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BACKGROUND:Mechanical stimulation has been confirmed to promote osteogenic differentiation of bone marrow stromal stem cells,but the mechanism is unknown.Primary cilia are important mechanoreceptors and regulate various signaling pathways such as TGF-β1/BMP-2/SMAD.They are likely to be important targets for mechanical regulation of bone marrow stromal stem cells. OBJECTIVE:To investigate the effect and mechanism of fluid shear stress on osteogenic differentiation of bone marrow stromal stem cells. METHODS:Rat bone marrow stromal stem cells were divided into control group,mechanical stimulation group(fluid shear mechanics intervention by shaking table),mechanical stimulation + IFT88 silencing group(mechanical stimulation + silencing IFT88 expression with siRNA).After 24 hours of intervention,qRT-PCR was utilized to determine the expression of transforming growth factor β1 and bone morphogenetic protein 2.Western blot assay was used to detect the expression of phosphorylated SMAD2/3 protein.Immunofluorescent staining of primary cilia was conducted and morphology was analyzed. RESULTS AND CONCLUSION:Shear stress stimulation could promote the transcriptional activity of transforming growth factor β1 and bone morphogenetic protein 2 genes,and increase the expression of phosphorylated SMAD2/3 protein.After siRNA interfered with primary cilia,this mechanical response effect was significantly reduced.There was a Spearman correlation between the change ratio of the primary cilium area of bone marrow stromal stem cells and the increased ratio of transforming growth factor β1 and bone morphogenetic protein 2 gene transcription.These findings indicate that primary cilia/intraflagellar transport mediates the activation of fluid shear stress-responsive transforming growth factor β1/bone morphogenetic protein 2/SMAD signaling pathway and promotes osteogenic differentiation of bone marrow stromal stem cells.
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BACKGROUND:Cervical neutral position magnetic resonance imaging is widely used for the diagnosis and treatment of cervical spondylotic myelopathy.However,it is not possible for patients to maintain the exact same position of the head and neck during repeated cervical magnetic resonance imaging examinations.The cervical spine undergoes minor flexion and extension movements in the sagittal plane,and the head may have a certain degree of variation in flexion and extension.Whether these changes in the neutral position of the cervical spine affect the volume of cervical discs herniation and cervical curvature is unclear. OBJECTIVE:Using artificial intelligence-assisted measurement,this study aimed to analyze the accuracy and reliability of magnetic resonance imaging examinations for measuring the volume of cervical discs herniation and cervical curvature in patients with cervical spondylotic myelopathy undergoing two consecutive cervical neutral positions in the short term. METHODS:A retrospective study was conducted on patients with cervical spondylotic myelopathy who underwent conservative treatment and underwent two consecutive cervical magnetic resonance imaging examinations within three months between June 2012 and June 2023.We proposed the use of occipital-thoracic distance and occipital-thoracic angle to evaluate the variation in flexion and extension of the head in the neutral position of the cervical spine.Based on the changes in occipital-thoracic angle,patients were divided into occipital-thoracic angle increase group and occipital-thoracic angle decrease group.Cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature were measured using artificial intelligence-assisted measurement software.Normal distribution data were represented by mean±SD,while non-normal distribution data were represented by the median(interquartile range).Spearman's rank correlation coefficient was used to analyze the correlation between changes in Cobb angle,cervical(C3-C7)curvature,and cervical discs herniation volume. RESULTS AND CONCLUSION:(1)A total of 104 patients and 326 cervical discs herniation were included in the study.There were 47 patients in the occipital-thoracic angle increase group and 57 patients in the occipital-thoracic angle decrease group.(2)Extension and flexion index of the head:There were no significant differences in occipital-thoracic distance and occipital-thoracic angle during the initial diagnosis and follow-up examination.The variation of occipital-thoracic distance was 0.035(3.23)mm,and the variation of occipital-thoracic angle was-0.31(3.28)°.The deviation range of occipital-thoracic distance and occipital-thoracic angle was small,and there was no significant correlation.(3)Cervical curvature index:There were no significant differences in C2-6 Cobb angle and C3-C7 curvature during the initial diagnosis and follow-up examination.There were no significant differences in C2-6 Cobb angle and C3-C7 curvature between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.(4)There was no significant difference in volume of cervical discs herniation during the initial diagnosis and follow-up examination.There was no significant difference in volume of cervical discs herniation between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.There was no significant correlation between the change of cervical discs herniation volume and the change of C2-6 Cobb angle and the cervical(C3-C7)curvature.(5)These results indicate that in the neutral position of the cervical spine,there were negligible minor flexion and extension movements in the sagittal plane,and the head was limited to a specific position.Although the head has a certain range of flexion and extension variation,it does not affect the accuracy and reliability of parameters including cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature.
