OBJECTIVE: To investigate the effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon (LHBT) in situ for repairing rotator cuff tear. METHODS: A retrospective analysis was conducted on 31 patients with rotator cuff tears and LHBT injuries admitted between June 2022 and November 2023. All patients underwent arthroscopic double fixation and enhanced suture of LHBT in situ. There were 12 males and 19 females, with an average age of 61.6 years (range, 53-76 years). There were 10 cases of acute injury and 21 cases of chronic injury. According to DeOrio and Cofield classification criteria, the degree of rotator cuff tear rated as medium-sized tears in 3 cases, large tears in 12 cases, and massive tears in 16 cases. Associated injuries included 5 cases of shoulder joint adhesions, 12 cases of subscapularis muscle tears, and 31 case of shoulder impingement syndromes. The shoulder range of motion (ROM) (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores [visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, Constant-Murley score] were recorded before operation and at last follow-up. MRI at last follow-up were taken to evaluate the rotator cuff healing and structural integrity. RESULTS: All 31 surgeries were successfully completed with operation time ranging from 90 to 210 minutes (mean, 144 minutes). The 3-5 anchors (mean, 3.8 anchors) were used during operation. All incisions healed by first intention. All patients were followed up 12-29 months (mean, 18.5 months). At 3 months after operation, 2 cases developed joint adhesions, 3 had internal rotation limitations, and 2 experienced residual pain at the intertubercular groove, all resolved with conservative management. No Popeye deformity occurred during follow-up. At last follow-up, shoulder ROM (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores (VAS, UCLA, and Constant-Murley scores) showed significant improvements compared to preoperative values ( P<0.05). At last follow-up, MRI evaluation showed that the rotator cuff healing rate reached 90.3% according to the Sugaya classification criteria. LHBT exhibited normal morphology, course, and continuity without dislocation. Surrounding synovial sheath showed no thickening or effusion. CONCLUSION Arthroscopic double fixation and enhanced suture of LHBT in situ for repairing rotator cuff tear can significantly reduce shoulder joint pain, improve ROM, and achieve a high rotator cuff healing rate.
Humans ; Male ; Middle Aged ; Arthroscopy/methods* ; Rotator Cuff Injuries/physiopathology* ; Female ; Retrospective Studies ; Aged ; Range of Motion, Articular ; Suture Techniques ; Treatment Outcome ; Rotator Cuff/surgery* ; Shoulder Joint/physiopathology* ; Tendons/surgery*

