OBJECTIVETo study clinical results of reduction and fixation under arthroscopy for the treatment of osteochondrotical lesion in the knee.

METHODSFrom December 2012 to December 2013, 4 patients with the knee joint osteochondritis lesion and free bone fragments were treated with arthroscopy to detect the stripped cartilage, and then the cartilages were reduced with small incision and fixed by cartilage nail. There were 3 males and 1 female, with age of 15, 15, 20 and 27 years old. The durations of the disease were 1 d, 5 d, 1 month and 1 year. All the patients had swelling and effusion in the knee joint, and the floating patellar test was positive. CT examination showed bone defects and loose bodies. The Lysholm, VAS, and Tegner scale were used to evaluate the knee joint functions before and after operation.

RESULTSAll the patients underwent successful surgery. Postoperative CT showed good location of the cartilage without loss of reduced bone and cartilage. All the patients were followed up, and the duration ranged from 10 to 13 months, with a mean of 12 months. In one patient, arthroscopy examination was conducted for a second time to examine the connection of the fracture part to the surrounding cartilage, and it showed that the internal fixator was not absorbed. The Lysholm, VAS and Tegner scale of all patients were better than those before operation.

CONCLUSIONTreatment of osteochondritis lesion with the fixation of absorbable cartilage nails may reconstruct the integrity of articular surface and recover the stability of joints, and it is an effective treatment method.

Adolescent ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Knee Joint ; surgery ; Male ; Osteochondritis Dissecans ; etiology ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Visual Analog Scale

Objective To study the operative techniques and clinical effect of arthroscopic reconstruction for posterior cruciate ligament (PCL) with ligament advanced reinforcement system (LARS)Y-shape double bundles artificial ligament.Methods From June 2006 to August 2010,14 patients (10 males and 4 females,at age range of 19-58 years,mean 38 years) with PCL ruptures were treated with LARS under arthroscopic observation.The injury causes included sports contusion in nine patients,traffic accidents in three and falling from height in two.Five patients were with left knee injury and three with right knee injury.The course of injury was 10-30 days (average 15.7 days).MRI indicated complete PCL ruptures in 14 patients and complete anterior cruciate ligament (ACL) ruptures in two.The combined injuries included medial meniscus injury in five patients,lateral meniscus injury in three and posterior acetabular wall fracture in one.The preoperative Lysholn score was (40 ± 7.9 ) points ( range,20-55 points).According to the international knee documentation committee (IKDC) grading,three patients were rated as grade C and 11 as grade D preoperatively.The operation was performed under arthroscopic observation.The ending point and tunnel of PCL of the femur and tibia were drilled with the help of a locator.ResultsAll the patients obtained primary healing,with no complications such as infection,spontaneous rupture or laxity of graft postoperatively.The regular follow-up for all cases ranged from6-60 months ( average 20.5 months).The postoperative Lysholn score was ( 88 ± 3.6 ) points ( 84-93 points),with statistical difference in comparison with the preoperative score (P ＜ 0.05 ) The IKDCgrading was A in 10 patients and B in four 12 months postoperatively. ConclusionsArthroscopic reconstruction with LARS artificial ligaments can effectively recover the stability of the knees,avoid the complications brought by autologous tendon and prevent the allograft rejection complications induced by allogenic tendon graft.The treatment is characterized by simple procedures,minor wound and fast recovery.

OBJECTIVE To investigate the clinical manifestation,diagnosis and treatment of Castleman disease(CD)in the neck. METHODS The data of 2 patients with pathological proved CD in the neck,who were seen in our hospital,were reviewed retrospectively in order to analyze their clinical manifestations,clinical and histological types, imaging characteristics and treatment. RESULTS The age of onset were 24 and 29 years respectively. Both of them only presented as a solitary,painless neck mass and met the criteria of localized CD, and also had histological evidence of the hyaline vascular variant. Complete surgical resection was the first treatment.Both of them were alive without evidence of recurrence for one year and half a year respectively. CONCLUSION CD in the neck often presents as localized lesion,which often presents as a progressive, painless, slowly growing lymph node enlargement that is generally asymptomatic. The locations most commonly are the cervical lymph nodes. CD in the neck is almost always the hyaline-vascular variant and complete surgical excision of the tumor is the best treatment.

