OBJECTIVETo explore the methods and outcomes of a minimally posteromedial transverse incision in the hip knee flexion for the treatment of tibial avulsion fracture at the insertion of posterior cruciate ligament (PCL).

METHODSTwenty-one patients with tibial avulsion fracture at the insertion of PCL treated with a minimally posteromedial transverse incision in the hip knee flexion by cannulated screw fixation from March 2010 to March 2013 were retrospectively analyzed. There were 13 males and 8 females with an average age of 35.1 years old (ranged, 20 to 56 years). Eleven cases caused by traffic accident, 3 caused by falling, 4 caused by sport, 3 caused by heavy pounds. The injury duration ranged from 3 hours to 9 days with a mean of 3.5 days. The results of posterior drawer test were positive in all patients. Lysholm score was used to evaluated knee joint function.

RESULTSAll operations were successful without infection, vessel and nerve injuries and all incisions healed by first intention with the mean length of 5.8 cm (ranged, 5 to 6 cm). All patients were followed up from 7 to 23 months with an average of 12.7 months. The results of posterior drawer test were negative in all patients. X-ray films showed that all fractures healed. The Lysholm score was improved from preoperative 40.76±9.55 to 95.86±2.33 final follow-up (t=30.07, P=0.000).

CONCLUSIONTreatment of tibial avulsion fracture at the insertion of the posterior cruciate ligament through a minimally posteromedial transverse incision in the hip knee flexion with cannulated screw fixation is a better surgical procedure with the advantages of minimal incision, sufficient exposure, effective fixation, small scar and satisfactory effects.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Hip Joint ; surgery ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Posterior Cruciate Ligament ; surgery ; Tibial Fractures ; surgery

Intracorporeal anastomosis in laparoscopic right hemicolectomy of colon cancer is becoming a hot spot in colorectal surgery. A number of retrospective studies have suggested that intracorporeal anastomosis has potential advantages in promoting postoperative recovery and reducing postoperative complications compared with conventional extracorporeal anastomosis. Several randomized controlled trials published recently have also confirmed that intracorporeal anastomosis can promote postoperative gastrointestinal function recovery and reduce postoperative pain, but there is still insufficient evidence to draw a conclusion about the incidence of complications, especially the anastomotic leakage rate. Heterogeneity of surgical techniques and unclear definition of anastomotic leakage are the main difficulties in current studies. Several high-quality prospective randomized controlled trials are currently under way, and high level of evidence is needed to objectively evaluate the laparoscopic right hemicolectomy of colon cancer. The authors review the relevant literatures at home and abroad, systematically elaborate the research status and prospects of digestive tract reconstruction after laparoscopic right hemicolectomy of colon cancer, in order to explore a new direction for the clinical research of colorectal surgery in China.

Objective: To observe the clinical efficacy of Jin's three-needle therapy on post-stroke cognitive impairment (PSCI) and the effect on neuroelectrophysiology (event-related potentials). Methods: A total of 60 PSCI patients were selected and divided into a treatment group and a control group according to the method of random number table, with 30 cases in each group. The patients in the control group received routine treatment while the patients in the treatment group received additional Jin's three-needle therapy. The treatment for both groups lasted four weeks. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores as well as amplitude and latency of potential 300 (P300) were adopted to compare the between-group results before and after treatment. Results: Before treatment, there were no significant differences (all P>0.05) in MMSE and MoCA scores, P300 latency and P300 amplitude between the two groups. After 4 weeks of treatment, the MMSE and MoCA scores and P300 amplitudes were improved in both groups, and the P300 latencies became shorter. The results showed significant intra-group and between-group differences (all P<0.05). Conclusion: Based on the routine treatment, Jin's three-needle therapy is effective for PSCI. The mechanism is probably through its regulation on the patients' neuroelectrophysiology.