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Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ2 test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.
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Male , Female , Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Retrospective Studies , Intervertebral Disc Displacement/surgery , Conservative Treatment , Quality of Life , Treatment Outcome , Spondylosis/surgery , Cervical Vertebrae/surgery , Spinal Cord Diseases , Laminoplasty/methods , DecompressionABSTRACT
Objective@#To investigate the satisfaction and well-being of Chinese women with breast deficiency, and to analyze the relevant influencing factors.@*Methods@#A cross-sectional study was conducted using a self-designed questionnaire to investigate the women with breast deficiency, visiting the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from November 2013 to August 2018. The BREAST-Q BR (breast reconstruction) pre-operation and post-operation modules were used to assess the quality of life.@*Results@#A total of 139 effective questionnaires were collected, including 83 patients before BR surgery and 56 post. There was no difference in quality of life in different ages, marital status, education levels, working status, and causes of breast deficiency. Mean scores of satisfaction with breasts, psychosocial well-being and sexual well-being of patients after breast reconstruction were significantly higher than those of patients without reconstruction (P=0.000), but there was no statistical difference in physical well-being-chest score. The physical well-being abdomen scores of patients with abdominal flap reconstruction was lower than that of the patients without reconstruction (P=0.007). With regard to analysis of specific items, compared with preoperative patients, patients with abdominal flap reconstruction reported lower scores in the items related to abdominal muscle weakness (P<0.05).@*Conclusions@#The breast deficiency resulting from Poland syndrome, breast cancer and other causes, can lead to a significant decrease in quality of life. Breast reconstruction can improve satisfaction with breast, psychosocial and sexual well-being in women with breast deficiency. The abdomen well-being of patients with abdominal flap reconstruction is decreased. Therefore, more attention should be paid to retain abdominal muscles to maintain abdominal shape and motor function during operation.
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Fat regeneration plays an important role in maintaining fat volume after transplantation, and preadipocyte is the primary source of fat regeneration. Inflammatory microenvironment plays an important role in regulating fat regeneration. As a key role in this process, the effect of macrophages on preadipocytes is a research hotspot. In this paper, we summarized the previous studies in related fields at home and abroad, and made a briefly review of the effects of macrophages on adipogenesis, proliferation and survival of preadipocytes.
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Objective To investigate the related factors of fat necrosis nodules after autologous fat grafting for breast reconstruction.Methods Different methods of purification,number of operations,and history of breast radiation were analyzed.The relationship between fat graft and necrosis were compared.A total of 48 patients undergoing autologous transplantation for breast reconstruction after radical mastectomy between January 2015 and June 2017 in Chinese Academy of Medical Sciences were retrospectively analyzed,and 51 breasts were used.Results After surgery,9 cases of palpable nodules were found in the breast,including 8 cases in the centrifuge group and 1 case in the sedimentation group.There were 20 cases of multiple hypoechoic nodules in breast ultrasound,including 13 cases in the centrifugation group and 7 cases in the sedimentation group.The incidence of breast nodules in the centrifuge group was 33.33％,and the incidence of fat liquefaction cysts was 54.17％;the incidence of breast nodules in the sedimentation group was 3.7％,and the incidence of fat liquefaction cysts was 25.93％.In this study,there were 4 cases of breast fat filling surgery,18 cases of fat graft for 2 times,23 cases of breast fat filling for 3 times,and 6 cases of fat filling for 4 times;the more time of fat graft surgery,the higher of the fat necrosis incidence.There were 21 cases of breasts with radiotherapy history,30 cases of breast without radiotherapy history,7 cases of nodules after autologous fat transplantation and breast reconstruction in radiotherapy group,2 cases of nodules that could be touched after autologous fat transplantation without breast reconstruction,and 2 cases with radio therapy.The incidence of fat necrosis after fat transplantation breast reconstruction was higher than those without radiotherapy.Conclusions The incidence of fat necrosis after fat-purified with centrifugation autologous grafting for breast reconstruction is higher than that by sedimentation method.The higher rate of fat necrosis is observed after breast reconstruction with autologous fat grafting in radiotherapy than that without radiotherapy.
