[Operative effect and treatment strategies for the low distal humerus fracture].

Objective: To explore the operative effect and treatment strategies for the low distal humerus fracture. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results: The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion: Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.

[Clinical effect of compound internal fixations in treating extreme distal radial fractures].

Objective: To investigate the clinical character and treating strategy of extreme distal radial fractures. Methods: From June 2012 to May 2014, 12 patients who suffered from extreme distal radial fractures were treated in Department of Orthopedics, Tongji Hospital, Tongji University. According to AO/OTA classification, there were 4 cases of type 23B1, 3 cases of 23B2, 3 cases of 23C1 and 2 cases of 23C3.When classified by morphological features, there were 4 of simple styloid process fracture, 3 of simple extreme distal radial fracture without articular surface involved, 3 of styloid process fracture combined with distal radial articular fracture, and 2 of articular surface splintered or collapse fracture. According to the fracture features that radiographic exams showed, different surgical paths and fixation methods were chosen in order to protect soft tissues to the best advantage. To those patients with simple styloid process fracture, screw alone, Kirschner-wire or styloid plate were used for fixation. To the other types of fracture, open reduction and compound internal fixation with low-notch volar plate, dorsal or volar mini-plate, screw or Kirschner-wire was applied to ensure the stability of fixation, and maximally protect soft tissues like tendons, ligaments and neurovascular bundles, counting on the "stuffing-squeezing" effects after reduction or reconstruction of the articular surface. Situation of the wound and soft tissue were mainly checked in the first 2 weeks, and in the 3rd month post-operatively, fracture reduction and internal fixation were evaluated by radiographic methods like X-ray and CT scan. When 12 months post-operatively, not only radiographic follow-up such as fracture reduction, internal fixation and osteoarthritis were taken, but also some other evaluation, such as pain of wrist, rotation range of forearm, grip strength, and function of wrist according to DASH scores. Results: All of the 12 cases were followed up for at least 1 year. The wound healed well in all cases 2 weeks post-operatively, and no soft tissue infections, necrosis or neurovascular complications occurred. All fractures healed and no loss of reduction occurred 3 months post-operatively. Internal fixations were at good condition except in 2 cases, whose Kirschner-wire had been removed 2.5 and 2.8 months after the operation due to loosening and partly backing out on dorsal side. When followed up at 12 months post-operatively, one from these 2 patients suffered from a mild pain of wrist, and grip strength together with the function of the affected wrist dramatic declined when compared to the unaffected side. With the help of radiograph, local collapse on the articular surface was found, which meant to be traumatic arthritis. There were no pain in the rest 11 cases, and flexion-extension range of the wrist, rotation range of forearm and grip strength of the affected side recovered to over 80% of the unaffected side, with a DASH score was from 7 to 15 points(average 11.9 points)below 15 points. Conclusions: Traditional volar plates can not be used for extreme distal radial fractures. It may be an effective way to treat extreme distal radial fractures with compound internal fixation on the basis of morphological feature of fractures and the situation of soft tissue because of vivid of the fixation, reducing damage of soft tissue and early functional training.

Analysis of soft-tissue complications of volar plate fixation for managing distal radius fractures and clinical effect while preserving pronator quadratus.

The aim of the study was to analysis soft-tissue complications of volar plate fixation and it's prevention strategies along with exploring clinical effects of preserving pronator quadratus (PQ) muscle. From February 2011 to February 2013, sixty-five patients with distal radius fracture underwent open reduction and internal fixation with the volar locking palmar plates. The group with preserving PQ involved 30 patients and group with PQ repair involved 35 patients. Surgeons must took great care of not -letting drill pierce dorsal cortical bone rapidly and dorsal carpal tangential fluoroscopy was also taken in addition to lateral fluoroscopy to get accurate screw length. Volar plate must be placed not go beyond the watershed region of distal radius. The wrist pain, forearm range of motion, grip strength, wrist functional recovery score, X-ray and CT imaging were followed-up after surgery. Two groups were compared for Clinical efficacy. The minimum follow-up for the whole cohort was one year. The relevant post operative data were collected after 2 weeks, 6 weeks, 3 and 12 month respectively. Fractures healing after postoperative 3 months are significant in X -ray and CT imaging. Fixation position and stability were good, but each group had one case with a screw piercing the dorsal cortical. The -differences between the two groups were significant regarding the wrist pain, forearm range of motion, grip and strength at 2 and 6 weeks after operation, but not significant at 3 and 12 month after operation. The differences between the two groups were also significant regarding wrist functional scores at 6 weeks, but not significant at 3 and 12 month after operation. Drilling the dorsal cortical bone gently and accurate screws length can avoid extensor tendon injury. -Dorsal carpal tangential fluoroscopy is a useful supplement for accurate screws length besides lateral fluoroscopy. Volar plate's position not go beyond the watershed region of distal radius is the key factor in reducing the flexor tendon injury and preservation of the PQ muscle can also prevent the flexor tendon -injury, yield better early wrist function and shorten rehabilitation time.