CD4 Antigens ; immunology ; Humans ; Interleukin-2 Receptor alpha Subunit ; immunology ; T-Lymphocyte Subsets ; immunology ; physiology ; T-Lymphocytes, Regulatory ; physiology

This study was to evaluate the feasibility of hepatectomy for primary liver cancer (PLC) without hepatic blood flow occlusion. Methods 194 PLC patients admitted between 1988～1998 underwent hepatectomy without hepatic blood flow occlusion including nonanatomical hepatectomy (100 cases),hepatolobectomy (41 cases), combined adjacent organ resection (30 cases), hepatic segmentectomy (22 cases) and left hemihepatectomy (3 cases). Results Operative time was 2 4 hr, intraoperative blood transfusion averaged at 649 ml. Operative complication rate was 18 0%, and there was no mortality. Conclusion Hepatectomy without hepatic blood flow occlusion for PLC patients can be performed safely, so it is a useful technique for hepatectomy.

Objective To investigate the regulation of melatonin (MT) on Toll-like receptor 4 (TLR4) signaling in diabetic db/db mice kidneys.Methods The 48 10-week-old male db/db mice were randomly divided into db/db group,db/db+MT 50 μg/kg group,db/db+MT 100 μg/kg group and db/db+MT 200 μg/kg group,each consisting of 12 mice.These mice received i.p.injections of MT These mice received i.p.injections of MT [dissoved in phosphate buffer solution (PBS)/ dimethylsulfoxide (DMSO) solution,given every day].Alternatively,12 db/m mice served as the control group.db/m and db/db group were injected i.p.with the same volume of PBS/DMSO solution.The animals were sacrificed after 12 weeks of dosage administration.Blood glucose (BG),body weight (BW),kidney weight (KW) and 24 h urinary albumin excretion rate (UAER) were determined;Kidney pathological lesions were evaluated by renal pathological staining.Immunohistochemistry of renal TLR4,NF-κB p65,and ED-1 was performed to determine the immunoreactivity.Western blotting was used to detect the expression of renal TLR4,myeloid differentiation factor 88 (MyD88),TIR-domaincontaining adaptor inducing interferon-β (TRIF),interferon regulatory factor 3 (IRF-3) and NF-κB p65,while the mRNA expressions of renal tumor necrosis factor-α (TNF-α) and monocyte chemotactic protein-1 (MCP-1) were evaluated by real-time PCR.Results Compared with control group,the levels of BG,BW,KW and UAER were much higher in db/db mice group (P ＜ 0.01),while KW in db/db+MT (100,200 μg/kg) groups and UAER level in db/db+MT (50,100,200 μg/kg) groups were distinctly decreased compared with those in db/db group (P ＜ 0.01).In week 12 db/db mice,the glomerular mesangial expansion index and tubulointerstitial injury index were increased compared with those in db/m mice (P ＜ 0.01).The above kidney histopathologic lesions were distinctly ameliorated by 50,100,200 μg/kg MT (P ＜ 0.05).Immunohistochemistry intensity of renal TLR4,NF-κB p65 and ED-1 displayed obvious differences between db/m mice and db/db mice (P ＜ 0.01),and that were remarkably decreased in db/db+MT (50,100,200 μg/kg) mice compared with db/db mice (P ＜ 0.05).Western blotting showed that the protein expression of renal TLR4,MyD88,TRIF,IRF-3 and NF-κB p65 were stronger in db/db group compared with those in db/m group (P ＜ 0.05) and weaker in db/db+ MT (50,100,200 μg/kg) groups compared with those in db/db group (P ＜ 0.05).Futhermore,the mRNA expressions of renal MCP-1 and TNF-α were higher in db/db group compared with those in db/m group (P ＜ 0.01) and lower in db/db+MT (50,100,200 μg/kg) groups compared with those in db/db group (P ＜ 0.01).Conclusion Melatonin may partly down-regulate TLR4 signaling pathway to inhibit Inflammatory reaction and alleviate kidney injury in diabetic db/db mice.

Objective To explore the complication and its cause and treatment of pace markers implantation in older patient.Methods Among 205 older patients aged 70 to 90 years,103 were male,the others were female.Of these patients,162 were implanted with single chamber pace marker,43 with dual chamber pace markers.Results 21 patients happened complication(10.2%),the common complications related to operation were blood effusion and hematoma formation in pocket 12 cases,lead dislodgement 4 cases and infection with or without pocket rapture 2 cases.Occurrence of blood effusion was related to aspirin administration,lead dislodgement and infection with or without pocket rapture were related to operation.Conclusion To pay attention to ample preparation,close operation and strict observation can decrease the complication rate when pace marker is implanted.The serious result will be avoided by timely and effective treatment.The older patient with pace markers implantation is safe.

