Objective To evaluate the short-term outcomes and analyze the complications of medial unicompartmental knee osteoarthritis (MUKOA) treated by unicompartmental knee arthroplasty (UKA).Methods Retrospectively analyzed the patients suffered with MUKOA and registered into our department from Jul 2015 to Jan 2017.71 cases were enrooled in the study,of which 17 are male (19 UKA) and 54 are female (66 UKA).The general information,perioperative data,Hospital for Special Surgery (HSS) score,visual analogue score (VAS) and complications of the group were analyzed.Results Females were three times more than males (54∶ 17).The average age of female subjects was lower than that of male,the difference was significant (P ＜ 0.05).The rate of Osteoporosis of females was significantly higher than that of males (P ＜ 0.05).The operative time,length of incision,total overt blood loss and postoperative in-bed time were (54.06 ± 6.24) min,(8.56 ± 0.83) cm,(86.10 ± 5.44) ml,(3.51 ± 1.01) d,respectively.No significant differences were found between males and females (P ＞ 0.05).The preoperative,3 months and 6 months postoperative HSS scores were 45.2 ± 4.5,80.3 ± 5.7 and 88.4 ± 4.2,respectively.No differences were found between males and females (P ＞ 0.05).The preoperative,3 months and 6 months postoperative VAS scores were 6.6 ± 1.2,1.7 ± 0.7 and 0.5 ± 0.5,respectively.No differences were found between males and females (P ＞ 0.05).There were 2 revised cases,and the reasons for revision were infection and unstability caused by sport injury.Conclusions UKA is an ideal choice for patients with MUKOA,Especially for the ones older than 60 years.However,the corrections on lower-limb forceline and joint unstability are limited,thus,the indications for UKA should be controlled strictly.

Objective To compare the clinical effect and safety evaluation of three different dose regimens for treating children with viral encephalitis.Methods Totally 126 cases treated in Xi'an Central Hospital from January 2010 to December 2015 were randomly divided into observation group 1 (ganciclovir combined with gangliosides,42 cases),observation group 2 (ganciclovir combined with gamma globulin,43 cases),and control group (39 cases).The clinical effect and levels of NSE,inflammatory cytokine were compared in the three groups.Results The total effective rate in observation group 1 was 95.24％ and that of observation group 2 was 93.02％,which were significantly higher than that of control group (79.48％).The disappearance time of headache,fever,convulsions,clouding of consciousness,meningeal irritation sign,cerebrospinal fluid abnormalities,and length of stay in observation groups (both 1 and 2)were significantly shorter than those in control group (P ＜ 0.05);After therapy,the levels of NSE in three groups were obviously decreased compared with those before therapy (P ＜ 0.05),and those in observation group were significantly lower than the control group (P ＜ 0.05);the levels of inflammatory cytokine in all three groups were obviously decreased compared with those before therapy (P ＜ 0.05),and that of observation group 1 had no statistical difference with the normal group,whereas that in control group was significantly higher than the normal group (P ＜ 0.05).Conclusion Ganciclovir combined with gangliosides as well as ganciclovir combined with gamma globulin were both effective methods in treating children with viral encephalitis and could decrease levels of inflammatory cytokine.Ganciclovir combined with gangliosides could effectively repair nerve damage,which deserves clinical expansion.

Objective To explore whether macrophage migration inhibitor factor (MIF)can protect human bone microvascular endothelial cells (HBMECs)from glucocorticoid-induced damage.Methods HUVECs were isolated from human femoral head.After HUVECs were cultured and identified,we constructed the ECs damage model with high-dose hydrocortisone.The cells were randomly divided into blank control group,low-dose MIF group,high-dose MIF group with corresponding treatment.Cell activity was detected by AlamarBlue in each group. The number of viable cells was detected in Live/Dead staining.The cell morphology was observed after cytoskeleton staining.Cell migration ability was compared by scratch test and the level of VEGF expression was detected by ELISA.Results Cell model was successfully constructed.The activity of cells in high-dose MIF group (178.3± 15.2)% was significantly higher than that in the control group (100±8.4)% and low-dose MIF group (149.1± 13.8)% (P<0.05).The number of viable cells in high-dose MIF group (139.5±14.3)% was higher than that in low-dose MIF group (121.3±12.9)% while the two groups had more viable cells than the control group (100± 8.4)% (P<0.05).The scratch test results indicated that cell migration ability in high-dose group was the strongest and the scratch disappeared at 24 hours after scratching.The expression of VEGF at 24 hours after intervention was (170±15.7)pg/mL in normal group,(328±25.3)pg/mL in low-dose group and (405±31.2)pg/mL in high-dose group.VEGF level was lower in low-dose group than in high-dose group (P<0.05),but higher than the normal group (P<0.01).Conclusion MIF can promote the proliferation and migration of ECs in a dose-dependent manner and upregulate the expression of VEGF.MIF can improve ECs damage induced by high-dose glucocorticoid.

