Objective To compare the effect of continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) on pain relief,rehabilitation efficacy,satisfaction degree following total knee arthroplasty (TKA) in an attempt to find a safe and effective analgesia at the stage of rehabilitation.Methods The records of 116 patients undergone unilateral TKA for osteoarthritis or rheumatoid arthritis of the knee were evaluated.The patients with preoperative American Society of Anesthesiology (ASA) score of 1 to 3 were randomized into CFNB group (58 cases) and PCIA group (58 cases) according to the random number table.Both operations were performed under ultrasound guidance.Postoperative visual analogue score (VAS),knee function,incidence of adverse reaction,and satisfaction degree were compared between the two groups.Results Regardless of the score at postoperative 4 and 12 hours,VAS between CFNB and PCIA groups revealed significant differences at postoperative 24 [(3.2±1.1)pointsvs (4.1 ±1.5)points],48 [(3.4±1.2)pointsvs (4.1 ±1.0) points] and 72 hours [(3.3 ± 1.2) points vs (4.0 ± 1.1) points] (all P ＜ 0.05).Time to achieve knee rehabilitation training objectives like straight leg raise,walking with crutches,and passive bending to 90° were similar between the two groups.Both groups achieved comparable knee function status with respect to Hospital for Special Surgery (HSS) score,Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score,and maximal knee flexion angle at postoperative 3 months.Postoperative nausea and vomit were significantly more frequent in PCIA group (24％) than in CFNB group (14％) (all P ＜O.05),but patients in both groups were satisfactory.Conclusion Ultrasound guided CFNB is an effective analgesic method during the early stage of TKA,for it can control pain,accelerate rehabilitation training and function recovery,reduce adverse reaction as well as improve patients' satisfaction.

Objective To study the precision of computer-aided preoperative templating for total hip arthroplasty. Methods Thirty patients (11 males, 19 females; age ranged from 42 to 85 years, mean 56 years) received unilateral total hip arthroplasty from March 2008 to December 2008. Preoperative tem-plating was done with LINK -Preop-PlanTM to compare the size of the planned hip joint with the size of the prosthesis, as well as the discrepancy of the limbs before and after operation. Results The predicted sizes of the prosthesis corresponded well with the actual ones. The cup size of the prosthesis completely matched the actual ones in 19 patients (63%), and the variation was within 1 size in 8 patients (27%) and ≥2 sizes in 3 patients (10%). The stem size of the prosthesis completely matched the actual ones in 19 patients (63%), and the variation was within 1 size in 9 patients (30%) and ≥2 sizes in 2 patients (7%). The variation of the cemented and cementless stem size of the prosthesis was within 1 size in 16 patients (89%) and 12 patients (100%), respectively, with no statistical difference (P > 0.05). The discrepancy of limb length was (9.0±8.5) mm preoperatively and (1.1±2.4) mm postoperatively. Conclusions Preoperative planning is of paramount significance in total hip arthroplasty. Computer-ai-ded preoperative templating can accurately anticipate the type of the prosthesis, which is helpful in correc-ting the discrepancy in leg length.

OBJECTIVETo study parathyroid hormone-related protein (PTHrP) expression during forward mandibular positioning and compare it with the expression during natural growth in different seasons.

METHODSSixty-four SD rats were randomly divided into experimental and control groups. Each group were randomly divided into four groups according to seasons. Immunohistochemical (IHC) methods were used to test the protein expression of PTHrP. Macroscopic and microscopic approach were applied to analyze the results.

RESULTSPTHrP expressed in mandibular condylar cartilage (MCC), the expression was accelerated and enhanced when the mandible was positioned forward. Furthermore, there was a seasonal rhythm in the protein expression of PTHrP in both experimental and control groups. The protein expression in spring group rose more than other groups.

CONCLUSIONThe functional appliance therapy can enhance the protein expression of PTHrP. The enhancement has a seasonal rhythm, which indicates that for the functional treatment better results can be achieved in spring.

Animals ; Cartilage ; Mandible ; Mandibular Condyle ; Parathyroid Hormone-Related Protein ; Rats ; Rats, Sprague-Dawley ; Seasons

OBJECTIVETo evaluate the efficacy and safety of three different spinal rotation manipulations for the treatment of lumbar disc herniation.

METHODSFrom September 2011 to April 2013,180 patients diagnosed as lumbar disc herniation were randomly divided into seat fixed rotation group (A), lateral position rotation group (B) and supine position rotation group (C) by using a digital table. Finally 10 patients were excluded and dropped, 170 patients were included in the study. There were 57 patients in group A, 57 patients in group B and 56 patients in group C. Baseline demographic characteristics of patients, clinical findings and indexes of health status had no statistically differences among three groups (P > 0.05). The manipulation was performed every other day, and the treatment duration for all patients was 3 weeks. Body pain (BP), Physical function (PF) in SF-36, Oswestry Disability Index (ODI) and adverse reactions were observed statistically 6 weeks, 3 months, 6 months, one year and two years after finishing treatment.

