OBJECTIVETo evaluate clinical outcomes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction under arthroscopy and repair of the injured posteromedial complex structure of the knee joint in the treatment of posterolateral knee dislocation with multiple ligament injuries.

METHODSFrom March 2008 to August 2012,22 patients (16 males and 6 females, ranging in age from 20 to 53 years old, with an average of 30.5 years old) with posterolateral dislocation of the knee were treated with primary reconstruction of ACL and PCL, combined with the repair of injuries in the posteromedial complex and soft-tissue. Eight patients had injuries caused by sports,5 patients road accidents and 9 patients falling down. The ACL was reconstructed using the gracilis and semitendinosus tendons. The PCL was reconstructed using LARS artificial ligaments (14 cases), or gracilis and semitendinosus tendons (8 cases). Suture repair was performed in 17 patients with posteromedial ligament injuries,and self-semitendinosus strengthening operations were performed in 5 patients. Continuouspassive montion (CPM) and active exercises were executed after operation at early stage. The IKDC and Lysholm system were used to evaluate therapeutic effects.

RESULTSAll the patients were regularly followed up, and the duration ranged from 11 to 56 months (averaged, 39 months). According to the IKDC scale,9 patients got a grade A result, 10 got a grade B result, and 3 got a grade C result. The IKDC subject score was 89.6±3.1 and the Lysholm scores was 90.7±1.8 at the latest follow-up, which were both better than those before operation.

CONCLUSIONReconstructing the ACL and PCL and repairing injured posteromedial complex of the knee followed by an active rehabilitation is an effective method to treat posterolateral knee dislocation.

Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; methods ; Female ; Humans ; Knee Dislocation ; surgery ; Male ; Middle Aged ; Posterior Cruciate Ligament ; injuries ; surgery ; Reconstructive Surgical Procedures ; methods

The study evaluates the lipolysis rate and extent of type Ⅲ lipid formulations using testosterone undecanoate as a model drug after digestion with in vitro lipolysis model, and studies the digestive regularity with optical microscope and electrical conductivity. The results showed that for testosterone undecanoate type Ⅲ lipid formulations with castor oil as oil phase and Transcutol HP as latent solvent, the lipolysis rate and extent were increased with the increase of oil phase proportion and were decreased with excessive proportion of surfactant, in which can see liquid crystal phase during lipolysis process. The lipolysis rate of type ⅢB lipid preparations with different surfactant were ordered as Labrasol > Tween 80 > Cremophor EL, but the rate of type ⅢA is different in quick digestion phase and slow digestion phase. The lipolysis extent of type Ⅲ lipid formulations with different surfactant were ordered as Cremophor EL > Tween 80 > Labrasol. These may be related to the digestive effect of pancreatic lipase on different surfactants. This study implied that the lipolysis rate and extent of type Ⅲ lipid formulations are greatly influenced by the proportion of oil phase and surfactant, and the surfactant structure. These factors will affect the in vivo digestion and should be taken into account when screening type Ⅲ lipid formulations.

OBJECTIVETo observe the therapeutic effect of moxibustion and exercise comprehensive scheme intervention for children with short stature of deficience of the kidney essence.

METHODSTwenty four cases of children in 12 to 14 years old were selected, 12 male and 12 female, they were treated with comprehensive therapy of exercise therapy and moxibustion. Running and jumping were selected as main exercise therapy, it became a suitable exercise amount when the heart rate reach to 150 to 170 times per minute, thrice each week, 35 to 45 minutes each time. After exercises they were treated with moxibustion, Qihai (CV 6), Guanyuan (CV 4), Zusanli (ST 36), Dazhu (BL 11), Xuanzhong (GB 39), Geshu (BL 17) etc. were selected. After treatment for half a year, the changes of the body height, body weight, bone age(BA), growth hormone (GH), testosterone (T) and estradiol (E2) were compared before and after treatment.

RESULTSThe body height and bone age of the boys and girls were significantly higher than those before treatment (all P<0.05), the growth of body height was more than 4 cm, the growth of bone age was more than 0.5 years old in half a year; the testosterone of all children was significantly increased (all P<0.05), and there were no significant differences in body weight, GH and E2 compared to those before treatment (all P>0.05).

