Alendronate combined with Lactobacillus rhamnosus to combat bone loss in ovariectomized mice / 中华创伤骨科杂志

Objective:To study the protective effect of alendronate combined with Lactobacillus rhamnosus on bone loss in ovariectomized mice.Methods:Fifty female C57BL/6 mice were divided into 5 equal groups ( n=10). Ovariotomy was performed in groups A, B, C and D while a sham operation was performed in group E. Group A was subjected to combined administration of alendronate and Lactobacillus rhamnosus, group B to administration of alendronate, group C to administration of Lactobacillus rhamnosus, and groups D and E to administration of physiological saline only. At 3 months after operation, all the mice were sacrificed to harvest their femurs. Micro CT scanning was performed to detect the bone mineral density (BMD), trabecular relative volume, bone surface area/bone volume, and trabecular thickness and number of trabecular bone. Three-point bending test was used to detect the maximum load, stiffness, ultimate load, Young＇s modulus, and fracture energy. Osteocalcin and alkaline phosphatase levels were measured using blood samples from the mice eyeballs. The 2 groups were compared in terms of all the above indexes. Results:The BMD [(669.87±67.87) mg/cm 3], maximum load [(14.35±0.75) N] and fracture energy [(1,497.43±38.29) J/m 2] in group A were significantly higher than those in group B [(520.07±9.01) mg/cm 3, (11.94±0.82) N and(1,277.61±35.12) J/m 2] and group C [(388.15±25.61) mg/cm 3, (11.10±0.93) N and (1,115.27±63.24) J/m 2] (all P<0.05). The osteocalcin level in group A [(22.25±1.78) ng/mL] was significantly higher than that in group B [(19.08±1.45) ng/mL] and group D [(19.33±1.66) ng/mL] (both P<0.05). The alkaline phosphatase level in group A [(83.21±9.69) ng/mL] was significantly lower than that in group C [(113.16±14.44) ng/mL] and group D [(137.96±14.01) g/mL] (both P<0.05). Conclusion:Alendronate combined with Lactobacillus rhamnosus may play a synergistic role in prevention of bone loss in ovariectomized mice, because combined administration of the two is more effective than administration of either of the two.

Clinical efficacy of bone transport technique in treatment of large segment infective nonunion of femoral shaft / 中华创伤杂志

Objective To investigate the clinical effect of bone transport technique in the treatment of large segment infective nonunion of femoral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 33 patients with large segment infective nonunion of femoral shaft admitted to Chinese PLA General Hospital from June 2012 to October 2015.There were 25 males and eight females,aged 19-58 years (mean,34.6 years).In terms of the initial injury,23 patients were with open fracture and 10 with closed fracture.All patients previously received 1-9 times of operation,with an average of 2.3 times.The duration from injury to operation ranged from 7-60 months,with an average of 34 months.All patients underwent treatment with bone transport technique.After thorough debridement,the length of femoral defect ranged from 6 cm to 18 ema,with an average of 10.5 cm.The single arm limb reconstruction external fixator was placed on the lateral side of the femur under C-ann X-ray fluoroscopy.The wound healing,bone healing time,external fixation index (EFI),and complications were recorded.The function of the affected limb was evaluated using the modified criteria of Association for the Study and Application of the Method of Ilizarov (ASAMI).Results All patients were followed up for 21-53 months (average,38.5 months).Femoral defects were completely repaired,with no recurrent infection reported.Bone healing time ranged from 8 months to 25 months (average,13 months).The external fixation index (EFI) ranged from 1.13 months/cm to 1.83 months/cm,with an average of 1.26 months/cm.The infection rate of the nail tract was 55％ (18/33).There were 12 patients with Type A,five with Type B,and one with Type C.The function of the affected limb was graded as excellent in 18 patients,good in six,fair in five,and poor in four,with an excellent and good rate of 73％ (24/33).Conclusions In the treatment of large segment infective nonunion of femoral shaft,bone transport technique can eontrol the infection,promote defect repair,and restore the function of affected limbs.

