Objective To explore relationship between anterior knee pain after total knee arthroplasty and patella resurfacing and prosthesis design,and to evaluate which femoral prosthesis is more friendly with patella:Genesis Ⅱ or PFC knee prostheses.Methods Data of 145 patients (145 knees) who had undergone primary total knee arthroplasty for treating osteoarthritis were retrospectively analyzed.Posterior-cruciate-substituting total knee prostheses were used in all patients.Among 74 patients who had undergone patella resurfacing,Genesis Ⅱ knee prosthesis was used in 32 patients and PFC knee prosthesis in 42 patients.Among 71 patients who had not undergone patella resurfacing,Genesis Ⅱ knee prosthesis was used in 38 patients and PFC knee prosthesis in 33 patients.The Hospital for Special Surgery(HSS) score,patella score,patellar function score,range of motion of knee,anterior knee pain scale,and patient satisfaction were used to evaluate clinical outcomes.At the same time,the imaging results were evaluated by X-rays.Results 144 patients were successfully followed up for 21 to 43 months (average,33 months).There was no significant difference in incidence of anterior knee pain between the group with patella resurfacing and the group without patella resurfacing,while a significant difference was found between patients receiving Genesis Ⅱ knee prosthesis and those receiving PFC knee prosthesis.Four patients who had undergone total knee arthroplasty using PFC prosthesis underwent reoperation.There were no significant differences in postoperative HSS score,range of motion of knee and patient satisfaction between the Genesis Ⅱ group and the PFC group,while there were significant differences in patella score and patellar function score between them.Conclusion Postoperative anterior knee pain was related to the prosthesis design,rather than to the patella resurfacing.Genesis Ⅱ knee prosthesis was more friendly with patella than PFC knee prosthesis.

Objective To investigate the effects of the jumbo cup in acetabular revision for patients with massive acetabular bone deficiency.Methods We retrospectively studies 48 patients (49 hips) who underwent jumbo cup revisions between 2006 and 2015 (19 men and 29 women;average age:62± 12 years).The acetabular bone defects were classified according to Paprosky classification (Paprosky Ⅱ 27 hips,Paprosky ⅢA 18 hips,Paprosky ⅢB 4 hips).Radiological assessments were conduced to evaluate the acetabular prosthesis loosening,dislocation and infection.The reasons for revisions were mechanical loosening in 41 cases,and infections in another 8 cases with cement spacer putted by last surgery.Results The operation duration and blood loss was 110 min (85-160 min) and 315 ml (270-455 ml) respectively.After an average follow-up of 6.8 years (1-11 years),Harris hip score was increased from 47.6±7.1 preoperatively to 82.4± 6.2 postoperatively.Osseointegration occurred in the acetabular components at 6 months postoperatively.Radiograph analysis showed satisfied position of acetabular cup without complications such as damages of vessels or nerves.The successful rate of jumbo cup revisions was 89.8％±4.4％.However,two in Paprosky ⅢA failures for periprosthetic infection occurred and two in Paprosky ⅢA,one in Paprosky ⅢA and the other in Paprosky ⅢB for acetabular component loosening.One patient in Paprosky ⅢB had weight-bearing pain and relieve slightly after conservative treatment.The radiologic study showed that there was no relationship between failure rate and acetabular abduction angle (r=0.06,P=0.53),rotation center migration in vertical direction (r=0.11,P=0.14) and horizontal direction (r=0.04,P=0.89).Conclusion The mid-term results show that using jumbo cup in revising acetabular failure with massive bone deficiency are optimal,which can be achieved by simplified operation procedures,reduction in the need of bone graft and promotion in acetabulum osseointegration.However,higher failure rate may occur in Paprosky ⅢB patients.

Esophageal cancer is a unique malignant disease in China. A fundamental difference exists between the Chinese population and the western population on esophageal cancer in terms of epidemiology, histogenesis, and carcinogenic risk factors. Therefore, ap-plying the western academic achievements to Chinese is difficult. Thus, Chinese scientists have the responsibility to conquer esopha-geal cancer in China. This article reviews the progress of esophageal cancer focused on the molecular mechanism for interactions of ge-netic and environmental risk factors and human esophageal multistage carcinogenesis.

