Objective To explore the mechanism of therapeutic action of needle knife “regulating sinews and treating bones” on knee osteoarthritis (KOA) by observing the effect of needle knife intervention on KOA rabbit behaviors, mechanical characteristics of patellar ligament (PL), and expressions of interleukin-4 (IL-4), matrix metalloproteinase-3 (MMP-3) and aggrecan in knee cartilages.Methods Forty New Zealand rabbits were randomly allocated to blank, model, needle knife and electroacupuncture groups, 10 rabbits each. A rabbit model of KOA was made by the modified Videman method of immobilization in extension position. After model making, the needle knife and electroacupuncture groups received needle knife and electroacupuncture treatments, respectively. A behavioral assessment was made using the modified Lequesne MG knee grade evaluation method in every group after model making and treatment. The samples were taken after treatment. PL tension, stress relaxation and creep state were tested using a Bose Electro Force 3300 protracted test machine. Cartilage cell IL-4 expression was examined by ELISA. MMP-3 mRNA and aggrecan mRNA expressions were detected by real-time PCR.Results After model making, there was a statistically significant difference in the Lequesne MG score between the model and blank groups (P<0.01); there was no statistically significant difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group (P>0.05). There was a statistically significant post-treatment difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group (P<0.01,P<0.05) and between the needle knife and electroacupuncture groups (P<0.05). There were statistically significant post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the model and blank groups (P<0.01,P<0.05). There were statistically significant post-treatment post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the needle knife and model groups (P<0.01,P<0.05). There was a statistically significant post-treatment difference in elastic modulus between the electroacupuncture and model groups (P<0.01). The IL-4 content and aggrecan mRNA expression decreased significantly and MMP-3 mRNA expression increased significantly in the model group after model making and there were statistically significant differences compared with the blank group (P<0.01,P<0.05). After treatment, the IL-4 content increased significantly in the needle knife and electroacupuncture groups compared with the model group (P<0.01,P<0.05) and aggrecan mRNA expression tended to increase in the two groups. The regulation of aggrecan mRNA and MMP-3 mRNA expressions was better in the needle knife group than in the electroacupuncture groups, but there was no statistically significant difference compared with the model group (P>0.05).Conclusion The mechanism of action of needle knife treatment on KOA may be that it improves ligament mechanical characteristics, regulates intra-articular stress environment, and modulates aggrecan mRNA and MMP-3 mRNA expressions and inhibits cartilage degeneration through IL-4 mechanical signal pathway, to produce the therapeutic effect of “regulating sinews and treating bones”.

Objective To investigate the effect of T lymphocyte proliferation,Th1 and Th2 cytokines on T cells from systemic lupus erythematosus (SLE)patients by blocking 4-1BB/4-1BBL.Methods The proliferation of T cells from 30 SLE patients and 20 normal controls was detected by MTT and the levels of patients stimulated with anti-CD3 McAb were significantly higher than those of T cells without stimulation(P＜IFN-γand IL-4 in SLE were significantly higher than those of normal controls(P＜0.01).There were more ex-pression of IFN-γ and IL-4 in supernatant of T cells from SLE after stimulated with anti-CD3 McAb(P＜0.01).However,the production of IFN-γ and IL-4 was inhibited by anti-4-1BB McAb(P＜O.05),and especially the level of IL-4 was markedly decreased.Conclusion Blocking 4-1BB/4-IBBL can significantlv inhibit the abnormal activation of T cells and the secretion of Thl and Th2 cytokines of SLE.

Objective To evaluate the application of percutaneous nephroscopy in the treatment of upper urinary tract transitional cell carcinoma, particularly renal pelvic carcinoma. Methods From June 2006 to June 2010, eight cases (with 10 sides) of renal pelvic carcinoma received percutaneous nephroscopy tumor resection. There were six males (with 7 sides) and two females (with 3 sides) in the study group. There were six cases with solitary kidney and two cases with bilateral renal pelvic tumors. There were four cases with high-grade tumors and six cases with low-grade tumors. The age of patients ranged from 52 to 72 yrs (average 61.2 yrs). Tumor sizes ranged from 0.5 to 3.5 cm (average 2.6 cm). Patients were treated with laser or electrocautery through percutaneous nephroscopy. A ureteral stent was placed in the patients after the procedure. Chemotherapy was administered postoperatively through the nephrostomy tube. Results All the operations were successfully completed uneventfully. The operative time was 45-95 min (average 73 min), estimated blood loss was 20-300 ml (average 50 ml). No remarkable differences were found in serum creatinine levels before and after operation. After 10 to 36 mon. follow-up by CT, MRI, and ureteroscopy, one patient died of tumor metastasis and two patients had local tumor recurrence. The remaining patients had no local recurrence. Conclusions Percutaneous nephroscopy in treating renal pelvic tumor is safe and feasible. This is a better choice for the renal pelvic carcinoma patients who are unsuitable for ureteronephrectomy.