Efficacy of percutaneous pedicle screw fixation of ankylosing spondylitis combined with thoracolumbar fractures / 中华创伤杂志

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.

Impact of Roux-en-Y gastric bypass surgery on the brown adipose tissue of type 2 diabetic rats / 中华内分泌外科杂志

Objective To observe what changes the brown adipose tissue (BAT) of T2DM rat models would have,including morphology,function and specially expressed uncoupling protein (UCP1) after the gastric bypass (Roux-en-Y,RYGB) and to explore the effects of RYGB on BAT of T2DM rat models and its related mechanism in order to provide a theoretical and experimental basis for treatment of T2DM patients with RYGB.Methods SD rats were given a high-fat and high-sugar diet for two weeks,by injecting streptozotocin (STZ) 30 mg/kg intraperitoneally to build models.Blood glucose was measured after 72 h and 1 week by the fast blood glucose meter.The models were built successfully if blood glucose at both times were ≥ 16.7 mmol/L.Feeding environment:individually caged,standard rat feed,natural circadian cycle,indoor temperature (18±2)℃,indoor humidity (50±2)％.50 rats were randomly selected and dividing into four groups according to intervention methods:diabetes operation group (group A,n=10),undergoing RYGB surgery with the whole stomach kept;diabetes sham operation group (group B,n=10),the same anesthesia and incision as the previous RYGB group.The operation mode was anterior gastric wall incision and suture,jejunum transection in corresponding position and in situ anastomosis with the same suture method as group A;diabetes control group (group C,n=10),normally feeding after building models;and the last one was the healthy control group (group D,n=10):no special treatment,adequate water feeding ensured.The rest of rats remained to be used.The body mass (BM),fasting blood glucose (FBG),fasting serum insulin(Fins)before and at the 1st,2nd,4th and 8th week after surgery were measured.The number of transversal ceils was calculated by IPP6.0 image software and the average radius of fat cells was calculated.UCP1 expression was tested with western blot.Results ① The fasting blood glucose,fasting serum insulin level and the body weight of dia betic rats were higher than those of the control group,but the insulin sensitivity index was significantly lower.② HE Staining showed:diabetes operation group (group A) rats,compared with diabetes control group and diabetes sham operation group(group B),had obviously higher brown fat cell counts transversally and average radius,and the difference was statistically significant (P＜0.01).Diabetes operation group (group A) rats had no significant difference from the healthy control group(group D) rats,and the diabetes control group (group C) rats had no significant difference from sham operation group (group B) rats as well.③ Western blot showed that after the gastric bypass surgery,compared with the diabetes sham operation group (group B) and the diabetes control group (group C),UCP1 expression of brown adipose tissue of the diabetes operation group (group A) increased significantly (P＜0.05).The diabetes sham operation group (group B) had no significant difference from the diabetes control group (group C),and the diabetes operation group(Group A) had no significant difference from the healthy control group (Group D) as well (P＞0.05).Conclusion RYGB can reduce the body mass and insulin resistance (IR) of diabetic rats and,at the same time,promote the expression of UCP1 of brown adipose tissue.RYGB might increase the activity of brown adipose tissue by regulating the UCP1 signaling pathway to improve body's insulin resistance.

Percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones / 中华创伤骨科杂志

Objective To evaluate the curative effects of percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones.Methods A retrospective analysis was performed of the 32 patients who had been treated using osteoperiosteal decortication combined with distraction osteogenesis from September 2011 to December 2014 for nonunion of lower-extremity fractures.They were 23 males and 9 females,with a mean age of 33.4 years (range,from 15 to 62 years).After their former internal or external fixators were removed,the 2 fracture ends were fixated by a retractile mono-lateral or circular external fixator.Under radiographic monitoring,a percutaneous incision was made with a 5 mm sharp chisel,down to the bone.Scar and ossified tissue between the fracture ends were debrided and cut along the fracture line.Mter the marrow cavity was reamed,a new irregular wound was created at sclerotic fracture ends.Scale-shaped chips (1 mm thin and 5 mm in diameter) were elevated using a chisel on surface of the cortical bone within 2 cm from the fracture ends.The external fixators were adjusted to compress the fracture sites.On the 8th day after operation,the eternal fixators were applied to distract and compress at nonunion sites to stimulate the osteogenesis.Results All the patients were followed up for an average of 12.5 months (range,from 8 to 42 months).Primary union was successfully achieved in 28 patients while delayed union occurred in 3 patients who finally achieved union after adjuvant therapies like shock wave and or local injection of bone marrow blood.The average time for union was 4.6 months(range,from 4 to 7 months).The mean time for external fixation was 6.2 months (range,from 5 to 8 months).One patient encountered nonunion of lateral tibial cortical bone 6 months after surgery but eventually achieved union by autologous ilium grafting.Joint functions in all postoperative patients were similar to those before operation.Conclusion Percutaneous osteoperiosteal decortication combined with distraction osteogenesis is a simple,minimally invasive and effective treatment for nonunion of lower-extremity bones,avoiding disadvantages brought by traditional surgery,like massive trauma and excessive bleeding.

Different fixation methods for transverse acetabular fracture：a finite element analysis / 中国组织工程研究

BACKGROUND:Transverse acetabular fracture often involves the damage of anterior and posterior columns of acetabulum. The most popular fixation of the anterior and posterior columns needs the combined anterior and posterior approach. Big trauma is not conducive to patient’s recovery after surgery. Limited incision or percutaneous minimaly invasive lag screw placement can reduce soft tissue injuries, but the strength of the fixation lacks of biomechanical verification. OBJECTIVE: To compare different types of fixations for transverse acetabular fracture, explore the appropriate fixation options that can achieve effective fixation and reduce tissue injury by combing with repair approach and the condition of soft tissue. METHODS: The fourth generation of synthetic semi-pelvic sawbones was set as a template to establish a model of acetabular transverse fracture using finite element analysis. Five different fixation options were used to fix the transverse acetabular fracture. The magnitudes of anterior and posterior displacement of transverse fracture were compared to assess the stability of different options under a simulated condition of incomplete weight bearing stand. RESULTS AND CONCLUSION:The motion at anterior column was minimal when fixed by anterior column locking plate + posterior column screw and the minimum displacement at posterior column was the fixation of anterior column screw + posterior column locking plate. Both of the motions of these two fixations were less than the reconstruction plate fixation respectively. The worst fixation was the anterior column and posterior column lag screw fixation with the largest displacement. The anterior column locking plate + posterior column screw, accomplished by single approach, could not only reduce surgical trauma, but also has a stronger stability. Moreover, this fixation option is effective method to place posterior column lag screw under direct vision and reduce the difficulty of screw implantation.

