Clinical characteristics and treatment of complex fracture-dislocations of the elbow in children / 中华骨科杂志

Objective:To summarize and discuss the concept and clinical manifestations of complex fracture-dislocations of the elbow in children, and compare its injury characteristics, treatment and clinical effect with adults.Methods:From September 2015 to January 2020, 34 patients seen and treated at our institution for complex fracture-dislocations of the elbow were identified, and their medical records and radiographs were reviewed retrospectively. The inclusion criteria were elbow dislocation combined with one or more fractures at the proximal ulna and radius. There were 25 boys and 9 girls, with an average age of 8.3±3.2 years. The left arm was involved in 27 cases, and the right arm was involved in 7 cases. The causes of injury included falling from a scooter in 16 cases, falling from height in 10 cases, cycling in 5 cases and traffic accident in 3 cases. All patients were treated with closed reduction and the application of plaster under local anaesthesia in the emergency room. Then, X-ray, CT and MRI were performed to evaluate the fracture-dislocation and ligament injury. The following treatment plan was comprehensively evaluated according to the size and displacement of the combined fracture block and the stability of the elbow, for example, open reduction with K-wires and tension band or plate fixation for olecranon fracture, open reduction with loop plate fixation for coronal process fracture, closed reduction or open reduction with K-wires or elasticstable intramedullary nail for radial neck fracture.Results:Among the 34 patients, there were 16 cases of transolecranon fracture-dislocation, 1 case of varus posteromedial rotational instability, 4 cases of valgus posterolateral rotatory instability and 13 cases of divergent dislocation of elbow. All patients were followed up for 13(8, 15) months, and the average fracture healing time was 3.5±0.8 weeks, with no failure of internal fixation. In 2 cases of elbow dislocation combined radial neck fracture, one case had ischemic necrosis of the radial head and one case had early closure of epiphyseal plate of the proximal radius. At the last follow-up, all patients had no subluxation, dislocation or instability of the elbow. The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score (MEPS) as excellent in 25 cases, good in 5 cases, fair in 3 cases, and poor in one case, with excellent and good rate 88%.Conclusion:The complex fracture-dislocations of the elbow is rare in children. We have the opinion that the clinical characteristics are dislocation combined with one or more fractures of the proximal ulna and radius. Compared with adults, its pathological characteristics and the scope of injury are similar, but most of the injuries are mild. The clinical manifestations are mainly transolecranon fracture-dislocation and divergent dislocation of elbow. Good results can be achieved in most cases through open reduction with internal fixation for fractures.

Diagnosis and treatment of a head-neck separation type of Monteggia equivalent fractures in children / 中华创伤骨科杂志

Objective:To explore the clinical characteristics and treatment of a head-neck separation type of Monteggia equivalent fractures in children.Methods:From March 2016 to February 2019, 12 children sought medical attention at Pediatric Orthopedic Hospital, Honghui Hospital Affiliated to Xi'an Jiaotong University for a head-neck separation type of Monteggia equivalent fractures. They were 8 boys and 4 girls, aged from 3 to 14 years (average, 8.3 years). All cases were treated with closed reduction, deformity correction and plaster fixation at emergency department after X-ray examination. In line with the treatment principles for Monteggia fractures, after the ulnar length was first restored and stabilized, a proper fixation method was chosen according to the location and type of the ulnar fracture, followed by treatment of the radial neck fracture. The fracture union and complications were evaluated according to the X-ray films after operation, and the therapeutic efficacy was evaluated according to the Mayo elbow performance score (MEPS) at the final follow-up.Results:The head-neck separation type of Monteggia equivalent fractures in children was characterized by a fracture of ulnar diaphysis or metaphysis and a fracture of the radial neck with complete separation of the head and neck, a longitudinal axis of the radius off the capitellum center at the distal fracture end but normal proximal humeroradial relationship. The fractures were classified into 2 types depending on the angulation direction of the ulnar fracture and the direction of distal displacement of the radial neck fracture: 7 cases belonged to the extension-valgus type and 5 cases to the flexion-varus type. The 12 patients were followed up for 8 to 38 months (average, 16.0 months). Of the ulnar fractures, one was treated with closed reduction and Kirschner wire fixation, 4 with elastic intramedullary nail fixation, 5 with plate fixation, one untreated, and one with manual reduction only. Of the radial neck fractures, 11 were treated with closed reduction and elastic intramedullary nail fixation, and one with open reduction and K-wires fixation. All fractures got united after 8 to 12 weeks (mean, 9.6 weeks). The time for removal of internal fixation ranged from 12 to 50 weeks (mean, 31.2 weeks). Avascular necrosis occurred in one case and bulk formation of proximal metaphysis in another. By the MEPS at the final follow-up, the therapeutic efficacy was excellent in 10 cases, good in one and fair in one.Conclusions:The head-neck separation type of Monteggia equivalent fractures in children is different from common Monteggia fractures or radial neck fractures, because its clinical manifestations are characterized by a fracture of ulnar diaphysis or metaphysis and a fracture of the radial neck with complete separation of the head and neck, a longitudinal axis of the radius off the capitellum center at the distal fracture end but normal proximal humeroradial relationship. The treatment options for ulnar fractures include closed reduction with Kirschner wire fixation, elastic intramedullary nailing, open reduction and bone plate fixation or no fixation, while radial neck fractures are mostly treated by closed reduction and elastic intramedullary nailing. Early functional exercise can lead to satisfactory clinical outcomes.

