Objective To investigate the expression of ki-67 and the development of the intimal hyperplasia(IH) of the irradiated human umbilical artery incorperated with nofloxacin and silver(IHUAINS) grafts into the carotid arteries of the rabbit. Methods Twenty IHUAINSs were sterilely produced. Thirty rabbit were performed bilateral carotid bypass grafting. The IHUAINS(experimental group)and the left carotid arteries (control group) were implanted in the left and right carotid arteries respectively. Graft patency was checked at the 2nd and 6th week after implantation, and the grafts were studied with standard histological techniques and immunohistochemieal method for meas-urement of intimal thickness and the expression of ki-67. Results The total patency rate of the grafts was 89.6%. Light microscopic exami-nation of the grafts revealed intimal and media proliferation, cellular in-filtration. The endothelial cells covered the vascular lumen. There was no significant difference of the intimal thickness between two groups at the 2nd week after grafting (P>0.05). The intimal thickness of the experimental group was larger than that in control group at the 6th week after implantation without statistical significance (P>0.05). At the same time, immunocytochemical analysis showed that the expression of ki-67 in the experimental group was stronger than that in control group without statistical significance(P>0.05). Conclusion The IH of the IHUAINS was larger than that of the autologous artery, but there is no difference between these two groups. Thus, IHUAINS may be an ideal graft in the field of coronary surgery.

ObjectiveTo improve the long term outcomes of the surgery for Stafford type A aorticdissection, we performed ascending aorta and total aortic arch replacement combined with transaorticstented graft implantation into the descending aorta for acute type A aortic dissection.MethodsFrom May 2005 to February 2011,36 consecutive patients with acute Stanford type A aorticdissection underwent this procedure.Right axillary artery cannulation was routinely used forcardiopulmonary bypass and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10 cm long selfexpandable graft.34 patients were followed up for 2 ～36 months.ResultsCardiopulmonary bypass time was (160 ± 31)min, average cross clamp time was (101 ±26)min, and average selective cerebral perfusion and lower body arrest time was (31 ± 16)min.The in-hospital mortality was 5.5％ (2/36).One patient died of multi-organ failure postoperatively and another died of cerebral infarction 9 day after surgery.No one suffered from spinal cord injury perioperatively.There was no late death during follow up.ConclusionsAscendingaorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to better long term outcomes of type A aortic dissection.

Objective:To investigate the short-term efficacy of rotational femoral neck osteotomy with preservation of the round ligament in the treatment of subchondral insufficiency fracture of the femoral head (SIFFH) in young and middle-aged people.Methods:A retrospective case series study was used to analyze the clinical data of 13 patients with SIFFH, who were admitted to 920th Hospital of Joint Logistics Support Force from January 2017 to January 2022. The patients included 10 males and 3 females, aged 22-49 years [(33.5±8.3)years]. There were 6 patients with fracture on the left hip and 7 on the right hip. All the patients were treated by rotational femoral neck osteotomy with preservation of the round ligament. Postoperatively, standardized joint functional training was given. The operative time and intraoperative bleeding were recorded. The modified Harris hip score and visual analogue score (VAS) were compared preoperatively, at 3, 6 months postoperatively and at the final follow-up. Radiological examinations were used to observe the occurrence of any collapse of the femoral head, non-union at osteotomy site or other complications.Results:The patients were followed up for 13-24 months [(17.9±3.1)months]. The operative time was (127.3±9.8)minutes, with the intraoperative bleeding of (393.9±21.9)ml. The values of modified Harris hip score were (61.6±3.3)points, (80.2±4.4)points, and (91.9±4.1)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly higher than the preoperative (51.4±3.5)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). The values of VAS were (4.9±1.1)points, (3.0±0.9)points, and (1.4±0.5)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly lower than preoperative (6.7±0.9)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). Imaging examination showed no femoral head collapse, with all the bones healed at the osteotomy site. There were no serious complications such as bone non-union, incision infection or peripheral nerve injury. Conclusion:Rotational femoral neck osteotomy with preservation of the round ligament in treating SIFFH in the young and middle-aged population has the advantages of shortened operative time, less intraoperative bleeding, promoted hip function recovery, attenuated pain and decreased complications, showing a satisfactory early effect.

Objective:To explore the clinical efficacy of the San Diego osteotomy in treating developmental dysplasia of the hip (DDH) in children.Methods:A retrospective analysis was conducted on 33 pediatric cases of posterolateral acetabular dysplasia treated with the San Diego osteotomy at the 920th Hospital of the People's Liberation Army Joint Logistics Support Force in China from August 2018 to August 2022. The cohort included 3 males (4 hips) and 30 females (36 hips), with an average age of 4.9±1.4 years (range, 2-8 years). Among these, 32 cases (38 hips) were diagnosed with DDH, and 1 case (2 hips) with paralytic dislocation of the hip. According to the T?nnis classification, 3 hips were classified as type II, 25 hips as type III, and 12 hips as type IV. The San Diego osteotomy technique was utilized to enhance the posterior lateral acetabular coverage, combined with femoral osteotomy to adjust the hip abduction, flexion, and adduction angles. Postoperative outcomes were assessed using the modified Severin radiographic classification and the McKay grading system.Results:All 33 patients were followed up for an average of 37.70±18.44 months (range, 12-74 months). No cases of postoperative hip redislocation or residual acetabular underdevelopment were observed. The hip abduction angle improved from 24.98°±3.48° at 6 weeks postoperatively to 37.28°±4.63° at the 3-month follow-up, and 64.05°±3.82° at the 6-month follow-up, with a statistically significant difference ( F=77.327, P<0.001). The hip flexion angle increased from 26.34°±5.05° at 6 weeks postoperatively to 76.53°±4.38° at 3 months, and 106.47°±2.29° at 6 months, also showing a statistically significant difference ( F=54.377, P<0.001). The hip adduction angle progressed from 1.73°±1.18° at 6 weeks postoperatively to 12.33°±1.97° at 3 months, and 29.03°±4.17° at 6 months, with a significant difference ( F=45.162, P<0.001). The McKay hip joint grading system indicated 11 excellent, 20 good, and 9 acceptable outcomes, yielding an overall excellent and good rate of 78%. The Severin radiographic grading revealed 16 hips at grade I and 24 hips at grade II. Five patients (5 hips) experienced transient vascular compromise of the femoral head at 3 months postoperatively, which resolved after a 1-month non-weight-bearing period. At the final follow-up, one patient had residual femoral head enlargement in the right hip, while the remaining 32 cases showed satisfactory ossification and remodeling of the femoral head. Conclusion:The San Diego osteotomy significantly enhances hip joint range of motion and results in satisfactory hip joint function in children with developmental dysplasia of the hip