Objective To modify anterior cruciate ligament (ACL)reconstruction to achieve better structure;to measure the tunnel's position and shape using three-dimensional computed tomography (CT)so as to show the change of the femoral bony tunnel.Methods Forty-five patients were diagnosed with an ACL tear and subsequently underwent the modified ACL reconstruction,using a minor-diameter drill to drill the femoral tunnel and then expand it to oval-shaped tunnel with the raspatory between July 2014 and 2015.All procedures were conducted by the same experienced surgeon (Ao Yf.).In all patients,CT was performed at one week after the ACL reconstruction to evaluate the femoral tunnel's positioning,then the CT-images were imported into the image processing software MIMICS to reconstruct the femoral bony tunnel to measure the tunnel's diameters of the section and the shape.The tunnel's position was evaluated using the quadrant method.Results In all the 45 patients,the graft could pass the tunnel.And no posterior tunnel wall blowout,neurological or vascular deficit was documented during the operation.According to the different methods of modification (6 to 7,6 to 8 and 7 to 8),the long diameters of the sections of the femoral bony tunnels were 8.34-± 0.52 mm,10.65 ± 0.72mm,9.27-± 0.11 mm,without significant difference from the theoretical value (8.16 mm,10.66 mm and 9.14 mm).However,the short diameters of the sections were 6.57--0.12 mm,6.74-± 0.13 mm,and 7.52 ± 0.05 mm,showing significant difference from the theoretical value (6mm,6mm and 7 mm).The average centre of the femoral tunnel was located at 26.4 ± 4.8％ of the femoral length and at 30.1 ± 5.6％ of the femoral height.Conclusion In this modified ACL reconstruction,a minor-diameter drill is used to drill the femoral tunnel and then expand it to oval-shaped tunnel with the raspatory,The graft was matched well with the bony tunnel intraoperatively.The three-dimensional CT shows that the femoral tunnels are well located within the anatomical ACL footprint,and its entrance is closer to the natural state.

Objective To retrospectively analyse the clinical data of off-pump coronary artery bypass grafting surgery(OPCAB)in our department and summarize the clinical experience of peri-operative management.Methods From January 2007 to May 2008,253 patients underwent OPCAB.Seventy-six cases with left main disease(including 18 cases of single left main lesion and 58 cases of complex lesion);13 cases had single vessel disease;32 cases had double vessels disease and 190 cases had triple vessels disease.Eighteen cases received emergency OPCAB.All vessel anastomosis were performed with coronary artery stablizer and shunt through median sternotomy.Resuits Three cases died after operation(1.2%).Intra-aortic balloon pump was used in 11 cases.Mechanical ventilation time was 3-168 h[(24.1±22.3)h],and ICU stay time was 1-14 day[(2.8±2.0)d].Postoperative hospital stay time was 8-42 days[(15.6±6.3)d].Conclusion OPCAB is reliable for most bypass cases.With appropilate peri-operative management,a satisfied result will be acceptable.

Objective To summarize the clinical experiences of 1386 patients undergoing off-pump coronary artery bypass grafting(OPCAB)during Jan 2002 to Mar 2008.Methods OPCAB was done through midsternumtomy under ordinary-temperature anesthesia after radial artery,left breast artery and vena saphena magna were taken.Patients over 70 years old accounted for 32.35%,and the oldest was 99 years old.Emergency and subemergency OPCAB was done in 111 cases,re-do CABG with off-pump technique was done in 52 patients.Results 24 cases died during perioperation,with mortality of 1.73%and all other patients discharged from the hospital.Following operation,the symptoms of angina pectoris were relieved and the life quality was much beaer than that before operation.Conclusion OPCAB is feasible for older patients,who are complicated with other chronic diseases for elder patients.Skillful technique of surgeon,right indications for OPCAB and management of peri-and postoperation are key to success of operation.

Objective To summarize the clinical experiences and early-to median effect of coronary artery bypass grafting(CABG)in patients aged 70 years or above.Methods From Dec.2006 to Dec.2007,86 patients aged 70 or above underwent CABG,of whom 71 cases underwent off-pump coronary artery bypass grafting(OPCAB),15 cases had CABG with cardiopulmonary bypass(CPB).5 cases underwent mitral valve replacement,3 underwent aortic valve replacement besides CABG,and one case underwent removal of ventricular aneurysm.Their clinical data were retrospectively analyzed.Results There was one case who died of enterobrosis after operation.The average ICU stay time was(77.4±49.6)h,the average postoperative stay time was 15 d,and the average drainage was 530 ml.22 postoperative complications were found.76 cases were followed up for 10-22 months.Follow up effect was better showing cardiac classification I-II and no angina pectoris,myocardial infarction and late death.Conclusion Patients with coronary heart disease in good condition will have not remarkable improvement in mortality as compared with ordinary patients but attention should be paid to their preoperative pulmonary function and angina pectoffs.OPCABG would have encouraging result in reducing the rate of postoperative complications and hospital death,which should be recommended as the first choice for the elderly patients.

