Research progress on the mechanism of pain related neural pathways above the spinal cord / 生理学报

Pain is a multi-dimensional emotional experience, and pain sensation and pain emotion are the two main components. As for pain, previous studies only focused on a certain link of the pain transmission pathway or a certain key brain region, and there is a lack of evidence that connectivity of brain regions is involved in pain or pain regulation in the overall state. The establishment of new experimental tools and techniques has brought light to the study of neural pathways of pain sensation and pain emotion. In this paper, the structure and functional basis of the neural pathways involved in the formation of pain sensation and the regulation of pain emotion in the nervous system above the spinal cord level, including thalamus, amygdala, midbrain periaqueductal gray (PAG), parabrachial nucleus (PB) and medial prefrontal cortex (mPFC), are reviewed in recent years, providing clues for the in-depth study of pain.

Revision total hip arthroplasty using a cementless prosthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the operative technique and results with the usage of cementless prosthesis in hip revision.</p><p><b>METHODS</b>Retrospective study was done on revision of total hip arthroplasty with cementless prosthesis in 72 patients (41 males and 31 females) with an average age of 65.7 years (28-82 years) from January 2004 to December 2009. The reason for revision was 2 infection, 54 aseptic loosening, 4 periprosthetic fractures, 5 fracture of femoral stems and 7 cases of acetabular abrasion after hemi-arthroplasty. The operation time, bleeding loss, complications of infection, dislocation, periprosthetic fractures and loosening were evaluated. The Harris score were used for hip function evaluation.</p><p><b>RESULTS</b>The average operation time was (146±47) minutes (70-280 minutes) and bleeding loss during the operation was (970±540) ml (200-2500 ml). Bacterium cultivation during operation demonstrated infection in 2 patients. Bone windows at the lateral femoral were opened in 4 patients and extend trochanteric osteotomy was done in 7 patients. Fracture of the proximal femur occurred in 8 cases. Twenty-nine patients were treated with bone graft including 18 autografts and 11 allografts. Sixty-seven patients were followed up for an average time of 66 months (20-92 months). Additional revisions were performed in 3 cases including 2 dislocations and 1 infection. There were no death, no damage of major blood vessels and nerves. The bone graft healed during 3-5 months. The survival rates of the femoral prosthesis and the acetabulum prostheses were 95.5% and 98.4%. The mean Harris score was 86±8 (55-95 points). Osteolysis were seen in 13 hips but migration was seen in only 1 patient.</p><p><b>CONCLUSIONS</b>The cementless prosthesis is useful in revision total hip arthroplasty and the perfect clinical results are related to the reliable primary fixation.</p>

Association of estrogen receptor alpha gene polymorphisms with bone mineral density: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A number of studies have examined the association between estrogen receptor alpha (ESR-α) gene polymorphisms and bone mineral density (BMD), but previous studies of ESR-α gene XbaI (rs9340799) and PvuII (rs2234693) polymorphisms have been hampered by small sample size, regional restrictions and inconclusive results. Thus a meta-analysis is needed to assess their pooled effects.</p><p><b>METHODS</b>This study reviewed all published articles indexed in Pubmed using the keywords in the title or abstract. All data were extracted independently by two reviewers using a standard form, the studies were meta-analyzed and minor discrepancies were resolved by authors' discussion.</p><p><b>RESULTS</b>Twenty seven eligible studies involving 8467 women and 2032 men were identified. The XbaI and PvuII polymorphisms were significantly associated with BMD of the lumbar spine. XX and PP homozygotes had a protective effect in comparison with carriers of the x and p alleles, the effects were more significant in premenopausal women or Western women. At the femoral neck, the results were different. XX served as a protective factor in postmenopausal women, Western women, Western postmenopausal women, and men, while PP was likely to serve as a risk factor in Eastern women, Eastern postmenopausal women, and men.</p><p><b>CONCLUSIONS</b>The XbaI polymorphism is correlated to BMD at diverse skeletal sites. PP had a protective role for the lumbar spine but might be a risk factor for the femoral neck.</p>

