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.

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 evaluate the method and outcomes of radiocarpal joint reconstruction via nonvascularized and vascularized fibular bone graft after distal radius bone and joint defect.Methods Between November,1966 and March,2009,27 cases with distal radius bone and joint defect due to tumor en bolc excision (24 cases) or AO C3 type fractures (3 cases) were treated with nonvascularized or vascularized fibular bone graft.There were 9 males and 18 females.The mean age of these patients at the time of surgery was 27 years (rage from 16 to 67 years).There were 14 left sides and 12 right sides and 1 bilateral side.Nine cases with vascularized and 18 cases with nonvascularized fibular bone graft for radiocarpal joint reconstruction.The bone fixed with plate or/and k-wire.DASH scores,G/W wrist scores,PRWE scores were applied for writ function evaluation and the grasp power recovery rate and bone healing time was also compared during postoperative follow up.Results All 27 patients were followed with an average follow-up time being 9 years (range from 3.5 years to 44.0 years).The average length of fibular bone harvested was 10 cm for vascularized bone graft and 9 cm for nonvascularized.The all fibular bone was healed and the average healing time was 4.7 months (range from 3-8 months).No tumor recurrence or distance metastasis occurred during the follow-up.The average DASH scores was 7.97 (2.5-17.0),G/W scores of 24 patients ranged from 1 to 2,the wrist function result was excellent,account for 88.9％,and 3 cases from 3 to 7,function was good,account for 11.1％; the average grasp power recovery rat was 85.81％ (75％-104％); the average PRWE scores were 25.3(10.5-38.0).Comparison outcomes between the nonvascularized and vascularized fibular bone graft for radiocarpal wrist joint reconstruction,there was no significant statistics difference for bone healing time,DASH,G/W,PRWE scores and grasp power recovery rate (P ＞ 0.05).There were no other complications occurred except 3 patients had mild leg pain after long distance walking and 1 case fracture following patient's accident postoperative 11 years,and healed through conservative treatment.Conclusion The nonvascularized or vascularized fibular bone graft is an excellent choice and has less complication with maximal wrist function recovery for radiocarpal joint reconstruction following distal radius bone and joint defect due to all kinds of reasons,such as tumor en bloc excision,distal radius AOC3 type comminuted fracture.The vascularized fibular graft is recommended for larger than 12 cm bone graft.

Objective To investigate the effects of hypoxic conditions on expressions of hypoxia-inducible factor 1α (HIF-1α) and P-glycoprotein (P-gp),and the relationship between HIF-1α and P-gp.Methods Tumor tissues from 54 cases of patients with colonic neoplasm in Xingtai People's Hospital were selected after operation from June 2013 to June 2015.The expressions of HIF-1α and P-gp in colonic tumor tissues were detected by using immunohistochemistry,and their correlations to clinical and pathologic features were analysed.The expressions of HIF-1α and P-gp in colonic tumor cell lines under normoxia and hypoxia conditions were detected by using cell smear method,and correlation between HIF-1α expression and P-gp expression was analysed.Results Among tumor tissues from 58 cases of patients with colonic neoplasm,the positive rate of HIF-1α expression was 58.62％,and that of P-gp expression was 46.55％.The positive rates of HIF-1α and P-gp expressions of patients on the Dukes stage C+D were significantly higher than those of patients on A+B phase (P＜0.05).Additionally,the positive rates of HIF-1α and P-gp expressions of patients with lymphatic metastasis were significantly higher than those of patients without lymphatic metastasis (P＜0.05).The HIF-1α expression was positively correlated with the P-gp expression (r=0.574,P＜0.01).For the same cell lines,the expression levels of HIF-1α and P-gp under hypoxia condition were significantly higher than those under normoxia condition,there were statistically significant differences (P＜0.01).While,under the same oxygen conditions,no statistically significant difference was found in expression levels of HIF-1 and P-gp among different colonic tumor cell lines (P＞0.05).Conclusion Overexpression and coexpression of HIF-1α and P-gp exist in colon cancer.The expression levels of HIF-1α and P-gp in patients with different Dukes stages and patients with or without lymph node metastasis are significantly different,and positive correlation is observed between the expression of HIF-1α and P-gp.Hypoxia condition can induce an increase in expressions of HIF-1α and P-gp in colonic tumor cells.

