BACKGROUND: Donor complications have been detected following autologous tendon transplantation for posterior cruciate ligament reconstruction. Although artificial tendon development and tissue-engineered tendon have achieved great progresses, there are some issues in clinical application. Since 1980's, allogenic tendon transplantation has aroused increasing attention. OBJECTIVE: To explore the selection of allogenic tendon materials and the effect of their application on reconstructing posterior cruciate ligament. METHODS: A total of 17 patients with posterior cruciate ligament injury of knee joint were treated with cryopreserved allogenic tendon by Tibial-inlay technique. During the operation, two tracts of tendons soaked in gentamicin saline for 15 minutes were conduplicated, and one end of the tendon was cancellous bone screw and fixed to the tibia attachment point of posterior cruciate ligament, and the other end was introduced into the joint through retention suture. The posterior joint capsule was repaired. The patient was placed at supine position, and the knee was flexed for 90°. The other end of the graft was introduced to femoral tunnel, and anterior drawer was tensed, and fixed by screw. RESULTS AND CONCLUSlN: The preoperative posterior drawer test of patients was >2+, including 7 cases of 3+ and 6 of 4+. The postoperative posterior drawer test was 0 in 4 cases, 1+ in 8 cases, 2+ in 4 cases and 3+ in 1 case, suggesting the posterior movement of the knee joint was significantly improved. Lysholm scores of patients were (48.5±4.3) points before operation and (88.3±5.4) points after operation. Results show that cryopreserved allogenic tendon by Tibial-inlay technique could restored function of posterior cruciate ligament with a favorable effect.

Objective To evaluate the effects of pregabalin combined with hydrochloric oxycodone on patients with ma-lignant neuropathic pain (MNP). Methods A total of 66 patients with MNP was divided into control group or treatment group randomly. The patients in control group received only hydrochloric oxycodone, and treatment group were treated with the combina-tion of pregabalin and hydrochloric oxycodone. Numeric rating scale (NRS) score was used to evaluate the analgesic effects. Med-ical outcomes study sleep scale (MOS-SS,Chinese version) was used to evaluate the improvement of sleep disorder. The changes of depression or anxiety were investigated by 17-item Hamilton Depression Rating Scale (HAMD-17) or Hamilton Anxiety Scale (HAMA), respectively. Side effects were accessed by Acute and Subacute Toxicity Grading Criteria of Anticancer Drugs (WHO). Results The pain control rate of treatment group was 87. 1% , which was superior to that of control group (58. 6% ) (P<0. 05). The improvement of sleep interference, and the quality and quantity of sleep in treatment group were also superior to that in control group (P<0. 05). After the treatment, depression and anxiety was attenuated in both groups, and the improvement degree in treatment group was higher than that in control group (P<0. 05). No obvious side effects were found in either groups. Conclusion The combination therapy of pregabalin and hydrochloric oxycodone is the better way to treat MNP.

BACKGROUND: Literatures report that double-bundle reconstruction is a better choice for posterior cruciate ligament (PCL),but Tibial-inlay technique exhibits no significant difference.OBJECTIVE: To evaluate the effect of Tibial-inlay technique used in the PCL reconstruction with allograft tendons.METHODS: Thirty-one patients with PCL rupture were verified by arthroscopy in the Department of Orthopaedics, at the Affiliated Hospital of Chengde Medical College between February 2006 and May 2008, including 14 knees caused by traffic accident injury,9 knees by crashing, and 8 knees by athletic injury. All the damaged PCLs were reconstructed with allograft tendons by Tibial-inlay technique under arthroscopy. During surgery, the remnants of the original PCL were retained as much as possible,PCL femoral tunnel was prepared. By using of allogeneic patella tendon with bone block at both ends or achilles tendon allograft with bone block at one side, the lateral bone block was chipped into trapezoidal block at a width of 1.0-1.5 cm and a length of 2 cm, that is, in addition to relying on friction force to fix between bone groove and bone graft, it can also generate compressive stress and increase its stability. The PCL tibial attached point was stripped, the trapezoid bone groove was prepared according to the size of bone block at the insertion site, and allogeneic bone block was embedded into bone groove, then the other end was introduced to femoral tunnel using pulling wire through the joint, after tensed at anterior drawer site, the extrusion screw was twisted forward to fix the tendon or bone. Before operation and during follow-ups, the posterior drawer test knee instability, joint activity, Lysholm knee function scores were recorded.RESULTS AND CONCLUSION: No severe complications, such as vascular nerve injury, rejection or infection, occurred in early stage after operations in 31 patients. All of them were followed up for 12-24 months. Posterior drawer test of all the subjects were above 2+ before operation, of which, 3+ and 4+ were 84%; the posterior drawer test re,suits were as the following after operation:4 cases of 0+ (normal), 17 cases of 1 +, 9 cases of 2+ and 1 case of 3+, which shows the improvement of retroposition (P ＜ 0.05);Lysholm score was remarkably improved at follow-up compared with preoperation (P ＜ 0.05), and there were significant improvements in the joint range of motion (P ＜ 0.05). The reconstruction of PCL by Tibial-inlay technique with allograft tendons has advantages of minimal trauma in surgery, reliable fixation and satisfactory outcome.

Objective:To investigate MRI texture features reflecting short-term medial femoral cartilage variations after anterior cruciate ligament (ACL) reconstruction.Methods:A retrospective case series analysis was conducted referring to the data of 20 patients who received ACL reconstruction at First Affiliated Hospital of Fujian Medical University from January 2017 to January 2020 including 17 males and 3 females, aged 23-43 years [(32.1±5.4)years]. The patients were evaluated before operation and at 1, 4, 12, 24, 48 weeks after operation: (1) the region of interest (ROI) in medial femoral cartilage was divided into ROI1 (meniscus anterior horn cartilage), ROI2 (meniscus body cartilage) and ROI3 (meniscus posterior horn cartilage) according to MRI image acquisition of the affected knee. The texture feature parameters were extracted for screening and analyzing to obtain the parameters reflecting sensitivity to cartilage variations; (2) the level of urinary C-telopeptide of type II collagen (uCTX-II) was measured by ELISA. At different time points, differences in texture feature parameters were compared to screen the parameters most sensitive to cartilage variations, and uCTX-II level were compared as well. Then, Pearson correlation analysis was used to determine the correlation between texture feature parameters most sensitive to cartilage variations and uCTX-II level.Results:After screening and analyzing, the horizontal direction of gray level non-uniformity (Horzl_GlevNonU) and Skewness of histogram (Skewness) of ROI3 were selected as sensitive texture feature parameters reflecting sensitivity to cartilage variations. There were significant difference in the Horzl_GlevNonU and Skewness of ROI3 before operation and at 1, 4, 12, 24, 48 weeks after operation (all P<0.05). Meanwhile, the Horzl_GlevNonU and Skewness of ROI3 were gradually increased over time, with a more significant tendency in the Horzl_GlevNonU. The Horzl_GlevNonU of ROI3 was similar at 4 weeks and 12 weeks after operation ( P>0.05), with significant differences at other time points (all P<0.05). The Skewness of ROI3 was significantly different at 1 week and 48 weeks after operation ( P<0.05), with insignificant differences at other time points (all P>0.05). The Horzl_GlevNonU of ROI3 was selected as the most sensitive texture feature parameter reflecting cartilage variations. Significant difference was reported in uCTX-II level before operation and at 1, 4, 12, 24, 48 weeks after operation (all P<0.05). After Pearson correlation analysis, the Horzl_GlevNonU of ROI3 was positively correlated with uCTX-II level before operation and at 1, 4, 12, 24, 48 weeks after operation ( r=0.554, 0.596, 0.550, 0.632, 0.756, 0.514, P<0.05 or 0.01). Conclusion:The Horzl_GlevNonU of ROI3 is the most sensitive texture feature parameter that reflects the early variations of medial femoral cartilage after ACL reconstruction and is positively correlated with uCTX-II level.

Objective:To evaluate the efficacy and safety of lenvatinib combined with camrelizumab as the second-line treatment for advanced intrahepatic cholangiocarcinoma (ICC).Methods:The clinical data of patients with advanced ICC undergoing the second-line treatment of lenvatinib combined with camrelizumab in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from June 2021 to June 2022 were screened and analyzed. A total of 12 patients were enrolled, including seven males and five females, aged (67.5±8.6) years. Response evaluation criteria in solid tumor 1.1 was used to evaluate the efficacy of treatment. The safety assessment adopts the Adverse Event Evaluation Standard 5.0. Kaplan-Meier method was conducted to plot survival curves.Results:Among the 12 patients (after 1-7 cycles of immune and targeted therapy), three achieved partial response, four achieved stable disease, and five were defined as progression disease. Adverse events of different degrees occurred in seven cases, among which three patients had adverse events of grade ≥ 3: one with hypertension, which was managed after antihypertensive and symptomatic treatment; one with elevated serum total bilirubin, which was improved after reducing the dose of lenvatinib; one with liver dysfunction, which was considered as immune-related liver toxicity and alleviated after discontinuing camrelizumab. The 1-month, 3-month, and 6-month survival rates and progression-free survival rates of the patients were 100.0%, 91.7%, 66.7%, and 83.3%, 41.7%, and 25.0%, respectively. The median overall survival of patients was 14.7 months (95% CI: 9.2-21.2) and the median time to progression was 8.0 months (95% CI: 4.1-11.9). Conclusion:Combination of lenvatinib and camrelizumab could bring survival benefits with controllable adverse events as the second-line treatment of patients with advanced ICC.