Objective To investigate surgical techniques and results of arthroscopic reduction and fixation for the treatment of avulsion fracture of the posterior cruciate ligament from the tibia through an additional posterolateral portal. Methods An additional posterolateral portal was established by using the inside-out technique under arthroscopic view.After a protective sleeve was placed through the portal and the displaced fracture was reduced,the fragment was fixed by the guide wire drilled through the sleeve temporarily.If the fluoroscopic control showed an anatomic reduction of the fragment and good placement of the wire,the self-attacked cannulated screw and washer was placed intra-articularly over the guide wire through the sleeve for the directive internal fixation of the avulsion fracture.Aggressive rehabilitation programs were recommended postoperatively.Results Except 1 case with 11 mm displacement and rotation of the fragment treated by the arthrotomy after the failure of arthroscopic reduction,the arthroscopic operation was accomplished in all the remaining 10 cases.The operative time was 63～98 min(mean,87.3 min).No injuries of popliteal vessels or nerves occurred.The postoperative X-ray firms showed an anatomic reduction of the fragment and good placement of the screw and washer.With the negative posterior drawer test confirmed by the physical examination,normal range of motion of the injured knee joint and gait were achieved in the 10 patients at 4～7 weeks after surgery.The bone union was confirmed by X-ray films at the 3 months postoperatively.The computer KT-2000 arthrometer measurements of posterior tibial displacement of both knee joints showed side-to-side difference not more than 1.2 mm in 6 patients at 5 months after surgery.Conclusions The additional posterolateral portal can be established by the arthroscopic inside-out technique safely.The displaced fragment of the avulsion fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the self-attacked cannulated screw and washer arthroscopicly.

BACKGROUND: Orphanin (OFQ) is associated with ischemia/hypoxia,which may play an important role in the production and development of fetal distress and neonatal asphyxia.OBJECTIVE: To observe the change of OFQ content in hypothalamus and peripheral blood of intrauterine ischemia/hypoxia fetal rats and analyze the role of OFQ in the perinatal ischemia/hypoxia.DESIGN: Randomized controlled animal trial.SETTING: Department of Obstetrics and Gynecology, Changhai Hospital of the Second Military Medical University of Chinese PLA.MATERIALS: The experiment was performed at the Department of Obstetrics and Gynecology, Changhai Hospital of the Secon d Military Medical University of Chinese PLA from May 2002 to September 2003. A total of 12 Wistar female rats, with the mean body mass of 260 g were selected and fed routinely [provided by the experiment animal center of this university, number of certificate scxk(Hu)2002/0006].METHODS: The 12 female rats were randomized into three groups: control group, ischemia/hypoxia for 10 minutes group, ischemia/hypoxia for 20 minutes group with 4 rats in each group. Female rats in each group were pregnant. On day 21 of pregnancy, female rats in each group were cut the belly open, and the uterine vessels were incarcerated for 10 minutes in the ischemia/hypoxia for 10 minutes group with 21 fetal rats and 20 minutes in the ischemia/hypoxia for 20 minutes group with 17 fetal rats, respectively. Fetal rats were directly obtained from control group with 19 ones. None of fetal rats died. All the fetal rats received Apgar score and decapitation. The blood of trunk was collected and the whole brain was obtained. OFQ content in hypothalamus and peripheral blood was measured with radioimmunoassay.MAIN OUTCOME MEASURES: OFQ content in hypothalamus and peripheral blood of fetal rats in each group.RESULTS: Totally 57 rats were involved in the result analysis. ①The levels ofOFQ in hypothalamus and peripheral blood were (71±14) pg/g and (31±7) ng/L in ischemia/hypoxia for 10 minutes group, (114±21) pg/g and (58±11) ng/L in ischemia/hypoxia for 20 minutes group, (48±9) pg/g and (19±4) ng/L in the control group. Compared with the control group, the levels of OFQ in hypothalamus and peripheralblood increased in the ischemia/hypoxia for 10 minutes group and ischemia/hypoxia for 20 minutes group (P＜ 0.05, P ＜ 0.01), and it in ischemia/hypoxia for 10 minutes group was significantly higher than that in ischemia/hypoxia for 20 minutes group (P ＜ 0.05). ②The score of Apgar was lower in the two groups than in the control group (P ＜ 0.01 ), of which it was lower in the ischemia/hypoxia for 20minutes group than in the ischemia/hypoxia for 10 minutes group (P ＜ 0.05).CONCLUSION: The perinatal ischemia and hypoxia can induce the increase of OFQ content in hypothalamus and peripheral blood.

