Objective To study the tolerance to 188Re-1-hydroxy-1 ,1-ethylidene disodium phosphonate(HEDP) in patients with bone pain caused by osseous metastases. Methods Thirty-one patients(10with prostate cancer, 9 with breast cancer, 3 with lung cancer, 5 with liver cancer, 2 with rectal cancer, 1with esophageal cancer and 1 with renal cancer) received a single injection dose of 188Re-HEDP. The patients were divided into four groups according to the injection dose: 20 MBq/kg (6 patients), 30 MBq/kg(6 patients), 40 MBq/kg (9 patients), and 50 MBq/kg (10 patients). Haematological toxicity (WHO grading) of grade Ⅲ- Ⅳ was considered unacceptable. Vital signs and adverse effects after injection were recorded for 8 weeks. Blood counts were measured weekly during a period of 8 weeks. Biochemical parameters and electrocardiogram were assayed at week 4 and 8. Statistical analysis was performed for per-protocol (pp) population (t-test). Results Twenty-seven patients belonged to PP population with 5 in the group of 20 MBq/kg, 5 in the group of 30 MBq/kg, 8 in the group of 40 MBq/kg and 9 in the group of 50 MBq/kg.No obvious adverse effects and no significant change of vital signs, electrocardiogram, liver and renal function were found after injection. Alkaline phosphatase was slightly higher than baseline at week 4 and 8 after therapy, but the difference was not statistically significant. In the 20 MBq/kg group, reversible grade Ⅰ leucopenia was noted in 1 patient. In the 30 MBq/kg group, 2 patients showed reversible grade Ⅰ leucopenia including 1 alone with reversible grade Ⅲ thrombopenia. In the 40 MBq/kg group, reversible grade Ⅰ leucopenia and thrombopenia was observed in 1 patient and reversible grade Ⅱ leucopenia and thrombopenia in another patient. In the .50 MBq/kg group, 3 patients showed reversible grade Ⅱ leucopenia. The lowest level of thrombopenia was at week 4(143.5 × 109/L), leucopenia at week 6 (5.4 × 109/L) and anaemia at week 8(t = 3.1325, 3.3156, 3.4917, all P ＜ 0. 05 compared with baseline). At week 8, the mean level of platelet and leucocyte recovered to baseline. "Bounce pain" was found in 2 of 27 patients (7.41%).Conclusions The dose of 20 MBq/kg, 30 MBq/kg, 40 MBq/kg or 50 MBq/kg of 188Re-HEDP do not cause significant side effects on cancer patients with bone metastases, though there is a tendency that the haematological toxicity may increase as the dose of 188Re-HEDP increases.

OBJECTIVESTo investigate the relationships among rotational alignment reference axes of distal femur and tibial mechanical axis, and determine the safest rotational alignment reference axis.

METHODSDigital photos were taken of 30 cadaveric lower extremities with knee in extension and flexion at 90 degrees , angles were measured among tibial mechanical axis and a line perpendicular to clinical epicondylar axis, a line perpendicular to surgical epicondylar axis, Whiteside's line and femoral mechanical axis. Statistical analysis of relationships among those axes were performed.

RESULTSThe angles among the tibial mechanical axis and a line perpendicular to the clinical epicondylar axis, a line perpendicular to the surgical epicondylar axis, Whiteside's line and femoral mechanical axis were 0.6 degrees varus, 3.9 degrees varus, 0.2 degrees valgus and 3.0 degrees varus respectively. The angle between the femoral mechanical axis and the tibial mechanical axis was significantly larger than the angles among the tibial mechanical axis and a line perpendicular to the clinical epicondylar axis, the Whiteside's line (P < 0.05). There was no significant difference compared with the angle between a line perpendicular to the surgical epicondylar axis and the tibial mechanical axis. Angles of the clinical epicondylar axis, the surgical epicondylar axis and the Whiteside's line between knee extension and flexion were 2.3 degrees valgus, 0.9 degrees varus and 3.1 degrees valgus respectively.

CONCLUSIONThe surgical epicondylar axis rather than the clinical epicondylar axis or the Whiteside's line is the safest femoral rotational alignment reference axis intraoperatively.

Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Femur ; anatomy & histology ; surgery ; Humans ; Knee Prosthesis ; Rotation ; Tibia ; anatomy & histology ; surgery

OBJECTIVESTo introduce the technique of arthroscopic simultaneous reconstruction of posterior cruciate ligament (PCL) using double femoral tunnel, single-bundle transtibial tunnel PCL technique and anterior cruciate ligament (ACL) with achilles allograft, and to evaluate the clinical outcome.