CONCLUSIONMoxbustion and exercise comprehensive scheme can effectively improve the children with short stature of deficience of the kidney essence, the mechanism is related to the improving of the testosterone level.

Adolescent ; Body Height ; Child ; Estradiol ; metabolism ; Exercise Therapy ; Female ; Growth Disorders ; metabolism ; physiopathology ; therapy ; Human Growth Hormone ; metabolism ; Humans ; Kidney ; physiopathology ; Male ; Moxibustion ; Testosterone ; metabolism ; Treatment Outcome

Objective:To investigate the efficacy of alveolar lavage combined with montelukast in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and its effect on oxidative stress and inflammatory factors in patients.Methods:A prospective study was conducted involving 90 patients with AECOPD who were admitted to the Intensive Care Unit of Shan County Central Hospital from December 2021 to December 2022. The patients were randomly divided into a control group and an observation group, with 45 patients in each group, using the random number table method. The control group received conventional treatment, while the observation group was additionally treated with alveolar lavage combined with montelukast. Symptom score, Acute Physiology and Chronic Health Evaluation II score, overall response rate, serum levels of oxidative stress markers (malondialdehyde, 4-hydroxynonenal, and superoxide dismutase), and serum levels of inflammatory factors (C-reactive protein, tumor necrosis factor-α, interleukin-6, and procalcitonin) were compared between the two groups before and after treatment.Results:After treatment, the symptom scores for both groups decreased significantly compared with their respective scores before treatment ( t = 6.68, 11.32, both P < 0.05). After treatment, the symptom score in the observation group was significantly lower than that in the control group [(8.69 ± 0.84) points vs. (15.39 ± 1.18) points, t = 8.75, P < 0.05]. After treatment, the Acute Physiology and Chronic Health Evaluation II score in the observation group was significantly lower than that in the control group ( t = 9.19, P < 0.05). The overall response rate in the observation group was significantly higher than that in the control group [93.33% (42/45) vs. 75.56% (34/45), t = 4.56, P < 0.05]. After treatment, serum levels of 4-hydroxynonenal and malondialdehyde in the observation group were significantly lower than those in the control group ( t = 4.20, 5.15, both P < 0.05), while serum level of superoxide dismutase in the observation group was significantly higher than that in the control group ( t = 5.23, P < 0.05). After treatment, serum levels of C-reactive protein, tumor necrosis factor-α, interleukin-6, and procalcitonin in the observation group were significantly lower than those in the control group ( t = 6.86, 5.60, 8.75, 4.89, all P < 0.05). Conclusion:Alveolar lavage combined with montelukast can reduce clinical symptoms in patients with AECOPD, promote recovery, enhances clinical efficacy, decreases oxidative stress responses, increases the body's antioxidant capacity, lowers the expression of inflammatory factors, and reduces inflammatory responses.

Objective To systematically evaluate the differences in preoperative planning for left atrial appendage closure(LAAC)using cardiac CT angiography(CCTA)and transesophageal echocardiography(TEE).Methods Relevant studies comparing CCTA and TEE for preoperative assessment of LAAC published from the inception of each database to July 18,2023,were searched in PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang,and CBM database.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results A total of 21 studies with 2 137 patients were included.Compared to TEE,preoperative CCTA measurement of the left atrial appendage(LAA)showed a larger maximum diameter(MD 2.27 mm,95％CI 1.70-2.83,P＜0.001)and higher accuracy in predicting occlusion device(RR 1.67,95％CI 1.39-2.01,P＜0.001).Subgroup analysis based on whether 3D reconstruction was performed and occlusion device type showed similar results.There was no statistically significant difference in the surgical success rate(RR 1.03,95％CI 0.98-1.08,P=0.230)between the two imaging methods.Additionally,preoperative 3D reconstruction based on CCTA resulted in fewer occlusion devices used(MID-0.29,95％CI-0.53--0.04,P=0.020),less contrast agent usage(MD-4.48 ml,95％CI-7.40—-1.56,P=0.003),shorter operative time(MD-14.98 min,95％CI-17.79—-12.17,P＜0.001),and a lower rate of postoperative residual leakage(RR 0.59,95％CI 0.36-0.99,P=0.040).Conclusions Compared to TEE,preoperative CCTA for LAAC improves the accuracy of occlusion device prediction.3D reconstruction based on CCTA reduces the occlusion devices used and the usage of contrast agents,shortens the operative time,improves surgical efficiency,and is associated with a lower rate of postoperative residual leakage.Therefore,CCTA has more advantages in preoperative planning for LAAC.

