Arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement in the treatment of chronic lateral ankle instability concomitant with fibular tendinitis / 中华创伤杂志

Objective:To compare the efficacies of arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement in the treatment of chronic lateral ankle instability (CLAI) concomitant with fibular tendinitis.Methods:A retrospective cohort analysis was conducted on the clinical data of 31 patients with CLAI concomitant with fibular tendinitis, who were treated in Beijing Tongren Hospital, Capital Medical University between March 2019 and December 2021. The patients included 17 males and 14 females, aged 16-57 years [(32.8±9.6)years]. The anterior drawer test and talar tilt test were positive in all patients preoperatively. Diagnosis was confirmed by physical examination and MRI, and calcaneofibular ligament rupture was excluded. Eleven patients received arthroscopic modified Brostr?m procedure combined with peroneal tendon debridement (modified Brostr?m procedure+tendon debridement group), and 20 underwent pure arthroscopic modified Brostr?m procedure (modified Brostr?m procedure group). The operation time, intraoperative blood loss and length of hospital stay were documented. The visual analogue score (VAS) in peroneal tendon area was assessed before operation and at postoperative 2, 6 and 12 weeks. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle outcome score (FAOS) were assessed before operation and at postoperative 6 and 12 weeks. The anterior drawer test was performed at the last follow-up. The foot and ankle ability measure (FAAM) score was assessed before operation and at the last follow-up. Postoperative wound healing and complications were also observed.Results:All the patients were followed up for 4-19 months [(11.3±3.5)months]. The operation time was (66.0±4.2)minutes in the modified Brostr?m procedure+tendon debridement group, which was significantly longer than (61.5±3.4)minutes in the modified Brostr?m procedure group ( P<0.05). There was no significant difference in intraoperative blood loss or length of hospital stay between the two groups (all P>0.05). Compared with the preoperation, the value of VAS was significantly lowered, and the values of AOFAS ankle-hindfoot score, FAOS and FAAM score were significantly increased at different postoperative timepoints (all P<0.01). No significant differences in the values of VAS, AOFAS ankle-hindfoot score, FAOS or FAAM score were seen between the two groups before operation (all P>0.05). The value of VAS was 3.0(3.0, 4.0) points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 4.0(4.0, 4.0)points in the modified Brostr?m procedure group at 2 weeks postoperatively ( P<0.05). The value of VAS was 2.0(1.0, 3.0)points in the modified Brostr?m procedure+tendon debridement group, being markedly different from 3.0(2.3, 3.0)points in the modified Brostr?m procedure group at 6 weeks postoperatively ( P<0.05). At 12 weeks postoperatively, there was no significant difference in the value of VAS between the two groups ( P>0.05). There were no significant differences in the values of AOFAS ankle-hindfoot score and FAOS between the two groups at 6 or 12 weeks postoperatively (all P>0.05). The anterior drawer test was negative in all patients at the last follow-up. No significant difference was seen in the value of FAAM score between the two groups at the last follow-up ( P>0.05). All incisions were healed well in the first stage after operation, without the occurrence of joint infection, impaired joint motion, nerve injury or deep vein thrombosis. Conclusions:Arthroscopic modified Brostr?m procedure combined with or without peroneal tendon debridement can both improve the foot function in CLAI patients concomitant with fibular tendinitis. However, the combined treatment allows for early pain relief, without increasing the risk of complications, and can therefore contribute to a faster postoperative recovery.

Research progress of cell transplantation in the treatment of osteochondral lesions of the talus / 中华创伤杂志

Osteochondral lesions of the talus (OLT) frequently manifest following ankle joint trauma, causing ankle pain, swelling and impaired mobility, thereby significantly impeding daily activities of the patients. Presently, clinical treatment approaches encompass both conservative management and surgical intervention. Conservative management endeavors to alleviate symptoms, while patients experiencing persistent symptoms resort to surgical intervention. Commonly employed surgical treatments encompass bone marrow stimulation, autologous osteochondral transplantation, and allogeneic osteochondral transplantation. Bone marrow stimulation is employed as a therapeutic approach for the management of smaller OLT, demonstrating favorable short-term effectiveness; however, the long-term prognosis remains uncertain. Autologous osteochondral transplantation is a viable option for larger OLT lesions, albeit it carries the potential of complications at the donor site. Conversely, allogenic osteochondral transplantation exhibits a diminished success rate. In recent times, the utilization of cell transplantation techniques has garnered escalating interest in the treatment of OLT due to their capacity to regenerate cartilage resembling hyaline and their diverse range of cellular origins. The authors reviewed the progress of cell transplantation in the treatment of OLT, providing a reference for the clinical treatment.