Objective:To investigate the efficacy of arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon in the treatment of irreparable massive rotator cuff tears (IMRCT).Methods:A retrospective case series study was performed on 11 IMRCT patients who were admitted to Affiliated Fuyang Hospital of Bengbu Medical University (Fuyang People′s Hospital) from May 2020 to June 2022, including 7 males and 4 females, aged 54-74 years [(62.6±7.3)years]. All the patients were treated with arthroscopic superior capsular reconstruction using composite patch graft combined with tenodesis of the long head of the biceps tendon. The Visual Analogue Scale (VAS), Acromiohumeral Distance (AHD), Constant-Murley score and University of California Los Angeles (UCLA) score and active range of motion of the shoulder joint before, at 6 months after surgery and at the last follow-up were compared. At the last follow-up, the integrity of reconstructed superior capsule and the long head of the biceps tendon was evaluated using MRI of the shoulder joint. Postoperative complications were observed.Results:All the patients were followed up for 13-39 months [16(13, 36)months]. The VAS score, AHD, Constant-Murley score, and UCLA score were 2(2, 3)points, (9.1±1.1)mm, (56.1±5.4)points, and (19.7±2.8)points respectively at 6 months after surgery, which were all significantly improved from those before surgery [6(5, 7)points, (5.1±1.2)mm, (37.9±2.2)points, and (11.8±1.2)points] ( P<0.05). The VAS score, AHD, Constant-Murley score, and UCLA score were 0(0, 1)points, (8.4±0.9)mm, (83.6±3.8)points, and (28.2±2.3)points respectively at the last follow-up, which were all significantly improved from those before surgery ( P<0.05). At the last follow-up, the VAS score or AHD were not significantly improved from those at 6 months after surgery ( P>0.05); Constant-Murley score and UCLA score were both significantly improved from those at 6 months after surgery ( P<0.05). At 6 months after surgery, shoulder active ranges of motion in forward flexion, abduction and external rotation were (134.6±13.5)°, (124.6±18.6)° and 45(40, 50)° respectively, which were all significantly improved compared with those before surgery [(63.2±36.1)°, (65.0±23.1)°, and [30(20, 40)°] ( P<0.05). At the last follow-up, shoulder active ranges of motion in forward flexion, abduction and external rotation were (144.1±12.6)°, (139.6±15.4)° and 60(45, 65)° respectively, which were all significantly improved compared with those before surgery ( P<0.05). There were no significant differences in active range of motion of the shoulder in forward flexion, abduction and external rotation between 6 months after surgery and the last follow-up ( P>0.05). At the last follow-up, MRI revealed integrity of the reconstructed superior joint capsule and the long head of the biceps tendon in 10 patients. One patient developed resorption of the greater tuberosity and 1 showed a partial tear of the supraspinatus tendon at 1 year after surgery. Conclusion:Arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon can relieve shoulder pain, decrease upward displacement of the humerus head, improve the function and range of motion of the shoulder joint, and reduce complications in the treatment of IMRCT.

In order to strengthen standardized residency training process management, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology combines informatization with teaching case library and establishes and improves the process of teaching case filling from the three aspects of the module for residency teaching case filling, the module for instructor feedback, and the module for functional department management, thereby establishing a teaching case system centered on residents and based on the standardized residency training process management and supporting the innovation of standardized residency training pattern with an integrated teaching platform, which provides new methods for the connotation construction of standardized residency training.

Objective To explore the related factors of anxiety and gloomy mentality people aged 60-80 years and investigate the effectiue methods to intervention.Methods A follow-up study was proportional and carried out in Xicheng district of Beijing.Multi-phase,stratified,unequal cluster sampling was adopted to investigate old people in 2011 with WHO-QOL,Memorial University of Newfoundl and Scale of Happiness,Social Support Rating Scale,Self-Rating Anxiety Scale and Self-rating Depression Scale.2342 old people were randomly divided into control group and trial group.The trial group received health education,community social support,lightening the psychological stress in face to face,psychology guiding and group discussion.The control group received general observation only.Results Among 2342 old people,126 (5.3％) obtained anxiety and 201(8.6％) had gloomy mentality.The anxiety in the elderly was significantly related to age,marriment,culture,job,family type,family relationship,housing,income,medical insurance,retirement type,reading,keeping pets,character,training,feeling adjusting,life quality,subjective well-being,social support,depression (all P ＜ 0.05).The depression in the elderly was significantly related to gender,marriment,culture,job,family type,family relationship,housing,income,medical insurance,retirement type,reading,watching plays,character,feeling adjusting,drinking,training,life quality,subjective well-being,social support,anxiety (all P＜0.05).Scores of two groups had no significant difference before intervention.The change in scores of anxiety and depression in the trial group was obviously lower than in control group (P＜0.05).Conclusions The anxiety and gloomy mentality are common in old people aged 60-80 years in Xicheng District,which independently associated with related factors such as life quality,subjective well-being,social support and so on.After 6 months of treatment,the scores of anxiety and depression in the trial group is obviously lower than in control group.

