Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

OBJECTIVES: To explore the risk factors for femoral neck fracture in elderly population. METHODS: A total of 124 elderly patients (≥60 years old) in hospital for trauma were enrolled, including 71 patients (57%) with femoral neck fracture and 53 non-femoral neck fracture patients (43%). All patients' age, gender, body mass index (BMI), bone mineral density (BMD), thigh length and average circumference were collected. Single factor analysis and multivariate logistic regression analysis were performed to explore whether the above factors were risk factors for femoral neck fracture. RESULTS: Single factor analysis showed that the age, gender, BMI, BMD, thigh length, and average thigh circumference between the 2 groups were statistically different (all CONCLUSIONS Older age, female, lower BMI index (low body weight), lower BMD (osteoporosis), longer thigh length, and lower average circumference are risk factors for femoral neck fracture in the elderly population.
Absorptiometry, Photon ; Aged ; Body Mass Index ; Bone Density ; Female ; Femoral Neck Fractures/etiology* ; Humans ; Middle Aged ; Osteoporosis ; Risk Factors

OBJECTIVES: This study evaluated the prognostic power of serum uric acid (UA) in predicting adverse events in elderly acute coronary syndrome (ACS) patients with diabetes mellitus (DM). METHODS: The analysis involved 718 ACS patients ‍>80 years old whose general clinical data and baseline blood biochemical indicators were collected prospectively from January 2006 to December 2012. These patients were classified into two groups based on DM status, and then followed up after discharge. The Kaplan-Meier method was used for major adverse cardiac event (MACE) rates and all-cause mortality. Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis. Receiver operating characteristic (ROC) curves were analyzed to predict the cutoff value of UA in elderly ACS patients with DM. There were 242 and 476 patients in the DM and non-DM (NDM) groups, respectively, and the follow-up time after discharge was 40‒120 months (median, 63 months; interquartile range, 51‒74 months). RESULTS: The all-cause mortality, cardiac mortality, and MACE rates in both DM and NDM patients were higher than those in the control group ( CONCLUSIONS Serum UA level is a strong independent predictor of long-term all-cause death and MACE in elderly ACS patients with DM.

Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.

Objective: To provide data references for Nuss procedure biomechanics research, and to understand morphological pathological changes in children with pectus excavatum. Methods: A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution. The anterior rib width(RW), anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient. The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic. The measurement indexes were compared between healthy children and children with pectus excavatum. Results: The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm). Children with pectus excavatum compared with healthy children, the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P<0.05), the 3rd and 4th RT were greater than healthy children (P<0.05). Conclusion The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research. By morphology contrast, it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function.

Objective To introduce a new posterior-anterior approach used to establish tibial tunnel for all-inside posterior cruciate ligament (PCL) reconstruction and evaluate its short-term therapeutic effects.Methods We retrospectively analysed the 15 patients (15 knees) with PCL injury who had been treated at Department of Orthopaedics,Zhejiang Provincial People's Hospital from January 2017 to January 2018.They were 9 men and 6 women,with a mean age of 46.3 years (from 23 to 60 years).Of them,8 left and 7 right sides were injured.The intervals from injury to surgery averaged 33.6 days (from 4 to 120 days).Their injury was complicated with medial meniscus tear in 3 cases,lateral meniscus tear in one case,lesion of medial collateral ligament in 2 cases and lesion of lateral medial collateral ligament in one case.After preoperative physical examination and MRI confirmed complete PLC tear in all of them,they were treated by arthroscopic all-inside PCL reconstruction in which a new posterior-anterior approach was used to establish the tibial tunnel.Lysholm scoring and International Knee Documentation Committee (IKDC) scoring were used preoperatively and postoperatively to evaluate the knee functions.Results Their follow-ups averaged 8.3 months (from 6 to 12 months).Operation time averaged 55 minutes (from 45 to 70 minutes).All the patients got rid of the knee instability after surgery.All their posterior drawer tests and sag signs turned to be negative.At the final follow-up,their range of motion of the knee ranged from 110° to 130° (average,118°);their average IKDC score was 88.1 ±3.3 (from 82 to 93),significantly higher than the preoperative value (52.3 ±2.1) (P ＜ 0.05);their average Lysholm score was 90.6 ± 3.1 (from 84 to 96),significantly higher than the preoperative value (43.1 ± 2.3) (P ＜ 0.05).Conclusions This new method can avoid neurovascular damage and overcome the killer turn because it provides adequate exposure of the tibial PCL footprint and accurate placement of the tibial tunnel.It is also very convenient because the new posterior-anterior approach can be used to establish the tibial tunnel in all-inside PCL reconstruction without special tools like tibia1 PCL guide and retrograde drill.Its short-term clinical results have proved to be satisfactory.

