Objective To describe postmedial approach to the knee and discuss the main technique using it to repair and reconstruct posterior cruciate ligament (PCL). Methods 24 patients with PCL injury were operated on with the postmedial approach. 13 cases were repaired directly using the technique of pulling out steel wire and 11 cases were reconstructed by semitendinosus. Prone position was adopted in 16 cases and supine position in 8 cases (21 cases had been followed up over six months). Applied anatomy, main techniques and clinical results were evaluated. Results The postmedial approach saved 30～60 minutes compared with the posteior approach, and was not restricted by body posture. Neurovascular structure did not need to be dissected, PCL repair and reconstruction could be finished in one incision.By a six month follow up evaluation, no symptoms of instability occured and they were completely stable on physical examination. Conclusion The postmedial approach is simple, safe, and yields excellent exposure. It's an ideal approach for repair and reconstruction of the PCL.The technique of pulling and steel wire and semitendinosas drawn out "U" shaped pins fixation are essential methods to repair and reconstruct the PCL.

[Objective]To investigate the injury characteristics and treatment of the Hoffa facture associated with extensor mechanism injury.[Method]Four patients with Hoffa facture associated with extensor mechanism injury treated in author's hospital in recent 6 years were enrolled in this study.All the patients were multiple-injured,and associated with the ipsilateral limb fracture and retinacular and capsule laceration.The site of the extensor mechanism injury included 1 distal patellar tendon disruption,2 proximal patellar tendon disruption,and 1 distal quadriceps tendon disruption.No cruciate ligament injury was found in 3 ipsilateral bicondylar fractures.One unicondylar fracture was associated with anterior and posterior cruciate ligament and medial collateral ligament injury simultaneously.Emergency operation was performed along with the debridement in the three open fractures.In another patient with closed fracture,operation was performed one week after injury.Fractures were reduced and fixed with lag screws.Extensor apparatus were repaired and strengthened with a tension band wire through both patella and tibia.Ipsilateral limb fractures were reduced and internal fixed with hardware simultaneously. The knees were immobilized in extension with cast after operation,and flexion exercise was commenced four to six weeks later.[Result]Four patients wounds reached the first rate healing.There was no infection and necrosis of skin.All patients were followed-up for six months to three years.All 7 condyles of the 4 patients reached bone union.Healing time was about six to twelve weeks.According to Letenneur’s functional assessment system,excellent and good results were in 1 cases,fine in 3 cases.[Conclusion]Hoffa facture associated with extensor mechanism injury are usually accompanied with injuries in other part of the body.In open fracture,emergency operation is mandatory,and fracture reduction and internal fixation and extensor apparatus repair should be performed along with debridement.Tension band wire may strengthen the stability of the extensor mechanism and facilitated early mobilization.

Objective To investigate the association betw een systemic lupus erythematosus(SLE)and polymorphismof Fc gamma receptor ty peⅢin Han patients fromHunan province.Methods Genotypes of Fc?RⅢa-158V/F were determined by polymerase chain reaction(PCR)and restriction fragment length polymorphism(RFLP)analysis in 65patients with SLE and 60normal controls.Results①It was found that the frequency of homozygous Fc?RⅢa-158F /F genotype was significantly h igher in patients with SLE than that i n controls(OR=2.23,? 2 =4.69,P=0.03).②The frequencies of both homozygous Fc?RⅢa-158F /F genotype and Fc?RⅢa-158F allele were significantly high er in patients with lupus nephritis c ompared with those in controls(OR=2.67,? 2 =5.36,P=0.02;OR=2.00,? 2 =4.91,P=0.03).Conclusions These results suggest that an abnorm al distribution of Fc?RⅢa-158V/F polymorphism is associated with SLE in the Hans of Hunan province,and the presence of Fc?RⅢa-158F allele is a risk factor for lupus nephritis.These findings support t he hypothesis of a genetic mechanism in the pathogenesis of SLE.[

