[Open reduction and internal and external fixation combined with anchor repair of intercarpal ligament for the treatment of peripheral injury of lunate bone].

OBJECTIVE: To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy. METHODS: From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed. RESULTS: All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair. CONCLUSIONS: The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.

[Minimally invasive internal fixation of pelvic ring for type C pelvic fracture].

OBJECTIVE: To evaluate the feasibility of minimally invasive internal fixation of pelvic anterior and posterior ring for the treatment of type C pelvic fracture, and to explore its operative techniques and therapeutic efficacy. METHODS: From December 2010 to December 2015, 18 patients with type C pelvic fracture were treated by reconstructive plates fixation through minimally invasive ilioinguinal approach for pelvic anterior ring injuries, and by invasive percutaneous sacroiliac joint screw fixation for pelvic posterior ring injuries. There were 11 males and 7 females ranging from 29 to 68 years old with an average age of 43.6 years old. According to Tile classification, there were 14 cases of type C1, 3 cases of type C2, 1 case of Type C3. To be specific, 12 cases with hemi-fracture of rami ossa pubis accompanied with fracture of the sacrum, 2 cases with hemi-fracture of rami ossa pubis accompanied with sacro-iliac joint dislocation, 3 cases with bilateral-fracture of rami ossa pubis combined with pubic symphysis separation accompanied with single-fracture of the sacrum, 1 case with bilateral-fracture of rami ossa pubis combined with bilateral-fracture of sacro-iliac joint were included. Operation time, intra-operative blood loss, injuries of lumbosacral nerves and iliac blood vessels, and fracture reduction were observed. RESULTS: All wounds were primary healing. No complications such as infection, deep venous thrombosis, injuries of lumbosacral nerves and iliaca vessels or heterotopic ossification occurred. According to Matta criterion of fracture reduction, 14 cases got excellent results, 3 good and 1 fair. Sixteen patients were followed up in a period varying from 6 to 33 months with 16.7 months on average. And according to functional score of Majeed, 13 cases obtained excellent results, 2 good and 1 fair, with an average score of 92.13±5.44. CONCLUSIONS: Internal fixation with reconstructive plates through the ilioinguinal approach and with percutaneous iliosacral screw for type C pelvic facture on pelvic anterior ring and pelvic posterior ring respectively have advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Thus, this technique is safe and practicable, yielding satisfying results.

[Expression and clinical significance of vascular endothelial growth factor-C and nm23-H1 in stage II and III colorectal carcinomas].

OBJECTIVE: To discuss the expression and clinical significance of VEGF-C and nm23-H1 in stage II and III colorectal carcinomas. METHODS: SP immunohistochemical staining was employed to determine the expression of vascular endothelial growth factor-C (VEGF-C) and nm23-H1 in the tumor tissues of 110 cases of stage II and III colorectal carcinomas and in the adjacent mucosal tissues of 53 cases as control, and analyze their correlation with cliniopathological features and prognosis. RESULTS: The positive expression of VEGF-C in the carcinoma tissues was 71.8%, significantly higher than that in the adjacent mucosal tissues (22.6%, P < 0.001). The positive expression of nm23-H1 in the carcinoma tissues was 57.3%, significantly lower than that in the adjacent mucosal tissues (90.6%, P < 0.001). The expression of VEGF-C was significantly correlated with lymph node metastasis (P < 0.05), and the nm23-H1 expression was significantly correlated with lymph node metastasis and pathological type (P < 0.05). The expression of VEGF-C and nm23-H1 did not show a significant correlation with age, gender, primary tumor site, tumor size and depth of invasion (P > 0.05). The VEGF-C expression was negatively related with nm23-H1 expression in colorectal carcinoma (r = -0.361, P < 0.001). The median overall survival (MOS) and median disease free survival (MDFS) of 110 patients with colorectal carcinoma were 55 and 48 months, respectively. The colorectal patients with different VEGF-C and nm23-H1 expression showed significant differences in the 5-year OS rate and 5-year DFS rate (P < 0.001). The patients with negative VEGF-C expression and positive nm23-H1 expression had a better prognosis. CONCLUSIONS: The joint detection of VEGF-C and nm23-H1 expression is very promising in prediction of the prognosis of patients with stage II and III colorectal carcinoma. However, whether it can be used as a marker in prognosis judgment needs further investigation.

