Objective To investigate the clinical effect of direct extra-articular endoscopic excision of popliteal cyst using double posteromedial portals.Methods For 92 patients in our department who suffered from symptoms such as pain and discomfort in the popliteal fossa,limited knee flexion,swelling after activity,and were diagnosed with popliteal cyst based on imaging examinations from March 2017 to January 2023,we performed direct extra-articular endoscopic excision of popliteal cyst using double posteromedial portals.The recurrence of cysts was evaluated by MRI at last follow-up.The Rauschning and Lindgren classification was used to evaluate clinical outcomes.Results A total of 92 patients were included in the study.Arthroscopic examination revealed intra-articular lesions in 80 patients(86.96％),including degenerative cartilage lesion in 52 patients(56.52％),medial meniscus tear in 48 patients(52.17％),lateral meniscus tear in 28 patients(30.43％),anterior cruciate ligament injury in 17 patients(18.48％),chondromalacia patellae in 3 patients(3.26％),intra-articular loose body in 2 patients(2.17％),tibial intercondylar eminence fracture in 1 patient(1.09％),gouty arthritis in 1 patient(1.09％),synovitis in 3 patients(3.26％)and septic arthritis in 1 patient(1.09％).The average duration of symptoms was 11.71 months(0.03 to 120 months).All patients were followed up postoperatively,with an average follow-up period of 12.8 months(6 to 23 months).There were no serious complications such as deep vein thrombosis,neurovascular injury or infection.Two patients were found to have residual cysts by MRI at last follow-up.According to the Rauschning and Lindgren classification:pre-operation:13 cases of grade Ⅰ,53 cases of grade Ⅱ and 26 cases of grade Ⅲ;post-operation:74 cases of grade 0 and 18 cases of grade Ⅰ.Conclusion Direct extra-articular endoscopic excision of popliteal cyst using double posteromedial portals has several advantages,such as mini-invasion,fast recovery,short surgical time and low recurrence rate.

Medication during pregnancy is widespread, but there are few reports on its fetal safety. Recent studies suggest that medication during pregnancy can affect fetal morphological and functional development through multiple pathways, multiple organs, and multiple targets. Its mechanisms involve direct ways such as oxidative stress, epigenetic modification, and metabolic activation, and it may also be indirectly caused by placental dysfunction. Further studies have found that medication during pregnancy may also indirectly lead to multi-organ developmental programming, functional homeostasis changes, and susceptibility to related diseases in offspring by inducing fetal intrauterine exposure to too high or too low levels of maternal-derived glucocorticoids. The organ developmental toxicity and programming alterations caused by medication during pregnancy may also have gender differences and multi-generational genetic effects mediated by abnormal epigenetic modification. Combined with the latest research results of our laboratory, this paper reviews the latest research progress on the developmental toxicity and functional programming alterations of multiple organs in offspring induced by medication during pregnancy, which can provide a theoretical and experimental basis for rational medication during pregnancy and effective prevention and treatment of drug-related multiple fetal-originated diseases.