Altered dynamics of ubiquitin hybrid proteins during tumor cell apoptosis.

The ubiquitin hybrid genes Uba80 and Uba52 encode ubiquitin (Ub), which is fused to the ribosomal proteins S27a (RPS27a) and L40 (RPL40), respectively. Here, we show that these genes are preferentially over-expressed during hepatoma cell apoptosis. Experiments using the tet-inducible transgenic system revealed that over-expression of the ubiquitin hybrid genes sensitized the cells to apoptosis. Further analysis suggested that Ub, and not RPS27a or RPL40, was associated with apoptotic cell death. Cleavage-resistant mutation analysis revealed that the N-terminal portion and the last two amino acids (GG) of Ub are critical for cleavage at the junction between the two protein moieties. An apoptogenic stimulus enhances the nuclear targeting and aggregation of Ub in the nucleus, resulting in histone H2A deubiquitylation followed by abnormal ubiquitylation of the nuclear envelope and the lamina. These events accompany the apoptotic nuclear morphology in the late stage of apoptosis. Each fused RP is localized in the nucleoli. These results suggest a role for Ub hybrid proteins in the altered nuclear dynamics of Ub during tumor cell apoptosis induced by apoptogenic stimuli.

The fluxes of CO2 from grazed and fenced temperate steppe during two drought years on the Inner Mongolia Plateau, China.

The CO(2) flux was measured by the eddy covariance method on a temperate Leymus chinensis steppe over a period of 17 months spanning two consecutive growing seasons. The amount of precipitation was nearly normal, but it was low in the early and high in the late growing period in 2006. In the 2007 growing season, the amount of precipitation was about 45% less than the multi-year average and more evenly distributed. Comparisons were made between a moderately grazed site and a 28-year-old fenced site. The maximum instantaneous CO(2) release and uptake rates were 0.12 (May) and -0.11mg CO(2)m(-2)s(-1) (July) at the fenced site, and 0.11 and -0.16mg CO(2)m(-2)s(-1) (both in July) at the grazed site. In both growing seasons, the grazed site always had a higher daily uptake rate or lower release rate than the fenced site. The grazed site was a CO(2) sink during the growing season of 2007 and a CO(2) source in the growing season of 2006, whereas the fenced site was a CO(2) source in both seasons. Lower precipitation decreased CO(2) loss during the growing season more in the grazed site than in the fenced site, mainly because of depression of total ecosystem respiration (R(e)) in the former and stimulation in the latter. During the dormant season (from October to April), the fenced and grazed sites released 60.0 and 32.4g of C per m(2), respectively. Path analysis showed that temperature had the greatest effect on daily variation of ecosystem CO(2) exchange during the growing seasons at the two study sites. The results suggest that decrease of precipitation and/or increase of temperature will likely promote C loss from L. chinensis steppes, whether fenced or grazed, and that a grazed site is more sensitive.

The characteristics and clinical significance of plantar pressure distribution in patients with diabetic toe deformity: a dynamic plantar pressure analysis.

This study evaluated plantar pressure distribution and its clinical significance in patients with diabetic foot toe deformities. Patients with diabetic claw or hammer toe deformities (patient group; n = 30) and healthy subjects without toe deformities (control group; n = 30) were recruited into the study. Plantar pressures in different regions of the foot were measured using the F-scan(®) in-shoe plantar pressure dynamic analysis system. Peak pressures in the hallux and first to fifth metatarsal heads were significantly higher in the patient group compared with the control group. In the midfoot there was no significant difference between the two groups. Hindfoot peak plantar pressures were significantly lower in the patient group compared with the control group. The results indicated that toe deformities in patients with diabetes increased forefoot plantar pressures to abnormally high levels. If plantar pressure is regularly monitored in patients with diabetic foot, toe deformities might be detected earlier and ulceration prevented.

[Clinical application of the medial multiplex flap pedicled with the posterior tibial vessel].