RESULTSBP, PF scores in 3 groups were significantly improved and ODI scores were significantly lower than those before treatment and the differences were statistically significant (P < 0.05); However, there was no significant difference among three groups in the BP, PF and ODI scores (P > 0.05). There were no obvious and serious adverse reactions among these groups.

CONCLUSIONBased on the theory of dislocation of bone joints in TCM, three kinds of spinal rotation manipulations can be used safely for the treatment of lumbar disc herniation, and the efficacy was similar.

Adolescent ; Adult ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; therapy ; Male ; Manipulation, Spinal ; methods ; Middle Aged ; Rotation ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis.

METHODSFrom January 2002 to March 2013, 145 patients (84 males and 61 females) with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them, 143 patients were followed up, aged from 2.5 to 81 years with an average of (42.60 +/- 17.14) years. Fourteen cases (6 cases with internal fixation and 8 cases without internal fixation) recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse, 1 case with muscle strength decrease, this 2 cases were grade D of Frankle, other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy, 144 cases with CT-guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up.

RESULTSThe mean follow-up time was 67 months (ranged, 21 to 149 months) in 143 cases, and 73 cases more than 5 years. All patients obtained clinical healing. ESR was (44.96 +/- 12.41) mm/h before operation and (7.25 +/- 3.43) mm/h at final follow-up, there was significant difference between preoperative and postoperative (t=35.06, P=0.000). Lumbar lordosis angle was (36.32 +/- 8.55) degrees before operation and (33.35 +/- 8.16) at final follow-up, there was significant difference between preoperative and postoperative (t=13.90, P=0.000).

CONCLUSIONWhen conservative treatment fails for 3 months or more, the patients have good spinal stabilization, nerve function is more than grade D of Frankel, CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Debridement ; Female ; Humans ; Lumbosacral Region ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Sacrum ; surgery ; Tomography, X-Ray Computed ; Tuberculosis, Spinal ; diagnostic imaging ; surgery ; Young Adult

Objective To investigate the general information such as study motivation, study de-mand, and encountered difficulties of foreign medical postgraduates in China. Methods 45 medical post-graduates in Chongqing Medical University participated in this survey in February 2014. The questionnaire consisted of 19 questions, including study motivation, the reasons to learn in China, language proficiency, study expectation, satisfaction rate, and future career plan. In total, 45 questionnaires were handed out, and 42 (93%) were recovered. Results All respondents (42 persons) had already acquired medical license in their own countries. 45%of them (19 persons) had obtained bachelor’s degree in other university and were attracted by the reputation of Chongqing Medical University. 50% of respondents (21 persons) considered language barrier as the biggest problem in their learning process. 60%(25 persons) were generally satisfied with their postgraduate education in China. And lack of clinical practice opportunity was ranked as the No. 1 reason of dissatisfaction (54%, 23 persons). Conclusion Language barrier as well as lack of clinical practice opportunity is the biggest two problems encountered by foreign medical postgraduates in China. Although Chongqing Medical University has gained a lot of experience in foreign medical postgraduate education, improvements regarding training program and mentor selection should still be made.

Objective To study the change and rule of immunological function among the patients with coal arsenic poisoning in order to provide a basis for tumor risk evaluation and monitoring.Methods Seventy patients with coal arsenic poisoning aged from 24 to 71 years old(44 men,26 women,averaging 41 years old)were divided into 4 groups including 23 cases having a course less than 10 years,21 case8 lasting for 10～19 years,20 cages for more than 20 years,6 cases of cancer,and 26 healthy normal controls.Flow cytometer(FCM)was used to analyze the frequency of CD3+(total T cell),CD3+CD4+(inducer/helper T cell),CD3+CD8+(suppressor/cytotoxic T cell),CD19+(B lymphocyte),and CD56+CD16+(natural killer cell)lymphocyte subsets in the peripheral blood of the subjects and the expression rates of lymphocytic membrane surface molecules of human leucocvte antigen (HLA)-DR,CD25,CD38 were also determined by FCM.Results The pmportions of CD3+cells in periDheral blood of less than 10 years,10～19 years,more than 20 years and cancer groups were (63.76±9.32)%。(55.63± 12.97)%,(51.00±12.23)%and(49.83±,9.89)%respectively,which were significantly lower than that in control group[(68.10±8.62)%],and there was a significant difference between different groups(F=12.862,P<0.05). In less than 10 years,10～19 years,more than 20 years and cancer groups,the proportion of CD3+CD4+cells cells was (31.35±6.62)%,(28.38±8,66)%,(24.13±6.46)%and(19.17±4.96)%respectively,which wag significantly lowerthan that in control group[(34.28±7.32)%],and significant in a-group difference was found(F=10.455, P<0.05).The percentages of CD19+cells in more than 20 yeats and cancer groups[(9.00±5.32)%,(9.00± 3.29)%]were lower than that in control group and less than 10 years group[(11.80±3.43)%,(12.35±4.53)%] (P<0.05),while no statistical difference was found between other groups.The expression rates of CD25 and CD38 in lymphocytes of cancer group[(17.96 ±4.98)%,(41.38±8.54)%]were obviously higher than those in control group[(13.10±338)%,(28.60±5.51)%]and there were statistical differences between the experimental groups(P<0.05).The expression rate of HLA-DR in 10～19 years groups[(18.20±6.25)%]was significantly higher than that in control group[(10.72±7.06)%]and less than 10 years group[(11.78±5.13)%],while it was the same in more than 20 years and cancer group[(20.30±8.01)%,(21.82±10.97)%].Conclusions Reduction of cellular immune function caused by coal arsenic poisoning may be an important mechanism of skin cancer.CelMar immune function may be used as a warning signal of skin cancerization of patients with coal arsenic poisoning.

