Modified Chevron osteotomy in the treatment of moderate and severe hallux valgus / 中国骨伤

OBJECTIVE@#To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus.@*METHODS@#From January 2015 to January 2019, 28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint, including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left, 16 feet on the right, 2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA), intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect.@*RESULTS@#All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients, and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA, IMA, DMAA and AOFAS were (36.06±6.02) °, (21.78±4.16) °, (8.21±2.65) ° and (52.90±10.97) respectively, at six months after operation, they were (8.87±2.46) °, (11.66±2.84) °, (3.65±1.00) ° and (87.45±10.55) respectively, there was significant difference between preoperative and 6 months after operation(P<0.05). At 6 months after operation, AOFAS score was excellent in 20 feet, good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores, 2 were excellent after revision, and 1 was significantly improved after using custom insoles.@*CONCLUSION@#Modified Chevron can effectively correct HVA, IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws, has strong correction ability, and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus.

Application of ICG fluorescence imaging in surgical treatment of recurrent hepatocellular carcinoma / 中国实用外科杂志

The recurrence rate of primary hepatocellularcarcinoma is very high,and repetitive resection is still the besttreatment for operable recurrent hepatocellular carcinoma.Indocyanine green(ICG) has been widely used andpopularized in resection of hepatocellular carcinoma,providesmore possibilities and diversity for the surgical treatment ofrecurrent hepatocellular carcinoma. Combined withpreoperative imaging,three-dimensional imaging technologyand intraoperative ultrasound,ICG can effectively improve theradical and accuracy of the operation for recurrent hepatocellular carcinoma. ICG-guided hepatectomy isappropriate for the new concept and technical system of liversurgery advocated by modern medical model, and realizesfunctional and anatomical hepatectomy for recurrenthepatocellular carcinoma.

Gastrokines 2 transfection inhibits proliferation, migration and invasion of gastric cancer cell line MKN28 / 基础医学与临床

Objective Gastrokines 2(GKN2) protein expression is detected in gastric cancer tissues, the distal gastric mucosa tissues and the adjacent normal gastric tissues; the effect of GKN2 overexpression is displayed on proliferation,migration and invasion in human gastric cancer cell line MKN28. Methods Immunohistochemistry was performed to observe GKN2 expression in gastric cancinoma tissues,adjacent gastric mucosa tissues and distal gastric mucosa tissues. Then,the GKN2 gene eukaryotic expression vector Xhol GKN3SP-hGKN2-TEV-SBP Xhol was transfected into human gastric cancinoma MKN28 cells. Western blot was used to evaluate the expression of GKN2 in MKN28 cells. Cell viability,migration and invasion ability were investigated by MTT,Transwell migra-tion assay and Transwell invasion assay. Results GKN2 expression in gastric cancinoma tissues is lower in com-parison with those in the adjacent normal gastric tissues or distal gastric mucosa tissues respectively (P< 0.05).The viability of MKN28 cells was significantly inhibited after transfected by GKN2 vs untransfected cells (P<0.05). GKN2 overexpression decreased the cells' number passing through both the membrane and matrigel, compared to those of untransfected cells(P < 0.05). Conclusions Downregulation of GKN2 protein expression is associated with the occurrence of gastric cancer; GKN2 overexpression can suppress the prolifera-tion, migration and invasion of MKN28 cells.

