Objective To explore the biomechanical influences of cystic degeneration in different locations on femoral head and guide the appropriated surgical treatment to preserve the femoral head. Methods First scanning a upper femur specimen with spinal CT, dealing the two-dimensional image with Efilm software, identifying the outline of the femoral head by range estimation, inputting coordinate value of the femur into the computer to build up three-dimensional finite element model of the upper femur by Ansys-5.7 software, then simulating necrosis and cystic degeneration of 1 cm diameter by analogue computer, at last putting three kinds of pressure on the femoral head respectively to analyse the stress distribution and the stress/strength ratio and predict the collapse of the femoral head. Results The tension concentration was obvious when the necrosis and cystic degeneration was beneath the loading area or medial or lateral to the loading area in the femoral head, the stress/strength ratio of the cancellous bone beneath the articular surface was high which tends to cause collapse of the femoral head. When the necrosis and cystic degeneration located in the inferior parts of the femoral head, the strain concentration was not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was normal and the femoral head had little danger of collapse. When the focus located in the anterior or posterior part of the femoral head, its upper edge displayed tension concentration but not obvious and the stress/strength ratio of the cancellous bone beneath the articular surface was lower than normal and the danger of collapse was little. Conclusion When the necrosis and cystic degeneration is beneath the loading area or medial or lateral to the loading area in the femoral head, the focus should be cleared thoroughly and the vascularised bone flap should be implanted ideally with abutment against the subchondral plate to prevent the collapse of the femoral head. If the necrotic range is large involved the loading area and its medial or lateral sides, the vascularised bone flap should be implanted beneath the loading area.

BACKGROUND: Although hand urgical doctors have drawn the attentions to carpal diseases mainly manifesting as carpalinstability, it is still expected to carry on the researches on biomechanical properties of Chinese carpal ligaments. OBJECTIVE: To understand the biomechanical properties of partial carpal ligaments so as to provide experimental evidence for the development ofclinical hand surgery. DESIGN: A simple specimen study.SETTING:Department of Orthopaedics,Kunming General Hospital of Chengdu Military Area Command of Chinese PLA,and Institute of Clinical Anatomy, First Military Medical University of Chinese PLA.PARTICIPANTS: Sixteen fresh specimens from Chinese adult wrists were obtained from the Departmentof Anatomy, First MilitaryMedical University of Chinese PLA and the experiment was performed in the Laboratory of Biomechanics. INTERVENTIONS:The partial carpalligaments were stretched till fragmentation of ligaments by using the SWD-10materialtesting machine, at the rated velocity of 5 mm per minute so as to determine the biomechanical properties of carpal ligaments. MAIN OUTCOME MEASURES:The tolerated maximum tension and rigidity during fragmentation of radioscaphoid ligament,radioscaphocapitate (RSC) ligament, radiolunate ligament, ulnolunate (UL) ligament, ulnotriquetral(UT) ligament,ulnar bursa,scapholunate interosseous(SLI) ligament,and lunotriquetral interosseous(LTI) ligament. RESULTS: Among the ligaments attached between distal radioulnar bone and carpal bone, the maximum tension and rigidity of UL ligament were the strongest, (219.2 ±55.4) N and (65.5 ± 19.6) N/mm2, of UT ligament and ulnar bursa were the weakest, (54.0 ±25.5) N, (17.8 ± 6.0) N/mm2and (58.7 ± 17.6) N, (13.4 ±4.7) N/mm2 respectively, of SLI ligament was stronger, (286. 1 ±90.8) N, (95.5 ±40.0) N/mm2, and of LTI ligament were more stronger, (375.3 ± 52.6)N, (179.0 ± 39.0 N/mm2.CONCLUSION: Among carpal ligaments, the maximum tension and rigidity of proximal row of intercarpal ligaments were stronger than those of the ligaments attached between distal radioulnar bone and carpal bone. Of proximal row of intercarpal ligaments,the maximum tension and rigidity of LTI ligament were stronger than those of SLI ligament. Of the ligaments attached between distal radioulnar bone and carpal bone,the maximum tension and rigidity of UL ligament were the strongest.

OBJECTIVE: To search the features and the treatment of vascular compressive syndrome caused by the facial, acoustic nerves. METHOD: Ten cases of vascular compressive syndrome caused by the facial, acoustic nerves were included in the group,which were treated by microvascular decompression(MVD). Besides, the microanatomic relationship between the nerve and their adjacent vessel at the root exit zone (REZ) were observed under microscope or nasoendoscopy in MVD. RESULT: Tinnitus, vertigo and facial spasm disappeared after MVD in 7 cases (70%), improved in 2 cases (20%), and relapse in 1 case (10%). All cases were found out vessels compressing at the root zone of the facial nerve and the auditory nerve. CONCLUSION The Clinical features of vascular compressive syndrome caused by the facial, acoustic nerves are facial spasm, tinnitus, and vertigo, for which microvascular decompression has a positive therapeutic effect as long as the diagnosis is correct.
Adult ; Cochlear Nerve ; Decompression, Surgical ; Facial Nerve ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; physiopathology ; surgery

