Cervical artificial disc replacement (CADR) as a new method for the treatment of cervical spondylosis, is becoming a basic and clinical research. Compared with the anterior cervical discectomy and fusion (ACDF), the biggest difference of CADR lies in the reconstruction of the cervical vertebra height and physiological curvature, retaining the spinal physiological function maximally and reducing the degenerative changes in adjacent segments. A large number of clinical investigation have suggested that ACDR can become an operation method to replace the ACDF. However, the complications and the problems of prosthesis itself are gradually exposed, such as that the prosthesis, can't completely simulate the biological effects of human intervertebral disc, the other factors and including the operation methods and prosthesis itself. At the same time, the problem that how to prevent complications and problems is required to be solved. Whether, the effect of CADR on the activity of the operation segment, and the prevention of adjacent segment degeneration can be guaranteed for a long time has drawn more and more attention from scholars.
Cervical Vertebrae ; surgery ; Humans ; Postoperative Complications ; etiology ; Total Disc Replacement ; adverse effects

BACKGROUND:Combination of mid-third clavicle fracture with acromioclavicular joint dislocation is a rare injury. The internal fixation treatment of this injury remains controversial.
OBJECTIVE:To investigate the treatment of a rare injury of mid-third clavicle fracture combined with acromioclavicular joint dislocation.
METHODS:Three patients with mid-third clavicle fracture with acromioclavicular joint dislocation from 2005 to 2011 were analyzed retrospectively. The three patients were treated with clavicle anatomic locking plate+wire subcoracoid cerclage, clavicle anatomic locking plate+clavicular hook plate and clavicle anatomic locking plate+dual Endobutton plate coracoclavicular ligament reconstruction, respectively. The treatment effects of these three methods were compared, including the operation time, blood loss, and the shoulder function evaluation.
RESULTS AND CONCLUSION:One case was misdiagnosed as simple mid-third clavicle fracture. Al the three patients were fol owed-up for more than 12 months, and the clavicle fracture healed in al three cases. The internal fixators were moved out at 12, 9 and 11 months, the Endobutton plate was stil in the body, and no redislocation happened in al cases. The pain, daily function, activity and muscle strength were compressively assessed before and after internal fixator removal. The scores of the three patients were 64, 71 and 92 before surgery, and 68, 79 and 95 after surgery. Patient treated with double Endobutton and locking plate had the best recovery. Double Endobutton plus clavicle plate are good choice as internal fixation in the treatment of mid-third clavicle fracture combined with acromioclavicular joint dislocation.

BACKGROUND:Treatment of complex tibial plateau fracture is a difficulty in orthopaedic trauma. Comprehensive assessment and appropriate surgical plan before surgery are the key points of surgery.
OBJECTIVE:To investigate the application value of three-dimensional reconstruction and virtual surgical techniques in assessing and surgical planning of complex tibial plateau fracture before surgery.
METHODS:The CT scan data of 30 patients with tibial plateau fracture were imported into the Mimics 13.0 software to establish the three-dimensional digital models of complex tibial plateau fracture, and three-dimensional measurements and reclassification was performed according to three-column classification were made. Virtual surgeries such as bone window operation, reduction of the fracture and bone grafting were made in these models.
RESULTS AND CONCLUSION:Reconstructed three-dimensional digital models of complex tibial plateau fracture could indicate the characteristics of fracture accurately, could be observed at any direction, and could help doctors to reclassify the fracture according to three-column classification. Virtual surgeries of bone window operation, reduction of the fracture and bone grafting made in computer by Mimics 13.0 were confirmed to be vividly simulate the clinical surgery, and helpful in estimating the amount of bone grafting. Three-dimensional reconstruction and virtual surgical techniques play an important role in assessing and surgical planning of complex tibial plateau fracture before surgery, which should be a conventional step in the management of complex tibial plateau fracture.

Objective To determine the safety location of the bony tunnel in reconstruction of the coracoclavicular ligaments on the basis of digital characterization of the anatomy of the clavicle and coracoid process.Methods Unilateral shoulder spiral CT scan was conducted in 30 patients without injury to the clavicle or coracoid process.They were 15 men and 15 women,aged from 20 to 71 years old (average,49.3 years).Thirty 3D digital models of the clavicle and coracoid process were constructed using the CT scan data by Mimics13.0.Half of the models were of the left shoulder and half of the right.Anatomic measurements of the clavicle and coracoid process were carried out on these models.Virtual transclavicular-transcoracoid bony tunnels were established according to the anatomy of the conoid ligament.Parameters of these bony tunnels were measured before the safety location was calculated.Results The mean clavicular length was 147.70 ± 5.34 mm in males and 133.09 ± 6.61 mm in females; the distance between the lateral edge of the clavicle and the center of the conoid tuberosity (CCD) was 35.90 ± 3.16 mm in males and 30.48 ± 0.54 mm in females; the distance between the lateral edge of the clavicle and the center of the trapezoid tuberosity (CTD) was 22.68 ± 1.23 mm in males and 18.69 ± 1.65 mm in females,with significant differences between genders (P ＜ 0.05).There were no significant differences between male and female regarding the ratio of the CCD to the clavicular length,the ratio of CTD to the clavicular length,or the mean internal rotational angle of the coracoid process (P ＞ 0.05).According the attachments of the conoid ligament on the clavicle and coracoid,from the superior-posterior edge of the clavicle to the anterior midpoint of the coracoid basement,the bony tunnels were established.These tunnels nearly bisected the cross section of the clavicle and coracoid basement,35.23° ± 2.36° medially inclined to the sagittal section and 5.91° ± 2.14° posteriorly inclined to the coronal section of the body.Conclusions To ensure that the bony tunnel should pass through the center of the clavicle and coracoid,it should be drilled from the superior-posterior edge of the clavicle and located at the clavicular attachment of the conoid ligament,tilting about 35° medially and 6° posteriorly to aim at the anterior midpoint of the coracoid basement.