Objective The radiotherapy is one of main treatments for patients with malignant tumor and leads to ovarian func-tion decreasing in young women .It is very important to protect ovarian function during the process of radiotherapy .The aim of this study is to investigate the effect of melatonin ( MT) agonist on radiotherapy-induced ovarian function damage in female rats . Methods Thirty SD rats were divided into five groups randomly , which received normal saline, 200 cGy radiotherapy+normal saline, 200 cGy radiotherapy+MT(25 mg/kg), 200 cGy radiotherapy+MT(50 mg/kg), and 200 cGy radiotherapy +MT(100 mg/kg), respectively.All rats were de-capitated two weeks after radiotherapy .Levels of serum follicle-stimulating hormone (FSH) and estradiol (E2) were measured by en-zyme-linked immune sorbent assay method;the number of the primordial follicles , the growth follicles and the mature follicle were ob-served;Caspase3 activity was assayed by spectrophotometry . Results In accordance with the normal control group , RT+MT (100 mg/kg) group, RT+MT (50 mg/kg) group,RT group , serum E2 levels decreased, respectively (6.68 ±0.48, 5.73 ±1.36, 4.26 ±0.44, 2.83 ±0.51)pmol/L;FSH levels increased, respectively (0.340 ±0.011, 0.431 ±0.053, 0.479 ±0.023, 0.604 ± 0.028)ng/mL ;the total number of follicles decreased ,respectively (21.67 ±1.97, 18.00 ±2.28, 15.50 ±1.05, 11.50 ±2.43);Caspase3 activity increased,respectively (0.14 ±0.03, 0.26 ±0.06, 0.36 ±0.05, 0.50 ±0.05).Except FSH had no significant difference between RT +MT(50 mg/kg)group and RT+MT(100 mg/kg) group(P>0.05), the rest indexes had significant difference between the two groups(P<0.05). Conclusion MT can diminish radiotherapy-induced ovarian damage in female rats, it may be related to the mechanism that MT inhibits the radiotherapy-induced activation of Caspase 3.

Objective To investigate the effects of heme oxygenase-1 (HO-1) protein transduction mediated by cell penetrating peptide PEP-1 on intestinal injury in a rat model of sepsis induced by cecal ligation and puncture (CLP).Methods Twenty-four healthy male Sprague-Dawley rats,aged 7-9 weeks,weighing 210-260 g,were randomly divided into 4 groups (n =6 each) using a random number table:sham operation group (group S),group CLP,low-dose fusion protein PEP-1-HO-1 + CLP group (group P1) and high-dose fusion protein PEP-1-HO-1 + CLP group (group P2).Fusion protein PEP-1-HO-1 0.3 mg was administrated via the left iliac vein at 1 h before CLP and 5 h after CLP in group P1.Fusion protein PEP-1-HO-1 0.6 mg was administrated via the left iliac vein at 1 h before CLP and 5 h after CLP in group P2.The equal volume of normal saline was given instead of PEP-1-HO-1 in the other groups.The animals underwent laparotomy,but the caecum was not ligated or punctured in group S.Blood samples were collected at 12 h after CLP from the right common carotid artery for measurement of serum TNF-α and IL-6 levels.The rats were then sacrificed and intestines were removed for microscopic examination and for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in intestinal tissues.Results Compared with group S,the serum TNF-α and IL-6 levels,and MDA content in intestinal tissues were significantly increased,while SOD activity in intestinal tissues was decreased in CLP,P1 and P2 groups.Compared with group CLP,the serum TNF-α and IL-6 levels,and MDA content in intestinal were significantly decreased,while SOD activity in intestinal tissues was increased in P1 and P2 groups.Compared with group P1,the serum TNF-α and IL-6 levels,and MDA content in intestinal tissues were significantly decreased,while SOD activity in intestinal tissues was increased in group P2.The pathological changes of intestines were significantly mitigated in P1 and P2 groups as compared with group CLP.Conclusion HO-1 protein transduction attenuates intestinal injury induced by sepsis in rats,and the mechanism is related to inhibition of systemic inflammatory responses and lipid peroxidation in intestinal tissues.