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Objective@#To investigate the application and therapeutic effect of external tissue expansion-assisted autologous fat grafting for delayed breast reconstruction.@*Methods@#Patients began wearing the BRAVA negative pressure system 8 hours a day for recipient tissue expansion for one month before the fat grafting procedure. After fat grafting, BRAVA was recommended to be worn 8 hours a day from postoperative 48 hours to one month. The interval of each fat grafting procedure was 2.5 to 3.0 months. The procedures were repeated until the completion of breast reconstruction. Water-jet assisted liposuction and subcutaneous release of scars were also performed during surgery.@*Results@#From January 2013 to November 2016, 29 patients were followed up for 12 to 58 months, with average of 31.6 months. 28 patients completed the external tissue expansion-assisted autologous fat grafting breast reconstruction. Completion required 1 to 6 procedures, with average of 3.4 procedures. The total initial fat fill volume for each breast was ranged from 200 to 1 000 ml, with average of 583.7 ml. The initial fat fill volume for each breast was ranged from 92.5 to 243.7 ml per operation, with average of 173.8 ml. One patient underwent latissimus dorsi myocutaneous flap breast reconstruction after 3 fat grafting procedures. 8 patients completed the inframammary fold reconstruction, 3 patients underwent breast lift, 1 patient underwent lipofilling augmentation for the contralateral side. Postoperative satisfaction rate was 82.8% in patients and 75.9% in surgeon. Complication statistics: 5 cases of palpable nodules which recognized as fat necrosis (17.2%), one case of nontuberculous mycobacterial infection (3.4%) and one case of locoregional cancer recurrence (3.4%).@*Conclusions@#External tissue expansion-assisted autologous fat grafting is a minimally invasive procedure for breast reconstruction. Satisfactory results could be obtained for most of the patients who would like to choose fat grafting and have enough fat deposit in other parts of the body.
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Objective@#To compare the scar condition after breast implantation with axillary, periareolar and inframammary fold (IMF) incisions.@*Methods@#The consecutive patients who were diagnosed as breast hypoplasia and underwent breast implantation surgeries between May 2012 to December 2014 were included in the research. The scars were assessed at 1, 6 and 12 months after surgery with VSS and patient satisfaction scoring. The results were analyzed with Variance and Kruskal-Wallis test based on the data type.@*Results@#The scars of 173 patients were assessed 3 times with the follow-up rate being 82.4%. The VSS scores of every incision declined with time, and the patient satisfaction scores increased gradually. At one month after surgery, the media VSS scores were 6 in axillary group and 4 in periareolar and IMF groups, the differences had statistical significance (P<0.05). The media scores of patients satisfaction were 8 in periareolar group and 7 in axillary and IMF groups. The scores of periareola group were higher than those of axillary with statistical significance(P<0.05). When 6 months after surgery, the media VSS scores were 4 in axillary group and 3 in periareolar and IMF groups. The scores of axillary group were higher than those of IMF with statistical significance(P<0.05). The media scores of patients satisfaction were 8 in 3 groups. When 12 months after surgery, the media VSS scores were 0.5 and 1 in periareolar group (left and right respectively), and 2 in axillary and IMF groups. The media scores of patients satisfaction were 9 in 3 groups. No differences were found in VSS and patients satisfaction scores among three kinds of incisions (P>0.05).@*Conclusions@#The scars of three incisions achieved similar cosmetic effects and patient satisfaction at long-time follow-up.
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Objective To present the clinical effect of the delayed tissue expanding breast reconstruction with implants.Methods For those who received breast tumor surgeries,round-shaped expander was implanted for increasing skin coverage and silicone implant was used for breast reconstruction after several months' expanding.Results 15 relevant cases were included in this study with an average of 5.1 months expanding period.Only one patient received reoperation for capsular contracture and there was no complication in the other cases.Conclusions Delayed tissue expanding breast reconstruction with implants,with a wide indication,is an ideal reconstructive method which can reduce the interference of tumor recurrence and radiotherapy and avoid the trauma of donor site and the patch-like appearance of breast.
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Objective To investigate the application of liposuction in refining the dog-ear deformity following autologous flap breast reconstruction.Methods Between May 2012 and September 2016,16 patients with dog-ear deformity in the donor site following autologous flap breast reconstruction were treated with liposuction.All the patients were female with an average age of 40.6 years (range,32-47 years).After the operational compression garment was used for at least one month.Regular follow-up was performed after the above operation.Results The follow-up period lasted for 6 to 8 months.The dog-ear deformity was restored to normal appearance.All cases achieved satisfactory results without complications such as local depression,infection,skin necrosis etc.Conclusions For some of the dog-ear deformity following autologous flap breast reconstruction,liposuction is a good and simple method without adjuvant incisions.
