OBJECTIVETo study the effectiveness of pie-crusting technique in improving the stiff knee.

METHODSFrom February 2012 to December 2013, 13 patients with stiff knee were reviewed retrospectively. There were 6 males and 7 females, ranging in age from 39 to 70 years old (averaged, 55.6 years old). Of the 13 cases, 8 patients had stiffness following fracture (comminuted tibial plateau fracture in 4, femoral supracondylar fracture in 3 and patellar fracture in 1), 5 patients had TKA-related stiffness.

RESULTSA follow-up lasted 8 to 12 months (mean 10 months)in 13 cases. The mean maximum flexion increased from (37 ± 6)° preoperatively to (52 ± 7)° after arthrolysis, and (108 ± 7)° after pie-crusting. At the final follow-up, mean maximum flexion was (105 ± 6)°. According to Judet evaluation system, 10 patients got an excellent result and 3 good. No major complications, such as extensor lag, skin necrosis, deep infection, dislocation of the patella or recurrent stiffness were found.

CONCLUSIONThe percutaneous technique of pie-crusting is a simple, minimally invasive and effective treatment for knee stiffness.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Range of Motion, Articular ; Treatment Outcome

ObjectiveTo explore the effect of different methods of drainage tube and catheter drainage in the treatment of intraventricular hematoma.MethodsThe analysis was conducted in 83 cases,who were randomly divided into two groups,the treatment group with 48 cases adopting lateral venticle catheterization combined with bulletshaped tube,and the control group with 35 cases adopting conventional catheterization.The contrasted study was conducted on the clearance rate of cerebroventricular hematoma and the effect of the different drainages.ResultsThe clearance rate in treatment group was 27.1％ ( 13/48 ),50.0％ (24/48),14.6％ (7/48),at the time of ＜ 24h,24 ～72h,＞ 72h after the operation,and 5.7 ％ ( 2/35 ),17.1％ ( 6/35 ),48.6％ ( 17/35 ) in the control group.It showed statistical significance(x2 =6.2425,9.4678,11.3757,all P ＜0.01 ).The cases with type Ⅰ of ADL stage in treatment group (47.9％)were more than control group( x2 =6.8347,P ＜0.01 ).The morbidity in treatment group was 12.5％,which was lower than control group( x2 =6.9636,P ＜0.01 ).ConclusionThe lateral venticle catheterization drainage combined with bullet-shaped tube could avoid the obstruction,reduce the morbidity,and improve the therapeutic effect.

OBJECTIVETo evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome (SAIS).

METHODSA prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome, Hawkins-Kennedy syndrome, painful arc empty can test and external rotation resistance test, also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement.

RESULTSThe ROC analysis indicated a significant area under the curve (AUC) (AUC=0.62 to 0.73, P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance, Tests with a-LR less than 0.5 were Neer,painful are ,external rotation resistance. The regression analysis found the painful arc, empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful are and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71).

CONCLUSIONThe single test of painful arc, empty can and external rotation resistance, as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS, while the single test of Neer, painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc, empty can and ex ternal rotation resistance are the best combination for the diagnosis of SAIS (when 2 or more are positive), while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative)

Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Physical Examination ; methods ; Prospective Studies ; Reproducibility of Results ; Shoulder Impingement Syndrome ; diagnosis

Objective To investigate the treatment effection of cranial decompression under temporal muscle in very-low position with large bone flap for severe cranial trauma.Methods 53 cases of severs cranial traumatic brain herniation were derided into two groups.22 cases with unilateral dilated pupil,and 31 cases of bilateral dilated pupil,all the patients were treated with cranial decompression under temporal muscle in very low position with large bone-flap.The ICP,appearance rate of cisternal,pupil contraction rate and GCS evaluation were observed,recorded and statistiely analysised.Results According to the intraeranial pressure monitoring,the rate of 24h ICP＜20mmHg was increased significantly,and the rate of 72h ICP＞40mmHg was decreased in both groups.The occurance rate of cisternal:81.82% in unilateral dilated pupil group,and 51.61% in bilateral dilated pupil group.The recoverance rate of pupil in 24h:77.2% in unilateral dilated pupil group,and 32.26% in bilateral dilated pupil group.GCS evaluation:All of the patient's average mark of GCS after operation wag(8.02±3.03)which increased(3.92±2.21)compared with the mark of GCS before operation,which was(4.10±0.82),with a significant difference(P＜0.01).Treat outcome:well/moderate disability:64.15%,severe/long-term coma:7.55%,and death:28.30%.Conclusion Cranial decompression under temporal muscle in very-low position with large bone-flap for severe cranial trauma can enlarge the cranial capacity effectively,increase the decompression space in dorsolateral cranium,which can alleviate the intracranial pressure in axial centre of brain truak,promote the effeetion of the brain herniation restore and the recover of the brain trauma.

Objective To study the surgical techniques of the extended subfrontal epidual approach to resect chordoma in skull base.Methods 18 cases of chordoma in skull base treated mierosurgically were analyzed retrospectively.Results Total resection were achieved in 15 patients(83%),gross resection in 3 patients(17%).There was no complication in all cases.Conclusion The microsurgery for chordoma in skull base via the extended subfrontal epidual approach is of the benefits such as clear and wide fields of vision,and minimize brain trauma.Lumber drain placement and the skull base reconstruction could improve the rate of total tumor removal and reduce complications.

