Partial fibulectomy is widely used in fibula transplantation and the treatment of fibular tumor and injury. After follow-up surveys and biomechanical experiments, many authors believe it is important to pay attention to the postoperative complications in leg，which now still remains in dispute. For the first time finite element analysis is used to find out the mechanical characteristics of crural bone before and after partial fibulectomy. Our results show that resection would alter significantly the stress distribution in tibia, fibula and the medial & lateral parts of talus, so influent the ankle joint stability. Causes of postoperative complications were also discussed.

OBJECTIVE:To prepare the curcumin solid lipid nanoparticles. METHODS:Microemulsion method was adopted to prepare curcumin solid lipid nanoparticles (SLN) and pseudo-ternary phase diagrams was conducted to optimize the preferable three-phase microemulsion factors. The optimal conditions were determined,and then hot microemulsion was dispersed in cold wa-ter to prepare SLN. After the preliminary screening of the factors (emulsifiers,lipid materials,amount of lipids,drug-to-lipid ra-tio,cold water phase temperature and the holding temperature of microemulsion)by single-factor test,with the index of encapsula-tion efficiency,the orthogonal test was conducted to optimize the formulation,followed by the verification test. RESULTS:The best microemulsion was produced at 65 ℃ with three phases consisting of stearic acid(oil phase),polysorbate 80(emulsifier)and ethanol (co-emulsifier) and the Km ratio of 1∶4. The optimal conditions for SLN were as follows as curcumin dosage of 50 mg, stearic acid of 0.5 g,cold water phase temperature of 2 ℃,holding temperature of microemulsion of 65 ℃. The encapsulation effi-ciency was 87.73% for solid lipid nanoparticles prepared,drug-loading rate was 7.72%,particle size was(156.9±2.2)nm,poly-dispersity coefficient was 0.480,average Zeta potential was -24.8 mV(RSD<2%,n=3). CONCLUSIONS:The microemulsion method to prepare SLN is simple and feasible.

BACKGROUND:Knee osteoarthritis can be treated by total knee arthroplasty. To improve therapeutic effect and promote postoperative recovery, we should take effective measures to improve the joint space and postoperative range of motion.
OBJECTIVE:To explore the effectiveness and feasibility of posterior composite release of the knee joint after total knee arthroplasty.
METHODS:118 knee osteoarthritis patients undergoing unilateral total knee arthroplasty in two hospitals from December 2009 to December 2013 were selected, and were randomly divided into control group (59 cases) and observation group (59 cases). After osteotomy during operation, the control group underwent bone removal of conventional condylar hyperplasia. Observation group underwent posterior composite release of the knee joint. Postoperative extension, flexion gap and the time required for postoperative active flexion 90° and 120° were observed in the two groups. Hospital for Special Surgery Knee Score and maximum flexion angle were recorded in 3 months of fol ow up, and compared between the two groups. RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference in flexion gap was found between the two groups (P>0.05). However, significant differences in extension gap, the time for active flexion 90° and 120°and the maximum flexion angle were detectable between the two groups, and above indexes were better in the observation group than in the control group (P<0.05). Hospital for Special Surgery Knee Score of each index and total score were significantly higher in the observation group than in the control group (P<0.05). These results suggest that rear joint composite release after total knee arthroplasty has certain validity and feasibility, can effectively improve knee extensor gap and the postoperative range of motion during replacement, but does not impact flexion gap during replacement.

Objective To study cytogenetic features of multiple myeloma(MM)cells and the relationship between chromosomal karyotypes and subtype,stage,prognostic parameters and treatment of MM.Methods Karyotyping in patients with MM by 24h short-term bone marrow cell culture and G-banding stain were done.Twenty-two patients were treated with conventional chemotherapy(VAD or MP)and 7 patients with Bortezomib(velcade)chemotherapy.Results There was 37.9% of aberrations in patients with multiple myeloma of 29 cases,and the complex and high complex aberrations were 81.8%.Twenty-two patients with VAD or MP chemotherapy;response rate was 81.2% in normal karyotype group;no response was received in the abnormal karyotypes group(P

Objective To explore the indications of physiotherapy and operative treatment for gluteal muscles contracture, and discuss the principles and necessity of classification in order to facilitate clinical management. Methods The standards of classification of gluteal muscles contracture were based on the signs and pathological examination, It consisted of three stages upon our standards. 210 patients could be divided into stage Ⅰof 23 cases, stage Ⅱand Ⅲ of 187 cases. For the patients of stageⅠ, physiotherapy was performed; However, all cases of stageⅡand Ⅲ, operative treatment was adopted by small superomedial incision above the greater trochanter. Furthermore, in the cases of stage Ⅱ, tight fibrotic gluteal muscles and thick contracted fascia lata should be released; For stage Ⅲ lesion, the release should be extended to the capsule of hip, and incision of the posterior capsule was necessary. Results In the group of stageⅠ, The symptoms and signs were relieved by maneuver , the rate of excellent and good results was 39%; while in the group of stageⅡand Ⅲ, it was 97% by operative treatment. Conclusion The staging system of gluteal muscles contracture could demonstrate exactly the severity degree of the disease, and is useful in choosing therapeutic method. Non-operatiive method can obtain satisfactory results in about 1/3 cases of stage Ⅰof gluteal muscles contracture; operative method is indicated for the patients of stage Ⅱand Ⅲ.