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Objective To investigate Chinese patients' preferences for different types of incisions for breast augmentation surgeries and to evaluate the impacts of preoperative education on patients' choices.Methods The 403 patients who underwent implantation surgeries during May 2012 to Dec.2016 were included in the survey.These patients were investigated with questionnaires before and after receiving preoperative education in order to ascertain their preferences and concerns based on comprehensive understanding of different types of incisions.Results After receiving the preoperative education on incisions,158 (39.21％) patients changed their initial choices.The number of patients who chose axillary or periareolar approaches decreased to 205 (50.87％) and 31 (7.69％) respectively,while the number of patients who chose IMF incisions increased to 167 (41.44 ％).The majority of patients who chose the axillary of periareola incisions cited easily-hidden scars as their primary selection criterion (81.95 ％ and 93.55 ％,respectively).However,the patients who opted for IMF incisions primarily concerned about the lower capsular contracture rate (31.74 ％),less tissue trauma (22.75 ％)and lower possibility of injury to the breast parenchyma (21.56 ％).Conclusions The preoperative education materials help the Chinese patients fully understand the characteristics of different types of incision locations and make proper decisions.
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Objective To prevent the occurrence of violence in the emergency department,to reduce the damage to medical personnel,and to maintain the normal medical order in emergency department.Methods A retrospective analysis of medical incidents of violence in the emergency department has been made.A root cause analysis (RCA) group has been established to explore the root cause of the incident and to make the violence emergency preplan of emergency department.Results Medical personnel have been trained according to the plan.It has improved the awareness of health care workers.The incidence of violent injury incidents decreased.Conclusions The establishment and training of emergency preplan can improve the awareness and prevention ability of emergency medical staff to violence injury.The safety of medical staff in emergency department can be guaranteed.
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Objective@#To evaluate the safety, reliability and effectiveness of "free style endoscopic technique" assisted transaxillary high level dual plane breast augmentation; To explore endoscopic techniques that can achieve higher efficiency and better result ; To discover a safe and effective method for dual plane dissection with the help of endoscopy.@*Methods@#Using new endoscopic techniques to perform transaxillary dual plane breast augmentation: ① High level dual plane technique, the muscle division line is about 1.5 cm higher than the original inferior mammary fold, the cephalic side of the muscle is retracted to the lower border of the areola with a special retractor to form a high level dual plane cavity, thus the upper and lower portion of the implant would be covered by pectorilis major muscle, while the rest of the implant was partially under breast parenchyma. ② "Free style endoscopic techniques" , the endoscopy and retractor are not fixed to each other, thus the space is exposed by an assistant with a new designed special retractor, while the operator is concentrate on dissecting with endoscopy in one hand and long tipped bowie in the other hand. ③ Accurate navigate technique, define the dissection border by acupuncture via skin in a 90 degree angle, thus to make the dissection right as preoperative design.@*Results@#There were 1 106 cases underwent this kind of surgery, while 405 of them, whose minimum follow up were 12 months were included in this retrospective study. The follow up period ranged from 12-60 months, the average follow up period is 24.3 months. The average operation time is (1.47 ±0.46) h, the average drainage removal time is (4.23±0.51) d after surgery. The perioperative complication rate is 0.99%, including an incision site change caused by intraoperative bleeding, 1 case of pneumothorax, 2 cases of bleeding after surgery. Long period complication including: 6 cases (1.48%) Ⅲ grade capsular contracture, 21 cases (5.20%) of nipple-areola sensation disorders, implant palpable occurred in 14 case (3.46%), 3 cases (0.74%) implant malposition, 2 cases (0.49%) implant distortion, the total reoperation rate is 2.47%. There was no infection, hematoma, seroma, curtain deformity, double bubble deformity occurred in our study.@*Conclusions@#The high level dual plane techniques not only can solve the deficient soft tissue coverage problem thus to lower the rate of implant palpability, but also can relieve the relationship of the pectorilis major muscle and the inframammary fold(IMF), offering an option to replace Ⅱ and Ⅲ type of dual plane techniques, decrease the risk of curtain deformity and double bubble deformity. The free style endoscopic techniques are very flexible and efficient, with the help of accurate navigate technique, it can archive an accurate cavity dissection, accurate and definite IMF, and a lower complication rate. Though the learning curve is relatively longer, it is really a safe and effective breast augmentation method worthwhile to learn and spread.