Objective To investigate the inhibitory effect of the lentiviral vector (LV)-mediated RNA interference (RNAi) targeting HIF-1α on the expression of HIF-1α and Glut-1 in human pancreatic cancer Patu8988 cells.Methods The RNAi targeting HIF-1α was combined to LV,and transfected into Patu8988 cells.The Patu8988 cells transfected with the empty vector and exposed to 0.5％ O2 for 4 h served as hypoxia negative control,the Patu8988 cells not transfected with vector and exposed to 0.5％ O2 for 4 h as hypoxia blank control,and the Patu8988 cells transfected with LV-RNAi-HIF-1α and exposed to 0.5％O2 for 4 h as experimental group.The expression of HIF-1α was measured by RT-PCR and Western blot respectively.The expression of Glut-1 was measured by RT-PCR.Each group was compared according to oneway analysis of variance and two-sample t test.Results After transfection with LV-RNAi-HIF-1α,HIF-1α mRNA expression decreased by 65.1％ (0.209/0.321) and 80.6％ (0.791/0.982) (t=10.52,15.24,both P＜0.05) under normoxia and hypoxia conditions,meanwhile with the empty vector,HIF-1α mRNA expression decreased by 0.6％ (0.002/0.321) and 7.2％ (0.071/0.982) (t =5.26,7.38,both P＜0.05).Under hypoxia conditions,the protein of HIF-1α in experimental group cells (0.159±0.010) was down-regulated obviously compared to the negative control group (0.745± 0.012) and the blank control group (0.711 ± 0.023)(F=35.52,t =6.72,10.56,all P＜0.05).The expression of Glut-1 mRNA in experimental group cells (0.040±0.003) decreased obviously compared to the negative control group (0.054±0.003) and blank control group (0.062±0.004) (F=35.28,t=5.94,8.55,all P＜0.01).Conclusion Gene silencing of HIF-1α using LV-mediated RNAi can inhibit the expression of HIF-1α and decrease the expression of Glut-1mRNA in Patu8988 cells.

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.

Objective To evaluate the treatment effects of middle and proximal phalangeal fractures with lateral fixation of mini-titanium plate.Methods From December 2011 to April 2015,56 patients (64 phalanges) suffered from closed middle and proximal phalangeal fractures were treated with lateral fixation of mini-titanium plate.There were 48 males and 8 females,aged from 17 to 65 years (average,36.3 years).Fractures included 25 cases of middle phalangeal fracture and 39 cases of proximal phalangeal fracture.According to site of fracture,12 cases were middle phalangeal condyle fractur,7 cases were middle phalangeal shaft fracture,6 cases were middle phalangeal base fracture,10 cases were proximal phalangeal condyle fracture,22 cases were proximal phalangeaal shaft fracture and 7 cases were proximal phalangeal base fracture.According to the type of fracture,13 cases were transverse,9 cases were short oblique,11 cases were long oblique,6 cases were spiral and 25 cases were comminuted fracture.All phalangeal fractures were exposed by lateral approach,in which the lateral band and oblique fibers of proximal phalanx were excised to fully expose proximal phalangeal fracture.After the reduction,the fractures were fixed with mini-titanium plate laterally.The Disabilities of the Arm,Shoulder and Hand (DASH)and the bilateral fingers total active motion (TAM) were employed to evaluate the functions.All patients took X ray during follow-up.Results All 56 patients were followed up from 9 to 47 months,average (14 ± 6) months.Phalangeal fractures were healed from 7 to 14 weeks,average (8.8 ± 2.4) weeks without loss of fixation or malunion.At final follow-up,DASH score were from 1.7 to 7.5,with an average of 4.8 ± 2.2.TAM of the fingers was excellent (＞ 90％ TAM of the contralateral side) in 33/64 (51.5％) cases,good (75％-90％ TAM of the contralateral side) in 30/64 (46.9％) cas es,fair (50％-75％ TAM of the contralateral side) 1/64 (1.6％) cases.Conclusion Lateral approach fully exposes middle and proximal phalangeal fractures and less interferes with the extensor mechanism.Lateral fixation with mini-titanium plate could provide stability and allow early motion.This technique may be an optional choice in clinical practice.