[Application of internal fixation for injuries of pelvic anterior ring through minimally invasive ilioinguinal approach].

OBJECTIVE: To evaluate the reliability of limited open reduction and minimally invasive plate osteosynthesis (MIPO) for injuries of pelvic anterior ring and to explore its operative techniques and therapeutic efficacy. METHODS: From March 2009 to March 2012,20 patients with injuries of pelvic anterior ring were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach. There were 13 males and 7 females with an average age of 41.6 years ranging from 25 to 61 years. According to classification of Tile, there were 5 cases of type A2, 2 cases of type B1, 9 cases of type B2, 1 case of type B3, 3 cases of type C1. Including 15 cases with anterior ring fracture, 2 cases with anterior ring fracture combined with pubic symphysis separation, and 3 cases with anterior and posterior fractures. Operation time, intra-operative blood losing, injuries of femoral nerve and iliac blood vessels, condition of fracture reduction were observed. RESULTS: All wounds healed at one stage. No complications such as infection or deep venous thrombosis occurred. According to Matta criterion of fracture reduction, 12 cases got excellent results, 7 good, 1 fair. Eighteen patients were followed up from 6 to 32 months with a mean of 16.3 months. According to functional score of Majeed, 15 cases obtained excellent results and 3 good,with an average score of 94.3 +/- 6.0. CONCLUSION: The modified ilioinguinal approach has advantage of short operation time, less blood losing,minimally invasive in treating injuries of pelvic anterior ring and can obtain satisfactory outcomes.

[The proliferation-promoting effects of calcitonin gene-related peptide on type II alveolar epithelial cell exposed to hyperoxia mediated by protein kinase C alpha pathway].

OBJECTIVE: To explore the effects of calcitonin gene-related peptide (CGRP) on type II alveolar epithelial cell (AECII) exposed to hyperoxia, and to determine whether the mechanism is mediated by protein kinase C alpha/nuclear factor-KappaB (PKC alpha/NF-KappaB) signal pathway. METHODS: AECII were isolated from the lung of 21 days fetal rat and cultured for 15 hours to coalesce. Then AECII were randomly assigned into four groups: air, hyperoxia, O(2)/CGRP, and O(2)/CGRP8-37 (a receptor antagonist against CGRP). AECII were exposed to FiO(2) 21% (air) or 85% (hyperoxia) for 24 hours respectively. In O(2)/CGRP and O(2)/CGRP8-37 groups CGRP or both CGRP and CGRP8-37 were added into cultural fluid before placing the plate into 85% oxygen. Cell proliferation ability was determined by methyl thiazolyl tetrazolium (MTT) assay and cell cycles by flow cytometry. Western blotting was employed to detect the fraction of PKC alpha in membrane and cytosol, and translocation of NF-KappaB was observed under laser confocal microscopy. RESULTS: AECII in hyperoxia group showed a decreased viability of AECII [(68.752+/-5.766)% vs. (100.000+/-6.682)%] and had an enhanced percentage of G0/G1 phase [(80.652+/-6.253)% vs. (45.825+/-2.899)%] with a corresponding decline in percentage of S phase [(14.198+/-4.785)% vs. (27.470+/-2.775)%] and G2/M phases [(5.148+/-1.688)% vs. (26.708+/-1.863)%] compared with AECII in air (all P<0.01). Addition with CGRP before hyperoxia exposure promoted AECII proliferation [(94.813+/-6.102)%] and enhanced the cell proportions in S and G2/M phases [(30.547+/-9.861)% and (17.668+/-9.509)%, all P<0.01]. The ratio of membrane to cytoplasm fraction of PKC alpha declined (0.63+/-0.10 vs. 1.00+/-0.09) and the fluorescence of NF-KappaB in nucleus enhanced (22.98+/-2.20 vs. 14.54+/-2.35) in hyperoxia compared with that in air, while both the ratio of PKC alpha and intensity of NF-KappaB were increased in O(2)/CGRP group (1.41+/-0.23, 35.38+/-3.37) compared with those in hyperoxia (0.63+/-0.10, 22.98+/-2.20) and O(2)/CGRP8-37 groups (0.74+/-0.10, 24.88+/-1.81, all P<0.01). CONCLUSION: CGRP could promote proliferation of AECII when exposed to high oxygen tension. PKC alpha participates in the signal transduction process and NF-KappaB is a downstream molecular of PKC alpha, executing in part the function of PKC alpha signal.