Objective By measuring the thoracic cage index with chest X-ray film in 3-17 years old healthy children,analyzing the bivariate correlations with age,to provide the reference data for evaluating and following up of chest wall deformity.Methods A retrospective study was conducted for 450 cases of health physical examination from May 2013 to March 2016 in our institution.The anterior intercostal space width(IS),the anterior rib width(RW),and thickness of the rib in the middle(RT) on the right side of 3-7 ribs have been measured in each patient.Statistical describing for each measurement index has been made,and Pearson correlation analysis was used to analyze the correlation between measurement values and ages.Results Each measurement index is strong positive correlated with age (0.6 ＜ r ＜ 0.8,P ＜ 0.05).Conclusion The anterior intercostal space width,the anterior rib width and the thickness of the ribs in the middle have a growing trend with age in children.It is indeed a useful way to measure thoracic cage data by using the chest X-ray film quantitative evaluation method.The measured values can be used as reference indexes.

BACKGROUND:The pathogenesis of knee intraarticular adhesion is yet unknown. Excessive proliferation of fibroblasts is considered to cause knee intraarticular adhesion. OBJECTIVE:To study the preventive effects of methotrexate on knee intraarticular adhesion through fibroblast apoptosis induced by endoplasmic reticulum stress. METHODS:The viability of the cultured fibroblasts treated with methotrexate(10-5-10-9mol/L)or PBSwas determined after 24 hours. Fibroblast apoptosis was detected by Hoechst33342 staining. Endoplasmic reticulum stress-and apoptosis-related proteins, including cleaved-PARP, CHOP, Bax and Bcl-2, were determined by western blotassay. Eighteen healthy male New Zealand white rabbits were used to establish the knee intraarticular adhesion models, and equaly randomized into three groups, and received topical application of 2 or 1 g/L methotrexate, or normal saline (control). The preventive effects of methotrexate on knee intraarticular adhesion and CHOP expression in scar tissue were observed. RESULTS AND CONCLUSION:Methotrexate inhibited the proliferation and viability of fibroblasts in a dose-dependent manner. The number of apoptotic fibroblasts was significantly increased compared with control group. Protein expression of cleaved-PARP, CHOP, and bax was increased, while protein expression of bcl-2 was decreased with time. The animal experiment showed that preventive effects of 2 g/L methotrexate on knee intraarticular adhesion were superior to 1 g/L methotrexate treatment. CHOP expression in the scar tissue in the methotrexate groups was higher than the control group and that was higher in high-dose methotrexate group. Our results suggest that methotrexate prevents knee intraarticular adhesionviaendoplasmic reticulum stress-induced fibroblast apoptosis.

Objective To investigate the effect of acute high altitude exposure on lung functions and the relationship between lung functions and acute mountain sickness ( AMS) .Method We collected the lung function and Lewis Lake data of 73 subjects (aged 18 to 26,male) at 400 m above sea-leve and those at high altitude(exposure to 3900 m, 5 d).Results Compared with sea-level, lung functions decreased in forced vital capucity (FVC), maximum midexpiratory flow(MMF), V50, V25 while forced expiratory volume in 1 second(FEV1), peak expiratory flow(PEF), V75 did not change.FVC, FEV1, PEF, MMF were used to analyze the relationship between lung functions and AMS .There was no difference in lung functions between AMS group and NON AMS group at sea-level, but lung functions of AMS group were significantly lower than those of NON AMS group in FVC , MMF at high altitude .There was difference between AMS group and NON AMS group in the rate of change of FVC and MMF .Logistic regression analysis showed that the rate of change of FVC was an independent risk factor , while correlation analysis showed that the change of FVC and the change of oxygen saturation were relevant.Conclusion Lung functions showed restrictive decrease after acute high altitude exposure .Changes of lung func-tions will increase hypoxia and susceptiblity to AMS .

Objective To access the development of thoracic volume of pectus excavatum use of Nuss operation used CT-basedpulmonary volumetric evaluation.Methods 98 patients with pectus excavatum in Beijing Children's Hospital under Nuss operation were documented.All patients had CT scan pre-and postopration.The CT-scan's data were calculated as lung's volume by handdraw-layers summation method.The lung's volume result was compared,and enquiry the position in CT lung volume developmental scale.Results The lung's volume was elevated 28.3％ after operation.The development of thoracic volume was keep with age,70％ was maintained and 15％ was elevated.Conclusion Nuss operation can prevent the decrease of thoracic volume in pectus excavatum.