Management and classification of the fracture of lateral process of talus:An overview and literature update

Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.

A comparison of the effect of alendronate and You-Gui-Wan on osteoporosis in female rats with kidney-yang deficiency

Background:In traditional Chinese medicine,You-Gui-Wan(YGW)is typically used to treat osteoporosis associated with kidney-yang deficiency.However,there have been few mechanistic studies on the effectiveness of kidney-yang deficiency-type osteoporosis with YGW.To further clarify the role of YGW in the effect of osteoporosis with kidney-yang deficiency,the study analyzed the therapeutic advantages of YGW by comparing the therapeutic effects of YGW and alendronate(ALN)on osteoporosis with kidney-yang deficiency.Methods:SPF female SD rats were randomly divided into control,osteoporosis,osteoporosis with kidney-yang deficiency,osteoporosis with kidney-yang deficiency+YGW and osteoporosis with kidney-yang deficiency+ALN groups.Except for the control group,osteoporosis was induced by the removal of bilateral ovaries.After 12 weeks,rats with osteoporosis in the kidney-yang deficiency group had kidney-yang deficiency syndrome triggered by hydrocortisone for 14 days.Rats were treated with YGW or ALN for 12 weeks.The weights of rats were recorded.Hematoxylin-eosin staining staining was used to observe pathological changes in bone trabeculae,liver,spleen,and kidneys of rats.Depletion of the growth plate cartilage of rats in different groups was observed by safranine-O staining.The expression of osteoclast key indices(ACP)and osteoblast key indices(ALP)in the bone tissue of rats in the different groups was observed by immunohistochemical staining.The expression of bone resorption-related indicators(TRAP and NXT-1),bone formation-related indicators(BALP,BGP,and P1NP),and major indicators of kidney-yang deficiency(ACTH,T3,T4,cAMP,and cGMP)were observed using an ELISA detection kit.The expression levels of the main indices of liver function(ALT and AST)were detected in different groups.Results:The differences between the osteoporosis with kidney-yang deficiency group and osteoporosis group were that the weight of rats and the expression of ACTH,T3,T4,and cAMP decreased significantly,and the expression of cGMP increased in the osteoporosis with kidney-yang deficiency group.Moreover,both YGW and ALN effectively improved the symptoms of osteoporosis,including the injury of bone trabeculae and growth plates,as well as the expression of bone metabolism-related indicators.However,unlike ALN,YGW simultaneously ameliorated the expression of key indicators of kidney-yang deficiency and prevented weight loss in rats.In addition,YGW caused no obvious damage to the liver,spleen,or kidney,whereas ALN led to liver cirrhosis.Conclusion:The results reveal that YGW plays a crucial part in osteoporosis with kidney-yang deficiency,increases bone mineral density,and improves bone metabolism indicators,and is safe and efficient for the efficacy of osteoporosis with kidney-yang deficiency.YGW might have a better therapeutic effect on osteoporosis in patients with kidney-yang deficiency.Therefore,alendronate should be used cautiously in patients with osteoporosis and poor liver function.

Alterations in gut microbiota are related to metabolite profiles in spinal cord injury

Studies have shown that gut microbiota metabolites can enter the central nervous system via the blood-spinal cord barrier and cause neuroinflammation, thus constituting secondary injury after spinal cord injury. To investigate the correlation between gut microbiota and metabolites and the possible mechanism underlying the effects of gut microbiota on secondary injury after spinal cord injury, in this study, we established mouse models of T8–T10 traumatic spinal cord injury. We used 16 S rRNA gene amplicon sequencing and metabolomics to reveal the changes in gut microbiota and metabolites in fecal samples from the mouse model. Results showed a severe gut microbiota disturbance after spinal cord injury, which included marked increases in pro-inflammatory bacteria, such as Shigella, Bacteroides, Rikenella, Staphylococcus, and Mucispirillum and decreases in anti-inflammatory bacteria, such as Lactobacillus, Allobaculum, and Sutterella. Meanwhile, we identified 27 metabolites that decreased and 320 metabolites that increased in the injured spinal cord. Combined with pathway enrichment analysis, five markedly differential amino acids(L-leucine, L-methionine, L-phenylalanine, L-isoleucine and L-valine) were screened out, which play a pivotal role in activating oxidative stress and inflammatory responses following spinal cord injury. Integrated correlation analysis indicated that the alteration of gut microbiota was related to the differences in amino acids, which suggests that disturbances in gut microbiota might participate in the secondary injury through the accumulation of partial metabolites that activate oxidative stress and inflammatory responses. Findings from this study provide a new theoretical basis for improving the secondary injury after spinal cord injury through fecal microbial transplantation.

