Objective To investigate a better method for repair of scalp avulsion with skull exposure.Methods After primary debridement and skin grafting,tissue expanders were placed into subgaleal layer of normal scalp.After enough expansion,expanded scalp flaps were used to repair the skull exposure and the bald deformity.Results All of 6 cases had satisfactory results,wounds were repaired,no bald deformity occurred and no tissue expander infected case was encountered.Conclusion Using this method,we can treat the scalp avulsion with skull exposure without bald deformity.

Objective To investigate the genotypes and epidemic of metallo-β-lactamase-(MBL )-producing Pseudomonas aeruginosa (P .aeruginosa)in Changsha.Methods P .aeruginosa isolated from seven comprehensive hospitals in Changsha were collected and performed identification and antimicrobial susceptibility testing,pheno-types of MBL were detected with EDTA-disk synergy test and E-test,genotypes were determined by polymerase chain reaction (PCR),homology analysis were conducted by enterobacterial repetitive intergenic consensus PCR (ERIC-PCR).Results Preliminary screening by EDTA-disk synergy test and E-test showed that only 10 of 81 iso-lates were strong positive;PCR result showed that 18 isolates were positive for MBL,11 of which were IMP-9-type MBL,1 was IMP-1-type,and 6 were VIM-2-type.SIM,SPM,GIM,and NDM-1-types were not found.ERIC-PCR showed that 12 strains of IMP-producing P .aeruginosa has multiple types,6 VIM-2-producing strains were of the same type.Conclusion IMP-9 and VIM-2 are main genotypes in P .aeruginosa in Changsha.

Objective Risk factor of radial and horizontal tear for posterior horn of medial meniscus is analyzed in present study.Methods A total of 390 patients diagnosed with medial meniscus tear received during January 2011 to December 2012 were of retrospective analysis.94 cases with radial tear of medial meniscus posterior horn and 95 horizontal cases were chosen as research objects.Age,gender,duration of symptoms,body weight index,trauma history,posterior slop of tibia plateau,knee valgus angle and Outerbridge cartilage classification of patients with radial or horizontal tear were recorded and analyzed.Multifactor unconditioned Logistic regression analysis was employed to analyze risk factor of meniscus radial tear.Results Significant difference could be spotted in the analysis of gender (x2=9.059,P=0.003),body weight index (t=2.549,P=0.012),knee valgus angle (t=-5.609,P=0.000) and Outerbridge cartilage classification (x2=42.300,P=0.000) between patients with radial or horizontal tear.Meanwhile,no significant difference could be spotted in the analysis of trauma history (x2=0.368,P=0.544),posterior slop of tibia plateau (x2=1.021,P=0.312),age (t=-1.228,P=0.221) and symptom duration (t=0.272,P=0.786).According to the results of multi-factor analysis,valgus angle (OR=12.581,P=0.001),age (OR=0.875,P=0.026) and Outerbridge cartilage classification (OR=33.790,P=0.000; OR=15.558,P=0.000; OR=39.891,P=0.000; OR=91.041,P=0.000) were risk factors of meniscus radial tear.Conclusion High incidence of posterior horn of medial meniscus tear was found in patients with senile osteoarthritis.The incidence of radial tear of medial meniscus posterior horn in elderly patients with knee varus or serious articular cartilage was higher than that of horizontal tear.

Objective: To study the protection of IL 1ra in cultured developing neuron injury following Mg 2+ free induced epileptiform discharges. Methods: Rat embryo cortical neurons cultured for 6 d and 17 d were directly exposed to Mg 2+ free media, or pretreated with IL 1 receptor antagonist or NMDA receptor antagonists before being exposed to Mg 2+ free media, and then returned to regular media.MTT assay was used to study mitochondrial function injury, laser scanning confocal microscope to measure [Ca 2+ ]i, and real time RT PCR to detect gene mRNA expression. Results:(1) MTT conversion rates were higher in neurons pre and co treated with 10 mg/L IL 1ra than those of neurons with only Mg 2+ free treatment in neurons cultured for 17 d, but not in neurons cultured for 6 d.(2) [Ca 2+ ]i was lower in neurons pre and co treated with 10 mg/L IL 1ra than those of neurons with only Mg 2+ free treatment, either in neurons cultured for 6 d or in neurons cultured for 17 d, and the effects of IL 1ra on [Ca 2+ ]i change were different between neurons cultured for 6 d and neurons cultured for 17 d.(3) Pre and co treated with 10 mg/L IL 1ra NR1 mRNA expression increase induced by Mg 2+ free treatment was decreased, either in neurons cultured for 6 d or neurons cultured for 17 d, and this effect showed no difference between neurons cultured for 6 d and 17 d; Pre and co treated with 10 mg/L IL 1ra NR2A mRNA expression increase induced by Mg 2+ free treatment in neurons cultured for 17 d was decreased, and NR2A mRNA expression showed no difference between IL 1ra group and age matched control group, but have no effect on neurons cultured for 6 d; Pre and co treated with 10 mg/L IL 1ra have NR2B mRNA expression increase induced by Mg 2+ free treatment was not affected, either in neurons cultured for 6 d or neurons cultured for 17 d. Conclusion:Neuroprotection of IL 1Ra in seizure induced injury is age dependent. The mech anism of the neuroprotection of IL 1Ra includes down regulation of [Ca 2+ ]i and others.

