 2016 to December 2021 were retrospectively analyzed, and patients were divided into two groups according to treatment method: double traction-closed reduction internal fixation group (referred to as double traction group) and open reduction internal fixation group (referred to as open group). The double traction group included 21 patients, with 15 male and 6 female patients, with a mean age of 56.14±9.24 years (range, 45-72 years). Schatzker classification of fractures: 1 type I, 2 type II, 2 type III, 5 type IV, 6 type V, and 5 type VI. The open group included 29 patients, with 20 male and 9 female patients, with a mean age of 58.97±4.84 years (range, 47-70 years). Schatzker classification of fractures: 2 type I, 4 type II, 8 type III, 4 type IV, 5 type V, and 6 type VI. The surgical time, incision length, intraoperative blood loss, length of hospital stays, fracture healing time, postoperative time to full weight bearing, Rasmussen score, Hospital for Special Surgery (HSS) knee score, and complications were compared between the two groups of patients.Results:Both groups were followed up for 24 to 36 months, with an average of 30 months. There were significant differences in the operation time (92.61±6.22 min vs. 47.92±9.53 min), incision length (4.54±0.56 cm vs. 6.26±0.51 cm), and intraoperative blood loss (47.05±9.72 ml vs. 156.82±4.62 ml) between the group treated with closed reduction and double traction and the group treated with open reduction, with statistical significance ( t=18.83, 10.78, 53.24, P<0.001). There were also significant differences in the hospitalization time (5.35±0.41 d vs. 5.84±0.78 d), fracture healing time (3.72±0.74 months vs. 4.22±0.42 months), and time to full weight-bearing after surgery (11.29±1.10 weeks vs. 15.07±1.96 weeks) between the two groups, with statistical significance ( t=2.30, P=0.026; t=3.38, P<0.001; t=7.96, P<0.001). The HSS score at 6 months after surgery in the group treated with closed reduction and double traction was 81.61±2.32 points, which was higher than the score in the group treated with open reduction (77.66±4.01 points), with statistical significance ( t=4.07, P<0.001); at 12 months after surgery, the Rasmussen score in the group treated with closed reduction and double traction was 16.71±1.00 points, which was higher than the score in the group treated with open reduction (13.79±1.42 points), with statistical significance ( t=8.05, P<0.001). There was no fracture malunion or compartment syndrome occurred in both groups. The incidence of complications was 5% (1/21) in the group treated with closed reduction and double traction, and 10% (3/29) in the group treated with open reduction, with statistical significance (χ 2=0.52, P=0.473). Conclusion:The advantages of double traction-assisted reduction and internal fixation for tibial plateau fractures include minimal trauma, minimal bleeding, early mobilization, and shorter fracture healing time. It is a safe and reliable treatment method.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

BACKGROUND:Studies have shown that umbilical cord blood stem cel transplantation promote the recovery of spinal cord injury, and electroacupuncture also can inhibit the proliferation of astrocytes to reduce damage to scar formation, suggesting that a combination of umbilical cord blood stem cel transplantation and electroacupuncture may play an important role in the treatment of acute spinal cord injuries. OBJECTIVE:To observe the influence of transplantation of human umbilical cord blood stem cels combined with electroacupuncture at theDu channel on expression of nerve growth factor and neurotrophin 3 in rats with spinal cord injuries. METHODS: Seventy-two female Sprague-Dawlay rats were randomly divided into control group, injury group, transplantation group and combined therapy group. In the control group, only an incision on the back was sutured;in the injury group, a piece of saline-infiltrated gelatin sponge, 1 mm×2 mm×2 mm, was placed into the transected spinal cord at T10 level; in the transplantation group and combined therapy group, a piece of gelatin sponged infiltrated in the suspension of human umbilical cord blood stem cels was placed into the transected spinal cord, respectively, and then, electroacupuncture stimulation at the Duchannel was performed in the combined therapy group at 1 hour after modeling. Specimens were taken at 7, 14, 28 days after modeling in each group, and then immunohistochemistry, western blot and real time-PCR methods were used to detect the expression of nerve growth factor and neurotrophin 3. RESULTS AND CONCLUSION:Compared with the transplantation group, the expression of nerve growth factor and neurotrophin 3 was lower in the injury group but higher in the combined therapy group at 7, 14, 28 days after modeling (P < 0.05). The results of western blot and real time-PCR were consistent with those of immunohistochemical detection. Findings show that human umbilical cord blood stem cel transplantation combined with electroacupuncture has a remarkable synergistic effect in the treatment of spinal cord injury that can significantly up-regulate the expression of nerve growth factor and neurotrophin 3, and contribute to injured spinal cord repair, regeneration and functional recovery after spinal cord injury.