Accessory navicular in children

Accessory navicular(AN)is a developmental variation of the secondary ossification center of the navicular tuberosity.Ten percent of patients with AN will have pain symptoms that affect walking and life.As the AN changes the position of the posterior tibial tendon insertion,children with AN often have posterior tibial tendon function insufficiency and flexible flat foot.Surgical treatment is often required after failure of conservative treatment.This article reviewed the etiology,clinical manifestations,complications,and treatment methods of AN.

Fibula allograft transplantation combined with locking plate for treatment of recurrent monostotic fibular fibrous dysplasia:A case report

BACKGROUND Fibrous dysplasia is a congenital disorder in which normal bone is replaced by fibro-osseous tissue or irregular trabeculae of woven bone intermixed with mature collagenous tissue.A single or multiple bones are affected.This rare bone disorder has three clinical patterns including monostotic,polyostotic,and that associated with McCune-Albright syndrome.Most studies report primary fibrous dysplasia.However,a few cases of recurrent monostotic fibular fibrous dysplasia have been reported.Here,we report a therapeutic strategy for recurrent fibular fibrous dysplasia.CASE SUMMARY A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo.He had no history of present or past illness.Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment.Tumor tissue in the fibular bone marrow cavity was removed by curettage,and rapid intraoperative pathological examination suggested fibular fibrous dysplasia.An allograft was implanted into the fibular medullary cavity.However,he was readmitted with clinical symptoms including persistent pain,abnormal gait,and local swelling at the age of 6 years.He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination.He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws.Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up.CONCLUSION Radical resection of fibrous dysplasia and longus fibula allograft combined with internal fixation for reconstruction are suitable for the treatment of recurrent monostotic fibular fibrous dysplasia.

Surgery for fibrous dysplasia associated with aneurysmal-bone-cystlike changes in right proximal femur:A case report

BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.

Bridging peripheral nerves using a deacetyl chitin conduit combined with short-term electrical stimulation

Previous studies have demonstrated that deacetyl chitin conduit nerve bridging or electrical stimulation can effectively promote the regeneration of the injured peripheral nerve. We hypoth-esized that the combination of these two approaches could result in enhanced regeneration. Rats with right sciatic nerve injury were subjected to deacetyl chitin conduit bridging combined with electrical stimulation （0.1 ms, 3 V, 20 Hz, for 1 hour）. At 6 and 12 weeks after treatment, nerve conduction velocity, myelinated axon number, ifber diameter, axon diameter and the thickness of the myelin sheath in the stimulation group were better than in the non-stimulation group. The results indicate that deacetyl chitin conduit bridging combined with temporary electrical stimu-lation can promote peripheral nerve repair.

Exosomes derived from stem cells as an emerging therapeutic strategy for intervertebral disc degeneration

Intervertebral disc(IVD)degenerative diseases are a common problem in the world,and they cause substantial social and economic burdens for people.The current methods for treating IVD degenerative diseases mainly include surgery and conservative treatment,which cannot fundamentally restore the normal structure of the disc.With continuous research on the mechanism of degeneration and the development of regenerative medicine,rapid progress has been made in the field of regenerative medicine regarding the use of stem cell-derived exosomes,which are active biological substances used in intercellular communication,because they show a strong effect in promoting tissue regeneration.The study of exosomes in the field of IVD degeneration has just begun,and many surprising achievements have been made.This paper mainly reviews the biological characteristics of exosomes and highlights the current status of exosomes in the field of IVD degeneration,as well as future developments regarding exosomes.

