[New strategy for decision making of Pilon fracture].

OBJECTIVE: To study the guidance of four column theory in decision making of Pilon fractures and its result. METHODS: Ninety-one cases of Pilon fractures classified by four column method and treated by open reduction internal fixation (ORIF) were reviewed from March 2005 to June 2009. Four column classification:lateral column of 67 cases were involved, posterior column of 34 cases were involved, medial column of 34 cases were involved and anterior column of 34 cases were involved. Among all the 94 fractures, single column of 20 fractures were involved, 2 columns of 49 fractures were involved, 3 columns of 15 fractures were involved and all of 4 columns of 10 fractures were involved. RESULTS: Eighty-nine cases had been followed up. The average follow-up time was 16.2 months ranging between 6.0 and 39.0 months. The average healing time was 3.7 months ranging from 3.0 to 5.0 months. Reduction of 91% reviewed Pilon cases were good or acceptable according to Burwell and Charley's radiology evaluation system. Ankle function of 87.6% cases were excellent or good according to AOFAS evaluation system. CONCLUSION: As a simple and comprehensive classification, four column classification can contribute to reasonable operating decision making and good prognosis of Pilon fracture.

[Favorable effect of chitosan sustained-release FK506 incorporated conduits on axonal regeneration in rat sciatic nerve].

OBJECTIVE: To investigate the efficacy of 3 mm gap bridging repairing neurotmesis with chitosan sustained-release FK506 incorporated conduits. METHODS: Forty-five adult male SD rats were divided randomly into 3 groups. The rats were received a neurotomy to bilateral sciatic nerve and subsequently reconnected with regeneration chambers. The bridging conduits of group A, B and C were made of silicon tube, chitosan and chitosan sustained-release FK506 incorporated respectively. Conduits absorption and surrounding tissue cicatrization were observed at 6, 8 and 12 weeks after neurotomy. The nerve regeneration and functional recovery were evaluated by electrophysiology, histological changes, morphometric analysis, and weighing of gastrocnemius muscles. RESULTS: The silicon tubes of group A adhered severely with surrounding tissue. Bridging grafts of group B and C adhered relatively slightly and could be stripped easily from surrounding tissue. The regeneration chambers still existed fully at 6 weeks and began to be degraded at 8 weeks after neurotomy. The bridging grafts of group B and C were disintegrated at 12 weeks and the continuity of sciatic nerve was established without obvious adhesion with surrounding tissue. The statistical evaluation for nerve regeneration demonstrated that rats of group C showed the best results. Although rats of group B and A were found to be the second and the third respectively, there is no significant difference between them. CONCLUSION: Remaining 3 mm gap bridging repairing rat sciatic nerve with chitosan sustained-release FK506 incorporated conduits, which stabilize for more than 2 months before degradation in vivo, can significantly promote nerve regeneration and facilitate function recovery without adverse effects.

[Arthroscopic assisted diagnosis and treatment of knee extension limitation].

OBJECTIVE: To figure out the incidence and etiology of knee extension limitation and then to find out the proper methods of arthroscopic assisted diagnosis and treatment. METHODS: We reviewed 303 cases of arthroscopic assisted operation from January to October 2003, 95 cases of which suffered from knee extension limitation before operation, including 54 male and 41female and the mean age was 36.2 years old. The direct reasons of knee extension limitation were identified by routine arthroscopic examination and operations were carried out according to results of the examination. RESULTS: Incidence of knee extension limitation in this group of patients was 31.4%. Trauma, mainly meniscus and ligament injury accounted for 67.4%, which was the most common reason of knee extension limitation. Acute or chronic arthritis like degenerative arthritis, non-specific synovitis, synovial chondromatosis, rheumatoid arthritis, pigmented villonodular synovitis, gouty arthritis and acute pyogenic arthritis formed another common reason. The follow-up period ranged from 3 to 20 months, average 13.3 months. 82 cases gained full extension immediately after operation, 9 cases gained full extension after 3 weeks rehabilitation post-operation, 4 cases did not gain full extension 1 year after operation, recurrence was observed in 4 cases. CONCLUSIONS: Arthroscopy is the best method for diagnosis of knee extension limitation at present. Satisfactory results can be expected after early arthroscopic assisted treatment.

[Effect of FK506 on axonal regeneration of rat sciatic nerve in regeneration chamber: an experimental study].

OBJECTIVE: To evaluate the effect of FK506 on expediting nerve regeneration of rat Sciatic Nerve in regeneration chamber and to look for a proper way of its administration to treat peripheral nerve injuries. METHODS: Sixty adult male SD rats which were randamizely divided into 3 groups received a neurotomy to bilateral sciatic nerves, then we reconnected the broken nerves with silicon tube to make regeneration chambers. The regeneration chambers were filled with either normal saline (group A and group B) or 1 microg/ml FK506 (group C). The rats of group B also received daily injection of FK506 (1 mg/kg) at the back of the neck for 14 days. Local immunoreaction, weight of fresh gastrocnemius muscles, histological changes and electrophysiology were observed at designate time after neurotomy. RESULTS: At 6 weeks postoperation the extent of local lymphocytes infiltration in group B and C were less than that in group A, all results in group B were much better than that of group A. Results of group C were better than that of group A without significance. CONCLUSIONS: (1) Systemic administration of FK506 (1 mg/kg) showed neuroprotective and neurotrophic effect, which can facilitate nerve regeneration and promote functional recovery. (2) Local administration of FK506 (1 microg/ml) showed some extent of neuroprotective effect at early period of nerve injury, but the neurotrophic function is uncertain and still needs to be studied further.