OBJECTIVE: To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. METHODS: Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm x 5.0 cm to 4.5 cm x 11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm x 8 cm to 12 cm x 25 cm. RESULTS: All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. CONCLUSION: The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.

[Repair of humeral fracture and non-union with transfer of vascularized periosteal flap].

OBJECTIVE: To study the results of humeral fracture and non-union repaired by vascularized periosteal flap transfer. METHODS: The clinical data of humeral fracture and non-union in 23 cases were analysized retrospectively since 1995. Among them, minuted or several segmental fracture in 12 cases, non-union in 11 cases, and following injury of radial nerve in 7 cases. The operative method was open reduction, inner or external fixation with vascularized periosteal flap transfer. RESULTS: The period of follow-up was 6 months to 2 years. The repair result of all patients was excellent and good, but elbow joint motion in 2 cases of non-union was not satisfactory. The periosteal flap had good osteogenic ability. The period of bone union was 2 to 5 months in humeral fracture and non-union. And function of radial nerve was recovery. CONCLUSION: Transfer of distal humeral periosteal flap pedicled with radial collateral vessels is a better method for humeral fracture and non-union.

[The applied anatomy of transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery].

OBJECTIVE: To investigate the anatomic basis for transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery to repair the defect of the 3rd or 4th and 5th metacarpal bone head. METHODS: In 30 adult cadaveric upper limbs, the branches and constitutions of the dorsal carpal arterial networks were observed. RESULTS: The dorsal carpal arterial networks were consisted of the dorsal carpal branches of ulnar and radial arteries, the terminal branches of posterior interosseous artery and the dorsal carpal branch of anterior interosseous artery, and then the 2nd, 3rd, 4th dorsal metacarpal branches were originated from the networks. The dorsal metacarpal branches were anastomosed with the deep branches of deep palmar arch to constitute the dorsal metacarpal artery. CONCLUSION: Transposition of the distal dorsal ulna bone flap pedicled with the 3rd, 4th dorsal metacarpal arteries can be used in repairing the defect of 3rd, 4th and 5th metacarpal bone head.

[Transposing the great trochanter bone flap pedicaled with the deep branch of the medial circumflex artery in repair of necrotic femoral head].

The transposition of the greater trochanter bone flap pedicled with the deep branch of the medial circumflex artery was designed as a new therapeutic method for the treatment of early ischemic necrosis of the femoral head in adults. Bone flap was successfully used in 15 limbs of 13 patients. Applied anatomy, operative indications and procedure of the bone flap was introduced.

[Experimental study on cellular electrophysiology of Viscum coloratum flavonoid in treating tachyarrhythmias].

Viscum Coloratum Flavonoid (VCF) is one of the dihydro-flavonoids isolated and purified from the stem and leaf of Viscum Coloratum. It was proved both experimentally and clinically to have the effects of anti-tachyarrhythmias. The mechanism of this effect, however, was unclear. In this study, the effects of the drug on the fast response action potentials (FAP) in canine Purkinje fibers and guinea pig ventricular myocardial cells were investigated by glass-microelectrode technique. The results indicated that 0.1 mg/ml VCF accelerated the repolarizations of 2nd and 3rd phase of FAP, shortened action potential duration (APD), and slightly shortened effective refractory period (ERP) (canine) or unchanged (guinea pig). delta ERP/delta APD ratio was increased, therefore, ERP was relatively prolonged. All effects appeared after using the drug for 2 minutes, reached stable status after 10 minutes, and disappeared after washing off the drug for 15 minutes. It was suggested that VCF was the drug which exerted effects rapidly, maintained effects shortly, and had effects reversibly. The cellular electrophysiologic mechanisms of VCF on anti-tachyarrhythmias should be attributed to prolong the ERP relatively and abolish the reentry. This drug is particularly applicable to the tachyarrhythmias due to reentry.

[Effects of Viscum coloratum flavonoids on fast response action potentials of hearts].

The effects of the total flavonoids of Viscum coloratum (VCF) on the fast response action potentials (FAP) of canine Purkinje fibers and guinea pig ventricular papillary muscles were studied by glass-microelectrode technique. The effects of VCF on the ionic currents through cellular membrane were analysed with selective ion blockers (CsCl, verapamil, and TEA+), respectively. VCF (100 micrograms.ml-1) accelerated the repolarization of FAP and increased delta ERP/delta APD ratio, which were related to decreasing Isi and increasing Ix. It was suggested that the anti-tachyarrhythmic mechanism of VCF was attributed to prolonging ERP relatively and to abolishing reentrant excitation.