An investigation of a family COVID-19 cluster / 上海预防医学

Objective To investigate epidemic characteristics of a family cluster of COVID-19, and to provide reference in improving the criteria for exclusion diagnosis and medical observation of close contacts. Methods Field epidemiological method was used to investigate the cases and close contacts of a family cluster of COVID-19 in Pudong New Area.Descriptive analysis was conducted on epidemiological data.Real-time fluorescence quantitative RT-PCR was used to detect 2019-nCoV nucleic acid in the respiratory tract specimens. Results There were two confirmed cases and one suspected case in the family cluster.The source of infection was Case 1 with a living history in Wuhan, Hubei Province.Case 2 and Case 3, as close contacts, received 14-day medical observation in a centralized isolation site.Case 2 showed symptoms 4 days after the onset of Case 1, and the diagnosis of COVID-19 was excluded after two negative nucleic acid tests during the isolation period.However, after the expiration of isolation, Case 2 was diagnosed positively for COVID-19 and Case 3 was suspected first and then excluded. Conclusion Daily close contact is critical for COVID-19 transmission and is the major cause of family clustering.Once the close contacts show symptoms, diagnosis should be made by combining the results of nucleic acid test, chest CT test, serological test, etc.We suggest to grade the risk of infection for close contacts, and to strengthen the standard of medical observation for close contacts with high risk of infection.

Sex-Specific Lower Extremity Biomechanics of Amateur Runners with Patellofemoral Pain / 医用生物力学

Objective To study the sex-specific lower extremity biomechanics of amateur runners with patellofemoral pain (PFP). Methods Fifteen male and ten female amateur runners with PFP were identified and enrolled in PFP group, twenty-five healthy amateur runners matched with the PFP group were recruited as control group. The kinematics and kinetics, surface electromyography (EMG) data from all the subjects in the running task were collected.Two-way analysis of variance was performed to determine the influence of group and sex on lower extremity biomechanics during running. Results Compared with control group, male amateur runners with PFP showed a greater peak knee flexion angle during the landing phase of running. Compared with control group, male and female amateur runners with PFP showed a greater peak hip adduction angle during the landing phase of running, while the peak hip adduction angle of female participants was significantly greater than that of male participants. Conclusions Amateur runners with PFP showed sex-specific lower extremity biomechanics in the running task, and the clinical intervention for PFP should be sex-specific.

Effect of arthroscopic augmention using suture-tape for Broström-Gould repair of anterior talofibular ligament injury / 中华骨科杂志

Objective@#To evaluate the short-term efficacy of Broström-Gould repair combined with Internal Brace artifi-cial ligament reinforcement under arthroscopy for anterior talofibular ligament injury in overweight and poor ligament quality popu-lation.@*Methods@#A total of 12 patients with anterior talofibular ligament injury treated by arthroscopy were enrolled from October 2017 to May 2018, involving 7 males and 5 females aged from 16 to 57 years old (mean 32.4 years). Patients were with ankle insta-bility, and their BMI was 28.0-30.7 kg/m2 (average, 28.8±0.91 kg/m2), among which there were 2 cases of poor ligament quality (Beighton score ≥4). The anterior tibiofibular ligament injury and the quality of the ligament stump were intraoperatively evaluated under arthroscopy. A 4.75 mm diameter anchor with Internal Brace artificial ligament was inserted into the fibula insertion site, and non-absorbable suture was placed at the talus under total arthroscopy. Firstly, the non-absorbable line on the anchor was per-formed under the standard Broström-Gould procedure to repair the anterior talofibular ligament, and the other end of the ligament was fixed near the distal end of the talus. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle ability measure (FAAM) was compared before and after surgery.@*Results@#All the incisions were healed in the first stage after operation, and no operative complications such as infection occurred. All the 12 patients were followed up for 7 to 12 months (average 9.1 months). After 2 weeks, the patient began functional exercise and could walk with ankle braces. At the latest follow-up, the anterior drawer test was negative. The ankle-posterior foot score of AOFAS was increased from 61.3±7.9 (preopera-tive) to 85.0±6.0 (latest follow-up) (t=21.422, P< 0.01), and the FAAM score was increased from 57.5±10.1 (preoperative) to 86.3±4.8 (latest follow-up) (t=15.032, P< 0.01). AOFAS score was excellent in 1 case and good in 11 cases. The excellent and good rate was 100% (12/12). No complications such as infection and re-rupture occurred after operation.@*Conclusion@#For anterior talofibu-lar ligament injury patients with overweight or poor quality of ligament, the Broström-Gould procedure can be applied to strengthen under arthroscopic Internal Brace ligament without additional tendon reconstruction, which can also obtain good results.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience / 中华泌尿外科杂志

