OBJECTIVETo study the effectiveness of pie-crusting technique in improving the stiff knee.

METHODSFrom February 2012 to December 2013, 13 patients with stiff knee were reviewed retrospectively. There were 6 males and 7 females, ranging in age from 39 to 70 years old (averaged, 55.6 years old). Of the 13 cases, 8 patients had stiffness following fracture (comminuted tibial plateau fracture in 4, femoral supracondylar fracture in 3 and patellar fracture in 1), 5 patients had TKA-related stiffness.

RESULTSA follow-up lasted 8 to 12 months (mean 10 months)in 13 cases. The mean maximum flexion increased from (37 ± 6)° preoperatively to (52 ± 7)° after arthrolysis, and (108 ± 7)° after pie-crusting. At the final follow-up, mean maximum flexion was (105 ± 6)°. According to Judet evaluation system, 10 patients got an excellent result and 3 good. No major complications, such as extensor lag, skin necrosis, deep infection, dislocation of the patella or recurrent stiffness were found.

CONCLUSIONThe percutaneous technique of pie-crusting is a simple, minimally invasive and effective treatment for knee stiffness.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Range of Motion, Articular ; Treatment Outcome

Adult ; Antidepressive Agents ; therapeutic use ; Depression ; complications ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Dyspepsia ; drug therapy ; psychology ; Female ; Gastric Emptying ; drug effects ; Gastrointestinal Agents ; therapeutic use ; Gastrointestinal Motility ; drug effects ; Humans ; Male ; Middle Aged ; Phytotherapy ; Powders

OBJECTIVETo evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome (SAIS).

METHODSA prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome, Hawkins-Kennedy syndrome, painful arc empty can test and external rotation resistance test, also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement.

RESULTSThe ROC analysis indicated a significant area under the curve (AUC) (AUC=0.62 to 0.73, P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance, Tests with a-LR less than 0.5 were Neer,painful are ,external rotation resistance. The regression analysis found the painful arc, empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful are and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71).

CONCLUSIONThe single test of painful arc, empty can and external rotation resistance, as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS, while the single test of Neer, painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc, empty can and ex ternal rotation resistance are the best combination for the diagnosis of SAIS (when 2 or more are positive), while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative)

Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Physical Examination ; methods ; Prospective Studies ; Reproducibility of Results ; Shoulder Impingement Syndrome ; diagnosis

Objective To evaluate the clinical result of Hering's law in the correction of asymmetric bilateral ptosis.Methods From January 2014 to July 2016,165 cases divided into 2 groups with asymmetric bilateral ptosis in mild and moderate ptosis were corrected with aponeurosis advancement type correction:A group of 15 cases,in which the surgery does not consider the influence of Hering's law,the first correction of mild side,and then corrected the heavier side;B group of 150 cases,in which the Hering's law was applied,the first correction of severe side so that the margin reached the edge of the cornea is tangent or low 0.5-1.0 mm,and then corrected mild side.That the difference of symmetry between the two sides of the palpebral fissure was less than 0.5 mm,and the follow-up was more than 3 months.The Pearson chi square test was used to compare the differences between the two groups.Results In this group,165 cases were followed up for 3-24 months,10 cases (66.67％) was satisfactory in group A (15 cases);145 cases (96.67％) was satisfactory in group B (150 cases);After 3 months,all the failure cases got satisfactory result by using the Hering's law in corrective surgery again.The P value of chi square test between groups was less than 0.05.Conclusions The application of Hering's law in the correction of asymmetry bilateral ptosis is more satisfactory.

OBJECTIVETo discuss the fracture patterns,operative procedures and clinical results of open reduction and internal fixation via a posterior approach to treat posterior fractures of tibial plateau.

METHODSFrom June 2008 to February 2011, 8 patients with posterior tibial plateau fractures treated with posterior approach, were reviewed retrospectively. There were 5 males and 3 females,with an average of 41.1 years ranging from 23 to 55. Of the 8 cases, 5 cases were caused by traffic accidents, 3 caused by fall. Two cases of posterior coronal fractures combined with avulsion of posterior cruciate ligament and 1 case of posterolateral fractures associated with collapse fractures was treated via a S-shaped approach, 2 cases of posteromedial fracture via a posteromedial reversed L-shaped approach, another 3 cases of complex fractures involving anterior and posterior of tibial plateau, and metaphsis via a posteromedial reversed L-shaped approach combined with anterolateral approach. Fractures with articular surface collapse were applied with bone grafting.

RESULTSAll the 8 cases were followed up for 8 to 39 months (means 20 months). All cases had attained bone union, the time of bone healing was 14.5 weeks in average ranging from 11 to 21 weeks. No infection, no blood vessel or nerve injuries and loosening or breakage of screw were found. There were no significant differences about the tibial plateau angle (TPA) and the posterior slope angle (PA) on radiographies between immediately after operation and 6 months after operation. According to the Rasmussen functional scoring,the results were excellent in 4, good in 3, fair in 1. Radiologic results were graded with the Rasmussen score to evaluate the reduction of the fracture, the scores at last followed-up was 14 to 18 scores (means 17.25), the results were excellent in 6, good in 2.

CONCLUSIONPosterior S-shaped or L-shaped approach can facilitate the reduction and fixation with good exposure for posterior fractures of tibial plateau.

Adult ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

AIM:To observe the effect of Tangshenfang(TS)on the liver protection and the levels of silent in-formation regulator 1(SIRT1)and peroxisom proliferator-activated receptor γcoactivator-1α(PGC-1α)in the liver tissue. METHODS:The rat model of diabetes mellitus(DM)was established by intravenous injection of streptozotocin(STZ;30 mg/kg)after having the high fat/high glucose diets for 1 month.The diabetic rats were randomly divided into DM group,DM with high-dose TS(TSHi)group, medium-dose TS(TSMed)group and low-dose TS(TSLow)group.The normal rats were served as control group.There were 8 rats in each group.After treatment with TS for 12 weeks,the serum biochemical indi-ces including fasting blood glucose(FBG), triglyceride(TG), alanine aminotransferase(ALT)and aspartate aminotrans-ferase(AST)were tested.Fasting insulin(FINS)was also detected by radioimmunoassay,and homeostatic model assess-ment for insulin resistance(HOMA-IR)was calculated.The serum levels of tumor necrosis factor-α(TNF-α)and interleu-kin-1(IL-1)were measured by ELISA.The activity of SOD and content of MDA in the liver tissues were measured by the methods of hydroxylamine and thiobarbituric acid.The liver pathological changes were observed under light microscope with HE and Masson staining.The protein expression of SIRT1and PGC-1αin the liver tissues was determined by Western blot. RESULTS:In DM group,serum FBG,TG,ALT,AST,FINS,HOMA-IR,TNF-αand IL-1 were obviously increased com-pared with the control group(P<0.01).The fatty changes,local necrosis,inflammation and fibrosis in the liver tissues were observed.The content of MDA in liver increased,while the activity of SOD decreased markedly.The protein expression of SIRT1 and PGC-1αwas decreased(P<0.05).In TS treatment groups,all these changes in DM rats were markedly reversed by TS,and the protein expression of SIRT1 and PGC-1αin the liver tissues was markedly increased.CONCLUSION:TS may protect the rats from diabetic liver injury by increasing the expression of SIRT 1 and PGC-1α,and thereby improving in-sulin resistance and oxidative stress.

OBJECTIVETo investigate the significance of PKC and p44/42 mitogen-activated protein kinase (MAPK) signal transduction in ischemic preconditioning (IP).

METHODSThrough liver cell IP models, PKC inhibitor and MEK inhibitor were utilized to analyze the phosphorylation level of p44/42 MAPK and cell viability was also observed. Rat liver IP models were established which were treated with various drugs. Then the phosphorylation level of p44/42 MAPK in vivo and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations were detected. And cellular structures were observed under light microscopy.

RESULTSSimilar results were obtained in vivo and in vitro IP models. Compared with the ischemia reperfusion (IR) group in vivo, the phosphorylation level of p44/42 MAPK was obviously increased in IP treated rats (q = 27.217, P < 0.01), and the cellular structure injured slightly. The concentrations of serum ALT and AST in IP group were significantly lower than those in IR group (281.0 U/L +/-35.6 U/L vs 762.8 U/L +/-130.5 U/L and 407.7 U/L +/-73.7 U/L vs 820.9 U/L +/-111.3 U/L, P < 0.01). However, opposite changes were found in PKC and MEK inhibited groups, when compared to IP group. The phosphorylation level of p44/42 MAPK was obviously decreased, the liver tissues injured evidently, and the concentrations of serum ALT and AST (645.61 U/L +/-90.4 U/L, 678.6 U/L +/-136.5U/L and 466.2 U/L +/-82.8 U/L, 732.9 U/L +/-91.1 U/L, respectively) were significantly greater than those in IP group.

CONCLUSIONThese results suggest that p44/42 MAPK pathway plays a vital role in the protection of hepatocytes in ischemic preconditioning.

Alanine Transaminase ; blood ; Animals ; Aspartate Aminotransferases ; blood ; Hepatocytes ; cytology ; physiology ; Humans ; Ischemic Preconditioning ; Liver ; blood supply ; cytology ; Male ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Mitogen-Activated Protein Kinase 3 ; metabolism ; Phosphorylation ; Protein Kinase C ; metabolism ; Rats ; Rats, Sprague-Dawley ; Signal Transduction

OBJECTIVETo evaluate the clinical result of check ligament suspension for correction of congenital severe blepharoptosis.