Effect of Roux-en-Y gastric bypass on the short-term immune function in patients with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of laparoscopic Roux-en-Y gastric bypass on the short-term immune function of type 2 diabetic patients and to explore the correlation between the immune regulatory effect and blood glucose control.</p><p><b>METHODS</b>Clinical data of 28 patients with type 2 diabetes mellitus who underwent laparoscopic Roux-en-Y gastric bypass surgery in our hospital during January 2014 to January 2015 were retrospectively collected. Fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), immunoglobulin (IgG, IgA, IgM), T lymphocytes CD3(+), killer T cells CD3(+)CD8(+), helper T cells CD3(+)CD4(+), natural killer(NK) cell subsets CD16(+),CD56(+) and B cell subsets CD19(+),CD45(+) levels were detected and compared between before and after surgery. Correlation of immunoglobulin and immune cell subsets with the level of FBG and HbA1c were examined.</p><p><b>RESULTS</b>After operation, FBG and HbA1c decreased significantly from (5.78±1.15) mmol/L to (14.21±1.89) mmol/L, and (9.96±0.97)% to (6.87±0.69)%, respectively (all P<0.05), and immunoglobulin (IgG, IgA, IgM) increased significantly [IgG: from(9.41±1.23) g/L to (12.74±1.61) g/L, IgM: from (1.71±0.22) g/L to (2.43±0.39) g/L, IgA: from (1.25±0.26) g/L to (1.97±0.23) g/L, all P<0.05]. Besides, T lymphocytes CD3(+), killer T cells CD3(+)CD8(+) and B cell subsets CD19(+)CD45(+) elevated significantly as well [T lymphocytes CD3(+): from (55.3±3.8)% to (67.6±4.6)%, killer T cells CD3(+)CD8(+): from (15.6±5.3)% to (28.7±4.2)%, B cell subsets CD19(+)CD45(+): from (8.4±3.7)% to (18.1±4.1)%, respectively, all P <0.05]. There was no significant difference in the expression of helper T cells CD3(+)CD4(+) and natural killer cell subsets CD16(+)CD56(+) between pre-operation and post-operation(all P>0.05). Levels of immunoglobulin (IgG, IgA, IgM), CD4(+)/CD8(+) ratio and B cell subsets were negatively correlated with HbA1c and FBG levels (IgG with FBG: r=-0.865, IgA with FBG: r=-0.887, IgM with FBG: r=-0.902, CD4(+)/CD8(+) with FBG: r=-0.956, CD19(+)CD45(+) with FBG: r=-0.834; IgG with HbA1C: r=-0.859, IgA with HbA1C: r=-0.957, IgM with HbA1C: r=-0.843, CD4(+)/CD8(+) with HbA1C: r=-0.912, CD19(+)CD45(+) and HbA1C: r=-0.885, all P<0.05), but the proportion of NK cells was not significantly correlated with HbA1c and FBG (P>0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic Roux-en-Y gastric bypass has good effect on the immune function of patients with type 2 diabetes mellitus. Improvement of immune function is correlated with the control of FBG and HbA1c.</p>

Radiographic analysis of treatment of inter-trochanteric fractures using proximal femoral nails / 北京大学学报(医学版)

Objective:To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design ( CAD ) soft-wares, e.g.Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimen-sional (3D) anatomy.Intra-class correlation coefficient ( ICC) was used to test the reliability of intra-and inter-observers.The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femo-ral nail anti-rotation ( PFNA) were retrospectively analysed and used to measure bilateral proximal femo-ral anatomical parameters, including 2D and 3D femoral neck-shaft ( NS) angle and femoral neck ante-version (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings.ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data.Results:The established measurement method hasdexcellent consistency within the intra-and inter-observers, with all the ICCs higher than 0.9.The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles.The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’ s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values <0.001).In PF-NA group, 57%of the differences between the 2D post-operative injured side’s and intact side’s NA an-gles were higher than 15°, which was more than 15.78%in InterTAN group.The paired student T-test showed no significant difference between the post-operative injured side’ s 2D or 3D NS angles and the in-tact side’s respective 2D or 3D angles in PFNA group (P values were 0.925 and 0.367, respectively), but in InterTAN group, the post-operative injured side’s 2D or 3D NS angles were significantly smaller than the intact side’s respective angles (P values were 0.033 and 0.009, respectively).Conclusion:By analyzing and comparing bilateral proximal femoral anatomical parameters after two kinds of IM nailings procedures, the differences between the bilateral post-operative NA angles in PFNA group were significantly larger than those in InterTAN group.There was significant correlation between the NA angles of the injured sides and NA angles of IM nailings in both the groups.

Assessment of plantar fasciitis using shear wave elastography / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis.</p><p><b>METHODS</b>The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion.</p><p><b>RESULTS</b>The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126).</p><p><b>CONCLUSION</b>SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.</p>