Objective@#To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH).@*Methods@#From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Qmax), maximum voided volume(Vmax), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up.@*Results@#The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2% (49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3) , respectively. At 12-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2) , respectively. All patients showed great improvement of IPSS, Qmax, Vmax, PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P<0.05). Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4%) preserved satisfactory anterograde ejaculation. No significant complication occurred during the procedure. No patient developed permanent urinary incontinence.@*Conclusions@#US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(>100 ml). Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique. It may be a new alternative method in the future for large-volume symptomatic BPH.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience / 中华泌尿外科杂志

Objective To report our initial experience with extraperitoneal approach RoboticAssisted Urethra-sparing simple prostatectomy (US-RASP)on large-gland (＞ 100 ml) benign prostatic hyperplasia(BPH).Methods From August 2015 to April 2018,32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed.The patient's median age was 73 (range 59-80) years,and median BMI was 24.9 (19.3-34.8) kg/m2,The estimated prostate volume(V),postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0 (119.0-223.1) ml,145 (0-280) ml and 13.7 (5.2-27.3) ng/ml,respectively.Four of 32 patients underwent preoperative urinary catheterization.The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire,maximum flow rate (Qmax),maximum voided volume(Vmax),quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33),5.9 (2.5-7.8) ml/s,110 (80-210)ml,5(3-6),and 27(26-29),respectively.Functional parameters including IPSS,QOL,Qmax,Vmax,PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up.Results The US-RASP was completed in all 32 patients and no open conversion.Median operation time was 180 (115-240) min,the estimated blood loss was 300(range 100 to 400)ml,Hemoglobin loss was 17 (5-38)g/L.The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days.Median specimen weight on pathological examination was 107.7(79.8-147.4) g with median of 64.2％ (49.4％-86.2％) resection ratio.At 3-mo follow-up,median IPSS score,Qmax,Vmax,PV and QOL were6(4-18),17.3 (13.8-21.1)ml/s,167(140-310)ml,50 (0-61)ml,1(0-3),respectively.At 12-mo follow-up,median IPSS score,Qmax,V PV and QOL were 4(1-9),20.1 (17.9-24.1)ml/s,205(176-305)ml,24(0-35)ml and 1(0-2),respectively.All patients showed great improvement of IPSS,Q V PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P ＜ 0.05).Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4％) preserved satisfactory anterograde ejaculation.No significant complication occurred during the procedure.No patient developed permanent urinary incontinence.Conclusions US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(＞ 100 ml).Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique.It may be a new alternative method in the future for large-volume symptomatic BPH.

Effect of arthroscopic augmention using suture-tape for Brostr(o)m-Gould repair of anterior talofibular ligament injury / 中华骨科杂志

