Attempt to treat degenerative arthritis of the knee by surgical means have been limited. Patellectomy or patelloplasty may be done in the presence of symptomatic patellofemoral arthritis; and joint debridement, including removal of loose bodies, large osteophytes, and damaged menisci, is occasionally used. Most patients with degenerative arthritis of the knee bear more of their weight on one tibial condyle than on the other. As the articular cartilage degenerates over the tibial condyle that bears the most weight, the natural varus or valgus deviation increases and a vicious cycle is set up in which increasing deformity creates increasing degenerative change. If weight-bearing and other stresses could be increased on this more normal area and decreased on the involved portion, it would been that pain might be relieved and the useful life-span of the knee joint considerably prolonged. The tibia in degenerative arthritis of the knee has become the preferred site for the osteotomy because of restriction of knee motion. The osteotomy is increasingly performed proximal, rather than distal, to the attachment of the patellar tendon at the tibial tuberosity because healing occurs faster in the cancellous bone of the metaphysis as compared with the cortical bone of the diaphysis, and particularly as the quadriceps extensor mechanism stabilizes the osteotomy. We have had 4 cases of modified high tibial osteotomy in the degenerative arthritis patients by division of proximal tibio-fibular ligament instead of removal of fibular head. And the follow-up resutts are “good” in all cases without any complication.
Arthritis ; Cartilage, Articular ; Child ; Clinical Study ; Congenital Abnormalities ; Debridement ; Diaphyses ; Femur Neck ; Follow-Up Studies ; Head ; Humans ; Joints ; Knee ; Knee Joint ; Ligaments ; Osteoarthritis ; Osteophyte ; Osteotomy ; Patellar Ligament ; Tibia ; Weight-Bearing

No abstract available.
Humans ; Moral Development* ; Students, Medical*

No abstract available.
Alcoholics* ; Depression* ; Humans

BACKGROUND:Separating umbilical cord blood stem cells using tubes has low efficiency,and microbial contamination easily occurs during this process,therefore,safety cannot be ensured in clinical application.lt is urgent to find a method for separating umbilical cord blood stem cells to treat femoral head necrosis.OBJECTIVE:To establish a high efficient,safe,and clinically valuable method to separate umbilical cord blood stem cells.DESIGN,TIME AND SETTING:A self-control experiment was performed at the First Department of Surgery,Zhengzhou Second People's Hospital,Institute of Blood Constituent Application,Henan Red Cross Blood Centre between February 2006 and August 2007.PARTICIPANTS:Eight male patients with femoral head necrosis,averaging 40.6 years of age,were included in this study.Of these patients,4 had the history of hormone application.An average of 90 mL umbilical cord blood was harvested from each healthy normal full term neonate from Maternal and Children Health Care Hospital of Zhengzhou City.The quadruple bags used for separating umbilical cord blood stem cells consisted of 1 main bag,1 empty bag,and 2 physiological saline bags,provided by Shandong Weigao Holding,China.METHODS:Within 6 hours after collection,umbilical cord blood was centrifuged in the empty bag of quadruple bag,which was connected with an aseptic filling machine.After centrifugation,partial blood plasma was discarded,and the remaining erythrocytes were thoroughly mixed by adding hetastarch.Five minutes later,the mixture was diluted with physical saline at 1:1.Umbilical cord blood was slowly added into the main bag (at 1:1),in which,human lymphocyte separating medium was pre-added.After cantrifugation,the upper layer of solution,i.e.,monocyte-rich solution,was transferred into another empty bag.Within 24hours of preservation,after suspension with umbilical blood plasma,umbilical cord monocytes were transfused into patients with femoral head necrosis via superficial vein on the hand back,monocytes≥1×108/portion,2 portions once.There were three treatment courses,each involving three transfusion sessions,one session every 4 days,and a 2-3-month interval between two treatment courses.MAIN OUTCOME MEASURES:Cell recovery rate and cell viability of umbilical cord blood monocytes and improvements in clinical symptoms.RESULTS:The separation of quadruple bags could obtain umbilical cord blood monocytes with high recovery rate.Furthermore,microbial contamination hardly occurred in the process of separation.Hip joint pain relieved or disappeared to different extents in all 8 patients,with an effective rate of 100%.Abduction and internal rotation of hip joint,ambulation distance,and gait were markedly improved.At 6 months after cell transplantation,5 patients presented with changed bone density in femoral head necrosis regions,2 showed normal femoral head morphology,and the remaining 1 exhibited no obvious changes.Joint effusion was reduced or disappeared in 12 hips.Magnetic resonance images showed that femoral head morphology had been improved in various degrees in 9 hips,but no changes in 3 hips.No complications,fever,or allergies occurred during and after cell transplantation.CONCLUSION:The method of separating stem cells from umbilical cord blood in junction with aseptic interface technology is highly effective,safe,and clinically valuable.Multiple intravenous transfusions of umbilical cord blood stem cells provide a novel approach for systemic treatment of femoral head necrosis.