Objective:To compare the clinical effect and safety of three different regimens treating children with severe pneumonia.Methods:120 cases treated in our hospital from January,2012 to January,2016 were randomly divided into the observation group 1 (dopamine combined with dobutamine,42 cases),observation group 2 (dopamine combined with phentolamine,40 cases),control group (38 cases).The clinical effect and levels of inflammatory cytokine were compared between the three groups.Results:The total effective rate in the observation group 1 was 90.48％ and that of observation group 2 was 87.5％,which were significantly higher than that of the control group (63.16％).The disappearance time of pulmonary rales,cough,dyspnea,pyretolysis and length of stay in the observation group (both 1,2) were significantly shorter than those of the control group (p ＜0.05).After therapy,the level of serum IL-6,IL-8,CRP and TNF-α in all the three groups were obviously decreased compared with those of before therapy (p＜0.05),and those of the observation group were significantly lower than the control group (p ＜ 0.05).Conclusion:Dopamine combined with dobutamine as well as dopamine combined with phentolamine were both effective methods in treating children with severe pneumonia,which were significantly better than conventional therapy.

To explore an effective measure to cultivate the clinical research capability of professional degree of clinical medicine, graduate students are classified according to their specialties. The orthopedic and non-orthopedic students are given different objectives and subjects of literatures. The ranges and pub-lishing years of literatures are also limited by tutors. The collected literatures are discussed, and then they have to give a speech within a limited time which will be reviewed by professional tutors. Professional tutors will answer the questions during the discussion at a fixed time to cultivate the interdisciplinary scientific research ability of clinical professional degree postgraduates. We get several advances: the discussion has a great effect on the cultivation of clinical research thinking of clinical professional degree postgraduates. And it enables graduate students to connect theoretical knowledge with the current frontier theory quickly, narrow the research focus gradually and then form a clear research direction. The cross-disciplinary thinking of graduate students is inspired by the participation of other professional tutors. Regular literature reading and tutor reviewing may be an effective method to improve the clinical research ability of graduate students in clinical medicine in the current stage.

BACKGROUND:Choosing internal fixator implants with good strength and stiffness is the key to repair femoral neck combined with ipsilateral subtrochanteric fractures. OBJECTIVE:To compare the biomechanical properties of different implant fixation for femoral neck combined with ipsilateral subtrochanteric fractures. METHODS:Totaly 24 adult antiseptic cadaver specimens were used to produce fracture models with femoral neck fracture combined with 5 cm of ipsilateral subtrochanteri medical cortical defect, and were divided into femoral proximal locking plate group, lengthening proximal femur anti-rotation intramedulary nail group and lengthening proximal femoral nail group according to the random number table method. The results of axial compression test, torsion test and axial compression failure rest in three groups were compared. RESULTS AND CONCLUSION: The axial compressive stiffness and failure load in lengthening proximal femur anti-rotation intramedulary nail group were significantly greater than those in femoral proximal locking plate group and lengthening proximal femoral nail group, and those in lengthening proximal femoral nail group were significantly greater than those in femoral proximal locking plate group (P < 0.05). The torsional stiffness in femoral proximal locking plate group was significantly greater than that in lengthening proximal femur anti-rotation intramedulary nail group and lengthening proximal femoral nail group, and that in lengthening proximal femur anti-rotation intramedulary nail group was significantly greater than that in lengthening proximal femoral nail group (P < 0.05). The indexes of biomechanical properties of specimens at the 4thand 8th weeks after fixation in three groups were slightly increased compared with those in 0 week after surgery, but the difference was no statisticaly significant (P > 0.05). These results demonstrate that to a certain extent, compared with the femoral proximal locking plate and lengthening lengthening proximal femoral nail, lengthening proximal femur anti-rotation intramedulary nail fixation for repair of femoral neck combined with ipsilateral subtrochanteric fractures has more biomechanical advantages.

BACKGROUND:Previous studies designed and made titanium metal rubber cervical disc prosthesis, and performed feasible studies on its effect on movement and stress distribution by replicating intervertebral discs. OBJECTIVE:To further observe the changes in the stability of goat cervical vertebra after metal rubber cervical disc replacement. METHODS:Nine goats were randomly divided into experimental group (n=6) and normal control group (n=3). Goats in the experimental group received metal rubber cervical disc replacement at C4/5segment. Goats in the normal control group did not receive any treatment. Radiographic data at anteroposterior and lateral position, hyperextension and excessive flexion were taken to measure intervertebral height, range of motion and intervertebral angle at C4/5 segment before operation, immediately, 4, 8, 12 weeks after operation. Subsequently, slicing and embedding of hard tissue at surgical segment, picric acid-acid fuchsin staining and scanning electron microscopy were conducted.RESULTS AND CONCLUSION:No significant difference in the intervertebral height and spinal range of motion at C4/5 segment at different time points was detected between postoperative results in the experimental group and preoperative results in the experimental group, normal control group. The intervertebral height at C4/5 segment was higher immediately, 4 and 8 weeks after surgery than preoperative result in the experimental group (P < 0.05). No significant difference in intervertebral angle at C4/5 segment was detectable between 4, 8 and 12 weeks postoperatively in the experimental group and normal control group (P < 0.05). At 4 weeks after surgery, bone did not contact with the edge of the prosthesis in the experimental group. At 8 weeks, the gap between bone and the prosthesis became smal, and some new bone attached to the edge of the prosthesis. At 12 weeks, a few osteoblasts were observed on the surface of the prosthesis. New osteogenic tissue grew into the prosthesis. Results suggested that metal rubber cervical disc replacement in the intervertebral space could maintain intervertebral height and range of motion in a short period, and tightly bind to the vertebral body.

