Objective: To evaluate the role of the deep radioulnar ligament in the stability of the distal radioulnar joint (DRUJ).Methods: In the study, 14 fresh cadaver upper extremities were randomly divided into two groups.After exposuring the palmar and dorsal deep distal radioulnar ligament, one group was marked as palmar deep radioulnar ligament, and the other group was marked as dorsal deep radioulnar ligament.The pronator teres and the supinator were exposed.A Kirschner wire perpendicular to the bone on Lister tubercle of radius was inserted, then another Kirschner wire on the same level of ulnar inserted when the forearm was in neural position, which was kept parallel to the first Kirschner wire.These specimens were mounted on a specially designed jig which held the limb rigidly, keeping the elbow fle-xion and the ulnar fixation.The radius could freely rotate around the ulnar.Then 50 N force on the pronator teres was applied to simulate the active pronation, and 60 N force on the supinator to simulate the active supination.The active pronation was stimulated, and the displacement of the distal radius was measured with respect to the ulna.The active supination was atimulated, and the displacement of the distal radius was measured with respect to the ulna.The palmar deep radioulnar ligament in one group was cut, then the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.The dorsal deep radioulnar ligament in the other group was cut, and the displacement of the distal radius measured with respect to the ulna when the forearm was in pronation and supination.Results: After resection of the palmar deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was statistically significantly different when the forearm was in pronation (t=5.591, P=0.001), but there was no difference when the forearm was in supination (t=0.433, P=0.680).After resection of the dorsal deep radioulnar ligament, the displacement of the distal radius with respect to the ulna was not different when the forearm was in pronation (t=1.000, P=0.356), but there was statistically significant difference when the forearm was in supination (t=6.225, P=0.001).Conclusion: DRUJ is unstable when the forearm is in pronation after resection of the palmar deep ra-dioulnar ligament, and DRUJ is unstable when the forearm is in supination after resection of the dorsal deep radioulnar ligament.

0.8). (2) The range of correlation coefficient of increasing regions is from 0.7 to 0.98. Time-course graph shows that the figure of most curve is like “”. [Conclusion](1) The function of puncturing Baihui may be connected with signal changes of corresponding brain areas. (2) fMRI is a feasible method on studying the mechanisms of acupunctrue.

Objective:To investigate the outcomes of applying microvascular anastomotic coupling de-vices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical out-come.Methods:From March to September 2013,19 injured arteries from 18 male patients who presen-ted at Department of Hand Surgery,Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures.COUPLER,a microvascular anastomotic coupling device was applied in these artery injury repair operations.The 19 repaired arteries included 3 brachial arteries,6 ulnar arteries and 10 radial arteries.After the procedures,all the 18 patients were then fol-lowed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality.Results:The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was (71.5 ± 40.9)d with the longest follow-up time as 116 d and shortest as 14 d.No patient returned to the opera-ting room after the procedures and after being dismissed from the hospital.None of the 18 cases were re-ported to have problems with circulation and thrombosis formation in their upper extremities.Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends.Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis;while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery.These evidences indicated that the outcomes of our initial evalua-tion for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were posi-tive.Conclusion:Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures.The procedures are quick,effective and safe. The clinical application of this microvascular anastomotic coupling device in artery injures is promising, however,additional evidences through further clinical investigation with more cases are warranted.

Objective To evaluate the preliminary clinical outcome of the screw fixation of minimally displaced scaphoid fracture assisted by computerized imaging reconstruction and preoperative planning system.Methods From March 2013 to Feburary 2014,Five screws on five patients were treated.We calculated and designed the position of scaphoid screw guide wire and ensured the guide wire centrally placed in the scaphoid by using the computerized imaging reconstruction and preoperative planning system software.The appropriate length of the screw was measured too in the software.We also identified the entry and exit points of the guide wire on the custom orthoses splinting the wrist joint.Five patients with scaphoid fractures were treated with percutaneous screw fixation under the guidance of a C-arm fluoroscopy and a guide wire were inserted based on the entry and exit points calculated preoperatively.All of the scaphoid fracture was nondisplaced or less than 1 mm.The modified MAYO wrist scoring system was used to evaluate the pain,function and range of motion for the wrist joint during follow up.Results Total surgical time was 28.8 min (25-39 min)and Fluoroscopy time was 18.4 s (11-23 s).The fracture healing was observed at routine 8 weeks follow up.No complication such as infection or fixation failure was reported.Modified MAYO wrist score was 83.8 (81-88)at average followup at 15 months (6-12 months).Conclusion Computer assisted percutaneous screw fixation is an effective method for the treatment of nondisplaced scaphoid fractures.It leads to significantly reduced guidewire placement time and radiological exposure time while provides accurate placement of the screw.