Objective:This study aimed to investigate the effect of differentiation osteogenic bone marrow mesenchymal stem cells (De-BMSCs) transplantation on the promotion of bone formation at the tendon-bone interface after anterior cruciate ligament reconstruction (ACLR), and further explored the molecular mechanism of the enhanced osteogenic effect of De-BMSCs.Methods:BMSCs from femur and tibia of New Zealand White rabbit were subjected to osteogenic induction and then cultured in no osteogenic factor medium; the obtained cell population was termed De-BMSCs. De-BMSCs were induced into osteo-, chondro-and adipo-differentiation in vitro to examine the characteristics of primitive stem cells. ACLR model with a semitendinosus tendon were performed in 48 adult rabbits, three groups were established: control group with alginate gel injectionat the tendon-bone interface, BMSCs group with the injection of alginate gel containing BMSCs, De-BMSCs group with the injection of alginate gel containing De-BMSCs. At 4 and 12 weeks after surgery, rabbits in each group were sacrificed to evaluate tendon-bone healing by histologic staining, micro-CT examination, and biomechanical test. During osteogenic differentiation of De-BMSCs, si-RNA of nuclear factor of activated T cells 2 (NFATc2) si-RNA of nuclear factor of activated T cells 1 (NFATc1) were used to verify the molecular mechanism of enhanced osteogenic effect of De-BMSCs.Results:De-BMSCs exhibited some properties similar to BMSCs including multiple differentiation potential and cell surface marker. At 4 weeks after surgery, the BV/TV value of the De-BMSCs group 0.36±0.01 was significantly higher than that of the control group 0.24±0.03 and BMSCs group 0.30±0.02 (all P<0.05), and the maximum load 40.34±1.19 N and stiffness 20.67±2.14 N/mm were significantly higher than those in the control group 14.88±2.74N, 8.67±2.19 N/mm and the BMSCs group 26.31±1.76 N, 13.81±2.14 N/mm (all P<0.05). At 12 weeks after surgery, the BV/TV value of the De-BMSCs transplantation group 0.47±0.02 was significantly higher than that of the control group 0.30±0.02 and the BMSCs group 0.35±0.03 (all P<0.05), and the maximum load 64.46±6.69 N and stiffness 25.18±3.11 N/mm were significantly higher than those in the control group 41.01±6.12 N, 11.59±2.54 N/mm and the BMSCs group 48.21±4.12 N, 15.89±2.94 N/mm (all P<0.05). During the osteogenic differentiation of De-BMSCs, the expressions of Nanog and NFATc1 were synergistically increased which promoted interaction of NFATc1 and Osterix ( P< 0.05), resulting in the increased expression of osteoblast marker genessuch as COL1A, OCN, OPN (all P< 0.05). Conclusion:De-BMSCs transplantation could promote bone formation at the tendon-bone interface after ACLR,Nanog/NFATc1/Osterix signaling pathway mediated the enhancement of the osteogenic differentiation effect of De-BMSCs.

Objective:To explore the effect of cholesterol on the expression of genes for matrix synthesis and degradation of human meniscal fibrochondrocytes and its mechanism.Methods:Meniscal tissue was taken from patients undergoing arthroscopic surgery to extract fibrochondrocytes. The cells were divided into a control group in which the normal cells were not processed, a positive control group in which interleukin-1 β was used to create a degeneration model, and 2 treatment groups which were subjected to treatment with 15 and 30 μg/mL cholesterol respectively. Safranin O staining, β-galactosidase staining and enzymic kits were used to detect the morphology and total cholesterol (TCH) content of meniscal fibrochondrocytes in the 4 groups. Immunofluorescence and western blot were used to detect the protein expression of type Ⅰcollagen precursor α1 (COL1A1) and type Ⅱ collagen precursor α1 (COL2A1). RT-qPCR was used to detect the mRNA expression of COL1A1, COL2A1, matrix metalloproteinase (MMP) 3, MMP9, MMP13, and genes related to cholesterol efflux pathways [like liver X receptor α (LXR α), ATP binding cassette transporter A1 (ABCA1) and ABCG1]. Results:There was no significant difference between the control and the positive control groups in the TCH content in human meniscal fibrochondrocytes ( P>0.05). The treatments with 15 and 30 μg/mL cholesterol resulted in significantly increased TCH contents in human meniscal fibrochondrocytes in the treatment groups ( P<0.05). Compared with the control group, the mRNA expression of LXR α, ABCA1 and ABCG1 was significantly decreased in the treatment groups ( P<0.05), and the meniscal fibrochondrocytes in the positive group and the treatment groups presented with a lower density, chaotic distribution and obvious signs of degradation. Compared with the control groups, the mRNA expression of matrix synthesis genes (COL1A1 and COL2A1) in the meniscal fibrochondrocytes was significantly inhibited while the mRNA expression of matrix degradation metalloenzymes (MMP3, MMP9 and MMP13) was significantly promoted ( P<0.05). Conclusion:Cholesterol may inhibit the cholesterol efflux pathways of meniscal fibrochondrocytes, and thus cause accumulation of cholesterol in the meniscal fibrochondrocytes, eventually leading to degeneration of meniscus.

Objective To evaluate the therapeutic effects of early reconstruction of medial patellofemoral ligament (MPFL) in acute traumatic patellar dislocation of knee joint.Methods 15 acute traumatic patellar dislocation of knee joint patient underwent early MPFL reconstruction, and were regular follow-up after operation.At the final follow-up, evaluated the stability of patellar and compared the Lysholm score, Kujala score and Tegner score between pre-injury and last follow.Results The average follow up was 18.6 months.All the patient had no recurrent patellar dislocation, and showed negative apprehension test.The preinjury Lysholm score, Kujala score and Tegner score were 90.6±13.1, 92.3±12.4 and 5.9±1.3, respectively;the postoperative Lysholm score, Kujala score and Tegner score were 91.2±12.5, 95.1±13.2 and 6.2±1.6.There were no significant difference between before injury and postoperation on Lysholm score, Kujala score and Tegner score at last follow-up (P＞0.05).Conclusion Early MPFL reconstruction for acute traumatic patellar dislocation can restore the stability and function of patellar.