Objective To evaluate the short-term efficacy of Brostr(o)m-Gould repair combined with Internal Brace artificial ligament reinforcement under arthroscopy for anterior talofibular ligament injury in overweight and poor ligament quality population.Methods A total of 12 patients with anterior talofibular ligament injury treated by arthroscopy were enrolled from October 2017 to May 2018,involving 7 males and 5 females aged from 16 to 57 years old (mean 32.4 years).Patients were with ankle instability,and their BMI was 28.0-30.7 kg/m2 (average,28.8±0.91 kg/m2),among which there were 2 cases of poor ligament quality (Beighton score ≥-4).The anterior tibiofibular ligament injury and the quality of the ligament stump were intraoperatively evaluated under arthroscopy.A 4.75 mm diameter anchor with Internal Brace artificial ligament was inserted into the fibula insertion site,and non-absorbable suture was placed at the talus under total arthroscopy.Firstly,the non-absorbable line on the anchor was performed under the standard Brostr(o)m-Gould procedure to repair the anterior talofibular ligament,and the other end of the ligament was fixed near the distal end of the talus.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle ability measure (FAAM) was compared before and after surgery.Results All the incisions were healed in the first stage after operation,and no operative complications such as infection occurred.All the 12 patients were followed up for 7 to 12 months (average 9.1 months).After 2 weeks,the patient began functional exercise and could walk with ankle braces.At the latest follow-up,the anterior drawer test was negative.The ankle-posterior foot score of AOFAS was increased from 61.3±7.9 (preoperative) to 85.0±6.0 (latest follow-up) (t=21.422,P＜ 0.01),and the FAAM score was increased from 57.5±10.1 (preoperative) to 86.3± 4.8 (latest follow-up) (t=15.032,P＜ 0.01).AOFAS score was excellent in 1 case and good in 11 cases.The excellent and good rate was 100％ (12/12).No complications such as infection and re-rupture occurred after operation.Conclusion For anterior talofibular ligament injury patients with overweight or poor quality of ligament,the Brostr(o)m-Gould procedure can be applied to strengthen under arthroscopic Internal Brace ligament without additional tendon reconstruction,which can also obtain good results.

Integrated targeted sphingolipidomics and transcriptomics explore the mechanism of efficacy and toxicity of Tripterygium glycosides tablets on delayed-type hypersensitivity model / 药学学报

Tripterygium glycosides tablets (TGT) have good immunosuppressive activity, but they can also significantly injure the liver and kidney and its mechanism is unclear. In this study, delayed-type hypersensitivity (DTH) Balb/c mouse were administrated with different doses of TGT. Then the changes of sphingolipids levels in live, kidney and plasma as well as the mRNA expression levels of their metabolic enzymes were studied by the integrated targeted sphingolipidomics and transcriptomics methods to reveal the mechanism of efficacy and toxicity of TGT. It was found that low dose of TGT could significantly decrease levels of total ceramide in the plasma, long chain sphingolipids and saturate sphingolipids in the liver and kidney, but increase them in the plasma, which were related to the efficacy mechanism of TGT. High dose of TGT can significantly increase levels of total ceramide, Cer(d18:1/18:0)-1-P, long chain sphingolipids and decrease saturation sphingolipids mechanism. TGT can also cause significant changes of mRNA expression levels of various sphingolipid metabolic enzymes in the liver and kidney, which were correspond to the changes of sphingolipid levels. The efficacy and toxicity of TGT were related to the regulation of these key enzyme expression levels. In conclusion, the efficacy and toxic mechanism of TGT were closely related to the sphingolipids metabolism. A variety of potential biomarkers were found and they can provide valuable information for the evaluation of the efficacy and toxicity of TGT.

Retzius-sparing robot-assisted laparoscopic radical prostatectomy for early-stage prostate cancer (with video) / 中华男科学杂志

Objective@#To investigate the application of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in the treatment of early-stage prostate cancer.@*METHODS@#We retrospectively analyzed the clinical data about 10 cases of early-stage prostate cancer treated by RS-RARP with the Da Vinci Robot Surgical System from September to October 2016.@*RESULTS@#All the operations were successfully completed without positive surgical margins. The operation time was 170－250 min (［196±25］ min), the intraoperative blood loss was 150－500 ml (［260±128］ ml), the postoperative hospital stay was 6－7 days, and the catheterization time was 14 days. Urinary continence occurred after catheter removal in 1 patient and was recovered 1 month later.@*CONCLUSIONS@#RS-RARP is a safe, effective and reliable method for the treatment of prostate cancer and conducive to the early recovery of urinary continence.