Objective:To study the effects of nitrous oxide(N2 O)sedation in the management of dental fear(DF)for dental treat-ments of children.Methods:66 cases of pediatric patients(aged 6 to 14 years)were given N2 O sedation for dental treatments.The heart rate(HR)and oxygen saturation(SpO2 )were measured before and after N2 O inhalation.N2 O effective concentration was eval-uated by Ramsay sedation score and Houpt behavior score.Results:The effective concentration of N2 O sedation was 25% -70%(49.6% ±12.1%),the maximum endurance concentration 35%-70% (56.4% ±10.1%).The Ramsy scores of N2 O sedation was (2.3 ±0.6).After N2 O inhalation,all patients could receive verbal demand during the treatments.The HR decreased(P <0. 05)and the Houpt behavior score increased(P <0.01).Before and after N2 O inhalation SpO2 had no significant difference(P >0.05).Conclusion:N2 O inhalation at 25% -70% is safe and effective in the management of DF for dental treatments of children.

Objective To observe the imaging features of intraosseous ganglion of the wrist. Methods The radiographs (6 cases), CT (4 cases), and MR (1 case) in 6 cases (7 lesions) of surgically confirmed intraosseous ganglion were retrospectively reviewed. Results Typical intraosseous ganglion was seen as sharp margined and cystic lesion with the size of approximately 0.5 cm in diameter. All but one lesion showed no communication with joint. No degenerative changes were seen in the joints nearby. CT was able to depict the lesions better than radiographs in 4 cases. Intraosseous ganglion was seen as slight low signal on T 1WI and slight high signal on T 2WI MR images. Conclusion Intraosseous ganglion was typically seen as sharp-margined and cystic lesion on radiographs, and it could be better demonstrated with CT and MR. With typical imaging appearance, a suggestion to the diagnosis of intraosseous ganglion could be made.

Objective To investigate the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC) and three-ligament tenodesis for chronic scapholunate dissociation,and to determine its recurrence rate and time after operation.Methods From January 2008 to January 2011,23 patients with chronic scapholunate dissociation were treated in our hospital.Among them,19 patients underwent DILC and 4 underwent three-ligament tenodesis.The average duration of follow-up was 10.1 months.The clinical and radiographic outcomes were recorded preoperatively,at 1 month after pin removal,and at final follow-up.The VAS and DASH questionnaire were used to assess the pre-and post-operative pain,improvement of function and degree of patient satisfaction,respectively.Results The radiographic outcome showed that the abnormal carpal alignment was reduced completely in all patients during operation.At 1 month after pin removal,the mean scapholunate gap was 4.0 mm,and average scapholunate angle was 75°.Compared with those before operation,the scapholunate gap and scapholunate angle were improved.At final follow-up,the mean scapholunate gap was 4.3 mm,and the mean scapholunate angle was 78°; they were worse compared with those at 1 month after pin removal,while there was no statistical difference in both results.The other three radiographic results at final follow-up remain unchanged.The wrist flexion,wrist extension and grip strength decreased from preoperative 66％,69％ and 71％ of the contralateral side to postoperative 52％,50％ and 66％ of the contralateral side.Conclusion Soft tissue reconstruction cannot withstand the large and repetitive forces.Carpal collapse recurs in a short time after dorsal capsulodesis and three-ligament ten-odesis,which mostly happens in 1 month after pin removal.The best way to treat scapholunate dissociation is still unknown.

To investigate the expression of alpha-smooth muscle action (alpha-SMA) in the renal tubulointerstitium in patients with kidney collateral stasis.

