Objective To study the maneuver of diagnosis and management of anterior cruciate ligament (ACL) partial tears. Methods 24 cases of ACL partial tears confirmed by arthroscopy including anteromedial band (AMB) tear in 7 cases and posterolateral bulk (PLB) tear in 17 cases were investigated, from Mar 2000 to Jun 2002. ACL reconstruction was performed in 16 cases under arthroscopy. Clinical findings including symptoms or signs, physical examinations and MRI were collected for differential diagnosis of AMB and PLB tear. The efficiency of ACL reconstruction was evaluated by Lysholm scale with average follow-up of 11 months. Results 28.5% AMB and 98.2% PLB tear cases showed knee instability. Regarding the results of anterior drawer test, Lachman test and pivot shift test, it is positive 71.4%, 14.3% and 0 in AMB tears respectively; and 17.6%, 98.2%, 76.5% in PLB tears. The Lysholm scores were significantly increased from preoperative 63.53?8.11 to postoperative 93.47?2.62(P

Objective To determine if patients with traumatic, unidirectional recurrent anterior shoulder instability who have labral repair plus arthroscopic capsular shrinkage have better outcomes than those with labral repair alone. Methods This retrospective clinical study had a case controlled cohort design. 72 patients who met the inclusion criteria had the arthroscopic anterior shoulder stabilization by the same surgeon with Suretac Ⅱ tissue tacks (Suretac group, n=32) during 1996-1999 or with the same Suretac Ⅱ tissue tacks plus arthroscopic radiofrequency(Suretac plus shrinkage group, n= 40) from 1999 to 2002. The postoperative rehabilitation protocol for these two groups was identical. Standardized patient-determined and examiner-determined outcome measures were obtained pre-operatively, and at 3, 6, 12, and 24 months after operation, respectively. Results 66 were available at the final follow-up in this study, including 28 patients treated with the Suretac stabilization and 38 patients treated with the Suretac plus radiofrequency shrinkage, with the average duration of 58 and 30 months, respectively. All patients had a Bankart lesion. Both groups were matched for sex, age, level of pre-operative activity in work and sports, time from first injury to surgery and the number of tissue tacks used. Both groups had similar results with respect to patient-determined and examiner-determined outcome measures. The only adverse outcome was recurrent instability. In the Suretac group, 5 patients recurred dislocation, 1 recurred subluxation. In the group of Suretac plus shrinkage, 6 recurred dislocation, 2 recurred subluxation. Most re-dislocations and subluxation occurred during the 6th-24th months postoperatively and were subject to sports injury. Kaplan-Meier analysis for time to re-dislocation or re-subluxation as the criterion standard showed no differences in the rate of instability recurrence between the two groups. Conclusion Arthroscopic thermal capsulorrhaphy neither improved nor impaired the outcomes of arthroscopic labral repair with biodegradable tacks in patients with primary anterior shoulder instability.

Arthroscopic rotator cuff repairs are preformed due to growing knowledge of rotator cuff tears among surgeons as well as patients.However,it is unavoidable and may sometimes very common that some patients develop structural failures or retears after surgical repairs because of unique blood supply and healing procedure of the rotator cuff,on which there is still much debate focusing on problems that one needs to deal with in clinical practice.Retears often occur,if without new trauma,during early postoperative period,or more specifically within the first 6 months after repair and are more frequently observed in those with old ages,diabetes or osteoporosis.In addition,risk factors of retears consist of longer preoperative duration of symptoms,larger primitive tear sizes,higher grades of fatty infiltration of muscles on preoperative imaging examinations,excessive tension within reconstructed structures,deteriorated quality of rotator cuff tissues and special shapes of the acromion,etc.Diagnosis is recently based on results of postoperative magnetic resonance imaging or echogram examination.MR/CT arthrography is also used.Each instrument has its advantages and limitations.However,the lack of a golden standard when establishing a diagnosis of rotator cuff retears makes integrating evaluations and comparisons of different methods a difficult question.It has been reported by many that the onset of retear leads to obvious shoulder pain or weakness,whereas more than a few studies demonstrated that very limited influences of retears in spite of generally unaffected shoulder functions,like decreased muscle strength on certain motions.The disagreement is possibly caused by specific methods of diagnosis,function instruments and time point of assessments used by different researchers as studies have displayed that feelings of patients after surgery and results attained by objective examinations are not always parallel.Moreover,some long-time follow-ups studies indicated that the impact posted by retears on shoulder functions evolves over a period of time.Owing to the varied opinions on actual symptoms and final functional outcomes caused by structural failure,the mainstay of treatment for rotator cuff tears are still conservative protocols,including observation and symptoms relief instead of second surgery.Second surgery could be an effective choice for certain patients,especially for those who have apparent symptoms.