Preliminary clinical outcome of domestic posterior-stabilized total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>Total knee arthroplasty (TKA) has been widely used in China. More and more attentions are paid to the development of knee prosthesis that fit for the anatomy of Chinese knee. This study is to summarize the surgical techniques and clinical outcome of domestic posterior-stabilized total knee arthroplasty.</p><p><b>METHODS</b>Fifty-one patients including 19 males and 32 females underwent TKA by using TC-Dynamic from Jan. 2003 to Dec. 2004 were reviewed. The average age at the time of operation was (76.4 +/- 4.1) years (range, 71 to 84 years). Thirty-seven patients suffered from osteoarthritis and 14 patients were rheumatism arthritis. The courses of the disease ranged from 5 to 40 years and the symptoms were pain and limitation of motion. The knee rating score system (HSS) as well as X-rays of the lower extremity was used to evaluate the clinical results.</p><p><b>RESULTS</b>All patients were followed up at the 3rd month after TKA and the duration of follow-up of 32 patients ranged from 48 to 61 months. The HSS scores before TKA was (53.3 +/- 6.7) (40 to 59) points. At the 3rd month and 48th month of follow-up, the HSS scores were (86.1 +/- 7.7) (63 to 95) and (83.5 +/- 8.1) (60 to 95) points respectively. The stress X-rays showed preoperative varus deformities from 9 degrees to 30 degrees with the average of (21.0 +/- 5.8) degrees and normal alignment of the lower extremities postoperative. There were no complications related to TC-Dynamic prosthesis and other complications such as infection, prosthetic loosening and dislocation of patella.</p><p><b>CONCLUSION</b>There is a good mid-term clinical result of TC-Dynamic knee system, which is designed according to anatomical characteristic of Chinese knee joint. More attention should be paid to this knee system about the long term follow-up.</p>

Clinical analysis and prevention from coating shedding of uncemented hip prosthesis / 中国骨伤

<p><b>OBJECTIVE</b>The long-term biological effects of HA-coated prostheses remain uncertain. The purpose of the study is to analyze the reasons of coating shedding of uncemented hip prothesis, so as to provide evidences for the preventions and treatment.</p><p><b>METHODS</b>From 2002.10 to 2009.2, 5 patients with coating shedding of uncemented hip prosthesis were treated with kip revision operation. Among the patients, 3 patients were male and 2 patients were female, ranging in age from 55 to 68 years. The hip prosthesis were taken out in the operation and the cause of coating shedding was analyzed. Another ten normal prosthesis taken out from the revision operation were used as the control group. The histomorphology and microarchitecture of hip prosthesis were observed. The micrometer caliper and vickers hardness test were used to measure the thickness and hardness. The interface shearing force was measured by push-out test. The function of hip joint was evaluated by Harris score.</p><p><b>RESULTS</b>There were difference between control and experience groups in his tomorphology observation. In the 2 patients with HA-coated shedding, the thickness of coating were 112 microm and 138 microm respectively; Vickers hardness were 5,843 Hv and 4,524 Hv respectively; and the shear strength were 12.4 MPa and 11.6 MPa respectively. In the 3 patients with Ti-coated shedding, the Harris scores were 82, 88 and 87 respectively.</p><p><b>CONCLUSION</b>There are many reasons of coating shedding of uncemented hip prosthesis. But most reasons have relationship with the quality of hip prosthesis. Nowadays, there are many methods to enhance the binding strength between the coating and prosthesis, and to prevent the early coating shedding.</p>

The monitoring and analysis of arthroplasty related infection / 中国骨伤

<p><b>OBJECTIVE</b>To monitor and analyze the arthroplasty related infection situations of Drum Tower Hospital, so as to provide evidences for the prevention of infection after arthroplasty.</p><p><b>METHODS</b>Monitoring of infection situations of nine arthroplasty operations were carried out from July to August in 2008. Five sampling methods were used to monitor the air of the 30 m2 surgery for 4 times. Through the cotton swab sampling, hands of 14 surgeons and 76 samples of surgical instruments (forceps, surgical scissors, retractors) were collected and then for bacterial culture.</p><p><b>RESULTS</b>The average amount of the total number of free-floating bacteria in our surgery was 88.2 cfu/m3. For the germiculture, 8 samples of hand detections were positive; 11 samples of surgical instruments including those used and unused and exposed at different times were positive.</p><p><b>CONCLUSION</b>In the surgery of arthroplasty, all operation personnels should protect the air cleanliness degree, obey the surgical hand-washing rules and diminish the exposed time of aseptic table.</p>