Objective To investigate the clinical and imaging features of Foot-Yangming meridian-muscle syndrome of knee osteoarthritis(KOA) so as to promote the normalization and standardization of the meridian-muscle therapies. Methods A total of 31 KOA cases (involving 31 knees) of Foot-Yangming meridian-muscle syndrome were included into the study group , and 31 healthy volunteers (involving 31 knees) served as the control group. A retrospective research of patellofemoral relationship was carried out based on the clinical and imaging features. Results The differences of Insall index and patella index between the study group and control group were insignificant(P> 0 . 05), but the differences of patellofemoral index , patellofemoral congruence angle, and external patellar angle between the study group and control group were significant(P<0.01). Conclusion The patellofemoral relationship disorder is one of main lesions in Foot-Yangming meridian-muscle syndrome of KOA.

OBJECTIVE To observe the effect of Qi Kwai Granule particles on the expression of in-terleukin 6 (IL-6), monocyte chemotactic protein 1(MCP-1) and transforming growth factor-β1(TGF-β1) in diabetic nephropathy(DN)rats and evaluate the protective effect of Qi Kwai Granule particles against renal injury of diabetic nephropathy. METHODS This experiment adopts adopted the high-sugar-high-fat diet and intraperitoneal injection of 2％ STZ+unilateral renal ligation to establish rat model of diabet-ic nephropathy.50 model rats were then randomly divided into model group,Irbesartan group,Qi Kwai Granule particles of high, medium, low dose group, 10 rats in each group. 10 normal rats were set as the sham operation group.Intragastric administration for 8 weeks were measured in rats.Measure the value of rat blood glucose by blood glucose meter,the determination of serum interleukin 6(IL-6)con-tent by ELISA, the expression of MCP-1 and TGF-β1by immunohistochemistry method. The value of rat blood glucose were measured by blood glucose meter.Serum interleukin 6(IL-6)were determinat-ed by ELISA.Expression of MCP-1 and TGF-β1were evaluated by immunohistochemistry method.RE-SULTS The blood glucose of Qi Kwai Granule particles of high,medium groups were decreased com-pared with those of the model group(P<0.05).The content of IL-6 of Qi Kwai Granule particles of high, medium groups were reduced(P<0.01). The content of MCP-1, TGF-β1in kidney of Qi Kwai Granule particles of high, medium, low dose groups were decreased (P<0.01). CONCLUSION Qi Kwai parti-cles have protective effect on renal tissue of diabetic nephropathy rats.Its mechanism might be related to the decrease of blood glucose value and IL-6,the inhibition of the expression of MCP-1 and TGF-β1.

Objective To study the different effects between intermittent eliminating white blood cells and immunosuppressive agents pulse therapy in children′s anaphylatoid purpura nephritis on the base of hormone′s treatment.Methods Twelve cases of anaphylatoid purpura nephritis were enrolled in the study and divided into 2 groups.After failure in the hormone′s treatment,the observation group was applied with intermittent eliminating white blood cells(5 mL/kg,1-2 times/week),and the control group was treated with immunosuppressive agents[cyclophosphamide(CTX) 0.8-1.0 g/m~2,or methotrexate(MTX) 8-10 g/m~2].Results There were no significant differences between the 2 groups.The observation group had no obvious side effects,but the control group all had different side effects.Conclusion The treatment of intermittent eliminating white blood cells can have better effects without the side effect resulting from immunosuppressive agents.