Clinical Features and Genetic Analysis of Pediatric Patients with Alagille Syndrome Presenting Initially with Liver Function Abnormalities / 华中科技大学学报（医学）（英德文版）

Alagille syndrome (AGS) is a multisystem disorder and caused by mutations in JAG1 or NOTCH2 gene.The diagnosis of AGS is hampered by its highly variable clinical manifestations.We performed a retrospective analysis on 16 children diagnosed as having AGS in recent five years in our hospital.Cholestasis was seen in 15 patients (93.8％),heart disease in 12 (75％),characteristic facies in 7 (43.8％),and butterfly vertebrae in 7 (43.8％).Ophthalmology examination was not performed on all the patients.Further,serum biochemical parameters were compared between AGS and 16 biliary atresia (BA) patients who were confirmed by surgery.Elevated liver enzymes were seen in all the patients.Serum total cholesterol (TC) (P=0.0007),alanine aminotransferase (ALT) (P=0.0056),aspartate aminotransferase (AST) (P=0.0114),gamma-glutamyl transferase (GGT) (P=0.035) and total bile acid (TBA) levels (P=0.042) were significantly elevated in AGS patients compared to those in BA cases.However,there were no significant differences in serum total bilirubin (TB),conjugated bilirubin (CB) and albumin (ALB) between the two groups.We identified 14 different JAG1 gene variations and 1 NOTCH2 gene mutation in 16 Chinese AGS patients.Our study suggested clinical features of AGS are highly variable and not all patients meet the classical diagnostic criteria.It was suggested that hypercholesterolaemia and significantly elevated GGT,TBA and ALT may be helpful to diagnose AGS.Genetic testing is integral in the diagnosis of AGS.

Clinical Features and Genetic Analysis of Pediatric Patients with Alagille Syndrome Presenting Initially with Liver Function Abnormalities / 华中科技大学学报（医学）（英德文版）

Alagille syndrome (AGS) is a multisystem disorder and caused by mutations in JAG1 or NOTCH2 gene.The diagnosis of AGS is hampered by its highly variable clinical manifestations.We performed a retrospective analysis on 16 children diagnosed as having AGS in recent five years in our hospital.Cholestasis was seen in 15 patients (93.8％),heart disease in 12 (75％),characteristic facies in 7 (43.8％),and butterfly vertebrae in 7 (43.8％).Ophthalmology examination was not performed on all the patients.Further,serum biochemical parameters were compared between AGS and 16 biliary atresia (BA) patients who were confirmed by surgery.Elevated liver enzymes were seen in all the patients.Serum total cholesterol (TC) (P=0.0007),alanine aminotransferase (ALT) (P=0.0056),aspartate aminotransferase (AST) (P=0.0114),gamma-glutamyl transferase (GGT) (P=0.035) and total bile acid (TBA) levels (P=0.042) were significantly elevated in AGS patients compared to those in BA cases.However,there were no significant differences in serum total bilirubin (TB),conjugated bilirubin (CB) and albumin (ALB) between the two groups.We identified 14 different JAG1 gene variations and 1 NOTCH2 gene mutation in 16 Chinese AGS patients.Our study suggested clinical features of AGS are highly variable and not all patients meet the classical diagnostic criteria.It was suggested that hypercholesterolaemia and significantly elevated GGT,TBA and ALT may be helpful to diagnose AGS.Genetic testing is integral in the diagnosis of AGS.

Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach.</p><p><b>METHODS</b>From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation.</p><p><b>RESULTS</b>All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate.</p><p><b>CONCLUSIONS</b>Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects.</p>

Novel Insights into the Pathogenesis of Hirschsprung's-associated Enterocolitis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To systematically summary the updated results about the pathogenesis of Hirschsprung's-associated enterocolitis (HAEC). Besides, we discussed the research key and direction based on these results.</p><p><b>DATA SOURCES</b>Our data cited in this review were obtained mainly from PubMed from 1975 to 2015, with keywords "Hirschsprung enterocolitis", "Hirschsprung's enterocolitis", "Hirschsprung's-associated enterocolitis", "Hirschsprung-associated enterocolitis", "HAEC", and "EC".</p><p><b>STUDY SELECTION</b>Articles regarding the pathogenesis of HAEC were selected, and the articles mainly regarding the diagnosis, surgical approach, treatment, and follow-up were excluded.</p><p><b>RESULTS</b>Several factors, mainly including mucus barrier, intestinal microbiota, and immune function, as well as some other factors such as genetic variations and surgical reasons, have been found to be related to the pathogenesis of HAEC. Changed quantity and barrier property of mucus, different composition of microbiota, and an abnormal immune state work together or separately trigger HAEC.</p><p><b>CONCLUSIONS</b>The maintenance of intestinal homeostasis is due to a well cooperation of microbiota, mucus barrier, and immune system. If any part presents abnormal, intestinal homeostasis will be broken. Meanwhile, for patients with Hirschsprung's disease or HAEC, dysfunction of these parts has been found. Thus, the happening of HAEC may be mainly attributed to the disorders of intestinal microbiota, mucus barrier, and immune system.</p>