Objective To evaluate the safety and short‐term efficacy of delta‐shaped anastomosis in the Billroth‐I reconstruc‐tion of totally laparoscopic distal gastric cancer radical operation (TLDG) .Methods The clinical data in 35 patients with TLDG Delta anastomosis(TLDG group) and 35 patients with laparoscopic assisted distal gastric cancer radical operation (LADG) extraper‐itoneal anastomosis (LADG group) in the gastroenterology department of our hospital from January to December 2014 were ana‐lyzed retrospectively .The intraoperative bleeding volume ,operative time ,gastroenterological function recovery time ,hospitalization duration ,postoperative pathological examination results and hospitalization total cost were compared between the two groups .Re‐sults Seventy cases successfully completed the operation without the cases of conversion to laparotomy and death .The TLDG group had no anastomotic leakage ,bleeding and stenosis after operation ;while the LADG group had 1 case of gastroparesis ,1 case of anastomotic bleeding and 2 cases of anastomotic leakage .The introperative bleeding volume ,tumor size ,number of lymph nodes dissection and distant and proximal incisal margin distance had no statistically significant differences between the two groups (P>0 .05);the operation time ,digestive tract reconstruction time ,first exhaustion time ,time taking liquid diet and postoperative hospital stay time in the TLDG group were significantly shorter than those in LADG group (P< 0 .05) ,but the hospitalization cost was higher than that in the LADG group ,the differences were statistically significant (P<0 .05) .Conclusion The delta‐shaped anasto‐mosis technique is safe and feasible for using in LADG ,moreover has better short‐term effect .

The lack of depth perception and spatial orientation in two-dimensional image of traditional laparoscopy require long-term training of the surgeons. Three-dimensional (3D) laparoscopy provides stereoscopic visions as compared to monocular views in a traditional laparoscopic system. In this review, the authors summarize the clinical application of 3D laparoscopy and its current research progress.
Imaging, Three-Dimensional ; instrumentation ; methods ; Laparoscopy ; methods

Objective To observe the macular retinal thickness and volume in patients with different degrees of Parkinson's disease (PD).Methods Thirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study.There were 17 males and 13 females,with the mean age of 63.2±6.4 years and disease course of 3.9± 2.4 years.The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients).The macular area was automatically divided into 3 concentric circles by software,which were foveal area with a diameter of 1 mm (inner ring),middle ring of 1 to 3 mm,and outer ring of 3 to 6 mm.The middle and outer ring were divided into 4 quadrants by 2 radiations,respectively.The changes of retinal thickness and macular volume of the macular center and its surrounding quadrants were analyzed.SPSS 16.0 software was used for statistical analysis.One-way ANOVA were used to analyze all data.Results Compared with the control group,the retinal thickness and volume in macular center and each quadrant of the mild to moderate PD group and severe PD group were reduced.Compared with the mild to moderate PD group,the retinal thickness and volume in macular center and each quadrant of the severe PD group were reduced.The differences of retinal thickness and macular volume among 3 groups were significant (F=5.794,5.221,5.586,5.302,5.926,5.319,5.404,5.261,5.603;P=0.001,0.007,0.003,0.005,0.000,0.004,0.004,0.006,0.002).In inner ring of the mild to moderate PD group and the severe PD group,the retinal thickness and macular volume in the upper and the nasal were the largest,the inferior was followed,and the temporal was the smallest.In outer ring of the mild to moderate PD group and the severe PD group,the retinal thickness and macular volume in the nasal was the largest,the upper was the second,the temporal and the inferior were the smallest.Conclusions The retinal thickness and volume of the macular central fovea and its surrounding areas in PD patients are significantly thinner than that in the healthy subjects.And with the increase of the severity of PD,the macular structure changes obviously,showing macular center and its surrounding macular degeneration thin,macular volume reduced.

Objective To observe the changes of optic disc structure and retinal nerve fiber layer thickness (RNFL) in patients with different degrees of Parkinson's disease (PD).Methods Thirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study.The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients).All the patients underwent OCT examination.The optic disc area,cup area,C/D area ratio,rim volume,disc volume,cup volume,rim area,C/D area,linear C/D,vertical C/D,the thickness of average RNFL,superior,inferior,temporal upper (TU),superior temporal (ST),superior nasal (SN),nasal upper (NU),nasal lower (NL),inferior nasal (IN),inferior temporal (IT),temporal lower (TL) quadrant RNFL thickness.Analysis of variance was performed for comparison among three groups.Minimum significant difference t test was performed for comparison between two groups.Results Optic disc structure parameters:there was no significant difference in the area of optic disc between the three groups (F=1.226,P＞0.05).The other optic disc parameters were significantly different in the three groups (F=5.221,5.586,6.302,5.926,5.319,5.404,5.861,6.603;P＜ 0.05).The cup area,cup volume,C/D area,linear C/D,vertical C/D of the mild to moderate PD group and severe PD group were higher than that of the control group (P＜0.05).The cup area,cup volume,C/D area,linear C/D,vertical C/D of the severe PD group were higher than those of mild to moderate PD group (P＜ 0.05),the rim area,rim volume and disc volume of the severe PD group were smaller than that of mild to moderate PD group (P＜ 0.05).The thickness of RNFL:there was no significant difference between the three groups of ST,SN,NU and NL (F=3.586,2.852,2.961,2.404;P＞0.05).The average thickness of RNFL,TU,IN,IT and TL in patients of the mild to moderate PD group and severe PD group were less than that in the control group (P＜0.05).The thickness of the average RNFL,TU,IN,IT and TL in patients of the severe PD group were less than that in the mild to moderate PD group (P＜0.05).With the increase of PD severity,the RNFL of TL and TU thinned most significantly.Conclusions With the increase of the severity of PD,the optic disc structure and RNFL thickness changes obviously,showing reduced optic disc area and volume,enlarged cup area and volume significantly enlarged C/D ratio.The average RNFL thickness of PD patients is significantly thinner than that of the controls,and it is the most obvious in the TU and TL quadrant.