Observation of the efficacy of local multimodal analgesic drugs injection in total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To study the efficacy of periarticular multimodal analgesic drugs injection in total hip arthroplasty.</p><p><b>METHODS</b>Seventy-six patients undergoing total hip arthroplasty were randomly divided into two groups, 38 patients received periarticular intraoperative injection of multimodal analgesic drugs, and others not do. Pain of patients were evaluated with a visual analog scale postoperatively, and all patients received patient-controlled analgesia for 24 hours after surgery. The consumption of patient-controlled analgesia was recorded at different time-points.</p><p><b>RESULTS</b>Compared to the control group, visual analog scores for pain of the patients of injected group had significantly lower in the post-anesthetic-care unit and four hours after surgery. Patients of the injected group used significantly less patient-controlled analgesia at 6, 12 hours, and over the first 24 hours after surgery than the control group. No adverse effects resulted from the multimodal analgesic drugs were noted in the injected group.</p><p><b>CONCLUSION</b>Periarticular injection of multimodal analgesic drugs in total hip arthroplasty can significantly reduce the postoperative pain of patients and the consumption of patient-controlled analgesia.</p>

Effects of intra-articular injection of p38 mitogen-activated protein kinase inhibitor on matrix metalloproteinase in articular cartilage of a rat model of osteoarthritis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the effect of intra-articular injection of SB203580, a selective p38 mitogen-activated protein kinase inhibitor, on the expression of matrix metalloproteinase (MMP)-3, MMP-13 in a rat model of osteoarthritis (OA) and to explore the relationship between the MMP-3/MMP-13 expressions and the severity of OA.</p><p><b>METHODS</b>Fourty SD rats underwent unilateral anterior cruciate ligament transection (ACLT) and then randomly divided into four groups, with 10 rats in each group. Group A received 0.1 ml intra-articular injection of SB203580 at a high concentration of 100 micromol/L (once a week) immediately after surgery, and group B were treated under the same condition using SB203580 with a low concentration of 10 micromol/ L Group C received 0.1 ml intra-articular normal saline, and group D were not injected as controls after ACLT. All rats were sacrificed seven weeks after the surgery. Macroscopic and immunohistochemical studies were performed on the cartilage. Protein expressions of MMP-3 and MMP-13 were determined by Western blot. RESULTS Cartilage degradation was significantly milder in group A and group B than in the control groups, as shown by morphological studies (P < 0. 05) and immunohistochemical studies (P < 0. 05). The protein expressions of MMP-3 and MMP-13 in cartilage were significantly lower in groups A and B than in groups C and D (P < 0.01).</p><p><b>CONCLUSION</b>SB203580 can inhibit the expressions of MMP-3 and MMP-13 and thus protect the cartilage.</p>

Arthroscopic treatment of tibial intercondylar eminence avulsion fractures using no absorbable suture fixation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgical skill and the clinical outcomes of arthroscopic treatment of tibial intercondylar eminence avulsion fractures using no absorbable suture fixation.</p><p><b>METHODS</b>A total of 30 cases with avulsion fractures of the tibial intercondylar eminence were treated with no absorbable suture fixation from January 2001 to December 2004. All procedures were performed arthroscopically by the same surgeons. There were 8 cases of type II, 17 type III, 5 type IV based on the Meyers and McKeever classification and 26 cases were fresh fracture. The procedure was completed with the assistance from No. 18 spine needle and Kirschner wire (Ø2.0 mm and Ø1.0 mm) and director drill guide. Postoperative immobilization was not required.</p><p><b>RESULTS</b>All patients were followed up for 3 to 24 months, average (15.0 +/- 4.7) months. Subjective results of all cases were uniformly excellent. The mean Lysholm score was 98.4 in 18 cases of fresh fracture, and 89.8 in 4 cases of old fracture. Mean KT2000 side-to-side difference was normal in all case.</p><p><b>CONCLUSIONS</b>The technique is simple, safe, reproducible, minimal invasion and effective; postoperative immobilization is not required; knee joint function is excellent.</p>