Objective To evaluate the projection marking which was designed to improve the surgical efficiency of antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures.Methods A total of 198 patients (158 femoral intertrochanteric fractures and 40 femoral shaft fractures) were analyzed retrospectively who had been treated at Department of Orthopedics,The First Affiliated Hospital to Wenzhou University from January 2012 to January 2016.They were 61 males and 137 females,aged from 13 to 95 years (mean,65.4 ± 14.6).By AO classification,there were 55 cases of type 31-A1,103 cases of type 31-A2,21 cases of type 32-A2 and 19 cases of type 32-A3.The intertrochanteric fractures which had been treated from January 2012 to May 2013 with no projection marking were assigned into group A1 (n =61) while the shaft fractures which had been treated in the same period with no projection marking into group B1 (n =12);the intertrochanteric fractures which had been treated from May 2013 to January 2016 with projection marking were assigned into group A2 (n =97) while the shaft fractures which had been treated in the same period with projection marking into group B2 (n =28).Comparisons were made between groups A1 and A2,and between groups B1 and B2 in terms of total operative time,total number of fluoroscopy,complications,Harris hip score (HHS),and pain and symptoms scores in Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months after operation.Results The 198 patients were followed up for 3 to 18 months (average,7.0 months).The total operative time (56.5 ±6.6 min) and the total number of fluoroscopy (26.6 ±6.2 times) in group A2 were significantly less than those in group A1 (59.2 ±9.2 min and 31.4 ±9.9 times) (P ＜ 0.05).The total operative time (84.6 ± 16.1 min) in group B2 was significantly less than that in group B1 (97.8 ± 17.9 min) (P ＜0.05) but the total number of fluoroscopy (49.4 ± 12.7 times) in group B2 was insignificantly less than that in group B1 (50.6 ± 10.1 times) (P ＞ 0.05).Conclusion The self-designed designed method of projection marking can reduce operative time and number of intraoperative fluoroscopy in the antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures.

Objective To evaluate the effectiveness of uncemented distal stem fixation for elderly patients needing revision of femoral prosthesis of hip arthroplasty.Methods From July 2005 to January 2013,22 patients(12 males and 10 females)aged from 70 to 85 years(average:76 years old) with aseptic loosening of the femoral stem undergone revision via uncemented distal stem fixation were enrolled into this study.Of all patients,10 had revision on the right side and 12 on the left side;11 patients received artificial replacement of the femoral head;9 had total hip replacements;2 had femoral fractures.According to the Paprosky classification system,2 cases were type Ⅰ,12 were type Ⅱ,6 were type [Ⅲ A,and 2 were type Ⅲ B.Femoral stems for revision included MP(Link)and Solution(Depuy).The Harris score,clinical and radiological results were retrospectively analyzed.Results All patients were followed up for 48 to 78 months(mean:61 months).The average Harris score increased from 38 (25-46) to 87 (76-94).All prostheses were initially stable,and no infection,dislocation or complication like deep venous thrombosis was observed after revision.All patients were able to walk without assistance;two of them had minor claudication;radiographs after surgery showed well-positioned implants with increased bone density and thickness around the prosthesis and without loosening or subsidence.Conclusions Reliable axial and anti-rotational stability can be achieved by using uncemented distal stem fixation,with good short-and medium-term clinical results for revision in elderly patients with less severe bone defects than those in Paprosky Ⅳ.