Objective To study the mRNA and protein expressions of the neurofilament in the region of acute spinal cord injury (SCI) of rats after olfactory ensheating cells (OECs) transplantation combined with methyprednisolone administration and investigate the molecular mechanisms of OECs transplantation combined with methyprednisolone administration in promoting the recovery of the spinal cord.Methods Acute spinal cord injury was established in SD rats ( T10 ) by using NYU instrument. The rats were randomly divided into control group, SCI group, DF12 group, OECs transplantation group,methyprednisolone administration group and OECs + methyprcdnisolone group. The mRNA and protein expressions of the neurofilament in the SCI regions of rats in different groups at different time points were detected by using immunohistochemistry, RT-PCR and Western blotting. Results A significant increase of mRNA and protein expressions of the neurofilament could be found in the other five groups compared with the control group at days 7, 14 and 28 after SCI. The mRNA and protein expressions of the neurofilament in the injury region of the OECs group, the methyprednisolone group and the OECs + MP group were more significantly increased than that of the SCI group and the DF12 group. The expression of the neurofilament in the injury region of the OECs + MP group was more significantly increased than that of the OECs group and the MP group ( P ＜ 0. 05). Conclusions OECs transplantation or methyprednisolone administration can induce the mRNA and protein expressions of the neurofilament. Meanwhile, OECs transplantation combined with methyprednisolone administration can significantly increase the mRNA and protein expressions of the neurofilament, as may be one of mechanisms promoting spinal cord repair.

Objective To observe the effect of aprotinin preconditioning on nitric oxide (NO), nitric oxide synthase (NOS) and oxyradical during spinal cord ischemia-reperfusion injury in rabbits.Methods 21 rabbits were randomly divided into the aprotinin treatment group (8 rabbits), control group (8 rabbits) and sham operative group (5 rabbits). The infrarenal segment in abdominal aorta was clamped for 60 min to construct the model of lumbosacral spinal cord ischemia in rabbits. Reperfusion was followed and kept on for 24 h until the blood flow regained normal. In the treatment group, aprotinin was given at 3×107 IU/kg as a short time intravenous injection for 10 min before ischemia, and then was drilled with micro pump by 1×107 IU/kg/h. Normal saline was used in the control group, the ischemia-reperfusion duration between aprotinin treatment group and control group remained same. The sham operative group was only exposured abdominal aorta and not clamped. The rabbits were killed before ischemia and 8 h, 24 h after ischemia-reperfusion, lumbar segment was harvested to detect content of NO, malondialdehyde (MDA), induced nitric oxide synthase (iNOS) and superoxide dismutase (SOD) of spinal cord.Results 8 h after spinal cord ischemia-reperfusion, compared with the control group, the content of NO, MDA and the activity of iNOS were less, and the activity of SOD was more in the aprotinin treatment group ( P<0.05).Conclusion Aprotinin pretreatment can reduce the content of NO, MDA and descend the activity of NOS. Moreover aprotinin pretreatment can ascend the activity of SOD and improve apoptosis of nerve cell.