METHODSSince Jan. 2010 to Nov. 2010, 15 eyes in 15 cases with congenital severe blepharoptosis were treated with the check ligament suspension. Palpebral aponeurosis was exposure by opening fascia palpebral during blepharoplasty. Palpebral aponeurosis was cut off about 5 mm above the tarsus. The check ligament was seen in the intermuscular space between the segment of levator and the anterior one third of superior rectus attached to the conjunctival fornix. Congenital blepharoptosis could be corrected by suturing the check ligament and levator palpebrae superior to the upper margin of tarsal plate with 3-0 silk thread. Double eyelid plasty was carried out in the end.

RESULTSThe follow-up period was 3-11 months with good cosmetic result. All the cases could close their eyes in 15 to 30 days with no complication.

CONCLUSIONSIn conclusion, this technique is quite successful in raising the level of the upper eyelid in severe congenital blepharoptosis. The check ligament moves in a similar direction as the natural movement of levator muscle, so both the postoperative static and dynamic appearance of the upper lid is more natural.

Adolescent ; Adult ; Blepharoplasty ; methods ; Blepharoptosis ; congenital ; surgery ; Female ; Humans ; Ligaments ; surgery ; Male ; Oculomotor Muscles ; surgery ; Young Adult

OBJECTIVETo establish and characterize imatinib-resistant gastrointestinal stromal tumor (GIST) xenografts. Further provided an ideal experimental platform through the imatinib-resistant GIST xenografts to investigate the mechanism of resistance to imatinib.

METHODSImatinib-resistant GIST cells were injected under the skin of athymic nude mice to establish animal models of human imatinib-resistant GIST. The molecular and histopathologic features of GIST xenografts were also analysed and compared with their counterpart of cell lines.

RESULTSThe xenograft tumor models had been established by subcutaneously injection of GIST cells into nude mice. Immunohistochemistry results showed CD117 expression was positive in GIST-PR2 xenograft tumor, but negative in GIST-R. In GIST-PR1, tumor areas showing rhabdomyoblastic differentiation were presented next to areas with classic GIST morphology. The rhabdomyoblastic component demonstrated consistently positivity for desmin and myogenin, whereas CD117 was completely negative. The mutation profiles of these xenograft tumors were the same as their counterpart of cell lines.

CONCLUSIONSHuman GIST xenografts with mutation in c-kit have been established from imatinib-resistant GIST lines. Those models will enable further studies on mechanisms of resistance, combination therapies and allow testing of novel targeted therapies.

Animals ; Antineoplastic Agents ; pharmacology ; Benzamides ; Cell Differentiation ; Cell Line, Tumor ; Desmin ; metabolism ; Drug Resistance, Neoplasm ; Female ; Gastrointestinal Neoplasms ; genetics ; metabolism ; pathology ; Gastrointestinal Stromal Tumors ; genetics ; metabolism ; pathology ; Humans ; Imatinib Mesylate ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Mutation ; Myogenin ; metabolism ; Piperazines ; pharmacology ; Proto-Oncogene Proteins c-kit ; genetics ; metabolism ; Pyrimidines ; pharmacology ; Rhabdomyosarcoma ; metabolism ; pathology ; Xenograft Model Antitumor Assays

OBJECTIVETo determine the circular DNA level of patients with hand foot and mouth disease (HFMD) and evaluate its potential clinical value.

METHODSVenous blood in 30 healthy children and 78 patients with HFMD within 3 days of onset of illness and convalescent period was collected. The level of plasma circular DNA was detected by duplex real-time polymerase chain reaction assay. Blood sugar, high-sensitive CRP(hs-CRP) and leucocyte were also detected.

RESULTSThe level of circular DNA in control group was (6.57 +/- 4.67) ng/ml. The level of circular DNA in ordinary and severe HFMD patients was (11.51 +/- 7.75) ng/ml and (20.59 +/- 10.67) ng/ml before treatment, respectively. The levels of circular DNA in ordinary and severe HFMD patients were significantly higher than that in control group (P = 0.021; 0.000); the level of circular DNA in severe HFMD patients was significantly higher than that in ordinary HFMD patients (P = 0.011). The level of circular DNA in severe HFMD patients after treatment were significantly lower than that before treatment (P = 0.033). The level of circular DNA before treatment and after treatment in ordinary HFMD patients had no significant difference. The levels of blood sugar and hs-CRP in severe HFMD patients were higher than those in ordinary before treatment (P = 0.045; 0.011). The levels of blood sugar and hs-CRP before treatment and after treatment in ordinary HFMD patients had no significant change. There was significantly positive correlation between the level of circular DNA and that of hs-CRP in HFMD patient (P = 0.021), but there was no correlation between the level of circular DNA and that of blood sugar and leucocyte.

CONCLUSIONSThe level of circular DNA not only become an early identification marker of severe HFMD patients, but also become monitoring marker of effect of treatment.

Biomarkers ; Blood Glucose ; analysis ; C-Reactive Protein ; analysis ; Child, Preschool ; DNA, Circular ; blood ; Female ; Hand, Foot and Mouth Disease ; blood ; genetics ; Humans ; Infant ; Male