Preliminary experience with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after total laparoscopic proximal gastrectomy for the treatment of adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

Objective: To explore the feasibility and preliminary technical experience of the double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after total laparoscopic proximal gastrectomy (TLPG) in the treatment of adenocarcinoma of esophagogastric junction (AEG). Methods: A descriptive case series study method was used. Clinical data of 12 AEG patients who underwent the double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after TLPG from January 2021 to June 2021 at the Department of General Surgery, First Medical Center, PLA General Hospital were retrospectively analyzed. Among the 12 patients, the median tumor diameter was 2.0 (1.5-2.9) cm, and the pathological stage was T1-3N0-3aM0. All the patients routinely underwent TLPG and D2 lymph node dissection with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis: (1) Double-tract reconstruction combined with π-shaped esophagojejunal anastomosis: mesentery 25 cm away from the Trevor ligament was treated, and an incision of about 1 cm was made on the mesenteric border of the intestinal wall and the right wall of the esophagus, two arms of the linear cutting closure were inserted, and esophagojejunal side-to-side anastomosis was performed. A linear stapler was used to cut off the lower edge of the anastomosis and close the common opening to complete the esophagojejunal π-shaped anastomosis. (2) Side-to-side gastrojejunostomy anastomosis: an incision of about 1 cm was made at the jejunum to mesenteric border and at the greater curvature of the remnant stomach 15 cm from the esophagojejunostomy, and a linear stapler was inserted to complete the gastrojejunostomy side-to-side anastomosis. (3) Side-to-side jejunojejunal anastomosis: an incision of about 1 cm was made at the proximal and distal jejunum to the mesangial border 40 cm from the esophagojejunostomy, and two arms of the linear stapler were inserted respectively to complete the side-to-side jejunojejunal anastomosis. A midline incision about 4-6 cm in the upper abdomen was conducted to take out the specimen, and an abdominal drainage tube was placed, then layer-by-layer abdominal closure was performed.@*INDICATIONS@#(1) adenocarcinoma of esophagogastric junction (Seiwert type II-III) was diagnosed by endoscopy and pathological examination; (2) ability to preserve at least 1/2 of the distal stomach after R0 resection of proximal stomach was evaluated preoperatively.@*CONTRAINDICATIONS@#(1) evaluation indicated distant metastasis of tumor or invasion of other organs; (2) short abdominal esophagus or existence of diaphragmatic hiatal hernia was assessed during the operation; (3) mesentery was too short or the tension was too high; (4) existence of severe comorbidities before surgery; (5) only palliative surgery was required in preoperative evaluation; (6) poor nutritional status.@*MAIN OUTCOME MEASURES@#operation time, intraoperative blood loss, postoperative complications, time to first flatus and time to start liquid diet, postoperative hospital stay, operation cost, etc. Continuous variables that conformed to normal distribution were presented as mean ± standard deviation, and those that did not conform to normal distribution were presented as median (Q1,Q3). Results: All the patients successfully completed TLPG with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis, and postoperative pathology showed that no cancer cells were found on the upper incision margin. The operation time was (247.9±62.4) minutes, the median intraoperative blood loss was 100.0 (62.5, 100.0) ml, no intraoperative blood transfusion was required, the incision length was (4.9±1.0) cm, and the operation cost was (55.5±0.7) thousand yuan. The median time to start liquid diet was 1.0 (1.0, 2.0) days, and the mean time to flatus was (3.1±0.9) days. All the patients were discharged uneventfully. Only 1 patient developed postoperative paralytic ileus and infectious pneumonia with Clavien-Dindo classification of grade II. The patient recovered after conservative treatment. There was no surgery-related death. The postoperative hospital stay was (8.3±2.1) days. Conclusion: The double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after TLPG is safe and feasible, which can minimize surgical trauma and accelerate postoperative recovery.

