Objective To study the effect of articular step-off on knee joint contact pressures in fractures of the medial tibial plateau. Methods Eight specimens of embalmed adult knee joint were used to establish models of articular step-off of the medial tibial plateau by 0,1,2,3 mm respectively (Schatzker Ⅳ fracture) .The technique of pressure sensitive film was used to measure the contact pressures on the weight-bearing area of the knee joint in the 3 models. Results When the step-offs of medial tibial plateau were 0,1,2,3 mm,the average contact pressures on the lateral compartment were respectively 3.34 ± 0.06 MPa,3.48 ± 0.06 MPa,4.19 ± 0.05 MPa,4.19 ± 0.04 MPa,while the average contact pressures on the medial coMPartment were 4.04±0.17 MPa,4.57±0.20 MPa,5.64±0.20 MPa,5.64±0.19 MPa.When the step-off of medial tibial plateau was 2 mm,the average contact pressures on the medial and lateral plateaus increased by 39.6％ and 25.4％ compared with the 0 mm step-off,with statistically significant differences (P ＜0.05). Conclusions If the step-off of the medial tibial plateau reaches ≥ 2mm,open reduction and internal fixation should be indicated to prevent secondary traumatic arthritis.When the step-off of the medial tibial plateau is ＜ 2 mm,conservative treatment can be a proper choice.

Objective To investigate whether TNF-α can promote, but TGF-β can reduce Gli2 expression in primary leukemia cells. Methods (1)Western blot was used to detect Gli2 protein expression in leukemic cells. (2)Primary leukemia cells were treated with TGF-β1 or TNF-α,and expressions of Gli2 and TGF-βR were detected. (3)Primary leukemia cells were treated with TGF-β1,TNF-α or/and SIS3, and Gli2 protein expression was detected. Results (1)The primary leukemia cells could express Gli2 protein. (2)Significant reduction of Gli2 mRNA was observed in 1 ~ 10 ng/mL TGF-β1-treated primary leukemia cells for 12 ~ 24 h, No significant differences of Gli2 mRNA was found between the control group and TNF-α group. (3)Protein expresson of TGF-βRⅠand TGF-βRⅡ in 5 ng/mL TNF-α-treated primary leukemia cells for 24 h was higher than that of the control group. (4)Gli2 portein expression was lower in TGF-β1 with or without TNF-α-treated primary leukemia cells for 24 h than that in the control group, and Gli2 portein expression in the TGF-β1 plus TNF-α group was lower than that in TGF-β1 group. Conclusion Combinations of TGF-β and TNF-α can efficiently inhibit Gli2 expression than TGF-β alone in primary leukemia cells.

Objective To isolate and identify differential expression genes associated with multidrug resistance of leukemia . Methods Differential expression genes between leukemia cell line K 562 and resistant cell lines K562/DOX were isolated by using suppression subtractive hybridization (SSH) technique .Total RNA were extracted .cDNA were synthesized and digested by restric-tion enzyme Rsa Ⅰ ,then connected with adopter1 and adopter2R ,and linked with pMD19-T vector .Constructed vectors were trans-ferred into E .coli .Subtracted cDNA library was constructed ,and the positive clones were screened according to base sequences and homologous sequences .The differential expression genes were indentified by comparison analysis of Gene Bank database .Results A total of 220 differential expression genes were sequenced ,including hemoglobin ,ribosomes and mitochondria related genes ,and heat shock factor binding protein 1 (HSPB1) gene and other genes .Conclusion SSH method and molecular cloning technique could be used to construct subtracted cDNA library of differential expression genes between drug resistant and not -resistant leukemia cells , which might be useful for further screening and cloning of differential expression genes of multidrug resistant tumor cells .

OBJECTIVETo study the effectiveness of pie-crusting technique in improving the stiff knee.

METHODSFrom February 2012 to December 2013, 13 patients with stiff knee were reviewed retrospectively. There were 6 males and 7 females, ranging in age from 39 to 70 years old (averaged, 55.6 years old). Of the 13 cases, 8 patients had stiffness following fracture (comminuted tibial plateau fracture in 4, femoral supracondylar fracture in 3 and patellar fracture in 1), 5 patients had TKA-related stiffness.

RESULTSA follow-up lasted 8 to 12 months (mean 10 months)in 13 cases. The mean maximum flexion increased from (37 ± 6)° preoperatively to (52 ± 7)° after arthrolysis, and (108 ± 7)° after pie-crusting. At the final follow-up, mean maximum flexion was (105 ± 6)°. According to Judet evaluation system, 10 patients got an excellent result and 3 good. No major complications, such as extensor lag, skin necrosis, deep infection, dislocation of the patella or recurrent stiffness were found.