OBJECTIVETo compare the effects and security between internal fixation and total hip arthroplasty for the patients in elderly with femoral neck fracture of displacement type through a meta analysis.

METHODSStudies on comparison between internal fixation and total hip arthroplasty for the patients in the elderly with femoral neck fracture of displacement type were identified from PubMed database,EMBase database, COCHRANE library, CMB database, CNKI database and MEDLINE database. Data analysis were performed using Revman 5.2.6(the Cochrane Collaboration).

RESULTSSix published randomized controlled trials including 627 patients were suitable for the review, 286 cases in internal fixation group and 341 cases in total hip arthroplasty group. The results of meta analysis indicated that statistically significant difference were observed between the two groups in the quality of life which was reflected by the Harris scale (RR = 0.82, 95%CI:0.72-0.93, P < 0.05) , the reoperation rate (RR = 5.81, 95%CI:3.09-10.95, P < 0.05) and the major complications rate (RR = 3.60, 95%CI:2.29-5.67, P < 0.05) postoperatively. There were no difference in the mortality at 1 year and 5 years postoperatively(P > 0.05).

CONCLUSIONSFor the patients with femoral neck fracture of displacement type in the elderly, there is no statistical difference between two groups in the mortality postoperatively. The quality of life and the security of operation in internal fixation group is worse than the total hip arthroplasty group.

Objective To evaluate the cLinical outcome and influencing factors of open reduction and internal fixation in treatment of hip dislocation combined with acetabular fractures. Methods A retrospective analysis was performed on 51 patients with hip dislocation combined with twetabular frac-tures, who were treated with open reduction and internal fixation under general anesthesia in the emergen-cy department on admission. Of all, 41 patients were treated with open reduction and plate/screw internal fixation, for which the reduction result was evaluated by postoperative X-rays and follow up X-rays accord-ing to Matta's criteria and the functional outcome by Merle d' Aubigne's criteria. Results Of 41 pa-tients, 33 were followed up for 1-7 years (mean 3.1 years). X-ray evaluation showed anatomic reduction in 27 patients (82%), imperfect reduction in five (15%) and poor reduction in one (3%). The clini-cal outcome at the time of final follow-up was graded as excellent in 18 patients (55%), good in 8 (24%), mederate in 3 (9%) and peor in4 (12%), with total excellence rate of 79%. Conclusion Prompt reduction of hip dislocation, precise reduction of the acetabular fracture and decrease of periopera-tive comphcations are key to excellent clinical outcome.

Objective To evaluate the clinical results of minimally invasive plate osteosynthesis (MIPO) in treatment of complex fractures of the distal femur. Methads From July 2005 to December 2006, 41 patients with complex distal femur fractures induced by high energy trauma were treated with MIPO plus locking compression plate(LCP). There were 31 males and 10 females, at average age of 38 years(17-65 years). According to the AO/OTA fracture classification system, there were 11 patients with type A3 fractures, 22 with type C2 and 8 with type C3. There were 16 patients with open fractures. The clinical result was evaluated by using function examination and radiographic assessment. Results All patients were followed up for average 8 months(2-18 months), which showed fracture healing, with mean healing time of 13 weeks(7. 16 weeks). There was only 1 patient with superficial infection but no fixation failure or implant breakage were found. The average knee range of motion was 110°(45°-135°). Hospital for special surgery knee rating scale(HSS) showed excellent or good results in 36 patients (88%). No patient with greater than 5°difference in either varus or valgus was detected when compared 2 days after operation with latest follow-up. Conclusion In treatment of complex distal femur frac-tures, MIPO plus LCP have advantages of minor trauma, stable fLxation, slight interference on soft tis-sues, early fracture healing and few complications.