Systematic reviews on reports of hip fractures in Web of Science: a bibliometric analysis of publication activity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The objective of this study was to analyze the trend in the publication of systematic reviews on hip fractures through a bibliometric approach.</p><p><b>METHODS</b>Literature including systematic reviews or meta-analyses on hip fractures was searched from the ISI Web of Science citation database. The search results were analyzed in terms of geographical authorship and frequency of citation by country, institution, author, and periodical distribution.</p><p><b>RESULTS</b>A total of 654 published systematic reviews from 1995 to 2013 in 48 countries or regions were retrieved. The United States (171) was the predominant country in terms of the number of total publications, followed by the United Kingdom (149), Canada (120), Australia (76), and China (54). The number of systematic reviews significantly increased during the last 6 years, especially in China. The production ranking changed in 2012, at which time the United States and China were the leaders in the yearly production of systematic reviews on hip fractures. The amount of literature (27 publications) from China contributed almost one-quarter of the total literature (109 publications) in 2012. However, the average number of citations of each article from China was still low (6.70), while the highest number of citations of each article was from Sweden (193.36). The references were published in 239 different journals, with 15 journals contributing to 41.3% of the systematic reviews on hip fractures. The two journals that contributed the most were Osteoporosis International (10.6%) and the Cochrane Database of Systematic Reviews (7.6%). The predominant institution in terms of the number of publications was McMaster University (36) in Canada.</p><p><b>CONCLUSIONS</b>The best evidence in the field of hip fractures has attracted increasing attention. Systematic reviews on hip fractures from China have been increasingly more frequent during the past 6 years, particularly in 2012.</p>

Control of hemorrhage during the operation of old pelvic fractures by temporary balloon occlusion of the common iliac artery / 中华骨科杂志

ObjectiveTo discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.ResultsThe mean time of operations was 290 min(range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.ConclusionThe effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.

Analysis of failure of transpedicular screw fixation for thoracolumbar fractures / 中华创伤杂志

Objective To discuss the causes of failure of transpedicular screw fixation in treatment of thoracolumbar fractures. Methods A retrospective analysis was done to analyze the failure causes of 24 patients (15 males and 9 females) who received pedicle screw fixation for their thoracolumbar fractures from June 2002 to June 2008 in our department. There were two patients with delayed infection, eight with pedicle screw breakage, one with connecting rod breakage, 10 with internal fixation loosening (including nut loosening) and three with poor screw position. Results All patients received reo-perations including removal of internal fixation plus debridement and lavage in two patients, simple removal of internal fixation in nine patients, removal of inter fixation and posterior fusion in two, replacement of the lengthened fixation plus posterior fusion in nine, and adjustment of the position and orientation of screw in two. All patients were followed up for 6-18 months (average 11 months) , which showed no any complications. Conclusion Improper surgical indication or approach, ineffective fusion, incorrect postoperative rehabilitation exercise, too late removal of the screws and improper surgical operation are main causes for failure of internal fixation.

High-frequency ultrasonography for diagnosing the brachial plexus disease / 中国医学影像技术

Objective To assess the clinical value of high-frequency ultrasonography in diagnosis of the brachial plexus disease. Methods Forty-two patients with suspected brachial plexus disease underwent high-frequency ultrasonography. The ultrasonographic findings were compared with clinical data. Results Among the 42 patients, 33 were diagnosed as brachial plexus abnormalities, while 9 as normal according to clinical data. With high-frequency ultrasonography, 26 patients were diagnosed as abnormal brachial plexus and 16 patients as normal. The sensitivity, specificity and accuracy of ultrasonography in diagnosing brachial plexus abnormalities was 78.79%, 100% and 83.33 %, respectively. Conclusion High-frequency ultrasonography is useful in evaluating the brachial plexus disease and may become an important imaging methods for brachial plexus.

Preparation and evaluation of recombinant human bone morphogenetic protein-2 loaded microsphere combined with fibrin glue / 中国组织工程研究

