Objective To establish a ten-zone divisional method of the knee joint and investigate its clinical application to arthroscopic total synovectomy for rheumatoid arthritis (RA). Methods A total of 22 fresh frozen specimens of adult knee joints were prepared for anatomical study on the sagittal septum of the knee to establish ten-zone divisional method of the knee joint. A retrospective study was carried out on 37 patients with early-stage RA (40 knees) undergone arthroscopic total synovectomy. Among the cases,15 knees were operated according to ten-zone divisional method; and the other 25 were treated with the routine method. The patients were followed up for 10-72 months to evaluate their Lysholm score,Lequesne Index,and Larsen stage classification. Results There was a sagittal septum in the knees,connecting anteriorly to the fat pad,alar fold,or mucous ligament. The middle part of the sagittal septum lied between the anterior and posterior cruciate ligaments,and its posterior part formed the posterior septum of the knee. Considering the anatomy of the sagittal septum,the synovium of the knee could be divided into 10 zones. All of the patients underwent total synovectomy by ten-zone divisional method achieved excellent or good outcomes (100%,15/15),none of them recurred during follow-up. Among the 25 knees that received total synovectomy by routine arthroscopic method,17 achieved excellent or good outcomes (68%,17/25),and 8 had recurrence (Fisher's exact test,P=0.016). Conclusions Arthroscopic total synovectomy was one of the effective treatments for early-stage RA. The ten-zone divisional method for total synovectomy according to the structure of the knee sagittal septum could improve the clinical results of total synovectomy for rheumatoid arthritis.

Objective To observe the influence of rizatriptan on the behavior and pain-related cytokines in peripheral blood of the migraine model rats, and to investigate the theraputic effect of rizatriptan on migraine.Methods A total of 24 rats were randomly divided into:control group,migraine group,rizatriptan control group and rizatriptan treatment group.The rats in rizatriptan control and rizatriptan treatment groups were intragastrically perfused with rizatriptan,1 mg·kg-1 per day (according to the adult daily dose),and the rats in control and migraine groups were perfused with normal saline,1 mL per day. After 7 d, nitroglycerin was subcutaneously inj ected into the buttocks of the rats in rizatriptan treatment and migraine groups to induce migraine.Normal saline was injected into the rats in control and rizatriptan control groups.At 60-90 min following nitroglycerin injection,the total number of behavioral symptoms was measured.The serum calcitonin gene-related peptide(CGRP),5-hydroxytryptamine (5-HT ), interleukin-1β(IL-1β), and tumor necrosis factor-α(TNF-α) levels were determined using ELISA. Results Compared with migraine group, the behavioral score of the rats in rizatriptan treatment group was significantly decreased (P<0.05).The serum CGRP level of the rats in migraine group was significantly higher than that in control group (P<0.05).Compared with control group,the serum 5-HT level of the rats in and migraine group was decreased, but there was no significant differece (P>0.05 );the serum 5-HT level in rizatriptan control group was significantly increased(P<0.05).The serum 5-HT level of the rats in rizatriptan treatment group was significantly increased compared with migraine group (P<0.05).The serum IL-1βand TNF-αlevels of the rats in varions groups had no significant differences (P>0.05).Conclusion Rizatriptan can relieve the behavior symptoms in nitroglycerin-induced migraine model rats, increase the serum 5-HT level, improve the vasomotor disturbance,and relieve the angiectasis.

Objective To investigate the assessment of multi-detector spiral CT on the cardiac function after bioprosthetic valve replacement with mitral valve preservation.Methods Thirty-five patients suitable for undergoing bioprosthetic mitral valve replacement in our hospital from May 2012 to February 2014 were randomly divided into 2 groups:group A(experimental group,intraoperative preservation of mitral valve and subvalvular structure during,n=16) and group B (control group,without intraoperative preservation of subvalvular structure of mitral valve,n=19).MDCT before operation and on postoperative 10 d was performed for evaluating the left ventricular function.Results In the comparison of preoperative MDCT,the end diastolic velocity(EDV),end systolic velocity(ESV),ejection fraction(EF) and stroke volume(SV) had no statistical difference between the group A and B.In MDCT results on postoperative 10 d,EDV,ESV and EF in the group A were 113.42±9.22)mL,(38.63±3.40)mL and (51.63±4.71) ％,which in the group B were(113.42 ± 9.22) mL,(38.63 ± 3.40) mL and (51.63 ± 4.71) ％ respectively,the difference was statistically significant(P＜0.05),but SV had no statistical difference between the two groups(P＞0.05).Conclusion The bioprosthetic valve replacement with mitral valve preservation is safe and feasible in technology,moreover effectively protects the postoperative left ventricular function.