Objective To investigate the relationship of the changes of bone density and biochemical marker of bone turnover with osteoporosis in the elderly with type 2 diabetes mellitus(T2DM). Methods A total of 102 elderly patients with type 2 diabetes and 42 healthy subjects (normal controls) were included in this study.The bone mineral density (BMD) of lumbar vertebrae and femur were measured by dual-energy X-ray absorptiometry (DXA).The T2 DM subjects were divided into two groups:osteoporosis group (56 cases) and non-osteoporosis group (46 cases).The levels of total procollagen type Ⅰ amino-terminal propeptide (TP Ⅰ NP),β-isomerized carboxyterminal propeptide (β-CTx),parathyroid hormone (PTH),serum calcium (Ca2+),serum phosphorus (P),alkaline phosphatase (ALP),fasting blood glucose(FBG),glycosylated hemoglobin (HbAlc) and body mass index (BMI) were detected. The correlations between BMD of the osteoporosis group and other related factors were analyzed. Results The BMD values of lumbar vertebrae and femur neck,troch,ward's triangle in the osteoporosis group were decreased as compared with control(t=9.006,6.347,7.387,5.321,P＜ 0.01) and the serum TP Ⅰ NP,β-CTx,PTH,ALP,FBG,HbAlc,Creatinine and albumin/Cr in the osteoporosis group were significantly higher than controls(t=2.212,4.431,2.215,3.544,0.433,1.629,0.365,5.436,P＜0.01 or P＜0.05),the 25-(OH)VD3 in the osteoporosis group was lower than in controls(t=2.700,P＜0.01).Correlation analysis showed TP Ⅰ NP was negatively correlated with the BMD of femoral Troch and Ward's triangle (r=-0.413,-0.375,P＜0.01),and β CTx was negatively correlated with the BMD of femoral Troch (r=-0.301,P＜0.05).The TP Ⅰ NP,β-CTx in the overweight group and obesity group were higher than in normal group(F=50.59,51.28; F =96.20,95.71,all P＜0.01);the melbine group had higher TP Ⅰ NP,β-CTx than the thiazolidinedione and sulfonylurea group(F=32.33,33.35,F=31.07,39.18,P＜0.01);the TP Ⅰ NP,β-CTx in the better blood glucose control group were lower than in the bad control group(F=11.32,13.69,P＜0.01);the TP Ⅰ NP,β-CTx in the group with complication were increased as compared with no complication group(F=52.75,70.34,P＜0.01).Conclusions The spine BMD in elderly T2DM patients is decreased to some degree.The combined application of TP Ⅰ NP and β-CTx is helpful for the early diagnosis of osteoporosis in patients with type 2 diabetes.

Objective To explore the clinical outcomes of Ligament reconstruction tendon interposition (LRTI) arthro-plasty for first carpometacarpal joint osteoarthritis. Methods From January 2008 to January 2011, 19 patients (21 thumbs) had surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radia-lis (FCR). There were 1 male and 18 were females with an average age of 60 years (range, 52-75 years);8 thumbs were on the left side and 13 thumbs on the right side. According to Eaton-Glickel classification, 1 thumb belonged to stageⅡ, 14 thumbs to stageⅢ, and 6 thumbs to stageⅣ. Pain level, grip strength, tip pinch strength, range of motion, and radiographic measurement were re-corded. According to the first metacarpal subsidence, the cases were classified in mild, moderate, and severe groups. Clinical out-comes of different group were evaluated and compared. Results All patients were followed up for 9-28 months with an average of 13.9 months. Comparision with the preoperative X-rays showed the first metacarpal had subsided 54.8% of the arthroplasty space after surgery. Grip strength improved from 18.6±10.1 kg to 20.5±11.9 kg, and tip pinch strength increased from 4.4±2.1 kg to 4.5 ± 1.9 kg after the surgery. Radial abduction increased from 55.7° ± 8.2° to 60.6° ± 7.2° and palmar abduction improved from 56.7° ± 8.5° to 63.5° ± 8.2° after the procedure. Patient pain levels (visual analogue scale, VAS) were significantly reduced, from 6.6 ± 1.4 to 0.5 ± 0.7. There was no difference of grip strength, tip pinch strength, thumbs range of motion, and VAS after LRTI in mild, moderate and severe groups. Conclusion LRTI resulted in excellent relief of pain and increase in range of motion. Howev-er, LRTI cannot sustain the arthroplasty space. Compared with the preoperative X-ray, the first metacarpal subsided more than 50%. Subsidence of the first metacarpal doesn't affect the pain relief, range of motion and strength improvement.