Objective The purpose of this study was to examine the clinical features, radiological and arthroscopic characteristics of mucoid degeneration of the anterior cruciate ligament (ACL) and to assess the results of arthroscopic treat?ment. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.81±7.97 years (42-74 years). All 32 patients have pain on terminal extension, in which 12 patients have pain on both terminal flexion and extension. Arthroscopic debridement of hypertrophied ACL was performed in conjunction with notchplasty. Biopsy specimens were taken from yellowish degenerative lesions of ACL posterolateral bundles. Manual Lachman and Anterior Drawer tests were taken or measured preoperatively, as well as, visual analogue scale (VAS), range of motion (ROM) of knee, Lysh?lm scores, Western On?tario and McMaster Universities (WOMAC) scores. Results The narrow intercondylar notch show in all 32 radiographs and sagit?tal magnetic resonance image showing with its attachment thickened and ill?defined ACL. All patients received follow?up. The mean follow?up time was 21.16 ± 5.53 months (15-32 months). The mean VAS score decreased significantly from 5.75 ± 1.32 to 1.13±1.36 (t=13.44, P=0.00). Extension deficits decrease gradually from a mean angle of 11.62°±3.52° preoperatively. Almost sta?ble 6 months postoperatively and the mean score was 0.41° ± 1.01° 1 year after operation. The extension deficit improved signifi?cantly. Manual Lachman tests and Anterior Drawer tests were all negative. At the same time, Lysh?lm scores increased from 50.13 ± 11.57 to 91.97 ± 3.04 and WOMAC scores decreased from 35.13 ± 7.88 to 6.25 ± 2.78, which is statistically significant (t=-20.20, P=0.00;t=24.72, P=0.00). Conclusion Mucoid degeneration of the ACL has a typical clinical feature and the MRI find?ings are fairly specific for clinical diagnosis before arthroscopy. Arthroscopic debridement of mucoid hypertrophy of the ACL in conjunction with notchplasty can effectively provide symptomatic improvement without instability.

BACKGROUND: Anterior cruciate ligament injury accompanied by unstable rotation is a hotspot in sports medicine. Further understanding of the anatomy and biomechanics of the anterolateral ligament can play a guiding significance for the recovery of knee joint rotational stability.
OBJECTIVE:To systematicaly review current literature on the anterolateral ligament of the knee and to understand the incidence, anatomy, morphology and histology of the anterolateral ligament as wel as mechanism of anterolateral ligament injury.
METHODS: The first author searched the PubMed, Medline, CNKI, Wanfang, VIP databases for articles specificaly addressing the anterolateral ligament. Data extraction related to the incidence, anatomy, morphometry, biomechanics, and histology of the anterolateral ligament and its relation to the “Segond” fracture was performed. The retrieve time ranged from 1878 to 2015. Totaly 362 literatures were retrieved, including 342 articles in English and 20 in Chinese. According to inclusive and exclusive criteria, 42 articles were included in result analysis.
RESULTS AND CONCLUSION:The occurrence rate of the anterolateral ligament ranges from 83% to 100%, and this range occurs because of smal discrepancies in the definition of the bony insertions of the anterolateral ligament. The anterolateral ligament originates anterior and distal to the femoral attachment of the lateral colateral ligament. It spans the joint in an oblique fashion and inserts between the fibular head and Gerdy tubercle of the tibia. Exact anatomic and morphometric descriptions vary in the literature, and there are discrepancies regarding the anterolateral ligament attachment to the capsule and lateral meniscus. The anterolaterial ligament is a contributor to the stability of tibial internal rotation, and histologicaly, it exhibits paralel, crimped fibers consistent with a ligamentous microstructure. The footprint of the anterolateral ligament has been shown to be at the exact location of the Segond fracture. The anterolateral ligament is a distinct ligamentous structure at the anterolateral plane of the knee, and it is likely involved in the control of excessive tibial internal rotation that can cause the Segond fracture.

