Objective To explore the changing regularity of humeral distal epiphysial anteverted angulation with ultrasonic measurement. Methods Using an ultrasonic diagnostic apparatus with a high frequency bougie to detect the dextral elbow joint of 203 normal individuals whose age range is from 5 d to 23 years old. The subjects were divided into 5 groups by age (5 d-4 years old, 5-8 years old, 9-12 years old, 13-16 years old, ≥17 years old),and by sex into two large parts.Anteverted angulation of capitellum and lateral semitrochlear ossification center were measured with statistic analysis and correlation calculation.Results Anteverted angulation of capitellum was 48.89?? 8.96?, lateral semitrochlea 33.70?? 7.18?. Anteverted angulation of capitellum enlarges with age growth, and it reaches the climax ( 55.00?? 5.88?) at the age 13-16 years old. There was a significant difference among groups. After 17 years old, anteverted angulation slightly reduces to 52.38?? 8.27?, compared with the climax ( 55.00?? 5.88?), there was no statistical difference. Changing regularity of anteverted angulation was similar to that of capitellum. Just between the 5 d-4 years old group and 5-8 years old group, the difference was significant in angulation enlargement. There was no statistical difference among the groups above the 5-8 years old group, and no significant difference between male and female in humeral distal epiphysial anteverted angulation. Conclusions Ultrasonic examination can clearly display the images of humeral distal epiphysis. Observation and measurement is available for the epiphysial anteverted angulation by acoustic images, and the changing regularity of anteverted angulation can be illustrated.

Objective To investigate the therapeutic effect of the ultra-early stent-assisted coil embolization of the ruptured intracranial aneurysms. Methods The clinical data of 13 patients with ruptured intracranial aneurysm treated by ultra-early stent-assisted coil embolization were analyzed retrospectively. The preoperative Hunt-Hess gradeⅠ-Ⅱ was in 7 cases,gradeⅢ was in 4 cases,and grade Ⅳ was in 2 cases. The patients were treated with stent-assisted coil embolization under the general anesthesia with endotracheal intubation within 24 h of aneurysm rupture. The postoperative embolization was assessed according to the Raymond grading standard. The postoperative complications and the assessment of the follow-up results from 1 to 6 months after procedure according to the modified Rankin scale (mRS ) scores were observed. Results All 11 patients recovered well,1 case had postoperative hemiplegia,1 case had postoperative bleeding,and none of them died. During the follow-up period,no patients had rebleeding, 1 had recurrence,and DSA revealed that the patient was embolized completely at 2 months after reembolization. Conclusion The method of ultra-early stent-assisted coil embolization of ruptured intracranial aneurysms is feasible. It may improve the cure rate of the ruptured aneurysms and improve the prognosis of patients.

ObjectiveTo investigate the experience in the treatment of acute encephalocele associated with delayed intracranial hematoma during severe brain injury operation.Methods42 patients suffered from acute encephalocele during brain injury operation were,retrospectively analyzed.ResultsAll patients with acute encephalocele were associated with delayed intracranial hematoma.The effective treatment of acute encephalocele was to remove the hematoma out of the brain timely and thoroughly.33 patients survived the disorder of acute encephalocele,of which,good recovery occurred in 20 patients,moderate disability in 6 patients,severe disability in 4 patients,and vegetative state in 3 patients according to Glasgow Outcome Score 3 months later.ConclusionHead-CT scanning should be timely performed when intracperative acute encephalocele occurred,whereas the measures of efficacy improvement on acute encephalocele were to timely.

Objective To evaluate high resolution manometry in the diagnosis of hiatal hernia.Methods Clinical data were reviewed on 20 patients suffering from gastroesophageal reflux who had laparoscopic Toupet fundoplication for preoperative tentative diagnosis of hiatal hernia.Preoperative diagnosis of hiatal hernia was made collectively by endoscopy,X-ray examination,24 hour esophageal pH monitoring and high resolution manometry before surgery.Results Preoperative diagnosis of hiatal hernia was made in 3 patients by X-ray examination,in 9 patients by high resolution manometry.11 patients were finally diagnosed with hiatat hernia intraoperatively.X ray was consistent with intraoperative diagnosis in 27％ cases.Intraoperative and endoscopic diagnoses were 55％.High resolution manometry and intraoperative diagnoses were consistent in 82％.Lower esophageal sphincter length was (1.92 ± 0.38) cm in hiatal hernia group and (2.10 ± 0.92) cm in non-hiatal hernia group (t =0.60,P ＞ 0.05),lower esophageal sphincter pressure (respiratory min) was (0.64 ±0.55) kPa in hiatal hernia group and (1.31 ± 1.07) kPa in nonhiatal hernia group(t =1.80,P ＞ 0.05),and lower esophageal sphincter pressure (respiratory mean) was (1.43 ±0.92) kPa in hiatal hernia group and (2.57 ± 1.33) kPa in non-hiatal hernia group(t =2.26,P ＜0.05).The reflux parameters,including the percent total time pH ＜ 4,and DeMeester score,were significantly greater in hiatal hernia group than in non-hiatal hernia group (all P ＜ 0.05).Conclusions Hiatal hernia patients are with poor esophageal antireflux competency and severe reflux.High resolution manometry is more valuable in the diagnosis of hiatal hernia than endoscopy or X-ray examination.

