[Objective]To evaluate the results of therapy with knee joint synovectomy or articular irrigation in rheumatoid arthritis.[Method]Thirty-six knees in 32 rheumatoid arthritis patients-according to ARA standard were performed with knee joint synoveetomy and articular irrigation.Twenty-two knees in 20 patients(most in grade Ⅰ)were treated with knee joint cavity irrigation operation combined with intra-articular injection of hyaluronic acid,and 14 knees in 12 cases(most in grade Ⅱ)with knee joint synovectomy,All 32 patients received routine anti-rheumatoid drug therapy preoperatively and postoperatively,and were followed-up for 6 months.All the cases were evaluated by the Lysholm scale.[Result]The early symptoms of all knee joints were improved.The excellent and good result rate of articular irrigation-group was 86.4%,and in synovectomy-group was 85.7%.[Conclusion]Satisfactory results can be obtained through articular irrigation combined with intra-articular rejection of hyaluronic acid and concomitant anti-rheumatoid drug therapy in early-stage of rheonmtoid arthritis,but for mid-stage patients,especially with hyperplasia synovium and deslxoyed cartilage,joint synoveetom should he performed early in order to obtain favoring rehabilitation.

Objective To explore the measures to prevent recurrent laryngeal nerve (RLN)injury during thyroid surgery.Methods The clinical data of 223 patients undergone thyroid surgery were retrospectively analyzed.Among the 223 surgeries,69 sides were undergone regional protection act of RLN and 191 sides were performed RLN exposure.Results There were 2 cases of RLN injury from the regional protection operation of RLN,including 1 case of temporary nerve injury which could be resulted from surgery clamp and 1 case of permanent nerve injury which might be caused by mistaking ligation during surgery.There was only 1 case of temporary nerve injury in RLN exposure procedure which was probably caused by the postoperative nerve edema and was recovered 2 months after the operation.The total RLN injury rate was 1.35％.Conclusion For benign thyroid lesions and non-dorsal lesions or during partial excision of the gland,the regional protection of RLN is helpful to prevent RLN injury.In cases with dorsal lesions of thyroid or contralateral RLN injury,or during lobe subtotal resection,lobe resection and reoperation,exposing RLN to prevent injury is necessary.Taking different approaches based on the profiles of lesions and surgical procedures to prevent RLN injury can significantly reduce the risk of RLN injury.

Objective To establish and observe the canine model with esophageal stent implantation for further study of the benign stenosis caused by proliferation.Methods According to orthogonal design,different combinations of two stents and six polytetrafluoroethylene (PTFE) patches were confirmed.Stent was designed as cylinder with mushroom shape on both ends.Beagle dogs (weight 10-12 kg) were adopted and cervical segment of esophagus were dissected.After PTFE patch was encircled around the esophagus,stent was delivered under fluoroscopy.The main body of the stent was located in accordance with the patch.Eating condition and position of the stent were followed on week 1,2,4,6 and 8.Gross specimen was harvested at the end point,and the degree of tissue hyperplasia was evaluated.Each animal model was given a mark according to the eating condition and tissue hyperplasia.Results Eight combinations of stent and patch were provided with orthogonal design.Three models failed for the following reasons:unable to eat in one dog,stent disgorged out in another,and the third died from esophageal necrosis between stent and patch.Four models had obvious tissue hyperplasia on the segment of stent,and weight loss or stent dislocation were observed in each model.One model developed appropriate tissue hyperplasia with normal diet,and stent dislocation was not found during the follow-up.Significant difference was confirmed among 8 models (F =14.7000,P =0.031).Conclusion Animal model with appropriate tissue hyperplasia could be established with following elements:beagle dogs weight from 10 kg to 12 kg; stent 50 mm in length,20 mm in diameter,with top mushroom 10 mm in length,30 mm in diameter,and end mushroom 10 mm in length,25 mm in diameter; PTFE patch 60 mm in length,15 mm in width.

Objective To explore the inhibitory effect of pulsed ultrasound on skeletal muscle fibrosis after injury.Methods Thirty elderly male rats with gastrocnemius muscle injury were divided into an ultrasound group (UG) and a control group (CG) using a random number table.The injured muscles in the UG were treated using pulsed ultrasound (frequency 1 MHz,average strength 40 mW/cm2,duty cycle 20％) for 10 min daily from day 3 after the injury.The CG was given no treatment.On days 3,7,14,21 and 28 after the injury,histological and immunohistochemical analyses of the gastrocnemius muscles of both groups were performed.Results The collagen fiber mean optical density of the muscles increased gradually after the injury and reached its peak on day 21.It was significantly lower in the UG than in the CG on each test day.The expression of α-SMA increased gradually after the injury,but it too remained significantly lower in UG than that in CG.Conclusion Pulsed ultrasound may reduce collagen formation and α-SMA expression in injured skeletal muscle,and then inhibit muscle fibrosis.

ts the shear stress, thus, facilitates the union of fracture and the restoration of function.