OBJECTIVETo establish a high performance liquid chromatography method for the determination of tetrahydropulmatine content in treatment of winter's diseases in summer path.

METHODThe analysis was performed on the Hypersil ODS2 column (4.6 mm x 250 mm, 5 microm) with methanol and 0.1% phosphoric acid solution (adjusted pH to 6.28 with triethylamine) as mobile phase at 63:37. The flow rate was 1.0 mL x min(-1) and the UV detection wavelength was 280 nm.

RESULTThe linear range of tetrahydropulmatine was obtained from the range of 2.08 - 49.92 mg x L(-1) (r = 0.999 8). The average recovery was 97.85% with RSD 2.49%.

CONCLUSIONThis method is simple, reliable and can be used for the determination of tetrahydropulmatine in this preparation.

BACKGROUND:Thromboelastography plays an important role in identifying the hypercoagulable state of blood and thrombosis in humans.Recent studies have shown a correlation between an increase in mean platelet volume and thrombosis.We can therefore ask whether the combined diagnosis of thromboelastography and mean platelet volume is a more accurate predictor of thrombosis. OBJECTIVE:To predict the status of blood and the occurrence of thrombosis after total knee arthroplasty by means of mean platelet volume combined with thromboelastography. METHODS:One hundred and twenty patients who underwent unilateral total knee arthroplasty between May 2015 and March 2022 were collected.Patients were divided into 60 patients in the thrombosis group and 60 patients in the control group based on ultrasound findings on postoperative day 7.Whole blood cell and thromboelastography were performed 1 day before,1 and 7 days after surgery,respectively.Multifactorial analysis was used to investigate independent predictors of thrombosis after total knee arthroplasty.The receiver operating characteristic curve and area under the curve were measured in the subjects. RESULTS AND CONCLUSION:Mean platelet volume correlated most strongly with maximum amplitude,followed by coagulation angle.Mean platelet volume and coagulation angle on postoperative day 1 were independent predictors of thrombosis.Mean platelet volume tended to rise and then fall in patients with thrombosis.The best critical value for mean platelet volume to predict thrombosis was 10.73 fL.The area under the receiver operating characteristic curve of subjects was 0.665(95%CI:0.568-0.762,P<0.05];whereas the area under the receiver operating characteristic curve for subjects using mean platelet volume combined with coagulation angle was 0.815(95%CI:0.750-0.879,P<0.05).In addition,the maximum amplitude,coagulation angle,coagulation index and mean platelet volume were significantly higher in the thrombosis group than in the control group postoperatively(P<0.05).The results suggest that the mean platelet volume can reflect the hypercoagulable state of blood after surgery,and the combination of mean platelet volume and coagulation angle on day 1 after total knee arthroplasty can improve the prediction of thrombosis.

Objective:To explore the effects and the mechanism of metformin combined with celecoxib on the proliferation and apoptosis of hepatoma HepG2 and Huh7 cells.Methods:Hepatoma cells HepG2 and Huh7 were divided into control group, metformin group, celecoxib group and combination medication group, CCK-8 assay was used to detect cell proliferation; Hoechst33258 staining method was used to investigate the cell apoptosis; wound healing test was used to detect cells migration ability; Transwell invasion chamber test was used to detect cell invasion ability; Western blotting was used to detect the expression of AMPK, PI3K, Akt, mTOR.Results:After metformin and celecoxib treatment, HepG2 and Huh7 cells were gradually contracted, disintegrated and more apoptotic cells were noticed, and cell proliferation was significantly inhibited. The wound healing test results showed that the cell migration was significantly decreased ( P<0.05) under metformin and celecoxib treatment. The results of the transwell invasion chamber test showed that the metformin and celecoxib treatment inhibited the invasion of HepG2 and Huh7 cells ( P<0.05). The expression levels of AKT, AMPK, and mTOR were decreased in HepG2 cells in the combinational treatment group, and the expression level of PI3K was decreased and then increased; the expression levels of AKT, AMPK, PI3K, and mTOR in Huh7 cells were decreased. Conclusions:Metformin can cooperate with celecoxib to enhance the inhibitory effect on the proliferation, migration and invasion of HepG2 and Huh7 cells. The mechanism may be related to the inhibition of the expression of mTOR signaling pathway.