Objectives To study the anatomic characteristic of medial patellar retinaculum and its function in patellar stability. Methods Anatomic dissection of the medial patellar retinaculum was performed on 26 knees of 13 embalmed cadaveric specimens,and its composition and conducted functional studies of the several parts were observed respectively. Results The medial patellar retinaculum comprises patellofemoral ligament, patellotibial ligament and patellomeniscal ligament. The medial patellofemoral ligament which is the thickest part in the medial patellar retinaculum contributes to the major restraints to the lateral patellar displacement.

Objective To construct a eukaryotic expression vector of huma n insuli n-like growth factor-1 (hIGF-1) gene,and to investigate the transfection and ex pression of pcDNA3.1(-)/hIGF-1 eukaryotic expression plasmid in myoblast cells. Methods pcDNA3.1(-)/hIGF-1 eukaryotic expression plasmid was co nstructed. Myobl ast C2C12 cells were transiently transfected with lipofectamine. RT-PCR a nd immunohistochemical methods were used to detect the expression of hIGF-1 gene . MTT test was used to detect the biological activity of the conditioned medium after the transfection. Results There were significant increas es of hIGF-1 mRN A and protein in the myoblast cells transfected with pcDNA3.1(-)/hIGF-1. The con ditioned medium after the transfection showed the biological activity which coul d stimula te the proliferation of fibroblast cells. Conclusion The pcDNA 3.1(-)/hIGF-1,a eukaryotic expression plasmid for hIGF-1 gene is constructed. High levels of hI GF-1 mRNA and protein expression can be obtained in the myoblast cells transfect ed with pcDNA3.1(-)/hIGF-1 eukaryotic expression plasmid. The expressed protein has the biological activity.

Periprosthetic osteolysis and aseptic loosening after total hip arthroplasty are the common causes for revision surgery,which are initiated by wear particles released from the articular surfaces of prosthetic components.These components include ultra-high molecular weight polyethylene,titanium alloy,Al2O3,ZrO2 and polymethylmethacrylate.Wear particles activate macrophage via phagocytosis or pattern recognition receptor,resulting in release of inflammatory mediators such as macrophage colony-stimulating factor (M-CSF),macrophage chemotactic protein-1 (MCP-1),macrophage inhibitory protein-1 (MIP-1),IL-1β,IL-6 and TNF-α.Furthermore,wear particles stimulate M0 macrophage to polarize to M1 macrophage,promoting the release of inflammatory mediators.The periprosthetic osteolysis process is a cell/cytokine-mediated biological cascade induced by macrophage activation,involving the monocyte/macrophage cell line,such as macrophages,osteoclasts,and dendritic cells.The mesenchymal cells,including osteoblasts,osteocytes,fibroblasts and lymphocytes,lead to a deviation in the balance of osteoblast-osteoclast interactions within the basic multicellular unit,resulting in periprosthetic osteolysis.Fibrobalst,dendritic,and lymphocyte cells can enhance the recruitment and activation of macrophages by secreting MCP-1,MIP-1,and IL-8.Furthermore,the upregulated expression of RANKL,TNF-α,and IL-1 β facilitates the osteoclast differentiation from osteoclast precursor.TNF-α,IL-1 β together with wear particles can upregulate the expression of IL-6,MCP-1 and M-CSF of osteoblast and promote the recruitment and activation of macrophages.Nuclear transcriptional factor NF-κB plays a vital role in mediating periprosthetic inflammatory response and gene expression of bone metabolism.Different inflammatory factors can induce different expression of its downstream gene,ultimately,promoting or hindering the osteolysis process.The individual difference of periprosthetic osteolysis may also relate to single nucleotide polymorphism of IL-1RA,IL-6 and MMP-1 gene.

Objective To investigate and establish thyroid function reference range during 3 pregnant stages in Chaoshan area:thyrotropin (TSH),free thyroxin (FT4).Methods 863 healthy pregnant women visited antenatal clinic in the Second Affiliated Hospital were included in this study.By detecting serum levels of TSH,FT4,thyroglobulin antibody (TgAb),and thyroid peroxi-dase antibody (TPOAb)in these women,the euthyroid reference ranges of serum TSH and FT4 in different pregnant stages were established based on the standards of the United States National Institute of Clinical Biochemical (NACB)guidelines.Results The ranges of serum TSH in the first,second and third trimester of pregnancy were 0.13-3.93 mIU/L,0.14-4.55mlU/L,and 0.42-3.85 mIU/L,respectively.The ranges of serum FT4 levels in these 3 stages were 12.00-23.34 pmol/L,6.27-12.65pmol/ L, and 9.80-18.20 pmol/L,respectively.The range of serum TSH levels in our study were similar with the reference range recom-mended by the guidelines in China,but were different compared with the American Thyroid Association (ATA)guidelines.Conclu-sion TSH,FT4 levels show dynamic changes during different stages of pregnancy.The thyroid function ranges of healthy pregnant women in Chaoshan area are quite different compared with non-pregnant population and pregnant women in distinct area.Due to the differences of diet,iodine intake,economy and culture in Chaoshan area,regional thyroid function reference ranges specific for differ-ent stages of pregnant women should be established.