Objective To identify and assess whether circumferential electrocautery is useful to improve outcomes after primary total knee replacement.Methods We searched MEDLINE,EMBASE,PubMed,SpringerLink,Web of Knowledge,OVID CINAHL,OVID EBM and Google Scholar,and included articles published through January 2014.This study used the methods of meta-analysis to assess whether circumferential electrocautery could improve anterior knee pain and knee function after total knee replacement,and identified the function of circumferential electrocautery in total knee replacement.Results A total of eight articles met the inclusion criteria.Among the 1 048 cases included in the analysis,526 cases had patellar denervation,and 522 cases were in the control group.The meta-analysis revealed no significant difference in the incidence of anterior knee pain (P =0.18) and visual analogue scale (VAS) (P =0.23) between two groups.However,patellar score (P =0.01),Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score (P ＜ 0.01),and range of motion (ROM) (P ＜ 0.01) indicated that circumpatellar electrocautery improved clinical outcomes compared to non-electrocautery groups.Conclusions The results indicated that circumferential electrocautery of the patellar did not significantly improve anterior knee pain relative to non-electrocautery techniques.However,circumferential electrocautery significantly improved patients' knee function after surgery.Therefore,circumferential electrocautery might be beneficial to the outcome of primary total knee replacement surgery without patella replacement.

Objective To investigate the repair effects of co-expression of the VEGF and BMP genes via an adeno-as-sociated viral vector on early steroid-induced avascular necrosis of the femoral head in rabbits. Methords To construct ani-mal model of early SANFH and screen by MRI. The SANFH animal were divided into rAAV-IRES-hrGFP(AAV-GFP), rAAV-hVEGF165-IRES-hrGFP(AAV-VEGF), rAAV-hBMP-7-IRES-hrGFP(AAV-BMP)and rAAV-hVEGF165-IRES-hBMP-7(AAV-VEGF/BMP)groups. The four group virus vectors were injected into core decompression region at the dose of 25μl/site after core decompression operation directly. Repair effects of rAAV vector on early SANFH in rabbits were evaluated by Western blot assay, HE staining, immunohistochemical staining, MRI, radionuclide bone scan, blood vessel counting detected by ink perfusion and fro-zen section, Micro-CT and biomechanical strength detection on the 12th week post-injection. Results Model success ratio was 73.33%. rAAV-hVEGF165-IRES-hBMP-7 virus vector efficiently expressed hVEGF165 and hBMP-7 genes on the 12th week after rAAV injection. hVEGF165 protein secreted in vivo promoted metabolism in core decompression region by increasing the quantity of new vessels and improving the blood supply;hBMP-7 protein secreted in vivo promoted new bone formation in core decompres-sion region by increasing bone mineral density and improving bone biomechanical strength. The AAV-VEGF/BMP group can pro-mote repair effects more effectively than AAV-VEGF group or AAV-BMP group. Conclusion The adeno-associated viral vectors co-expressing hVEGF165 and hBMP-7 can promote repair effects on early SANFH in rabbits by increasing the blood supply and strengthening the bone quality of femoral head.

BACKGROUND:As a bone scaffold material,β-tricalcium phosphate has good biocompatibility, osteoinductive, and biomechanical properties.
OBJECTIVE:To study the effect of al ogeneic osteoblasts compounded withβ-tricalcium phosphate in repairing rabbit radial defects.
METHODS:A total of 45 rabbit radial defect models were made and divided into three groups in random. Experimental group was repaired with the compound of al ogeneic osteoblasts andβ-tricalcium phosphate;
control group withβ-tricalcium phosphate;and blank control group with nothing. The new bone formation of each group was observed and assessed by X-ray and histopathological analysis at weeks 4, 8, 16 after implantation for evaluation of the bone repairing effect.
RESULTS AND CONCLUSION:With the repair time, the experimental group appeared to complete bone defect repair gradual y. By the end of 16 weeks, the X-ray showed that the bone cal us between the scaffold and the host was completely ossified, and bone defects were completely repaired in the experimental group. Histopathological observation showed continuous cortical bone formed in the defect area, and canal recanalization realized in the experimental group. Additional y, the repair effect in the experimental group was better than that in the control and blank control group at different time points (P<0.01). It is suggested that the al ogenic osteoblasts/β-tricalcium phosphate compound has the better effects on guiding bone regeneration and preventing from nonunion.