Objective To study the long term results of condylar reconstruction using pedicled patella in the treatment of giant cell tumor of lower femur. Methods From August 1964 to December 1996, 6 patients with giant cell tumor in the lateral condyle of femur were treated with unicondylar resection curettage and reconstruction with pedicled patella autograft. There were 3 males and 3 females. The average age of the pateints was 30.5 years. The operative indications were as the following: tumor was located in one condyle, complicated with pathological fracture or the tumor had invaded underneath cartilage which was difficult for curettage. Surgical procedure included: Lateral condyle resection according to X ray or CT image, curettage of the possible remaining tumor tissues in the medial condyle. A muscle pedicle of 2.5 cm wide from the quadriceps was raised with the patella, then the articular surface of patella was used to reconstruct the articular surface of femoral condyle, ilium graft(sometimes allograft) was used to fill the defect proximal to the patella. The grafts was fixed by screws and(or) plates. Anterior cross ligament was fixed to the patella. Results 6 patients were followed up for a mean period of 136 months. There were no infection, recurrence, metastasis and instability. All patients could walk for a long distance. The range of motion of the involved knees was between 80? and 120?. There was no varus deformity under stress test, but about 5 degrees valgus deformity under stress test could be found in some, muscle strenth was 5 grade. Conclusion Pedicled patella autograft is a good method for the treatment of giant cell tumor that invades unilateral condyle of lower femur, it is specially suitable to the patients with pathological fracture or severe destruction underneath the cartilage. Thorough resection and curretage of the tumor, preserving the blood supply of patella, refixing the cross ligament, and lower placement of patella are the key points to obtain the satisfactory results.

Objectiv e To evaluate the mid-term and long-term clinical outcome of total hip re-pl ace ment in patients with hip congenital dislocation.Methods From June198 3to Decem ber1998,36hips in32patients di agnosed as congenital disloca tion of hip(CDH),aged22to69years old(with the mean of 48.5years), were treated with total hip replacement (THR).Thirty-one hips of 28patient s were fol lowed-up with the duration of 9.5years(3.5to18years).Ac c ording to our system,the congen ital dys-pla sia of hip was divid ed into th ree degrees:the first degree was subluxation in15hips,the second degree was in termedi ate dislo cation in11hips,and the third degree was high dislocatio n in5hips.The fixation of the prosthetic compo nents was as follows :10cup s and12stems with cement,21cups and19stems with un-cement.In acetab ula r preparation,most of the patients with subluxation(13hips)underwent deep ening of the acetabu lum and were installed with larger cups;deepening of the acetabulum,smaller cup and auto femoral grafting on the su perior lip fixed w ith screws were performed in2hips with subluxation and all of hips with interm e di ate and high dislocation.Results The complications included intra operativ e lesser trochanter fracture in1case,deep vein thrombosis and thromboembolism of femoral artery in1case re spec-tively,limb discrepancy in3cases,asepti c loosening in4cases(1with trochanteric nonunion and migration,1with stem l oosening and2with both stem and cup loosening).The Harrisscore was85in th e other27hips(48scores before surgery).Con clusion Total hip replacement in patients with congenital dislocation of hip could be some what difficult be cause of the liability to complications.The techni cal difficulties en coun-t ered during surgery in cluded the correction of the length of bilateral lower extremi ty,the balance of the abductor muscles,the re lease of the soft tis sue,the dealing of the su perior segmental defect of acetabulum and selectio n of the compo nents.