BACKGROUND:Open fracture of lower limb with severe soft tissue and bone defects also accompanies anterior tibial soft tissue defects and exposure of sclerotin and steel plate, which can be crucial y treated with strong fixation and use of skin flap to block the wound.
OBJECTIVE:To explore the clinical efficacy of a large area of soft tissue defects in the anterior tibia using vacuum sealing drainage combined with groin free flap.
METHODS:A total of 24 patients with a large area of soft tissue defects in the anterior tibia were included in this study and then divided into two groups, with 12 cases in each group. In vacuum sealing drainage group, the scope of soft tissue defects was ranged from 10 cm×15 cm to 15 cm×20 cm. After the debridement, the fracture was fixed with external fixation scaffold and the wound was covered with the vacuum sealing drainage dressing. The blood clot was rinsed with normal saline via T-tube, and 7-10 days later the vacuum sealing drainage was given. According to the growth of granulation tissue, the wound was secondarily sutured, fol owed by groin free skin flap of superficial iliac circumflex artery with medial knee arteriovenous anastomosis transplantation. In the non-vacuum sealing drainage group, the wound size was ranged from 10 cm×5 cm to 30 cm×20 cm, the period from injury to admission was 1-24 hours. They were given conventional debridement and secondary fixation or skin flap transplantation.
RESULTS AND CONCLUSION:The length of preoperative hospital stay and the skin flap are in vacuum sealing drainage group were significantly better than those in non-vacuum sealing drainage group (P<0.05). There was no significant difference in the length of postoperative stay and total length of hospital stay between the two groups (P>0.05). The wound infection rate was 0 in vacuum sealing drainage group and 75%in non-vacuum sealing drainage group at 8-14 days after treatment. The wound and donor area incision were healed at I stage, the skin grafts survived. Al the involved patients in two groups were fol owed up, for 6-36 months. During the fol ow-up process, the fracture healing time in non-vacuum sealing drainage group was significantly longer than that in vacuum sealing drainage group. The skin flap in two groups was similar to surrounding skin in color and texture, the flap exhibited no vessels, no ulceration, and no clumsy. The vacuum sealing drainage combined with groin free flap can timely control a large area of soft tissue defects post-trauma, improve wound blood supply, shorten preoperative preparation time, early close the wound, significantly promote the healing of wound and fracture. The skin flap is soft, flexible, wel-looking, and active functional, it significantly shortens the course of treatment and maximizes the recovery of limb function.

Objective To discuss the optimal retrieval time of the indwelling Gunther Tulip and Cook Celcet inferior vena cava filters (VCF). Methods During the period from March 2013 to April 2015 at Shengli Oilfield Central Hospital, the implantation of retrievable inferior vena cava filter was performed in 58 patients. Among the 58 patients, Gunther Tulip VCF was used in 13 and Cook Celcet VCF was employed in 31. Twenty-one patients followed the doctor's advice to receive retrieval procedure of VCF within three months after the implantation. Results Among the 21 patients, successful retrieval of VCF was obtained in 19. The mean indwelling time of Gunther Tulip VCF was 54.4 days, the longest time being 79.0 days. Gunther Tulip VCF was successfully removed in 3 patients and retrieval of VCF failed in 2 patients, with a retrieval success rate of 60%. The mean indwelling time of Cook Celcet VCF was 37.6 days, the longest time being 67.0 days. Cook Celcet VCF was successfully removed in 16 patients, with the success rate of retrieval being 100%. Conclusion Despite many VCFs that have been indwelled for a long time can be safely retrieved, retrieval procedure should be performed as early as possible in order to improve the retrieval success rate of VCF. It seems that the use of Cook Celcet VCF is a better choice although it is more expensive.

Objective To investigate the differences of various two-stent techniques in vitro and virtual bench testing. Methods Stent implantation with classic crush, double kissing ( DK) crush and culotte stenting techniques were performed in the silicone simulation model of bifurcation vessels with various distal bifurcation angles. The whole processes were recorded by a micro-focus camera. Results Distal side branch (SB) re-crossing in classical crush technique left a significant gap without stent coverage near the carina in T type bifurcation model after final kissing balloon inflation (FKBI) . The gap was also noted in either classic crush with proximal SB re-crossing or DK crush with two times proximal SB re-crossing in T type bifurcation model. The size of the gap in DK crush technique was smaller than that of classic crush. In Y type bifurcation model, both DK crush and culotte stenting left no gap compared to T type bifurcation model. Two times proximal SB re-crossing in culotte stenting resulted in a new stent carina formation after FKBI. Conclusions Distal bifurcation angle was an anatomatic predictor of gap formation in two-stent technique. In T type bifurcation model, the size of gap in DK crush technique was smaller than that of classic crush. It was suggested to perform two times proximal SB re-crossing for DK crush technique and distal SB re-crossing for culotte stenting.

