[Objective]To explore the cause and treatment of refractory nonunion of patella combined with handicapped joint function.[Method]Retrospective analysis was given to twenty-four patients diagnosed as patellar nonunion that had been admitted to our hospital from Jan 1992 to Jan 2006.The series included fifteen males and nine females with an average age of 36(range 12-71) years.Initial treatment of the original fractures was nonoperative in 3,cerclage with wiring or suture silk in 11,tension band wiring in 6 and modified tension band wiring in 4.All fractures progressed to symptomatic nonunion at an average of 18 months from original injury(range 5-32).All patients were given open reduction and internal fixation,which consisted of Nickel-Titanium patella concentrator(NT-PC) in 9,NT-PC combined with cannulated compression screws in 6,combined with Kirschner wire in 5 and tension band wiring in 4.[Result]Twenty-four patients were followed up with an average of 35(range 6-168) months.The time of bone union averaged 4.2(range 3-6) months.No bone block displacement,loosening or breakage of internal fixation happened.According to Xu Shaoting' s knee function scores,the results were excellent in 14 cases,good in 6 cases,fair in 3 cases and poor in 1 cases.The excellent and good rate was 83.3%.[Conclusion]Operative reconstruction of smooth joint surface,rigid internal fixation and early functional exercise are effective remedies to refractory nonunion of patella combined with handicapped joint function.

0.05). CONCLUSION Nebulized 2% lidocaine inhalation is an easy, simple and reliable method of anesthesia for strobolaryngoscopy.

ObjectiveTo investigate the plasma endothelin(ET),angiotensin (Ang) Ⅱ levels on middle cerebral artery resistance in hypertension patients.MethodsThe plasma ET and Ang Ⅱ levels were determined in hypertension grade 1 (grade 1 group,40 cases),grade 2 (grade 2 group,40 cases ),grade 3(grade 3 group,40 cases) and healthy adults (control group,50 cases).The systolic velocity and pulsatility index of middle cerebral artery were determined by transcranial Doppler,and 24 h ambulatory blood pressure was monitored.ResultsThe pulsatility index in grade 2 group and grade 3 group was higher than that in control group and grade 1 group (1.23 ±0.22,1.31 ±0.21 vs.0.76 ±0.18,0.78 +0.13)(P＜0.05).The systolic velocity in grade 2 group was higher than that in control group,grade 1 group and grade 3 group [(87.8 ± 11.7) cm/s vs.(60.8 ± 10.6),(63.8 ± 11.8),(49.9 ± 10.8) cm/s](P ＜ 0.05),and in grade 3 group was lower than that in control group,grade 1 group and grade 2 group(P ＜ 0.05 ).The plasma ET,Ang Ⅱ in grade 1,2,3 group was higher than that in control group[(46.83 ± 8.83 ),(55.63 ± 10.28 ),(67.19 ± 10.73)ng/L vs.( 38.94 ± 7.83 ) ng/L and ( 50.23 ± 9.23 ),(64.34 ± 12.23 ),( 79.83 ± 13.43 ) ng/L vs.(41.63 ± 8.76 )ng/L] (P ＜0.05).A increasing trend in the plasma ET and Ang Ⅱ was present with increasing the hypertension grade(P ＜ 0.05 ).The night average systolic pressure,night average diastolic pressure and plasma ET,Ang Ⅱ levels in dipper hypertension patients (60 cases) were lower than those in non-dipper hypertension patients(60 cases) [(121.83 ± 11.83) mm Hg(1 mm Hg =0.133 kPa) vs.(138.84 ± 13.29)mm Hg,(77.23 ± 8.54) mm Hg vs.(86.93 ± 10.34) mm Hg,(48.83 ± 10.14) ng/L vs.(59.83 ± 11.29)ng/L,(55.84 ± 10.83 ) ng/L vs.(72.83 ± 20.29) ng/L,P ＜ 0.05].ConclusionMonitoring plasma ET,Ang Ⅱ levels and ambulatory blood pressure in hypertension patients is helpful in using medicine to improve endothelial function and to promote its dynamic type into a dipper blood pressure in the treatment of patients,thereby to reduce the incidence of hypertension adverse events.