Objective To observe the survival of myoblasts carrying hIGF-1 gene transplanted into the mice, and the expression of hIGF-1 in the transplanted mice. Methods Eighty four male C3H mice(20～30g,7～11w)were divided into four groups: group A, B, C and D (20 mice each group), and the remaining four mice were used as normal control. At the middle of the right gastrocnemius muscle, the mice in group A and B were injected with 1?10~6 myoblasts either carried with or without hIGF-1 gene. Muscle contusion at the middle of the right gastrocnemius muscle of the mice in group C and D was produced. At day 3 following injury, they were injected with 1?10~6 myoblasts either carried with hIGF-1 gene (group C) or without hIGF-1 gene (group D). At the day 2, 5, 10, 20, 30 after injection, four mice of each group were sacrificed randomly. BrdU staining in all mice were performed to evaluate cells surviving, and the expression level of hIGF-1 in group A and C was assessed by immunohistochemical staining and real-time-PCR. Results The BrdU staining in both normal and injured mice transplanted with myoblast carried with or without hIGF-1 were positive. hIGF-1 was expressed and secreted in both group A and C. Conclusion The myoblast carrying hIGF-1 gene transplanted into normal or injured mice can survive for a certain period of time, and can secrete hIGF-1.

Objective To observe the effect of different interventions on muscle healing following contusion by electromyographical signal, and functionally to study the significance of electromyographical technique in evaluating the healing quality of skeletal muscle after injuries. Methods A standard contusion model was developed at the right gastrocnemius by specific device in 108 male rats. The animals were divided into three groups:group IGF-1,local injection by exogenous IGF-1 at injured site; group Chinese medicine treated with the injection of Huangqidanshen, and group natural healing for control. EMG signals of gastrocnemius, such as fibrillation potentials, positive sharp waves as well as the latency and wave-amplitude of compound muscle action potentials (CMAPs) were probed, recorded and compared at day 2、5、7、10、14、21、28、35 and 56 after injury respectively. Results (1) Fibrillation potentials and positive sharp waves were discovered at day 2 to 5 after contusion, and reached its peak by day 7 to 10, and then normalized gradually around the 35th day with muscle healing in group natural healing. Above abnormal signals disappeared much more early in group IGF-1, then that in group Chinese medicine. (2) The latency and wave-amplitude of CMAP shown a gradual recovery process with muscle healing. The recovery tendency was most rapid in group IGF-1, slower in group Chinese medicine, and latest in group natural healing. (3) The wave-amplitude of CMAP approached to normal in group IGF-1 by 8 weeks following contusion, a little bit later in group Chinese medicine groups, and lastly in group natural healing. Conclusions(1) Electromyographical study verified that IGF-1 and Huangqidanshen could improve healing and functional recovery following muscle injury. IGF-1 was a much more strong intervention for healing promotion. (2) EMG is an useful tool in evaluating the healing process and healing quality of skeletal muscle.

Objective To observe the effect of the injection of myoblast carrying human insulin-like growth factor-1(hIGF-1) on the expression of endogenous IGF-1 mRNA and IGF-1 level in mice skeletal muscle following injury.Methods Seventy two male C3H mice(20~30g,7~11w)were randomly divided into three groups(24 mice in each group) with four mice normal controls.Applied a falling hit from certain height at the medial calf of right lower limbs in three groups,the injured skeletal muscle model was successfully simulated.Three days following injury,the mice in group A and B were injected with 1?106 myoblasts either carried with or without hIGF-1 gene respectively and the mice in group C were injected with 100?l saline at the injured muscle.Three mice in each group were sacrificed randomly at day 2,5,10,15,20,30 after contusion.The expression level of mIGF-1 was assessed by immunohistochemical staining and real time PCR.Results mIGF-1 mRNA expression and mIGF-1 factor secretion were observed in all three groups;the amount of mIGF-1 mRNA expression and mIGF-1 secretion in group A were significant higher than that in group B and C.Conclusion Myoblast carrying hIGF-1 transplantation could promote endogenous IGF-1 secretion in injured skeletal muscle.