The investigation of genetic and clinical features in Chinese patients with juvenile amyotrophic lateral sclerosis

Juvenile amyotrophic lateral sclerosis (JALS) occurs at an age of onset below 25 years with a heterogeneous disease onset location, variable progression and survival time. To investigate whether an ALS gene profile could resolve any aspects of clinical symptom heterogeneity, we have used targeted sequencing technology in a cohort of 12 JALS patients of Chinese descent. We detected 5 likely pathogenic mutations, 2 in familial probands and 3 in sporadic patients. One was a known TARDBP mutation (p.G348V) and 4 were FUS frameshift mutations including a known p.Gln519Ilefs*9 mutation and 3 novel mutations, p.Gly515Valfs*14, p.Gly486Profs*30, and p.Arg498Alafs*32. Of the 4 FUS mutations, 2 were able to be confirmed as de novo mutations. The TARDBP mutation carrier showed a classic ALS phenotype. All patients with FUS mutations experienced limb weakness at an early age and developed bulbar symptoms during the disease course. FUS mutations have previously been associated with increased JALS disease progression, however, we found a large range 12 to 84 months in disease survival (mean 58.2 months). Our results justify future screening for variants in FUS as it remains the most frequent genetic determinant of early onset, JALS (found in 30% of our patients).

Tenascin C is a prognostic determinant and potential cancer-associated fibroblasts marker for breast ductal carcinoma

Tenascin C (TNC) is a key of extracellular matrix glycoprotein and highly express in numerous human malignancies. Herein, we attempted to clarify the clinicopathological significance of TNC as a prognostic determinant of breast ductal carcinoma. Then, we investigated TNC immunohistochemical expression in 150 breast ductal carcinomas and 27 normal breast tissue samples. Clinical relevance of TNC expression and the association TNC expression with other factors related to cancer-associated fibroblasts were also examined. In results, TNC expression was significantly higher in breast ductal carcinoma (56.0%) than normal breast tissues (25.9%). The upregulation TNC in cancer stromal were associated with pT stage (P=0.003), lymph node metastasis (P=0.002) and tumor node metastasis stage (P=0.001), also was correlated with an increase in tumor-associated macrophage population (P<0.001). The microvessel density (MVD) was significantly higher in TNC positive group than in negative group (P<0.001). In both univariate and multivariate Cox regression analyses, TNC was an independent poor prognostic factor for overall survival (OS) in breast ductal carcinoma patients. Importantly, over-expression TNC (P<0.001), FSP1 (P<0.001), SMA (P=0.002) and Vimentin (P=0.049) were significantly correlation with the lower OS (P<0.005). In addition, TNC expression in breast ductal carcinoma stromal was positively correlated with FSP1 (P<0.001), SMA (P=0.001) and Vimentin (P<0.001). In conclusion, the high expression of TNC could be a useful cancer-associated fibroblasts marker for the prediction of prognosis of breast ductal carcinoma patients.

Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model

This study used a simulation model to determine the cost-effective threshold of fracture risk to treat osteoporosis among elderly Chinese women. Osteoporosis treatment is cost-effective among average-risk women who are at least 75 years old and above-average-risk women who are younger than 75 years old.

INTRODUCTION

Aging of the Chinese population is imposing increasing economic burden of osteoporosis. This study evaluated the cost-effectiveness of osteoporosis treatment among the senior Chinese women population.

METHODS

A discrete event simulation model using age-specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture; costs (2015 US dollars); and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness to pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute 10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs.

RESULTS

In baseline analysis, simulated ICERs were higher than the WTP threshold among Chinese women younger than 75, but much lower than the WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher WTP threshold or a lower annual treatment cost. A 30 % increase in WTP or a 30 % reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85.

CONCLUSIONS

The current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.

[Expression of Slit3/Robo signal pathway in mouse aortic smooth muscle cell and its impact on proliferation and migration]

OBJECTIVE

To observe the expression of neural axon guidance molecules Slit3 and Robo receptors in mouse aortic smooth muscle cell(MASMC) and investigate the effect of exogenous Slit3 protein on migration and proliferation of MASMC.

