Objective To observe and compare the short-time outcome in meniscal lesions with radiofrquency coblation technology or normally mechanical technology under the arthroscopy. Methods Thirty-eight patients with mentisci injury was selected, and divided into radiorfequency and normal group according to the standards. The patients in former group were treated with menisci reformation by radiofrequency, while in later group by menisci parthial excision. Some criteria were analysised and evaluated by comparison of operation-time, post-operation effusion of joint and improvement on the degrees of flexion and extension, clinical symptoms, functional restoration of knee joint of both groups. Results The average operation-time in radiofrequency group was less than that of normal group apparently. It was less possible for effusion of joint happened in the radiofrequency group after operation. The improvement on the degrees of flexion and extension and functional restoration of joint in the radiofrequency group exceeded in another group. Conclusion The radiofrequency under the arthroscopy is simper and less leading the surrounded tissue injury with more excellent functional restoration fo knee joint, also it has more advantage than the normal menisci partial excision mechanically.

Objective To study the clinical characteristics, diagnosis, treatment and prognosis of cancer metastasis to the thyroid gland. Methods A restropective review was performed on 35 patients with cancer metastasis to the thyroid gland in our hospital from 1958 to 2010. Diagnosis was confirmed by fineneedle aspiration cytology or histopathology in all cases. Results Primary tumor origin was identified in all but three cases. The lung was the most common primary tumor site( n = 16), followed by esophagus( n =9),breast ( n = 2), kidney ( n = 2), hypopharynx ( n= 1 ), nasopharynx ( n = 1 ) and soft palate ( n = 1 ). Thyroid metastasis was found before the diagnosis of the primary tumor was established in 12 cases; in the other 23 cases, the time lapse from diagnosis of the primary tumor to metastasis to the thyroid gland ranged from 0- 168 months, median 24 months. In 6 patients, this interval was more than 36 months. Fine-needle aspiration cytology ( FNAC ) confirmed metastatic malignancy in 7 patients, histology in 24, combined application confirmed the diagnosis in 4. After the metastasis to the thyroid gland was established, the median survival time for the entire group was 11.5 months, the 1-, 3- and 5-year survival rate was 43.8%,27. 8% and 11.9%, respectively. 28 patients were treated surgically, and 7 received nonsurgical therapy.The overall survival rate in the surgical group was higher than that in the nonsurgical group (P ＜0. 01 ). In those patients with metastatic cervical lymph nodes, median survival time did not vary from patients undergoing thyroidectomy with neck dissection to those undergoing thyroidectomy alone (P ＞ 0. 05 ).Conclusions Metastasis of carcinoma to the thyroid gland has an occult occurrence, thyroid metastases can be detected conclusively with FNAC. Metastasis to the thyroid gland implies advanced malignant tumors,often with poor prognosis.

AIM: To determine whether the viartrils could provide a beneficial effect on the prevention of early/middle stage osteoarthritis(OA) and affect the proliferation of chondrocytes. METHODS: An OA model was produced with severing the anterior, posterior cruciate ligaments of the knee in 24 adult New Zealand rabbits. The animals were then randomly divided into viartrils group and control group. After surgical operation, viartrils (mainly contains glucosamine sulphate) 2 pills per day were administered to the animals in viartrils group. The animals were sacrificed and specimens were taken from the weight-bearing portion of the femoral condylar seven weeks after operation. Each case was evaluated according to a modified histological-histochemical grading system(HHGS) using HE and safranin O/fast green staining slides, and immunohistochemical method was used to detect the proliferation of chondrocytes in articular cartilage. RESULTS: The method of severing the anerior, posterior cruciate ligaments of the knee could successfully induce the early/middle stage model of OA. The pathological remark in control group was significantly higher than that in the viartrils group (P

Objective To investigate the appropriate surgical procedure for unilateral papillary thyroid microcarcinoma (PTMC).Methods Clinical data of 323 patients with unilateral PTMC in Cancer Hospital of Chinese Academy of Medical Sciences from 1999-2007 were retrospectively studied.Survival outcomes and prognostic factors were analyzed.Results After a median follow-up of 102 (range,12-188) months,the 10-year overall and disease-specific survival was 95.3％ and 98.9％.The 10-year recurrence-free survival was 85.5％.The 10-year cumulative recurrence rate of residue glands was 6.5％.Capsular invasion,pT stage and clinical stage were significant predictive factors for recurrence of residue glands (all P ＜ 0.05).Cox regression multivariate analysis showed that pT stage (HR 2.153,95％ CI 1.231-3.767,P =0.007) was independent predictive factor.Of the 311 patients treated with non-total thyroidectomy,the 10-year cumulative recurrence rate of residue glands was 6.8％ Conclusions Unilateral PTMC has a good prognosis and hemithyroidectomy (lobectomy and isthmusectomy) is an appropriate surgical pattern.Extrathyroidal extension is a significant predictor for recurrence.