Partial resection, inner thigh skin graft, and glans reconstruction for early-stage penile cancer: A report of 6 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the optimal methods for the reconstruction and preservation of the glans after partial penis resection in the treatment of early-stage penile cancer.</p><p><b>METHODS</b>Between January 2012 and June 2015, we treated 6 cases of early- stage penile cancer by partial penis resection, inner thigh skin graft, and glans reconstruction and followed them up for 0.5-3 years.</p><p><b>RESULTS</b>The length of the penis before and after operation was ([6.5 ± 1.2] vs [4.5 ± 1.8] cm) in the flaccid state and ([12.8 ± 2.3] vs [9.1 ± 2.1] cm) in the erectile state. The sense of the reconstructed glans was completely recovered at 3 months after surgery. The glans skin was pale red and soft, nearly normal at 12 months, with no obvious graft contracture or scar formation. All the patients achieved normal erection and their partners were satisfied with their intercourse. No recurrence or metastasis was observed.</p><p><b>CONCLUSION</b>The strategy of partial penis resection, inner thigh skin graft and glans reconstruction, simple, effective, and with few complications, is one of the best treatments of early-stage penile cancer, which not only ensures radical removal of the tumor but also maximally reserves the function of the organ.</p>

Meta-analysis on effect of compound Danshen injection in treating neonatal hypoxic-ischemic encephalopathy / 中国中药杂志

To systematically evaluate the clinical efficacy and safety of compound Danshen injection in treating hypoxic-ischemic encephalopathy (HIE) of newborns. Computer retrievals were made in PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and China info (before May 2014) and relevant literature references, and manual retrievals were made for journals and conference papers, in order to collect randomized or semi-randomized controlled trials concerning compound Danshen injection in the treatment of neonatal HIE. The quality of included references was evaluated according to literatures recommended by Cochrane Handbook. RevMan 5. 3 software was applied in the statistical treatment. Finally, a total of 13 randomized controlled trials were included, covering 1,211 patients (including 639 patients in the compound Danshen injection-treated group and 572 patients in the control group). Meta-analysis results showed that the routine treatment combined with compound Danshen injection can improve the treatment efficiency of neonatal HIE [RR = 1.28; 95% CI (1.21-1.36)], reduce the mortality rate [RR = 0.42; 95% CI (0.23-0.75)] and the incidence of long-term neurological sequelae [RR = 0.48; 95% CI (0.35-0.65)], with statistical differences. No fatal side effect was observed in all of included trials. So far, limited evidences in this study proved that the application of compound Danshen injection in the treatment of neonatal HIE can enhance the clinical efficiency. However, because of the low quality of the included trials, more well-designed and large-scale multi-center randomized controlled trials shall be made in the future.

