[Objeetive] To assess the reproducibility and accuracy of four ratios used to measure patellar height,named the Blackburne-Peel,Caton Deschamps,Insall-Salvati and modified Insall-Salvati,before and after totalknee arthroplasty.[Methods]The patellar height was measured,by means of the four ratios,on the pre-and post-operative lateral radiographs of 44 patients(45 knees)who had undergone total knee arthroplasty.Two independent observers measured the films sequentially,in identical conditions,totally 720 measurements per observer.[Results]Before operation there was greater interobserver variation using either the Insall-Salvati or modified Insall-Salvati ratios than that when using the Caton-Deschamps or Blackburne-Peel methods.This was due to difficulty in identifying the insertion of the patellar tendon.Before operation,there was a minimal difference in reliability between these methods.After operation the interobserver difference was greatly reduced using both the Caton-Deschamps and Blackburne-Peel methods,which used the prosthetic joint line,compared with the Insall-Salvati and modified Insall-Salvati,which refered to the insertion of the patellar tendon.[Conclusion]The theoretical advantage of using the Insall-Salvati and modified Insall-Salvati ratios in measuring true patellar height after total knee arthroplasty needs to be balanced against their significant interobserver variability and inferior reliability when compared with other ratios.

Objective To analyze the relationships between body mass index (BMI), blood pressure and the cerebral vascular function in middle-aged population that underwent health checkup. Methods Participants from health management centers of Renmin Hospital of Hubei province, the Second Hospital Affiliated to Nanhua University, Hospital of Shandong Electric Power and Chinese People's Liberation Army No. 180 Hospital aged 45 to 64 years were selected from health checkup population by cluster sampling. Levels of height, weight and blood pressure as well as the cerebral hemodynamics were checked. Subjects were grouped according to age, BMI, systolic and diastolic blood pressure. The differences and distribution of cerebrovascular function scores (CVFS) between groups were compared and described. Moreover, the risk of stroke in the population was evaluated. Results Of the 17 258 individuals who met inclusion criteria, the abnormal rate (the score below 75 points) of CVFS was 20.9 percent. The CVFS in normal, overweight and obese groups were 91.0±15.4, 83.3±21.3, 70.3±26.5 and differences in all age groups were statistically significant (P<0.01). The CVFS in systolic blood pressure<120,120-139, 140-159,≥160 mmHg (1 mmHg=0.133 kPa) groups were 93.9±12.9, 86.5±18.9, 72.1±23.5, 56.2±25.7 and differences in all age groups were statistically significant (P<0.01). CVFS in normal diastolic pressure<80, 80-89, 90-99,≥100 mmHg groups were 91.0±16.1, 85.5±20.2, 75.4±23.6, 62.7±25.0 and the differences among all age groups were statistically significant (P<0.01). Conclusions The abnormal rate of cerebrovascular function integral and high risk stroke individuals in middle-aged health checkup people was approximately 21 percent. The overweight, obese and the high level of systolic and diastolic pressure may induce the injury of cerebrovascular function and the severity will increase with the level of BMI and blood pressure.