Objective To investigate the clinic effect of using three-dimensional conformal radiotherapy combining with Sanyangxuedai in treating advanced non-small cell lung cancer.Methods Grouping 100 patients with advanced non-small cell lung cancer randomly into a control group and a treatment group,with 50 patients in each.The control group was treated with three-dimensional conformal radiation therapy,the treatment group was treated on the basis of the control group with a ioint Sanyangxuedai.The clinical effects were compared in the two groups.Results The three-dimensional conformal radiotherapy combining with Sanyangxuedai had more better treating indications than using three-dimensional conformal radiotherapy only and the results had statistical significances(χ~2=12.01,P＜0.05).Conclusion The three-dimensional conformal radiotherapy combining with Sanyangxuedai had beaer clinical efrect in treating advanced non-small cell lung cancer.

Objective To investigate the role of expression of tall-like receptor 4 (TLR4) on medullary system cell (neutrophii, platelet) and endothelial cell surface in polymorphonuclear neutrophils (PMN) recruitment in rata with acute necrotizing pancreatitis. Methods C3H/He-J mice and C3H/He-N mice were divided into 4 groups by bone marrow transplantation: mosaic of medullary system cell TLR4-/- and endothelial cell TLR4 +/+ ; mosaic of medullary system cell TLR4 +/+ and endothelial cell TLR4-/-; mosaic of medullary system cell TLR4 +/+ and endothelial cell TLR4 -/-; mosaic of medullary system cell TLR4-/- and endothelial cell TLR4-/-, another control group was also established. ANP was induced in all these groups by intraperitoneal injection of cerulein and caudal vein injection of lipopolysaccharide. Serum amylase, pancreatic tissue naphthol AS-D chloroacetate esterase, MPO activity, TRL4 mRNA expression in peripheral blood granuloeyte was determined by RT-PCR, TRL4 protein expression in pancreatic tissue was measured by immunohistochemisty. Results Compared with that of control group, the levels of serum amylase in the 4 groups all significantly elevated and there was no difference among these 4 groups. Pathological scores of pancreas in the 4 groups were 5.52 ± 1.21, 5.18 ± 1.02, 2.03 ± 0. 82, 1.92 ± 0. 78, respectively; MPO activities were (1.834 ± 0. 170) U/g, (2. 596 ±0. 138) U/g, (0. 367 ±0. 018) U/g, (0. 202 ±0. 018) U/G, respectively; AS-D counts were 66.88 ± 2.17, 75.00 ± 2.43, 21.50 ± 2.38, 20.00 ± 2.19, respectively ; the expressions of TLR4mRNA of granular cell in peripheral blood were 0. 037 ± 1. 047 E-2, 1. 489 ± 8. 084 E-2, 1.470 ± 5. 210E-2, 0. 017 ± 6. 668 E-3, respectively; the 2 groups with endothelial eel1 TLR4 +/+ had strongly positive expression of TLR4 protein in vascular endothelial cell ; while the 2 groups with endothelial cell TLR4-/- had no expression; the pancreatic injuries, MPO activities, AS-D counts and TLR4 protein in the 2 groups with endothelial cell TLR4 +/+ were significantly higher than those in the 2 groups with endothelial cell TLR4-/-. Conclusions It was endothelial cell, not peripheral blood granulocyte, which played a key role in the process of neutrophil recruitment and pathological injure of ANP.

Objective To investigate the role of toll-like receptor 4 (TLR4) of endothelium or bone marrow derived cells in the acute lung injury (ALI) induced by lipopolyscccharide (LPS) in mice with reciprocal bone marrow transplantation. Method Chimeric mice were produced by reciprocal bone marrow transplantation between TLR4mut/mut and TLR4+/+ mice and divided into 4 groups: WT/WT (recipient/donor),WT/Mutant, Mutant/WT and Mutant/Mutant group. Six to eight weeks following transplantation, LPS was injected inot mice's tail vein in order to produce ALI model,and mice were sacrificed five hours later on.Samples of lung tissues were taken for the following analysis of wet/dry weight (W/D), lung permeabifity index (LPI), myeloperoxidase (MPO),levels of cytokines (TNF-α, IL-1β) and adhesion molecules (ICAM-1). Results Lung injury in the Mutant/Mutant mice was the mildest in the 4 groups. And lung injury in WT/Mutant mice was more serious than that in Mutant/WT mice. levels of MPO and ICAM-1 in WT/Mutant mice were much higher than those of Mutant/WT. In addition,the expression of ICAM-1 in WT/Mutant mice is comarable to that in WT/WT mice. Mutant/WT mice expressed higher levels of TNF-α and IL-1β than WT/Mutant mice. Conclusions Endothelial cell derived TLR4 plays ker-nel role in ALI induced by LPS via lung PMN recruitment,although bone marrow cells derived TLR4 are more im-portant for the release of cytokines.

