BACKGROUND:The tourniquet is usualy fuly used or bilateraly used in partial time during bilateral total knee arthroplasty. However, very few people try to use it on one side and on the other side in partial time.
OBJECTIVE:To investigate the effective strategy of using a tourniquet in simultaneous bilateral total knee arthroplasty.
METHODS:80 patients (160 knees) with severe osteoarthritis who underwent simultaneous bilateral total knee arthroplasty in the Department of Orthopedics, Chinese PLA Medical School from January to December 2013 were divided into two groups according to the different tourniquet strategies. In test group (n=40), left knees did not receive tourniquet, and right knees received tourniquet in partial time. In control group (n=40), al knees received tourniquet in the whole time. The perioperative and postoperative blood loss, 3-day postoperative thigh sweling rate and pain visual analog scale, 3-week and 1-year postoperative Knee Society Score were recorded in both groups.
RESULTS AND CONCLUSION:There were no statisticaly significant differences between two groups in perioperative total blood loss (P > 0.05). However, postoperative blood loss in test group was less than that in control group (P < 0.05). The visual analog scale scores were significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). Visual analog scale scores on the left side were lower than on the right side in the test group at 3 days post surgery (P < 0.05). Bilateral thigh sweling rate was significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). The thigh sweling rate was lower on the left side than on the right side in the test group at 3 days after surgery (P < 0.05). Knee Society Score was higher in the test group than in the control group in the early stage, and no significant difference in long-term Knee Society Score was detected (P > 0.05). These findings verify that taking the strategy that the first knee without tourniquet and the second knee with part time tourniquet technique in simultaneous bilateral total knee arthroplasty wil aleviate pain and sweling after operation and promote early functional rehabilitation without increasing the perioperative total blood loss.

Autoimmune Diseases ; diagnosis ; immunology ; pathology ; surgery ; Humans ; Immunoglobulin G ; blood ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatectomy ; Pancreatitis ; diagnosis ; immunology ; pathology ; surgery

Objective To investigate the effect of PBL combined with EBM applied in the teaching of fever of unknown origin. Methods PBL combined with EBM teaching was applied in fever of unknown origin course for 30 clinical medicine specialty(eight years) students of Tongji class of grade 2009(experiment group), while PBL teaching was applied in fever of unknown origin course for 30 clinical medicine specialty (eight years) students of Tongji class of grade 2008 (control group). After teaching, the theory examination for both basic knowledge and case analysis was organized for all students of both groups. At the same time the questionnaire survey was conducted to 30 students of grade 2009 to evaluate the teaching effect. The results were assessed by using SPSS 18.0 statistical software for the T-test of the experimental group and the control group.Inspection level was α=0.05. Results The theory test score of students in the experimental group was (93.5±3.2) point, signifi-cantly higher than that of the students in the control group(84.7±2.8). There was statistically signifi-cant difference between the scores of the two groups of students (P=0.00). Survey results showed 19 students ( 63 . 33%) thought that the development of PBL teaching combined with evidence-based medicine teaching had its necessity, and 16 students(53.33%) thought that the teaching method im-proved their clinical thinking ability of logical reasoning. Conclusion The concept of PBL combined with EBM has achieved significant resultsinthe teaching offever of unknown origin, and it is necessary to carry out this teaching mode in medical colleges with certain teaching strength.

Adenocarcinoma, Follicular ; metabolism ; pathology ; Adenoma, Chromophobe ; metabolism ; pathology ; Adenoma, Oxyphilic ; metabolism ; pathology ; Angiomyoma ; metabolism ; pathology ; Biomarkers, Tumor ; metabolism ; Carcinoma, Papillary ; metabolism ; pathology ; Carcinoma, Renal Cell ; classification ; metabolism ; pathology ; ultrastructure ; Diagnosis, Differential ; Humans ; Kidney Neoplasms ; classification ; metabolism ; pathology ; ultrastructure ; Thyroid Neoplasms ; metabolism ; pathology