[An experimental study of the neuroprotective effect of FK506 on acute spinal cord injury in dogs].

OBJECTIVE: To explore the neuroprotective effect of FK506 on acute spinal cord injury in dogs. METHODS: Acute spinal cord injury model was made with the Allen technique. Animals were randomly divided into 3 groups. Group A (n = 8) was the control group and received operation but no therapy, while group B and C (n = 8) received a single dose of FK506 (0.18 mg/kg and 0.3 mg/kg, respectively) administered with an arterial duct 2 h after spinal cord injury (SCI). Spine MRI, neurological function, histopathological examination of injured spinal cord and immunohistochemical examination of expression of NF(200) in neurons and GFAP in astrocytes were assessed at certain time after injury. RESULTS: Neurological function score of group C and B was better than that of group A (P < 0.05), with significance between group C and A, while no significance between group B and A statistically. The signal scope of spinal cord injury on MRI in group C was the smallest among all the groups, and the signal scope in group B was smaller than that in group A, which was directively associated with the neurological outcome. The expression of NF and GFAP was significantly higher in group C than in group A (P < 0.05), but without statistical significance between group B and A. CONCLUSION: Local administration of FK506 (0.3 mg/kg) possesses neuroprotective effect on acute spinal cord injury, which can improve neurological function recovery and attenuate secondary spinal cord injury. Local administration of FK506 possesses a dosage-effect relation.

The correlation of plasma omentin-1 with insulin resistance in non-obese polycystic ovary syndrome.

OBJECTIVES: Aberrant circulating adipokines are considered to be related to the pathological mechanism of polycystic ovary syndrome (PCOS). This study aims to evaluate the relationship between plasma omentin-1 levels, metabolic and hormonal parameters in the setting of non-obese Chinese women with PCOS. MATERIAL AND METHODS: This was a case-controlled, cross-sectional study of 153 non-obese (BMI<25kg/m(2)) PCOS and 114 age-matched healthy non-obese control individuals. Levels of plasma omentin-1, fasting blood glucose, insulin and sexual hormones and ovary volume were analyzed in all subjects. RESULTS: Plasma omentin-1 levels of non-obese PCOS individuals were significantly lower than in healthy non-obese controls. Body Mass Index (BMI), homeostasis model of assessment for insulin resistance index (HOMA-IR), levels of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), LH/FSH ratio and ovary volume (OV) were significantly higher in subjects with PCOS than controls. In the HOMA-IR stratified subgroups, PCOS individuals with insulin resistance had lower omentin-1 than those without insulin resistance after BMI adjustment. Omentin-1 was negatively correlated with BMI, HOMA-IR and fasting insulin. Multiple linear regressions revealed that BMI contributed to omentin-1 levels. Ovary volume was negatively correlated to HOMA-IR but had no correlation with omentin-1. CONCLUSIONS: Plasma omentin-1 concentrations were decreased in the non-obese PCOS group. Insulin resistance could further decrease plasma omentin-1 in non-obese individuals with PCOS independent of BMI status.

A Meta-analysis Reveals S-1-based Chemotherapy Improves the Survival of Patients With Advanced Gastric Cancer.

The aim of this study was to compare the efficacy and safety of S-1-based therapy versus non-S-1-based therapy in advanced gastric cancer (AGC) patients.Eligible studies stratifying objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) in AGC patients were identified from Embase, Pubmed, Cochrane Library, and China National Knowledge Infrastructure databases. The STATA package (version 11.0) was used to pool the data from the eligible studies.Fifteen studies with 2973 AGC cases, of which 1497 (50.4%) received S-1-based therapy and 1476 (49.6%) received non-S-1-based therapy, were identified in the meta-analysis. AGC patients who had received S-1-based therapy had a higher median OS, median PFS, and ORR than those who had received 5-fluorouracil (FU)-based therapy (OS: hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.98, P = 0.015; PFS: HR 0.88, 95% CI 0.80-0.98, P = 0.016; ORR: OR 1.25, 95% CI 1.08-1.45, P = 0.003, respectively). S-1-based therapy had similar efficacy to capecitabine-based therapy in terms of median OS (HR 1.14, 95% CI 0.91-1.41, P = 0.253), median PFS (HR 1.01, 95% CI 0.82-1.25, P = 0.927), and ORR (OR 0.84, 95% CI 0.63-1.12, P = 0.226). Subgroup analysis for grade 3 to 4 toxicity showed higher incidence of neutropenia (relative risk [RR] = 0.827, P = 0.006), nausea (RR = 0.808, P = 0.040), and lower diarrhea (RR = 1.716, P = 0.012) in 5-FU-based arm, and higher diarrhea (RR = 0.386, P = 0.007) in capecitabine-based arm.S-1-based chemotherapy is favorable to AGC patients with better clinical benefit than 5-FU-based chemotherapy and with equivalent antitumor compare with capecitabine-based therapy.

Pilon fractures: a new classification and therapeutic strategies.

BACKGROUND: Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result. METHODS: One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved. RESULTS: One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley's Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system. CONCLUSION: As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.