The tibial plateau fracture is a common fracture in the knee joint. Tibial plateau fracture involves most always the articulating cartilage and produce the disability of the knee joint oftenly. The 25 cases of tibial fractures have been classified by Hohls method and analysed their clinical courses more than three month period. The 13 cases out of 25 had treated in conservative method such as plaster of Paris with or without closed reduction. Remaining 12 cases were treated operatively due to the failure of closed reduction or associated injury of major ligaments. More than 8 mm of depression or 5 mm split of the plateau fragment is classified as failure of closed reduction. Excellent end result is obtained in 21 cases with free of pain on walking and full range of joint motion without instability and muscle weakness, Three cases were classified as Good result with occasional pain on walking, range of joint motion is available more than 0~90 degree and good grade of muscle power without instability. One case was poor in result with instability of joint and pain on walking. The radiological end result of accurate reduction of fragment is not closely correlated with functional result in the treatment of tibial plateau fracture. The most important factor in the treatment of tibial plateau fracture is the exercises of the joint as early as possible.
Calcium Sulfate ; Cartilage ; Depression ; Exercise ; Joints ; Knee Joint ; Ligaments ; Methods ; Muscle Weakness ; Tibial Fractures ; Walking

AIM:To observe the structural basis of ocular motility abnormalities in patients with congenital fibrosis of the extraocular muscles type Ⅰ ( CFEOM Ⅰ) due to missense mutations in the developmental kinesin KIF21A using high - resolution magnetic resonance imaging ( MRI) .
METHODS: Totally 11 affected individuals reported KIF21A mutations were correlated with MRI studies demonstrating extraocular muscles ( EOMs ) size, location, contractility, and innervation. EOMs and the motor nerve in the orbits were imaged with T1 weighted in a triplanar scan using a dual-phased coils with 2. 0mm thick. Motor nerves were imaged at the brainstem using head coils and 3D-FIESTA with 0. 6-mm thick.
RESULTS: Patients with CFEOM Ⅰ exhibited different degrees of hypoplasia of oculomotor nerve, the abducens nerve and the trochlear nerve were also affected, of which 8 cases of orbital section could see the signal of abnormal nerve dominated by oculomotor nerve to lateral rectus. The both sides of six EOMS in all patients exhibited variable atrophy and abnormal bright internal signal on T1 imaging, particularly severe for the superior rectus and levator muscles.
CONCLUSION: High - resolution MRI can directly demonstrate pathology of motor nerves,affected EOMs, and ‘Pulley' hypoplasia caused by CFEOM Ⅰ due to mutations in KIF21A,and these findings suggest that the neuronal hypoplasia is the etiological factor of CFEOM.

The efficacy and safety of uric-acid-lowering therapy (UALT) on slowing the progression of chronic kidney disease (CKD) accompanied by hyperuricemia were assessed. We searched Cochrane Library, PubMed, EMbase, CNKI, Wanfang and Vip databases up to November 15, 2012 for randomized controlled trials (RCTs) which compared the effect of UALT to control therapy in hyperuricemic patients secondary to CKD, and then performed quality evaluation and meta-analysis on the included studies. Seven RCTs involving 451 cases were included. UALT delayed the increase of serum creatinine (MD=-62.55 μmol/L, 95% CI: -98.10 to -26.99) and blood urea nitrogen (MD= -6.15 mmol/L, 95% CI: -8.17 to -4.13) as well as the decrease of glomerular filtration rate [MD=5.65 mL/(min·1.73 m2), 95% CI: 1.88 to 9.41], decreased systolic blood pressure (SBP) (MD= -6.08 mmHg, 95% CI: -11.67 to -0.49), and reduced the risk of the renal disease progression (RR=0.30, 95% CI: 0.19 to 0.46). However, there was no statistically significant difference in 24-h urinary protein quantity and diastolic blood pressure (P>0.05). We identified that UALT could delay the progression of CKD with secondary hyperuricemia. And this also indirectly proved that hyperuricemia was a risk factor for the CKD progression.

No abstract available.
Arteriovenous Fistula ; Lower Extremity

The first description on the discoid meniscus was made by Young in 1889 and was known as it affects only the lateral meniscus for a long time. However, Cave and Staples had reported the two cases of discoid changes on medial meniscus in 1941. Smillie(1948) had stated that the menisci exist as cartilagenous discs at an early stage of fetus and remain in discoid shape congenitally. Kaplan(1957) reported that the discoid meniscus is not caused by congenitally but acquired in relation of joint motion. A clinical analysis is made on the 22 discoid meniscus which were removed surgically and summarized as follows: 1. The click sound on walking, tenderness and positive McMurray test were important as diagnostic criteria and were present all of the cases. 2. The most of the discoid meniscus were found in first and second decade in 13 cases(76.5%) out of 22. The five cases were bilateral. 3. The discoid change of the meniscus had no sex defferences in their incidence but lateral involvement were far superior than in ten times. 4. The discoid meniscus shows degenerative change microscopically 17(77.3%). 5. The clinical result of surgical removal of discoid meniscus was satisfactory in resuming their full activities in six weeks.
Clinical Study ; Fetus ; Incidence ; Joints ; Menisci, Tibial ; Walking

Objective To prepare a glycerol reference material.Methods The material was prepared and characterized according to the primary standard substance technological specification(JJG 1006- 1994).Glycerol was dissolved in water containing 0.5% sodium azide and dispersed to glass ampules.The homogeneity and stability of this material were tested with an HPLC method.Glycerol concentration was determined by a titration method as specified in the Pharmacopoeia of China.Results The three time measuring result of glycerol reference material was 1.297 5?0.014 3,1.302 0?0.008 9,1.313 7? 0.007 8,respectively.Statistical analysis showed that this material was homogeneous (F=1.462,P=0.166) .It was stable for at least 4 years at 4℃.The assigned reference value was 0.103 6 g/g and the expanded uncertainty was 0.000 4 g/g.Conclusions This material meet the technical requirements of national primary standard reference material.It is approved as the Certified Reference Material (GBW 09149) by General Administration of Quality Supervision,Inspection,Quarantine of the People's Republic of China in May,2006.