Effect of spinal cord extracts after spinal cord injury on proliferation of rat embryonic neural stem cells and Notch signal pathway in vitro

OBJECTIVE@#To investigate the effect of the spinal cord extracts (SCE) after spinal cord injuries (SCIs) on the proliferation of rat embryonic neural stem cells (NSCs) and the expressions of mRNA of Notch1 as well as of Hes1 in this process in vitro.@*METHODS@#The experiment was conducted in 4 different mediums: NSCs+PBS (Group A-blank control group), NSCs+SCE with healthy SD rats (Group B-normal control group), NSCs+SCE with SD rats receiving sham-operation treatment (Group C-sham-operation group) and NSCs+ SCE with SCIs rats (Group D-paraplegic group). Proliferative abilities of 4 different groups were analyzed by MTT chromatometry after co-culture for 1, 2, 3, 4 and 5 d, respectively. The expressions of Notch1 and Hes1 mRNA were also detected with RT-PCR after co-culture for 24 and 48 h, respectively.@*RESULTS@#After co-culture for 1, 2, 3, 4 and 5 d respectively, the MTT values of group D were significantly higher than those of group A, group B and group C (P0.05). Both the expressions of Notch1 and Hes1 mRNA of group D were significantly higher than those of other 3 groups after co-culture for 24 h and 48 h as well (P0.05). There was no difference in expressions of Notch1 and Hes1 mRNA between 24 h and 48 h treatment in group D.@*CONCLUSIONS@#SCE could promote the proliferation of NSCs. It is demonstrated that the microenvironment of SCI may promote the proliferation of NSCs. Besides, SCE could increase the expression of Notch1 and Hes1 mRNA of NSC. It can be concluded that the Notch signaling pathway activation is one of the mechanisms that locally injured microenvironment contributes to the proliferation of ENSC after SCIs. This process may be performed by up-regulating the expressions of Notch1 and Hes1 gene.

Epidemiological status and risk factors of hyperuricemia in rural area of the Three Gorges / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the epidemiological status and risk factors of hyperuricemia in rural area of the Three Gorges.</p><p><b>METHODS</b>A cross-sectional survey was carried out in rural area of Yiling District, Yichang City, which was located north-west bank of Xiling Gorge in 2007. A standard structure questionnaire was used to collect demographic data, social-economic status and life-style features. Fasting venous blood was collected and serum uric acid (SUA) was determined. Hyperuricemia was defined as SUA levels ≥ 417 µ mol/L (70 mg/L) in men and ≥ 357 µmol/L (60 mg/L) in women. Multiple logistic regression analysis was used to analysed the risk factors of hyperuricemia.</p><p><b>RESULTS</b>A total of 9354 participants aged 35 and above were included, 19.9% (1866/9354) participants were the Three Gorges migrants. Serum uric acid level in men was significantly higher than that in women [(285.1 ± 80.2) µmol/L vs. (210.3 ± 65.0) µmol/L,P < 0.01].Serum uric acid level increased significantly in both genders in proportion to increase of age, and was higher in men than in women in all age groups (all P < 0.01). The age-adjusted prevalence was significantly higher in men than in women (5.6% vs. 3.3%, P < 0.01), and was also higher in men aged 35-44 and aged 45-54 than in women (both P < 0.01). There was no significance in prevalence of hyperuricemia in both men and women aged 55-64 and aged ≥ 65. After adjusting age, gender, educational level, migration and occupation, the multiple logistic regression analysis showed that the prevalence of hyperuricemia was higher in alcohol drinking participants than that of non-alcohol drinking participants (OR = 2.06, 95%CI:1.59-2.67, P < 0.01), and in participants used to consume less green vegetables and fruits than in participants consuming more green vegetables and fruits (OR = 1.77, 95% CI:1.27-2.47, P < 0.01).</p><p><b>CONCLUSIONS</b>The prevalence of hyperuricemia is relatively low in rural area of the Three Gorges.Alcohol drinking and low intake of green vegetables and fruits are the risk factors of hyperuricemia in this population.</p>