BACKGROUNDBudd-Chiari syndrome (BCS) is characterized by liver sinusoidal congestion, ischemic liver cell damage, and liver portal hypertension caused by hepatic venous outflow constriction. The aim of this research was to investigate the clinicopathological features of BCS-associated hepatocellular carcinoma (HCC) and explore its surgical treatment and prognosis.

METHODSClinical data from 38 patients with BCS-associated HCC who were surgically treated in our hospital from July 1998 to August 2010 were retrospectively analyzed. The clinicopathological features and prognosis of patients with BCSassociated HCC and surgical treatment for BCS-associated HCC were investigated.

RESULTSCompared to the patients with hepatitis B virus (HBV)-associated HCC, the patients with BCS-associated HCC showed a female predominance, and had significantly higher cirrhosis rate, higher incidence of solitary tumors, lower incidence of infiltrative growth, higher proportion of marginal or exogenous growth, lower rate of portal vein invasion, and higher degree of differentiation. Median survival was longer in patients with BCS-associated HCC (76 months) than in those with HBV associated HCC (38 months). Of 38 patients with BCS-associated HCC, 22 patients who received combined surgery mainly by liver resection plus cavoatrial shunts exhibited hepatic venous outflow constriction relief, while the other 16 patients only underwent liver resection. The combined surgery group had significantly longer survival and lower incidences of post-operative lethal complications (P < 0.05). Multivariate analysis showed that relief of hepatic venous outflow obstruction was a protective factor for survival of patients with BCS-associated HCC, whereas portal vein invasion was a risk factor.

CONCLUSIONSBCS-associated HCC has a more favorable biological behavior and prognosis than HBV-associated HCC. For patients with BCS-associated HCC, tumor resection accompanied with relief of hepatic venous outflow obstruction can reduce the incidence of complications and extend survival.

Adult ; Aged ; Budd-Chiari Syndrome ; complications ; Carcinoma, Hepatocellular ; mortality ; pathology ; surgery ; Female ; Humans ; Liver Neoplasms ; mortality ; pathology ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis

Objective To analyze the etiology of 628 patients with refractory hypertension and to observe the disease distribution with respect to gender and different age groups. Methods In this study,clinical data of 628 refractory hypertensives who hospitalized in our hospital from September 1997 to December 2005 were retrospectively analyzed. Results (1) There were 80.1% (503/628) patients with essential hypertension, 18. 9% (119/628) with secondary hypertension (SH) while diagnosis was not clear in 1.0% (6/628) patients. Renovascular hypertension (33.6%) and obstructive sleep apnea syndrome (23.5%) were the major causes of SH. The highest prevalence rate of endocrine hypertension was primary aldosteronism (13.5%). (2) There were significantly more male patients than female patients with essential hypertension, SH, renal hypertension, obstructive sleep apnea syndrome, rimary aldosteronism while the incidence of pheochromocytoma in female was significantly higher than that in male patients (all P < 0.05).The incidence of renovascular hypertension was similar between male and female patients. (3) SH occurred more often in young patients (33.1%) than in aged patients (13.8%, P < 0.05). Conclusion Our data from this patient cohort showed that SH, especially renovascular hypertension and obstructive sleep apnea syndrome are major causes for refractory hypertension in young patients and primary aldosteromsm was the commonest reason of endocrine hypertension in youth and middle-aged patients with refractory hypertension.