Objective To explore the clinical effect of treatment on facial soft tissue depression by autologous fat granule mixed with adipose-derived stem ceils.Methods A lof of 36 patients with facial soft tissue depression from September 2011 to March 2013 in this clinic were as the research objects.The autologous fat granules were harvested from patients' lateral thigh.The autologous fat granules mixed with adipose-derived stem cells (ADSCs) which were harvested by separating and cleaning were injected into facial soft tissue depression.The standard was based on the subjective satisfaction of patients and the physicians' objective assessment;there were two unrelated doctors to reach an objective assessment of the clinical efficacy based on the comparison of preoperative and postoperative photographs.Results A lof of 36 patients were followed up for 5 16 months,low absorption rate of injec ted fat and significant improvement in shape filling areas were observed,and skin texture,pores,spots and wrinkles were significantly improved.Conclusions Autologous fat granule mixed with AD SCs in the treatment of facial soft tissue depression is a minimally injuried,easily-handled,cheap and safe procedure.It is an ideal treatment of facial soft tissue depression.All the patients have no complications such as infection,induration and fat liquefaction.

Objective To discuss biomechanical mechanism of reconstructed joint capsule ligament stabilizing hip joint by means of three-dimensional finite element analysis.Methods A finite element model of total hip arthroplasty(THA)including ischiofemoral ligament reconstruction was construtted by using finite element analysis software Unigraphics NX 2.0 and SolidWorks 2006 to simulate seated leg crossing and obtain peak resisting moment and range of motion prior to impingement.Results The current form of finite element model was characterized by large deformation multi-body contact,large interfacial sliding and high elasticity and could clearly reflect real anatomy and biomechanical behavior of ischiofemoral ligaments.Compared with model with only metal,model of ischiofemoral ligament reconstruction could reduce the peak polyethylene stress at the impingement site and at the head egress site by typically 17%and 31%respectively,increase peak resisting moment by nearly 57%and provide 2.29-fold stability.Conclusions As a discrete structure within the posterior capsule of the hip joint,the ischiofemoral ligament may be the most important contributor to the mechanical integrity of the posterior stability structure.The joint capsule ligament must be reconstructed in hip arthroplasty.

OBJECTIVE: To assess the effects of iterative model reconstruction (IMR) on image quality for demonstrating non-calcific high-risk plaque characteristics of coronary arteries. MATERIALS AND METHODS: This study included 66 patients (53 men and 13 women; aged 39–76 years; mean age, 55 ± 13 years) having single-vessel disease with predominantly non-calcified plaques evaluated using prospective electrocardiogram-gated 256-slice CT angiography. Paired image sets were created using two types of reconstruction: hybrid iterative reconstruction (HIR) and IMR. Plaque characteristics were compared using the two algorithms. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the images and the CNR between the plaque and adjacent adipose tissue were also compared between the two reformatted methods. RESULTS: Seventy-seven predominantly non-calcified plaques were detected. Forty plaques showed napkin-ring sign with the IMR reformatted method, while nineteen plaques demonstrated napkin-ring sign with HIR. There was no statistically significant difference in the presentation of positive remodeling, low attenuation plaque, and spotty calcification between the HIR and IMR reconstructed methods (all p > 0.5); however, there was a statistically significant difference in the ability to discern the napkin-ring sign between the two algorithms (χ2 = 12.12, p < 0.001). The image noise of IMR was lower than that of HIR (10 ± 2 HU versus 12 ± 2 HU; p < 0.01), and the SNR and CNR of the images and the CNR between plaques and surrounding adipose tissues on IMR were better than those on HIR (p < 0.01). CONCLUSION: IMR can significantly improve image quality compared with HIR for the demonstration of coronary artery and atherosclerotic plaques using a 256-slice CT.
Adipose Tissue ; Angiography ; Atherosclerosis ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Methods ; Multidetector Computed Tomography ; Noise ; Plaque, Atherosclerotic ; Prospective Studies ; Signal-To-Noise Ratio