Objective To compare the clinical effects of catheter-directed thrombolytic therapy for acute superior mesenteric vein thrombus (SMVT) between via superior mesenteric vein (SMV) route and via superior mesenteric artery (SMA) route. Methods The clinical data of 32 patients with acute SMVT, who were treated with catheter-directed thrombolytic therapy at the Central Hospital of Shengli Oil Field, were retrospectively analyzed. Among the 32 patients, percutaneous transhepatic catheter-directed thrombolytic therapy via SMV route was performed in 23 (SMV group), and percutaneous transhepatic catheter-directed thrombolytic therapy via SMA route was carried out in 9 (SMA group). Results After the treatment, the clinical symptoms were significantly improved in 28 patients, including 22 of SMV group (95.7%) and 6 of SMA group (66.7%). CT angiography showed that the blood flow became almost complete patency in 17 patients of SMV group (73.9%) and in only 3 patients of SMA group (33.3%). Both the thrombolysis procedure time and X-ray exposure time of SMV group were obviously longer than those of SMA group. Conclusion Both via SMV and via SMA catheter-directed thrombolytic therapies are effective treatment for acute SMV thrombosis. The former is more effective, while the manipulation of the latter is technically simpler.

BACKGROUND: Following renal transplantation, native renal pelvic or ureteral tumor occurs not only on one side, but also on both sides simultaneously or continuously.OBJECTIVE: To describe a new procedure in managing native renal pelvic or ureteral tumor, in which, retroperitoneal laparoscopic nephroureterectomy was first done followed by transurethral resection of ureteral orifice, and finally the kidney and the complete ureter with a bladder cuff were taken out through a midline abdomen incision, and to validate its feasibility.DESIGN, TIME AND SETTING: A technique modification experiment was performed at the Department of Urinary Surgery, Third Hospital, Peking University between July 2004 and March 2006.PARTICIPANTS: Eight patients (7 males and 1 female) with native renal pelvic or ureteral tumor who received laparoscopic nephroureterectomy with bladder cuff resection were included into this study. Of them, 4 cases had bilateral lesions. Laparoscopic nephroureterectomy with bladder cuff resection was conducted 12 times totally.METHODS: Retroperitoneal laparoscopic nephroureterectomy was first done in the lateral decubitus, followed by transurethral resection of the ureteral orifice with resectoscope in the lithotomy position, and finally, an incision was created in the lower midline abdomen to allow dissection of the distal ureter and bladder cuff and intact specimen extraction. Postoperatively, intravesical chemotherapy was routinely performed to prevent tumor recurrence. The patients were followed up at 3, 6, and 12 months after surgery, and once a year thereafter.MAIN OUTCOME MEASURES: Surgery time, blood loss volume, pathological report, tumor recurrence time, tumor-free survival time, and complications.RESULTS: The mean surgery time was 3.8 hours (range: 2.5-7 hours). The mean hemorrhage volume was 240 mL (range: 50-1 200 mL). Two cases needed blood transfusion, 600 and 1 000 mL, respectively. Transitional cell carcinoma grade Ⅲ was found in 3 cases, grade Ⅱ in 4 cases, and grade Ⅰ-Ⅱ in 4 cases. In addition, there was 1 case presenting with tumor breaking through the serous membrane of the ureter and 1 case suffering from poorly differentiated adenocarcinoma. The tumor recurred locally in one case 6 months after surgery, and the remaining cases all survived in a tumor-free state.CONCLUSION: After renal transplantation, laparoscopic nephroureterectomy with bladder cuff resection through a lower midline abdomen incision is feasible for treatment of native renal pelvic or ureteral tumor, with low tumor recurrence rate and satisfactory excision effects.

Objective To describe our experience in laparoscopic radical prostatectomy (LRP)for incidental prostate cancer after TURP. Methods From April 2007 to July 2010, 5 patients with incidental prostate cancer after TURP were treated with a mean age of 73 years. The patients underwent LRP (2.8± 1.1) months after TURP. Results The five cases of LRP were performed successfully, with 1 case of transperitoneal approach and 4 cases of extraperitoneal approach. Mean operation time was (227.6±38.4) min, mean blood loss was (130±152.5) ml, and the mean follow-up was (16.1 ± 15.9) months. All five patients survived, and their urinary function was good without any incontinence. Conclusions Previous TURP represents a technical challenge when performing LRP, but highly skilled surgeons trained to perform LRPs can handle it.