BACKGROUND: Auditory evoked potential P50 (AEP-P50) is a cerebroeilectrophysiological index to directly reflect normal inhibitory function of brain.OBJECTIVE: To observe the changes of AEP-P50 of sensory gating (SG)in model rats with Alzheimer disease (AD).DESIGN: Randomized controlled animal study.SETTING: Neuroscience Institute of Kunming Medical College.MATERIALS: A total of 24 healthy female SD rats, aged 4-6 months,weighing 200-300 g, were randomly divided into experimental group, control group and normal group with 8 in each group. Morris water maze was consisted of round pool and lucite plant. Pool was divided into platform,left, right and bilateral quadrants. METHODS: The experiment was carried out in the Neuroscience Institute of Kunming Medical College from September 2003 to March 2005. ① Experimental group: Bilateral fimbria-fornix was transected to induce AD models; control group: Except fimbria-fornix, cortex and callus were transected; normal group: Rats were not treated with any operation. ② One week after modeling, all rats were tested with Morris water maze which contained localizing navigational ability and spatial seeking ability in order to determine successful models. Each rat was trained 4 times a day for successive 5 days. The duration from putting in pool to finding out platform was regarded as the escape latency (EL) which could reflect localizing navigational ability. Swimming trace of rats which searched platform within 1 minute could reflect spatial seeking ability. ③ AEP-P50 was recorded with "condition (C)-test (T)" auditory double clicks stimuli, additionally,differences of AEP-P50 among the three groups were compared at the same time. C-P50 amplitude, T-P50 amplitude, T/C and absolute value of difference of S2-S1 amplitude were calculated. Measurement data were compared with one-way analysis of variance among groups and with t test intergroup.MAIN OUTCOME MEASURES: ① Morris water maze, I.e., comparison between localizing navigational ability a nd spatial seeking ability; ② comparison of AEP-P50 of rats among three groups.RESULTS: All 24 rats were involved in the fin al analysis. ① results of Morris water maze: With increase of training time, mean latency was shortened. The latency was decreased in the first 3 days and then stabilized gradually. Latency in experimental group was longer than that in normal group and control group (P ＜ 0.05). Swimming traces in normal group and control group were located at platform quadrant, and they were accounted for 45.23% and 39.7% of total quadrant, respectively. There was significant difference as compared with other quadrants (P ＜ 0.01). Swimming traces of rats in experimental group were accounted for 28.31%, 29.84%,20.47% and 21.38% in platform, right, bilateral and left quadrants, respectively; however, there was not significant difference (P ＞ 0.05). Swimming trace was randomly located in four quadrants. ② Results of AEP-P50 of SG: C-P50 amplitude and absolute value of difference of S2-S1 amplitude were (21.00±2.85), (15.26±4.07) μV in control group and (17.04±5.32), (10.85 ±4.24) μV in normal group, which were obviously higher than those in experimental group [(9.67±3.77), (2.89±2.61) μV, P ＜ 0.01].T-P50 amplitude and C-P50 amplitude were 0.25±0.18 in control group and 0.39±0.16 in normal group, which were lower than those in experimental group (0.92±0.41, P ＜ 0.01).CONCLUSION: ① Transection of bilateral fimbria-fornix can be used to establish AD animal models successfully. ② AD model rats whose bilateral fimbria-fornix is transected have deficiency of SG.