BACKGROUND: The skill to culture osteoblasts primarily has been well developed. However, trypsinase can affect membrane protein of osteoblasts if the time of digestion is long. Therefore, it is of great significance to select an ideal method to avoid the damage from trypsinase to cells as possible when culturing osteoblasts.OBJECTIVE: To explore a novel method to isolate and culture SD rat osteoblasts in vitro, and identify the functions of the cells.DESIGN: Observational study.SETTING: Department of Orthopaedics, First Affiliated Hospital of Jinan University.MATERIALS: This experiment was carried out in the Department of Orthopaedics, First Affiliated Hospital of Jinan University from March to May in 2007. Eight SPF 24-hour old SD rats were used in the experiment. The rats, irrespective of gender, were provided by the Experimental Animal Center of Nanfang Medical University. The experimental animals were disposed according to ethical criteria. The main reagents were detailed as follows: collagenase Ⅱ (Sigma Company);trypsin (Sigma Company); alkaline phosphatase (ALP) kit (Nanjing Jiancheng Biological Products Company); SABC-1021(Wuhan Boster Biotechnology Company).METHODS: 24-hour old SD rats were chosen for experiment. The newly born SD rats were sacrificed by anesthesia and the cranial bones of the rats were obtained cleanly, erased completely of the periosteum and cut to blocks of I mm3. The cranial bones were digested by 0.25 % trypsinase for 20 minutes, then by 0. 1% type Ⅱ collagenase for 60 minutes. The digestive time of trypsinase was controlled in the process of digestion to avoid to harm the cells. The liquid was gathered and centrifuged. The cells were cultured in culture flask and were purified by many times adhered.MAIN OUTCOME MEASURES: Morphology observations under the inverted phase contrast microscope, transmission electron microscope, and scanning electron microscope were performed. The phenotype, calcium tuberculation and the expression of alkaline phosphatase were studied with alizarin red staining and modified Gomori Ca-Co assays respectively.The cells were also evaluated with collage Ⅰ immunohistochemical staining.RESULTS: The cultured cells had active proliferation ability. Cells showed multi-angle or fusiform shape. Nucleus was immature and organell was plentiful. Therefore, they had typical morphological characters of osteoblasts. Moreover, they showed the osteoblastic phenotypes such as their synthesis of alkaline phosphatase, collage Ⅰ and formation of calcium tuberculations.CONCLUSION: The cells cultured by our modified enzymatic digestion method had typical morphological and biological characteristics of osteoblasts.

AIM:To conduct the relevance analysis of serum Dickkopf-1 (Dkk-1) and bone mineral density (BMD) in the different ages of female populations.METHODS: The women volunteers (n=100, 20~80 years old) were selected and divided into young group (20~39 years old), middle age group (40~59 years old) and elderly group (60~80 years old).The serum levels of Dkk-1 in the 3 groups of volunteers were detected by ELISA.In the middle age group, 25 people of 45~55 years old were selected and divided into postmenopausal group and premenopausal group to de-tect the serum level of Dkk-1 in the 2 groups of volunteers by ELISA.The BMD was measured by the method of dual energy X-ray absorptiometry.The differences of Dkk-1 expression levels among different ages of female populations, and the rele-vance with BMD were compared.RESULTS:With the increase in age, the serum Dkk-1 expression level increased ( P<0.05), and BMD were reduced (P<0.05).The blood level of Dkk-1 and BMD negatively correlated (P<0.05) in the 3 groups of volunteers.The serum levels of Dkk-1 and BMD had stronger negative correlation in postmenopausal women group than that in premenopausal women group.CONCLUSION:With the increase in age, the expression level of serum Dkk-1 increases and the BMD level decreases, which contribute to a risk of osteoporosis.In the same age range, the postmeno-pausal women express higher level of Dkk-1, and the decreased BMD is more obvious, which contribute to a greater risk of osteoporosis.The increased level of Dkk-1 also inhibits bone formation and promotes bone resorption.It may become a new target for preventing and treating osteoporosis.