Objective To investigate the effects of radiofrequency thermocoagulation in relieving refractory pain of knee osteoarthritis in older patients.Methods A total of 18 patients with refractory pain of knee osteoarthritis were under treatment of radiofrequency thermocoagulation to denervation and compared to 20 patients with refractory pain of knee osteoarthritis which were under treatment of arthroscopy combined with compound betamethasone (control group).The Oxford knee score and visual analogue scale were used to evaluate the clinical effects before operation,at 1 week,4 weeks and 12 weeks after operation.Results There were significant decreases in both groups after operation than before operation(Foxford ＝4.12,3.98,FVAS ＝3.98,4.11,both P＜0.05),but there were no statistics differences between radiofrequency thermocoagulation group and control group at 1 week,4 weeks and 12 weeks after operation(toxford ＝ 1.215,1.426; tVAS＝1.319,1.123,0.867,P＞0.05).Conclusions The treatment of radiofrequency thermocoagulation is a minimally invasive method,which can relieve refractory pain of knee osteoarthritis in middle and older patients and recover knee function effectively.

BACKGROUND: Frenulum of prepuce of penis contained many nerve terminals is an extremely sensitive region. If the frenulum is injured in circumcision or other operations, the complication, such as postoperative spontaneous pain of penis, sexual disturbance and so on, will occur. But there still is no define explanation for this up to now.OBJECTIVE: To observe the distribution of immunoreactive nerve terminal of calcitonin gene-related peptide (CGRP) in prepuce of penis and frenulum of prepuce of adult SD rats, and look for the source of CGRP immunoreactive nerve terminal in frenulum of prepuce.DESIGN: A single sample trial.SETTING:Department of Anatomy, School of Medicine, Zhejiang University.MATERIALS: The experiment was performed at Department of Anatomy,School of Medicine. Zhejiang University from September 2004 to May 2005. A total of 20 adult male SD rats were selected, and were raised in warm, quiet, photophygous environment for 1 week before the trial so as to make the rats fit for the environment and maintain their basal state.METHODS: The rats were assigned randomly into 2 groups. Ten rats in the first group were treated with the immunohistochemical method to observe the distribution of CGRP immunoreactive nerve terminal in prepuce of penis and frenulum of prepuce of adult rats. Ten rats in the second group were treated with fluorogold (FG) retrograde labeled combined with CGRP immunofluorescence labeled method to look for the source of CGRP immunoreactive nerve terminal in frenulum of prepuce of penis. MAIN OUTCOME MEASURES: ①The morphology and distribution of CGRP immunoreactive nerve terminal in prepuee of penis and frenulum of prepuce of adult SD rats were observed under light microscope. ②The distributive density and difference of CGRP immunoreactive nerve terminal in prepuce of penis and frenulum of prepuce were detected and compared (represented by A). ③Morphology and distribution of FG retrograde labeled -positive, CGRP single-labeled positive and FG/CGRP double-labeled positive neurons in dorsal root ganglion were observe under fluorescence microscope. ④Mean quantity of FG retrograde labeled positive, CGRP single abeled positive and FG/CGRP double-labeled positive neurons in dorsal root ganglion was counted.RESULTS: Totally 20 rats were involved in the analysis of results. ① Amber-coloured CGRP immunoreactive nerve terminal appeared in prepuce of penis and frenulum of prepuce of adult rats. These nerve terminal mainly occurred in basal layer of epidermis and papillary layer of dermis, distributed as twig shape or intestiniform; mostly of them were bundled, different in length, and some of them showed enlarged nodosity. ②The distributive density of CGRP immunoreactive nerve terminal in frenulum of prepuce of penis was significantly larger than that in prepuce of penis (2.15±0.32, 1.02±0.22,t =-2.03,P＜0.01). ③Combined with the FG retrograde labeled method it was found that these nerve terminal was derived from neurons of dorsal root ganglion opposed to the sixth lumbar spinal cord and the neurons of dorsal root ganglion opposed to the first acral spinal cord. FG retrograde labeled positive neurons differed in length. The cell body showed round or orbicular-ovate, without obvious prominence. Bright inaurate fine particle appeared in cytoplasm, no label in nucleus. Most cells arranged in line along nerve tract or diffusedly distributed. Most CGRP single-labeled positive neurons were middle or small cells found by CGRP immunofluorescence labeling. Dyeing was too dark.Reaction product distributed evenly in cytoplasm, which showed bright dark green (FITC labeled color). The same positive section was observed comparatively under different excitation light. It was found that FG/CGRP double-labeled positive cells were middle or small, and its amount accounted for a half of the total number of FG retrograde positive cells.CONCLUSION: CGRP may participate the transmission of sensory information in prepuce of penis and frenulum of prepuce of rats. The CGRP immunoreactive nerve terminal in frenulum of prepuce of penis of rats is sourced from neurons of dorsal root ganglion opposed to the sixth lumbar spinal cord and the neurons of dorsal root ganglion opposed to the first sacral spinal cord.