Experience and challenges in the treatment of neovascular glaucoma / 中华眼底病杂志

Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.

Curative effects of Masquelet technique and 3D printing for repair of Cierny-Mader type Ⅳ long bone osteomyelitis / 中华创伤骨科杂志

Objective:To evaluate the curative effects of Masquelet technique and 3D printing in repair of Cierny-Mader type Ⅳ long bone osteomyelitis.Methods:A retrospective study was conducted of the 8 patients who had been treated at Department of Orthopaedics, The Third Affiliated Hospital to Peking University for Cierny-Mader type Ⅳ osteomyelitis of the lower extremity from June 2017 to December 2019. They were 6 males and 2 females, aged from 27 to 79 years (average, 54.6 years). The defects involved femoral shaft in 5 cases, femoral metaphysis in one, tibia shaft in one, and tibial metaphysis in one. The defect lengths ranged from 7.7 to 15.5 cm, averaging 10.2 cm. Stage one was local infection control and temporary stability reconstruction using Masquelet technique, stage two design and 3D printing of the prosthesis and stable pattern design, and stage three prosthesis implantation and rehabilitation. The ranges of motion of the knee and ankle were recoded postoperatively and the functions evaluated using the Johner-Wruhs scores.Results:The average follow-up time for the 8 patients was 12.6 months (from 6 to 18 months). The total treatment time from the first admission to the last discharge ranged from 62 to 125 days (average, 91.0 days), the time for stage one from 13 to 57 days (average, 28.7 days), that for stage two from 30 to 87 days(average, 48.3 d), and that for stage three from 28 to 84 days (average, 63.0 days). The infection was controlled and there was no recurrence, implant loosening or breakage. Seven patients were capable of full weight-bearing at 14.7 days (from 4 to 42 days) after surgery. One patient recovered full weight-bearing 6 months after surgery due to severe osteoporosis. Fine functional recovery was achieved in the 8 patients, with a range of motion from 0° to 100° for the knee and a range from 35° dorsal flexion to 40° toe flexion for the ankle. The Johner-Wruhs scores at the last follow-up showed 2 excellent, 5 good and one moderate cases.Conclusion:In repair of Cierny-Mader type Ⅳ long bone osteomyelitis, Masquelet technique and 3D printing can shorten the treatment process and allow for early recovery.

Cement augmented pedicle screw combined with vertebroplasty for the treatment of Kümmell's disease with type Ⅲ / 中国骨伤

OBJECTIVE@#To explore clinical effect of cement-augmented pedicle screw combined with vertebroplasty in treating Kümmell disease with type Ⅲ.@*METHODS@#From January 2015 to December 2018, 37 patients with type Ⅲ Kümmell disease were retrospectively analyzed, including 11 males and 26 females, aged from 61 to 84 years old with an average of (68.6±4.2) years old, and the courses of disease ranged from 2 to 10 months with an average of(6.5±2.3) months. Nine patients were grade C, 20 patients were grade D and 8 patients were grade E according to Frankle grading. All patients were treated by cement-augmented pedicle screw combined with vertebroplasty. Operation time, blood loss, postoperative drainage, hospital stay and complicationswere observed after oeprtaion. Visual analogue scale(VAS), Oswestry Disability Index(ODI), height of anterior vertebral body, Cobb angle before and after operation were compared.@*RESULTS@#All patients were followed up from 12 to 60 months with an average of (22.4±10.9) months. Operation time was (240.9±77.4) min, blood loss was (315.0±149.2) ml, postoperative drainage was (220.8±72.0) ml, hospital stay was (12.6±4.7) days. One patient occurred incision redness and 1 patient occurred infection after opertaion. No loosening of bone cement occurred. Postopertaive VAS and ODI were lower than that of before opertaion(@*CONCLUSION@#Cement-augmented pedicle screw combined with vertebroplasty is a safe and effective method for the tretament of Kümmell disease with type Ⅲ.