METHODS

The primary cultured MASMC were identified by immunofluorescent assay. The expression of Slit3/Robo signal pathway was detected by RT-PCR and immunocytochemical staining. MASMC were divided into 6 groups: the negative control group (DMEM medium containing bovine serum albumin 86 μg/L), Slit3 0 μg/L group (DMEM medium without Slit3), Slit3 24 μg/L group (DMEM medium containing Slit3 24 μg/L), Slit3 40 μg/L group (DMEM medium containing Slit3 40 μg/L), Slit3 80 μg/L group (DMEM medium containing Slit3 80 μg/L) and the positive control group (DMEM medium containing platelet derived growth factor 10 μg/L). The effects of exogenous Slit3 on MASMC proliferation and migration were detected by CCK-8 and scratched cells and transwell chambers respectively.

RESULTS

(1) The mRNA and protein expressions of Slit2, Slit3, Robo1 and Robo4 were detected in MASMC. mRNA level of Slit2 was lower than Slit3 (P<0.05) and there were no significant difference between mRNA level of Robo1 and Robo4. (2) The mitogenic responses of MASMC were significantly enhanced in Slit3 24 μg/L group, Slit3 40 μg/L group and Slit3 80 μg/L group compared with negative control group (1.13±0.04, 1.19±0.02, 1.18±0.08 and 0.64±0.10 respectively, all P<0.05). The mitogenic activity of MASMC was the strongest in Slit3 40 μg/L group (compared with positive control group 1.27±0.05, P>0.05). (3)The autonomous migration activity of MASMC were significantly increased in Slit3 24 μg/L group, Slit3 40 μg/L group, Slit3 80 μg/L group compared with negative control group (cell scratch width were (0.40±0.03)cm, (0.32±0.03)cm, (0.30±0.02)cm and (0.49±0.01)cm respectively, all P<0.05). The autonomous migration activity of MASMC was the strongest in Slit3 80 μg/L group (compared with positive control group (0.22±0.01)cm, P>0.05). The transmembrane migration activity of MASMC were significantly increased in Slit3 24 μg/L group, Slit3 40 μg/L group, Slit3 80 μg/L group compared with negative control group (the number of cell migration were 46.67±2.23, 65.33±3.43, 81.67±4.22 and 39.33±2.03 respectively, all P<0.05). The transmembrane migration activity of MASMC was the strongest in Slit3 80 μg/L group (compared with positive control group 84.00±2.02, P>0.05).

CONCLUSION

Slit2, Slit3, Robo1 and Robo4 were expressed in MASMC, and exogenous Slit3 could promote proliferation and migration of MASMC in vitro.

Wnt activation protects against neomycin-induced hair cell damage in the mouse cochlea

Recent studies have reported the role of Wnt/β-catenin signaling in hair cell (HC) development, regeneration, and differentiation in the mouse cochlea; however, the role of Wnt/β-catenin signaling in HC protection remains unknown. In this study, we took advantage of transgenic mice to specifically knockout or overactivate the canonical Wnt signaling mediator β-catenin in HCs, which allowed us to investigate the role of Wnt/β-catenin signaling in protecting HCs against neomycin-induced damage. We first showed that loss of β-catenin in HCs made them more vulnerable to neomycin-induced injury, while constitutive activation of β-catenin in HCs reduced HC loss both in vivo and in vitro. We then showed that loss of β-catenin in HCs increased caspase-mediated apoptosis induced by neomycin injury, while β-catenin overexpression inhibited caspase-mediated apoptosis. Finally, we demonstrated that loss of β-catenin in HCs led to increased expression of forkhead box O3 transcription factor (Foxo3) and Bim along with decreased expression of antioxidant enzymes; thus, there were increased levels of reactive oxygen species (ROS) after neomycin treatment that might be responsible for the increased aminoglycoside sensitivity of HCs. In contrast, β-catenin overexpression reduced Foxo3 and Bim expression and ROS levels, suggesting that β-catenin is protective against neomycin-induced HC loss. Our findings demonstrate that Wnt/β-catenin signaling has an important role in protecting HCs against neomycin-induced HC loss and thus might be a new therapeutic target for the prevention of HC death.

Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Impact of cataract surgery on vision-related life performances: the usefulness of Real-Life Vision Test for cataract surgery outcomes evaluation

PURPOSE

Real-Life Vision Test (RLVT) is a newly developed performance-based measures of functional vision. This present study is designed to determine whether it could be a meaningful assessment for cataract surgery outcomes evaluation.

PATIENTS AND METHODS

Age-related cataract patients (56) who scheduled for bilateral cataract surgery and 44 age-matched controls were evaluated by four types of measurements: (1) demographic, medical, cognitive and depressive evaluation, and the reaction time testing; (2) clinical measures (visual acuity, contrast sensitivity, stereopsis, and color perception); (3) the 25-item National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ); (4) the RLVT. Spearman's coefficients and multiple regression analysis were conducted to investigate the relationship among RLVT, clinical measures, and self-report assessment of visual function.

RESULTS

The results of RLVT, clinical measures, and NEI-VFQ total scores were improved significantly after cataract surgery. There were no differences between control subjects and post-surgery patients with respect to NEI-VFQ-25 total scores, self-rating depression scale scores and three tasks of RLVT. Change of RLVT was significantly associated with the change of clinical measures in the cataract group. Multiple regression analysis demonstrated that change of distance, intermediate, and near visual acuity, and binocular contrast sensitivity were significant predictors of improvements of RLVT.

CONCLUSIONS

Cataract surgery could improve real-world visual ability effectively for cataract patients. Our study highlights the potential usefulness of RLVT as an adjunct to the current outcomes evaluation system for cataract surgery. The use of RLVT combined with clinical and self-survey methods may be the comprehensive strategy to manifest the impact of cataract surgery on patients' overall vision-related quality of life.

Bmi1 regulates auditory hair cell survival by maintaining redox balance

Reactive oxygen species (ROS) accumulation are involved in noise- and ototoxic drug-induced hair cell loss, which is the major cause of hearing loss. Bmi1 is a member of the Polycomb protein family and has been reported to regulate mitochondrial function and ROS level in thymocytes and neurons. In this study, we reported the expression of Bmi1 in mouse cochlea and investigated the role of Bmi1 in hair cell survival. Bmi1 expressed in hair cells and supporting cells in mouse cochlea. Bmi1^−/− mice displayed severe hearing loss and patched outer hair cell loss from postnatal day 22. Ototoxic drug-induced hair cells loss dramatically increased in Bmi1^−/− mice compared with that in wild-type controls both in vivo and in vitro, indicating Bmi1^−/− hair cells were significantly more sensitive to ototoxic drug-induced damage. Cleaved caspase-3 and TUNEL staining demonstrated that apoptosis was involved in the increased hair cell loss of Bmi1^−/− mice. Aminophenyl fluorescein and MitoSOX Red staining showed the level of free radicals and mitochondrial ROS increased in Bmi1^−/− hair cells due to the aggravated disequilibrium of antioxidant–prooxidant balance. Furthermore, the antioxidant N-acetylcysteine rescued Bmi1^−/− hair cells from neomycin injury both in vitro and in vivo, suggesting that ROS accumulation was mainly responsible for the increased aminoglycosides sensitivity in Bmi1^−/− hair cells. Our findings demonstrate that Bmi1 has an important role in hair cell survival by controlling redox balance and ROS level, thus suggesting that Bmi1 may work as a new therapeutic target for the prevention of hair cell death.

Investigation of clinical diagnosis and liver biopsy diagnosis in cases of patients with chronic HBV infection

