Objective To evaluate the outcome of unconstrained shoulder arthroplasty for severe injury of proximal part of the humerus.Methods Twelve eases were all treated with unconstrained shoul- der arthroplasty.Six patients with complex fractures of proximal humerus and four with bone tumor in the proximal part of the humerus used hemiarthroplasty and two patients with osteoarthritis were managed with total shoulder arthroplasty.Cemented prostheses were used in all the cases.Results The average age was 65 years and the follow-up was 2.3 years.Two cases of complex fractures had light pain with limited external rotation of the shoulder.No pain or prosthetic stems loosening were found,and the range of motion and the function of the shoulder were satisfactory in other cases.Conclusion Unconstrained shoulder arthroplasty is a satisfactory and safe technique for severe injury of proximal humerus.

Objective To compare the efficacies of the treatment of sternal fracture with wire fixation and the titanium sternal fixation system. Methods Thirty patients with sternal fracture from May 2003 to July 2009 were followed up. Among them,there were 20 patients with wire fixation (wire fixation group), 10 patients with the titanium sternal fixation system (titanium sternal fixation system group). The conditions before, during and after operation,complications and effects were compared to evaluate the effieaeies of titanium sternal fixation system. Results The operative time of titanium sternal fixation system group and wire fixation group were (67.0 ± 7.9) min and (90.0 ± 8.6) min, the blood loss were (11.0 ± 5.4) ml and (48.0 ± 8.4)ml,the duration of drainage were (0.5 ± 0.4) days and (1.9 ± 0.7) days,the amount of drainage were (1.9 ± 1.3) ml and (19.0 ± 4.6) ml, the average hospitalized days were (2.3 ± 0.5) days and (6.9 ± 0.9) days, the duration of pain were (1.5 ± 0.5) days and (3.8 ± 1.1) days, there were all significant difference between two groups (P < 0.05). The rates of wound infection, delayed union or nonunion, re-fracture,plate fracture or plate shift of wire fixation group were 5% (1/20) ,5% (1/20) ,5% (1/20), 10% (2/20). But the rates of titanium sternal fixation system group were 0, there were all significant difference between two groups (P < 0.05). Conclusion The treatment of sternal fracture with titanium sternal fixation system is a simple and stable fixation,high bone union rate and few complications,especially for the sternal fracture.

Objective To investigate the clinical value of different double-J tube indwelling time in the treatment of ureteral stone-street complications after flexible ureteroscope lithotripsy. Methods Clinical data of 64 kidney calculi patients with ureteral stone-street complications after flexible ureteroscope holmium laser lithotripsy were retrospectively analyzed. The patients were divided into observation group (extubating the double-J tube 2 weeks after the surgery) and control group (retaining the double-J tube) with 32 cases in each group. The calculi clearance results and complication were compared between 2 groups. Results The success rate of stone removal in observation group was significantly higher than that in control group: 100.0% (32/32) vs. 65.6%(21/32), the calculi elimination time was significantly shorter than that in control group:(26.4 ± 6.6) d vs. (45.3 ± 10.9) d, the treatment cost was significantly lower than that in control group:(768.4 ± 152.6) yuan vs. (1 262.3 ± 156.8) yuan, the incidences of irritation symptoms of bladder and macroscopic hematuria were significantly lower than those in control group: 15.6% (5/32) vs. 90.6%(29/32) and 15.6% (5/32) vs. 100.0% (32/32), and there were statistical differences (P<0.05). There was no statistical difference in incidence of renal colic between 2 groups (P>0.05). Conclusions Removing the double-J tube 2 weeks after flexible ureteroscope lithotripsy results in higher stone clearance rate and less complications compared with retaining the double-J tube. It can reduce the occurrence of irritation symptoms of bladder, macroscopic hematuria and treatment cost.

Objective To investigate the proportion, risk factors and tendency of the change of stones composition in recurrent urolithiasis. Methods One hundred and fifty-six recurrent urolithiasis patients from January 2011 to January 2016 were enrolled. Compositions of initial and recurrent stones were measured by infrared spectrophotometry. Stones types, recurrence interval and recurrence frequency were studied as potential risk factors for composition change. Chi square test and Logistic regression analysis was employed in the statistical analysis. Results Stones composition changed during recurrence in 48 patients (30.8%). 22.8%(18/79) of calcium oxalate stones change to infection stones, and 25.8%(8/31) of infection stones changed to calcium oxalate. Univariate analysis showed the risk ratio of composition change in the patients with recurrence interval of 1- 5 years was 0.529(P = 0.039) , compared with those of less than 1 year or more than 5 years. Logistic regression analysis showed the odds ratio of recurrence interval of 1- 5 years was 0.242 (95%CI: 0.086- 0.718, P = 0.012). Conclusions Stones composition changes in about 30.8% of recurrent urolithiasis. The mutual conversion between calcium oxalate and infection stones is the most common. Recurrence interval is an independent risk factor to predict composition change.