Objective To summarize the clinical characteristics,diagnosis and treatment of chronic mucocutaneous candidiasis(CMC).Methods The case diagnosed as CMC in the Department of Nephrology and Immunology of Shenzhen Children's Hospital in February 24,2014 was analyzed in terms of symptoms,signs,laboratory findings,gene tests and treatment process,and related literature was reviewed.Results The patient was a 14-year-old boy.The patient started to develop recurrent oral candida infection shortly after birth,then candida infection of skins and nails,which could be alleviated by antifungal agents,but easily relapsed.Since 4 years ago,autoimmune reactions such as autoimmune anemia,thrombocytopenia,leucopenia,proteinuria,and hypothyroidism had successively appeared,and cytopenia began to palliate after administering Glucocorticoid and Cyclosporin,but easily relapsed when the dosage was reduced.The genetic test showed the case was of signal transducer and activator of transcription 1 (STAT1) gain-of-function mutation.During the hospitalization,hemophagocytic syndrome (HPS) and stagnation of hematopoietic function successively occurred.The cytopenia did not improve and the patient suffered severe infection in spite of washing red blood cells 13 times and blood palate 3 times via infusion,together with high dosage of Dexamethasone and Cyclosporine.The peripheral blood cells and bone marrow gradually returned to normal after being treated by human granulocyte colony-stimulating factor combined with Dexamethasone and Cyclosporin.Retrieving the database in PubMed database,824 articles were found which were about CMC,and 39 of them were about the STAT1 gain-of-function mutation,including 120 cases.But there was only 1 domestic case in 2012,who was a three-year-old child,manifesting recurrent fungal infection of the skin.Conclusions STAT1 gain-of-function acquired mutation is one of the reasons that can lead to CMC.Autoimmune reactions prominently represented by cytopenia occur in a few patients with CMC.It should be alert on those who are with CMC and simultaneously with autoimmtne reaction of blood system.And gene tests facilitate the early diagnosis.

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

Objective To compare the fascia iliaca compartment block versus femoral nerve 3-in-1 block for postoperative analgesia in elderly patients undergoing hip surgery.Methods A total of 160 patients with hip fracture,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 70-101 yr,weighing 30-93 kg,scheduled for elective total hip replacement or artificial femoral head replacement under general anesthesia,were divided into 2 groups (n =80 each) using a random number table:fascia iliaca compartment block group (FIB group) and femoral nerve 3-in-1 block group (FNB group).Ultrasound-guided fascia iliaca compartment and 3-in-1 blocks were performed with 0.2％ ropivacaine 40 ml in FIB and FNB groups,respectively.Patient-controlled analgesia (PCA) with 0.2％ ropivacaine 275 ml was used for postoperative analgesia until 72 h after operation in both groups.The PCA pump was set up with a 5 ml bolus dose,a 60 min lockout interval and background infusion at a rate of 5 ml/h,and the visual analog scale score was maintained≤4.When the visual analog scale score＞4,tramadol 50-100 mg was taken orally or injected intramuscularly for rescue analgesia.Before implanting the catheter,at 15 min after the initial administration and at 12 h after operation,temperature sensation and light touch sensation tests were performed in the anterior regions of thigh (innervated by femoral nerve),lateral region of thigh (innervated by lateral femoral cutaneous nerve) and superior part of the anterior region of thigh (innervated by obturator nerve).Successful sensory block was defined as the occurrence of a decline in temperature sensation or in light touch sensation in any area,and the successful sensory block was recorded.The requirement for rescue analgesia and patient's satisfaction with analgesia were recorded within 72 h after operation.The development of adverse reactions such as nerve damage,nausea and vomiting,dizziness and palpitation was also recorded within 48 h after operation.Results Compared with group FIB,the rate of successful analgesia in lateral thigh area was significantly decreased at 15 min after the initial adminstration and 12 h after operation,the requirement for rescue analgesia after operation was increased,the rate of satisfactory analgesia after operation was decreased (P＜0.05),and no significant change was found in the incidence of postoperative nausea and vomiting or dizziness in group FNB (P＞0.05).Conclusion Ultrasound-guided continuous fascia iliaca compartment block provides better efficacy for postoperative analgesia than 3-in-1 block in elderly patients undergoing hip surgery.