Objective To identify the possible existing suppressive oligodeoxynucleotides(ODNs)in the DNA sequence which encodes Schistosoma japonicum 22.6 kDa(Sj22.6)antigen.Methods Several ODNs within the DNA sequence encoding Sj22.6 antigen were synthesized.Splenocytes separated from mice were stimulated with optimal immunostimulatory CpG 1826 in the absence or presence of different synthetical ODNs.The suppressive efficacy of each ODN was examined by 3H-TdR incorporation.Results ODN F311 suppressed the proliferation of splenocytes caused by CpG 1826 stimulation.The significant suppression was observed when ODN F311∶CpG 1826 at a ratio of 1∶1 and 3∶1,the suppression reached 11% and 58% respectively.The maximal inhibition was observed when ODN F311 was pre-administered with CpG ODN for 2 h.Conclusions Certain suppressive ODN exists in the DNA sequence encoding Sj22.6 antigen,and this effect shows dose-and time-dependent manner.

Objective To explore a new method for assessing the walking efficiency of the paraplegic patients assisted by functional electrical stimulation (FES). Methods The measurement system based on a standard walker was developed. During FES assisted walking of the paraplegic, the real time of the upper limb support were obtained and transformed into a 3 D center of gravity (CG) motion map with a paraplegic upper body mechanical model to describe the CG motion locus. Then the FES efficiency indicated by walking balance condition was assessed objectively and quantitatively. Results In this design, the pilot study of a paraplegic patient undergoing walking training with FES showed that the force accuracy was better than 1.01%, nonlinearity was less than 0.8%, and crosstalk was less than 3.2%. Conclusion The results showed that this system may be used as 1) an evaluation index of FES assisted paraplegic walking efficiency, 2) a balance control indicator during FES assisted paraplegic walking training and 3) a feed back signal to choose an efficient FES pattern and sequence.

Objective:To investigate the effect of arterialised Flow-through venous flap with palmaris longus tendon in repairing dorsal digit composite tissue defect.Methods:From March, 2010 to December, 2018, 23 cases (23 digits) of dorsal digit composite tissue defect were repaired with arterialised Flow-through venous flap with palmaris longus tendon. There were 17 males and 6 females aged between 23 to 53 (average, 37.2) years old. Causes of injury: 15 cases of strangulation, 5 of electric plane and 3 of thermal crush. Number of injured digit were 1 thumb, 11 index fingers, 9 middle fingers and 2 ring fingers. All of the injured digits had skin and extensor tendon defects with an area of 2.0 cm×1.8 cm-4.2 cm×2.6 cm, and the length of extensor tendon defect was 1.6-2.6 cm. One case had terminal and central tendon insertion defects and 5 suffered with terminal tendon insertion defect. Three cases were repaired by emergency surgery, and 20 were repaired by sub-emergency surgery. All donor sites were directly sutured. The shape, colour, texture, sensation, recovery of digit function and donor site appearance were followed-up at outpatient clinic.Results:The patients were followed-up for 8 to 23 (average, 11) months. The flap was soft, with mild pigmentation and recovery of protective sensation. The range of motion of the proximal and distal interphalangeal joints was 145°-170° (average,162.6°). According to Strickland hand function evaluation method, the results were excellent.Conclusion:The arterialised Flow-through venous flap with palmaris longus tendon is an ideal method in repair of the dorsal digit composite tissue defect.