AIM: To observe effect of the iris location to femtosecond - combined wavefront guided LASIK for myopia and astigmatism.?METHODS:The patients with astigmatism >1. 0D during the same time and followed up for 1a were selected. A total of 129 eyes in 67 patients were treated under iris location with femtosecond-combined wavefront guided LASIK ( experimental group) and 161 eyes in 82 cases with femtosecond-combined wavefront guided LASIK ( control group) . Laser cutting went with the same laser machine. The uncorrected visual acuity ( UCVA ) , best corrected visual acuity ( BCVA) , and wavefront aberration between the two groups were compared at 1, 3, 6mo and 1a after surgery.?RESULTS:At 1 and 3mo after surgery, the number of patients with better postoperative UCVA than preoperative BCVA between the two group showed a statistically significant difference (χ2=6. 423, P=0. 011,χ2=14. 431, P=0. 01 ); at 1d and 1mo after surgery, the residual astigmatism showed a statistically significant difference between two groups (t=1. 98, P<0. 05; t=2. 23, P<0. 05). At 3, 6mo and 1a after surgery, the differences on the change of residual astigmatism between the two groups weren’t significant ( P > 0. 05 ). At 6mo and 1a after surgery, the differences on UCVA between the two groups weren’t significant ( P > 0. 05 ). Until 1a after surgery, the root mean square ( RMS ) of high order wavefront aberration of the two groups, spherical aberration and coma aberration ( COMA ) were all enhanced compared to before surgery(P<0. 05). At 1, 3mo after surgery, the RMS showed a statistically significant difference between two groups (P<0. 05). At 1, 3, 6mo, 1a after surgery, the increase of COMA in experimental group was significantly lower than that in control group (P<0. 05).? CONCLUSION: Iris location technology applied in femtosecond - combined wavefront guided LASIK for myopia and astigmatism, can make the vision recovery faster, the RMS of high order and COMA increase less, the residual astigmatism less, show better and more stable treatment effect.

AIM:To contrast analysis of postoperative variation of corneal posterior surface heights after Femtosecond LASlK ( FS - LASlK ) and small incision lenticule extraction ( SMlLE) for high myopia.
●METHODS: Sixty-seven cases of high myopic patients (132 eyes) operated with laser corneal refractive in our hospital from May to Dec. in 2015 (-6. 00D≤spherical equivalent degree≤-10. 00D) were selected and divided into FS-LASlK group and SMlLE group. The thickness of corneal flaps at FS-LASlK and the thickness of map at SMlLE were designed to be 110μm. Corneal posterior surface heights were examined by Pentacam at preoperation, postoperative 3 and 6mo after FS-LASlK and SMlLE operation. Surface height changes after preoperative, postoperative 3 and 6mo were compared by measuring Pentacam corneal analysis system.
●RESULTS: Six months after operation, the FS-LASlK posterior corneal surface height was 6. 47 ± 1. 65mm, significantly higher than 5. 20 ± 1. 32mm before operation. SMlLE posterior corneal surface height was 6. 40 ± 1. 33mm, significantly higher than 5. 18 ± 1. 25mm before operation, the differences were statistically significant( P<0. 05). Six month after surgery, two methods of corneal surface height variation obtained was 1. 29 ± 1. 28mm and 1. 22 ± 0. 89mm, there was no significant difference ( P>0. 05).
●CONCLUSION:After FS-LASlK and SMlLE, the corneal posterior surface is protrusive. FS - LASlK is slightly obvious than SMlLE in early period. The stability of the posterior surface is better after SMlLE.