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Autophagy is a highly evolutionarily conserved physiological mechanism of organism, including several stages such as autophagosomes formation, the fusion of lysosomes and autophagosomes, and autophagosomes degradation. In physiological conditions, autophagy is responsible for clearing the spoiled organelles and long-lived proteins to maintain the homeostasis of cells and organism. Meanwhile, autophagy is also involved in the formation and development of diseases, but the mechanism has not been confirmed yet. The relationship between autophagy and hypoxic ischemic brain injuries represented by stroke is a research hotpot in recent years, but there is no clear conclusion about autophagy's role and mechanism in hypoxic ischemic brain injuries. We reviewed the activation, function and mechanism of autophagy in hypoxic ischemic brain injuries, in order to provide some perspectives on these researches.
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Animals , Humans , Autophagy , Homeostasis , Hypoxia-Ischemia, Brain , LysosomesABSTRACT
Objective To evaluate the implication and necessity of deepithelialization in mastopexy.Methods A total of 124 patients with mastoptosis were randomly divided into 2 groups:group Ⅰ and group Ⅱ,62 cases each.A double-circle incision technique was used for all the patients.In group Ⅰ,full thickness skin around nipple-areola was resected.While in group Ⅱ,deepithelialization was performed and the peri nipple-areola dermis was preserved.Results The average full skin resection time was 4.5 minute per side in group Ⅰ and the skin deepithelialization time was 15.8 minute per side in group Ⅱ.Postoperative follow-up was carried out for all the 124 patients with duration of 2 weeks to 4 years.In group Ⅱ,sebaceous cysts,epidermal inclusion cyst and suture knot exclusion were found at the incision site in 8 patients (12.9 ％) at 3 weeks to 1.5 years after operation.Conclusions The blood supply to the nipple-areola complex is not affected by full-thickness skin removal during mastopexy,while the incidence of complication at the incision site decreases significantly.We conclude that deepithelialization has not much clinical significance in mastopexy.
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The present study was aimed to investigate how the induced pluripotent stem cells (iPSCs) and bone marrow mesenchymal stem cells (BMSCs) differentiate into neuron-like cells under the induction of hippocampal microenvironments and Reelin's regulation. iPSCs or BMSCs were co-cultured with WT (wild type) or genotypic hippocampal slice and cerebral homogenate supernatant, then the stem cells' differentiation under the induction of hippocampal environment was observed by using immunofluorescence technique. In the meantime, stem cells were co-cultured with hippocampal slice and cerebral conditioned medium of reeler (Reelin deletion) mouse respectively. The results showed that both adhesive iPSCs and BMSCs on WT hippocampal slice exhibited lamination of double "C" shape with high density on granular and pyramidal layers. The stem cells could differentiate into neuron-like cells with obvious polarization on WT hippocampal slice. In pyramidal cell layer, the differentiated neuron-like cells were oriented vertically with similar shapes of pyramidal cell in vivo, and the cells within molecule layer were arranged horizontally. In addition, adhesive iPSCs and BMSCs could differentiate into Nestin positive neural stem cells and NeuN positive neurons, respectively, under WT hippocampal microenvironment. On the other hand, under induction of hippocampal microenvironment of reeler mouse, iPSCs and BMSCs differentiation could also be seen, but their lamination was in disorder, and cell polarization was irregular. Moreover, differentiation and polarization of the iPSCs and BMSCs were delayed. These results suggest both iPSCs and BMSCs can differentiate into neuron-like cells under the induction of hippocampal microenvironments. Reelin is involved in the regulation of neuronal differentiation and cell polarization. Without Reelin, the cellular lamination and polarization appear irregular, and the stem cells' differentiation is delayed.
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Animals , Mice , Cell Adhesion Molecules, Neuronal , Metabolism , Cell Differentiation , Cells, Cultured , Coculture Techniques , Culture Media, Conditioned , Extracellular Matrix Proteins , Metabolism , Hematopoietic Stem Cells , Cell Biology , Hippocampus , Induced Pluripotent Stem Cells , Cell Biology , Mice, Inbred C57BL , Nerve Tissue Proteins , Metabolism , Neural Stem Cells , Cell Biology , Neurons , Cell Biology , Serine Endopeptidases , MetabolismABSTRACT
For the current situation of the time background and the cultivation of innovation ability of undergraduates, the problems of fracture classification, function evaluation and postoperative rehabilitation were realized by a software research team which mainly consisted of medical undergrad-uates. We put the project into practice in forms of software production and software promotion trial separately in the field of teaching and clinical practice to encourage students to be involved in learn-ing in the process of software production of professional knowledge. The implementation of the project worked well, and developed the well-designed relevant mobile software which was convenient in clini-cal practice and acquired computer software copyright, indicating that it can effectively motivate the undergraduates' innovation interest and consciousness through participating in the various links and the software production process, and it can also contribute to the cultivation of the comprehensive practical and innovation ability of medical undergraduates.