BACKGROUND:Some overseas searchers have shown that,the midvastus approach in total knee arthroplasty(TKA)can reserve the complete medial structure of quadriceps femoris,improve the functional recovery of knee extension apparatus,but also preserve the blood supply of medial knee joint and maintain proprioceptive sense of knee joint.OBJECTIVE:To evaluate the early functional outcome of midvastus approach and standard medial parapatellar approach in TKA.DESIGN:A prospective,randomized,double-blind,comparative study.SETTING:Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA.PARTICIPANTS:From March 2004 to March 2006,34 patients undergoing bilateral TKA simultaneOusly were admitted to the Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA,including 7 males and 27 females.They aged 56-78 years with a mean of 70.5 years,and consisted of 24 cases with osteoarthritis,and 10 cases with rheumatoid arthritis;24 cases with bilateral genu varum,9 cases with bilateral enu valgum,and 1 case with lateral genu varum and contralateral genu valgum.Informed consents were obtained from all the included patients.Materials:Press Fit Condylar(PFC)Sigma knee prosthesis(DUPUY Company),the central tibial pad was added with a polyethylene prominence,while the corresponding femoral prosthesis was treated with anterioposterior steotomy,identical with the remained prosthesis.METHODS:The surgical approach of 34 patients was randomized into a midvastus approach in one knee and a standard medial parapatellar approach in the other knee.The comparison included the surgical parameters and clinical parameters.mevemnt,the time of performing an active straight leg raise,the time of reaching 90°knee flexion,range of motion and complications.RESULTS:All of 34 patients were involved in the result analysis.There was no significant difference in the surgical time botween the two roups.The assessment revealed significantly less blood loss[(286±29.8)Ml,(368±35.8)Ml,P＜0.05],fewer lateral release in valgus knee(20%,50%,P＜0.05),less pain in the first week(P＜0.05),earlier return of active straight-leg raise[(1.8±0.3)days,(4.5±0.8)days,P＜0.01],earlier reach of 90° knee flexion [(3.2±0.8)days.(7.1±1.2)days,P＜0.01]and greater range of motion at 45 day[(107±20)°,(98±12)°,P＜.05]in the midvastus approach group.CONCLUSION:The midvastus approach,which is based on diminished disruption of extensor mechanism and peripatellar pIexus of vessels,relieves pain and improves range of motion in the early rehabilitation period following TKA.

BACKGROUND:Artificial tissue-engineered bone combined with acel ular bone matrix has been shown to be favorable for bone repair. OBJECTIVE:To explore the safety and biocompatibility of the stromal vascular fraction of the adipose tissue combined with the acel ular bone matrix-chitosan scaffold in the repair of rabbit radial defects. METHODS:A total of 38 New Zealand rabbits were selected, 3 rabbits were used to extract stromal vascular fraction of adipose tissue, 3 used to prepare acel ular bone matrix and 32 divided into experimental and control groups. Models of rabbit radial defects were established using Brownlow method. The rabbits in the experimental group were treated with the SVF of adipose tissue combined with the acel ular bone matrix-chitosan scaffold, while those controls received no treatment. General situation, gross observation, X-ray examination, histological observation and Lane-Sandhu scores were performed at 2 and 4 months postoperatively. RESULTS AND CONCLUSION:No infections occurred in both two groups at 2 and 4 months postoperatively, but the activity level and degree of healing in the experimental group were significantly better than those in the control group. In the experimental group, there were high-density shadows at 2 months postoperatively and the X-ray image of the bone defect site was the same as that of the normal one at 4 months, while bone nonunion occurred in the control group. The bone tissues in the experimental group grew significantly better than that in the control group at 2 and 4 months postoperatively, and the Lane-Sandhu histological scores in the experimental group were significantly higher than those in the control group at 2 and 4 months postoperatively (P<0.05). These results indicate that the stromal vascular fraction combined with the acel ular bone matrix-chitosan scaffold exhibits safety and biocompatibility in the repair of rabbit radical defects.

OBJECTIVETo prospective examine the relationship between smoking, quitting and mortality in older Chinese men by in Xi'an, China.

METHODSThe design was a cohort analytic study. One thousand two hundred and sixty-eight retired male military veterans aged 60 or older were examined in 1987. At baseline, there were 388 never-smokers, 461 former smokers and 419 current smokers. Main outcome measure was all-cause and tobacco-associated mortality.