Objective To study the effects of nitric oxide synthase(NOS) and nitric oxide(NO) in post-asphyxial renal injury in neonatal rats.Methods Forty-eight Wistar neonatal rats were randomly divided into 4 groups:controls,2 h,24 h and 48 h post-asphyxia groups (12 in each group).The rats were decapitated in different times(2 h,24 h and 48 h) after asphyxia for 30 minutes.The renals were dissected to determined the concentrations of NO and NOS.And the scores of renal tubules were measured under light microscope.Results Compared with control group,the levels of NO and NOS significantly increased at 2 h and 24 h after asphyxia.The scores of renal tubules were significant difference at 24 h and 48 h after asphyxia compared to controls.Conclusion These findings suggest NOS and NO may play an important role in the development of post-asphyxia renal injury.

Objective:To investigate the effect of dexmedetomidine (DEX) on reducing urethral stimulation in patients undergoing laparoscopic gastrointestinal surgery.Methods:From January 2019 to February 2020, 90 patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia in the Third Affiliated Hospital of Sun Yat-sen University were selected. They were randomly divided into 3 groups: catheterization before induction (group A), catheterization during induction (group B), and catheterization after induction (group C). In group A, patients received general anesthesia after awake catheterization. In group B, intravenous injection of DEX 0.5 μg/kg was pumped for 10 minutes, followed by catheterization and induction. In group C, patients received general anesthesia and then catheterization. Visual analogue scale (VAS) score of urethral stimulation, morphine dosage and the incidence of agitation during resuscitation were recorded. The heart rate and mean arterial pressure of the three groups were compared at the time of entering the room, catheterization, tracheal intubation, entering postanesthesia care unit (PACU), about extubation and 30 minutes after extubation.Results:The fluctuation of blood pressure and heart rate in group B was significantly less than that in group A and group C at the time of extubation and 30 minutes after extubation ( P<0.05). VAS of urethral stimulation in group B [(2.9±0.9)point] was significantly lower than that in group A [(4.4±1.8)point] when catheter was indwelling ( P<0.05). After extubation, VAS in group B [(2.8±1.1)point] was significantly lower than that in group A [(3.2±1.2)point] and C [(5.2±1.8)point] ( P<0.05). The utilization rate of morphine within 24 hours after surgery in group B (10%) was significantly lower than that in the other two groups (40%, 57%), and the incidence of postoperative agitation in group A and B was lower than that in group C within PACU ( P<0.05). The satisfaction of patients in group B (86.7%) was higher than that in group A (70%) and C (46.7%). The satisfaction of PACU personnel in group A (76.7%) and B (80%) was significantly higher than that in group C (43.3%). Conclusions:Sedation with dexmedetomidine during urethral catheterization can reduce urethral stimulation during resuscitation and improve patients' and PACU staffs' satisfaction.

ObjectiveTo evaluate the clinical effectiveness of posterolateral autograft bone graft fusion transpedicular screw system internal fixation and anterior debridement in the treatment of dorsal and lumber spinal tuberculosis. MethodsFrom March 1996 to July 2000,posterolateral autograft bone graft fusion transpedicular screw system internal fixation and anterior debridement procedures were used in 62 patients suffering from dorsal and lumber spinal tuberculosis in our department,48 of them were involved in a longitudinal study follow-up for a mean of 3.6(1.5-5.5)years postoperatively. ResultsAll patients showed successful posterolateral bone graft fusion. Among 38 cases of Pott's paraplegia, 30 were completely recovered,5 were partly recovered,the rate of recovery was 92.1%. The average immediate postoperative correction of kyphosis angle was 29.1°,the average loss of correction was only 3.2°at final follow-up.ConclusionsPosterolateral autograft bone graft fusion transpedicular screw system internal fixation and anterior debridement procedure were found helpful in strengthening the stability of the spine in dorsal and lumber spinal tuberculosis, providing successful interbody fusion and recovery of Pott's paraplegia, correcting the kyphosis, and preventing progression of kyphosis.

OBJECTIVETo summarize the experience in the application of circumcision anastomat in the treatment of phimosis and redundant prepuce in children.