Carotid endarterectomy in the real world: Controversies and thinkings / 第二军医大学学报

As the “gold standard” treatment for carotid artery stenosis to prevent ischemic stroke, carotid endarterectomy (CEA) has heen widely accepted in the western countries; hut was developing rapidly only within the past years in China. We noticed that many surgeons in China can master the surgical skills, hut there is still much room for improvement in their concept understanding, surgical procedure selections, technical concepts, complication management and other aspects. Many surgeons are still puzzled by the following questions during their clinical practices, such as “Is it the plaque or intima that should he resected in CEA?” “How to resect?” “How to select the resecting site?” “To what extent should it be resected?”. and “Whether to perform additional vascular culling and anastomotic plasty?”. Hereby, we summarize the above four controversies of CEA in the real world, including concept doubt, surgical tangle, conceptual differences and technical confusion. We also put forward our thinkings on the issues and shared the latest developments in this field.

Progress on graft and fixation options of arthroscopic anterior cruciate ligament reconstruction / 中国骨伤

Anterior cruciate ligament injury is one of the most common injuries of knee joint. Arthroscopic reconstruction of anterior cruciate ligament is the most commonly performed procedure. A variety type of fixation techniques are being used nowadays, such as interference screw, cortical suspension fixation and transfix, all of which can achieve good effect, with both advantages and disadvantages. However, the healing of reconstructed grafts is a complicated and long-term process, which can be affected by many factors. The mechanical properties of the grafts are also changed greatly in all stages of healing process, adding variables for the post-operative rehabilitation.

Clinical effect of arthroscopy-assisted minimally invasive management of bunion / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of arthroscopy-assisted minimally invasive management of bunion and hallux valgus deformities.</p><p><b>METHODS</b>Total 50 patients (53 feet) with bunion and hallux valgus deformities were treated under arthroscopy from July 2008 to July 2011, with an average age of 42.3 years old (ranging from 30 to 65 years old) involving 19 left feet, 28 right feet and 3 both feet. The American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal(MP-IP) Scale Score was used to evaluate the therapeutic effect.</p><p><b>RESULTS</b>There were no complications such as hallux varus, hallux rigid and nerve or blood vessel injury. Clinically, AOFAS MP-IP Scale Score was increased from 62.19 ± 6.01 preoperatively to 88.26 ± 6.81 postoperatively.</p><p><b>CONCLUSION</b>Arthroscopy-assisted minimally invasive management appears to be a good procedure with advantages of less complication, little trauma and early rehabilitation for bunion and hallux valugs deformities.</p>

Clinical observation of arthroscopic debridement for acute gouty arthritis of the ankle / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effects of arthroscopic debridement for acute gouty arthritis of the ankle.</p><p><b>METHODS</b>Forty-one patients with acute gouty arthritis of the ankle were treated under arthroscopy from January 2010 to June 2012. All the patients were male, age in ranging from 28 to 69 years with an average of 43 years. Eighteen patients were in the left ankles and 23 in the right ankles; 12 cases were firstly attack and 29 cases were recurrent attack. Course of disease was from 2 weeks to 30 months. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score was used to evaluate the clinical effects. Number of acute attacks of gouty arthritis were observed.</p><p><b>RESULTS</b>All the patients were followed up at least 12 months. The mean AOFAS Ankle-Hindfoot Scale score increased from 58.44 +/- 9.45 preoperatively to 86.15 +/- 7.36, 83.41 +/- 9.22, 84.10 +/- 8.22 postoperatively at 6, 12, months and the last follow-up respectively. Swelling of the ankle were improved significantly, pain was relieved and the mean number of acute attacks of gouty arthritis decreased significantly.</p><p><b>CONCLUSION</b>Arthroscopy is helpful for the diagnosis of acute gouty arthritis of the ankle and improvement of clinical symptoms and ankle function.</p>

A review of research on the application of small intestinal submucosa in repairing osteoarticular injury / 中国骨伤

The ideal treatment and recovery of osteoarticular injury remain to be resolved. Small intestinal submucosa (SIS), a naturally-occurring decellularized extracellular matrix, has been recognized as an ideal scaffold for tissue engineering and widely used in repairing various tissues and organs. Nowadays its application has also been gradually increased in the field of orthopedics. We reviewed laboratorial studies and clinical trails about the application of SIS in bone and joint repair, aiming to evaluate its effects on the repair of bone, cartilage, meniscus, ligament and tendon. SIS has showed promising results in repairing bone, meniscus, ligament or tendon. However, additional studies will be required to further evaluate its effects on articular cartilage and tendon-bone healing. How to optimize SIS material,is also a focused problem concerned with making SIS a potential therapeutic option with high value for orthopedic tissue repair.