Objective An experiment study on the femoral head plastic operation to prevent and treat aseptic necrosis of the femoral head. Methods 60 Chinese white rabbits were equally random divided into 4 groups. The four groups except A group were made a globose defect and filled with 95% alcohol tampon for 30 minutes. The B group was natural repair group. The C group was filled with bone cement after being made defect. The D group was filled with bone cement added barium sulfate agent after being made defect. After 12 weeks, all rabbits in four groups were killed. The specimens were random divided into two parts. The articular cartilage was observed and measured immediately. The other specimen was determined with histological examination and extreme anti-pressure rigidity test . Result The femoral heads of bone cement group and the femoral heads of contrast agent bone cement group kept their outline all the time through the articular cartilage observation. After 12 weeks the cartilage thickness of natural repair group (511.74 ± 69.00) was thinner than the other three groups [ control group ( A group ) (511.74 ± 69 00 );Bone cement group ( C group) (468. 36 ± 82. 99 ); Bone cement group contrast agent ( D group ) ( 515.61 ±64. 65 ) ], and it had significant difference ( P < 0. 05, P < 0. 01 ). The rigidity of natural repair group [ (676. 57 ±50. 92) N/mm] had significant difference with that of the other three groups[ A group( 884. 66±52. 29)N/mm;C group(1178.40 ± 170.45) N/mm;D group(928.60 ± 104.42) N/mm] ( P <0.05, P<0. 01 ). Conclusions Femoral head plastic operation was simple and it could release pain. And femoral head outline could be kept integrity. It would be a new operation which was used to treat young patients in Ficat Ⅱ～Ⅲ period to postpone or substitute total hip replacement.

Objective:To investigate the effects of continuous monitoring intracranial pressure (ICP) and brain oxygen partial pressure (PbtO 2) on the prognosis of patients with severe craniocerebral injury. Methods:A prospective randomized controlled trial was conducted. Seventy patients with severe craniocerebral injury with a Glasgow coma score (GCS) 4-8 admitted to the neurosurgical intensive care unit (NICU) of the People's Hospital of Inner Mongolia Autonomous Region from January 2017 to May 2020 were enrolled, and they were divided into ICP monitoring group and ICP+PbtO 2 monitoring group by random number table. Patients in ICP monitoring group received ICP monitoring and were given traditional treatment of controlling ICP and cerebral perfusion pressure (CPP), the therapeutic target was ICP < 20 mmHg (1 mmHg = 0.133 kPa) and CPP > 60 mmHg. Patients in ICP+PbtO 2 monitoring group were given ICP and PbtO 2 monitoring at the same time, and oxygen flow was adjusted on the basis of controlling ICP and CPP to maintain the PbtO 2 > 20 mmHg, and the therapeutic target of ICP and CPP was the same as the ICP monitoring group. ICP and PbtO 2 values were recorded during monitoring in the two groups, the results of CPP, GCS and arterial blood gas analysis were recorded, and the prognosis at 3 months and 6 months after injury was compared by Glasgow outcome scale (GOS) score between the two groups. GOS score > 3 was considered as good prognosis. Kaplan-Meier survival curve was drawn, and the 3-month and 6-month cumulative survival rates of the two groups were analyzed. Linear regression analysis was used to further evaluate the relationship between PbtO 2 and GOS score. Results:Finally, a total of 70 patients with severe craniocerebral injury were enrolled in the analysis, 34 patients received ICP combined with PbtO 2 monitoring and guided therapy, and 36 patients received ICP monitoring alone. The average ICP of ICP+PbtO 2 monitoring group was significantly lower than that of ICP monitoring group (mmHg: 13.4±3.2 vs. 18.2±8.3, P < 0.01). Although the CPP in both groups was great than 60 mmHg, the average CPP of ICP+PbtO 2 monitoring group was significantly higher than that of ICP monitoring group (mmHg: 82.1±10.5 vs. 74.5±11.6, P < 0.01). No significant difference was found in average GCS score or arterial partial pressure of carbon dioxide (PaCO 2) between the ICP+PbtO 2 monitoring group and ICP monitoring group [GCS score: 5.3±2.3 vs. 5.2±2.2, PaCO 2 (mmHg): 33.5±4.8 vs. 32.6±5.2, both P > 0.05]. The average arterial partial pressure of oxygen (PaO 2) of ICP+PbtO 2 monitoring group was obviously higher than that of ICP monitoring group (mmHg: 228.4±93.6 vs. 167.3±81.2, P < 0.01). Compared with the ICP monitoring group, the good outcome rates of 3 months and 6 months after injury in the ICP+PbtO 2 monitoring group were significantly higher (3 months: 67.6% vs. 38.9%, 6 months: 70.6% vs. 41.7%, both P < 0.05). Kaplan-Meier survival curve showed that the 3-month and 6-month cumulative survival rates of ICP+PbtO 2 monitoring group were significantly higher than those of ICP monitoring group (3 months: 85.3% vs. 61.1%, Log-Rank test: χ2 = 5.171, P = 0.023; 6 months: 79.4% vs. 55.6%, Log-Rank test: χ2 = 4.511, P = 0.034). Linear regression analysis showed that PbtO 2 was significantly correlated with GOS score at 3 months and 6 months after injury in patients with severe craniocerebral injury ( r values were 0.951 and 0.933, both P < 0.01). Conclusions:PbtO 2 compared with ICP monitoring guiding therapy is valuable in improving the prognosis of patients with severe craniocerebral injury. It can improve the prognosis at 3-6 months after injury.