BACKGROUND: The active component in recombinant human bone morphogenetic protein-2/poly(lactide-co-glycolide) (rhBMP-2/PLGA) microsphere prone to be absorbed or lost during solution with physiological saline, and the setting time is uncontrollable using blood solution, so it is necessary to explore an sustained-release carrier that can control the setting time.OBJECTIVE: To construct an injectable BMP release system by combing rhBMP-2/PLGA microsphere with fibrin glue. DESIGN, TIME AND SETTING: An experimental comparative study was performed at the Department of Othopaedics, General Hospital of Chinese PLA from January 2005 to April 2008.MATERIALS: PLGA (polylactic acid/polyglycolic acid 75/25, M_r=3 000, with 0.025 L/g viscosity) was supplied by Shandong Institute of Medical Instruments; rhBMP-2 was offered by The Academy of Military Medical Sciences; and fibrin glue was supplied by Hangzhou Puji Medicine Technology Development Co., Ltd.METHODS:The rhBMP-2/PLGA microsphere was prepared using W/O/W solvent evaporation methods. rhBMP-2 loaded PLGA microsphere were incorporated in fibrin glue to establish injectable BMP release system.MAIN OUTCOME MEASURES: The setting time,release behaviors, electron spectroscopy for chemical analysis (ESCA) as well as pH values of composites were measured.RESULTS:①Compared with fibrin glue, the setting time of composites were slightly increased.②Initial burst release of the composites occurred, the drug release exceeded 16.76% within 2 days, and 76.75% of the drug was release within 42 days. ③ESCA showed that composites prolonged release times.④The PH value of composites was between microsphere and fibrin glue.CONCLUSION: RhBMP-2/PLGA microsphere/fibrin glue composite has satisfactory slow-release effect and syringeability, which not only degrade partial acid environment but also maintain the biological effect of higher density. Therefore, it forms a promising synthetic bone graft.

Combination of the contrast-enhanced ultrasound and color Doppler's grade to diagnose breast masses / 中华超声影像学杂志

Objective Comparing the enhancement of contrast-enhanced ultrasound(CEUS) with the intensity of the blood signals of breast masses, and producing the parameter of peak intensity (PI), to determine whether they can reflect the differentiation of the benign breast masses from the malignant ones.Methods Fifty patients with the breast masses (25 benign,25 malignant) were implemented the contrastenhanced ultrasound inspection.The blood signals of the masses could be got before performing the CEUS,then the CEUS was performed.The enhancement of the masses was divided into 4 grades according to the enhancement of breast which was around the mass (no enhancement, low enhancement, equal enhancement,and high enhancement as well).The PIs of all masses and high enhanced massed were calculated by software in machine,then them were compared according to "the groups which had been classified by their maximal diameters.Results Forty-one of 50 cases showed an obvious enhancement using CEUS compared with the routine CDFI.Malignant masses were more obviously than that of benign ones ( P＜0.05).In the 50 cases,the no enhanceed ones( n = 2) and equal enhanced ones( n = 5) were benign,and 1 case of the low enhanced masses( n = 9) was malignant.The high enhanced masses ( n = 34) were malignant or benigh.About the high enhanced masses, there were statistics meanings using the parameter of PI for the masses whose maximal diameters＜2 cm( P＜0.05),and no statistics meanings when their maximal diameters≥2 cm(P＞0.05).Conclusions The CEUS of breast can improve the appreance of the tumor' s blood vessel obviously, especially for malignant masses.The PI of the breast benign masses are different from the malignant ones.Combination of them can help to discriminate benign masses from malignant ones.The parameter of PI is useless for differentially diagnosing the breast masses if their maximal diameters≥2 cm and the blood flow grade Ⅲ before CEUS.

Treatment of femoral neck fracture using modified cannulated screw with injectable BMP release system / 中国矫形外科杂志

[Objective]To treat the femoral neck fracture using cannulated screw and BMP release system in animals,and to evaluate the possibility of treating femoral neck fracture and provide experimental basis for clinical application.[Method]Eighteen mongeral were used in this study.The model of bilateral femoral neck dislocation fracture was established.The control side was fixed using cannulated screw,and the experiment side was fixed with cannulated screw and injectable BMP release system.At 4,8,12 weeks,6 animals were sacrificed at one time point respectively.Results were obtained through histology,radiography,scintimetry and gross observation.[Result]The fracture line was vague at four weeks,and at eight weeks the fracture line almost disappeared.It was healed completely at twelve weeks.Radiological study showed that the healing of the fracture in experimental side was better than that of the control side.There was the same result of observation in histology.[Conclusion]The cannulated screw combined with BMP used in the experiment is effective and feasible.It may not only provide strong internal fixation but also infuse growth factor into site of fracture.It would accelerate the reconstructing of the vascular supply to the femoral head after the fracture and promote the restoration of bone.