The aim of this study was to investigate the pathomorphological changes of chronic hepatitis B virus (HBV) infection and the coincidence between clinical and pathological diagnosis. Hematoxylin and eosin staining and immunohistochemistry for HBsAg and HBcAg were performed on 97 liver biopsy specimens collected from 97 patients with chronic HBV infection, including 55 HBV carriers. The agreement between clinical diagnosis and pathological diagnosis in mild, moderate and severe chronic hepatitis was 71.4, 60 and 83.3%. The rate of clinical diagnosis matching the pathological diagnosis for fibrosis was higher than for inflammation (83.33 vs 54.76%), especially in moderate (83.33 vs 26.67%) and severe chronic hepatitis (66.67 vs 16.67%). The rate of serological/imaging examination results and immunohistochemistry confirmation was as high as 93.81% for HBsAg and 92.78% for HBcAg. In HBV carriers, the degree of inflammation and fibrosis in most cases was mild, and the younger the patients, the higher the ratios of G0 and S0. The clinical diagnosis was correct in most cases, especially for inflammation and in mild chronic hepatitis; the patients who were diagnosed as HBV carriers actually already had inflammation and fibrosis.

Osteogenic potentials of osteophytes in the cervical spine compared with patient matched bone marrow stromal cells

BACKGROUND

Osteophytes that form adjacent to degenerated disc have osteogeic potential. Studies suggest that their formation is associated with mesenchymal precursors arising from the chondrosynovial junction. This study is aimed to determine the cellular aging and osteogenic differentiation potential of osteophyte-derived mesenchymal cells (oMSCs) when compared to patient-matched bone marrow stromal cells (bMSCs).

MATERIALS AND METHODS

oMSCs and bMSCs were isolated from tissue samples during anterior cervical discectomy and fusion surgery. Extensive expansion of cell cultures was performed and early and late passage cells (P4 and P9, respectively) were used to study cell senescence and telomerase activity. Furthermore, osteogenic differentiation was applied to detect their osteogenic capacity.

RESULTS

The proliferation capacity of oMSCs in culture was superior to that of bMSCs and these cells readily underwent osteogenic differentiation. Our results showed that oMSCs had higher telomerase activity in late passages compared with bMSCs, although there was no significant difference in the telomerase activity in the early passages in either cell types. The telomerase activity was detectable only in early passage oMSCs and not in bMSCs.

CONCLUSIONS

Our results indicate that oMSCs retain a level of telomerase activity in vitro, which may account for the relatively greater longevity of these cells, compared to bMSCs. Furthermore, when compared to bMSCs, oMSCs maintained a higher proliferative capacity and the same osteogenic capacity, which may offer new insights of tissue formation.

Inhibition of activin receptor-like kinase 5 induces matrix metallopeptidase 9 expression and aggravates lipopolysaccharide-induced pulmonary injury in mice

BACKGROUND

TGF-β (Transforming Growth Factor-β) mediates its biological effects through members of activin receptor-like kinase (ALK) family and TGF-β/Smad3 signaling link inflammation to pulmonary fibrosis.

AIM

The aim of this study was to evaluate the role of SB431542 as a specific inhibitor of Activin receptor-Like Kinase 5 (ALK5) in pneumonic injury.

MATERIALS AND METHODS

Anesthetized and endo-tracheally intubated C57BL/6 mice were randomized to three groups: the control group with intra-tracheal instillation of 1.5 mg/kg normal saline (NS); LPS stimulation group with intra-tracheal instillation of 3 mg/kg LPS (lipopolysaccharide); and LPS+SB431542 group with intra-peritoneal (i.p.) injection of 4.2 mg/kg SB431542 1 h before intra-tracheal instillation of 3 mg/kg LPS. The lung tissue was obtained 6 h after injury, and the degree of pulmonary injury was evaluated by pathologic scoring. The lung wet/dry weight ratio was measured. TNF-α, IL-1β, and MMP-9 (matrix metallopeptidase-9) mRNA expression levels were assayed by real time PCR (polymerase chain reaction). The content of MMP-9 total protein was measured by Western blotting. The content of active MMP-9 was detected by gelatin zymography. Location of MMP-9 in mouse lung tissue was monitored by immunohistochemistry.