Intestinal microcirculatory dysfunction and neonatal necrotizing enterocolitis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Based on the observation that coagulation necrosis occurs in the majority of neonatal necrotizing enterocolitis (NEC) patients, it is clear that intestinal ischemia is a contributing factor to the pathogenesis of NEC. However, the published studies regarding the role of intestinal ischemia in NEC are controversial. The aim of this paper is to review the current studies regarding intestinal microcirculatory dysfunction and NEC, and try to elucidate the exact role of intestinal microcirculatory dysfunction in NEC.</p><p><b>DATA SOURCES</b>The studies cited in this review were mainly obtained from articles listed in Medline and PubMed. The search terms used were "intestinal microcirculatory dysfunction" and "neonatal necrotizing enterocolitis".</p><p><b>STUDY SELECTION</b>Mainly original milestone articles and critical reviews written by major pioneer investigators in the field were selected.</p><p><b>RESULTS</b>Immature regulatory control of mesentery circulation makes the neonatal intestinal microvasculature vulnerable. When neonates are subjected to stress, endothelial cell dysfunction occurs and results in vasoconstriction of arterioles, inflammatory cell infiltration and activation in venules, and endothelial barrier disruption in capillaries. The compromised vasculature increases circulation resistance and therefore decreases intestinal perfusion, and may eventually progress to intestinal necrosis.</p><p><b>CONCLUSION</b>Intestinal ischemia plays an important role through the whole course of NEC. New therapeutic agents targeting intestinal ischemia, like HB-EGF, are promising therapeutic agents for the treatment of NEC.</p>

Changes of glucagon-like peptide-2 expression in serum and ileum after colectomy in rats / 中华实用儿科临床杂志

Objective To explore the effect of colectomy on the expression of glucagon-like peptide-2 (GLP-2) in serum and ileum and compare the changes of GLP-2 after different colectomy in rats.Methods Eighty male or female rats,aging 3-4 months old,were recruited in this study.The rats weight 180-250 g.The 80 rats were evenly and randomly distributed into 4 groups according to the surgical procedures they underwent:control group,in which the rats were not performed any procedures; sham surgery group,in which the rats underwent laparotomy ;left hemicolectomy group,in which the rats were performed left hemicolectomy;and subtotal colectomy group,in which the rats were performed subtotal colectomy.According to execution time,each group had 4 subgroups,including 0 day group,10 day group,20 day group and 30 day group,and 5 rats were included in each subgroup.The whole blood was collected through cardiac puncture.Serum was collected and GLP-2 in serum was determined by enzyme-linked immunosorbent assay.The GLP-2 in ileum was studied by immunohistochemistry staining.The length of villus of ileum was also measured by HE staining.Results The protein of GLP-2 was found in fibroblasts,epithelium and endocrine cells in ileum.Compared with control group and sham surgery group,the expressions of GLP-2 in serum and ileum increased significantly in the rats that underwent left hemicolectomy after surgery(all P ＜ 0.05),and it was increasing with time.The villus length of the rats underwent left hemicolectomy also increased significantly compared with the control group and sham surgery groups 20 days and 30 days after surgery(all P ＜ 0.05).The expressions of GLP-2 in serun and ileum and villus length of the rats with subtotal colectomy were not significantly different from those of the control group and sham surgery group(all P ＞ 0.05).Conclusions The expressions of GLP-2 in serum and ileum are elevated after left hemicolectomy but not in subtotal colectomy,which may be related to the delayed intestinal adaption after colectomy.

Comparison of embryonic nature orifice transumbilical endoscopic surgery with conventional laparoscopic surgery treatmenting Hirschsprung disease / 中华实用儿科临床杂志

