Objective To evaluate the efficacy of arthroscopic debridement combined with microfracture on management of chronic enthesiopathy of Achilles tendon.Methods Fifteen cases of chronic enthesiopathy of Achilles tendon were enrolled in this study from January 2013 to January 2016.There were 11 males and 4 females,with an average age of 55.5±8.9 years.Five were in left side,and 10 in right side.All the patients failed to recover after conservative treatments for 18 months to 10 years.Pathological tissue was eliminated by blade.Then microfracture was made.Arthroscopic awls (1.5 or 2 mm in diameter) were used for making multiple holes at the footprint of achilles tendon.These holes were made far enough (3-4 mm) apart so they do not break into each other.Fat droplets and bleeding from the marrow cavity were seen when the appropriate depth (approximately 5 to 10 mm) has been reached.The patients were evaluated preoperatively and postoperatively using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and visual analogue scale (VAS) scores.Results Average operation time and length of stay were 30.6± 15.4 min and 6.2±2.8 d,respectively.Postoperative incisions were Ⅰ stage healing for all patients.There were no perioperative and postoperative complications related to the procedure,such as rupture of achilles tendon,blood vessel and nerve injury.No infection and recurrence was found in all cases.All patients were followed up for an average time of 13.5 months.No rupture of achilles tendon or relapsing symptom was found.Average VAS scores before surgery,6 month after surgery and at the lattest follow-up were 7.3± 1.6,2.4± 1.3,and 2.3± 1.3,respectively.Average AOFAS Ankle-Hindfoot scores were 38.5± 7.8,92.9±6.9,and 91.6±7.1,respectively.Average postoperative VAS scores and AOFAS Ankle-Hindfoot scores were significantly improved compared with those before surgery.There was no statistically significant difference among all check point after operation in VAS scores and AOFAS Ankle-Hindfoot scores.At the latest follow-up,all patients were satisfied with the degree of painful relief.According to AOFAS Ankle-Hindfoot scores,overall excellent and good rate was 93.3％ (excellent in 10 cases,good in 4 cases,and fair in 1 case).Conclusion Clinical results of arthroscopic debridement combined with microfracture for treatment of chronic enthesiopathy of Achilles tendon are good.This technique is easy and safe to perform.

Objective To study if β-elemene can increase radiation-induced deoxyribonucleic acid (DNA) damage and decrease the damage repair.Methods Exponentially growing human lung adenocarcinoma cells (A549) were exposed to 10 or 20 μg/ml β-elemene for 24 h before irradiation.The effect of β-elemene on the in vitro radiosensitivity of A549 cells was evaluated using clonogenic assay.DNA damage and repair were evaluated using comet assay.Results Exposure to β-elemene before irradiation increased the radiosensitivity of A549 cells.The SERD0 for 10 μg/ml and 20 μg/ml β-elemene was 1.55 and 1.64, respectively.The SERDq for 10 μg/ml and 20 μg/ml β-elemene was 1.43 and 1.75, respectively.Combined treatment, comparing to irradiation or β-elemene treatment alone, induced higher levels of DNA damage and slower rate of damage repair.A549 cells exposed to 20 μg/ml β-elemene followed by irradiation showed a higher levels of tail moment (TM) than those exposed to irradiation or β-elemene alone at 0 h,2 h,6 h and 24 h after irradiation.The TM of the three groups at 0 h,2 h,6 h and 24 h after irradiation was 7.16±2.61,0.95±0.65 and 1.81±1.23(F=231.24,P<0.01), 3.65±2.06,0.11±0.07 and 1.58±1.40(F=90.22,P<0.01), 2.09±0.83,0.1±0.05 and 0.45±0.25(F=238.44,P<0.01), 1.45±1.37,0.11±0.08 and 0.60±0.40(F=38.94,P<0.01), respectively. Conclusions β-elemene can enhance the radiosensitivity of A549 cells through the enhancement of DNA damage and the inhibition of DNA damage repair.

