Objective To investigate the effect of single bundle anatomic reconstruction of the anterior cruciate ligament (ACL) with the hamstring autograft through anteromedial approach. Methods From January 2012 to Jan-uary 2014, 39 patients with ACL tore had been treated with single bundle anatomic ACL reconstruction with the hamstring autograft. In this group, 20 males and 19 females, 16 cases of the left knee and 23 cases of the right knee;including 27 cases of sports injuries, 5 cases of traffic accident injury and 7 cases of fall injury.8 cases were acute injury the others were old injury. 22 cases were had the meniscus injury. All patients were treated with single bundle anatomic ACL reconstruction with the hamstring autograft. The femoral tunnel was establish through the anteromedial approach. The medial meniscus suture was performed in 10 cases, partial resection in 2 cases, lateral meniscus su-ture in 9 cases, partial resection in 1 cases. The hamstring autograft was fixed with the RIGFIX system in the femoral tunnel and the BIOSURE SYNC in the tibia tunnel. The Lysholm score was used to evaluate the recovery of knee function, and the MRI score was used to evaluate the integraty of the grafts. Results All cases were followedup for 15 to 39 months with an average of 21.5 months. All cases had no vascular nerve injury, joint stiffness, infec-tion and other complications. All cases had good stability after 1 year and recover to normal sports after six months and intense sports after half past a year postoperation. The anterior drawer test and the Pivot shift tests were negative in all patients. The Lacheman test wasⅠin 1 patient and others were negative. The mean Lysholm score was (93.85± 4.33) which significantly increased compared with preoperative scores which was (36.84 ± 5.60) after 15 months (P <0.05). The MRI showed good maturity and normal morphology of the ACL autograft, the MRI score was (9.80 ±1.70) after 1 year postoperation. Conclusion The arthroscopic single bundle individual anatomic ACL reconstruction with hamstring autograft through anteromedial approach is effective, simple to perform and gives a graft the same as nor-mal anatomy. The grafts revascularization is good and effectively restore the stability of the knee.

BACKGROUND:The surgical management to reconstruct the stability in lumbosacral region is very chal enging. There are many techniques to reconstruct the stability of the lumbosacral region, but the internal fixation loosening, fracture and pseudoarthosis are not uncommon. OBJECTIVE:Finite element analysis was used to analyze the stability of two types of reconstruction procedures and the stress of the internal fixation system. METHODS:A 64-slice spiral CT scan was used in a subject from L1 to pelvis. The scan data were imported into the Mimics 15.0 software to generate a three-dimensional surface model. The three-dimensional solid model was established using in the SolidWorks software. The solid geometry model of the L3, 4 pedicle screws combined with single iliac screw fixation and L3,4 pedicle screws combined with dual iliac screws and anterior titanium mesh cage support fixation were constructed by the Solidworks software. Two kinds of reconstruction procedures were simulated. The models were given material properties and analyzed by using the ABAQUS software. RESULTS AND CONCLUSION:(1) The maximum stress was 195.3 MPa in the complete model, 189.5 MPa in single iliac screw model, and 149.2 MPa in dual iliac screw+titanium cage model when constrained the roof of double acetabulum and applied a vertical load of 1 000 N. (2) The axial compression rigidity was 551.572 N/mm in the complete model, 613.87 N/mm in the single iliac screw model and 1 683.50 N/mm in the dual iliac screw+titanium cage model. (3) The bending rigidity of the dual iliac screw+titanium cage model was bigger than other models at 6 directions when applied 7 N?m bending loads. The maximum stress of single iliac screw model was bigger than other models. (4) The results suggest that the dual iliac screw+titanium mesh cage reconstruction can effectively restore the stability of the lumbosacral area. The stress of internal fixation system is smal er and more dispersed. There is obvious stress concentration in the connecting rod and the tail of the single iliac screw. The single iliac screw internal fixation system is easy to fatigue fracture and loosening.