Objective To evaluate the efficacy of different doses of dexmedetomidine for prevention of postoperative cognitive dysfunction (POCD) in the elderly patients undergoing hyperthermic intraperitoneal chemotherapy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged over 65 yr,weighing 50-70kg,undergoing elective hyperthermic intraperitoneal chemotherapy,were equally and randomly assigned into 4 groups using a random number table:control group (group C),different doses of dexmedetomidine groups (groups D1-D3).In D1-3 groups,a loading dose of dexmedetomidine 0.2,0.4 and 0.8 μg/kg was infused over 30 min before induction of anesthesia,respectively,followed by infusion at a rate of 0.5 μg· kg-1 · h-1 until the end of surgery,while the equal volume of normal saline was given in group C.After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Venous blood samples were collected at 30 min before induction of anesthesia (T0),immediately after intubation (T1),at 0 and 1 h after skin incision (T2,3),at 1 min after abdomen closure (T4) and immediately after onset of extubation (T5) for determination of serum concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by ELISA.The development of POCD was recorded within 7 days after surgery.Results Compared with group C,the serum concentrations of TNF-α and IL6 and incidence of POCD were significantly decreased in D1-D3 groups (P ＜ 0.05).Conclusion Dexmedetomidine pretreatment can decrease the development of POCD in elderly patients undergoing hyperthermic intraperitoneal chemotherapy and inhibition of inflammatory responses may be involved in the mechanism.

Objective To explore the effects of dehydroepiandrosterone (DHEA) on learning and memory ability and activities of choline acetyltransferase (ChAT),acetylcholinesterase (AchE),acetylcholine (Ach) in the frontal,temporal,hippocampal area of the aged rat.Methods Forty 24-month-old male SD rats were randomly divided into 4 groups (n=10,each group):control group,solvent group (intraperitoneal injection with equal volumes of DMSO),low-dose group (intraperitoneal injection with equal volumes of DHEA,1 mg/kg),and high-dose group (intraperitoneal injection with equal volumes of DHEA,5 mg/kg).The activities of ChAT,AchE,and Ach were measured by enzyme linked immunosorbent assay (ELISA) method.Learning and memory ability was detected by Morris water maze test.Results The levels of ChAT in frontal,temporal and hippocampal area were (118.5±1.3) U/mg,(120.6±1.5) U/mg,(130.8±1.5) U/mg,respectively in control group,(i39.5±1.6) U/mg,(137.4±1.4) U/mg,(141.46±1.9) U/mg,respectively in high-dose group,(131.8±1.9) U/mg,(132.4±1.2) U/mg,(139.9±1.3) U/mg,respectively in low-dose group.The levels of AchE in frontal,temporal and hippocampal area were (0.5±0.0) U/mg,(0.4±0.0) U/mg,(0.5±0.0) U/mg,respectively in control group,(0.4±0.0) U/mg,(0.4±0.0) U/mg,(0.4±0.0) U/mg,respectively in high-dose group,and (0.4±0.0) U/mg,(0.4±0.0) U/mg,(0.4±0.0) U/mg,respectively in low-dose group,and (0.5±0.0)U/mg.The Ach levels in frontal,temporal and hippocampal area were (26.0±0.8) U/mg,(24.5±1.4) U/mg,(30.1±0.8) U/mg respectively in control group,(28.7±0.9) U/mg,(28.9±1.3) U/mg,(35.9±1.4) U/mg,respectively in high-dose group,and (27.6±0.1) U/mg,(28.0±1.1) U/mg,(34.2± 1.0) U/mg,rcspectively in low dose group.The activities of ChAT in frontal,temporal and hippocampal area were higher in DHEA treatment group than in control group (P＜0.05).The activities of AchE in frontal,temporal and hippocampal area were much lower in DHEA treatment group than in control group (P＜ 0.05).The Ach levels in frontal,temporal and hippocampal area were much higher in DHEA treatment group than in control group (P＜0.05).There were significant differences in the activities of ChAT and AchE and Ach levels between low-dose group and high-dose group (P＜0.05).Compared with control group,the activities of ChAT and AchE and Ach levels had no significant differences in solvent group (P＞0.05).The escape latency was shorter in low-dose group and high-dose group than in control group (P＜0.05,P＜0.01,respectively),and there was a significant difference in escape latency between low-dose group and high dose group (P＜ 0.05).Conclusions DHEA administration can significantly increase the activity of cholinergic system,and improve the learning and memory ability in aged SD rats.