Loss of the posteromedial support: a risk factor for implant failure after fixation of AO 31-A2 intertrochanteric fractures / 中华医学杂志(英文版)

BACKGROUND@#The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure.@*METHODS@#Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled. Focusing on posteromedial support, the A2 ITFs were divided into two groups, namely, those with (Group A, n = 153) or without (Group B, n = 241) posteromedial support post-operatively, and the failure rates were compared. Based on the final outcomes (failed or not), we allocated all of the patients into two groups: failed (Group C, n = 66) and normal (Group D, n = 328). We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups. In addition, a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure. The basic factors were age, sex, American Society of Anesthesiologists (ASA) score, side of affected limb, fixation method (intramedullary or extramedullary), time from injury to operation, blood loss, operative time and length of stay.@*RESULTS@#The failure rate of group B (58, 24.07%) was significantly higher than that of group A (8, 5.23%) (χ = 23.814, P < 0.001). Regarding Groups C and D, the comparisons of the fixation method (P = 0.005), operative time (P = 0.001), blood loss (P = 0.002) and length of stay (P = 0.033) showed that the differences were significant. The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR = 5.986, 95% CI: 2.667-13.432) (P < 0.001).@*CONCLUSIONS@#For AO31-A2 ITFs, the loss of posteromedial support was an independent risk factor for fixation failure. Therefore, posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.

Antedisplacement and fixation of thoracic vertebra-ossification of posterior longitudinal ligament complex for treatment of severe multi-level thoracic ossification of posterior longitudinal ligament / 第二军医大学学报

Objective: To introduce a technical innovation for the treatment of severe multi-level thoracic ossification of posterior longitudinal ligament (OPLL). Methods: The detailed surgical procedure included isolation of vertebra-OPLL complex (VOC), implantation of screws and rods, and antedisplacement of the VOC. A patient diagnosed as multi-level thoracic OPLL with myelopathy was treated by this technique and the outcomes were reported. Results: Neurological outcomes achieved an evident improvement, with the recovery rate of modified-Japanese Orthopaedic Association score being 75%. The operation took 480 min and the intraoperative bleeding was 1 000 mL. Postoperative computed tomography and magnetic resonance imaging showed sufficient decompression of spinal cord. The occupation ratio of spinal canal improved from 86.6% to 58.8% in T2/3, and from 68.2% to 45.9% in T3/4. Conclusion: Posterior thoracic vertebra-OPLL complex antedisplacement and fixation is a feasible, theoretically safe and effective surgical option for the treatment of severe multi-level thoracic OPLL with myelopathy. The operation is simple and performed outside the spinal canal, and no ossified mass is removed. However, further studies with large-scale cases and control groups are required to reveal the applicability and safety of this technique.

Analysis of risk factors for necrosis of femoral head after internal fixation surgery in young and mid-aged patients with femoral neck fracture / 北京大学学报(医学版)