RESULTS

The results showed that (1) pathologic changes including interstitial pulmonary edema, neutrophil infiltration, alveolar edema and hemorrhage were observed 6 h after LPS instillation. The lung wet/dry weight rate and pathologic scores confirmed that SB431542 administration aggravated LPS injury to the mouse lung; (2) the amount of TNF-α and IL-1β mRNA expression in LPS groups was significantly higher than that in the control group, and the highest in LPS+SB431542 group; (3) the amount of MMP-9 mRNA and MMP-9 protein expression and active MMP-9 in the lung tissue of LPS groups was significantly higher than that in the control group 6 h after injury, and the highest in LPS+SB431542 group; and (4) MMP-9 expression was mainly observed in the airway epithelial cells, vascular smooth muscle cells and cytoplasm of inflammatory cells as shown by immunohistochemistry, and brownish yellow uniformed stained areas were also seen in the exudate from part of the alveoli.

CONCLUSIONS

These results indicate that blocking the activity of TGF-β/Smad pathway by specific inhibitor SB431542 of ALK5 promoted the releaser of large amounts of TNF-α, IL-1β and other pro-inflammatory cytokines from the lung tissue of mice sustaining acute lung injury (ALI). At the same time, the amount and activity of MMP-9 expression in the lung were increased, and MMP-9 expression was mainly located in the airway epithelial cells, vascular smooth muscle cells and inflammatory cells, causing increased permeability of the pulmonary blood vessels, degradation of the extracellular matrix and destruction of the normal lung tissue structures, which directly or indirectly promotes the progression of pulmonary inflammatory responses and aggravates ALI.

Clinical features of Chinese patients with Huntington's disease carrying CAG repeats beyond 60 within HTT gene

Patients with Huntington's disease (HD) carrying CAG repeats beyond 60 are less frequently seen and clinical features of them have been rarely reported. We identified four unrelated patients carrying CAG repeats beyond 60 (84.0 ± 13.76, ranging from 74 to 104) from 119 Chinese HD patients via direct sequencing. These four were all early onset with a mean age at presenting symptom of 9.8 ± 1.71 years. Paternal transmission was found in three of them and the fourth was apparently sporadic. In addition, they had atypical onset symptoms including epilepsy, intellectual decline, tics and walking instability, which might lead the clinicians to make the wrong diagnosis in the early stage of disease. Our work explores clinical features of Chinese HD patients with an expanded CAG repeat over 60 and may help the clinicians make a correct diagnosis in the early stage of disease.

Chinese patients with Huntington's disease initially presenting with spinocerebellar ataxia

Recent studies have described Huntington's disease (HD) patients with atypical onset of ataxia. Symptoms in these patients can overlap with those of spinocerebellar ataxia (SCA). We retrospectively examined clinical data for 82 HD probands and found 7 had initially been clinically diagnosed as SCA cases. Clinical features in these patients were further investigated and the number of CAG repeats in the huntingtin (HTT) gene was determined by direct sequencing. Genetic screenings for SCAs in the 7 patients were all negative. By contrast, HTT was heterozygous in each patient. The distribution of CAG number in the 7 patients was statistically the same as that in the other 75 patients. Each of 7 HD patients had presented with atypical onset of ataxia. The mean time from onset to HTT genetic testing was 5.6 ± 5.52 years. Three of the patients developed chorea, but the others did not. Our observations confirm the clinical heterogeneity of HD in Han Chinese. Based on these findings, testing for HTT expansions should be considered for clinically diagnosed SCA patients who test negatively in genetic screening of SCA genes.

Inhibition of autophagy induced by overexpression of mda-7/interleukin-24 strongly augments the antileukemia activity in vitro and in vivo

Melanoma differentiation-associated gene-7/interleukin-24 (mda-7/IL-24) is a novel candidate of tumor suppressor that can selectively induce apoptosis experimentally in a spectrum of human cancer cells including leukemia cells. However, a recent study suggests that mda-7/IL-24 promotes the survival of chronic lymphocytic leukemia B-cells. In this study, we showed that mda-7/IL-24 was constitutively expressed in leukemia cell lines and primary acute myeloid leukemia samples. Using a conditionally replicating adenovirus expressing mda-7/IL-24 (ZD55-IL-24), we showed that enforced expression of mda-7/IL-24 in leukemia cells induced autophagy, which was triggered by the upregulation of Beclin-1. Immunofluorescence and coimmunoprecipitation studies suggested that mda-7/IL-24 protein interacts with Beclin-1. Class III PI3K/Beclin-1 complex was shown involved in the mda-7/IL-24-induced autophagy. Moreover, autophagy inhibition by phosphatidylinositol 3-kinase inhibitor, wortmannin, resulted in a reduced Beclin-1 expression and autophagosome formation associated with significantly enhanced cell death. Importantly, the combination of ZD55-IL-24 with wortmannin elicited a strongly enhanced antileukemia efficacy in established leukemia xenografts. These results suggest that mda-7/IL-24-induced autophagy in leukemia cells may provide survival advantage and mda-7/IL-24 combined with agents that disrupt autophagy is a promising new strategy for the treatment of leukemia.