Objective To observe the formation of autophagosome,the expression and distribution of autophagy-related protein LC3-Ⅰ,LC3-Ⅱ and Beclin-1 in adriamycin nephropathy rats at different pathological periods,to explore the relationship between autophagy and renal tissue injury,the occurrence of proteinuria,the progression of renal disease.Methods Sixty normal male SD rats were randomly divided into control group (n=30) and model group (n=30),the rats in model group were injected with adriamycin(6.5 mg/kg) via tail-vein for one time,while the rats in control group were injected with saline.Urine protein quantitation of 24 hour,the levels of serum albumin and total cholesterol were measured serially at the 2,4,6,8,10 weeks.The changes of kidney tissue pathology were detected after HE,PAS and Masson staining by light microscope.The formation of autophagy were detected by transmission electron microscopy,the localization and distribution of LC3-Ⅰ,LC3-Ⅱ and Beclin-1 were detected by indirect immunofluorescence staining in kidney tissue,the autophagy-related proteins LC3-Ⅰ,LC3-Ⅱ and Beclin-1 expression was detected by Western blotting.Results In model group,urinary protein began to increase at the first two weeks,serum albumin decreased at the same time,and total cholesterol increased in the four weeks.There was a statistically significant difference compared with the control group (P ＜ 0.01).The Scr and BUN were increased slightly at the four weeks in model group,and showed the deterioration of renal function after the eight weeks.There was a statistically significant difference compared with the control group (P ＜ 0.01).Mesangial cell proliferation,mitochondrial swelling and foot process broadening and integration appeared early in the model group,while foot process disappearing and nuclear pyknosis were observed in the late by transmission electron microscope;Renal pathology gradually changed from mesangial proliferation to focal segmental glomerulosclerosis (FSGS) by light microscope.A low expression of autophagy was detected in renal tissue of control group rats by transmission electron microscopy and immunofluorescence microscope;in model group,with the progression of disease,the autophagy was significantly enhanced and maintained at a high level.With the progression of disease,the autophagyrelated proteins LC3-Ⅰ,LC3-Ⅱ and Beclin-1 was significantly enhanced in the model group than the control group (P＜0.05).Conclusion Autophagy is involved in renal tissue injury and the occurrence of proteinuria,closely related to the progression of renal disease.

At present, the existing problem in nasal feeding perfusion apparatus is laborious and instability. Designing the rolling type perfusion apparatus by using a roller pump, the problem is solved. Compared with the traditional perfusion apparatus, the advantage lies in liquid carrying only need once and simulating human swallowing process. Through testing and verification, the apparatus can be used in nasal feeding perfusion for elderly or patients.
Aged ; Enteral Nutrition ; instrumentation ; Humans ; Nose ; Surgical Tape

Objective To detect the expression of BclGL in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE) and to investigate its significance.Methods Peripheral blood was obtained from 20 patients with active SLE (A-SLE),18 patients with inactive SLE (Ⅰ-SLE) and 30 healthy controls.Flow cytometry was performed to calculate the number of PBMCs,flow cytometry combined with annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining to determine the early apoptotic rates of PBMCs,fluorescence-based quantitative PCR and Western blot to measure the expression of BclGL mRNA and protein,respectively.The serum level of interferon (IFN)-α was determined by enzyme-linked immunosorbent assay (ELISA).Data were analyzed by using the software SPSS13.0.Mann-Whitney U-test or Kruskal-Wallis test was used for group comparisons.Pearson correlation coefficient test was applied to evaluate the relationship of BclGL expression with cell apoptotic rate and some clinical parameters.Results The number of PBMCs was significantly lower in patients with A-SLE than in those with Ⅰ-SLE and healthy controls ((0.16 ± 0.06) × 109/L vs.(0.27 ± 0.14) × 109/L and (0.34 ± 0.23) × 109/L,both P ＜ 0.01).Increased apoptotic rate of PBMCs was observed in patients with A-SLE compared with those with Ⅰ-SLE and healthy controls ((22.6 ± 1.1)％ vs.(16.4 ±0.9)％ and (10.1 ± 0.4)％,both P ＜ 0.01),and in patients with Ⅰ-SLE compared with the healthy controls (P ＜0.01).The mRNA and protein expressions of BclGL in PBMCs were both significantly higher in patients with ASLE than in those with Ⅰ-SLE and healthy controls (all P ＜ 0.01).A significant increase was observed in serum IFN-α level in the patients with SLE compared with the healthy controls ((32.5 ± 2.2) μg/L vs.(15.5 ± 1.3) μg/L,P ＜ 0.01).The mRNA expression of BclGL in PBMCs from patients with SLE was positively correlated with the apoptotic rate in PBMCs (r =0.486,P ＜ 0.01),SLE disease activity index score (r =0.496,P ＜ 0.01),titers of antinuclear antibodies (r =0.516,P ＜ 0.01) and serum IFN-o level (r =0.535,P ＜ 0.01),but was negatively correlated with complement C3 level (r =-0.515,P ＜ 0.01).Conclusions The increased expression of BclGL in PBMCs may contribute to the abnormal apoptosis in PBMCs,which in turn takes part in the pathogenesis of SLE.

Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction.

Objective To evaluate the effect of gabapentin for treatment of neuropathic pain induced by bilateral sciatic nerve chronic constriction injury (bCCI) of rats.Methods Forty-eight female SPF Sprague-Dawley rats,weighing 180-200 g,aged 7-9 weeks,were randomly divided into 4 groups (n =12 each) using a random number table:control group (C group),sham operation group (S group),bCCI group,and bCCI + gabapentin group (G group).Gabapentin 100 mg/kg was intraperitoneally injected once at 15 min before operation and twice a day during 7-13 days after operation for 7 consecutive days.The bilateral mechanical paw withdrawal threshold (MWT),thermal paw withdrawal latency (TWL) and number of cold-stimulated paw withdrawal were measured before operation (baseline) and at 1,3,6,8,10,14 days after operation.Results Compared with C group,the bilateral MWT was significantly decreased,and the bilateral TWL was shortened in bCCI and G groups,and no significant change was found in MWT and TWL in S group.Compared with bCCI group,the bilateral MWT was significantly increased,the bilateral TWL was prolonged,and no significant change was found in the number of cold-stimulated paw withdrawal in G group.Conclusion Gabapentin can relieve thermal and mechanical hyperalgesia induced by bCCI,however,it exerts no effect on cold allodynia in rats.

The operation path, lymph node dissection and reconstruction of the alimentary tract are the three most technical difficulties of laparoscopy-assisted gastrectomy. The essential difference between laparoscopy-assisted gastrectomy and open gastrectomy is the operation path. Based on our clinical experience, we investigated reasonable paths for laparoscopyassisted gastrectomy. Patients were placed in a supine position with their legs apart, and the operator stood on the left side of the patient. Five trocars were placed in the abdominal wall in a curved line. The operation was carried out in the order of greater gastric curvature, the lower region of the pylorus and antrum,the upper region of the pancreas, omentum minus, cardia, and arcuate diaphragm. From May 2004 to April 2010, we successfully carried out 761 laparoscopy-assisted gastrectomies with satisfactory outcomes.

Objective To investigate the efficacy of balloon dilatation in the treatment of traumatic biliary stricture(TBS).Methods Eighty-one patients with TBS who had been admitted into General Hospital of Chengdu Command from February 1997 to February 2007 were divided into 2 groups.In the control group,40 patients underwent choledoco-jeiunostomy with T tube stenting in the anastomotic stoma for 6 months.In the balloon dilatation group,41 patients received implantation of the balloon catheters along with the two arms of the T tube in the anastomotic stoma.The efficacy of different surgical procedures were analyzed by chi-square test.Results Seven patients in the control group were failed with a failure rate of 18%.Of the 7 palients,6 were transferred to receive balloon dilatation and 5 were cured.In the balloon dilatation group,only 1 patient was failed and the failure rate was 2%.The diameter of the anastomotic stoma ilq the balloon dilatation group was dilated gradually to 12 mm in 3 months.The difference upon the success rate of the operation between the 2 groups had statistical significance (x2=5.10,P＜0.05).Conclusions Balloon dilatation is effective in the treatment of TBS.