AIM To investigate whether ginsenoside Rg1 can reverse chronic lead-induced impairment of long-term potentiation (LTP) in the CA1 region of rat hippocampus. METHODS Neonatal Wistar rats were exposed to lead from parturition to weaning via milk of dams whose drinking water (20 mL per day) contained 0.2% lead acetate. Field excitatory postsynaptic potentials (fEPSP) were recorded and LTP was induced in the CA1 region in rat hippocampal slices on postnatal 20-25 d. RESULTS In hippocampal slices from both control and lead-exposed rats, perfusion with ginsenoside Rg1 50 μmol·L-1 for 20 min induced enhancement of fEPSP (LTP), while the amplitude of LTP in lead-exposed rats was lower than that of controls. In hippocampal slices from chronic lead-exposed rats, LTP induced by high-frequency stimulation (HFS, 1s, 100 Hz) was significantly reduced, while perfusing with ginsenoside Rg1 (50 μmol·L-1) for 20 min increased the amplitudes of LTP induced by HFS by 47.1%. CONCLUSION Rg1 can increase basic synaptic transmission and partially reverse chronic lead-induced impairment of HFS-LTP.

Objective To evaluate the inhibitory effect of phase change doxorubicin loaded carboxymethyl hexanoyl chitosan nanodroplet on ovarian cancer cells,and the effect of its ultrasound image in vitro.Methods The carboxymethyl hexanoyl chitosan synthesized through the acylationreaction with carboxymethyl chitosan and hexanoic anhydride.The drug loaded carboxymethyl hexanoyl chitosan nanodroplets were prepared by ultrasonic emulsification.The surface morphology,particle diameter and electric potential were characterized.Ultrasound imaging of the nanodroplet was evaluated in vitro.The encapsulation efficiency was determined by ultraviolet spectrophotometry.The survival rate of ovarian cancer cell was detected using CCK-8 reagent.The statistical analysis was performed.Results The drug loaded carboxymethyl hexanoyl chitosan nanodroplet was successfully prepared which showed regular morphology in microscope,the mean diameter of (458.33± 43.50)nm.The encapsulation efficiency was (52.06 ± 10.14)％.The nanodroplet could enhance ultrasonic imaging.The survival rate of ultrasound combined with drug loaded nanodroplet group ([62.54± 3.60]％) was lower than those of the free drug group ([75.55±7.21]％) and drug loaded nanodroplet group ([76.18±4.94]％),ultrasound group ([89.90±0.83]％;P＜0.05).Conclusion Ultrasound-mediated drug loaded nanodroplet can inhibit ovarian cancer cells,and has the potential for application in the clinical diagnosis and treatment.

Objective To explore the significance of multiple microelectrode guided technique in determining the sensory?motor area of the sub?thalamic nucleus(STN)in deep brain stimulation(DBS)surgeries. Methods A total of 22 electrophysiological recording data of STNs recorded by multiple microelectrode was retrospectively analyzed ,while another 20 electrophysiological recording data of STNs recorded by a single micro?electrode was recruited as the control group. Results A total of 64 microelectrodes were used in 22 STNs guided by multiple electrophysiological recording electrodes. Sensory or motor activated potentials were recorded in 21 sides(95.5%),while regular discharge was recorded in one side. The average length of typical STN activity on the optimal channel of multiple electrophysiological recording electrodes was 5.58±0.53 mm,and the average length of sensory or motor activated potentials was 3.27±1.54 mm. In contrast,the average length of typical STN activity recorded by single microelectrode was 5.02±1.01 mm. However,sensory or motor activated potentials were recorded in 13 sides(65.0%)with the average length of 1.36±0.98 mm. Among the 22 STNs guided by multiple electrophysiological recording electrodes,the final implanted target was consistent with the initially selected anatomic target in 13 sides(coincidence rate,59.1%). In 9 sides,the electrophysiological target was inconsistent with the initially selected anatomic target. Conclusion STN DBS performed with multiple electrophysiological recording electrodes resulted in better outcomes of recording of the average length of typical STN activity or the average length of sensory or motor activated potentials of STN ,final confirmation of STN sensory motor area and determination of the optimal channel of implantation. Application of multiple electrophysiological recording electrodes provides a premise for the precise electrode placement in STN DBS surgeries.