CONCLUSIONThe percutaneous technique of pie-crusting is a simple, minimally invasive and effective treatment for knee stiffness.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Joint Diseases ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Range of Motion, Articular ; Treatment Outcome

Standardized rotary residency training is an important part of clinical medical education. Traditional clinical teaching can't meet the rapid development of oncology medicine. In the rotary residency training in oncology department, we put forward the problems encountered in clinical practice, stimulate the interest and initiative of residence, the PBL teaching model is combined with the evidence-based medicine in the teaching process through the relevant training, literature review and discussion. By standardizing the treatment concept the residence's understanding of the basic theory and frontier knowledge of oncology was improved, the thinking innovation and clinical practice ability of the residency doctors were enhanced.

Objective To explore the safety and applicability of a temporary protective ileostomy that closes itself in the prevention of anastomotic leakage following anterior resection after chemoradiation for rectal cancer.Methods From Oct 2010 to Oct 2013,54 cases of middle or low rectal carcinoma were admitted.Protective ileostomy was created to prevent anastomotic leakage.Patients were divided into two groups receiving respectively intubation ileostomy (group A,28 cases),and conventional ileostomy (group B,26 cases).Results The mean time for anus to restore defecation was identical in the two groups.The period of protection of the anastomosis,was 21 d (15 ～ 35 d) in group A.The rate of spontaneous closure of the stoma after removal of the tube was 100％.The stoma was reduced after 3 to 6 months in group B and major complication developed in one case in this group.Conclusions Temporary ileostomy prevents anastomotic leakage of anterior resection in patients of rectal carcinoma receiving preoperative neoadjuvant chemoradiotherapy.Intubation ileostomy is effective and safe in prevention of anastomotic leakage saving stoma reduction procedures.

Objective To explore the effect of heat shock protein 70(HSP70)expression in the role of Curcumin inhibited staurosporine(STS)-mediated neurons toxic injury.Methods The primary cultured hippocampal neurons was cultured in vitro and the stress damage model of STS-induced nerve cell toxicity was established.The experiment were divided into six groups according to the added drugs:normal control group,the STS model group (final concentration was 20μmol/L),Quercetin+STS model group(final concentration were 10 μmol/L and 20 μmol/L,respectively),Curcumin+STS pretreatment group(for 20μmol/L final concentration),Curcumin+Quercetin+STS treatment group(final concentration were 20μmol/L,10μmol/L and 20μmol/L,respectively)and Curcumin treatment group(final concentration was 20μmol/L).The cell viability were determined by thiazole blue (MTT)method,cell toxicity were measured by lactate dehydrogenase(LDH)release rate and HPS70 expression were detected by Western Blot. Results MTT results showed that the cell viability of Curcumin+STS pretreatment group was significantly higher than STS model group(P<0.001).Compared with Quercetin+STS model group,the cell viability of Curcumin+Quercetin+STS treatment group had little change.LDH results show that the nerve cell toxicity of Curcumin+STS pretreatment group was obviously less than that of STS model group(P<0.001).Western Blot results show that compared with STS model group,HSP70 protein expression in Curcumin+STS pretreatment group was significantly increased(P<0.001).Conclusion Curcumin can inhibit STS-mediated neurons toxicity stress damage though increasing HSP70 expression,when added Quercetin to block HSP70 expression in nerve cells,the inhibiting effect of Curcumin on STS-mediated neuron toxic stress injury is counteract.