Objective This investigation was launched to characterize the relationship between some popular sports and the meniscus injury as well as the impairment extent due to practice duration.Methods The overall 819 women aged 20-49 years from clinic service,hospital,community and gymnasium were selected to join the investigation.The participants practice yoga or any other popular sports including badminton,jogging,climbing hills for at least one hour per day.The subjects were diagnosed with meniscus injury by means of physical examination and MR imaging.All of the subjects were therefore divided into the case(273)and the control(546)pools.The nested case-control model was applied to assess the relative risk of the meniscus.The 181 yoga subjects had been further divided into three sub-groups of 3-6 months,6-12 months and over 12 months,and they were accordingly analyzed with the variables of the age,body mass index(BMI)and Lysholm score.Results The study showed that yoga was associated with higher risk(OR=1.621,P=0.008)of meniscus injury,but the other sports showed no statistically significant risk (badminton 0R=1.028,jogging OR=1.116,climbing hills OR=1.259).The trainees appeared to be statistically different between the groups of 3-6 months and over 12 months on the items of the Lysholm score(P=0.006)and BMI(P=0.003).Conclusion Yoga plays a risky role on the issue of meniscus injury comparing some other popular sports among young women.The yoga players who exercise longer got lower Lysholm scores and lighter weight.

Objective: To compare the peri-implant tissue stability between immediate implant and delayed implant in maxillary anterior region after loading 2 years.Methods: In the study, 38 patients with single anterior tooth loss in the Second Clinical Division of Peking University School and Hospital of Stomatology from October 2010 to December 2011 were enrolled , and 43 implants were inserted .The gin-gival contour was induced using implant-supported temporary crowns prior to restoration till permanent prostheses delivered .The gingival papilla height , labial gingival margin level and peri-implant bone level were measured immediately after the permanent restoration and 2 years later .Results: In the study , 16 patients were treated by immediate implant for 17 implants;22 patients were treated by delayed im-plant for 26 implants .The implant stability quotient ( ISQ ) value of the 2 groups showed no significant difference before permanent restoration (P>0.05).In all the cases after loading 2 years, the average mesial gingival papilla height in the implant area of the immediate group and delayed group increased by (0.15 ±0.42) mm and (0.06 ±0.65) mm, respectively;the distal gingival papilla height increased by (0.06 ±0.50) mm and (0.02 ±0.57) mm respectively;while the labial gingival margin level shrinka-ges were (0.15 ±0.23) mm and (0.15 ±0.46) mm, respectively.The peri-implant bone losses in the mesial side were (0.67 ±0.35) mm and (0.69 ±0.49) mm, respectively, while in the distal side were (0.73 ±0.31) mm and (0.75 ±0.48) mm, respectively.All these indicators showed no significant difference between the 2 groups ( P>0 .05 ) .Conclusion:Both the cases obtained optimizer results after loading 2 years, and the soft and hard tissues around the implant were very stable , which means that both the protocols can achieve reliable therapeutic effects .If we can handle the indications , immediate implant for anterior teeth shows similar efficacy with delayed implant in the short term .But immediate implant in terms of shortening the course of treatment is clearly superior to delayed implant .

Objective To observe the morphologic protection effect of intra-articular injection of osteoprotegerin (OPG)on articular cartilage in a rabbit model of osteoarthritis (OA).Methods Sixty male New Zealand rabbits were randomly divided into 3 groups:OPG group (n=20),sham-operated group (n=20) and PBS group (n=20).In OPG group and PBS group,each rabbit underwent anterior cruciate ligament transection (ACLT) in left knee joint,then 0.1 ml OPG solution or PBS were injected into the left knee for 8 weeks (5 times a week) in OPG group and PBS group,respectively.In sham-operated group,the anterior cruciate ligament was just exposed without transection,and then the incision was closed.All rabbits were sacrificed 12 weeks after operation,and the left knee joints were obtained.The Pelletier score and Mankin score were used to evaluate the macroscopic and microscopic cartilage morphology.Results The score of femoral condyle cartilage and tibial plateau cartilage was 1.80±0.89 and 1.80±0.77 in OPG group,respectively,and 3.10±0.97 and 3.20±0.77 in PBS group.However,there was no statistical difference in Pelletier score between the sham-operated group and the OPG group.Consistent with the macroscopic data,the OPG group has a significantly lower Mankin score involving cartilage structure (2.65±0.88),chondrocyte (1.35±0.71),Safranin O staining (1.83±0.83),tidemark integrity (0.30±0.47) and total score (6.13±1.97) compared with the PBS group (4.52±1.09,1.85±0.63,2.80±0.75,0.65±0.49,and 9.83±1.98,respectively).The OPG group has a significantly higher total Mankin score compared with the sham-operated group (4.80±1.25),however,there were no statistical differences in four subitem scores between the two groups.Moreover,the cartilage thickness in OPG group was 371.84±38.94 μm,255.09±74.82 μm in PBS group,and 404.68±15.97 μm in the sham-operated group,and the differences were statistically significant between three groups.Conclusion OPG has a protective effect on articular cartilage and can slow the progression of OA by reducing the grade of synovitis,decreasing the volume of osteophytes,and suppressing the loss of cartilage thickness.

