Objective To discuss the practical significance and clinical therapeutic effects of shoulder arthroscopy technique in the diagnosis and treatment of glenoid labrum injury. Methods In order to have an accurate diagnosis of glenoid labrum injury of the shoulder, X-ray, arthrography, MRI and arthrog-raphy and arthroscopy techniques were used respectively for thirty-six cases of glenoid labrum injury. Under shoulder arthroscopy, the injured glenoid labrum was partially resected in twenty-eight patients affected with single glenoid labrum injury. The injured glenoid labrum of five SLAP cases were treated with debridement under shoulder arthroscopy, and then the affected shoulder was immobilized by zero-degree traction. The injured glenoid labrum of three Bankart cases also underwent debridement under shoulder arthroscopy, and then treated with improved Bristow operation through limited incision. Results After 2-year follow-up, according to the standard criterion of U. S. Michasel Reese Medical Center, the total pain score and the total joint function score were 75 and 25 respectively; the patients' average score was 65 and 20 postoperatively, compared with 35 and 10 preoperatively. The clinical symptoms of all these cases were greatly improved and the unstable symptoms disappeared postoperatively in eight SLAP injury or Bankart injury patients and they all returned their preoperative activities. Conclusion Glenoid labrum is one of the most frequent parts of shoulder joint to be injured. Shoulder arthroscopy is a necessary and effective advanced technique for a definite diagnosis and treatment of glenoid labrum injury. There is some difficulty to carry out operation with arthroscopy and some specific instruments, however, it is necessary for the surgeon to understand and handle the technique.

Nonunion or delayed union remains one of the major complicatio ns of fractures. Repair of fractures involves a sequence of dynamic events which ultimately restore the integrity of bone and its biomechanical properties, incl uding such methods as surgery, internal fixation, bone grafting, external fixati on, electrical stimulation, ultrasound, and high-energy extracorporeal shock wa ve. The preferred management of nonunion and delayed union is autologous bone gr afting. However, the supply of suitable bone is limited and it often results in additional morbidity to the donor site. Recently some advances have been made in the therapeutic principle for nonunion or delayed union. It is aimed at providi ng non-invasion, less complication, and safe treatment. This article introduces the development of some effective and safe therapies for nonunion or delayed un ion.

Total hip and knee replacements, which have developed for abou t forty years, have been widely used as effective surgical treatments for severe hip and knee diseases. This article discusses the recent advance in techniques of hip and knee replacement Chiefly in the aspects of hip or knee prosthesis des ign, improvement of materials and surgical techniques. In total hip replacement, second-generation cementing technique, new types of metal-on-metal prosthesi s and minimally invasive technique have been applied to enhance the stability, r educe the wear rate and facilitate the functional recovery. In knee replacement, mobile bearing and high flexion are great advancements made in design. The comp uter-aided operational technique has greatly improved the replacement.

Objective: To estimate the biological characteristics of HA gradient coating in vivo.Method:We inserted coated and uncoated implants in bilateral femur of loading area in dogs.Result:Histological findings demonstrated that HA coated implants bind the host bone tightly and the amount and velocity of the new bone formation are more than the uncoated implants.The mean interface shear strength between HA gradient coated implants were greater than those of uncoated implants (p<0.01).Conclusion:The results of this study confirms that HA gradient coatings can has its practical value in orthopeadics fields.

Objective To observe the tissus implanted into the damaged articular cartilage of rabbits with induced autogeneic mesenchymal cells. Methods The autologous mesenchymal cells derived from bone marrow of New Zealand rabbits were harvested. With basic fibroblast growth factor(bFGF， 25 ng/ml) and transforming growth factor beta 1(TGF-? 1， 2 ng/ml)， the cells were induced and expanded in cell culture. The induced cells with absorbable gelatin sponge as a carrier were then implanted into the damaged articular cartilage in rabbits as experimental group. The absorbable gelatin sponge without cells were served as control. Specimens were harvested at the end of 4, 12 and 24 week after implantation, and were stained with toluidine blue. Results By RT- PCR, it was confirmed that there was expression of typeⅡ procollagen mRNA in the induced mesenchymal cell. After implantation, it was difficult to macroscopically distinguish the repaired tissues from the normal cartilaginous tissue in the experimental group in 24 weeks. While the defect of articular cartilage was filled with white and swampy tissue in the control group at the same time. Histologically, the defective area of the articular cartilage was replaced by the formation of neo- cartilage which showed positive staining of toluidine blue in 4 weeks in the experimental group. The neo- cartilage was modeled to normal cartilage tissues in 12 weeks and was similar to the surrounding cartilage in 24 weeks. But in the control group, the defect of articular cartilage was not repaired by cartilage tissue at every stage and were replaced by fibrocartilage which was shown weakly positive staining of toluidine blue in 24 weeks. Conclusion The transplant of the induced autogeneic mesenchymal cells derived from bone marrow might promote repair of articular cartilage, and restore its structure and function.