Neuroprotective effect of ischemic postconditioning on sciatic nerve transection

Ischemic preconditioning or postconditioning has been shown to have neuroprotective effect on cerebral ischemia, but it has not been studied in peripheral nerve injury. In this study, a rat model of sciatic nerve transection was established, and subjected to three cycles of ischemia for 10 minutes ＋ reperfusion for 10 minutes, once a day. After ischemic postconditioning, serum insulin-like growth factor 1 expression increased; sciatic nerve Schwann cell myelination increased; sensory function and motor function were restored. These findings indicate that ischemic postconditioning can effectively protect injured sciatic nerve. The protective effect is possibly associated with upregulation of insulin-like growth factor 1.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

Inhibition of immune checkpoints prevents injury-induced heterotopic ossification

Heterotopic ossification(HO),true bone formation in soft tissue,is closely associated with abnormal injury/immune responses.We hypothesized that a key underlying mechanism of HO might be injury-induced dysregulation of immune checkpoint proteins(ICs).We found that the earliest stages of HO are characterized by enhanced infiltration of polarized macrophages into sites of minor injuries in an animal model of HO.The non-specific immune suppressants,Rapamycin and Ebselen,prevented HO providing evidence of the central role of the immune responses.We examined the expression pattern of ICs and found that they are dysregulated in HO lesions.More importantly,loss of function of inhibitory ICs(including PD1,PD-L1,and CD152)markedly inhibited HO,whereas loss of function of stimulatory ICs(including CD40L and OX-40L)facilitated HO.These findings suggest that IC inhibitors may provide a therapeutic approach to prevent or limit the extent of HO.

Early complications of preoperative external traction fixation in the staged treatment of tibial fractures:A series of 402 cases

BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.AIM To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.METHODS A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study.Data regarding the demographic information,Tscherne soft tissue injury,fracture site,entry point placement,and duration of traction were recorded.Procedure-related complications such as movement and sensation disorder,vessel injury,discharge,infection,loosening,and iatrogenic fractures were analyzed.RESULTS The mean patient age was 42.5(18-71)years,and the mean duration of traction was 7.5(0-26)d.In total,19(4.7%)patients presented with procedure-related complications,including technique-associated complications in 6 patients and nursing-associated complications in 13.Differences in the incidence of complications with respect to sex,affected side,soft tissue injury classification,and fracture sites were not observed.However,the number of complications due to hammer insertion was significantly reduced than those due to drill insertions(2.9%vs 7.4%).CONCLUSION We found a low incidence of early complications related to the fixation.Furthermore,the complications were not significantly associated with the severity of the soft tissue injury and fracture site.Although relatively rough and more likely to cause pain,the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.

Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis

BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.

Quadrilateral plate fractures of the acetabulum:Classification,approach,implant therapy and related research progress

The quadrilateral plate(QP)is an essential structure of the inner wall of the acetabulum,an important weight-bearing joint of the human body,which is often involved in acetabular fractures.The operative exposure,reduction and fixation of QP fractures have always been the difficulties in orthopedics due to the special morphological structure and anatomical features of the QP.Fortunately,there have been many effective methods and instruments developed for QP exposure,reduction and fixation by virtue of the combined efforts of numerous orthopedists.At the same time,each method presents with its own advantages and disadvantages,resulting in different prognoses.It is necessary to have a thorough understanding of the anatomy,radiology and fixation techniques of the QP in terms of patient prognosis optimization.In this paper,the anatomical features,definition and classification of QP,operative approach selection,implant internal fixation methods and efficacy were reviewed.

Effects of silent information regulator of transcription 2 on inflammatory response and bone destruction in cartilage tissue of osteoarthritis