Objective To investigate the effect of penehyclidine hydrochloride ( PHC) pretreat?ment on nuclear factor erythroid 2?related factor 2∕heme oxygenase?1 ( Nrf2∕HO?1) signaling pathway in re?nal tissues of rats with rhabdomyolysis?induced acute kidney injury ( AKI) . Methods Thirty?six pathogen?free male Sprague?Dawley rats, weighing 200-220 g, were assigned into 3 groups ( n=12 each) using a random number table: control group (group C), group AKI and PHC pretreatment group (group PHC). Rhabdomyolysis was induced by intramuscular injection of 50% glycerol 10 ml∕kg in bilateral hindlimbs. PHC 0?2 mg∕kg was injected intraperitoneally at 30 min before glycerol was injected intramuscularly in group PHC. At 1 and 6 h after glycerol injection, serum was collected for determination of blood urea nitro?gen ( BUN) and creatinine ( Cr) concentrations, and bilateral kidneys were harvested for pathological ex?amination and for determination of HO?1 activity and expression of Nrf2 mRNA and HO?1 mRNA ( by quan?titative real?time polymerase chain reaction) , Nrf2 in nucleoprotein and total protein and HO?1 in total pro?tein in renal tissues ( by Western blot) . The damage to the renal tubules was scored. Results Compared with group C, the BUN and Cr concentrations in serum and renal tubular damage scores were significantly increased, the expression of Nrf2 in nucleoprotein and total protein and HO?1 in total protein was signifi?cantly up?regulated, and HO?1 activity was significantly increased in AKI and PHC groups, the expression of HO?1 mRNA was significantly up?regulated in group AKI, and the expression of Nrf2 mRNA and HO?1 mRNA was significantly up?regulated in group PHC (P<0?01 or 0?05). Compared with group AKI, the BUN and Cr concentrations in serum and renal tubular damage scores were significantly decreased, the ex?pression of Nrf2 in nucleoprotein and total protein and HO?1 in total protein was significantly up?regulated, and HO?1 activity was significantly increased in group PHC ( P<0?01 or 0?05) . Conclusion The mecha?nism by which PHC pretreatment attenuates rhabdomyolysis?induced AKI may be related to activation of Nrf2∕HO?1 signaling pathway in renal tissues of rats.

Objective To find an effective method to prevent expanding flap from necrosis when expanders were removed. Methods After the expanders were removed, dexamethasone (5mg/kg) was injected into vein immeadiately when flaps showed blood flow disturbance, then decreased gradually and stopped until 6 days after operation. Results 33 of 35 patients recovered completely, and other 2 flaps survived mostly. Conclusion Dexamethasone given immeadiately could prevent expanding flap from necrosis.

Objective:To improve previous method of primary rat cortical neuron culture to get purer and more long-lasting cells for study.Methods:Timed-pregnant Wistar rats at a gestational age of 16 or 17 days(16-17 d) were used.Fetal brains were removed and the cerebral cortices were dissected out.Papain digestion and mechanical dissociation were combined to conduct mono-cell suspending media.Four to six hours(4-6 h) post-plating,all plating media were removed from cultures and replaced with Neurobasal medium supplemented with B27.On the third day,10 ?mol/L cytosine arabinoside(Ara-C) was added to the culture for 24 h to inhibit the outgrowth of glial cells.Half of the culture medium was changed every week.The morphological changes of neuron cells were observed by light microscope.Double immuno-staining of microtubule-associated protein 2(MAP2) and karyon were applied to assess the culture purity.Evaluation of synapse formation was processed by immunocytochemical analysis using antibodies against both pre-and postsynaptic protein markers.Results:The improved method could remarkably increase the cell number and reduce neuronal damnification.The primary culture was characte-rized by high uniformity,purity,normal synapse formation and longtime livability.Conclusion:This is a simple and reliable technique for the in vitro primary culture of rat cortical neurons.

Objective To explore the medial open wedge high tibial osteotomy (OWHTO) combined with arthroscopic condyle plasty with clinical flexion deformity in patients with osteoarthritis of knee varus.Methods From January 2014 to July 2015,11 cases (11 knees) of varus knee joint flexion deformity were applied the procedure of OWHTO combined with arthroscopic condyle plasty,including 4 male and 7 female;the average age was 52.1 years old (ranged from 48 to 58 years).OWHTO could adjust the line of force of the lower limbs in coronal plane (the connection line between femoral head center point and the center point of ankle joint) through lateral tibial plateau 62.5％ position,and implant allogeneic bone to support posterior inclination angle,underwent arthroscopic condyle plasty to improve flexion deformity at the same time.Results 11 patients in this group were all followed up,and the follow-up time was 1-2.5 years,average 1.5 years.No case of fracture nonunion or delayed healing was found.Imaging data was measured to evaluate the mechanical axis of lower extremity by the relative position of tibial plateau,femoral tibial angle,femoral notch width index,tibial plateau posterior angle before operation and one year after the operation.The relative position of the mechanical axis of the lower limb through the tibial plateau was 17.4％ ± 4.9％ preoperatively,and 58.9％ ± 3.1％ after operation,femoral tibial angle changed from 181.6°± 1.2° to 170.3°± 1.3°,tibial plateau posterior inclination angle:preoperative 7.7°±2.2°,postoperative 7.9°±1.9°,femoral notch width index was increased from 0.221±0.007 to 0.272±0.009 after operation,flexion deformity angle of preoperative was 11.1 °± 3.1 °,and 1.4°± 1.5° one years after operation,VAS score was (6.5 ± 1.1)points before surgery,and (2.5±0.8) points of postoperative,Lysh(o)lm score was (50.72±6.57) points before operation,and (75.72±7.41) points one year after operation,and the differences were all statistically significant.Conclusion 0WHT0 combined with arthroscopic condyle plasty can significantly improve the lower limb line and flexion deformity,and also maintain the posterior inclination angle of tibial plateau,and can get a good short-term efficacy.