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 investigate the factors affecting depression and anxiety symptoms among the elderly, so as to provide the basis for promoting mental health among the elderly. Methods: The elderly aged 60 years and above in Ningbo City, Zhejiang Province were recruited using the multistage stratified random sampling method from June to August 2022, and demographic information, lifestyle and self-rated health status were collected by questionnaires. The symptoms of depression and anxiety were assessed by the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. The presence of depressive and anxiety symptoms was determined when both the PHQ-9 score and the GAD-7 score were 10 points and higher. Factors affecting depressive and anxiety symptoms were identified using a multivariable logistic regression model. Results: A total of 7 771 individuals were surveyed, including 3 490 males (44.91%) and 4 281 females (55.09%), and had a mean age of (72.11±6.79) years. The prevalence of depression and anxiety symptoms was 2.05%. Multivariable logistic regression analysis identified residence (urban area, OR=0.316, 95%CI: 0.201-0.498), sedentary duration (<3 h/d, OR=0.349, 95%CI: 0.232-0.525; 3-5 h/d, OR=0.458, 95%CI: 0.313-0.671), physical activity (≥3 times/week, OR=0.551, 95%CI: 0.373-0.815), sleep quality (poor, OR=2.491, 95%CI: 1.738-3.571), social isolation (OR=1.688, 95%CI: 1.148-2.481) and self-rated health (poor, OR=5.857, 95%CI: 3.547-9.671; normal, OR=1.903, 95%CI: 1.234-2.937) as the influencing factors for depression and anxiety symptoms among the elderly. Conclusion The prevalence of depression and anxiety symptoms among the elderly is associated with residence, sedentary duration, sleep quality, physical activity, social interactions and self-rated health status.

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

Objective:To explore the clinical effect of the V-Y plasty of musculocutaneous flap in repairing the excessive width of inner canthus deformity.Methods:Retrospective analysis was performed between July 2018 and June 2021 in patients treated with this method. V-Y design along the inner corner of the eye before operation. The key points of operation are the elevated under the orbicularis oculi muscle. The skin orbicularis oculi muscle flaps are formed on both sides of the incision. After the V-Y of the outside myocutaneous flap is advanced and formed at the new medial canthus point, the V-Y of the orbicularis oculi muscle and the skin are sutured in layers. The degree of reduction of the inner canthus width, epicanthal fold shape, incision scarring, and patient satisfaction was followed up. All patients were measured at the preoperative and postoperative review to record data of the intercanthal distance, and used paired t-test for statistical analysis. P<0.05 was statistically significant. Results:83 patients, including 81 female patients and 2 males, with an average age of 28 years (19 to 56 years) were followed up from 3 months to 2 years, with an average of 1 year. The overexposure of the tear caruncle was significantly reduced, the asymmetry of the bilateral inner corners has been improved, the shape of the epicanthal folds reverted to its natural appearance and the old scars became inconspicuous; patient satisfaction evaluation: very satisfied 34.94% (29/83), satisfied 54.22% (45/83), relatively dissatisfied 6.02% (5/83), dissatisfied 4.82% (4/83). Among the 4 cases of dissatisfaction, 2 cases were due to insufficient correction and were re-operated to obtain satisfactory result, 1 case was improved by reoperating due to excessive correction which led to the reduction of inner canthal distance, 1 case regrets surgery the next day after surgery and cannot accept the appearance and strongly requires removal and restoration. The distance between intercanthal distance of the patients was 28.8 mm to 38.0 mm, average (33.58±3.34) mm before the operation, and 32.2 mm to 41.5 mm, average (37.47±2.90) mm after the operation, an average increase of 3.89 mm ( t=-15.78, P<0.001) after the operation. Conclusions:The V-Y plasty of musculocutaneous flap is suitable for the repair of excessive width of inner canthus deformity after epicanthoplasty. The design idea is simple, the postoperative effect is reliable, and the postoperative satisfaction rate of patients is high.

Objective:To explore the clinical effect of the V-Y plasty of musculocutaneous flap in repairing the excessive width of inner canthus deformity.Methods:Retrospective analysis was performed between July 2018 and June 2021 in patients treated with this method. V-Y design along the inner corner of the eye before operation. The key points of operation are the elevated under the orbicularis oculi muscle. The skin orbicularis oculi muscle flaps are formed on both sides of the incision. After the V-Y of the outside myocutaneous flap is advanced and formed at the new medial canthus point, the V-Y of the orbicularis oculi muscle and the skin are sutured in layers. The degree of reduction of the inner canthus width, epicanthal fold shape, incision scarring, and patient satisfaction was followed up. All patients were measured at the preoperative and postoperative review to record data of the intercanthal distance, and used paired t-test for statistical analysis. P<0.05 was statistically significant. Results:83 patients, including 81 female patients and 2 males, with an average age of 28 years (19 to 56 years) were followed up from 3 months to 2 years, with an average of 1 year. The overexposure of the tear caruncle was significantly reduced, the asymmetry of the bilateral inner corners has been improved, the shape of the epicanthal folds reverted to its natural appearance and the old scars became inconspicuous; patient satisfaction evaluation: very satisfied 34.94% (29/83), satisfied 54.22% (45/83), relatively dissatisfied 6.02% (5/83), dissatisfied 4.82% (4/83). Among the 4 cases of dissatisfaction, 2 cases were due to insufficient correction and were re-operated to obtain satisfactory result, 1 case was improved by reoperating due to excessive correction which led to the reduction of inner canthal distance, 1 case regrets surgery the next day after surgery and cannot accept the appearance and strongly requires removal and restoration. The distance between intercanthal distance of the patients was 28.8 mm to 38.0 mm, average (33.58±3.34) mm before the operation, and 32.2 mm to 41.5 mm, average (37.47±2.90) mm after the operation, an average increase of 3.89 mm ( t=-15.78, P<0.001) after the operation. Conclusions:The V-Y plasty of musculocutaneous flap is suitable for the repair of excessive width of inner canthus deformity after epicanthoplasty. The design idea is simple, the postoperative effect is reliable, and the postoperative satisfaction rate of patients is high.