Objective To improve short-and mid-term surgical outcomes ofter the tricuspid ring annuloplasty,and to provide theoretic basis for strategy making among patients with tricuspid regurgitation secondary to left-sided heart diseases.Methods Tricuspid regurgitation secondary to left-sided heart diseases ( including mitral valve diseases and aortic valve diseases) were treated by using tricuspid ring annuloplasty techniques.Patients'age averaged (47.3 ± 12.0) years old,there were a total of 84 female patients(53.2％ ).The average systolic pulmonary pressure was (53.4 ± 19.8) mm Hg.From August 2002 to December 2007,a total of 158 consecutive patients underwent tricuspid ring annuloplasty in Fuwai Cardiovascular disease Hospital.Among this group of patients,there were 66 mild tricuspid regurgitation(41.8％ ),54 moderate(34.2％ ),and 38 severe tricuspid regurgitation(24.0％ ).The average age was (47.3 ± 12.0) years old and female accounted for 53.2％ of the whole cohort.The indications for the tricuspid ring annuloplasty included:moderate to severe tricuspid regurgitation or moderate to severe pulmonary hypertension ( systolic pulmonary hypertension ＞40 mm Hg).In the current study,the ring annuloplasty techniques were modified in the following aspects:selection of undersized ring and partial fixation of tricuspid septal segment.In all the patients,we chose Cosgrove-Edwards ring for tricuspid annuloplasty.The surgical outcomes were evaluated through multivariate regression and Cox analysis.Results Compared with moderate and severe tricuspid regurgitation groups,mild regurgitation group had the smallest ring diameter,mild group ( 38.2 ± 4.9 ) mm,moderate group(47.0 ± 11.6 ) mm,severe group(44.5 ± 8.9) mm,P ＜0.001.No significant differences were noted in terms of ejection fraction among three groups (0.59 ± 0.08,0.59 ± 0.06 and 0.58 ± 0.09,P =0.73 ).Compared with mild and moderate tricuspid regurgitation groups,severe regurgitation group had the highest systolic pulmonary pressure.The diameter reduction was most significant in severe regurgitation group,diameter reduction in mild,moderate and severe regurgitation groups were ( 12.4 ±5.6) mm,(20.8 ± 11.5 ) mm,( 18.6 ± 8.3 ) mm,respectively,P ＜ 0.00 1.An in-hospital death occurred in moderate regurgitation group.157 patients discharged alive.The median follow-up time was 49.1 months.During follow up,three moderate to severe regurgitation occurred,among which one was in moderate regurgitation group,two in severe regurgitation group ( P =0.06).There were three deaths in mild regurgitation group,two in moderate regurgitation group,and four in severe regurgitation group.No significant differences were found in terms of mid-term morality,P =0.10.Conclusion For patients with tricuspid regurgitation secondary to left-sided heart diseases,the mid-term outcomes of modified Cosgrove-Edwards ring annuloplasty were satisfactory.The taking home messages include:positive recommendation for patients with pulmonary hypertension to accept tricuspid annuloplasty,use of undersized ring,and partial fixation of septal segment.

Objective To compare blood pressures results measured by automated sphygmomanometer and standard mercury sphygmomanometer,and to investigate the application of measurements consistency evaluation method in accurate measurement of automated sphygmomanometer.Methods Intraclass correlation coefficient was used to estimate the reliability of repeated measurements,and Bland -Altman method was adopted to evaluate the consistency between automated sphygmomanometer and standard mercury sphygmomanometer.Meanwhile,the results were compared with protocol of European Society of Hypertension.Results The tested automated sphygmomanometer did not adapt to the criteria of European Society of Hypertension.The intraclass correlation coefficient of mercury sphygmomanometer was 0.937 for systolic blood pressure,0.849 for diastolic blood pressure.The intraclass correlation coefficient of tested sphygmomanometer was 0.944 for systolic blood pressure,0.929 for diastolic blood pressure.The 95% consistency interval was(-10.20 to 16.94)mmHg for systolic blood pressure and(-6.25 to 11.69)mmHg for diastolic blood pressure.Conclusion Normally,Bland-Altman method has the same judgment result with protocol of European Society of Hypertension.

Objective To investigate the therapeutic effect of stage treatment of severe complicated injuries in palmar forearm and wrist.Methods From March 2008 to Novemler 2011, eleven cases with skin lost combined with fracture and lost of flexor tendon, ulnar radial arteries, median and ulnar nerves,and some of them had fracture of ulnar and radius were treated in the first stage with vacuum sealing drainage after emergency debridement and tissue repair. Secondary microsurgical repair was performed after the VSD was removed. The lost of median and ulnar nerves was repaired with transplantation of sural nerve,and the wound was repaired with free flaps and complex tissue flaps. Results Eleven cases were treated with vacuum sealing drainage for 7 to 10 days.Infections were under control,wound areas reduced and most wound areas were covered by granulation tissues.Flaps and skin grafts were survived.After postoperative follow-up for 3 to 36 months (average 13 months),three cases was received flexor tendolysis.As result,the blood circulation of hand was good, the sensor of injured nerve was higher than S3, and there was a good functional rehabilitation of hand muscles. Conclusion Using vacuum sealing drainage after emergency debridement and tissue repair, there was a good repairing effect of secondary repair with flaps and skin grafts for severe complicated tissue defect in palmar forearm and wrist,and it is an effective choice of operation.