Objective:To study the effects of silent information regulator of transcription 2 (SIRT2) on inflammatory response and bone destruction in cartilage tissue of osteoarthritis.Methods: A total of 200 patients who underwent knee replacement due to knee osteoarthritis in Kashgar Prefecture First People's Hospital between September 2014 and September 2017 were selected as the osteoarthritis (OA) group of the research, and 80 patients who underwent knee replacement or meniscus operation due to trauma in Kashgar Prefecture First People's Hospital during the same period were selected as the control group. Articular cartilage tissue was collected after surgery to measure the expression of SIRT2 and bone destruction-related apoptosis molecules as well as the levels of inflammatory response molecules and bone destruction-related collagen metabolism molecules.Results: SIRT2 and Bcl-2 mRNA expression as well as SOX9 and Col-II levels in articular cartilage tissue of OA group were significantly lower than those of control group whereas TNF-α, bFGF, NO, IP-10, CCL2, PAR-2,β-catenin, OPN and MMP13 levels as well as Fas, GRP78, ATF6 and Caspase-3 mRNA expression were significantly higher than those of control group;SIRT2 mRNA expression in articular cartilage tissue of OA group was positively correlated with Bcl-2 mRNA expression as well as SOX9 and Col-II levels, and negatively correlated with TNF-α, bFGF, NO, IP-10, CCL2, PAR-2,β-catenin, OPN and MMP13 levels as well as Fas, GRP78, ATF6 and Caspase-3 mRNA expression.Conclusion: The lowly expressed SIRT2 in cartilage of osteoarthritis can aggravate inflammatory response and bone destruction.

The sequential treatment of extensive mandibular ameloblastoma

Ameloblastoma is the most frequent odontogenic tumor of the jaw. If not treated, ameloblastoma can gain an enormous size and cause severe facial disfigurement and functional impairment. Here we report two patients afflicted with extensive mandibular ameloblastoma (sized in 23 cm × 18 cm × 17 cm and 15 cm × 12 cm × 10 cm, respectively). Both the patients received the same sequential treatment including radical tumor resection, simultaneous reconstruction with fibula free flap graft, vertical distraction osteogenesis on the fibula graft, placement of endosseous dental implants, and final pros-thodontic rehabilitation. It took about 15 months to finish the entire course of treatment. And after the four-year follow-up, neither soft tissue related, nor hard tissue related problems were observed. Satisfactory facial symmetry, chewing and speech functions of the patients were restored. So this sequential treatment for extensive mandibular ameloblastoma can obtain an excellent effect by the shortest time and the lowest economical cost. Furthermore, the series also can be used to reconstruct giant mandibular defects caused by different reasons.

Prophylaxis against venous thromboembolism in orthopedic surgery

静脉的 thromboembolism (VTE ) 作为深静脉血栓(DVT ) 和肺的栓塞(PE ) 被表明，代表死亡，残疾，和不快的一个重要原因。他们是各种各样的外科的过程的经常的复杂并发症。变老的人口和更严重地受伤的病人的幸存可以在损伤病人建议 thromboembolism 的增加的风险。在风险挑战医生扩展了人口的理解小心地检验风险因素让 VTE 识别能得益于预防的高风险的病人。基于证据的风险因素的精确知识在预言并且阻止手术后的 DVT 是重要的，并且能为 appropriatethromboprophylaxis 使用被合并到一个决定支持系统。在一张高风险的损伤人口的 DVT 预防的标准使用在下导致 DVT 的发生。VTE 的发生在亚洲是普通的。评估包括实验室测试， Doppler 测试和 phlebography。屏蔽 Doppler sonography 应该在所有非常受伤的病人上为监视被执行识别 DVT。D 暗淡是一个有用标记在损伤外科病人监视预防。开始预防的最佳的调子以前在 2hours 之间并且在外科以后的 10 个小时，而是 PE 的风险继续因为几 weeks.Thromboprophylaxis 为预防包括毕业压缩袜子和抗凝剂。抗凝剂包括 Warfarin，它属于维生素 K 对手， unfractionatedheparin，低分子的重量肝磷脂，因素 Xa 间接禁止者 Fondaparinux，和口头的 IIainhibitor Melagatran 和 ximelagatran。Recombinant 人的 solublethrombomodulin 是一个新、高度有效的 antithrombotic 代理人。在选择损伤病人的 venacaval 过滤器的预防放置可以减少 PE 的发生。为预防劣等的静脉 cava 过滤器插入的指示与多重损害，关上的头损害，骨盆的破裂，脊骨破裂，多重长骨头破裂，和出席谨慎包括延长固定。多重损伤的病人在为 DVT 的增加的风险，但是也在流血，和肝磷脂的使用的增加的风险可以被禁忌。连续压缩设备(SCD ) 是为 DVT 预防的一种选择。压缩设备向足够的 DVTprophylaxis 提供低失败率和没有设备相关的复杂并发症。固定是 VTE 的重要原因之一。走动的病人多半少些是远的发展迟钝，不是仅仅静脉的血栓的复杂并发症，而且挛缩，褥疮溃疡，或骨质疏松症(与它的联系疲劳破裂) ，以及肠或膀胱复杂并发症。