METHODSA total of 551 children with phimosis or redundant prepuce were treated by circumcision from 2008 to 2010, 342 with circumcision anastomat and the other 209 by traditional circumcision. Their clinical data were retrospectively analyzed.

RESULTSCompared with traditional circumcision, circumcision with the anastomat showed the advantages of less operation time (P < 0.05), fewer complications, no need for dressing, and better cosmetic appearance, but it also exhibited the disadvantages of longer healing time (P < 0.05) and more obvious postoperative pain (P < 0.05).

CONCLUSIONCircumcision with the anastomat and traditional circumcision for the treatment of phimosis and redundant prepuce in children each have their own advantages and disadvantages, but the former is more advantageous and more feasible clinically.

Adolescent ; Anastomosis, Surgical ; Child ; Circumcision, Male ; instrumentation ; methods ; Humans ; Male ; Phimosis ; surgery ; Treatment Outcome

Adipose tissue contains a population of multipotent cells called adipose-derived stem cells (ADSCs). With the similar properties of marrow-derived mesenchymal stem cells, ADSCs have the ability to differentiate differentiate towards adipogenic, osteogenic, chondrogenic, myogenic, endothelial, hematopoietic, hepatic, islet, and neurogenic cell lineages. As adipose tissue in harvested in large amounts with minimal morbidity, it can be widely used in tissue engineering, organ repair and gene therapy. This paper focused on the plasticity of ADSCs and reviewed the new advances of this field. Finally, the problems and prospect for application was also discussed.
Adipose Tissue ; cytology ; metabolism ; Animals ; Antigens, CD ; metabolism ; Cell Culture Techniques ; Cell Differentiation ; Genetic Therapy ; Humans ; Multipotent Stem Cells ; cytology ; metabolism ; Stem Cells ; cytology ; metabolism ; Tissue Engineering

Background It has become a consensus about the necessity of topical administration of corticosteroid eye solutions after myopic laser-assisted in situ keratomileusis(LASIK).The glucocorticoid eye drops with good anti-inflammatory effect and less adverse effects is helpful for the repair of corneal epithelium following LASIK.Objective This study was to evaluate the clinical effects of 0.5％ loteprednol etabonate eye drops after LASIK.Methods A prospective randomized-controlled study was designed.One hundred and twelve myopia patients(224 eyes)who had received LASIK were included in this study and randomly divided into two groups,and 97 patients finished the follow-up,including 108 eyes of 54 patients in the 0.5％ ioteprednol etabonate eye drops treatment group and 86 eyes of 43 patients in the control group.0.5％ loteprednol etabonate eye drops or dexamethasone/tobramycin eye drops were administered topically to the treatment group and control group,respectively 4 times daily from postoperative day 1 through day 7 following LASIK in addition to regular basic treatment.The follow-up was performed 1 day,1 week and 1 month after LASIK.Subjective symptoms including eye pain,foreign body sensation and blurring were scored,and uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),intraocular pressure(IOP),central corneal thickness,corneal fluorescein staining and diffuse laminar keratitis(DLK)were evaluated and compared between the two groups 1 day,1 week,and 1 month after LASIK.This clinical trial was approved by the Ethic Commission of Zhongshan Ophthalmic Center,and written informed consent was obtained from each patient before the trial.Results No drug-related ocular and systemic adverse events were found in the treatment group throughout the follow-up duration.There was no significant difference in the subjective symptom score after 1 day,1 week and 1 month(P＞0.05).At 1 week post-LASIK,the corrected actual IOP was (16.27±3.31)mmHg in the treatment group and(17.49±4.48)mmHg in the control group,with a statistically significant difference between them(t =-2.113,P =0.036).However,there was no statistically significant difference in IOP between the treatment group(15.01±3.22)mmHg and the control group(15.30±4.17)mmHg at 1 month post-LASIK(t=-0.532,P=0.595).Mild diffuse lamellar keratitis developed in 7 eyes in the treatment group and 5 eyes in the control group without a significant difference on the first day after LASIK(x2 =0.153,P =0.926).The scores of corneal fluorescein staining were not statistically different between the two groups at 1 day,1 week and 1 month postoperative(Z=-0.566,P=0.571 ;Z=-0.689,P=0.491 ;Z=-1.628,P=0.103).Conclusions 0.5％ loteprednol etabonate eye drops could effectively inhibit postoperative inflammation and low the incidence of DLK.It can lessen the risk of IOP elevation in comparison with traditional steroid eye drops.