Objective To obtain the short peptides from phage-displayed random peptide library through screening the epitope of monoclonal antibody against tumor necrosis factor(TNF-?). Methods Anti-TNF-? was used to immunoscreen a phage random peptide library of 12 amino-acidresidues displayed as a fusion to protein Ⅲ of filamentous phage M13. The positive clones were obtained by three rounds of biopanning, and the reactivity of each clone binding to anti-TNF-? was examined by double-antibody sandwich ELISA and Dot-ELISA. Mixed positive phage clones were used to detect the serum from SLE patients and healthy persons by Dot-ELISA. Results The eluted phages were enriched nearly 100 fold through three rounds of biopanning, 7 phage clones from the third round biopanning were randomly selected and 5 clones of them could bind to the anti-TNF-?. The binding rate of mixed clones with SLE patients was significantly higher than that of healthy persons. Conclusion The phage display technique can be applied to study the anti-TNF-? antigenic peptides, and these epitopes provide the potential for developing immunodiagnostic reagents of vaccines.

Objective To evaluate the effect of bladder volume change on the doses to normal tissues in cervical cancer patients undergoing external three-dimensional conformal radiotherapy (3DRT)plus 3D conformal brachytherapy (3DCBT).Methods The study included 56 patients with cervical cancer who were admitted to our hospital from 2012 to 2013 and received radical external 3DRT and 3DCBT.During 3DCBT,the doses to 0.1,1.0,and 2.0 cm3(D0.1 cm3,D1.0cm3,and D2.0cm3,respectively) for the rectum,small intestine,sigmoid colon,and bladder under different bladder filling status (empty,50,100,and 150 ml) were compared and analyzed by paired t-test.Results The rectum D0.1cm3 with bladder volumes of 50and 100 ml were significantly reduced compared with that with an empty bladder (P =0.000,0.000).The D0.1 cm3,D1.0cm3,and D2.0cm3 for the small intestine with bladder volumes of 50,100,and 150 ml were significantly reduced compared with those with an empty bladder (P =0.008,0.000,0.000 and 0.000,0.000,0.000 or 0.000,0.000,0.000).The D0.1 cm3,D1.0cm3,and D2.0cm3 for the bladder with bladder volumes of 100 and 150 ml were significantly increased compared with those with an empty bladder (P =0.000,0.000 and 0.000,0.000 or 0.000,0.000).Conclusions The doses to the bladder and small intestine are influenced by different bladder filling status,but the doses to the rectum and sigmoid colon show no significant variation.The increase in bladder volume is helpful in reducing the dose to the small intestine.Without any change in the bladder dose,the bladder volume of 50 ml is more beneficial to reduce the dose to the small intestine than those of 100 and 150 ml.

Two patients who developed typical skin eruptions 24 hours after consumption of shiitake mushrooms are reported.Case 1:a 56-year-old woman suddenly developed widespread itching eruptions one day after intake of shiitake mushrooms.On examination,there were erythematous and edematous linear streaks (flagellate erythema) over the neck,trunk and limbs.Case 2:a 60-year-old man presented with edematous flagellate erythema over the trunk and limbs for four days.He reported intake of shiitake mushroom several days prior to the presentation.Pathological examination revealed focal parakeratosis,intracellular and intercellular edema in the prickle cell layer,severe edema of papillary dermis,evident widening of interfibrous spaces,dilation and congestion of capillaries in the superficial dermis with a mixed perivascular infiltrate of massive lymphocytes and sparse neutrophils.Both patients were diagnosed with shiitake dermatitis,and treated with prednisone and antihistamines.The lesions subsided after 3 and 4 days of treatment in patient 1 and 2 respectively.

Objective To study the telomerase activity,the keratinocyte apoptosis in condyloma ac-cuminatum(CA)and the correlation between them.Methods CA specimens from30patients were stud-ied,and compared with normal tissue and tumor cell lines.Telomerase activity was detected with telomeric repeat amplification polymerase chain reaction(TRAP)-ELISA.Terminal deoxynucleotidyl transferase(TdT)-mediated biotin dUTP nick end-labeling(TUNEL)was used to evaluate apoptotic cells.Results Increased telomerase activity was detected in27(90%)patients with CA,with A 450 ranging between0.50and2.76(mean1.3022).Apoptotic keratinocytes were found in24out of30CA cases(80%).A statistically signifi-cant inverse correlation was found between telomerase activity and apoptotic index(r =-0.52,P=0.004).Conclusion Keratinocyte telomerase is activated in condyloma acuminata,which is correlated with the downregulation of apoptosis,thus they might be involved in the pathogenesis of CA.