Comparison of the 1-year Outcomes of Conbercept Therapy between Two Different Angiographic Subtypes of Polypoidal Choroidal Vasculopathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Polypoidal choroidal vasculopathy (PCV) is characterized by the presence of polyps with or without a branching vascular network and more prevalent among Asians. The aim of this study was to compare the outcomes of conbercept therapy between two different angiographic subtypes of PCV.</p><p><b>METHODS</b>Fifty-eight patients of PCV were classified into two phenotypes according to indocyanine green angiography (ICGA). In Type 1, both feeder and draining vessels are visible on ICGA and network vessels are numerous. In Type 2, neither feeder nor draining vessels are detectable, and the number of network vessels is small. The patients were treated with intravitreal conbercept (IVC) for 3 months. Additional IVC was given at subsequent monthly visits, if needed. The patients were followed up for 12 months, and changes in mean best-corrected visual acuity (BCVA), central retinal thickness (CRT), subretinal fluid (SRF) thickness, pigmented epithelial detachment (PED), hemorrhage, and number of polypoidal lesions were evaluated.</p><p><b>RESULTS</b>The mean BCVA in Type 2 PCV (15.92 ± 9.76 letters) achieved a significantly greater improvement than that in the Type 1 (14.10 ± 9.07 letters) at month 12 (t = 2.37, P< 0.01). Moreover, the mean CRT decrease was numerically greater in Type 2 (120.44 ± 73.81 μm) compared with Type 1 (106.48 ± 72.33 μm) at month 6 (t = 4.31, P< 0.01), and greater in Type 2 (130.21 ± 76.28 μm) compared with Type 1 (111.67 ± 79.57 μm) at month 9 (t = 1.87, P< 0.01). There was no significant difference between the two types for the decrease in SRF thickness, PED height, and regression of polyps from month 3 to 12 (t = 2.97, P > 0.05).</p><p><b>CONCLUSION</b>Classification systems for PCV will show differences in presentation, natural history, or response to anti-vascular endothelial growth factor treatment and might, therefore, provide a new key to the choice of treatment for the disease.</p>

CT-guided percutaneous radiofrequency ablation for adrenocortical adenoma with Cushing's syndrome / 中华内分泌外科杂志

Objective To evaluate the feasibility , safety, therapeutic effects and adverse reactions of CT-guided radiofrequency ablation (RFA)for adrenocortical adenoma with Cushing's syndrome.Methods From Jan.2009 to Dec.2013, 24 patients with 24 tumors diagnosed as adrenocortical adenoma with Cushing's syn-drome received CT-guided percutaneous RFA.The average tumor size was(2.1 ±0.7)cm(ranging from 1.1 to 3.9 cm) .RFA was performed under real-time computed tomography guidance .Technical success was defined as disappearance of tumor enhancement on contrast CT imaging 1 week after RFA .Clinical success was defined as improvement in serum cortisol, adreno-cortico-tropic-hormone(ACTH)and symptoms within the follow-up.Patho-logical diagnosis was acquired through the needle biopsy after RFA procedure .Results RFA was technically successful in all the 24 patients.No conversion occured.During operation, patients suffered blood pressure fluc-tuation but no one experienced a hypertensive crisis .Mild postoperative lumbar pain occurred in 6 patients . Tumor enhancement disappeared in CT scan .The mean follow-up was 18 months, ranging from 3 to 36 months. Both serum cortisol and ACTH basically returned to normal levels , and the symptoms related to Cushing's syn-drome gradually disappeared .No severe complications occurred during this procedure .Histopathology results showed all were adrenal cortical adenomas .No serious complication occurred to any patient during RFA .Conclu-sion CT-guided RFA for adrenocortical adenoma with Cushing's syndrome is a feasible , safe, effective and mini-mally invasive treatment with few complications .