Objective To investigate the effect of Valsartan on Disintegrin metalloproteinases (ADAMs10,17) expressions in the process of heart failure (HF) after myocardial infarction (MI).MethodsAdult male Wistar rats weighing (200 ± 30) g were given humane care in compliance with the rules of the Animal Experimentation Committee of the first hospital of Harbin Medical University.And then the left anterior descending coronary artery was ligated.Based on UCG (LVEF ＜ 45％) Results The successfully MI-operated Wistar rats were divided randomly (random number) into three groups:HF group (HF group),placebo group (Pla group) and valsartan group (Val group).The rats in the Pla group and Val group were given the same volume of normal saline and valsartan 50 mg/ (kg · d),provided by Novartis company) by gavage.After 16 weeks,heart function was assessed by hemodynamic evaluation and serum TNF-α from LV cavity was measured by ELISA (R&D,USA).Muscle samples were extracted from the ischemic zone,and then the ADAMs 10,17 expressions were measured by immunoblotting.All the data were expressed by mean ± standard and evaluated by Student' s t test.Results After 16 weeks,the data of LV function including LVdp/dt LVdp/dtmin and LVSP were significantly improved in Val group than the others (P =0.006,P =0.015,P =0.003),and the LVEDP level was decreased (P =0.002).At the same time,the TNF-o level in the Val group was lower than that in the HF group (P =0.023).The ADAM17 and TNF-R1 expressions in the Val group was reduced compared with those in the HF group (P =0.01 1,P =0.022).However,ADAM10 expression is unchangeable in the four groups.Conclusions Valsartan may reduce the ADAM17 and TNF-R1 expressions in the ischemic zone,decrease the TNF-αconcentration and function in LV cavity so as to inhibit cardiac remodeling and improve heart function after MI.

Objective To explore the causes of per-hospitalization high inpatient expenditure of a tertiary hospital in 2015,by analyzing the influencing factors.Methods We retrospectively studied 1 282 inpatient cases who cost more than 100 000 yuan per case at a tertiary hospital in 2015,analyzing statistically major influencing factors of such expenditure in variance analysis and multiple stepwise regression analysis.Results The average days of stay of these cases were 27.6 days,and the average medical cost of those cases was 149 153 yuan per person.Costs for medicines and material made up a large proportion of medical costs,respectively accounting for 33.38% and 31.98% of the total.The days of stay,prognosis of the patient,complications as well as hospital infection,surgeries,gender of the patients constituted major factors on inpatient medical expenditure.Conclusions Reducing the average days of stay,guiding reasonable applications of drugs and medical materials,strengthening management on operations and controlling excessive medical services are effective approaches to reducing excessive growth of medical costs.

Objective To explore the relationship between alcohol drinking and fatty liver disease and its influencing factors.Methods From October to December,2013,a total of 394 people who underwent a physical examination in the medical examination center of Wenzhou central hospital were selected for this study.Anthroposomatology measurement and biochemical tests were conducted.Results There were significantly statistical differences of triglyceride,uric acid and cholesterol in different drinking groups (P <0.05).The prevalence of high triglyceride and uric acid were increased with alcohol consumption (P <0.05).There was no significant difference of alcohol consumption between fatty liver and non -fatty liver group (P =0.42).Logistic regression showed that waist -hip ratio,hypertension,overweight,obesity and hypertriglyceridemia were risk factors of fatty liver,while daily alcohol consumption cannot be thought as risk factor yet. Conclusion Waist -hip ratio,hypertension,overweight -obesity and hypertriglyceridemia were the risk factors of fatty liver.Alcohol consumption could contribute to the prevalence of triglyceride and uric acid.

Objective To examine the effect of eating behavior and dietary intake on the sleep quality of college students,and to provide basis for improving students' sleep quality.Methods College students from Hangzhou Normal University were randomly selected and they were investigated from October to November,2014.Pittsburgh Sleep Quality Index (PSQI) was used to measure the quality of sleep,and a self-designed questionnaire was used to measure eating behavior and dietary intake.Results A total of 588 college students were investigated.The average score of PSQI was 4.72 ±2.52,and 76 (12.9％) of the respondents have poor sleep quality.Single-factor analyses showed that sleep quality was not associated with gender,BMI,cigarette smoking and academic pressure,but was associated with peer effect,meal regularity,and frequency of fish and poultry intake (P ＜ 0.05).Multi-factor logistic regression showed that frequency of eating-out (OR =3.04,95％ CI:1.58-5.84;P =0.001,4 or more than 4 times vs.less than once per week) irregular dinner (OR =1.96,95％ CI:1.23-3.40;P =0.017,irregular vs.regular) and less fish intake (OR =2.48,95％ CI:1.27-4.85;P =0.01,less than once vs.2-3 times per week) increased the risk of poor sleep quality.Conclusion Eating behavior and dietary intake are closely related to sleep quality of college students and they should concern about meal regularity and nutrition balance.

Disease Management ; Hospitals ; standards ; Humans