Objective To retrospectively analyze the surgical methods and efficacy in 70 cases of type A aortic dissection patients over 65 years old.Methods From January 2005 to May 2012,70 type A aortic dissection patients over 65 years old received surgical treatment.Among them,there were 47 males aged 65 to 78 years old with mean 71,23 females,aged 65 to 72 years old with mean 68.55 cases were acute onset,while 15 cases were chronically onset.Different surgical methods were selected depend on patients' situations.We followed up all patients after discharged from hospital to continue to observe their health situation and evaluate the therapeutic effects.Results After surgery,eight patients died in the hospital,62 patients were recovered and discharged from the hospital.The mortality rate is 11.4％.During the follow up period from 3 to 72 months,there were no dead,aneurysm rupture and others severe complications.9 cases received endovascular graft exclusion within 6 months after discharged from hospital.The survival patients were satisfactory healed with their daily living activity resumed.Conclusion For over 65 years old patients with aortic dissection,the accurate and rapid selection of surgical method could improve the survival rate and the quality of life with a lower occurrence rate of complications.

In current study of femoral head necrosis and femoral neck fractures, more attentions has been paid to relationship between the femoral head trabecular bone within the spatial structure and its biomechanics. In this connection, PMMA (polymethyl methacrylate), special square iron, dental base acrylic resin liquid and powder were used to embed and fix human dry femur. Then, M618 Lie Axle Rectangle Desk Plane Grinding Machine was applied to grind the femur specimen, and then air blower clean, two-dimensional cross section image was obtained by using scanner. With Mimics software reconstruction, a three-dimensional model of spatial structure of trabecular bone was obtained, and the trabecular bone three-dimensional parameters were calculated. The authors obtained clear three-dimensional model of trabecular bone, reconstructed the real anatomic morphology of proximal femur. This is a good method to research into the interior structure of femur and to provide the foundation for the three-dimensional finite element analysis.
Biomechanical Phenomena ; Compressive Strength ; Computer Simulation ; Femur ; anatomy & histology ; diagnostic imaging ; physiology ; Finite Element Analysis ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; methods ; Models, Anatomic ; Radiography

OBJECTIVETo compare thoracoscopic esophagectomy with traditional esophagectomy in radical mediastinal lymphadenectomy for esophageal cancer, and to explore the feasibility and safety of thoracoscopic mediastinal lymphadenectomy for esophagectomy.

METHODSClinical data associated with perioperation and mediastinal lymph nodes clearance of 304 patients undergoing radical operation of esophageal cancer via left neck-right chest-upper abdomen in our department from June 2009 to June 2011 were analyzed retrospectively. Among 304 cases, 199 received traditional open radical resection and 105 thoracoscopic esophagectomy. The intrathoracic mediastinal lymph node metastasis rate, extent of metastasis, time of operation, blood loss and complications between two groups were compared.

RESULTSAll the 304 cases completed their operations successfully. A total of 3724 mediastinal lymph nodes were removed, mean 12.3±7.0 per case, including 1065 in thoracoscopic group, mean 10.1±5.5 per case, and 2659 in open group, mean 13.3±7.5 per case, whose difference was significant. But further analysis according to the postoperative pathologic staging showed no significant difference of above lymph nodes removed between two groups. Mediastinal lymph node metastasis was found in 126 patients with a rate of 41.4%, which was 35.6% and 44.7% in thoracoscopic and open groups respectively without significant difference(P>0.05). The left laryngeal recurrent nerve lymph node metastasis rate in open group and thoracoscopic group was 16.1% and 6.7% respectively, and the difference was significant(P<0.05). Differences of lymph node metastasis rate in other regions were not significant between the two groups. There were 365 positive lymph nodes, and the lymph node metastasis degree was 9.8%. which was 8.2% and 10.5% in thoracoscopic group and open group respectively(P<0.05), besides metastasis degree of open group was much higher in right laryngeal recurrent nerve and subcarinal lymph node region. The overall complication rate was 36.8%, which was 28.6% in thoracoscopic group and 41.2% in open group respectively with significant difference(P<0.05). There were no significant differences in operative time and blood loss between the two groups(both P>0.05).