Objective To study the clinical features,diagnosis and treatment of eosinophilic granuloma of bone(EGB).Methods Twelve cases(8 male and 4 female)of EGB and their medical record,imaging examinations,follow-up data were reviewed,and the lesion sites,symptom and clinical features were analyzed with reference to relative literature.Results Nine unifocal cases were found in the cervical spine(3 cases),the thoracic spine(1 case),the lumber spine(1 case),the femur(1 case),the metacarpal bones(1 case),and the ilium(2 cases).Three multifocal cases were found in the thoracic and lumber spine(1 case),in the femur,the multiple ribs,the skull,the scapula(1 case)and in the skull,the femur,the ilium(1 case).The most common presenting symptom was pain at the lesion site and restricted motion was obviously in the cervical lesion.The case of the thoracic lesions was found neurologic deficit.Osteolytic destruction was found in the radiologic examination in EGB and the periosteal reaction was found in the long bone lesions,and vertebra plana was considered as typical cha-racteristics in the spine lesion.The lesions not in the spine were diagnosed by biopsy,exclusive methods and close following-up were performed in the spine lesions.Two unifocal were healed spontaneously and three were performed with curettage with one bone grafting.Multifocal and the lesions in the spine underwent chemotherapy.All cases were followed up and no recurrence was found.Conclusions EGB is commonly solitary and not seldom in the spine.Topical pain may be chief complaint.Osteolytic image was found in the radiologic examination.Biopsy and exclusive methods combining closely follow-up were used for diagnosis.EGB is self-limited observation,so curettage or chemotherapy can be used in treatment,and prognosis is good.

OBJECTIVETo observe the clinical effect of low-dose once-daily tadalafil combined with Shuganyiyang Capsules in the treatment of mild-to-moderate erectile dysfunction (ED).

METHODSNinety patients with mild-to-moderate ED were equally randomized to groups A, B and C to receive Shuganyiyang Capsules, tadalafil, and tadalafil + Shuganyiyang Capsules, respectively. The scores of the patients on IIEF-5 and SF-PAIRS (15-Item Short Form of Psychological Interpersonal Relationship Scales) were recorded before and at 1 and 3 months after treatment.

RESULTSThe IIEF-5 scores of groups A, B and C were 10.13 +/- 1.55, 11.00 + 1.60 and 10.73 +/- 1.91 before treatment, and 13.77 +/- 2.11, 17.77 +/- 2.13 and 17.17 +/- 3.84 at 1 month after treatment, significantly higher in B and C than in A (P <0. 001) , but with no remarkable difference between B and C (P =0. 411). At 3 months after treatment, the IIEF-5 scores were 15.77 +/- 2.05, 18.07 +/- 2.24 and 19.37 +/- 3.76 in the three groups, dramatically higher in B and C than in A (P <0.001) as well as in C than in B (P<0.05). The scores on sexual self-confidence, sexual spontaneity and time concerns in SF-PAIRS were 3.90 +/-0.80, 8.67 +/- 1.94 and 14.43 +/- 1.92 before medication, 5.83 +/- 1.02, 9.90 +/- 1.75 and 11.17 +/- 1.68 at 1 month and 6.73 +/- 0.98, 11.07 +/- 2.08 and 10.67 +/-1.60 at 3 months after medication in group A; 4.17 +/- 0.87, 9.37 +/-1.43 and 14.47 +/-1.57 before medication, 6.47 +/-0.78, 10.83 +/- 2.18 and 10.20 +/-1.56 at 1 month and 6.83 +/-0.91, 11.30 +/- 1.88 and 9.47 +/- 1.57 at 3 months in group B; and 4.23 +/-0. 94, 9.50 +/- 1.89 and 14.67 +/- 2.91 before medication, 8.03 +/- 1.67, 13.43 +/-1.10 and 9.70 +/-1.21 at 1 month and 8.93 +/- 1.78, 14.70 +/- 1.26 and 8. 87 +/- 0. 97 at 3 months in group C. Compared with the baseline, the SF-PAIRS scores of the three groups were all significantly improved after treatment (P <0. 05) , and markedly higher in C than in the other two groups (P <0.05).

CONCLUSIONLow-dose once-daily tadalafil combined with Shuganyiyang Capsules is obviously effective in the treatment of mild-to-moderate ED, which not only improves the patients'erectile function, sexual self-confidence and sexual spontaneity, but also reduces their time concerns.