METHODSFourteen patients with PCL and ACL injuries after a minimum follow-up 18 months were received. Arthroscopically assisted simultaneous ACL/PCL reconstruction with achilles allograft were performed using the single-incision endoscopic ACL technique and the double femoral tunnel, single-bundle transtibial tunnel PCL technique. The Lysholm and Tegner knee score scale were used for functional evaluation. All patients were evaluated with physical examination and KT-1000 arthrometer testing. The mean knee flexion was (123.6 +/- 2.5) degrees preoperatively. The Lysholm score was 52.8 +/- 2.2. The Tegner score was 5.9 +/- 0.5 before injury, 1.2 +/- 0.9 preoperatively.

RESULTSThe mean time from injury to the reconstructive procedure was 19.5 d. The mean knee flexion was (117.9 +/- 2.8) degrees postoperatively( t = 1.54, P = 0.14). As to the Lachman test for 14 patients, the results of 13 patients (92.9%) was negative. As to posterior drawer test, the results of 12 patients (85.7%) was negative. The Lysholm score was 92.9 +/- 3.3 at final evaluation (t = 17.009, P < 0.001). KT-1000 arthrometer testing at 25 degrees knee flexion showed that the side-to-side difference was below 2 mm in 9 cases, 3-5 mm in 4 cases, 6 mm in 1 case. At 75 degrees knee flexion the difference was below 2 mm in 10 cases, 3-5 mm in 3 cases, 6 mm in 1 case. The Tegner score was 5.4 +/- 0.8 at final evaluation. The difference between the preoperative score and the postoperative was statistically significant (F = 4.2, P < 0.01).

CONCLUSIONSCombined ACL and PCL injuries can be successfully treated with arthroscopic simultaneous reconstruction of PCL using double femoral tunnel technique and ACL with achilles allograft. The double femoral tunnel technique more closely approximates the anatomic insertion the native PCL. Most patients recover a functionally stable knee.

Achilles Tendon ; transplantation ; Adult ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; methods ; Female ; Femur ; surgery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; surgery ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo investigate the incidence and variation of tunnel enlargement after anterior cruciate ligament (ACL) reconstruction.

METHODSACL reconstructions using hamstring tendons were performed in 58 patients (58 knees) in the study. MRI scans were taken in a consistent manner at 1, 3, 6, 12 and 24 months after surgery to measure tibial and femoral tunnel expansion.

RESULTSFemoral tunnel enlargement was observed in 9 knees (9/58, 15.5%); Tibial tunnel enlargement was found in 12 knees (12/58, 20.7%). Of those with enlarged bone tunnels, there was no significant difference of tunnel diameters between 1 and 3 months after surgery (P>0.05). Six, 12 and 24 months postoperatively, the average tunnel diameters were larger than those of 1 or 3 months after surgery (P<0.05), however, no significant difference was found in between the tunnel diameters 6, 12 and 24 months postoperatively either (P>0.05).

CONCLUSIONTunnel expansion mainly occurs during 3 to 6 months after surgery, and it remains basically unchanged between 12 and 24 months postoperatively.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; China ; epidemiology ; Female ; Femur ; pathology ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; pathology ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies ; Tendons ; transplantation ; Tibia ; pathology ; Time Factors ; Transplantation, Autologous

OBJECTIVEThe aim of work was to evaluate the efficacy of microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) associated with hypertension.

METHODSFive hundred and thirty-eight cases of TN associated with hypertension treated with MVD were retrospectively analyzed, all the cases were treated with MVD in the zone of the ventrolateral medulla oblongata and inspected postoperative blood pressure.

RESULTSAmong 538 cases, 341 cases (63.4%) had cure result, 71 cases (13.2%) had obvious effectiveness, 53 cases (9.8%) had effectiveness, and 73 cases had no effectiveness. Four hundred and eighty-three cases have been followed 1.0 approximately 15.8 years, mean 6.3 years. At the time of their follow-up, 313 cases had cure result, 63 cases had obvious effectiveness, 42 cases had effectiveness and 65 cases had no effectiveness.

CONCLUSIONSIt was pathogenesis of nedulla oblongata by abnormal vascular tab, long-term aching stimulation and emotional stress. It was an effective method to treat TN associated with hypertension with MVD in this zone.

Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; methods ; Female ; Humans ; Hypertension ; complications ; Male ; Medulla Oblongata ; pathology ; Microsurgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Trigeminal Neuralgia ; complications ; surgery ; Vascular Surgical Procedures ; methods

OBJECTIVE To explore the anti-atherosclerotic effect of the extract of traditional Chinese medicine formula Dan-yi-lian(DYL)and the related mechanism.METHODS Atherosclerosis(AS)mod-el was established in ApoE(-/-)mice with a western diet. The mice were orally administered with differ-ent doses of DYL or vehicle daily for 28 d.The anti-atherosclerotic effect was evaluated by measuring the aortic atherosclerotic lesion area and media thickness with ultrasound imaging and histological sec-tions staining method. The effect on blood lipid was investigated by determining TC, TG, LDL, HDL, Apo-A1, Apo-B, etc. The anti-oxidative activity as assessed by determining the level of SOD, CAT, GSH,GSH-Px and MDA.Western blot analysis was used to determine the effect on ICAM-1,VCAM-1, MMP-2 and TNF-α. RESULTS In Dan-yi-lian administered ApoE(-/-)mice,the plaque area and media thickness were significantly reduced. Meanwhile, serum TC, TG, LDL and Apo-B were decreased, in contrast to the increased level of HDL and Apo-A1.On the other hand,SOD,CAT,GSH and GSH-Px were increased, while MDA was reduced in liver homogenate. In addition, the expression of ICAM-1, VCAM-1,MMP-2 and TNF-α was obviously inhibited by Dan-yi-lian.CONCLUSION Dan-yi-lian exhibit-ed potent anti-athero-sclerotic efficacy,in which the lipid-regulating,anti-oxidative and anti-inflammato-ry mechanism might be involved.

Objective To investigate the relationship between impaired glucose tolerance(IGT)and carotid atheromatous plague in patients with acute cerebral infarction and analyze the risk factors for plaque formation.Methods The 326 patients hospitalized in our department for acute cerebral infarction were divided into diabetes mellitus(DM)group,IGT group and normal glucose tolerance (NGT)group.The clinical features,biochemical indices and results of Doppler ultrasound examination of the carotid artery were compared between the 3 groups.Results The body mass index(BMI),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)of IGT group were markedly higher than those in NGT group(P＜0.05).Both the IGT and DM group showed significantly increased carotid intimal-medial thickness,plaque detection rate and the incidence of carotid scleratheroma in comparison with the NGT group(P＜0.05).Logistic regressive analysis identified age,TC,LDL-C and 2-h postprandial serum glucose as the independent risk factors for carotid scleratheroma.Conclusion In patients with acute cerebral infarction,those having impaired glucose often show obvious carotid scleratheroma with a severity similar to that in the DM patients.

OBJECTIVETo compare the effects of increased posterior tibial slope or partial posterior cruciate ligament (PCL) release on knee kinematics of total knee arthroplasty (TKA).

METHODSAnteroposterior laxity, rotational laxity, varus and valgus laxity and maximum flexion angle were evaluated in 6 normal cadaver knees and the knees after TKA at flexion 0 degrees , 30 degrees , 60 degrees , 90 degrees and 120 degrees . Then the femoral prosthesis was shifted 5 mm posteriorly to simulate the tightly implanted knee. The same tests were performed on the tightly implanted knees. After that, the posterior tibial slope was increased 4 degrees or the PCL was partially released, and the same tests were made as in the normal knees respectively. Statistical analysis of the results was made using student's t test.

RESULTSAnteroposterior laxity, rotational laxity and varus and valgus laxity of the tightly implanted knees at flexion 30 degrees , 60 degrees , 90 degrees and 120 degrees were significantly less than those of the normal TKA knees (P < 0.05). Compared with the tightly implanted knees, anteroposterior laxity, rotational laxity and varus and valgus laxity at flexion 30 degrees , 60 degrees , 90 degrees and 120 degrees significantly improved after increased 4 degrees posterior tibial slope (P < 0.05); in the partial PCL released group, anteroposterior laxity at flexion 30 degrees , 60 degrees , 90 degrees and 120 degrees was significantly improved (P < 0.05), varus and valgus laxity was significantly improved only at flexion 90 degrees (P < 0.05), and rotational laxity was significantly improved at flexion 30 degrees , 60 degrees and 90 degrees (P < 0.05). Compared with PCL released group, varus and valgus laxity at flexion 30 degrees , 60 degrees and 90 degrees and rotational laxity at flexion 0 degrees , 30 degrees , 60 degrees and 90 degrees were significantly improved in the group of increased 4 degrees posterior tibial slope (P < 0.05). Maximum flexion angle of the tightly implanted knee (120.4 degrees ) was less than that of the normal TKA knees (130.3 degrees , P < 0.05) and that of increased 4 degrees posterior tibial slope group (131.1 degrees , P < 0.05). There was no significant difference at the maximum flexion angle between the increased 4 degrees posterior tibial slope group and the PCL released group (131.1 degrees vs 124.0 degrees , P = 0.0816).