CONCLUSIONRadical mediastinal lymphadenectomy with thoracoscopic esophagectomy is technically safe and feasible for early to moderate stage esophageal cancer with similar lymph nodes removed and lower complication morbidity. In the early period of carrying out thoracoscopic radical mediastinal lymphadenectomy, laryngeal recurrent nerve and subcarinal lymph node region should be identified to prevent incidental injury.

Blood Loss, Surgical ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; methods ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Mediastinum ; pathology ; Operative Time ; Retrospective Studies

Objective:To investigate the characteristics and associated factors of depression in elderly patients with Parkinson's disease(PD).Methods:A total of 1138 elderly PD patients from Xuanwu Hospital of Capital Medical University were consecutively enrolled.The Hamilton Depression 17-item Scale(HAMD-17)was used to diagnose depression(scores ≥14). The depressive characteristics of PD patients with depression and those without depression were compared, and Logistic regression model was used to analyze the clinical risk factors of depression in PD patients.Results:Among the 1 138 PD patients, 233 cases had depression.The incidence of depression in PD patients was 20.5%, and the treatment rate was only 6.0%(14 cases). The main symptoms of depression in PD patients included sleep disturbance(101 cases, 43.3%), depression(57 cases, 24.5%), work and interest loss(49 cases, 21%). Compared to PD patients without depression, PD patients with depression were more likely women(49.4% vs36.3%), and had lower cognitive scores[(25.56 ± 4.22)scores vs(27.07 ± 3.08)scores], higher rate of freezing of gait(51.0% vs24.0%), higher incidence of disability(87.1% vs28.5%)( P<0.05). A comparison of each part of the unified Parkinson's disease rating scale(UPDRS)between the two groups revealed that the scores of activities of daily living[(16.52 ± 8.71)scores vs(10.15 ± 5.48)scores], the motor examination[(33.78 ± 19.48)scores vs(22.87 ±13.08)scores]and the complications of therapy[2.0(0.0, 6.0)scores vs0.0(0.0, 2.0)scores]were higher in the PD patients with depression group than in the PD patients without depression group( P<0.05). Logistic regression analysis showed that women( OR=1.532, 95% CI: 1.073-2.187, P=0.019), disability( OR=6.357, 95% CI: 4.399-9.186, P<0.001), activities of daily living evaluated by UPDRS( OR=1.093, 95% CI: 1.043-1.146, P<0.001)and motor complications( OR=1.100, 95% CI: 1.014-1.193, P=0.022)were independent risk factors for PD depression. Conclusions:Depression was common in PD patients and usually manifested as sleep disturbance and low motivation, women, motor complications, disability and decreased quality of daily living were independent risk factors for depression.

Objective To grasp the general situation of patent application and authorization of 77 medical and health institutions in Zhejaing,to provide reference and basis for promoting the patent application and conversion.Methods Patent data were searched through Bai Teng net patent database,and SPSS 19.0 was used for statistical analysis.Results The total number of patent application showed a trend of generally rise.There were 1430 valid invention patents in total,among which 264 were invention patents and 1166 utility model patents.The total number of patens as well as invention patents were positive correlated to province GDP GDP and doctors per thousand population (r=0.824,0.812,0.784,0.771 respectively,P＜0.001).The rate of collaborative patent application was 6.28％,and there was a significant difference (α=0.05/3,P＜0.001) in the collaborative patent applications around Hangzhou,provincial and other cities medical and health institutions.Conclusions The total number of patents in 77 medical and health institutions in Zhejaing has reached a certain scale,and the number of patents increase with the economic development and the number of doctors per thousand population.The effective patents present in concentrating in regions,and the proportion of invention patents was low.