Adult ; Carbolines ; administration & dosage ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Tadalafil ; Treatment Outcome

BACKGROUND:Insufficient oral soft tissues in the implant zone may have a negative effect on the wound healing and the aesthetic restoration in the late stage. Platelet-rich fibrin can promote the wound healing of soft tissue defects. But there is stil a lack of in-depth studies on the promotion of oral soft tissue defects in animal experiments.
OBJECTIVE: To compare the repairing effects of platelet-rich fibrin and colagen membrane on soft tissue defects of the hard palate in New Zealand rabbits.
METHODS:Fifty-four New Zealand rabbits were randomly divided into three groups (n=14 per group): platelet-rich fibrin group, colagen membrane group and blank control group. A 5 mm-diameter circular ful-thickness soft tissue defect was made in the front of the hard palate, 2 mm distant to the rear maxilary incisors and mucosal edge of the bilateral hard palates. Autologous platelet-rich fibrin membrane or colagen membrane were implanted into the defect in the platelet-rich fibrin group and colagen membrane group, respectively. No treatment was given in the blank control group. General observation of the wound and wound healing analysis were performed at days 3, 7, 14, 21, 28, 56 post operation. Hematoxylin-eosin staining, CD31 immunohistochemical staining and Masson staining were used to observe inflammatory reaction, angiogenesis and colagen formation in the surgical site.
RESULTS AND CONCLUSION:The wound healing rate was fastest in the platelet-rich fibrin group, and no obvious scar formed. At 3 days post operation, there was no difference in the wound healing rates among the three groups; at 7 days, the wound healing rate in the platelet-rich fibrin group was significantly higher than that in the colagen membrane group and blank control group (P < 0.05). At 3 and 7 days after operation, the inflammatory reaction in the platelet-rich fibrin group was less than that in the colagen membrane and blank control groups (P < 0.05); at 14, 21, 28 and 56 days, there was no significant difference between the three groups. At 7, 14, 21 days after operation, the average absorbance value of CD31 in the platelet-rich fibrin group was significantly higher than that in the colagen membrane and blank control groups (P < 0.05). The average absorbance value of colagen formation in the platelet-rich fibrin group was significantly higher than that in the colagen membrane and blank control groups at 7 days after operation (P < 0.05), significantly higher than that in the blank control group at 14 days (P < 0.05), but lower than that in the colagen membrane and blank control groups at 21, 28 and 56 days after operation (P < 0.05). These findings show that platelet-rich fibrin can reduce inflammatory reactions in the process of wound healing, accelerate the angiogenesis, regulate the metabolism of colagen, reduce the formation of scar and improve the quality of wound healing, thereby promoting the repair of oral soft tissue defects.

Objective To explore application of the bolus-triggered technique and optimal match between collimation and pitch of MSCTA in intracranial and cervical arteries.Methods(1)The small-dose tests were performed in 19 healthy volunteers and the theoretical threshold was obtained by the time-density curve.(2)forty healthy volunteers were divided randomly into two groups and the scanning parameters were as follows.Group A:collimation 1.0 mm,pitch 1.750. Group B:collimation 2.5 mm,pitch 0.625. Statistical significance was determined with the X~2 test and t test(?=0.05).Results(1)In 19 volunteers,CT value 4 seconds before the peak was 75 HU,the CT value at the beginning segment of the carotid artery and the C_1 segment of internal carotid artery was in accordance with the standard.(2)Image quality ofⅠ,Ⅱgrades artery structures of group B was superior to that of group A.Image quality ofⅢ,Ⅴ grades artery structures of group A was superior to that of group B.Conclusions(1)MSCTA in intracranial and cervical arteries can display systematically the cerebral and carotid arteries.(2)The bolus-triggered technique can improve the image quality of the target vessels.The image quality of the MSCTA of intracranial and cervical arteries is better with the threshold of 75 HU on the basis of 3.5 ml/s injection rate.(3)On the basis of the same other parameters,the optimal scanning parameters are a collimation of 1.0 mm with a pitch of 1.750.