Objective To evaluate the safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction. Methods A total of 108 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2011 to May 2014 were enrolled. The clinical suc-cess rates and the complications were reviewed. Results The clinical success rates were 92.59%(100/108). Abdomi-nal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 16.67% (18/108), 7.41% (8/108), 6.48% (7/108), respectively. The abdominal pain in most patients was self-reliev-ing except for 6 patients with perforation of colon. Patients with perforation were cured by emergency surgery. The 7 patients developing bleeding recovered themselves. Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study. As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effec-tive and safe for malignant colorectal obstruction.

PURPOSETo explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing.

METHODSWe retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 (ranging from 21 to 56) years old. The inclusion criteria included: (1) traumatically closed fracture of femoral shaft, with pre- operative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; (2) closed reduction and fixation with interlocking intramedullary nail at 3-7 days after trauma; (3) complete follow-up data available. The relationship between the following factors (fracture site, reduction degree, direction of nail insertion and nail size) and nonunion was studied.

RESULTSThe incidence of femoral nonunion was 2.8% in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail (p < 0.05). There was no significant difference between antegrade nail and retrograde nail (p > 0.05).

CONCLUSIONSNonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.

Adult ; Age Distribution ; China ; Cohort Studies ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Fracture Healing ; physiology ; Fractures, Ununited ; epidemiology ; etiology ; surgery ; Humans ; Incidence ; Injury Severity Score ; Male ; Middle Aged ; Reoperation ; methods ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Time Factors ; Trauma Centers ; Treatment Outcome ; Urban Population ; Young Adult

Objective: To investigate the incidence of CMV infection(CMV-I) and CMV related diseases (CMV-D) after allogeneic hematopoietic stem cells transplantation in 70 consecutive allogeneic hematopoietic stem cells transplantation(allo-HSCT) patients and to search for the optimal prophylactic strategy.Methods: Blood samples were monitored using the CMV pp65 antigenemia assay.Of the 70 patients observed,30 patients with chronic myeloid leukemia［CML:CP(27),AP(2),BC(1)］,12 with acute myeloblastic leukemia(AML),10 with acute lymphoblastic leukemia(ALL)and other cases were NHL(3), AA(5), MDS(7), SCLC with pancytopenia (1),CLL(1), and MF (1). Sixty six patients received HLA - identical siblings transplantation and four received tranplants from their HLA- haploidentical donors. Seventy cases included allo-PBPCT (64 cases) , allo-BMT (4 cases) and allo-PB+BMT (2). Before transplantation, all patients and donors received CMV serological examination except 4 pairs of donors/recepients. All 66 patients (3 cases were CMV IgM positive) and 64/66 donors were CMV IgG positive. Results：After transplantation, 64/70 patients developed CMV viremia during monitoring period. Forty three of 70 patients developed CMV-D.Thirty five of them suffered from CMV-associated interstitial pneumonia(CMV-IP). The high peak levels of CMV antigenemia were associated with development of CMV disease　. Close correlation was found between acute graft vs host disease(GVHD) and CMV disease. The patients were followed up for 2 to 24 months. The patients who received preemptive therapy(group A)had significantly better outcome than CMV disease group(group B, P=0.0001). Conclusions: The results suggest that CMV antigenemia has high predictive value for subsequent CMV disease and CMV pp65 antigenemia -guided early therapy has particular advantage for avoiding morbidity and mortality caused by CMV disease.