Objective: To investigate the experience of patients in the implementation of enhanced recovery after surgery (ERAS) strategy after radical gastrectomy and the factors affecting the treatment experience. Methods: A prospective cohort study was carried out. Patients who were diagnosed with gastric cancer by pathology and underwent radical gastrectomy at the Xijing Digestive Disease Hospital from December 2019 to December 2020 were consecutively enrolled. Those who received emergency surgery, residual gastric cancer surgery, preoperative neoadjuvant chemotherapy, non-curative tumor resection, intraperitoneal metastasis, or other malignant tumors were excluded. Patients' expectation and experience during implementation were investigated by questionnaires. The questionnaire included three main parts: patients' expectation for ERAS, patients' experience during the ERAS implementation, and patients' outcomes within 30 days after discharge. The items on the expectation and experience were ranked from 0 to 10 by patients, which indicated to be unsatisfied/unimportant and satisfied/important respectively. According to their attitudes towards the ERAS strategy, patients were divided into the support group and the reject group. Patients' expectation and experience of hospital stay, and the clinical outcomes within 30 days after discharge were compared between the two groups. Categorical data were reported as number with percentage and the quantitative data were reported as mean with standard deviation, or where appropriate, as the median with interquartile range (Q₁, Q₃). Categorical data were compared using the Chi-squared test or Fisher's exact test, where appropriate. For continuous data, Student's t test or Mann-Whitney U test were used. Complication was classified according to Clavien-Dindo classification. Results: Of the included 112 patients (88 males and 24 females), aged (57.8±10.0) years, 35 patients (31.3%) were in the support group and 77 (68.7%) in the reject group. Anxiety was detected in 56.2% (63/112) of the patients with score >8. The admission education during the ERAS implementation improved the patients' cognitions of the ERAS strategy [M(Q₁, Q₃) score: 8 (4, 10) vs. 2 (0, 5), Z=-7.130, P<0.001]. The expected hospital stay of patients was longer than the actual stay [7 (7, 10) days vs. 6 (6, 7) days, Z=-4.800, P<0.001]. During the ERAS implementation, patients had low score in early mobilization [3 (1, 6)] and early oral intake [5 (2.25, 8)]. Fifty-eight (51.8%) patients planned the ERAS implementation at home after discharge, while 32.1% (36/112) preferred to stay in hospital until they felt totally recovered. Compared with the reject group, the support group had shorter expected hospital stay [7 (6, 10) days vs. 10 (7, 15) days, Z=-2.607, P=0.009], and higher expected recovery-efficiency score [9 (8, 10) vs. 7(5, 9), Z=-3.078, P=0.002], lower expected less-pain score [8 (6, 10) vs. 6 (5, 9) days, Z=-1.996, P=0.046], expected faster recovery of physical strength score [8 (6, 10) vs. 6 (4, 9), Z=-2.200, P=0.028] and expected less drainage tube score [8 (8, 10) vs. 8 (5, 10), Z=-2.075, P=0.038]. Worrying about complications (49.1%) and self-recognition of not recovery (46.4%) were the major concerns when assessing the experience toward ERAS. During the follow-up, 105 patients received follow-up calls. There were 57.1% (60/105) of patients who experienced a variety of discomforts after discharge, including pain (28.6%), bloating (20.0%), nausea (12.4%), fatigue (7.6%), and fever (2.9%). Within 30 days after discharge, 6.7% (7/105) of patients developed Clavien-Dindo level I and II operation-associated complications, including poor wound healing, intestinal obstruction, intraperitoneal bleeding, and wound infection, all of which were cured by conservative treatment. There were no complications of level III or above in the whole group after surgery. Compared with the support group, more patients in the reject group reported that they had not yet achieved self-expected recovery when discharged [57.1% (44/77) vs. 22.9% (8/35), χ²=11.372, P<0.001], and expected to return to their daily lives [39.0% (30/77) vs. 8.6% (3/35), χ²=10.693, P<0.001], with statistically significant differences (all P<0.05). Only 52.4% (55/105) of patients returned home to continue rehabilitation, and the remaining patients chose to go to other hospitals to continue their hospitalization after discharge, with a median length of stay of 7 (7, 9) days. Compared with the reject group, the support group had a higher proportion of home rehabilitation [59.7% (12/33) vs. 36.4% (43/72), χ²=4.950, P=0.026], and shorter time of self-perceived postoperative full recovery [14 (10, 20) days vs. 15 (14, 20) days, Z=2.100, P=0.036], with statistically significant differences (all P<0.05). Conclusions: Although ERAS has promoted postoperative rehabilitation while ensuring surgical safety, it has not been unanimously recognized by patients. Adequate rehabilitation education, good analgesia, good physical recovery, and early removal of drainage tubes may improve the patient's experience of ERAS.
Enhanced Recovery After Surgery ; Female ; Gastrectomy ; Humans ; Length of Stay ; Male ; Pain ; Patient Outcome Assessment ; Postoperative Complications/surgery* ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms/surgery* ; Treatment Outcome

Objective To explore the expression and effect of transforming growth factors-β1 (TGF-β1) and heat shock protein (HSP47) on gluteal muscle contracture (GMC). Methods We collected contraction band and adjacent muscle from GMC patients and explored the expression of TGF-β1 and HSP47 using immunohistohemistry, reverse transcription and polymerase chain reaction (RT-PCR), and Western blot analysis. Results TGF-β1 and HSP47 were intensely expressed in fibroblast cells and vascular endothelial cells. The expression of them increased 8.1-fold and 3.6-fold at the mRNA level, respectively (P<0.05). The same changes were found at the protein level, which increased 11.2-fold and 7.6-fold, respectively (P<0.05). Conclusion Up-regulation of TGF-β1 and HSP47 may initiate fibrotic cascade in the gluteal muscles of GMC patients.

Objective To observe the differential gene expression in human nasopharyngeal carcinoma (NPC) cell line with different radiosensitivity by cDNA microarray analysis. Methods A radioresistant cell line, CNE-2R, was established from a human nasopharyngeal carcinoma cells line CNE-2 by repeated X-ray irradiation. The differential gene expression of CNE-2 and CNE-2R was screened with cDNA microarray by BioStarH-141s profile gene chip. Results There were expressed 308 genes to be screened out between CNE-2R cell line with different radiosensitivity and its parental CNE-2 cell line, while 176 up-regulated genes in CNE-2R cells and 132 down-regulated genes were found. In them, there were 40 up-regulated ones and 36 down-regulated ones whose ratios were higher than 6.0 or lower than 0.1. The different genes included DNA damage- and repair-related genes; cell cycle-related and cytoskeleton-related proteins; and apoptosis-related genes. Conclusion The radioresistant CNE-2R cells were isolated from the CNE-2 cell line by repeated X-ray irradiation. The stable radioresistance is the result of co-effect by polygene and multiple factors, which provide several gene targets to sensitize the radioresistant cells for improving the radiocurability of NPC.