RESULTSThrough 1999, 299 had died, 943 were alive and 26 lost. The mean follow-up time was 11 years and total person-year of follow-up was 14 163. After adjusting for age, blood pressure, body mass index, total cholesterol, triglycerides, alcohol intake, exercise and existing diseases, using Cox proportional hazard regression model, the relative risks (95% confidence intervals) for ever-smoking, deaths resulting from all causes, chronic obstructive pulmonary disease (COPD), lung cancer and coronary heart disease (CHD) were 1.34 (1.02 - 1.76), 3.23 (0.95 - 10.91), 2.31 (0.95 - 5.61) and 1.60 (0.81 - 3.19) respectively. The risks increased significantly with increasing amount and duration of smoking. Compared with current smokers, former smokers had lower risks of total mortality (excess risk reduction of 56%) and from CHD death (93%), but had higher risks for COPD death (excess risk increased 174%).

CONCLUSIONSSmoking is a major cause of death in older Chinese men and quitting can save lives. These results showing that higher risks of COPD death in former smokers with or without existing diagnosed COPD at baseline than those in current smokers could be explained by either the "healthy smoker effect" or the "ill quitter effect" or both. Early recognition of the significance of COPD symptoms followed by prompt quitting should be emphasized as strategies in the control of the growing tobacco epidemic.

Aged ; China ; Cohort Studies ; Coronary Disease ; etiology ; mortality ; Humans ; Lung Neoplasms ; etiology ; mortality ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; etiology ; mortality ; Risk Factors ; Smoking ; adverse effects ; mortality ; Smoking Cessation ; Survival Rate ; Veterans

Objective To observe the clinical effects of ultrasound-guided median nerve block on carpal tunnel syndrome.Methods A total of 40 patients (69 hands,aged 33-61 years,ASA Ⅰ or Ⅱ,were randomly assigned into ultrasound group (group U) and control group (group C),20 cases in each.The ultrasound group underwent ultrasound-guided median nerve blocking,while the control group did through by anatomic landmark palpation.3 ml of 4.5 mg bupivacaine,5 mg triamcinolone acetonide and 100 μg vitamin B12 was injected in a single shot in the two groups.Symptoms and functions were evaluated by Boston carpal tunnel questiormaire (BCTQ) at the onset and after the treatment.Electrophysiological parameters were recorded at the time of pretreatment and post-treatment.Cases receiving two or more and side effects were also recorded.Results Both the symptom severity scale (SSS) and funcational status scores(FSS) of the BCTQ showed significant decrease 1 month after treatment in the two group (P＜0.05).Compared with group C,SSS of group U showed a significant decrease (P＜0.05),while there was no significance difference in FSS.Compared with pretreatment,MDL,SDL3 showed a significant decrease and SNCV showed significant increase 1 month after treatment in the two group (P＜0.05),while there was no significant change in the MNCV.SNCV was quicker in group U than in group C at 1 month after treatment (P＜0.05),while other electrophysiological parameters were not significantly different between the two groups.Less cases with treatment times≥2 and less side effects were found in group U than in group C (P ＜ 0.05).Conclusion Median nerve blocking under ultrasound guidance effectively improves the symptom in patients with carpal tunnel syndrome and reduces complications.

Objective:To analyze and compare the risk factors for hemorrhagic stroke and ischemic stroke and understand the exposure levels in population.Methods:A cohort study of risk factors of stroke was conducted in a rural community in Fengxian District of Shanghai in 2003, and the common risk factors of stroke were investigated at baseline survey, the cerebrovascular hemodynamics indexes were detected, the cerebrovascular function score was calculated according to the unified integral rule, and the incidence of stroke was observed in follow up. The risk factors for hemorrhagic stroke and ischemic stroke were analyzed by cohort study. The risk factors for two subtypes of stroke were compared.Result:A total of 10 565 participants were included in the study, with a mean follow-up period of (11.15±2.26) years, and 103 hemorrhagic stroke cases and 268 ischemic stroke cases were observed during follow-up period. The independent risk factors of hemorrhagic stroke included decreased cerebrovascular function score [hazard ratio ( HR)=1.56, 95% CI: 1.23-1.98], history of alcohol consumption ( HR=2.46, 95% CI: 1.39-4.34), hypertension ( HR=1.75, 95% CI: 1.00-3.07) and older age ( HR=1.07, 95% CI: 1.04-1.10). The independent risk factors of ischemic stroke included decreased cerebrovascular function score ( HR=1.43, 95% CI: 1.25-1.65), smoking history ( HR=1.52, 95% CI: 1.13-2.05), hypertension ( HR=1.51, 95% CI: 1.10-2.07), family history of stroke ( HR=1.89, 95% CI: 1.13-3.15), left ventricular hypertrophy ( HR=1.74, 95% CI: 1.07-2.81) and older age ( HR=1.07, 95% CI: 1.05-1.08). Conclusions:Decreased cerebrovascular function score, hypertension, and older age were common independent risk factors of both types of stroke, alcohol consumption history was an independent risk factor of hemorrhagic stroke, and smoking history, and family history of stroke and left ventricular hypertrophy were independent risk factors of ischemic stroke.