Melanoma is an intractable cancer that is aggressive, lethal, and metastatic. The prognosis of advanced melanoma is very poor because it is insensitive to chemotherapy and radiotherapy. The incidence of melanoma has been ascending stably for years worldwide, accompanied by increasing mortality. New approaches to managing this deadly disease are much anticipated to enhance the cure rate and to extend clinical benefits to patients with metastatic melanoma. Due to its high degree of immunogenicity, melanoma could be a good target for immunotherapy, which has been developed for decades and has achieved certain progress. This article provides an overview of immunotherapy for melanoma.
Humans ; Immunotherapy ; Melanoma ; therapy

Objective:To explore the hepatoprotective effect and its mechanism of the geraniin on mice with acute liver injury induced by D-galactosamine (D-GalN). Method:A total of 60 Kunming mice were randomly divided into normal group, model group, Silymarin group (positive group 180 mg·kg^-1), and low, medium and high-dose geraniin groups (50, 100, 200 mg·kg^-1). All the mice were given with saline or corresponding dose of drugs (10 mL·kg^-1) by gavage once a day for 10 d. After 2 h of the last administration, except the normal group, the mice of other groups were injected intraperitoneally with D-GalN (500 mg·kg^-1) to induce the acute liver injury. After 16 h, the eye balls of mice were removed to take blood, and all mice were put to death to collect samples of liver. Activity or content of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), malondialdehyde (MDA), total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-Px) in liver were determined by biochemical method. The serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), γ-interferon (IFN-γ) and interleukin-6 (IL-6) were detected by enzyme-linked immunosorbent assay (ELISA), and expressions of Toll-like receptor-4(TLR-4) and nuclear factor(NF)-κB proteins were detected by Western blot. Liver histopathological changes were observed by hematoxylin-eosin (HE) staining. Result:Compared with the normal group, the serum levels of ALT, AST, ALP, TBIL and liver MDA in the model group were significantly increased (P<0.05, P<0.01). Compared with the model group, geraniin can reduce activities or contents of ALT, AST, ALP, TBIL in serum and MDA in liver of mice (P<0.05, P<0.01), but increase activities of T-SOD and GSH-Px in liver (P<0.05,P<0.01), while inhibiting the contents of TNF-α, IL-1β, IL-6, IFN-γ and the expressions of TLR-4 and NF-κB proteins in serum (P<0.05,P<0.01). HE staining showed that acute liver injury of mice was alleviated obviously by geraniin. Conclusion:Geraniin has an obvious protective effective on acute liver injuries induced by D-GalN in mice. Its mechanism may be correlated with oxidative stress, inflammation and TLR-4/NF-κB signaling pathway.

Objective:To explore the efficacy and safety of domestic RECO flow restoration device in acute intracranial large-vessel occlusion (LVO).Methods:This study was a multicenter, prospective, randomized, open, controlled trial; 136 patients with acute intracranial LVO at 7 Chinese stroke centers from February 2014 to August 2016 were randomly assigned into an experimental group (thrombectomy by RECO device, n=67) and a control group (thrombectomy by Solitaire device, n=69). The efficacy and safety of patients from the two groups were compared and analyzed. The primary efficacy end point was set as achievement of good recanalization (modified thrombolysis in cerebral infarction [mTICI] grading≥2); the secondary efficacy end points included good prognosis (modified Rankin scale scores≤2 90 d after thrombectomy), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained, or mortality within 90 d of thrombectomy. The safety end points included any device-related serious adverse events, symptomatic intracerebral hemorrhage or serious adverse events within 24 of thrombectomy. Results:There was no statistically significant difference between the experimental group and the control group in successful rate of good recanalization (91.0% vs. 86.9%), good prognosis rate (62.7% vs. 46.4%), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained([85.4±47.0] min vs. [89.9±53.3] min), and mortality within 90 d of thrombectomy (13.4% vs. 23.2%, P>0.05). There were no device-related serious adverse events in all patients. No significant differences were found in the incidences of symptomatic intracranial hemorrhage (1.5% vs. 7.4%) or serious adverse events (death [1.5% vs. 1.4%] and brain hernia [4.5% vs. 0.0%]) between the two groups ( P>0.05). Conclusion:The domestic RECO flow restoration device is an effective and safe mechanical thrombectomy stent retriver for acute intracranial LVO.