Objective To investigate the effect of Zishen Yutai Pills on follicle apoptosis and related protein expression in diminished ovarian reserve(DOR) rat model induced by tripterygium glycosides.Methods Forty rats were divided into the control group,model group,progynova group,and Zishen Yutai Pills high and low dose groups,8 cases in each group.Tripterygium Wilfordii Glycosides Tablets were given by gavage for establishing the rat DOR model.Then the HE staining was used to detect the pathological morphology of rat ovary.All levels of follicles were counted.Expression levels of Bcl-2 and Bax protein in follicle and ovarian stroma of each group were detected by using the immunohistochemical method.Results Compared to the control group,the number of great and small follicles in the model control group was decreased,number of atretic follicles was increased,Bcl-2 expression in all kinds of follicles was decreased,and Bax expression was increased,the differences were statistically significant(P＜0.05).Compared to the model group,the number of great and small follicles in the Zishen Yutai Pills high and low dose groups and progynova group was increased,number of atretic follicles was decreased,the Bcl-2 expression in great and small follicles was significantly increased and the Bax expression was significantly decreased,the differences were statistically significant(P＜0.05).Conclusion Zishen Yutai Pills can inhibit the premature and too fast follicles apoptosis by upregulating the expression of Bcl-2 protein and down-regulating the expression of Bax protein,thus plays the effect for treating DOR.

BACKGROUND:In recent years,computer-assisted navigation has gradually attracted attention in the medical field.Some scholars have reported that the clinical effects of computer navigation in total knee arthroplasty vary.To explore the clinical effect of the new generation of Brainlab Knee 3 navigation system,this study is conducted. OBJECTIVE:To analyze the application effect of computer navigation system(Brainlab Knee 3)combined with gap balance technology in total knee arthroplasty. METHODS:A total of 71 patients received total knee arthroplasty at the Department of Joint Surgery of Dalian Second People's Hospital from November 2020 to May 2021.In the navigation group,35 patients underwent total knee arthroplasty by computer navigation combined with gap balance.In the traditional group,36 patients underwent osteotomy with traditional surgical instruments.The difference between medial and lateral joint spaces,knee range of motion,hospital for special surgery knee score,hip-knee-ankle angle,deviation values of coronal femoral component angle,coronal tibial component angle,and sagittal tibial component angle were compared between the two groups. RESULTS AND CONCLUSION:(1)In the navigation group,the differences of intraoperative medial and lateral joint gap at knee extension 0,1,and 2 mm were found in 19,14,and 2 cases,respectively.The gap difference was 0 mm in 18 cases,1 mm in 15 cases and 2 mm in 2 cases at 90° degree knee flexion.In the traditional group,the gap difference at knee extention was 0 mm in 10 cases,1 mm in 20 cases,and 2 mm in 6 cases.The gap difference at 90 degree knee flexion was 0 mm in 10 cases,1 mm in 15 cases and 2 mm in 8 cases.(2)The operation time in the navigation group was longer than that in the traditional group(P<0.05),and two patients in the navigation group developed lower limb intermuscular vein thrombosis after surgery,and none of the patients in the traditional group had complications.(3)The range of motion between the two groups increased significantly at 6 and 12 months after surgery,and the range of motion in the navigation group was higher than that in the traditional group(P<0.05).(4)At 12 months after surgery,the hospital for special surgery knee scores of both groups increased significantly,and the hospital for special surgery knee score in the navigation group was higher than that in the traditional group(P<0.05).(5)At 6 months after surgery,the deviation values of hip-knee-ankle angle,coronal femoral component angle,coronal tibial component angle,and sagittal tibial component angle of navigation group were significantly lower than those in the traditional group(P<0.05).(6)The results showed that computer navigation technique combined with gap balance in total knee arthroplasty had advantages in postoperative range of motion,lower limb alignment and the accuracy of tibial prosthesis component position,and joint function recovered well.