Objective To compare the therapeutic effects of embryonic nature orifice transumbilical endoscopic surgery(ENOTES) with conventional laparoscopic(CL) surgery in Hirschsprung disease(HD).Methods A total of 111 children from Sep.2009 to Dec.2010 were included in the retrospective study.The patients were divided into 2groups:ENOTES group (66 cases) and CL group (45 cases).The general conditions of children were reviewed operative situation,postoperative complications and defecation 1 year after operation.Results In the left colectomy,there was no difference between 2 groups in age,weight,operative blood loss and postoperative stay (all P ＞ 0.05),but ENOTES took up less time than CL(P ＜ 0.05) ;in the subtotal colectomy,no significant difference existed in all series.All children underwent primary radical surgery,neither transfer to open surgery nor dead case.In ENOTES group,there were 9 cases suffering from enterocolitis postoperatively (13.6％),while 7 cases (15.6％) in CL group.Twenty-eight patients in ENOTES group and 12 in CL group were followed up for 1 year.Less abdominal distension postoperatively was noted in ENTOES group than CL group(P ＜ 0.05),but no other difference in other available data.In addition,no obvious operative scar was noted on the abdomen in ENOTES group,what meant better cosmetic benefit than CL.Conclusion HD treated with ENOTES can gain the same outcomes with CL with better cosmetic effect.

Analysis of perioperation complications of total hip arthroplasty in treating Crowe type IV developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH) and analyze perioperative complications.</p><p><b>METHODS</b>From March 2000 to March 2010, 19 patients (23 hips, of them, 4 patients with bilateral hips) with Crowe type IV DDH underwent THA. There were 5 males and 14 females, with average age of 61.3 years (ranged, 41 to 72 years). All hips were treated with small acetabular components combined with medial protrusion technique in acetabular reconstruction, as well as subtrochanteric shortening osteotomy in femur. Joint function of hips were evaluated according to Harris scoring.</p><p><b>RESULTS</b>All patients were followed up with an average of 4.2 years (ranged, 1 to 8 years). Postoperative X-ray films showed all acetabular prosthesis were in true acetabulum. No loosening and nonunion were found in all patients. Harris scoring improved from preoperative 34.0 +/- 6.9 to postoperative 85.0 +/- 7.5. Complications occurred in 11 cases in the patients, including femoral split fracture in 3 cases, nerve injury in 3 cases, delayed union in 2 cases, dislocation in 3 cases.</p><p><b>CONCLUSION</b>Total hip arthroplasty using small acetabular component, medial protrusion, femoral subtrochanteric shortening osteotomy technique for the Crowe type IV DDH can effectively restore hip function and leg length. But incidence of complications is high. The long-term follow-up is necessary for further study.</p>

Effects of Bushen Zhuangjin Decoction containing serum on the apoptosis of chondrocytes induced by mechanics stimulus / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effects of Bushen Zhuangjin Decoction (BZD) containing serum on the apoptosis of chondrocytes induced by mechanics stimulus.</p><p><b>METHODS</b>The BZD containing serum was extracted. The chondrocyte nutritive media was divided into 3 groups, i.e., the common nutritive medium group, the blank rabbit serum medium group, and the BZD nutritive medium group. The apoptosis of chondrocytes was induced by continuing mechanics stimulus in 24 h. Then the chondrocytes were collected. The apoptosis rate of chondrocytes was determined by flow cytometry. The contents of interleukin 1beta (IL-1beta) and nitric oxide (NO) in the corresponding media were determined.</p><p><b>RESULTS</b>The apoptosis of chondrocytes in the BZD nutritive medium group (19.55 +/- 7.98)% was lower than that of the common nutritive medium group (39.32 +/- 13.45)% and the blank rabbit serum medium group (37.87 +/- 9.67)%, showing statistical difference (P < 0.05). The contents of IL-1beta and NO were also lower in the BZD nutritive medium group with statistical difference when compared with those of the other two groups (P < 0.05).</p><p><b>CONCLUSION</b>BZD containing serum could protect mechanics stimulus induced apoptosis of chondrocytes.</p>