Clinical characteristics and prognostic factors of children with critical hand-foot-mouth disease treated with mechanical ventilation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of children with critical hand-foot-mouth disease (HFMD) who were treated with mechanical ventilation and to explore the risk factors for poor prognosis.</p><p><b>METHODS</b>The clinical data of 63 children with critical HFMD who were admitted to the pediatric intensive care unit between April 2012 and September 2013 and needed mechanical ventilation were retrospectively analyzed.</p><p><b>RESULTS</b>Among the 63 children, 43 were boys and 20 were girls, and their mean age was 25 ± 18 months, with 81% under 3 years old. The four death cases were all under three years old. Compared with the cured cases, the death cases had a significantly lower mean age (8 ± 3 months vs 25 ± 18 months; P<0.05). Poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage were all closely related to death (P<0.01). The death cases and cured cases had significantly different peripheral white blood cell counts, blood lactic acid, and blood glucose (24 ± 11× 10⁹/L vs 12 ± 5×10⁹/L; 6.6 ± 1.8 mmol/L vs 3.6 ± 1.7 mmol/L; 16.4 ± 2.5 mmol/L vs 10.0 ± 3.0 mmol/L). The cases with critical illness score <90 had a significantly higher death risk (P<0.01).</p><p><b>CONCLUSIONS</b>Children with critical HFMD are mainly under 3 years old. The children face extremely high risk of death when they suffer from poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage. Significant increases in peripheral white blood cell counts, blood lactic acid, and blood glucose are risk factors for poor prognosis. Critical illness score is also related to poor prognosis.</p>

Hamstring tendon transplantation embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent patellar dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effectiveness of hamstring tendon graft embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent dislocation of the patella.</p><p><b>METHODS</b>From March 2008 to June 2013,67 patients with recurrent dislocation of patella were treated, including 28 males, 39 females with an average age of 22 years ranging from 10 to 42 years old. The clinical manifestations involved knee joint instability,"giving way", sense of patellar dislocation, anterior knee pain. All 67 patients underwent arthroscopic hamstring tendon graft embedding reconstruction of the medial patellofemoral ligament. The curative effect were evaluated by preoperative and postoperative Lysholm score and Q angle changes.</p><p><b>RESULTS</b>All cases were followed up after operation and the mean follow-up time was(27.5±13.4) months(4 to 69 months). Postoperative incision were healed well and no patellar dislocation or subluxation occurred. Lysholm score improved from preoperative 76.35±2.86 to 82.71±2.29 postoperatively; Q angle decreased from preoperative (18.75±2.33)° to postoperative(13.28±1.75)°.</p><p><b>CONCLUSION</b>The method for the reconstruction of medial patellofemoral ligament can provide enough tension, patellar stability.imoroving the function of knee ioint.</p>

Laparoscopic radiofrequency ablation for centrally located renal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the safety and effectiveness of laparoscopic radiofrequency ablation for centrally located renal tumors.</p><p><b>METHODS</b>From January 2009 to April 2013, thirteen patients who diagnosed as centrally located renal tumors were treated with laparoscopic radiofrequency ablation in the Department of Urology of Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. All of the cases were T1aN0M0 stage, 9 patients were male, 4 were female, the mean age was 56 years (range, 38-73 years). All tumors were unilateral, eight lesions were in the left kidney and five in the right kidney. Intraoperative real-time ultrasound and temperature probes were used to guide the range of radiofrequency ablation. Ice saline was injected through ureteral catheter for cooling the collecting system. The postoperative serum creatinine and glomerular filtration rate (GFR) data were collected,all patients were followed up with enhanced CT or MRI.The pre- and post-operative date were compared by paired t test.</p><p><b>RESULTS</b>All patients underwent laparoscopic radiofrequency ablation successfully. The mean operation time was (113±13) minutes and the mean blood loss was (99±23) ml. The mean pre- and post-operative serum creatinine was (71±11) µmol/L and (74±11) µmol/L, the mean pre- and post-operative GFR was (49±8) ml/min and (45±7) ml/min. There was no significant statistic difference between pre-operation and post-operation (t=-1.371 and 1.986, P>0.05). The mean follow-up was 37 months, range 12-63 months. No evidence of local recurrence or distant metastasis was found.</p><p><b>CONCLUSIONS</b>Laparoscopic radiofrequency ablation for T1aN0M0 centrally located renal tumors could be performed safely with good outcomes. Intraoperative real-time ultrasound and temperature probes are helpful to control the range of radiofrequency ablation. Physical cooling of renal collecting system could reduce the occurrence of postoperative hydronephrosis and leakage of urine.</p>