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Objective To measure the value of orthopedic physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modified POSSUM (P-POSSUM) scoring systems in predicting operative risks in aged hip fracture patients.Methods Orthopedic POSSUM and P-POSSUM were performed to predict complication incidence and mortality for 164 aged patients operated for hip fracture.Validation of the scoring systems was tested by assessing observed to expected ratio,discrimination,and calibration.Discriminative ability and calibration of both scores were estimated using receiver operation characteristic curve (ROC) and Hosmer-Lemeshow test respectively.Results Orthopedic POSSUM score performed in predicting incidence of postoperative complications showed overall observed to expected ratio of 0.86,area under the curve of 0.82,and good calibration (H2 =3.66,df=8,P ＞ 0.05).P-POSSUM performed in predicting mortality showed overall observed to expected ratio of 0.80,area under the curve of 0.93 and good calibration (H2 =3.21,df =4,P ＞ 0.05).While orthopedic POSSUM overestimated postoperative mortality (overall observed to expected ratio =0.27).Conclusion Orthopedic POSSUM and P-POSSUM scores are respectively accurate in predicting postoperative complication incidence and mortality in aged hip fracture patients,but orthopedic POSSUM score overestimates the mortality.
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Objective To investigate the expression of type Ⅱ collagen in the articular chondrocyte of osteoarthritis (OA) patients and normal human. Methods The samples of articular cartilage were obtained from the patients undergoing total joint replacement, including 8 primary OA patients, 8 secondary OA patients and 9 normal subjects. Type Ⅱ collagen expression in chondrocyte was detected by reverse transcriptase polymerase chain reaction (RT-PCR). Results The expressin of type Ⅱ collagen mRNA in normal OA group was higher than that in primary OA group and secondary OA group with a statistical difference (P=0.014), while there was no statistical difference between primary OA group and secondary OA group(P=0.716). Conclusions The reduction of type Ⅱ collagen expression leads to the change of collagen directly and possibly plays an important role in OA, which is the common pathway of the occurrence of both the primary and secondary OA.
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Chitinases are ubiquitous chitin-fragmenting hydrolases, however until a few years ago that chitinase like proteins have been found in mammalian. A silica-induced bronchoalveolar lavage protein (iSBLP58) with fibroblast growth promoting activity in silicotic rat, which had high sequence homology with members of the mammalian chitinase protein family has been previously purified and characterized. Bioinformatics analysis showed that several human EST clones from pooled colon, kidney or stomach matched the rat protein sequence. Thereafter clone from human kidney RNA samples with several pairs of primers was managed and a set of sequences was obtained, whose cDNA and amino acid sequences have high similarity with each other and several human chitinases in GenBank. Comparison with human genome sequence suggests that these molecules may be from variant transcripts of same a Pre-mRNA. Here the characterization of these sequences is reported.
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0.05).The clinical outcomes were evaluated according to improvement HSS knee joint function scoring,and the score showed an average of 87.5 points (range,71-97).[Conclusion]The dual-incision technique resulted in accurate fracture reduction with low tissue complication rate,and the medial and lateral plating treatment achieved improved stabilization which enabled mobilization of the knee joint to start immediately after surgery.Medial and lateral plating treatment with dual incisions is a safe and effective technique for Schatzker type Ⅴ tibial plateau fractures.
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BACKGROUND: It is often seen in clinical practice that children, aged3-15 years, suffer from knee pain of unknown cause at night, which occurs frequently. Most of them can be called "pain of growth".OBJECTIVE: To analyze the related factors of knee pain in adolescents and observe the interventional effect of alpha-D3 (α-D3).DESIGN: Case control analysis, self-control analysis SETTING: Department of Orthopaedics, Jinshan Hospital Affiliated to Shanghai Fudan University PARTICIPANTS: We admitted 22 children outpatients, aged 3 to 15years, who suffered from recurrent attack of knee pain of unknown reasons and received treatment in Jinshan Hospital Affiliated to Shanghai Fudan University from June 1998 to August 2002, servingas group A. Another 20children outpatients of fracture recovered for half a year were recruited simultaneously, serving as Group B (control group).METHODS: Group A adopted the therapy of α- D3 of 0.25 μg taken orally once everyday for successive 7 days then stopped to observe the symptoms for the next three weeks. Four weeks was one therapeutic course.If the pains were still alive or reoccurred, another therapy period was needed until they vanished. The contents of bone gla protein (BGP), blood calcium (Ca2+), blood phosphorus (P3+), blood magnesium (Mg2+), alkaline phosphatase (ALP) and bone mineral density (BMD) of patients were detected between Group A and Group B. GBP index and change of pain in knee at night was observed with α-D3 before therapy and 1,3 and 6months after therapy. After one therapy period, the levels of blood Ca2+, P3+,Mg2+, ALP, BGP, CT, urine and X-ray of knees were detected again, so was BMD after 6 months.MAIN OUTCOME MEASURES: ① Blood Ca2+, P3+, Mg2+, ALP contents of children patients were detected before and after therapy . ② In the Group A, content of BGP was detected before and 1,3 and 6 months after therapy, and BMD before and 6 months after therapy; The above indexes were detected 6 months and one year after bone fracture healing in the control group. ③ Therapeutic effect of α-D3.RESULTS: All the 42 patients entered the stage of result analysis. ① The levels of blood Ca2+, P3+, Mg2+, ALP of patients who suffered pain in knee were all normal before and after therapy . ②BGP content of patients in the control group was significantly lower 1 year after bone fracture healing than 6 months after bone fracture healing [(7.06±0.74), (7.44±1.16)μg/L,P ＜ 0.01]; BGP content of patients in Group A was 15.98 μg/L before therapy , which was significantly higher than that in the control group .BGP content was (12.12±2.2), (10.6±81.31), (7.60±0.95)μg/L , respectively in 1,3 and 6 months after therapy. There was significant difference of BGP content between before and after therapy (P ＜ 0.05). ③ There was no significant difference of BMD of patients between two groups (P ＞ 0.05).④ Symptoms of pain in knee at night improved or disappeared after α-D3therapy, and the therapeutic time was 9 to 83 days.CONCLUSION: Although the knee pain of adolescents and children at night can not reach the diagnostic criterion of rachitis, it is still correlated with the deficiency of bone mineralization, in clinical practice, the BGP determination should be used as a means of monitoring the pain of unknown cause. There is significant effect using vitamin D3 in treatment of knee pain of children at night.