[Biomechanical research of ideal compression screw for treatment of femoral neck fracture]

OBJECTIVE

To explore the biomechanical stability of ideal compression screw (I.CO.S.) for treatment of femoral neck fracture and to provide theoretical basis for choosing I.CO.S. in clinical application.

METHODS

Thirty cadaveric human femurs were selected and divided randomly into experimental group (n=15) and control group (n=15), 15 in each group were divided equally into three sub-groups (n=5) again. The model of subcapital femoral neck fracture was made, then given anatomical reduction and fixed with I.CO.S. (experimental group) and general cannulated compression screw (control group) separately with three different configurations: two horizontal (parallel screws in superior aspect of femoral neck), two vertical (parallel screws in sagittal plane of femoral neck) and reverse triangle. The different biomechanical performances were evaluated through experimental stress analysis.

RESULTS

In biomechanical stability aspect: groups A, B, C was better than groups D, E, F in respect of horizontal displacement and yield load (P < 0.05); groups A, D was better than groups B, E in respect of the straining, horizontal displacement and yield load (P < 0.05); and there were not significant differences in all biomechanical indicators between group C and group F, and between group A and group C (P > 0.05).

CONCLUSION

I.CO.S. has the good biomechanical stability for treatment of femoral neck fracture, which may provide basis for application.

[Long PHILOS locking compression plate for treatment of proximal humerus and humeral shaft fractures]

OBJECTIVE

To investigate the therapeutic effect of long PHILOS locking compression plate on the proximal humerus and humeral shaft fractures.

METHODS

From March 2005 to December 2007, 35 cases with the proximal humerus and humeral shaft fractures were treated with long PHILOS locking compression plate, including 16 males and 19 females aged 29-68 years old (average 54.5 years old). There were 34 cases of fresh and close fracture, and the time from injury to operation was 3-9 days. One case had delayed union of fracture 5 months after receiving T-plates and internal fixation with steel plate. For the proximal humerus fracture, 7 cases had 2 parts of fracture, 19 had 3 parts of fracture, and 9 had 4 parts of fracture according to Neer classification; while for the humeral shaft fracture, 3 cases were classified as A1, 5 as A2, 10 as B1, 3 as B2, 6 as B3, 7 as C1 and 1 as C3 according to AO classification. Postoperatively, Neer scoring system was employed to evaluate the function of shoulder joint and HSS scoring system was adopted to evaluate the function of elbow joint.

RESULTS

All incisions healed by first intension, and 30 cases were followed up for 12-33 months (average 18.2 months). Postoperatively, 2 cases had symptoms of radial nerve paralysis, which disappeared within 3 weeks; 1 case suffered from humeral head necrosis and received the secondary operation of humeral head replacement; humeral head was reduced evenly in 1 case, and 2 cases felt chronic slight pain in shoulder joints and received no further treatment. X-ray films showed 29 cases had fracture healing 6 months after operation, and all the patients had bone union 12 months after operation except 1 case receiving humeral head replacement. No such complications as screw loosening and internal fixation loosening occurred. By Neer scoring system, 6 cases were graded as excellent, 19 as good, 3 as fair, 2 as poor, and the excellent and good rate was 83.3%. By HSS scoring system, 16 cases were graded as excellent, 14 as good, and the excellent and good rate was 100%.

CONCLUSION

Applying long PHILOS locking compression plate in the treatment of the proximal humerus and humeral shaft fractures provides a solid fixation and high satisfactory rate with minor complications.