Objective To evaluate the efficacy of the traditional Chinese medicine NAOAN capsule in primary prevention of stroke in high?risk populations. Methods A multicenter, randomized controlled study was performed in community setting, involving 1 088 individuals at high risk of stroke, with cerebrovascular function scores<75 and 10?year Framingham stroke risk ≥6%. Subjects were recruited in communities at Beijing, Shanghai, Changsha, and Chengdu communities, through resident committees or the village unit. A total of 559 subjects were randomized into a group treated with the NAOAN capsule, and 529 subjects in an aspirin treatment group. Follow?up was performed every 2 months for 2 years. At the mid?point and end of the intervention, we compared cerebrovascular function differences between the 2 groups. Results During the 2?year community trial, 531 subjects in the NAOAN capsule group and 465 in the aspirin group followed the protocol. Cerebrovascular function scores increased from 45.2±19.7 at baseline to 61.7±26.5 after the 2?year trial (t=－12.931, P<0.001) in the NAOAN capsule group, and from 47.2±18.9 at baseline to 53.7 ± 25.1 (t=－5.058, P<0.001) in the aspirin group; greater increases in cerebrovascular function scores were found in the NAOAN capsule group than that in the aspirin group (t=4.906, P<0.001). Conclusions Cerebrovascular function in individuals at high risk of stroke was improved by taking NAOAN capsule. Cerebrovascular function scores improved more with NAOAN capsules than with aspirin.

Detailed characterizations of genomic alterations have not identified subtype-specific vulnerabilities in adult gliomas. Mapping gliomas into developmental programs may uncover new vulnerabilities that are not strictly related to genomic alterations. After identifying conserved gene modules co-expressed with EGFR or PDGFRA (EM or PM), we recently proposed an EM/PM classification scheme for adult gliomas in a histological subtype- and grade-independent manner. By using cohorts of bulk samples, paired primary and recurrent samples, multi-region samples from the same glioma, single-cell RNA-seq samples, and clinical samples, we here demonstrate the temporal and spatial stability of the EM and PM subtypes. The EM and PM subtypes, which progress in a subtype-specific mode, are robustly maintained in paired longitudinal samples. Elevated activities of cell proliferation, genomic instability and microenvironment, rather than subtype switching, mark recurrent gliomas. Within individual gliomas, the EM/PM subtype was preserved across regions and single cells. Malignant cells in the EM and PM gliomas were correlated to neural stem cell and oligodendrocyte progenitor cell compartment, respectively. Thus, while genetic makeup may change during progression and/or within different tumor areas, adult gliomas evolve within a neurodevelopmental framework of the EM and PM molecular subtypes. The dysregulated developmental pathways embedded in these molecular subtypes may contain subtype-specific vulnerabilities.
Humans ; Brain Neoplasms/pathology* ; Neoplasm Recurrence, Local/metabolism* ; Glioma/pathology* ; Neural Stem Cells/pathology* ; Oligodendrocyte Precursor Cells/pathology* ; Tumor Microenvironment