OBJECTIVETo explore the safety, efficacy and feasibility of 3D laparoscopic subtotal thyroidectomy via a breast approach.

METHODSThe clinical data of 30 patients undergoing 3D laparoscopic subtotal thyroidectomy via a breast approach were analyzed in comparison with 30 patients receiving traditional laparoscopic subtotal thyroidectomy during the period from September, 2013 to December, 2013. The operation time, blood loss, postoperative drainage, postoperative hospital stay, and total hospitalization expenses were compared between the two groups.

RESULTSThe operation time in the 3D group was significantly shorter than that in the 2D group (45∓26.3 vs 62∓24.8 min, t=0.53, P<0.05). The intraoperative blood loss, postoperative drainage, postoperative hospital stay and total hospitalization expenses did not show significant differences between the two groups.

CONCLUSIONS3D laparoscopic subtotal thyroidectomy via a breast approach is safe and effective and shortens the operation time, and can be used as a routine operation for subtotal thyroidectomy.

Blood Loss, Surgical ; Breast ; Drainage ; Humans ; Laparoscopy ; methods ; Length of Stay ; Postoperative Period ; Thyroidectomy ; methods

OBJECTIVETo introduce a method of repairing facial tissue defects caused by various factors.

METHODSThe reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm.

RESULTSThis fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis.

CONCLUSIONThis fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Face ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Surgical Flaps

Objective To study the effects of sleep inertia (SI) of different time course sleeps on sleep stages and cognitions in healthy men after 30 h sleep deprivation,and also to investigate the mechanism of cognitive functions impairment in sleep inertia stages and the influential factors of sleep inertia.Methods Ten healthy men (age,(20.8 ±2.1) years) participated in the program.The program was divided into 2 stages.First,participants attended a series of tests after 20 min nap(20 min nap group)after 30 h sleep deprivation.The testing series included 3 parts:the continuous performance task,the Stroop Tests,and the Addition Tests.The series of tests were done 3 times immediately after the volunteers were awoken and each lasted about 15 minutes with an interval of 10 minutes between each test.The polysomnogram (PSG) was recorded during the nap.The following 7 days was set as washing-out period to ensure a complete recovery.Participants repeated the similar processes with 2 h nap(2 h nap group) instead of 20 min nap.The cognitive performance of each group was compared with each other along with the best cognitive performance in awakening to estimate whether or not the cognitive abilities regained the normal condition.Results ( 1 ) Sleep latency became shortened in both groups after 30 h sleep deprivation.There were no slow wave sleep (SWS) and rapid eye movement sleep (REM) sleep stages in the 20 min naps,while the percentage of SWS was increased and percentage of REM declined in 2 h naps.(2)In the early of SI (5 min after awaking),cognitive tasks showed that the abilities of continuous attention,selected attention and addition ability were all impaired (continuous performance task:(371.8 ± 21.3 ) times/3 min vs (334.4 ± 22.4) times/3 min,( 373.2 ± 19.0) times/3 min vs ( 323.7 ± 23.8) times/3 min,t =10.443,7.774,both P＜0.01; Stroop tests:(20.3 ±1.5) points vs(17.3 ± 1.0) points,(21.5 ±0.8)points vs( 16.1 ± 1.4 ) points,t =8.478,4.934,both P ＜ 0.05 ; Addition Tests:( 222.2 ± 13.2 ) s vs ( 266.6 ±23.7 ) s,( 226.3 ± 10.9) s vs ( 267.6 ± 23.4 ) s,t =5.748,6.685,both P ＜ 0.01 ).The cognitive functions impairments of 2 h nap group were more severe at the initiation of sleep inertia,but regained the normal condition more quickly.Different cognitive tasks recovered at different speeds.The dispersion of SI needed 30 min.Conclusions ( 1 ) There are difference in the sleep construction and awaked sleep stage between 20 min nap and 2 h nap groups.(2) SI exerts negative influences on cognitive performances of continuous attention,selected attention and addition after sleep deprivation.Many factors may influence the dispersion of SI,including sleep debt,compensation of sleep debt and others.(3) Fragments of sleep are unfavorable to the recovery of body.