Summary: The effect of rosiglitazone as the ligand of peroxisome proliferator-activated receptorγ (PPARγ) inhibiting the TLR4 expression in ischemic lobes in partial hepatic ischemia/reperfusion injury (IRI) in BABL/C mice and the action of rosiglitazone inhibiting the TLR4 receptor-mediated inherent immune response were investigated. The model of the mouse partial hepatic ischemia/reperfusion injury was established. All the animals were randomly divided into 3 groups: rosiglitazone group, vehicle (dimethylsulphoxide, DMSO) group and sham operation group. The hepatic samples were collected when mice were sacrificed 0, 2, 4 and 6 h after reperfusion following 1h ischemia to analyze the acute phase of hepatic IRJ. The dynamic expression of TIR4 mRNA was detected quantitatively by real-time-PCR, and the levels of TNF-α, IL-10 and ALT in portal vein were determined in all groups. After restoration of blood supply, the expression of TLR4 mRNA in ischemic lobes was detected in 0, 2, 4 and 6h after reperfusion following 1h ischemia in rosiglitazone group and vehicle group. The most intensive expression of TLR4 mRNA was present at 4 h after reperfusion in ischemic lobes in vehicle group. As compared with vehicle group, the expression of TLR4 mRNA in ischemic lobes in rosiglitazone group was significantly decreased at 4h after reperfusion. The level of IL-10 in portal vein was markedly up-regulated in rosiglitazone group as compared with vehicle group. Contrarily, the levels of TNF-α and ALT in portal vein were markedly down-regulated in rosiglitazone group as compared with vehicle group at every time point in mouse partial hepatic IRI model. Rosiglitazone could alleviate the hepatic IRI by inhibiting TLR4 receptor-mediated inherent immune response.

Objective To observe the synthesis of TLR2 protein and mRNA expression in Kupffer cells(KCs). Methods BALB/C mice were used to make model of partial hepatic ischemia/reperfusion (I/R) injury. After injury, KCs were isolated with two-steps in situ perfusion technique. The synthesis of TLR2 protein was determined by flow cytometric analysis (FCM) and real time reverse transcription(polymerase) chain reaction (Real Time RT-PCR) was used to analyse its gene expression in KC. Results The expression of TLR2mRNA and synthesis of protein in KC were significantly higher in experimental group, compared with sham group (protein expression: 9.19?0.43 % vs 1.52 ?0.24%, P

Objective To explore the relation between activation of TLR4 and liver injury in partial hepatic ischemia/reperfusion (I/R) injury in mice. Methods BALB/c mice were used in a model of partial hepatic I/R injury, the distribution of TLR4 in liver was observed with immunohistochemical stains. The level of plasma ALT and endotoxin in portal vein were measured. TLR4-deficient mice (C3H/Hej) and wild type mice (C3H/Heouj) were used in a model of I/R injury, the hepatic function and serum TNF-? were observed. Results 1. After one hour ischemia the expression of TLR4 protein increased at 1 st, 3 rd h of reperfusion. especially in Kupffer cells, followed by Granno-monocyte and liver sinus epithelial cell; 2. No endotoxemia developed; 3. At 3 rd h of reperfusion, serum TNF-? was significantly higher than sham group [Hej: (152?43)pg/ml vs. (18?10)pg/ml, n=6, t=5.26, P