Objective To explore antitumor effect of 131I-Trastuzumab on human epidermal growth factor receptor(HER) 2 overexpressing breast cancer cells and investigate its possible mechanism.Methods The expression levels of HER2 of three different breast cancer cell lines (BT474,MCF-7,HCC1937) were detected with immunofluorescence.Trastuzumab was labeled with 131I using the Iodogen method and 131I-Trastuzumab was isolated with ultrafiltration membrane,then the labeling efficiency,radiochemical purity and immunoreactivity were measured.The effects of 131I,Trastuzumab and 131I-Trastuzumab on viability of BT474 cells were evaluated with cell counting kit-8 (CCK-8) assay.The levels of total Akt and phosphorylated Akt (p-Akt) were detected with Western blot analysis.One-way analysis of variance (ANOVA),ANOVA for factorial design,Bonferroni correction and Pearson correlation analysis were used for data analysis.Results The expression level of HER2 in BT474 cells was much higher than those in HCC1937 and MCF-7 cells.The labeling efficiency,radiochemical purity and immunoreactivity of 131I-Trastuzumab were (89.71± 2.93)％,(91.80±1.43)％ and (58.84±3.35)％ respectively.131I (4.625 GBq/L),Trastuzumab(125.0 rmg/L) and 131I-Trastuzumab(4.625 GBq/L) exhibited a dose-dependent cytotoxicity against BT474 cells (r =-0.964,-0.912,-0.618;all P＜0.05).The cell viability of 131I-Trastuzumab treated gourp (34.73％ ±5.03％) was significantly lower than those of 131I and Trastuzumab treated groups (64.36％± 1.51％ and 58.09％±4.14％;t=10.373 and 8.180,both P＜0.05),and the cell viability of control group was (100.00±4.54)％.131I-Trastuzumab shown a positive multiplicative interaction between 131I and Trastuzumab (F=9.226,P＜0.05;CDI =0.929).Western blot results showed that there was no significant difference of total Akt expression among the control group,131I group,Trastuzumab group and 131I-Trastuzmab group (F=0.208,P＞0.05).P-Akt expression in both Trastuzumab group and 131I-Trastuzumab group were much lower than those of control group and 131I group (t=12.524,15.984,7.347,10.807;all P＜0.05),while there was no significant difference of p-Akt expression between Trastuzumab group and 131I-Trastuzumab group(t =3.460,P＞0.05).Conclusions 131I-Trastuzumab may kill HER2 overexpressing breast cancer cells more effectively than Trastuzumab alone.The underlying mechanism may be attributed to that 131I-Trastuzumab may enhance the radiosensitivity by the inhibitory effect on PI3K/Akt pathway and thus exert synergistic effects with 131I.

OBJECTIVETo investigate effects of exogenous hydrogen sulfide ( H2 S) on the spatial memory disorder induced by cerebral anoxia in mice and explore related mechanism.METHODS Sodium nitrite (NaNO2) 120 mg·kg-1 was sc given to mice for4 d in model group.Sodium hydrosulfide (NaHS) 1 mg·kg-1 was ip given and NaNO2 120 mg·kg-1 simultaneously was sc given to mice for4 d in NaHS group.All drugs were given to mice immediately after Morris water maze experiment every day and escape latency.The number of crossings over the target area (NCTA) and search time in target quadrant (STTQ) were recorded.The activity of superoxide dismutase (SOD) and malondialdehyde (MDA) level in the brain was determined with colorimetry.The morphological alterations in hippocampus slices were assessed by microscope.RESULTSOn the third and fourth days in Morris water maze experiment,compared with ( 16.1 ±9.6)s and ( 11.1 ±6.2)s in normal control group,the escape latency in model group was longer,(26.0 ±7.3)s(P＜0.05) and (23.3 ±8.7)s(P＜0.01).On the fifth day,compared with 7.2 ± 1.6 and (28 ± 8) s in normal control group NCTA and STTQ in model group were 4.1 ± 1.9and (20 ± 8 ) s ( P ＜ 0.05 ),and they were obviously less.Compared with normal control group,SOD activity and M DA content of mice in model group were reduced by 12.6％ (P ＜ 0.01 ) and increased by 43.9％ (P ＜ 0.01 ),respectively.The neuron degenerative changes including karyopyknosis,dark cytoplasm and irregular pyramidal layer were observed in model group.On the third and fourth day,compared with model group,the escape latency in NaHS group was shorter,(17.9 ±7.0)s and (15.8 ±8.5)s (P＜0.05).Compared with model group,NCTA and STTQ in NaHS group increased to 6.7 ± 2.5 and ( 30 ± 9) s ( P ＜ 0.01 ).SOD activity and MDA content in NaHS group were increased by 8.9％ ( P ＜ 0.05 ) and reduced by 29.6％ ( P ＜ 0.01 ),respectively.Neuron degeneration was significantly attenuated in NaHS group (P ＜ 0.01 ).CONCLUSIONNaHS can attenuate the spatial memory disorder induced by cerebral anoxia and the mechanism may be related to the antioxidation effect and alleviation of neuron damage of H2S.