Aerospace physiology is an important part of aerospace medicine.There are some problems existing in the current practice classes.Microlecture is a new kind of teaching methods.With its advantages, microlecture improved the teaching efficiency, and played a good role in the practice classes for undergraduate students, successfully solving part of the problems and promoting the teaching reform.The microlecture, as an auxiliary means, provides a new way for practice class of aerospace physiology.It`s suggested to be popularized in undergraduate teaching of aerospace medicine.

Objective To explore the clinic application value of ultrasonography examination of optic nerve sheath diameter(ONSD) in brain injury.Methods From July 2008-June 2011,90 cases of brain injured patients were chosen as experimental group including light (A group),medium (B group),and heavy (C group) brain injured patients according to the admission GCS score ;50 cases of conventional physical examination and 90 cases of volunteers 50 in neurosurgical outpatient were chosen as control group.The ONSD of both groups were measured 3 mm behind the globe through orbital using color sonographic with different time after admission.3 times measurements were carried out for every optic nerve sheath.All client's ONSD mean and standard deviation were calculated.In 0.5 h after color dopplar ultrasound examination,lumbar vertebra puncturing measured intracranial pressure in different groups.Results After admission (1d,3 d,7 d,14 d),the ONSD of A group was (4.54 ±0.32)mm,(4.42 ±0.30)mm,(4.44 ±0.32) m,and (4.43 ± 0.25) mm,respectively; The ONSD of B groups was (4.48 ± 0.28) mm,(4.52 ± 0.24) mm,(4.46 ±0.28)mm,and (4.38 ±0.22)mm,respectively; The ONSD of C group was (5.67 ±0.35)mm,(6.36 ± 0.42) mm,(5.65 ± 0.23) mm,and (4.76 ± 0.35) mm,respectively.After admission (1 d,3 d,7 d,14 d),the intracranial pressure (IP) of A group was (82 ± 11) mmH2O,(79 ± 12) mmH2O,(90 ±15) mmH2O,and (86 ± 14) mmH2O,respectively; The IP of B group was (78 ± 15) mmH2O,(85 ± 10)mmH2O,(78 ± 16) mmH2O,(80 ± 11) mmH2O,The IP of C group was (225 ± 26) mmH2 O,(288 ± 23)mmH2O,(256 ± 23) mmH2O,(122 ± 18) mmH2O,respectively.Group D had the ONSD average of (4.58± 0.41)mm and IP of (88 ± 10)mmH2O after eyeball 3-mm place.No difference was found between A and B,A and D,or B and D (P＞0.05) ; A difference was found between A and C,B and C,or D and C (t =12.24～24.67,P＜0.01).Conclusions The ONSD and IP in light medium brain injured patients had no change.In patients with severe brain injury,IP changed with the time after injury,the ONSD increased with the IP,the ultrasonography examination of ONSD with the important value in the diagnosis and treatment can respond the IP increase,which is a non-invasion,convenient,fast,and feasible method for evaluation of cranial high pressure.

Objective:To evaluate the clinical effects of anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy in the treatment of chronic ankle instability after trauma.Methods:A retrospective study was conducted to analyze of the clinical data of 16 patients with chronic post-traumatic instability of the medial malleolus who had been treated at The Eighth Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine from December 2015 to February 2017. There were 14 males and 2 females with an age of (28.1±4.2) years. Seven left sides and 9 right sides were affected; the time from injury to operation was (8.9±2.4) months. Before operation, X-rays (anteroposterior, lateral and Saltzman views) and MRI of weight-bearing ankle were taken. All patients were treated by anatomical reconstruction of the deltoid ligament using the autologous semitendinosus and medial migration osteotomy of the calcaneus. The time for injury healing and occurrence of complications were recorded. The talus tilt angle, Meary angle, hindfoot valgus angle, visual analogue scale (VAS), and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot function score were compared between the preoperation and the last follow-up. The Sefton evaluation for efficacy in ankle ligament reconstruction was used to assess stability of the ankle joint.Results:Of this cohort, 14 patients were followed up for (16.4±4.9) months after operation and 2 patients lost to follow-up. The 14 patients all returned to normal physical activities 3 months after operation. All incisions healed at the first stage with no infection. One patient experienced pain at the site for harvest of the semitendinosus but the symptoms were relieved after rehabilitation treatment like massage and physical therapy. At the last follow-up, the talus tilt angle [1.0 (0.0, 2.0)°], Meary angle (1.4°±4.2°), hindfoot valgus angle (3.2°±2.4°), VAS score [0.5 (0.0, 1.0) points], and AOFAS ankle-hindfoot score [(89.2±6.1) points] were all significantly improved compared with the preoperative values [8.3°±1.8°, 0.8°±3.8°, 9.9°±3.4°, (5.7±2.5) points, and (49.6±9.8) points] (all P<0.05). According to the Sefton evaluation, the stability of the ankle joint was excellent in 9 cases, good in 4 cases, and fair in 1 case. Conclusion:In the treatment of chronic ankle instability after trauma, anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy is safe and effective, resulting in limited complications.