OBJECTIVE@#To retrospectively analyze the risk factors of avascular necrosis of femoral head (ANFH) after internal fixation in young and mid-aged adults.@*METHODS@#From January 2007 to December 2017, femoral neck fracture patients (18-60 years old) treated by reduction and internal fixation were retrospectively studied in Peking University Third Hospital. We recorded their gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) grade, reason of injury, fracture side, interval between injury and surgery, location of fracture line, Garden classification, Pauwels classification, reduction method (open or closed), internal fixation and reduction quality. The diagnosis of ANFH was confirmed based on X-ray and MRI images during the follow-up. The internal fixation method included cannulated compression screw (CCS) or dynamic hip screw (DHS, with or without anti-rotation screw). χ2 test and Logistic regression analysis were used to analyze the relationship between the various factors and postoperative ANFH.@*RESULTS@#A total of 113 patients were included in this study, including 63 males and 50 females with an average age of (43.17 ± 12.34) years. They were followed up by (25.08 ± 16.17) months. ASA grade included grade I (21 cases), grade II (55 cases) and grade III (37 cases). The reasons of injury included low-energy trauma (76 cases) and high-energy (37 cases). The fracture line included subcapital type (37 cases), transverse type (74 cases) and basal type (2 cases). Garden classification included type I (3 cases), type II (46 cases), type III (39 cases) and type IV (25 cases). Pauwels classification included type I (21 cases), type II (55 cases) and type III (37 cases). Interval between injury and surgery was (3.88 ± 3.66) days, 108 patients and 5 patients performed closed and open reduction respectively. 63 patients performed CCS, and 50 patients performed DHS. The reduction quality included grade A (91 cases), grade B (18 cases) and grade C (4 cases). 18 patients developed ANFH after surgery, the incidence rate was 15.93% (18/113). The result of χ2 test showed the reason of injury (OR=0.19, P < 0.01), Garden classification (OR=0.13, P < 0.01), Pauwels classification (OR=0.12, P = 0.02), internal fixation method (OR=3.29, P = 0.04) and reduction quality (OR=0.33, P < 0.01) were significantly associated with ANFH. These five factors were further included into the Logistic regression analysis, and its results showed that the reason of injury (OR=4.11, P = 0.03) and Garden classification (OR=4.85, P = 0.04) were statistically significant.@*CONCLUSION@#The reason of injury, Garden classification, Pauwels classification, internal fixation and reduction quality may increase the risk of ANFH after surgery, and the reason of injury and Garden classification were much more significant.

Treatment of nonunion of lateral humeral condyle complicated with cubitus valgus with primary fixation in situ and secondary supracondylar varus osteotomy / 中华创伤骨科杂志

Objective:To evaluate the treatment of nonunion of lateral humeral condyle complicated with cubitus valgus with primary fixation in situ and secondary supracondylar varus osteotomy.Methods:A retrospective analysis was made of the 8 children who had been treated for nonunion of lateral humeral condyle complicated with cubitus valgus at Department of Pediatric Orthopedics, Honghui Hospital from January 2016 to March 2018. They were 5 boys and 3 girls with 5 left and 3 right sides involved. Their age at injury ranged from 6 to 14 years (average, 10 years) and the duration from injury to operation from 2 to 6 years (average, 4 years). At the primary stage, the fragments were fixated in situ with compressive cannulated screws after cleaning the nonunion ends, followed by iliac autograft. At the secondary stage, the humeral supracondylar varus osteotomy was performed after the nonunion was healed and the elbow range of motion recovered. The therapeutic effects were assessed by comparing the elbow range of motion, carrying angle and Mayo elbow performance score (MEPS) between preoperation and the final follow-up.Results:All the patients were followed up for an average of 44.5 months (range, from 27 to 64 months). The average healing time for obsolete nonunion of lateral humeral condyle was 81.3 days (range, from 55 to 120 days) after the primary operation and that for supracondylar varus osteotomy 51.1 days (range, from 45 to 60 days) after the secondary operation. The elbow range of motion was 129.0°±4.6° before operation and 138.0°±5.4° at the final follow-up, showing a significant difference ( P<0.001). The average carrying angle at the healthy side in 8 children was 5.4° (range, from 3° to 8°). The carrying angle at the affected side was 31.9°±4.7° (range, from 25° to 42°) before operation and 4.0°±2.2°(range, from 1° to 8°) at the final follow-up, showing a significant difference ( P<0.05). Their preoperative MEPS was 57.5 ± 6.5 (4 good cases and 4 poor ones) but 95.9±3.4 (6 excellent cases and 2 good ones) at the final follow-up, showing a significant difference ( P<0.05). Conclusions:Treatment of nonunion of lateral humeral condyle complicated with cubitus valgus can be effectively carried out by cleaning fibrous tissue in the nonunion gap, iliac autograft and fragments fixation in situ with compressive cannulated screws at the primary stage and supracondylar varus osteotomy at the secondary stage. Intraoperative preservation of the blood supply to the nonunited fragments is the key to successful management.