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<p><b>BACKGROUND</b>Calcaneal fractures are relatively common but complex, while the treatment of these fractures is still controversial. The objective of this study was to compare the biomechanical stability of minimally invasive, locking, and non-locking plating systems used for fixing Sanders type II and type III calcaneal fractures. Finite element analysis was used for comparing the three types of plating systems. This study helped in guiding the clinical management of calcaneal fractures.</p><p><b>METHODS</b>The CT data acquired from a volunteer was used to construct a finite element model of calcaneus. The fracture lines were made according to Sanders type II (A, B, C) and type III (AB, AC, BC) and six calcaneal fractures models were constructed accordingly. Three fixation methods used in clinical treatment were simulated by design tools (minimally invasive plating with percutaneous screws, Y-size non-locking plating, and locking plating) and then fixed to these fracture models with the help of clinical principles. The single minimally invasive plating fixation was also tested to compare the function of percutaneous screws. Then, the neutral force was applied on established methods. The displacement and presses distribution condition in various plating models were analyzed and compared.</p><p><b>RESULTS</b>The levels of displacement and compressive press on the bone around fixation or strains on plating were within the physiological limit, indicating that the three methods were suitable for application. Compared with the locked and unlocked plates, the minimally invasive plating caused a relatively lower displacement without the high stress in bone or fixation. The minimum stress in fixation was observed in locking plate as the distribution of stress was concentrated in the anterior part of locking plate.</p><p><b>CONCLUSIONS</b>The minimally invasive plating method could be a better alternative method in treating Sanders type II and type III calcaneal fractures. The observed stiffness of locking plate was not obviously stronger than unlocked plate.</p>
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Adult , Humans , Male , Young Adult , Ankle Injuries , General Surgery , Bone Plates , Calcaneus , Wounds and Injuries , General Surgery , Finite Element Analysis , Fracture Fixation, Internal , Fractures, Bone , General SurgeryABSTRACT
A preliminary exploration of the application and effects of digital orthopaedic technique combined with the clinical practice in our clinical teaching of orthopaedics and trauma for 8-year program medical students has been made. Construction of 3D-model of bone and joint with the digital reconstruction technology, combination of 3D-display with detailed clinical cases, individual studying of knowledge, and fracture models performed by three dimensional printing, all have enhanced the students' understanding of the basics knowledge of orthopaedic trauma and accelerated the process of its joining into clinical practice. Related software has been used to realize the virtual design of fracture reduction and fixation and based on it, students have been guided to personally involve in the development and realization of surgical simulation program on a personal computer, thus improving students' capabilities of analysis, diagnosis and treatment of illness. Besides, students have been actively guided to use digital technology to conduct the finite ele-ment analysis of posterior malleolar fractures and calcaneus fractures , and to produce APP software for mobile devices such as ankle fracture classification and function scoring , which has aroused students' in-terest of clinical research and innovation.
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<p><b>OBJECTIVE</b>The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture (PMF).</p><p><b>DATA SOURCES</b>Data used in this review were mainly from English literature of PubMed data base. Study selection Articles were included in this review if they were related to the PMF or trimalleolar fracture.</p><p><b>RESULTS</b>No consensus was found regarding what sizes of posterior malleolus fragments would lead to ankle instability thus affecting prognosis and should be fixed. X-ray measurement is unreliable, while CT scan is widely recommended and it can recognize the occult posterior malleolus fractures associated with tibia shaft fractures, which are always undetected previously. Direct posterior malleolus fixation is suitable to stabilize syndesmotic injury. The basic and clinical researches support direct reduction and buttress plate fixation of posterior malleolus fracture through the posterolateral approach. Operative indications and timing of weight bearing are still in discussion.</p><p><b>CONCLUSIONS</b>Knowing whether ankle instability occurs and the proper methods to diagnose, evaluate, and operate can help manage the fracture. Further biomechanical research on ankle stability and clinical study to compare various treatment methods are required.</p>