This study was sought to compare and evaluate the biomechanical properities of rotating-arm self-locking intramedullary nails (RSIN) with domestic femoral intramedullary nail (DFIN) in communited femoral shaft fractures. A 2 cm midshaft defect was created on seven pairs of cadaver femur, and fixed with two kinds of intramedullary nails. Then the torsion, four-point bending and axial loading to failure were tested on these models. The load versus deformation curve was generated from the load recorded by the load cell and the deformation simultaneously recorded by the linear variable displacement transducer. The mean torsional stiffness of the femora fixed with RSIN was 0.98 Nm/degree, which was significantly less than that fixed with the similar nails reported in documents, and the mean value of bending stiffness of the femur fixed with DFIN was larger than that of the femur fixed with RBIN, but there was no significant statistic difference. For use in fracture models under compression load beyond 1200 N, the RBIN was more rigid than DFIN, which provided the biggest load. All the parameters of the test with nails were greater than that for femur fixed with nails. In conclusion, FBIN probably provides enough strength and rigidity for use in communited femoral shaft fractures.
Adult ; Biomechanical Phenomena ; Bone Nails ; Female ; Femoral Fractures ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Humans ; In Vitro Techniques ; Male ; Random Allocation ; Stress, Mechanical ; Tensile Strength

ObjectiveTo investigate the correlation of lipids and lipoproteins with cardiac function in patients with coronary heart disease (CHD).MethodsParameters of blood pressure, serum lipids and lipoproteins, clinical features, radionuclide ventriculographic and coronary angiographic findings were analyzed retrospectively in 584 CHD patients treated with standard treatment.ResultsThe left cardiac dysfunction of CHD patients was correlative positively with age, systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose, body mass index (BMI), smoking, total cholesterol(TC) and low density lipoprotein cholesterol(LDL-ch) significantly(P<0.001), not correlative with high density lipoprotein-cholesterol (HDL-ch). The left ventricular ejection fraction (LVEF) and left ventricular peak filling rate (LVPFR) were decreased along with the levels of TC and LDL-ch increased (P<0.05～0.01).ConclusionTC and LDL-ch are positively correlative with left cardiac dysfunction in CHD patients. In order to reduce cardiac damage of CHD associated with hyperlipoidemia, more attention should be paid to the amelioration of coronary arteriosclerosis and the reduction of serum lipids and lipoproteins.

We have designed a new kind of self-locking intramedullary nail for the treatment of unstable fracture of the middle and distal tibial shaft and have compared it with the interlocking nail by means of biomechanical experiments. The data could be used as a basis for clinical application. Fourteen formalin-fixed tibials of adults were made into unstable fracture models with a 2cm bone defect each. They were divided into 2 groups. Group 1 was fixed with self-locking intramedullary nail and group 2 was fixed by interlocking nail. All specimens were submitted to biomechanical test. The data were analysed by t test. The results showed there is no difference in anti-bending stiffness between the self-locking intramedullary nail and the interlocking nail. The anti-rotating and anti-compressing stiffness of interlocking nail is slightly better than that of self-locking intramedullary nail, but still the firmmess of the self-locking intramedullary nail in resisting rotation can meet the requirement of biological fixation. Its structure is reasonable, simple, practical, and it can resist certain harmful stress.
Biomechanical Phenomena ; Bone Nails ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Tibial Fractures ; surgery