Objective:To analyze the factors affecting the disappearance time of airway necrosis and repair time of airway scar stenosis in patients with ulceration necrosis tracheobronchial tuberculosis (TBTB Ⅱ) after standardized chemotherapy and bronchoscopic intervention.Methods:The clinical data of 222 TBTB Ⅱ patients admitted to Hunan Chest Hospital from January 2015 to December 2018 were collected, bronchoscopic interventional treatment was performed on time. The texture, blockage of lumen, granulation proliferation, airway stenosis of TBTB patients before treatment, the disappearance time of airway dead objects, scar repair time and stenosis degree after treatment were followed up. The disappearance time of airway necrosis and repair time of airway scar stenosis and its influencing factors were recorded and analyzed.Results:In 222 patients, 508 ulceration necrosis airway lesions were found under bronchoscopy, with a median of 2(1-6); 170(76.6%) cases of airway lesions had different degrees of stenosis before treatment. 79(35.6%) patients had tough necrosis, and 86(38.7%) patients had necrosis blocking the lumen; 132(59.5%) patients had granulomatosis. The disappearance time of airway necrosis after treatment was 1 to 32 weeks, and M( Q1, Q3) was 6(3, 9) weeks; the repair time of airway scar stenosis was 2 to 73 weeks, and M( Q1, Q3) was 14(10, 19) weeks; after treatment, there were 90.5%(201/222) patients with different degrees of scarring in the airways. Cox multiple analysis showed that the risk factor for the disappearance time of airway necrosis was tough tough necrosis ( HR=1.52, 95% CI: 1.10-2.10); the risk factor for the repair time of airway scar stenosis was the disappearance time of airway necrosis 6-9 weeks ( HR=2.73, 95% CI: 1.84-4.05). Conclusions:90.5% of patients with type Ⅱ TBTB developed airway scar stenosis after treatment. The median time for the disappearance of airway necrosis was 6 weeks, and the median time for the repair time of airway scar stenosis was 14 weeks. In the interventional process, attention should be paid to the removal of tough necrosis and the efficiency of necrosis removal to reduce the risk of airway scar stenosis.

Objective To preliminary evaluate the mid-term clinical effect of endovascular repair in treating spontaneous extracranial internal carotid artery (ICA) dissection,and to observe the patency of stent.Methods The clinical data and imaging materials of 6 patients with spontaneous extracranial ICA dissection,who were treated with endovascular repair during the period from March 2012 to December 2012,were retrospectively analyzed.The U.S.National Institute of Heahh Stroke Scale (NIHSS) scores were determined before and after endovascular repair,and the postoperative stent patency condition was assessed,the results were analyzed.Results A total of 6 patients,including 4 males and 2 females with a median age of 50 years old (40.75-54.75 years old),received endovascular repair therapy.The median interval from the onset of disease to accept endovascular treatment was 10 days (one week-3 months).After the implantation of stent,the blood flow in the true lumen returned to normal immediately,although part of the false lumen was still filled with contrast agent.Embolism of retinal artery occurred in one patient during the operation,no death occurred.The median follow-up time was 54.4 months (49.7-57.9 months).The NIHSS score determined at the last follow-up visit was not significantly different from the preoperative one (P=0.102).Imaging reexamination revealed that the false lumen at the ICA stent segment disappeared in all 6 patients,and no obvious in-stent stenotic changes were observed.Conclusion Endovascular therapy of selected symptomatic extracranial carotid artery dissection with bare stents can effectively prevent the recurrence of clinical symptoms and promote ICA remodeling with excellent mid-term patency.