0.05)respectively.[Conclusion]The technique of radiographic assessment to define the anteromedial OA of the knee is not easy to perform,but it can be used,by well trained doctors,in the most knee OA cases with high accuracy.The MR imaging gives more information about cartilage defects and can be used in some doubted cases.

Objective To observe the Smad5 gene knockout and induced-changes of auditory physiology and cochlea morphology in mouse, to explore whether Smad5 gene is a new gene related to hearing function. Methods Double blind control methods were used to detect the auditory threshold of auditory brainstem responses (ABR) in the mouse of Smad5 (+/+) to Smad5(+/-) and the cochlea morphology (cochlea paraffin-cut section and basal membrane spreading section). The hair cell count was also taken. Results As shown by ABR audiometry, the average hearing of Smad5 (+/-) mouse (aged 24 weeks) is 90.63?17.65 dB (SPL) and that of Smad5(+/+) mouse is 63?19.94 dB(SPL), which are of significant difference (P0.05). Conclusion Smad5(+/-) gene knockout can cause the mouse a auditory threshold decline in moderate or severe extent. Cochlea morphology indicated that hair cells (mainly outer hair cells) in mouse cochlea basal membrane became deficient. A mechanism of Smad5 gene knockout to caused the deafness and the deficiency of hair cells remained to be further studied.

Objective To evaluate the accuracy of vasopressin (VP) secretion in the late phase of septic shock for predicting patient outcomes and further investigate its relationship with the prognosis of septic shock.Methods Fifty-five patients presented at late phase of septic shock,who were admitted to the intensive care unit of our hospital,were enrolled.Their VP secretion was measured.The method for measurement was as follows:3％ sodium chloride solution 600 ml was infused over 2 h,serum concentrations of VP and sodium were measured before and after infusion,the difference in VP before and after infusion (△VP) and in Na before and after infusion (△Na) was calculated,and △VP/△Na was used to reflect VP secretion.The patients were divided into either abnormal secretion of VP group (△ VP/△ Na ≤ 0.5 ng/mmol) or normal secretion of VP group (△VP/△Na＞0.5 ng/mmol) according to △VP/△Na ratio.Immediately before testing VP secretion,venous blood samples were collected for determination of serum lactic acid and C-reactive protein concentrations.The consumption of vasoactive drugs at the moment of enrollment and 28-day fatality rate were recorded.Results There were 30 cases in abnormal group (54％) and 25 cases in normal group (46％).Compared with normal group,the serum lactic acid,C-reactive protein concentrations and consumption of dopamine or norepinephrine were significantly increased,and the 28-day fatality rate was increased (67％ vs 40％) in abnormal group.ROC curve analysis showed that when △VP/△Na 0.5 ng/mmol was used as the criteria for determining prognosis,the sensitivity was 66.7％,specificity was 64.0％,and the area under the ROC curve was 0.828.Conclusion VP secretion in the late phase of septic shock may affect patient prognosis.

