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Objective To investigate the role of signal transducer and activator of transcription (STAT1) signaling pathway in osteoblast apoptosis,and to study the effect of STAT1 inhibitor (fludarabine) on osteoblast.Methods The viability of the osteoblasts in different concentration of fludarabine was detected by cell counting kit-8 (CCK-8) assay.Osteoblasts were divided into 4 groups:control group,dexamethasone (Dex) group,fludarabine (Flu) group,and Dex + Flu group.Enzyme linked immunosorbent (ELISA) was used for determining the protein expression of Bcl-2 Associated X Protein (BAX),STAT1 and phosphorylation-sigual transducers and activators of transcription 1 (p-STAT1),and cleaved caspase-3 to reflect the apoptosis in all groups.Results Treatment with Dex increased the protein expression of apoptosis-related proteins and p-STAT1 in time-dependent and dose-dependent manner.Exposure of the cells to Flu,which was a selective STAT1 inhibitor,resulted in a decreased the protein levels of apoptosis-related proteins.Conclusions Our results suggest that fludarabine could suppress Dex-induced apoptosis through the inhibition of STATl-mediated up-regulation cleaved caspase-3 expression in osteoblasts.
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Objective To evaluate the clinical value of MDCTA (Multi-detector computed tomographic angiography) in reconstruction of the soft tissue defect of the limbs combined with the main vascular defects by using Flow-through anterolateral thigh flap.Methods From September,2013 to May,2016,12 cases of limb soft tissue with main vascular defects were examined by MDCTA.The length of vascular defect was measured.The length of bridging vessel needed to design a Flow-through anterolateral thigh flap was measured.The points of anterolateral thigh flap perforator were positioned.The relationship between the perforation and the trunk vascular pedicle was defined.The outcomes were evaluated based on Berton scores for upper extremities and John-Wruh scores for lower extremities.Results The length of the main vascular defects,the positions of flap perforators and the configuration of vascular pedicles were successfully imaged through MDCTA.The length of the main vascular defects were 5-12 cm,which was consistent with the intraoperative findings.The length of bridging vessel for the defects were 7-14 cm,which was enough for the vascular defects.There were not vessel grafts.Twenty perforators were imaged by MDCTA preoperatively,and 22 perforators were found during the operations,which means 2 perforators were not imaged.All flaps survived completely.All patients were followed-up from 6 to 21 months (average,11 months).According to the Berton scores for upper extremities and John-Wruh scores for lower extremities,the excellent/good were 6 in 8 cases and 4 in 4 cases,respectively.Conclusion MDCTA can be used to evaluate the pedicle conditions of the free Flow-through anterolateral thigh flap for the reconstructions.It is worthy to be popularized in clinical application.
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Objective To respectively analyze the results and complications of hip arthroplasty for failed intertrochanteric hip fractures treating with internal fixation.Methods From July 2004 to June 2006,32 patients(24 males and 8 females)were treated with hip arthroplasty after the failed internal fixation of intertrochanteric fractures.The mean age was 71 years(range,57-81 years)at the time of the hip arthroplasty.The average interval from fracture to arthroplasty was 40 months(range,5-70 months).Fifteen patients had been treated with sliding hip screw,10 with intramedullary nail,5 with plate and screws,2 with multiple screws.The failure modes were nonunion in 8 patients,implant cut out from the femoral head in 9,avascular necrosis of the femoral head in 7,and traumatic arthritis in 8 patients.Cemented stems were used in 12 hips,and uncemented stems in 20 hips.Standard prostheses were used in 25,long-stem prostheses in 7.Results Twenty-eight patients were followed up for a minimum of 4 years after the hip arthroplasty,with the mean period of 5 years(range,4-6 yeas).For these 28 patients,the average preoperative Harris Hip Score was 37(range,32-45),and 88(range,84-95)at the latest follow-up.The average acetabular inclination was 44°(range,42°-48°).No loosing was found in cotyloid components.Nine of 10 cemented femoral components had cementation rated as grade C,and 1 as grade A.Three had heterotopic bone six months postoperatively,and 2 were Brooker type Ⅱ,one was type Ⅲ.Conclusion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient.