This article summarizes transforming growth factor-β1 in the primary hepatocellular carcinoma's occurrence and development, and carries on the summary to its possible mechanisms, and explains the research progress and the hot spot at present, then discusses the questions.

[Objective]To evaluate the value of clinical examination and magnetic resonance imaging in diagnosing chronic anterior cruciate ligament injury.[Method]Sixty-five patients with the diagnosis of chronic anterior cruciate ligament injury were retrospectively analyzed about the course of diagnosis and treatment.To gain the primary diagnosis through clinical examination,8 patients were performed magnetic resonance imaging.Finally all the patients were carried out arthroscopic surgery to make a final diagnosis.[Result]Arthroscopy found 53 cases with complete anterior cruciate ligament tears,12 cases with partial anterior cruciate ligament tears.In the complete anterior cruciate ligament tears cases,79.2% patients had positive anterior drawer test,96.2% had positive Lachman test and 92.5 % had positive pivot shift test.In the partial anterior cruciate ligament tears cases,16.7% patients had positive anterior drawer test,50.0% had positive Lachman test and 33.3 % had positive pivot shift test.The accuracy of MRI in diagnosing anterior cruciate ligament tears was 100%.[Conclusion]Clinical examination and magnetic resonance imaging can diagnose chronic anterior cruciate ligament effectively.

Objective To study the feasibility and short-term effects of arthroscopic anterior cruciate ligament (ACL) reconstruction by using the Ligament Advancement Reinforcement System (LARS) artificial ligaments. Methods Arthroscopic ACL reconstruction was carried out in 16 patients with ACL injuries by using the LARS artificial ligaments. Bone tunnels of the femur and the tibia were prepared with an identical interval between each other. The artificial tendon was inserted into the tunnels, and then, fixed with 2 interface screws after being tightened, with the free end of the tendon within the articular cavity. The complicated injuries were treated simultaneously. Results The operation time was 51~86 min (mean, 64 min). No postoperative complications such as synovitis, ligament rupture, or movement restriction occurred. A follow-up checkup was made in the 16 patients for 1.5~6 months (mean, 3.8 months). The International Knee Documentation Committee (IKDC) scores showed 6 cases of grade C and 10 cases of grade D before the surgery, while 6 cases of grade A, 9 cases of grade B, and 1 case of grade C after the surgery ( ? 2 =6.264, P

Objective The attempts was made to compare the results of a quadruple-strand semi-tendinosus tendon versus patellar tendon reconstruction for anterior cruciate ligament by arthroscopy in chronic complete anterior cruciate ligament injury.Methods60patients were enrolled in a prospective,ran-domized,controlled study.30patients underwent reconstruction with a quadruple-strand semitendinosus tendon autograft,30patients were treated with a bone-patellar tendon-bone autograft.The surgery was car-ried out in an alternating sequence with two autograft constructed materials.At the time of arthoscopy,the knee was examined totally,associated joint pathology was documented,and irreparably torn meniscal frag-ments were removed.60patients were followed up14to30months after operation,and evaluated in terms of the clinical test findings,the activity level,the functional status in daily activities,the range of motion,the stability of the knee,the level of return to sports and the patellofemoral crepitus at final follow-up.Results The objective outcome of replacement with a bone-patellar tendon-bone graft was identical to that obtained with a quadruple-strand semitendinosus tendon graft.The stability of the knee in the quadrupled-strand semitendinosus reconstruction was equal with that in the bone-patellar tendon-bone autograft.The return to sport was more frequent in the quadrupled-strand semitendinosus group comparing with in the bone-patellar tendon-bone group,there was80%and73%in each group respectively with no significant difference.A mild loss(≤3?)of knee extension was more frequent in the patellar tendon group than that in the quadru-pled-strand semitendinosus group,there was40%and6%in each group respectively,the difference was sig-nificant statistically.KT-2000arthrometer side-to-side difference of anterior displancement was13%versus20%in the quadrupled-strand semitendinosus group and patellar tendon group at133.4N.Patellofemoral crepitus was6%and17%in the quadrupled-stranded semitendinosus group and patellar tendon group re-spectively.Conclusion In a chronic complete injury of anterior cruciate ligament,the clinical results of re-construction with a quadrupled-strand semitendinosus tendon or patellar tendon by arthroscopy were satis-factory without significant differences between the two operative procedures.

BACKGROUND: Knee arthroplasty can correct the joint deformity, alleviate the pain and improve the joint function,thereby improving the patients' quality of life. Early rehabilitative training is the key to the functional recovery of the joint.OBJECTIVE: To observe the clinical effectiveness of early gait training on the rehabilitation of patients after knee arthroplasty.METHODS: Eighty-six cases undergoing unilateral knee arthroplasty in the Department of Sports Medicine were selected and randomly divided into experimental and control groups (n=43 per group). The experimental group wasgiven rehabilitation instruction before operation, and the gait training was carried out just after the operation. The patients in the control group only received the basic rehabilitation training. The Visual Analogue Scale and the Hospital for Special Surgery scores were evaluated at baseline and 2, 4, and 8 weeks, and 6 months postoperatively, and the clinical effectiveness was compared between two groups.RESULTS AND CONCLUSION: (1) The range of motion of the knee in the experimental group was significantly higher than that in the control group at 4 and 8 weeks, and 6 months postoperatively (P < 0.05). (2) At 8 weeks and 6 months postoperatively, the Visual Analogue Scale scores in the two groups both were significantly decreased (P < 0.05). (3) At 2 weeks postoperatively, the Hospital for Special Surgery scores in both groups were significantly increased (P < 0.05);the scores at 8 weeks postoperatively in the experimental group were higher than those in the control group (P > 0.05);the scores at 6 months postoperatively in the experimental group were significantly higher than those in the control group (P < 0.05). (4) These findings suggest that compared with conventional training, early gaiting training can significantly improve the range of motion and pain of the knee, as well as enhance the functional recovery of the knee joint, which exhibits remarkable curative efficacy in the rehabilitation following knee arthroplasty.

Objective To compare the lower limb alignment and prosthesis position after total knee arthroplasty (TKA) with or without using electromagnetic navigation.Methods Sixty-four patients (100 knees) underwent TKA under electromagnetic navigation,while 62 patients (100 knees) underwent conventional TKA.Three months after operation,the mechanical axial line angle and prosthesis position (angels α,β,γ) were measured via the full-length radiograph of both lower limbs and anteriorposterior and lateral Xrays of the knee.Results The average mechanical axial line angle and angle α were 1.20°±1.92°and 89.33°±1.64° in navigation group,respectively,and 2.31°±2.25° and 88.68°±2.57° in conventional group.And the differences were significant with regard to the above two indexes between two groups.The average angle β and angle γ were 89.64°±1.47° and 90.86°±2.37° in navigation group,respectively,and 89.26°±2.05° and 90.59°±3.44° in conventional group.However,the differences were not significant with regard to the above two indexes between two groups.After operation,mechanical axial line angle error was within ±3°in 86％ of patients in navigation group,while in 79％ of patients in conventional group; there was no significant difference between them.The angle α error was within 90°±3° in 92％ of patients in navigation group,while in 77％ of patients in conventional group; there was significant difference between them.However,there were no significant differences in percentage of patients whose errors of angle β and angle γ were within 90°±3° between two groups.Conclusion With using electromagnetic navigation in TKA,more precise prosthesis position and the mechanical axis can be achieved compared with the conventional technique.And its advantages mainly contribute to the coronal plane of the femoral side rather than the tibial side.

Objective To compare the therapeutic effect between Kirschner wire- loop plating and clavicular hook plate in the treatment of distal clavicle fractures. Methods Forty- two patients with type Neer Ⅱ distal clavicle fracture were selected, among whom 23 patients were treated with Kirschner wire- loop plating (group A), and 19 patients were treated with clavicular hook plate (group B). The operative time, fluoroscopy time, length of incision, intra- operative bleeding volume and hospitalization time etc were recorded. The patients were followed up at 6 weeks, 3 months, 6 months and 12 months after operation. The American shoulder and elbow society (ASES) score was evaluated, and the therapeutic effect was evaluated by Karlsson standard. Results The operative time and fluoroscopy time in group B were significantly lower than those in group A: (63.5 ± 12.4) min vs. (71.5 ± 11.1) min and (3.6 ± 1.9) s vs. (4.8 ± 1.5) s, but the intra- operative bleeding volume, length of incision and cases of postoperative shoulder pain in group A were significantly lower than those in group B:(91.5 ± 18.5) ml vs. (108.7 ± 32.5) ml, (6.6 ± 0.7) cm vs. (11.3 ± 0.9) cm and 2 cases vs. 14 cases, and there were statistical differences (P<0.05 or <0.01). There was no statistical difference in hospitalization time between 2 groups (P>0.05). There was no statistical difference in ASES score at 6 weeks and 3 months after operation between 2 groups (P>0.05); but the ASES score at 6 and 12 months in group A was significantly higher than that in group B: (89.9 ± 12.6) scores vs. (79.7 ± 12.6) scores and (96.1 ± 4.8) scores vs. (86.1 ± 12.4) scores, and there was statistical difference (P<0.05 or <0.01). There was no statistical difference in the cases of good and excellent at 6 weeks, 3 months and 6 months after operation (P>0.05);but the cases of good and excellent at 12 months in group A was significantly more than that in group B:23 cases vs. 13 cases, and there was statistical difference (P<0.05). Conclusions Kirschner wire- loop plating provides a new treatment option for type Neer Ⅱ distal clavicle fractures. It is conducive to decrease the incidence of shoulder pain and improve the range of motion of should joint. Besides, this technology has advantage of small incision, relatively simple operation steps and small damage to the surrounding soft tissues of the acromioclavicular joint. It may be superior to the clavicular hook plate.

Objective:To investigate whether knee osteoarthritis has an impact on the patient′s depression and whether it′s progression will affect the patient′s depression, and to provide a reference for clinical work.Methods:Patients diagnosed with osteoarthritis in Dalian Central Hospital from 2016 to 2019 were divided into 4 groups according to Kellgren-Lawrence staging, and the patients were scored on WOMAC scale, AKSS clinical scale, and AKSS. The score of the scale and the score of the HAMD scale were collected and statistically analyzed using SPSS 17.0.Results:χ2 test was used to show that there was no difference in the gender composition of patients in different stages ( P<0.05). The AKSS clinical scale score, AKSS functional scale score, WOMAC scale score and HAMD scale score were statistically analyzed for each stage. The results showed that the average AKSS clinical scores of patients in each stage were as follows: stage Ⅰ: (90.01 ± 8.41) points; stage Ⅱ: (79.98 ± 10.93) points; stage Ⅲ: (71.78 ± 13.64) points; stage Ⅳ: (54.18 ± 12.58) points. The AKSS functional scores were as follows, stage Ⅰ: 100 points; stage Ⅱ: 80 points; stage Ⅲ: 70 points; stage Ⅳ: 45 points; the average WOMAC scale scores of patients in each stage were as follows, stage Ⅰ: (28.69 ± 19.22) points ; stage Ⅱ: (49.43 ± 22.69) points; stage Ⅲ (70.13 ± 24.84) points; stage Ⅳ: (107.79 ± 24.39) points. The average HAMD scale scores of patients in each stage were as follows, stage Ⅰ: (4.89 ± 3.42) points; stage Ⅱ: (7.65 ± 4.20) points; Stage Ⅲ: (9.05 ± 5.03) points; stage Ⅳ: (12.35 ± 5.41) points. The analysis showed that there were significant statistical differences in the scale scores between each period ( P<0.05). There was a correlation between the patient′s depression status and the patient′s age, pain, and joint function, and there were statistical differences ( P<0.05). Conclusions:There is a significant correlation between depression and pain and function in patients with knee osteoarthritis. The progress of the osteoarthritis course will aggravate the patient′s depression state. Conversely, the patient′s depression state can also aggravate the symptoms of osteoarthritis patients and affect the clinical efficacy of the patients.

aration caused by varieties of violence does not catch the attention of domestic orthopedic surgeons enough in the past years.This passage is to discuss the damage mechanism,clinical treatment and prognosis evaluation of this kind of injury through the analysis of the case of Logsplitter injury.Methods Retrospective analysis 23 patients of Logsplitter injury from December 2006 to December 2014,male in 17 cases,female in 6 cases,average age (43.68±12.67) years (21-60 years).Hurt injury in 9 cases,sports injury in 1 case,falling injury in 2 cases,traffic injuries in 10 cases,crushing injury in 1 case.Open injures in 10 cases,of which the Gustilo Ⅱ type in 7 cases,Gustilo Ⅲ A type or above in 3 cases,closed injuries in 13 cases.According to the AO/OTA fracture classification,44c type in 19 cases,44b type in 3 cases,44a type in 1 case.Fibula fractures in 22 cases,19 cases of medial malleolus fracture.Results 23 patients received follow-up,with an average period was (0.91±0.26) years (0.4-2.37 years).21 cases underwent open reduction internal fixation (ORIF),2 cases underwent closed reduction external fixation and K-wire fixation.17 cases were fixed with the syndesmosis screws,among them,1 screw was used to fix 14 cases,two screws were used to fix 3 cases;the utilization rate of 3.5 mm screws is higher,at 94.1％,and all screws were entered through 3 layers of cortical;Combined with medial malleolus fracture cases were fixed with cannulated screws/K-wire internal fixation.Average healing time of the skin surrounding the ankle skin was (2.26±1.91) weeks;average healing time of fracture was (15.34±5.13) weeks;Joint pain ocurred combined with joint space narrowing after loading in 18 cases,at 78.3％;Postoperative infection,2 cases,the proportion was 8.7％;Fracture delayed union 1 case.Functional examination of the ankle joint (angle measurement method):Dorsiflexion average angle (23.9±2.21)degrees,Plantar flexion average angle (32.1 ±4.13) degrees.Average angle of introversion was (23.91 ±2.24) degrees.Hallux valgus average angle (27.6±3.81) degrees.75 points and over were got in AOFAS in 21 cases,the ratio of excellent was 91.3％.Conclusion Logsplitter injury represents a kind of important and unique ankle fracture,dislocation and the inferior tibiofibular syndesmosis separation caused by varieties of violence,accompany with potentially soft tissue injury and platford injury,according to existing treatment principle and treatment strategy summarizied by us,the clinical therapeutic effect of this damage is ideal,functional recovery is relatively satisfactory prognosis.

Aim: To establish a simple and convenient quality evaluation method for Fructus Gardeniae(FG).Methods: The internal standard correction factors(f_(km))of four crocetin derivatives to crocin-1 were established and the system suitability was tested.The content of crocin-1 was determined by external standard method,the contents of other crocetin derivatives were calculated by the content of crocin-1 and their f_(km).Results: There was no significant difference between the test results obtained by the methods oftheoretical calculation by f_(km)androutire determination technique.Conclusion: The internal standard correction method(the method oftheoreti-cal calculation by f_(km))is practical and feasible in the quantitative analysis of Frnctus Gardeniae.