Objective To compare the minimum 5?year follow?up outcomes of surgical management by posterior only ap?proaches, anterior only approaches and combined posterior and anterior approaches for thoracic tuberculosis in adults, and evalu?ate the mid term follow?up results of posterior only approaches. Methods All of 184 patients with monosegment thoracic tubercu?losis between January 2003 and November 2010 were studied retrospectively. Among these patients, 62 cases were treated with posterior debridement combine with interbody fusion (PO group), 65 cases were treated by posterior instrumentation, anterior de?bridement and bone graft in one or two?stage procedures (AP Group ), and 57 cases were treated by anterior only approach (AO Group). The operation time, blood loss, Visual Analogue Scale, complications, recovery of neurological function, kyphosis angle, correction rate and loss angle were respectively compared between each group. Results Comparison of postoperative curative ef?fects showed:mean operation time and blood loss:PO group (260.05±30.75 min,735.95±161.43 ml) was better than AP group (411.65 ± 55.61 min, 1178.65 ± 184.50 ml)and AO group (343.65 ± 24.74 min, 965.35 ± 122.59 ml);corrective angle and correction rate:PO group (6.78°±1.13°, 72.48%±12.97%) and AP group (6.97°±1.05°, 73.10%±11.42%) were better than AO group (13.98°± 1.73°, 44.95%±16.84%);bed time:PO group and AO group were shorter than AP group. Mid term follow?up outcomes showed:ky?phosis angle and loss angle:PO group (8.56°±1.09°, 1.89°±1.41°) and AP group (8.55°±1.65°, 1.63°±1.11°) were better than AO group (16.39°±1.59°, 2.80°±1.29°);bone fusion time, VAS and recovery of neurological function:there were no statistically differ?ence in all groups. Conclusion The mid term follow?up outcomes of posterior debridement combined with interbody fusion is sat?isfied in the management of monosegment thoracic tuberculosis. It is a safe and effective method.

Objective To investigated the clinical distributions and antimicrobial susceptibility of Streptococcus agalactia strains isolated from the patients .Methods The identification and susceptibility of the strains were mainly measured by automatic VITEK‐Ⅱ system ,the K‐B disc diffusion tests were used for the resistance test of erythromycin ,meropenem ,and D‐test .Results The iso‐lates were mainly from urine (63 .1% ) ,genital tract(7 .8% ) and wound secretion(6 .7% ) .They were obtained from patients in dif‐ferent situations ,including 110 patients who were older than 50 years old (61 .5% ) ,113 female patients (63 .1% ) ,12 gravidas (6 .7% ) ,3 vertical transmitted newborns(1 .7% ) ,and 82 patients with cancer ,undergoing chemo radiotherapy ,with diabetes ,tuber‐culosis or after operations(45 .8% ) .The resistant rates of the isolated Streptococcus agalactia to erythromycin and clindamycin were 42 .9% -93 .3% and 41 .9% -80 .0% respectively .The positive rate of D‐test was 4 .1% .The strains were highly resistant to tet‐racycline(>80% ) ,while the resistance to penicillin was below 10% except in 2008 .All isolates were susceptible to vancomycin and meropenem .Only one strain was resistant to Quinupristin‐dalfopristin .Conclusion Streptococcus agalactia infection in adults most‐ly cause genitourinary tract ,skin and soft tissue infections .There were more females than males with Streptococcus agalactia infec‐tion .Penicillin andβ‐lactams are still the first choice for the treatment .Erythromycin ,clindamycin and tetracycline should be used with caution under the guidance of laboratory susceptibility test results .