CONCLUSIONSAnteroposterior laxity, varus and valgus laxity, rotational laxity and maximum flexion angle of the tightly implanted knees are less than those of the normal TKA knees. After increased 4 degrees posterior tibial slope, these indexes are improved significantly. Partial PCL released can significantly improve the anteroposterior laxity and had less effect on the varus and valgus laxity, rotational laxity and maximum flexion angle. So, a knee that is tight in flexion can be more likely to be corrected by increasing posterior tibial slope than by partially releasing PCL.

Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Cadaver ; Humans ; Knee Joint ; physiopathology ; surgery ; Posterior Cruciate Ligament ; physiopathology ; surgery ; Postoperative Period ; Range of Motion, Articular ; Tibia ; surgery

OBJECTIVETo explore the carrier state of hepatitis E virus(HEV) in livestock in Xi'an area.

METHODSBile samples from swine, canine, sheep and cow were collected from a local slaughtering house. Reverse transcriptase nested polymerase chain reaction (RT-nPCR) was employed to amplify the ORF2 region in HEV RNA genome. All positive samples were sequenced and compared with data from GenBank. Homology analysis was conducted based on the outcome of sequencing.

RESULTS194, 178, 79 and 191 bile samples from swine, canine, cow and sheep were collected. Positive rates with RT-nPCR method in these domestic animals were 4.10%, 0%, 0% and 0% respectively. Genetic distance analysis indicated that strains being identified were close to genotype IV of HEV, then genotype I, II and III in nucleic acid. Same outcome was shown by the same analysis on amino acid.

CONCLUSIONSwine was the only reservoir of HEV in livestock and genotype IV was the prevalent genotype.

Animals ; Animals, Domestic ; virology ; Cattle ; China ; Dogs ; Genome, Viral ; genetics ; Genotype ; Hepatitis E virus ; classification ; genetics ; isolation & purification ; Phylogeny ; RNA, Viral ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Sheep ; Swine

OBJECTIVETo prospectively evaluate the clinical effects of posterior paramedian approach in nerve root decompression and reducing muscle damage in low back surgeries.

METHODSStudy group included 30 cases treated from January 2007 to May 2008, DDD 8 cases, spondylolisthesis 6 cases, LDH 11 cases, Low back surgery failure re-operation 5 cases. Based on the comprehensive understanding of modern spine anatomy, we abandoned laminectomy in our procedure, applied a mid-waist skin incision, dissect to the paraspinal muscles where you could easily reach the facets by separating between the multifidus and longissimus, enlarge the canal by performing resection along ligamentum flavum and the inner broader of the articular process, remove enough tissue till you could expose the traversing root and the disc space, this method could achieve a limited but precise and effective decompression with not taking out all of the articular process. Once the anatomy mark of the pedicle is located (usually would be at the central area of the incision), pedicle screws placement would be precise and easy without struggling with muscle traction. The following procedures would be Spondylolisthesis reduction, discectomy and interbody fusion.

RESULTSPost-op patients of study group all showed significant improvement of pain symptoms, VAS reduced from 7.14 + or - 1.8, pre-op to 1.39 + or - 0.72 post-op, narrowed disc space regained height, spondylolisthesis reached anatomic reduction, no complications such as pedicle screw misplacement and nerve root damage were found, the lumbar spine regained it's physiological lordosis structure. Significant difference is discovered (P < 0.001) in statistic study concerning the rate of intractable low back pain between pre-op and post-op.

CONCLUSIONSApplying low back surgery through posterior para-median approach could directly reach the inferior/superior facets and the "soft" structures of the spinal canal, expose the exact decompression region and anatomy mark of the pedicle in the central surgical field without strong retraction on the para-spinal muscles. This approach has the advantage of lowering the surgical difficulty of implantation, reducing the risk of nerve damage and is also a minimum invasive procedure. In many cases, laminectomy is unnecessary, leaving the lamina intact could preserve the physiological anatomy of the spine.

Adult ; Aged ; Aged, 80 and over ; Diskectomy ; methods ; Female ; Humans ; Low Back Pain ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Prospective Studies ; Spinal Fusion ; methods ; Spondylolisthesis ; surgery