Objective To investigate the effect of early enteral nutrition.Methods 248 patients with esophageal and gastric carcinoma were randomly divided into two groups,and received enteral nutrition(EN)and parenteral nutrition(PN)each continuously for 6 days after operation.The body weight,blood routine test,liver function,and postoperative day 8 were compared with those before operation.Results The body weight,red blood cell count,and the levels of hemoglobin,serum albumin and transaminase decreased less in EN group than those in PN group(P＜0.01).The complication rates of anastomotic fistula,pulmonary infection,and delayedincision healing and average volume of pleural effusion were 0,13.8%,0,780ml in EN groups,while 3.2%,28.2%,7.2%,1842ml in PN group.Conclusion Early postoperative enteral nutirtion after esophageal carcinoma surgery can improve nutritional status and reduce complications in comparision with parenteral nutrition.

Objective To study the effects of oral rehydration with the solution of pyruvate-glucoseelectrolyte (PGES) by comparison with the bicarbonate-glucose-electrolyte solution (BGES) on resuscitation in rats with lethal hemorrhagic shock.Methods Sixty adult male SD rats with intra-gastric tube,and cannulation of femoral artery and vein were subjected to 45％ total blood volume loss from the femoral artery,and then randomly divided into three groups (n =20 in each group):no fluid resuscitation group (NR),oral fluid resuscitation with the PGES group (PGES) and oral fluid resuscitation with the BGES group (BGES).In NR group,the animals received no fluid replacement or any other treatment.Rats in PGES and BGES groups were infused intra-gastrically with pre-warmed PGES or BGES in volume of 2 times shed blood given at 30 min after hemorrhage and completed within 6 hours.Blood samples in each group were collected from the abdominal aorta before or at 0,1,2,4 h post hemorrhage to detect serum alanine aminotransferase (ALT),creatinine (Cr),creatine phosphate kinase isoenzyme (CK-MB) and intestinal fatty acid binding protein (iFABP).Another 84 rats randomly divided into four groups:NR group (n =24),PGES group (n =24),BGES group (n =24),and no hemorrhage group (NH group,n =12).Rats in the three hemorrhage groups were treated the same as described above,and the rats in NH group underwent the same surgical procedure without hemorrhage were served as the sham group.All these rats were observed for their 24-hour survival rates.Results The 24-hour survival rates of PGES and BGES groups were both significantly higher than the rate of NR group (11/24 vs.1/24,x2 =18.087,P ＜0.01 ; 5/24 vs.1/24,x2 =6.445,P ＜ 0.05) ; the survival rate of PGES group was also significantly higher than that of BGES group (11/24 vs.5/24,x2 =4.02,P ＜ 0.05).All levels of ALT,CK-MB,Cr and iFABP in both the NR group and two oral resuscitation groups at 1 h,2 h and 4 h post hemorrhage were significantly higher than those before the blood loss,respectively (P ＜ 0.01).These biomarkers at 2 h,4 h post hemorrhage were significantly lower in the PGES and BGES groups than those in NR group (P ＜ 0.01) ; the serum levels of ALT,CK-MB,Cr and iFABP were significantly lower in the PGES group than those in the BGES group at 2 h and 4 h post hemorrhage,respectively (P ＜ 0.05).Conclusions Present results demonstrated that the pyruvate-enriched oral re-hydration solution (ORS =PGES) was more effective in preserving the organ function and prolonging the animal survival after resuscitation of lethal hemorrhagic shock in comparison with the bicarbonate-containing ORS (BGES).The oral re-hydration solution (PGES) recommended by the World Hygiene Organization (WHO ORS) may require further improvement in oral resuscitation of shock and the PGES may be recommended as a choice of oral re-hydration salts in the treatment of lethal hemorrhagic shock when intravenous administration is not available.