Objective To determine the long-term outcomes of cN0 papillary thyroid carcinoma without elective central compartment neck dissection. Methods The clinical data of 180 patients with clinically lymph node negative papillary thyroid carcinoma who were treated in our center between 2000 and 2005 were retrospectively analyzed. All of these patients did not receive elective central compartment neck dissection. Clinicopathological characteristics including gender,age,surgical range,pathologic type,tumor size,and extrathyroidal extension(ETE)or not were collected. Results After a median follow-up period of 90 months,only one patient died of stroke without tumor. Sixteen patients had tumor recurrence:seven patients had a recurrent disease in residual thyroid tissue,two in the thyroid bed,six in central compartment,eight in lateral cervical compartment,and one in lung. The 10-year overall survival,disease-specific survival,and recurrence-free survival was 99.4%,100%,and 87.9%,respectively. The 10-year accumulative lymph node recurrence rate in central compartment and lateral compartment was 7.8% and 7.0%,respectively. ETE was an independent risk factor for central compartment lymph node recurrence. Male gender(P=0.010)and ETE(P=0.028)were independent risk factors for lateral compartment lymph node recurrence. Conclusions The prognosis of patients with cN0 papillary thyroid carcinoma without elective central compartment neck dissection is good after ten years of follow-up. Male gender and ETE are independent risk factors for lateral compartment lymph node recurrence.

Objective To investigate the clinical value and relating problems in treating atlantoaxial instability by using transpedicular instrumentation with fusion. Methods The study reviewed 18 patients (11 males and 7 females, at age range of 13-82 years, mean 46.5 years) with atlantoaxial instability undergone transpedicular screw internal fixation with bone grafts fusion. There were 15 patients with type Ⅱ odontoid fractures, two with traumatic disruption of transverse atlantal ligament and one with fracture of the anterior ring of C1, all of which were associated with atlantoaxial subluxation or obvious instability. Preoperative JOA score was 6-13 points (average 9.5 points). Results The operation lasted for mean 115 minutes (range 75-180 minutes), with intraoperative blood loss of mean 235 ml (range 130-450 ml). One patient presented intraoperative plexus venous bleeding during removal of lower edge of the posterior arch of atlas and was treated with hemostasis using compession of gelatin sponge. All the patients were followed up for a mean period of 13.5 months (6-38 months), which showed no complications including infection, loosening or breakage of internal fixators or neurovascular injury related to internal fixation. Postoperative JOA score was 12-17 points (average 14.5 points). Reduction and solid fusion of the bone graft were achieved satisfactorily in all patients. Conclusions Posterior transpedicular screw internal fixation with bone grafts fusion can achieve good reduction, reliable fixation, high fusion rate and is a reliable method to manage atlantoaxial instability. Correct selection of the indication, familiarity with local anatomy and mastery of the operation technique are key to a satisfactory curative effect.

Objective To evaluate the clinical results of the PCL-retaining total arthroplasty in treatment of knee osteoarthris with valgus.Methods From June 2002 to January 2005,8 cases of osteoarthris with valgus knee were treated with PCL-retaining total knee replacement.The X-ray before operation showed average 21.6 degrees(ranging from 10 to 35 degrees) valgus.The cases were follow-uped from 6 to 36 months,each of them was evaluated with the Special Surgery Knee Scoring System.Results The X-ray after operation showed average 5.7 degrees(ranging from 3 to 9 degrees) valgus.The average HSS scores increased from preoperative 54 to postoperative 91.The range of motion was significantly improved from preoperative 83 degrees to postoperative 118 degrees.All of the cases were no pains after operation,and the function of knees were apparently improved.Conclusions The preliminary clinical results are quite satisfactory for the PCL-retaining total arthroplasty in treatment of osteoarthris with valgus knee.The adequate relaxing and balancing of soft tissue is the key factor to the success of total knee arthroplasty.The follow-up is necessary for further long-term outcome.

AIM:To study the expression level of S100 calcium-binding protein A4 (S100A4) in synovial tissue of the knee joint in rheumatoid arthritis (RA) patients and normal persons, and the effect of S100A4 on the angiogenesis induced by rheumatoid arthritis fibroblast-like synoviocytes (RAFLSs).METHODS:The synovial tissue was taken from the knee joint of the RA patients (RA group) and the normal persons (control group).The protein expression of S100A4 and vascular endothelial growth factor (VEGF) in the synovial tissue of the 2 groups was observed by immunohistochemistry.RAFLSs were isolated from synovial tissue of patients with active RA.ELISA was used to detect the effect of S100A4 on the secretion of VEGF by RAFLSs.The effect of S100A4 on the angiogenesis of HUVECs cultured with conditioned medium from RAFLSs was also detected.RESULTS:The protein of S100A4 and VEGF was highly expressed in the synovial tissues of RA group (P<0.05).rhS100A4 significantly stimulated the secretion of VEGF in RAFLSs in a time-and dose-dependent manner (P<0.05).Cultured with conditioned medium from RAFLSs, rhS100A4 significantly promoted HUVECs to form tube-like structures in vitro.CONCLUSION:S100A4 protein is highly expressed in synovial tissue of the knee joint in RA patients, and S100A4 stimulates synovial angiogenesis by promoting RAFLSs to generate VEGF, indicating that S100A4 may be used as a potential target for the treatment of RA.