40/h) and non-severe group(n=15,AHI 5-40/h).Anthropometric measurements,fasting plasma glucose,insulin,blood fat,and CT quantitative measurement of abdominal adipose tissue were recorded. Results Insulin resistance index(HOMA-IR) in patients with OSAS was related to hypoxia independently of obesity variables.The severe group was characterized by more serious metabolic disorders and higher prevalence of metabolic syndrome than the non-severe group.OSAS was positively associated with an increased metabolic disorders risk for the severe group versus the non-severe group(OR=8.8).Using the receiver operating characteristic(ROC) curve analysis,waist circumference had the greatest areas under the ROC curves compared with body mass index and neck circumference.The results of multiple stepwise regression of lowest pulse oxygen saturation(LSpO2)during overnight sleep indicated that neck circumference followed by epworth sleepiness score(ESS) entered the equation(P

Background As a new tonometer,it is necessary to assess the clinical value of Icare rebound tonometer.Objective This study was to compare the intraocular pressure(IOP)values measured by Icare with that measured by GAT,and discuss the clinical value of leare rebound tonometer. Methods IOP measurement was performed on 152 eyes of 78 subjects with suspicious glaucoma,glaucoma,refractive error and normal examinnee by Icare and GAT respectively.The Icare IOP was measured firstly and then the GAT IOP was carried out with the 3-or 5-minute interval.The IOP values were compared between Ieare and GAT.This study was approved by Ethic Committee of Wuhan General Hospital of Chinese PLA.Written informed consent was obtained from each subject prior to this study. Results The mean IOP values of Icare and GAT were(19.16±5.03)mmHg and(18.41±4.52)mmHg respectively.The differences between Icare IOP and CAT IOP were less than or equal to 1 mmHg in 96 of 105 eyes(63.2%).The positive correlation was found between the Icare IOP and GAT IOP(r=0.940,P<0.01).The Ieare IOP was lower than that of GAT when IOPIcare<16 mmHg,however,the IOP of Icare were higher when IOPIcare≥6 mmHg;the IOP of Icare were higher than that of GAT in the total CCT range.The correlation coefficients of IOP of Icare or CAT with CCT were 0.341(P<0.01)and 0.333(P<0.01),respectively. Conclusion Compared with GAT,Icare is more feasible in clinic because it is practicable and reliable.

Objective To explore the value of carbon nanoparticles in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy combined with ipsilateral central lymph node dissection.Methods 43 patients with unilateral PTC were retrospectively analyzed.All patients underwent total thyroidectomy combined with central lymph node dissection.Patients were divided into carbon nanoparticles group and the control group according to whether carbon nanoparticles were used in the operation.The operation time,postoperative hospitalization time,the serum calcium level and its rate of change,the parathyroid hormone and its rate of change on the 1 st day after surgery,the number of central lymph node and the transfer rate,and the postoperative complications were compared between the 2 groups.Results There was no statistical difference between the 2 groups in operation time(P ＞ 0.05),while the postoperative hospitalization time of the carbon nanoparticles group was shorter than that of the control group(P ＜ 0.05).The serum calcium and the parathyroid hormone on the 1 st day after surgery in the carbon nanoparticles group was (2.31 ± 0.13) mmol/L and (33.45 ± 14.37) pg/ml respectively,higher than those of the control group (P ＜ 0.05).The low blood calcium rate (3/20 (15％)),the temporary hypoparathyroidism rate (2/20 (10％)) and the decline degree of parathyroid hormone (47.3 ± 14.31)％ in the carbon nanoparticles group were lower than those of the control group(P ＜0.05).The number of central lymph node dissected (9.45 ± 2.33) pieces/case in the carbon nanoparticles group was more than that of the control group (P ＜ 0.05).The number of lymph node in the right recurrent laryngeal nerve (3.12 ± 0.65) pieces/case was more than that of the control group(P ＜ 0.05).The lymph node metastasis rate had no significant difference between the 2 groups(P ＞ 0.05).The incidence of postoperative complications in the carbon nanoparticles group was lower than that of the control group (P ＜ 0.05).Conclusion The application of carbon nanoparticles in total thyroidectomy combined with central lymph node dissection can contribute to the recognition and protection of parathyroid glands and its blood supply,improve the rate of central lymph node dissection,and reduce the incidence of postoperative complications.