Objective:To compare the difference between the operation of ureteral calculi patients with COVID-19 infection during COVID-19 infection and after recovery to find out the best timing for surgery.Methods:The clinical data of 327 ureteral calculi patients with COVID-19 infection were retrospectively analyzed, including 141 cases who underwent ureteroscopic surgery. According to the time of ureteroscopic surgery, the patients were divided into two groups: operation before recovery of COVID-19 infection group ( n=81) and operation after recovery of COVID-19 infection group ( n=60). The success rate of primary surgery, stone removal incidence, complication inciednce, mortality, operation time, postoperative hemoglobin decline, hospital stay, and total hospitalization cost and other indicators of the two groups were compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), independent t-test was used for inter-group comparison. Chi-test or continuous correction Chi-test was used for inter-group comparison for count data. Results:The success rate of primary surgery (38.3%, 31/81), stone removal rate (86.4%, 70/81) in the operation before recovery of COVID-19 infection group were significantly lower than those in the operation after recovery of COVID-19 infection group [80.0% (48/60), 98.3% (59/60)], and the differences were statistically significant ( P< 0.05). The incidence of complication, postoperative hemoglobin decline [(2.1±0.6) g/L vs (0.6±0.3) g/L], hospital stay [(14.7±3.6) d vs (4.1±1.1) d], total hospitalization cost [(34 733.3±4 412.4) yuan vs (21 919.7±3 251.3) yuan] of the operation before recovery of COVID-19 infection group were significantly higher than those in the operation after recovery of COVID-19 infection group, and the differences were statistically significant ( P< 0.001). The operation time of the operation before recovery of COVID-19 infection group was shorter [(16.9±5.4) min vs (37.7±8.9) min], and the difference was statistically significant ( P< 0.001). There was no significant difference in mortality between the two groups (3.7% vs 0, P> 0.05). Conclusion:The risk of surgical treatment for ureteral calculi patients with COVID-19 infection is high, The treatment of them should mainly be conservative treatment, and operation should be performed after COVID-19 infection is cured.

Objective:To evaluate the clinical outcomes of arthroscopic debridement combined with in situ ulnar nerve release in patients with osteoarthritic elbow stiffness complicated by tardy ulnar neuritis.Methods:A retrospective chart review was conducted on 36 patients with osteoarthritic elbow stiffness and tardy ulnar neuritis who underwent arthroscopic debridement and in situ ulnar nerve release between January 2018 and October 2022. The mean patient age was 51.3±6.5 years (range: 40-62 years), with 29 males and 7 females. The procedure was performed on 28 right and 8 left elbows, all on the dominant side. Radiographic classification of elbow osteoarthritis (OA) revealed 16 cases of Kellgren-Lawrence grade II, 15 cases of grade III, and 5 cases of grade IV. The duration of OA was 4.2±1.8 years (range: 2-8 years), and the duration of ulnar nerve compression symptoms was 4.6±3.2 months (range: 2 months-1 year). Elbow function and pain were assessed preoperatively and 12 months postoperatively using flexion-extension range of motion, the Mayo Elbow Performance Index (MEPI), and the Visual Analogue Scale (VAS) for pain. Ulnar nerve function was evaluated through grip strength, pinch strength, two-point discrimination of the little finger, and motor and sensory nerve conduction velocities (MNCV and SNCV).Results:The mean operation time was 151.4±16.2 minutes (range: 125-180 minutes), with an average hospital stay of 6.5±1.0 days (range: 5-8 days). One patient (2.8%) experienced skin necrosis at the ulnar nerve release incision, while all other incisions healed at the first stage. At the 12-month follow-up, significant improvements were observed in elbow extension [26.00° (20.00°, 30.00°) vs. 6.00° (5.00°, 10.00°), Z=-5.235, P<0.001], flexion range of motion [98.00° (88.25°, 100.00°) vs. 120.50° (109.00°, 128.00°), Z=-5.234, P<0.001], VAS pain scores (7.5±0.9 vs. 1.8±0.8, t=32.788, P<0.001), and MEPI [32.50 (26.25, 43.75) vs. 85.00 (80.00, 85.00), Z=-5.269, P<0.001]. Improvements in grip strength (24.1±2.4 N vs. 35.0±2.7 N, t=30.745, P<0.001), pinch strength (16.2±1.3 N vs. 23.8±1.7 N, t=40.239, P<0.001), two-point discrimination [16.00 (14.00, 18.00) mm vs. 5.00 (3.00, 7.00) mm, Z=-5.270, P<0.001], and MNCV (27.5±3.0 m/s vs. 41.6±3.0 m/s, t=53.673, P<0.001) / SNCV (25.1±2.7 m/s vs. 35.0±2.9 m/s, t=47.538, P<0.001) were also noted. At the 12-month follow-up, 5 patients (13.9%) had an elbow extension lag greater than 15° (range: 18°-20°), though elbow flexion recovered to at least 100°, sufficient for daily activities. One patient (2.8%) had incomplete relief of ulnar nerve symptoms postoperatively, but was generally satisfied with the outcome. Three patients (8.3%) experienced temporary worsening of ulnar nerve symptoms during rehabilitation, which improved with adjusted exercise routines, and the symptoms resolved by the 1-year follow-up. Conclusion:Arthroscopic debridement combined with in situ ulnar nerve release is a safe and effective treatment for osteoarthritic elbow stiffness complicated by tardy ulnar neuritis. This minimally invasive procedure is associated with a low complication rate and yields significant functional improvements.