Objective To compare the graft maturity of the anterior cruciate ligament reconstruction using the oval-shaped tunnel technique and round-shaped tunnel technique by signal/noise quotient (SNQ) of MRI postoperatively.Methods Forty patients diagnosed as the anterior cruciate ligament rupture between August 2015 and June 2016 were included according to the inclusion and exclusion criteria.Patients were randomized into a round-shaped group and an oval-shaped group,undergoing traditional round-shaped tunnel and oval-shaped tunnel reconstruction of the anterior cruciate ligament respectively.One year postoperatively,the MRI was conducted,and three intra-articular regions of interest (ROI) were selected to compare the graft maturity by calculating SNQ.Results None of the forty patients experienced complications of bone tunnel blowout,graft getting through difficulties and neurological or vascular injuries.SNQ of the round-shaped group were 3.72 ± 2.29,significantly higher than that of the oval-shaped group(P＜0.001).Moreover,SNQ of proximal ROI and distal ROI of ovalshaped group were 1.97 ± 1.30 and 2.76 ± 1.75,significantly lower than the round-shaped group with proximal site of 3.53 ± 2.11(P=0.008) and distal site of 4.46 ± 2.28(P=0.012).Conclusion Comparing MRI signal intensity one year after the treatment,we have found the graft SNQ after oval-shaped tunnel reconstruction was lower than the round-shaped reconstruction,with better graft maturity.

BACKGROUND:Previous studies on the effects of valgus and varus angles of tibial component on short-term postoperative outcomes after mobile bearing unicompartmental knee arthroplasty have been reported in and outside China.However,there are few reports on the effect of the valgus and varus angles of tibial component on short-term postoperative outcomes after fixed bearing unicompartmental knee arthroplasty. OBJECTIVE:To investigate the effect of valgus and varus angles of tibial component on short-term clinical outcomes in patients with medial knee osteoarthritis undergoing fixed bearing unicompartmental knee arthroplasty. METHODS:120 patients(122 knees)who underwent fixed bearing unicompartmental knee arthroplasty for medial knee osteoarthritis in Department of Orthopedic Surgery,Affiliated Hospital of Xuzhou Medical University from August 2020 to January 2023 were selected as the study subjects.Two physicians measured the varus angle of femoral prosthesis,valgus and varus angles of tibial prosthesis,flexion and extension angles of femoral prosthesis,and posterior inclination angle of tibial prosthesis after unicompartmental knee arthroplasty based on postoperative X-ray.After excluding the influence of the other three angles,the measurement results of the tibial component varus angle were divided into three groups:<-2°,-2° to 2°,>2°,which were denoted as groups 1,2,and 3,respectively.The range of knee motion,the hospital for special surgery knee score,the American knee society score,and forgotten joint score were recorded and compared before and after the operation. RESULTS AND CONCLUSION:(1)A total of 120 patients(122 knees)were enrolled in this study.They were divided into three groups according to the size of the valgus and varus angles of the tibial prosthesis after operation:37 patients in the first group,60 patients in the second group,and 23 patients in the third group.There was no significant difference between the three groups in terms of baseline information such as age,gender,and side of surgery(P>0.05).(2)Patients were followed up for 3-30 months after arthroplasty.(3)The hospital for special surgery knee score of the second group was higher than that of the first group(P=0.015)and the third group(P=0.012).The American knee society score of the second group was significantly higher than that of the first group(P=0.014)and the third group(P<0.001).The forgotten joint score of the second group was higher than that of the first group(P=0.033)and the third group(P=0.016).(4)After fixed bearing unicompartmental knee arthroplasty,when the valgus angle of tibial prosthesis was-2° to 2°,which can achieve better short-term clinical results,the degree of prosthesis self-realization is higher.

Health technology assessment(HTA)is an important tool to inform health decision-making.Although highly related to ethical issues in the context of HTA,equity has attracted much attention from the academia,a consensus has not yet been reached on how to define and evaluate equity in China and abroad.It introduces the concept of equity,pointes out the necessity to realize health equity and the reflection of equity in healthcare sector,and further elaborates four ways to consider equity,and described the official practice of equity in HTA at home and abroad.It proposes several suggestions for China's HTA:considering equity in HTA and the discussion of equity should depend on specific decision-making scenarios;clarifying what health measurement perspective should be adopted before measuring health equity;paying attention to the value judgment of equity adopted by various stakeholders;conducting basic researches on the general population's preference for health measurement perspectives and value judgments of equity in China in a gesture to improve the evaluation system of equity in HTA.