In most cases of arthritic varus knees, stepwise osteophytes removal and medial soft tissue release could achieve satisfactory soft tissue balance during total knee arthroplasty. However, in some severe cases, conventional balancing techniques are not enough, necessitating other procedures like epicondylar osteotomy. To the best of our knowledge, no published article has reported the application of lateral epicondylar osteotomy in a severe varus knee. Here we reported a case of successful correction of a severe varus knee following lateral epicondylar osteotomy, and described its underlying rationale.
Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Knee ; abnormalities ; Osteotomy ; methods

Objective To study the application of pediculated skin flaps in the treatment of com-plicated long urethratresia. Methods From March 1999 to May 2006, a total of 18 male patients with complicated long urethratresia were treated by using the pediculated skin flaps. The causes of urethratresia were 7 cases of postoperative pelvic fractures with posterior urethral stricture, 4 cases of transurethral intravesical chemotherapy, 3 cases of postoperative bulbar urethral stricture, 2 cases of gonorrhea, and 2 cases of long-time urethral catheter placement. Four cases were urethratresia nf cor-pus penis, 7 cases were anterior urethral obliteration, 7 cases were posterior urethral and anterior ure-thral obliteration. Urethro-perineal fistulas were found in 8 cases, posterior urethrorectal fistulas in 7 cases, false passage formations in 8 cases. The average length of urethratresia was 15.1 cm (range 8. 7 to 23. 0 cm). The urethral scar was rasected, the posterior urethrorectal fistula was repaired, and different kinds of pediculated skin flaps depending on the length of urethratreaia was used. Results All the patients were followed up for 12 to 18 months (mean 14 months). Fifteen patients voided well 3 months postoperatively, none of the urography showed stricture. The mean peak urinary flow rate was 16. 9 ml/s (range from 16. 5 to 21.7 ml/s). Of the other 3 cases, 1 case experienced difficult voi-ding due to the long and circuitous tabularized skin flap but recovered after proper shortening;1 case had restenosis for the infection of anastomosis but voided well after excision and reanastomnsis;1 casehad a urinary fistula resulting from hematoma and infection, but was successfully treated by the neo-plasty of the urinary fistula. The mean peak urinary flow rate was 17.0 ml/s (range 15.0 to 22.0 ml/s) for 17 patients 6 months postoperatively, except for one who experienced genuine urinary incon-tinence. At 9-18 months after operations, the mean peak urinary flow rate was 17.5 ml/s (range 15.8 to 22.5 ml/s) for 17 patients. Conclusion The single-stage urethroplasty based on pediculated skin flaps is a reliable and durable method for complicated long urethratresia.

The efficacy and safety of Lishengsu (a rhG-CSF preparation) were evaluated for treatment of chemotherapy-induced leukopenia. 327 cases of leukopenia with grade I-IV induced by chemotherapy were subcutaneously administered at 2.5 - 5.0 micro g/(kg x d) of Lishengsu, and hemogram and the side effects were observed. The results showed that Lishengsu had satisfactory effect to cure leukopenia after chemtherapy, with an effective rate of 99.4% (325/327), the side effects were quite slight. It is concluded that Lishengsu is efficient and safe for patients with leukopenia, and can be used as an adjuvant drug for treatment of leukopenia after chemotherapy.
Adolescent ; Adult ; Aged ; Drug-Related Side Effects and Adverse Reactions ; Female ; Granulocyte Colony-Stimulating Factor ; therapeutic use ; Hemoglobins ; analysis ; Humans ; Leukocyte Count ; Leukopenia ; blood ; chemically induced ; drug therapy ; Male ; Middle Aged ; Neoplasms ; blood ; drug therapy ; Platelet Count ; Recombinant Proteins ; Treatment Outcome