Adult ; Bronchoalveolar Lavage ; adverse effects ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; therapy ; Tachycardia, Sinus ; etiology

Objective To explore the application of diffusion tensor imaging in the assessment of ischemic muscle in hind-limb ischemia model of rabbit. Methods Excision of femoral artery in unilateral hind limb was done in 14 New Zealand white rabbits and ischemic model were established in 12 rabbits. Three (12 rabbits),10(10 rabbits) ,28(7 rabbits),56(5 rabbits) days after the model establishment, DTI scan was performed on bilateral hind limbs in each of the models, respectively and, λ_1,λ_2,λ_3, ADC and FA values were measured. Histological analysis was also performed at these time points. Pared t test was used to compare the differences of these indexes in bilateral hind limbs. Results Following femoral artery excision, a rapid ascending of ADC,λ_2,λ_3 values with sharply reduced FA value was observed in ligated hind-limb, which reached maximal on 3 days post-excision (ADC_(ligated)= 1.72±0.16, ADC_(unligated)= 1.53±0.16, t = 6.48, P < 0.01 ; λ_(2 ligated)= 1.70±0.15, λ_(2 unligated)= 1.51±0.06, t=10.87, P < 0.01 ; λ_(3 ligated_ =1.17±0.12, λ_(3 unligated)= 0.88±0.12, t=6.67, P < 0.01 ; FA_(ligated)= 0.24±0.04, FA_(unligated) =0.39±0.03, t = -10.61 ,P <0.01) and histologic analysis revealed the severest muscle damag at that time. Ischemic muscle recovered very slowly during the first 10 day post-excision accompanied with reduction of ADC , λ_2, λ_3 values, however there was also difference of ADC,λ_2, λ_3 values between ligated and nonligated limbs except λ_1 ( ADC_(ligated) = 1.65±0. 16, ADC_(unligated)= 1.50±0.12, t =6.42, P <0.01 ; λ_(2 ligated) = 1.62±0.32, λ_(2 unligated) =1.48±0.31, t=5.09, P < 0.01) ; λ_(3 ligated)= 1.11±0.13, λ_(3 unligated)= 0.85±0.09, t=6.26, P <0. 01;λ_(1 ligated)=2.20±0.21, λ_(1 unligated) =2.18+0.20, t=0.87, P=0.40). After 28 days, ADC and λ_3 returned to normal (ADC_(ligated)= 1.51±0. 16, ADC_(unligated)= 1.55±0.14, t=-1.35, P=0.23 ; λ_(3 ligated) =0.95±0. 10, λ_(3 unligated)= 0.92±0.06, t=1.70, P=0.14), but λ_2 and FA of ligated limb were still different from those of nonligated limb (λ_(2 ligated)= 1.45±0.23, λ_(2 unligated)= 1.52±0. 95, t=-3.56, P=0.012; FA_(ligated)=0.35±0.02, FA_(unligated)=0.40±0.03, t=-3.83, P<0.01). After 56 days, all parameters retuned to normal(ADC_(ligated) =1.57±0.18, ADC_(unligated)=1.58±0.23, t=-0.71, P=0.52; λ_(1 ligated) =2.18±0.18, λ_(1 unligated)=2.24±0.14, t=-0.22, P=0.10; λ_(2 ligated)=1.64±0.13, λ_(2 unligated)=1.59±0.15, t=0.89, P=0.42; λ_(3 ligated)=0.89±0.1,λ_(3 unligated)=0.91±0.07, t=- 1.64,P= 0.18; FA_(ligated)= 0.39±0. 03, FA_(unligated)= 0.41±0.02, t=-0.83, P=0.47). Conclusion DTI is a quantitative and relatively accurate technique to assess time-dependent changes of ischemic muscle in hindlimb ischemia model of rabbit.

Objective To systematically evaluate the safety of high dose atorvastatin (80 mg daily) in Chinese patients. Methods Randomized controlled trials (RCTs) investigating 80 mg/ d atorvastatin vs. low-dose atorvastatin or placebo or blank were electionically retrieved in date bases of EMbase, PubMed, the Cochrane Library, WanFang, CNKI and WeiPu. Meta-analysis was performed using RevMan 5. 2 and Stata 11. 0 software. Results A total of 20 RCTs involving 2282 cases were included. The results of meta-analysis showed no significant differences betweent the 80 mg/ d atorvastatin group and the control group in the incidence of gastrointestinal adverse events (RR 1. 53, 95% CI 0. 85-2. 76, P = 0. 16), hepatic adverse events (RR 1. 53, 95% CI 0. 99 - 2. 36, P = 0. 05), muscular adverse events (RR 1. 51, 95% CI 0. 92 -2. 49, P = 0. 10), serious hepatic injuries ( RR 2. 33,95% CI 0. 88 - 6. 20, P = 0. 09) and serious muscular myopathies (RR 1. 40, 95% CI 0. 46 - 4. 30, P = 0. 56). Subgroup analysis by type of cotrast media used and durations of taking 80 mg/ d atorvastatin showed there were higher risks of gastrointestinal adverse events in the 80 mg/ d group when compared to blank control ( RR 4. 22, 95% CI 1. 11 - 16. 04, P = 0. 03). Conclusions The current evidence shows that 80 mg / d atorvastatin may be relatively safe in terms of adverse events in gastrointestinal tract, liver and muscular system, and relatively has risk in causing severe liver injuries and myopathies. With limited quantity and quality from the RCTs available, more high quality RCTs are needed to verify the above conclusion.