Assessment of Nd:YAG laser via metal cap and sapphire tip delivery system. An experimental and clinical investigation.

Sixteen segments of normal human aorta were irradiated by Nd:YAG laser beam delivered via domestically made metal cap and sapphire tip fibre systems. It was found that the metal tip fibre caused more target tissue damage and adhesion than the sapphire tip fibre. The sapphire tip fibre caused an ablation crater with a smoother edge, less carbonization layer and smaller thermal necrotic zone than the metal tip did. The metal cap and sapphire tip fibre were applied to 2 cases of iliac artery stenosis and 5 cases of coronary stenosis, all showing an immediate ablation.

[Application of antero-lateral femoral free skin flap in the repair of hand injuries].

From July 1988 to Jan 1990, 7 cases of hand injuries with skin defects have been reconstructed using anterolateral femoral free flaps. Reconstruction was successful. The anterolateral femoral flap was suitable for the skin defect in the dorsum and wrist of the hand. In this paper, advantages and disadvantages, management of variations in flap vascular pedicle, delayed primary transplantation of the free flap were discussed.

[Changes in the deformability of erythrocytes and 2,3-DPG in coronary artery stenosis].

The changes of deformability of RBC and 2,3-DPG in RBC in patients with coronary artery stenosis and the influence of some factors on them were studied. The results showed that: (1) the deformability index was inversely proportional to the degree of lesions of coronary vessels (P less than 0.01); (2) the 2,3-DPG was inversely proportional to the degree of lesions of coronary vessels (P less than 0.01); (3) there was a significant decrease in deformability index after using contrast medium; (4) Saliva may increase deformability of RBC and 2,3-DPG; (5) Nifedipine may increase deformability of RBC. These results showed: (1) the possible existence of microcirculatory dysfunction in coronary artery disease and in parallel of impaired deformability of RBC; (2) the possibility of normalization of the decreased deformability of 2,3-DPG in RBC by Salvia; (3) the possibility of increase of velocity of blood flow in microcirculation in coronary artery disease by Salvia.

[Extent of treatment of early carcinoma of the uterine cervix--local treatment of 198 stage I patients].

The extent of treatment of early carcinoma of the uterine cervix is still controversial. 198 patients with Stage I carcinoma of the uterine cervix who received local treatment for the primary tumor are summarized, 107 with early invasive carcinoma and 91 with invasive cancer. Microscopic examination showed that 62.2% of the patients had lesions less than 1 cm in diameter. In 82.8% of the patients, the invasion was confined to the cervical ring by pathological examination. The accuracy of multiple biopsies was 79.3%. Of 198 patients, 124 received intracavitary radiotherapy only, 73 hysterectomy and 1 cone resection of the uterine cervix. All of them were followed for 5 years or more. The 5-year survival rate was 98% and none of them died of cancer. The author considers that the extent of treatment of early invasive carcinoma can be localized. For localized invasive carcinoma (stage Ib) with lesion less than 1 cm and extent of invasion less than half of the uterine cervix ring as confirmed by biopsy, the treatment of regional lymph nodes can be omitted. Multiple biopsies may replace diagnostic cone resection in most instances.

[Pyometra and radiotherapy of cancer of the uterine cervix--analysis of 282 patients].

From March 1958 to December 1980, 11284 patients with cancer of uterine cervix were treated with radiotherapy in our hospital. Among them, 282 were complicated with pyometra with an incidence of 2.5%. The incidence of pyometra was higher in patients treated by combined intracavitary with external irradiation than by other radiation methods. 74.1% was diagnosed during the manipulation of intracavitary therapy. Escherichia coli comprised 46.5% by culture. The 5 year survival rate was lower in patients with pyometra than without it. The patients who had a temperature over 38 degrees C and uterus enlarged to more than 6 weeks of pregnancy had a bad prognosis. It was even worse for patients whose pyometra did not heal or developed at the end of radiation. Endometrial biopsy was done in 36 patients with pyometra and cancer cells were seen in 55.6% of them. Endometrial biopsy positive rate reached to 77.8% in the patients whose pyometra was not cured or occurred after radiotherapy. This is the main reason of the poor prognosis. The authors believe that endometrial and cervical biopsy should be taken for cancer of uterine cervix complicated with pyometra; for biopsy positive patients during the treatment, the intracavitary dose should be increased; for positive patients after radiotherapy, operation is strongly indicated.