Objective:To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment knee osteoarthritis (OA) with concomitant lateral discoid meniscus.Methods:A retrospective analysis was conducted on 13 patients (16 knees) who underwent UKA for medial compartment OA of the knee associated with lateral discoid meniscus at Central Hospital of Cangzhou between January 2016 and July 2021. The mean age of the patients was 59.1±7.7 years (range, 49-74 years), with a mean body mass index (BMI) of 28.9±1.7 kg/m 2 (range, 25.2-31.3 kg/m 2). Of the 13 patients, 7 were male (9 knees) and 6 were female (7 knees). The procedure was performed on 10 knees of the left leg and 6 knees of the right leg. Preoperative radiographic assessment showed that all patients had Kellgren-Lawrence grade 3-4 knee OA (9 knees with grade 3, 7 knees with grade 4). The average duration of knee pain was 6.0±1.5 years (range, 3-8 years). No surgical intervention was performed on the lateral discoid meniscus during the UKA procedure. The alignment of the lower limbs was assessed by measuring the hip-knee-ankle (HKA) angle using full-length weight-bearing X-rays. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) score, Oxford knee score (OKS), and American Knee Society (AKS) knee and function scores. The presence of lateral knee pain or tenderness along the lateral joint line was used to assess symptoms related to lateral meniscus injury. Results:The average surgical time for the 16 knees was 55.9±4.5 min (range, 48-62 min), and the mean length of hospital stay was 10.2±3.2 days (range, 7-15 days). The mean follow-up duration was 53.2±11.1 months (range, 36-68 months). At 6 months, 1 year, and the final follow-up, significant improvements were observed in HSS scores [57.00(54.25, 58.00) vs. 91.00 (89.25, 92.00) vs. 95.50(92.00, 97.00) vs. 96.50 (95.00, 97.75)], OKS [37.00(36.00, 39.00) vs. 15.00(15.00, 16.00) vs. 14.00(13.00, 14.00) vs. 13.00(12.25, 13.00)], AKS knee scores [52.00(50.00, 53.75) vs. 91.50(91.00, 92.00) vs. 95.00(95.00, 97.00) vs. 96.50 (95.00, 97.00)], and AKS function scores [53.00(45.00, 55.00) vs. 90.00(90.00, 90.00) vs. 95.00(92.00, 99.25) vs. 95.00(95.00, 100.00)] compared to preoperative values ( P<0.001). Statistically significant differences were found between the 6-month follow-up and the 1-year or final follow-up ( P<0.05), but no significant differences were observed between the 1-year and final follow-up ( P>0.05). Preoperative HKA angle was 8.00°(6.25°, 9.75°) of varus, whereas the postoperative HKA angle was 3.00° (3.00°, 3.75°) of varus. The postoperative alignment showed a significant reduction in varus deformity, with a statistically significant difference compared to preoperative values ( Z=-3.419, P=0.001). One knee developed symptomatic intra-articular loose body at 5 years postoperatively, which was successfully treated with arthroscopic removal. At the final follow-up, all prostheses were well-positioned, with no signs of loosening, subsidence, periprosthetic infection, or the need for revision surgery. No symptoms were indicative of lateral discoid meniscus injury were observed. Conclusion:UKA for the treatment of medial compartment knee OA in patients with lateral discoid meniscus yields favorable clinical outcomes, with significant improvements in knee function and pain relief, as well as stable midterm prosthesis performance.