Apigenin accelerates lipopolysaccharide induced apoptosis in mesenchymal stem ceils through suppressing vitamin D receptor expression

Background Transplantation of mensenchymal stem cells （MSCs） has been proposed as a promising way for tissue engineering. However, the application of MSCs for transplantation will undergo apoptosis due to the extremely harsh microenvironment such as excessive inflammation. Apigenin （API） has been reported to protect cells against inflammatory damage and cell death by exhibiting anti-inflammatory and anti-oxidative capacity. Here we investigated the modulatory effects of API in lipopolysaccharide （LPS）-mediated inflammation and apoptosis of MSCs, and further defined the underlying mechanism. Methods Effects of different concentrations of API （0, 5, 10, 20, 40 and 80 IJmol/L） for 24 hours, and LPS （0, 0.5 and 5.0 pg/ml） for 6 hours and 24 hours on MSCs viability were assayed by MTT. Based on this, MSCs were pretreated with different concentrations of API （0-40μmol/L） at the indicated times （6, 12 and 24 hours） followed by exposure to 5μg/ml LPS for 24 hours. MTT, phase-contrast microscopy, annexinV/propidium iodide （PI） double stain flow cytometry （FCM） and Hoechst staining were applied to explore the effects of API on MSCs induced by 5 μg/ml LPS for 24 hours. In addition, reverse-transcription polymerase chain reaction （RT-PCR） was applied to detect the mRNA expression of pro-inflammatory factors including cyclooxygenase-2 （COX-2）, inducible nitric oxide synthase （iNOS）, nuclear factor-kappa B （NF-KB）, pro-apoptotic gene caspase-3, Bad, and anti-apoptotic gene Bcl-2. Moreover, AutoDock software was used to imitate the docking score of API and vitamin D receptor （VDR）. In parallel, Western blotting and RT-PCR were used to investigate protein and mRNA expression of VDR. Results MSCs stimulated with LPS 5 IJg/ml for 24 hours was used as a model of apoptosis induced by over inflammatory stimulus. API （0-40μmol/L） had non-toxic effect on MSCs; however, it could decrease mRNA expression of COX-2, iNOS and NF-KB at different time points in MSCs induced by LPS, except for API at the concentration of 5 μmol/L Results from phase-contrast microscopy, MTT, Hoechst staining and AnnexinV/PI double stain FCM demonstrated that with the increasing concentrations of API and extension of administrating time, significant morphological changes of MSCs occurred, viability of cells was strongly inhibited, and meanwhile, apoptosis of LPS-administrated MSCs was exacerbated, compared with LPS individual group. In addition, API promoted caspase-3, Bad mRNA expression and inhibited Bcl-2 mRNA expression in a time-dePendent and concentration-dependent manner. Further study found that pro-apoptosis effect of API was related to suppress VDR expression. Conclusions API could inhibit the expression of inducible inflammatory factors, therefore exert the strong anti-inflammatory function. However, API could not protect MSC apoptosis induced by LPS but amplified the apoptosis, The apoptosis is related to Bad/Bcl-2 increasing and caspase-3 activation, which is mediated through suppressing VDR expression.

Focused research in emergency medical systems in Asia: a necessity for trauma system advancement

Since trauma is a growing health problem worldwide,emergency trauma care including emergency medical services(EMS)is becoming an integral part of the healthcare system.The optimal EMS which will improve access to trauma care,will be different in each country because of different healthcare systems,trauma etiology,and economic situations.To adopt models that have succeeded in developed countries is not always appropriate.In order to identify the optimal EMS model in developing countries,comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary.Therefore,this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries,and discusses the need to conduct more detailed and extensive comparisons.