Objective To investigate the hidden blood loss of intertrochanteric fractures in different gender. Methods Data of 108 patients with intertrochanteric fractures who were admitted to the department of orthopaedics from January 2012 to De?cember 2015 were retrospectively analyzed. For all patients who were composed of 42 males and 66 females and whose ages ranged from 32 to 95 years old, the average age was 75.4±10.8 years old. With the equation of Gross, the amount of perioperative hidden blood loss (PHBL) was calculated as well as the fraction of PHBL. The lineal regression model was utilized to analyze the correlations between PHBL and those factors including age, time interval between injury and surgery, injured side, Evans classifi?cation of intertrochanteric fractures, patients' ASA grade, and type of anesthesia. The difference of hemoglobin (Hb), hematocrit (Hct), total blood volume, the amount of PHBL, and the percentage of PHBL were respectively compared between male group and female group. Results PHBL had no correlation of lineal regression with age, time interval between injury and surgery, injured side, Evans classification of intertrochanteric fractures, patients' ASA grade, or the type of anesthesia. The share of PHBL did not have correlation of lineal regression with age, time interval between injury and surgery, injured side, Evans classification of inter?trochanteric fractures, patients' ASA grade, or the type of anesthesia as well. Lineal regressive correlation only existed between gender factor and the PHBL fraction of total blood volume, and there was no regressive correlation between gender factor and the amount of PHBL. In the male group, the mean amount of preoperative Hb was 121.8±16.6 g/L and preoperative Hct was averagely 36.7%±5.0%;in the female group, the amount of preoperative Hb was 99.5±13.1 g/L on average and the mean amount of Hct was preoperatively 30.6%± 3.7%. Postoperatively, the mean amount of preoperative Hb was 103.4 ± 19.3 g/L and Hct was averagely 29.8%±4.2%;in the female group, the amount of postoperative Hb was 79.0±10.4 g/L on average and the mean amount of Hct was postoperatively 23.9%± 2.6%. Significant difference of perioperative Hb and Hct was found between two groups. The total blood volume was averagely 4 500.6±191.5 ml in the male group and 3 607.0±235.7 ml in the females group. There was statistical differ?ence between two groups. For male group, the amount of PHBL was 647.9±174.1 ml on average and accounted for 14.4%±4.0%of total blood volume. For the female group, the mean amount of PHBL was 694.8±216.5 ml and making up 19.3%±6.1%of the total blood volume. As for the amount of PHBL, no significant difference was observed between male group and female group, but there was statistical difference of the share of PHBL accounting for total blood volume between two groups. Conclusion Female pa?tients' PHBL fraction of total blood volume is greater than male patients', therefore females' PHBL conditions need to be paid more attention to and ought to be corrected in time.

Objective To investigate the current situation of quality of care for people with disabilities and the related factors. Methods In November, 2015, 399 disabled persons from five special service institutions in Hubei, China were conveniently sampled, and investigated with the Chinese version of Quality of Care and Support (QOCS) for people with disability scale and demographic questionnaire. Results The total score of QOCS was (38.11±6.24), and the proportion of total score in the dimensions of caring provision, caring environment and caring information were more than 70%. The score of QOCS was various with the age, domicile, employment, medical insurance, monthly household expenditure and expenditure for food of the people with disabilities, and the age (β=0.06, P<0.01) and medical insurance (β=-0.850, P<0.001) were the independent factors related with the score of QOCS. Conclusion People with disabilities self-reportedly satis-fied in the quality of care in Hubei, and it can be improved from the increase of medical insurance level.

Prosthetic joint infection (PJI) is a devastating complication that can occur after any arthroplasty procedure and is associated with significant morbidity and substantial healthcare costs.Recently,the use of Rifampicin in PJI subjects has become a hot research direction in the field of orthopaedics,its efficacy is definite and encouraging.But till date,to the best of our knowledge,we still have no associated reports about the application of Rifampicin on PJI.Therefore,articles concerned with the administration of Rifampicin in PJI subjects published till date were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang and Weipu databases.The articles,which met the inclusion and exclusion criteria,were summarized into the following categories:1) The development and the application status of Rifampicin on PJI;2) The therapeutic mechanism of Rifampicin on PJI;3) The usage of Rifampicin in the postoperative antimicrobial therapy.By reviewing the associated articles,we found out that PJI is difficult to treat,because the causative bacteria forms and exists in a biofilm that is adherent to the prosthetic surface.The formation and maturation of the bacterial biofilm is a time dependent process.The longer the biofilm exists,the troublesome it gets to eradicate.Rifampicin not only has an excellent anti-staphylococcal activity,but also has a very good oral bioavailability and good bone penetration.The application of Rifampicin may significantly improve the surgical success rate especially after debridement and retention in PJI subjects.However,the optimal course,dosage and route of administration still need further exploration.