Objective To study the effect of intra-articular injection of dehydroepiandrosterone (DHEA) on the balance of ADAMTS/TIMP-3 system in a rabbit osteoarthritis models.Methods Sixty rabbits were underwent bilateral anterior cruciate ligament transection (ACLT).Rabbits were randomizedn to the following treatment:one knee of each rabbit was treated with 100 μmol/L DHEA dissolved in dimethylsulphoxide (the experimental group) and the other knee was treated under the same schedule using dimethylsulphoxide (the control group) 4 weeks after transection,once a week for eight weeks.Twelve weeks after ACLT,all rabbits were killed after X-ray assessment and the knee joints were evaluated by gross morphology and histology.The concentration of hydroxyproline and glycosaminoglycan in the cartilage were analyzed.The mRNA expression of ADAMTS-4,ADAMTS-5,tissue inhibitor of metalloproteinases-3 (TIMP-3),transforming growth factor (TGF)-β1.Aggrecan and Collagen Ⅱ in the cartilage were analyzed using reverse transcription polymerase chain reaction (RT-PCR).The protein expression of aggrecan ARGxx and Collagen Ⅱ in the cartilage were analyzed by Western blot.Results By Mann-Whitney test,Gross morphologic scores on femoral condyle and tibial plateau in the control group were significantly higher than the experi-mental group (Z=-3.517,P＜0.01 ; Z=-2.518,P＜0.05).By unpaired Student's t test,histological evaluation showed that the grade of cartilage damage in the experimental group [(5.3±1.2) μg/ml] were less severe than that in the control group (10.1 ± 1.3,P＜0.01).The concentration of hydroxyproline [(5.7±0.3,23.6± 1.7) μg/ml] and glycosaminoglycan (30±4) in the experimental group increased significantly when compared with the control group [(4.6±0.5),(18.5±1.4),(24±4) μg/ml,P＜0.01].The mRNA expression of ADAMTS-4 (0.15±0.03)and ADAMTS-5 (0.10±0.04) in the experimental group decreased significantly compared with the control group (0.29±0.08,0.15±0.05; all P＜0.05).The mRNA expression of TIMP-3 (0.85±0.10),TGF-β1(1.2±0.4),Aggrecan (0.87±0.31) and Collagen Ⅱ (2.74±0.59) in the experimental group increased significantly when compared with the control group (0.70±0.13,0.8±0.4,0.49±0.16,2.2±0.5; all P＜0.05).The protein expression of Aggrecan ARGxx (0.53±0.10) in the experimental group decreased significantly when compared with the control group (0.81±0.12,P＜0.01).The protein expression of Collagen Ⅱ (2.3±0.7) in the experimental group increased significantly when compared with the control group (1.7±0.5,P＜0.05).Conclusion DHEA protects against cartilage degradation and inhibits the progression of OA,TGF-β1,Aggrecan and Collagen Ⅱ in cartilage may be the mechanism of the protective effect of DHEA on OA.

Objective To evaluate the results of total knee replacement (TKR) in treating post traumatic degenerative arthritis. Methods A retrospective study was carried out on the results of TKR that performed in 11 patients with post traumatic degenerative arthritis due to a previous fracture around knee from 1997 to 2002. There were one female and 10 males with an average age of 59 years (31 76 years). The time from fracture to TKR averaged 8.7 years (2 27 years). Internal fixation was performed in seven cases, among which the removal of the hardware at one stage at the time of TKR was performed in four and TKR in three. Lateral retinacular release was done in four cases, extensor mechanism realignment in one and collateral ligament reconstruction in two at the time of TKR. Fracture malunion appeared in two cases during operation. Results All the cases were followed up for average 36 months (12 72 months). The mean pre operative Knee Society Scores for 37 scores (10 69 scores) for knee and 42 (0 60) for function were improved significantly to mean post operative 85 (10 100) and 75 (20 100), respectively. The mean knee arc of motion improved from pre operative 83?to post operative 93?. Post operative manipulation under anesthesia for poor motion was carried out in four knees. No knee had aseptic loosening that required subsequent revisions. One knee developed superficial infection treated with debridement and retention of components. Conclusions Significant improvement in function and relief in pain is seen in the patients with previous fractures following subsequent TKR. However, special efforts to restore limb alignment, ensure correct component position and manage soft tissue balance may improve outcome of TKA.