Transumbilical laparoscopic pull-through for children with hypoganglionosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical outcomes after on transumbilical laparoscopic pull-through procedure for pediatric hypoganglionosis(HYP).</p><p><b>METHODS</b>Twelve children with HYP had received transumbilical laparoscopic pull-through procedure from June 2009 to June 2010. Specially designed curved and elongated laparoscopic instruments were used during the procedures. All the patients were followed up over 10 months. Data were collected and analyzed. The diagnosis of hypoganglionsis was pathologically confirmed.</p><p><b>RESULTS</b>No conversions to laparotomy or traditional laparoscopic surgery were required and there were no damages to the abdominal blood vessels, intestine, ductus deferens, or ureters. The average duration of operation was 140 min. The mean intraoperative blood loss was 45 ml. The mean length of specimen was 40 cm. Postoperatively there were no complications such as anastomotic leak, anastomotic stricture, constipation, seepage, or fecal in continence. The average hospital stay after surgery was 9 days. During 10 to 22 months of follow-up(median 16 months), no postoperative recurrence was noticed. No obvious scar was seen 1 months after surgery.</p><p><b>CONCLUSION</b>It is safe and effective for children with hypoganglionosis to undergo transumbilical laparoscopic pull-through procedure.</p>

Surgical treatment and the fixator selection for Pilon fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the internal fixation selection and the operative method of Pilon fracture.</p><p><b>METHODS</b>From Aug. 2004 to Aug. 2007,there were 40 patients with Pilon fractures involving 30 males and 10 females. Thirty cases were closed fracture and 10 were open fracture. Seven patients were treated by emergency operation, 3 patients were debrided and suture at first. Twenty-three patients were treated with open reduction and internal fixation (ORIF),the other seventeen patients were treated with LC-DCP,reconstruct plate for fixation or screw, Kirschner wire combine screw for fixation.</p><p><b>RESULTS</b>All patients were followed up for 6 to 32 months (means 19 months). The time of union of fracture was about 3 to 5 months. The outcome was evaluated according to Baired-Jackson criteria, the results were excellent in 27 cases,good in 7, fair in 5, poor in 1. Seven cases were found the operative incision and wound surface difficult to heal,among them 5 cases came from the emergency operation patients, 1 case was closed fracture patient. They were be healed by change of dressing or dermatoplasty or skin flap.</p><p><b>CONCLUSION</b>It is the key factor of treatment for Pilon fractures to correct evaluate before operation and select correct operation time. It is also important to selected suitable internal fixation and good reduction.</p>

Spiral CT reconstruction for typing of tibial plateau fracture to guide surgical therapy / 中国骨伤

<p><b>OBJECTIVE</b>To typing of tibial plateau fracture based on spiral CT reconstruction and to explore effect of the typing method for treatment.</p><p><b>METHODS</b>A hundred and twenty-six cases with tibial plateau fracture (male 95, female 31, age from 23 to 58 years old), the fractures were classified based on reconstruction image of spiral CT. Including central compression type in 13 cases, split type in 8, split compression type in 79, comminution type in 26. According to the different typing the suitable incision of operation and fixed method for fracture were select.</p><p><b>RESULTS</b>A hundred and twenty-six cases were followed up for 0.5-4 years with an average of 1.2 years. According to Hohl system score to knee joint function, there were statistical significance in the pain,active movement,active range of motion between before and after operation (P < 0.01) and there were no statistical significance in stability and self-evaluation (P < 0.01).</p><p><b>CONCLUSION</b>Typing of tibial plateau fracture based on spiral CT reconstruction helpful to choose operative approach, reduction and fixed method and obviously improve clinical effect.</p>

Study Progress of Ex Utero Intrapartum Treatment / 实用儿科临床杂志

Airway problems in foetus that may cause airway obstruction can be safely managed by using an ex utero intrapartum technique(EXIT).The EXIT procedure maintains a period of uteroplacental circulation for fetal oxygenation during delivery to provide time to explore and secure the airway of the fetus or to perform fetal operations before the umbilical cord is clamped.The common indication for the EXIT procedure is the presence of foetal airway obstruction,which is usually caused by neck mass,congenital diaphragmatic hernia,congenital high way obstruction syndrome,thoracic abnormality,congenital heart and lung dysfunction,conjoined twins,and so on.It avoids the acute airway obstruction in a neonate that has disastrous consequences.