Objective To evaluate the effect of the bone grafting through a femoral neck window at high location in the treatment of osteonecrosis of the femoral head (ONFH).Methods From January 2009 to December 2011,26 patient (35 hips,11 males and 15 females) with ONFH were treated with bone grafting through fenestration at high level of femoral head and neck,and then they were followed up for average of 24 months,with the mean age of 37.4 years (range,18-65 years).According to the Association Research Circulation Osseous (ARCO) classification,there were 6 hips,13 hips,and 16 hips on stage Ⅱ A,Ⅱ B,Ⅱ C respectively.The patients were treated with the bone grafting through fenestration at high level of femoral head and neck.The fenestrated area was located in the junction of the femoral head and neck,involved part of the femoral head cartilage.The effectiveness was evaluated according to Harris Scoring system and excellent and good rate.Results All the cases were followed up in outpatient department for 24 months,and 1 was lost to follow-up.After the treatments with the bone grafting through fenestration at high level of femoral head and neck,no infections,nerve damage and other complications were found in all patients.Harris score of overall patients before and after treatment increased from 73.42±7.30 points to 85.85±11.63 points; Harris score of patients with ARCO Ⅱ A before and after treatment increased from 74.50± 1.76 points to 91.17± 1.60 points; Harris score of patients with ARCO Ⅱ B before and after treatment the average score increased from 73.92±8.03 points to 86.00±10.49 points.Harris score of patients with ARCO Ⅱ C before and after treatment increased from 72.60±8.29 points to 83.60± 14.29 points.The overall excellent and good rate before and after treatment in patients with preoperative 36.4％ up to 84.9％.The rate of patients with ARCO Ⅱ A increased from 33.3％ to 100.0％ after treatment.The rate of patients with ARCO Ⅱ B increased from 41.7％ to 91.7％ after treatment.The rate of patients with ARCO Ⅱ C increased from 33.3％ to 73.3％ after treatment.The difference in Harris scores and excellent and good rate between untreatment and treatment were statistical significant.Conclusion Bone grafting through a femoral neck window at high location in the treatment of osteonecrosis of the femoral head were proved to have good short-terms effects which can promote the restoration of osteonecrosis and improve the clinical symptoms of hip.

BACKGROUND: Distraction osteogenesis is an effective method for large bone defects, bone tumors and osteomyelitis. However, there is a lack of a standard model in the basic research concerning distraction osteogenesis. OBJECTIVE: To establish a rabbit femoral model of distraction osteogenesis and to assess its osteogenic effect. METHODS: Twenty male New Zealand rabbits were enrolled to establish the rabbit femoral model of distraction osteogenesis using a novel distractor. Subsequently, the gross observation and X-ray examination of the specimens were performed to assess the osteogenic effect. RESULTS AND CONCLUSION: Gross observation: on day 14 after fixation, there were light-colored and dense newborn bones distributing evenly in the distraction gap, and appeared with a columnar connection with the broken ends; the boundary with normal bones became vague. On day 35, the surface of newborn bones in the distraction gap showed the same color and texture with the normal ones, the boundary between the newborn and normal bones was difficult to distinguish, and the bone mineral density was increased notably. Radiology results: on day 14 after fixation, the stent was fixed stably, the broken ends got good reduction, and cloudy shallows connecting the two ends of the normal bones in the distraction gap and increased bone mineral density were detectable. Completely calcified new-born bones, intact bone cortex and open medullary canal were further visible on day 35. These results suggest that the rabbit femoral model of distraction osteogenesis is established successfully using the self-designed single-arm distractor based on rational surgical procedures and standard operations.

Objective To establish the model of distraction osteogenesis for rabbit femur bone defect, and to observe the effect of icariin on regenerate ossification after distraction osteogenesis, thus to find a method for promoting regenerate ossification after distraction osteogenesis. Methods After the rabbit model of bone defect had been established successfully, the rabbits were equipped with distraction device. And then the 24 modeled rab bits were randomly divided into 2 groups. The experimental group was injected with icariin extract of Herba Epimedii into the interspace of bone distraction, and the control group was given local injection of recombinant human bone morphogenetic protein-2 (rhBMP-2, 100μg/kg) . On week 0, 1, 4 and 6 after the resting period, X-ray photography was carried out in both groups. On week 6 after distraction osteogenesis, the bone specimens of distraction osteogenesis region in both groups were observed by micro-computerized tomography ( CT) for the comparison of bone mass, and bone mineral content and mineral density of the newly-formed bone. Results The results of the features of imageology, and the statistical data of the bone mineral content and density showed that osteogenesis speed and osteogenic quality of the experimental group were superior to those of the control group. Conclusion The rabbit model of distraction osteogenesis for femur bone defect has been established preliminarily, and icariin can promote the speed and quality of regenerate ossification after distraction osteogenesis.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Objective: To investigate the impact factors for central neck lymph node metastases(CLNM) of papillary thyroid carcinoma(PTC). Methods: A total of 498 patients with PTC who underwent total or hemi-thyroidectomy plus central neck lymph node dissection between January 2014 and July 2016 were included. Univariate and multivariate analyses were performed to identify clinicopathological characteristics, thyroid function parameters and US findings that associated with CLNM of PTC. A nomogram was developed to predict the probability of CLNM. The receiver operating characteristic curve(ROC) was used to estimate the efficiency of the nomogram. Results: Among 498 patients, 284 patients were affected by CNLM. The sensitivity and specificity of US in predicting PTC metastasis in the central neck were 31.3% and 88.3%, respectively. Univariate and multivariate analyses showed that gender, age, number and size of suspicious malignant nodules in thyroid, and suspicious lymph node metastasis detected by ultrasonography were independently correlated with CLNM. The ROC showed that the AUC was 0.748, with sensitivity of 80.8%, and specificity of 59.8%. Conclusions Gender, age, number and size of suspicious malignant nodules in thyroid, suspicious lymph node metastasis were predictive factors for CLNM in patients with PTC. The nomogram developed based on related factors with CLNM is more sensitive than sonographic central neck lymph node features in predicting the probability of CLNM.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.