Objective To compare thoracoscopic esophagectomy with traditional esophagectomy in radical mediastinal lymphadenectomy for esophageal cancer , and to explore the feasibility and safety of thoracoscopic mediastinal lymphadenectomy for esophagectomy. Methods Clinical data associated with perioperation and mediastinal lymph nodes clearance of 304 patients undergoing radical operation of esophageal cancer via left neck-right chest-upper abdomen in our department from June 2009 to June 2011 were analyzed retrospectively. Among 304 cases, 199 received traditional open radical resection and 105 thoracoscopic esophagectomy. The intrathoracic mediastinal lymph node metastasis rate , extent of metastasis, time of operation, blood loss and complications between two groups were compared. Results All the 304 cases completed their operations successfully. A total of 3724 mediastinal lymph nodes were removed, mean 12.3±7.0 per case, including 1065 in thoracoscopic group, mean 10.1±5.5 per case, and 2659 in open group, mean 13.3 ±7.5 per case, whose difference was significant. But further analysis according to the postoperative pathologic staging showed no significant difference of above lymph nodes removed between two groups. Mediastinal lymph node metastasis was found in 126 patients with a rate of 41.4%, which was 35.6% and 44.7% in thoracoscopic and open groups respectively without significant difference (P>0.05). The left laryngeal recurrent nerve lymph node metastasis rate in open group and thoracoscopic group was 16.1% and 6.7% respectively , and the difference was significant (P<0.05). Differences of lymph node metastasis rate in other regions were not significant between the two groups. There were 365 positive lymph nodes , and the lymph node metastasis degree was 9.8%. which was 8.2% and 10.5% in thoracoscopic group and open group respectively (P<0.05), besides metastasis degree of open group was much higher in right laryngeal recurrent nerve and subcarinal lymph node region. The overall complication rate was 36.8%, which was 28.6% in thoracoscopic group and 41.2% in open group respectively with significant difference (P<0.05). There were no significant differences in operative time and blood loss between the two groups (both P>0.05). Conclusion Radical mediastinal lymphadenectomy with thoracoscopic esophagectomy is technically safe and feasible for early to moderate stage esophageal cancer with similar lymph nodes removed and lower complication morbidity. In the early period of carrying out thoracoscopic radical mediastinal lymphadenectomy, laryngeal recurrent nerve and subcarinal lymph node region should be identified to prevent incidental injury.

Objective:To examine the short-term outcomes of modified load-sharing rip-stop repair (mLSRS) and suture-bridge repair (SB) for large rotator cuff tear.Methods:The clinical data of patients who underwent shoulder arthroscopy for large rotator cuff repair at Department of Orthopedic, China Academy of Chinese Medical Sciences Wang Jing Hospital from January 2017 to December 2018 were collected. Totally 111 patients (39 in mLSRS group and 72 in SB group) were included in the study. There were 45 males and 66 females, aged (58.0±6.9)years (range: 40 to 72 years).A total of 39 pairs of patients were successfully matched by propensity score matching. The pain of shoulder joint was assessed by visual analogy score (VAS) , the shoulder function was assessed by Constant-Murley score, the abduction strength of bilateral shoulder joint was assessed by 90? force assessment method of upper limb on the plane of scapula, and the healing of rotator cuff on the operative side was assessed by sugaya ultrasonic classification standard. The difference of short-term outcome between the two groups were compared using t test, χ 2 test, Mann-Whitney U test, repeated measures design anova and multivariate analysis of variance. Results:At the 4th week after surgery, the VAS of mLSRS group was significantly lower than SB group(1 (2) vs. 2 (2) , F=5.32, P=0.02). One year after surgery, Constant-Murley score of two groups were significantly higher than those before surgery, but there was no significant difference between two groups(89.1±5.7 vs. 87.6±7.3, t=1.00, P=0.32). Abductor strength of affected limbs were lower than that of the opposite side, but there were no statistically significant differences between two groups(4.28±1.61 vs. 4.54±1.64, t=-0.70, P=0.49). According to the Sugaya classification, 32 cases in mLSRS group were healed while 7 cases were not healed,30 cases in SB group were healed while 9 cases were not healed(χ 2=0.32, P=0.58). Conclusion:The use of mLSRS fixation construct on large rotator cuff tear can reduce pain and the short-term outcome is reliable.