Objective To discuss the therapy for acetabular comminuted fractur e combined with compressive defects. Methods From July 1997 to February 2005, 43 cases of comminuted acetabular fracture combined with compressive defect were t reated. 25 cases were obsolete, 16 fresh, and 2 malformed (90 days after injury) . 34 cases were complicated fractures with defects, and 9 simple fractures with defects. The defect volumes ranged from 3 to 9 cm3, averaging 4.5 cm3. They were treated with ATMFS (acetabular tridimensional memory fixation system) to fixate the comminuted bone fragments tridimensionally. The modified acetabular approac h, reduction of acetabular comminuted articular face, anatomical reconstruction of posterior wall of acetabulum with autogenous ilium, autogenous and artificial bone implantation and bone wax isolation were used. The follow-ups lasted from 5 to 86 months, averaging 15.7 months. Results 31 cases achieved anatomical red uction by filling up the compressive defects. 12 cases were treated by anatomica l reconstruction of posterior wall. On average, 5.3 months after operation, the injured hip joint was as good as the healthy one in 40 cases. Ischemia necrosis of femoral head occurred in 1 case, and 2 cases experienced heterotopic ossifica tion with ischemia necrosis of femoral head which led to osseous fusion of hip j oint. Conclusion The new methods for treatment of acetabular fractures with comp ressive defects elevate the reduction rate of acetabulum and femoral head, and a re effective for the functional recovery of hip joint.

Objective: To investigate the value of Multislice computed tomography volume rendering(VR) technique and 3D printing technique in auricular reconstruction. Methods: Six patients were enrolled for auricular reconstruction with costal cartilage, including 5 congenital microtia patients and 1 traumatic auricular defect patient. We harvest the three-dimensional reconstructive data of the contralateral sixth, seventh, eighth and ninth costal cartilage with VR technique. Three-dimensional solid models were 3D printed with nylon material according to the data exported in STL format. Preoperative simulation was performed on the models, accordingly, we determined the strategies of costal cartilage harvest and framework fabrication, and operations were performed based on the pre-designed plan. Results: In all 6 patients, the actual costal cartilage harvest and framework fabrication process was consistent with the preoperative design and simulation results, and more scientific than before. The shapes of reconstructed ears were vivid and natural. No complications such as infection, absorption, distortion and chest deformity happened. Conclusions Through costal cartilage VR and 3D printing technique, we could make more reasonable preoperative design and simulation. The results can be improved with reduced injury, while avoiding the risks of thoracic deformity.

OBJECTIVETo determine whether the level of serum cardiac troponin T (cTnT) was increased in patients with congestive heart failure (CHF).

METHODSThis study consisted of 265 patients with CHF and 75 healthy people. Serum cTnT was measured by electrochemiluminescence immunoassay using an Elecsys 1010 automatic analyzer.

RESULTScTnT concentration was 0.181 +/- 0.536 ng/mL in CHF patients and 0.003 +/- 0.001 ng/mL in controls (P < 0.001). Patients were categorized according to the levels of heart function and left ventricular ejection fraction (LVEF). In the first group consisting of 105 patients with LVEF 35%, cTnT was 0.07 +/- 0.0 5 ng/mL (P < 0.01). In patients with NYHA class I, II, III and IV, cTnT values were 0.062 +/- 0.022 ng/mL, 0.113 +/- 0.121 mg/mL, 0.191 +/- 0.231 mg/ml and 0.384 +/- 0.211 mg/mL, respectively (class I vs class II P > 0.05, class II vs class III P < 0.01, class III vs class IV P < 0.01). A negative correlation was observed between serum cTnT concentration and LVEF in 265 patients with CHF (r = -0.493, P < 0.001).

CONCLUSIONSThis study shows that the level of serum cTnT is increased in patients with CHF and that the increased level indicates the severity of CHF.

Adult ; Aged ; Female ; Heart Failure ; blood ; physiopathology ; Humans ; Male ; Middle Aged ; Stroke Volume ; Troponin T ; blood ; Ventricular Function, Left

Infective endocarditis is a microbial infection of the endocardium and can easily affect heart valve.Its characteristic lesion is vegetation formation,and the shedding of vegetation results in arterial embolism and ischemic necrosis of corresponding tissues and organs.A case of infective endocarditis with multiple extracardiac complications was described in this article.The characteristic ultrasound finding was the vegetation formation in anterior mitral valve.CT and MRI scans revealed involvements in multiple organs and blood vessels,which were manifested as splenic infarction,renal infarction,cerebral infarction,splenic aneurysm,superior mesenteric artery aneurysms,renal artery aneurysms,and distal segment stenosis and occlusion of right middle cerebral artery.
Embolism ; Endocarditis ; Endocarditis, Bacterial ; Humans ; Infarction ; Mitral Valve