BACKGROUND: Orphanin, which was found in recent years, is an important bioactive polypeptide. Its extensive distribution in the central nervous system and peripheral tissue suggests a function of adjusting global behaviors.OBJECTIVE: To explore the correlation of plasm orphanin level and monoamine neurotransmitters in patients with postpartum depression by determining the levels of orphanin and monoamine neurotransmitters such as 5-hydroxytryptamine (5-HT) and dopamine(DA) in patients.DESIGN: Case-control experiment taking diagnosis as evidence.SETTING: Departments of Obstetrics and Gynecology, Changzheng Hospital and Changhai Hospital, Second Military Medical University of Chinese PLA.PARTICIPANTS: Twenty-five healthy women and seventeen women patients with postpartum depression after delivery who came in the Department of Obstetrics and Gynecology, Changzheng Hospital and Changhai Hospital, Second Military Medical University of Chinese PLA for further consultation during February 2002 to October 2004 were enrolled in this study, and served as control group and postpartum depression group, respectively. All the enrolled women, aged 21 to 43 years, with fair education levels, and voluntarily participated in this study. Women patients of 15 to 25 days after delivery suffered from the incipient postpartum depression with total scores of Edingburgh Postnatal Depression Scale (EPDS) above 13. Informed consents were obtained from all the subjects.METHODS: The levels of orphanin and monoamine neurotransmitters in venous blood from 25 healthy women and 17 women patients with postpartum depression were determined. ① Sample collecting: Blood was taken from women in the postpartum depression group 2 weeks after onset, while from control group 35 days after delivery. ② Assay method:The level of orphanin was determined with radioimmunoassay (RIA). The reagent kit was provided by phoenix company (USA) and the procedure was strictly performed according to the instructions on the reagent kit. The levels of 5-HT and DA were measured with high-performance liquid chromatography or electrochemical detection method.MAIN OUTCOME MEASURES: ① Changes in the levels of orphanin as well as 5-HT and DA in postpartum depression group and control group. ② Correlation of the total scores of EPDS and the levels of orphanin in postpartum depression group.RESULTS: Twenty-five healthy women and seventeen women patients with postpartum depression after delivery all participated in the result analysis. ① The level of orphanin in the postpartum depression group[(27.39±6.04) ng/L] was significantly higher than that in the control group [(10.37±3.65) ng/L](P ＜ 0.01),the levels of 5-HT in the postpartum depression group [(0.93±0.21) μmol/L] was remarkably lower than that in the control group[(1.43±0.36) μmol/L](P ＜0.05) ,and the levels of DA in postpartum depression group[(2.15±0.41) μmol/L] was obviously lower than that in the control group [(3.64±0.72) μmol/L]( P ＜ 0.01). ②The level of orphanin was negatively correlated with those of 5-HT and DA in postpartum depression group(r = -0.601 , -0.593,P ＜ 0.05). ③ The total scores of EPDS were significantly positively correlated with the level of orphanin (r = 0.512, P ＜ 0.05), and negatively correlated with the levels of 5-HT and DA (r = -0.571,-0.526, P＜ 0.05).CONCLUSION: The level of orphanin in patients with postpartum depression is increased and is negatively correlated with the levels of 5-HT and DA, but positively correlated with the total scores of EPDS.

Objective To evaluate the effect of stellate ganglion block (SGB) on postoperative synaptic structure in hippocampal CA3 region in aged rats.Methods Seventy-two male Sprague-Dawley rats,aged 20-22 months,weighing 550-650 g,were randomly divided into 3 groups (n =24 each) using a random number table:control group (group C),operation group (group O) and SGB + operation group (group SGB).Group SGB received right SGB with 0.25％ bupivacaine 0.15 ml.Groups O and SGB underwent 30 min of exploratory laparotomy starting from 15 min after the end of administration.Y-maze test was performed on 1 day after operation in 6 rats chosen from each group for assessment of cognitive function.The frequency of standard training and standard time were recorded.Six rats were chosen from each group on 1,3 and 7 days after operation and sacrificed and the hippocampal CA3 region was isolated for microscopic examination and for measurement of synaptic structure.Results Compared with group C,the standard time was significantly prolonged,and the frequency of standard training was increased in groups O and SGB,the width of synaptic cleft was increased,the thickness of post-synaptic density was decreased,the length of active zones was shortened,and the curvature of the synaptic interface was decreased on 1,3 and 7 days after operation in group O (P ＜ 0.05),and no significant changes were found in each synaptic structure parameter in group SGB (P ＞ 0.05).Compared with group O,the standard time was significantly shortened,the frequency of standard training was decreased,the width of synaptic cleft was decreased,the thickness of the post-synaptic density was increased,the length of active zones was prolonged,and the curvature of the synaptic interface was increased on 1,3 and 7 days after operation in group SGB (P ＜ 0.05).Conclusion The mechanism by which SGB improves the postoperative cognitive dysfunction in aged rats may be related to inhibition of changes of synaptic structure in hippocampal CA3 region.