OBJECTIVE:To study the effect of paroxetine combined with low dose of olanzapine on sleep process and architec-ture of depression patients with insomnia. METHODS:84 depression patients with insomnia were randomly divided into control group and observation group. Control group was given 20 mg Paroxetine tablet,once every morning;observation group was addi-tionally given 2.5 mg Olanzapine tablet,once before going to bed. Sleep quality [Pittsburgh Sleep Quality Index(PSQI)],depres-sion scores [Hamilton Depression Scale (HAMD)],sleep process [sleep latency (SL),awakening times (AT),the actual total sleep time (TST),sleep efficiency (SE),rapid eye movement (REM) sleep latency (RL)] and sleep architecture [sleep stage 1 (S1),2(S2),3(S3)and the proportion of REM to sleep] in 2 groups before and 3,6 months after treatment and the incidence of adverse reactions(ADR)were observed. RESULTS:After treatment,PSQI and HAMD scores in 2 groups were significantly lower than before,and gradually decreased by time,and observation group was lower than control group;TST in observation group was significantly higher than before and control group,S1 in observation group was significantly lower than before,SE,S3 and REM in 2 groups were significantly higher than before,and observation group was higher than control group,SL,AT,RL and S2 were significantly lower than before,and observation group was lower than control group,the differences were statistically significant (P<0.05). There were no obvious ADR in 2 groups. CONCLUSIONS:Paroxetine combined with low dose of olanzapine can sig-nificantly relieve depression,optimize sleep process and sleep architecture,then impove sleep quality.

Objective To investigate the prognostic value of decreased vasopressin (VP)modulation in the late-phase of septic shock. Methods A prospective study was conducted. Fifty-five septic shock patients hospitalized in intensive care unit (ICU)of the First Hospital of Hebei Medical University from January 2012 to February 2014 were enrolled. All patients received 3% hypertonic saline solution infusion. Serum concentrations of sodium and VP were measured before and after hypertonic saline solution infusion. Patients with ratio of difference in sodium and VP before and after infusion of 3%hypertonic saline (△VP/△Na)≤0.5 pg/mmol were defined as non-responders,and who>0.5 pg/mmol were defined as responders. The levels of lactic acid,C-reactive protein (CRP),and vasoactive drug〔dopamine(DA)and norepinephrine(NE)〕usage between the two groups were compared. The 28-day mortality,live time in the dead,and ICU day in survivors were analyzed between the two groups. The receiver operating characteristic curve (ROC curve)was drawn to assess prognostic value of VP. Results There were 30 cases (54.5%) in non-responsive group,and 25 (45.5%)in responsive group. There were no significant differences in the age,acute physiology and chronic health evaluationⅡ (APACHEⅡ)score,central venous pressure (CVP),blood pressure, plasma albumin level,sodium level before and after hypertonic saline solution infusion between the two groups. The baseline level of VP in the non-responsive group was markedly lower than that of the responsive group (ng/L:10.66± 1.57 vs. 17.13 ±5.12,t=6.091,P<0.001). After hypertonic saline solution infusion,the VP level was also significantly decreased compared with that in the responsive group(ng/L:11.65±1.74 vs. 22.50±5.31,t=9.758,P<0.001). The non-responders showed higher lactic acid (mmol/L:3.04±0.55 vs. 2.28±0.38,t=-5.881,P<0.001) and CRP (mg/L:117.9±23.0 vs. 94.9±17.0,t=-4.143,P<0.001),and received larger dosage of vasoactive drugs〔DA(μg·kg-1·min-1):14.8±3.9 vs. 8.9±1.6,t=-5.725,P<0.001;NE(μg·kg-1·min-1):0.96±0.42 vs. 0.40± 0.09,t=-5.625,P<0.001〕for maintaining blood pressure compared with those in responders. The non-responsive group showed higher 28-day mortality(66.7%vs. 40.0%,χ2=3.911,P=0.048)and longer ICU day(days:9.9±2.3 vs. 6.7±1.7,t=-4.044,P<0.001),but the live time in the dead showed no difference between non-responsive group and responsive group(days:5.8±1.9 vs. 6.1±2.3,t=0.384,P=0.704). ROC curve showed that the area under ROC curve(AUC)forΔVP/ΔNa predicting the outcome was 0.828,and theΔVP/ΔNa threshold value of 0.5 pg/mmol had the sensitivity of 66.7%and specificity of 64.0%for prediction of the outcome(95%confidence interval:0.722-0.934). Conclusion Osmotic pressure-regulated VP secretion was impaired and decreased in the late-phase of septic shock, and made the sense in prognosis.