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 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.

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.

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.

OBJECTIVETo observe and evaluate objectively the clinical effect of Guilong Tongluo Capsule (GTC) in treating chronic inflammatory demyelinating polyneuropathy (CIDP).

METHODSSixty CIDP patients were equally randomized into two groups. The treated group was administered with GTC and prednisone, while the control group with prednisone alone. Changes before and after 3-month treatment in terms of muscle force, functional and sensory disturbance of extremities, as well as scoring by Activity of Daily Living Scale (ADL) and electromyogram (EMG) for nerve conduction velocity were observed and compared.

RESULTSThe total effective rate gained in the treated group and the control group was 90.0% (27/30) and 70.0% (21/30) respectively, showing significant difference between them (chi2 = 14.82, P < 0.01). The improvement in the treated group was superior to the control group in muscle force of lower limb, motive and sensory function of extremities, ADL scores and motive function of ulnar nerve (P < 0.05, P < 0.01).

CONCLUSIONThe curative effect of GTC combined with prednisone in treating CIDP was better than that of prednisone alone.

Adolescent ; Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating ; drug therapy ; Prednisone ; therapeutic use ; Young Adult

Objective To affirm the expression of Toll like receptor 4 (TLR4) on the surface membrane of platelet and to explore the immunomodulatory factors[(interlukine-8(IL-8),β-thromboglobulin(β-TG), soluble CD40 ligand(sCD40L)] released by platelets after platelets stimulated by TLR4 ligand.Methods TLR4 expressed on the platelet was detected by flow cytometry. Monoclonal anti-human FcγRⅡantibody(Ⅳ.3)-treated human platelets were cultured with LPS in the presence or absence of blocking monoclonal antibody to human TLR4. The release of IL-8, β-TG, sCD40L were measured by specific enzymelinked immunosorbent assay. Results Human platelets could express functional TLR4. The detection rate of TLR4 on platelets were decreased after LPS involvement(P<0.01). It was noted that sCD40L and β-TG were present in large concentration in the release of platelets stimulated by TLR4 ligand but the release of IL-8 was independent of platelet activation after TLR4 engagement. The concentration of sCD40L and β-TG had no statistical difference between 1-5 μg/ml LPS. The effects of LPS on the modulation of secretory factors were attenuated by preincubation of platelets with an anti-TLR4 monoclonal antibody. Conclusion The TLR4 on platelet could recognize and link LPS, induce the release of sCD40L, β-TG by platelet, but could not influence IL-8.