Objective To evaluate the clinical efficiency of humanized anti-CD52 monoclonal antibody (Campath-1H) and anti-CD25 monoclonal antibody (Zenapax) induction therapy in intestinal transplantation patients.Method The data of 6 patients receiving Campath-1H and 5 patients receving Zenapax induction therapy in intestinal transplantation between 2007 and 2012 were analyzed retrospectively.The counts of peripheral blood lymphocytes and monocytes,incidence of rejection and infention,and liver and kidney toxicity of recipients were recorded before and 3 months after transplantation.Results Of 6 intestinal transplantation patients receiving Campath-1H induction therapy,1 died of acute heart failure on the postoperative day 3,and the rest 5 patients had a powerful depletion of lymphocytes and monocytes in 8 weeks,followed by gradual increases after 8 weeks.The percentage of peripheral blood CD3 + T cells,CD4 + T cells,and CD8 + T cells was dropped to 5％ before administration,and remained at a steady low level in the first 8 weeks after induction.Of 5 patients receiving Zenapax induction therapy,1 died of Aspergillus infection on the postoperative day 25,and the rest 4 patients had an obeivous increase of lymphocytes and monocytes on the postoperative day 1.Counts of lymphocytes and monocytes kept steady at normal levels from the 1st to 12th week.One case of mild rejection was found in Campath-1H group.One case of mild,one moderate and one severe rejection were detected in Zenapax group.All rejections were successfully cured by prompt anti-rejection therapy.There were no significant difference in serum creatimine,urea nitrogen,alanine aminotransferase or total bilirubin after 3 months in comparison to preoperation.Conclusion Both Campath-1H induction therapy and Zenapax induction therapy successfully induce immune tolerance in patients with intestinal transplantation.Campath-1H seems to offer better immunosuppression against Zenapax during the first 3 months posttransplantation.

Objective To study and summarize the successful experience and the safety, easibility, practicality and operation skills of totally laparoscopic extraperitoneal herniorrhaphy (TEP). Methods From October 2006 to May 2008,225 patients in our two hospitals were performed TEP (265 totally laparoscopic extraperitoneal hernia repairs for inguinal hernia), including 55 direct inguinal hernia, 197 indirect inguinal hernia and 13 complex inguinal hernia operations. Among the 225 patients, 185 patients had unilateral hernia and 40 patients had bilateral hernias, including 29 recurrent hernia. Results The operations were lasted for 30 to 182 minutes(the average operating duration was 48 minutes for unilateral hernia and 106 minutes for bilateral hernia). The patients stayed in hospital for 2 to 8 days(the average inpatient hospital stay was 3.0 ± 1.2 days). The most common complication was scrotum bematomas,which appeared in 18 cases. Urinary re-tention appeared in 21 cases. Inguinal pain appeared in 5 cases. Bladder injury appeared 1 case. All the pa-tients were followed up for 3 months- 3 years. There was only 1 case of recurrence. Conclusions The proce-dure of TEP is safe,with faster postoperative recover,less pain,lower incidence of pain,better comfort quality and lower recurrence rate. TEP should be the main laparoscopic procedure for inguinal hernia repair.