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Treatment of chronic osteomyelitis has become a difficult problem in clinical medicine due to its extended pathological process,high occurrence of complication and recurrence of disease.The major pathogenesis mechanism is Gram-negative bacteria infection,such as staphylococci.LPS is an important substance found in the cell wall of Gram-negative bacteria and administration of LPS to skeleton relevant cells in vitro could simulate the pathological characteristics of osteomyelitis patients.The results of quantitative real-time PCR and Western blot showed that CHI3L1 was up-regulated obviously in the infected bone tissues of osteomyelitis patients and LPS-stimulated osteoblasts.Analysis of the luciferase activity of NF-?B reporter gene vector revealed that LPS could activate NF-?B.Bay11-7082,an inhibitor of NF-?B activation,suppressed the elevation of CHI3L1 expression induced by LPS.Pre-incubation of osteoblasts with anti-TNF-? antibody or silencing TNF-? receptor expression by siRNA inhibited the induction effect of LPS on CHI3L1.Inhibition of NF-?B activation also prevented up-regulation of TNF-? induced by LPS.In conclusion,LPS stimulated TNF-? expression through activating NF-?B,then TNF-? induced CHI3L1 expression.It was demonstrated for the first time that CHI3L1 expression is promoted in osteomyelitis and LPS-treated osteoblasts and investigates the molecular mechanism of LPS-induced CHI3L1 expression in osteoblasts.
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Objective To review the results of operative treatment of the distal radius fractures. Methods The group of 12 cases were classified accorded to universal classification. There was 1 case of type Ⅲ, 3 cases type ⅣA,2 cases type ⅣB, 5 cases type ⅣC and 1 case type ⅣD. Five of them were checked preoperatively by spiral CT and three dimensional evaluation. They were given respectively treatment by external fixation, by volar or dorsal buttress plate, with or without percutaneous K wires. Results The average period of follow up was 12 months. 9 cases were excellent and 2 cases were good. The excellent and good rate was 91.7%. Conclusions Operative interventions for intra articular fractures of distal aspect of the radius should be considered when non operation management failed. The spiral CT and three dimensional evaluation can reveal enough information about the fracture preoperatively. The proper operative method should be chosen according to the fracture type.
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Objective To observe the indications for early surgical trea tment of thoracolumbar burst fracture (TLBF). Methods 139 cases who had been def initely diagnosed as TLBF were analyzed retrospectively. They were divided into 2 groups: operation and non-operation. 47 patients had non-surgical treatment, such as bed-rest plaster brace. 92 patients had surgical treatment with plate and root screw. Spinal cord functions were evaluated according to the ASIA metho d. Results All patients were followed up for 6 months to 10 years (averaged 6 y ears and 2 months). Their average kyphosis angle measured with Cobb method was 2 3.5? before the operation and 8.5? after the operation. The average degree o f middle column posterior convexity was 25%～85% before the operation (averag ed 33%) and 0～53% after the operation (averaged 12%). The average height of anterior column was 45% before the operation and 85% after the operation. T he average degree of spinal stenosis was 30%～85% before the operation (avera ged 55%) and 0-50% after the operation (averaged 20%). There were more case s whose neural function recovered to grade E in the operation group than in the non-operation group (P
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AIM: To confirm the existence of the endothelial progenitor cells in human cord blood and to study its differentiation and development process. METHODS: The mononuclear cells in human cord blood were isolated using lymphocyte separation solution. Then the mononuclear cells were cltured in MCDB131 containing 20% fetal bovine serum. The effects of 5 ?mol/L dexamethasone,the extract from bovine brain,insulin and hypoxanine on the proliferation and differentiation of the adherent cells were observed. The morphology of the adherent cells were examined twice daily by inverted phase contrast microscope. CD34 and CD14 expression were determined by FACS. Immunohistochemistry was used to confirm the expression of factor Ⅷ. RESULTS: The proliferative endothelial progenitor cells existed within the CD34 - adherent mononuclear cells of human cord blood. Dexamethasone and hypoxanine decreased the number of spindle-shaped cells and caudated cells. Bovine brain extract,insulin and FCS enhanced the number of spindle-shaped cells and caudated cells. CONCLUSION: The existence of endothelial progenitor cells within the CD34 - adherent monouclear cells of the human cord blood was observed and these cells were able to differentiate into endothelial-like cells in vitro.