Objective To investigate the effects of glucocorticoids o n the expression of Th1/Th2 cytokines at mRNA and protein levels in peripheral b lood mononuclear cells (PBMCs) of patients with systemic lupus erythematosus (SL E). Methods Th1 cytokine (IFN-IL-10) in PBMCs fro m 48 patients with SLE were detected before and after treatment with glucocortic oids by RT-PCR for mRNA expression and ELISA for protein production. The systemi c lupus erythematosus activity measure (SLAM) scores of patients were compared b efore and after treatment. Results After treatment, the expression and product ion of IFN- versus 1.4094 pg/mL; P

Objective To investigate the clinical application of Utrecht applicator in three-dimensional image-guided brachytherapy (3D-IGBT) for locally advanced cervical cancer,as well as its application discipline in intracavitary/interstitial (IC/IS) therapy.Methods A retrospective analysis was performed for the clinical data of 45 patients with locally advanced cervical cancer who received radical radiotherapy,and the patients received external beam radiotherapy followed by 3D-IGBT.A total of 130 times (n =45) of IC/IS therapy were performed,and the patients who received such therapy were all enrolled.The patients who met the target dose fractionation defined in the plan were enrolled as group A (n=37,86 times),and the other patients were enrolled as group B (n=22,44 times).Two groups difference was analyzed with Group t-test.Results The frequencies of use of 15-,20-,and 25-mm ovoids by the applicator were 50.0％,20.0％,and 30.0％,respectively,and the 30-mm ovoid was not used.A total of 499 needles were used,and the frequencies of use of 6,7,10,and 11 insertion holes were 23.1％,21.2％,21.2％,and 24.1 ％,respectively.Group A had a significantly lower mean number of the needles than group B (3.7 vs.4.2,P=0.008).Compared with group B,group A had a significantly lower mean high-risk clinical target volume (CTV)(40.71±18.43 cm3 vs.51.81±14.74 cm3,P=0.001),as well significantly lower width and height of high-risk CTV (P=0.011 and 0.006),but the thickness of high-risk CTV was similar between the two groups (P=0.595).The difference between height and insertion depth (DH) was similar between the two groups (P=0.366).Group A had a smaller difference between width and pinhole distance Dw than group B (P=0.007).Conclusions When IC/IS therapy is performed for locally advanced cervical cancer,the 15-,20-,and 25-mm ovoids of Utrecht applicator and 6,7,10,and 11 insertion holes are frequently used.When the number of needles is no less than 4 and the depth is no less than 3 cm,width is the major factor which affects the planned dose.

Objective To investigate the dosimetric differences between Utrecht applicator and ring applicator in three-dimensional (3D) conformal brachytherapy for locally advanced cervical cancer.Methods Twenty-five patients with locally advanced cervical cancer were treated with magnetic resonance imaging-guided 3D conformal brachytherapy.Utrecht applicator and ring applicator were used interchangeably for 96 cycles.Patients were divided into two groups according to the type of applicator.Each group received 48 cycles of treatment, in which ring applicator was first applied for 26 cycles and Utrecht applicator was first applied for 22 cycles.High-risk clinical target volume ( HR-CTV) , width, thickness, and D90 at the point A level, D2 cm3 of organs at risk (OARs), V7 Gy , W7 Gy,A, V7 Gy ,A, and W/T7 Gy were evaluated and analyzed using paired t-test.Results There were no significant differences in HR-CTV and the width, thickness, and D90 at the point A level between the Utrecht group and the ring group ( P=0.487;P=0.340;P=0.857;P=0.921);there were no significant differences in D2 cm3 values of bladder, rectum, sigmoid, and bowel between the two groups ( P=0.136;P=0.802;P=0.985;P=0.458);there were no significant differences in V7 Gy and T7 Gy,A between the two groups ( P=0.076;P=0.435) .The Utrecht group had a significantly larger W/T7 Gy,A than the ring group ( P=0.002 ) .Conclusions Utrecht applicator is appropriate for patients with relatively large width and width/thickness ratio of HR-CTV at the point A level.