Objective To investigate the influence of intraoperative thermostasis over respiratory burst of polymorphonuclear neutrophils (PMNs) in patients undergoing radical operation for lung cancer.Methods Thirty-two ASA Ⅱ or Ⅲ patients scheduled for radical operation for lung cancer under general anesthesia were randomized into two groups ( n = 16 each): control group (Group C) and warming group (Group W). The patients in Group C were kept warm by routine measures such as using woollen blankets, while the patients in Group W were kept warm by force-air warming system and fluid warming device as soon as the patients were admitted to the operation room. Rectal and axillary temperatures were continuously monitored as the core and surface temperature, respectively. The core temperature was maintained at the preoperative level (baseline). Anesthesia was induced with midazolam, fentanyl and propofol. Tracheal intubation was facilitated with rocuronium. Anesthesia was maintained with isoflurane and nitrous oxide and intermittent i.v. boluses of fentanyl, midazolam and vecuronium. Venous blood samples were obtained before, during and at the end of surgery for normal blood analysis and respiratory burst of PMNs which included activated PMNs count and reactive oxygen species (ROS) production.Results (1) WBC and PMN counts were significantly increased during and after operation as compared with the baseline values before operation in both groups and there was no significant difference in WBC and PMN counts between the two groups. (2)Phorbol-12-myristate-13-acetate (PMA) stimulation resulted in higher intraoperative and postoperative activated PMN counts in both groups and higher postoperative ROS production in Group W. Postoperative ROS production was significantly higher in Group W than in Group C. (3) The PMN counts without stimulation activation during operation and intra- and post-operative ROS production were significantly decreased as compared with the baseline values before operation in Group C, while in Group W there was no significant difference in pre-, intra- and post-operative activated PMN counts and ROS production. The intraoperative PMN counts and intra- and post-operative ROS productions were significantly higher in Group W than in Group C.Conclusion Intraoperative thermostasis can effectively maintain activated PMN count and ROS production without stimulation and enhance ROS production with stimulation in patients undergoing radical operation for lung cancer.

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Objective To investigate the effects of dexmedetomidine on renal function in patients with hemorrhagic shock undergoing emergency surgery.Methods Sixty patients (27 males, 33 females) with hemorrhagic shock, aged 18-69 years, ASA physical status Ⅲ or Ⅳ, required emergency surgery under general anesthesia, were randomized into two groups (n=30 each): dexmedetomidine group (group D) and control group (group C).The patients in group D receiving a loading dose of dexmedetomidine (0.5 μg/kg within 10 min) after the induction of anesthesia followed by a continuous infusion rate of 0.4 μg·kg-1·h-1 till 30 min before the end of surgery, while those in group C received equal volume of normal saline.Venous blood were obtained immediately before beginning of surgery (T1), immediately after surgery (T2), 24 h after surgery (T3) and 72 h after surgery (T4) for detecting the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN), the contents of neutrophil gelatinase-associated lipocalin (NGAL) and high mobility group box-1 (HMGB1).The range ability of the concentration of the serum Scr from T4 to T1 (ΔScr) and the content of the serum HMGB1 from T4 to T1 (ΔHMGB1) were also calculated and recorded.Hemodynamic index (including MAP, HR) and arterial blood gas results were recorded during surgery.Results Compared with T1, MAP, CVP and BE were increased, meanwhile, HR and Lac were decreased at T2, but there was no statistically significant difference between the two groups.No statistical difference was found in BUN at any time point between group D and group C.Compared with T1, Scr decreased in both groups at T2-T4.The ΔScr in group D was higher than that in group C at T4 (P＜0.05).The content of serum NGAL at T4 in group D was significantly dropped when compared with T1 (P＜0.01) and was lower than that in group C (P＜0.05).Compared with T1, the content of serum HMGB1 was significantly decreased in both groups at T2 (P＜0.05);the content of serum HMGB1 at T3 in group C was significantly increased and was higher than that in group D;the ΔHMGB1 in group C was higher than that in group D.Conclusion Hemorrhagic shock could induce acute kidney injury.Perioperative continuous infusion of dexmedetomidine facilitated renal function recovery after ischemia-reperfusion injury in patients with hemorrhagic shock through inhibiting the elevation of serum HMGB1.