Preparation and characterization of laser microporous acellular osteochondral scaffolds / 中国组织工程研究

BACKGROUND: Preparing a scaffold with cartilage derived components and good initial mechanical strength is the direction of tissue engineering cartilage research. OBJECTIVE: To prepare porous acellular osteochondral scaffolds, and to explore their mechanical properties and cell compatibility. METHODS: Osteochondral bone from the porcine knee joint was taken, and then porous osteochondral scaffolds were made by laser microporation technology. Subsequently, the scaffolds were decellularized chemical methods. Scaffold structure was observed by scanning electron microscopy, and the compression modulus of the scaffolds was determined. Bone marrow mesenchymal stem cells were cultured in L-DMEM containing 10% fetal bovine serum (control group) and cultured in the medium extract of porous acellular osteochondral scaffolds (experimental group), respectively. Cell proliferation was detected by cell counting kit-8 method within 5 days of culture. Bone marrow mesenchymal stem cells were seeded on the porous acellular osteochondral scaffolds, and within 28 days of co-culture, cell growth was observed by hematoxylin-eosin staining and toluidine blue staining. RESULTS AND CONCLUSION: (1) Observation under scanning electron microscopy: The porous acellular osteochondral scaffolds had the smooth surface with evenly distributed pores. The pores of the scaffold extended longitudinally into the subchondral bone. (2) Mechanical properties: The average compressive modulus of porous acellular osteochondral scaffolds was 0.77 MPa, which was close to the compression modulus of the normal cartilage (1.15 MPa). (3) Cell counting kit-8 test: There were no differences in cell proliferation between the control and experimental groups at 1, 2, 3, 4 and 5 days of culture. (4) Cell-scaffold co-culture: A large amount of bone marrow mesenchymal stem cells were observed to be adherent to the scaffold after 1 day of culture through hematoxylin-eosin and toluidine blue staining. However, as time went on, a few cells adhered to the pore wall or grew into the pores at 7 and 21 days of culture. There were also some adherent cells but a large amount of cell masses formed in the pores at 28 days of culture. To conclude, the porous acellular osteochondral scaffold has good mechanical properties and cell compatibility.

Intra-articular migration of transplanted bone marrow mesenchymal stem cells in rats with articular cartilage injury / 中国组织工程研究

BACKGROUND: The application of mesenchymal stem cells (MSCs) in the treatment of cartilage damage has become a hot spot of research. Further studies on the distribution of MSCs in the body after injection and on the underlying mechanism of action are needed. OBJECTIVE: To observe the migration of bone marrow mesenchymal stem cells (BMSCs) after injection into the region of osteochondral defect. METHODS: Thirty Sprague-Dawley rats were randomized into two groups (n=15 per group). In the control group, the femoral tochlear was exposed but an osteochondral defect was not made; and after the suture, PKH26-labeled BMSCs were directly injected into the articular cavity of rats. In the experimental group, a cartilage defect of 1 mm in diameter and 1 mm in depth was made in the rat femoral trochlea, and 5×106PKH26-labeled BMSCs were injected into the defect after operation. At 1, 3 and 7 days after injection, the femoral condyle was taken to make frozen sections followed by DAPI staining. The distribution of BMSCs was observed under laser scanning confocal microscope. RESULTS AND CONCLUSION: In the control group, PKH26-labeled BMSCs were not transferred to the subchondral bone. In the experimental group, BMSCs were detected in the subchondral bone area at 1, 3 days after injection of PKH26-BMSCs in the bone cartilage defect area, and the BMSCs were also found in the bone marrow cavity at 7 days after injection. In conclusion, BMSCs in the articular cavity cannot migrate into the subchondral bone and bone marrow cavity unless the cartilage of the femoral condyle is damaged.

The prognostic impact of microvascular invasion on patients with intrahepatic cholangiocarcinoma after R0 resections / 中华肝胆外科杂志

Objective To study the clinical impact of microvascular invasion (MVI) on patients with intrahepatic cholangiocarcinoma (ICC) after R0 resections.Methods The clinicopathological data of 359 patients with ICC who underwent R0 resection in the Zhongshan Hospital,Fudan University between January 2000 and December 2008 were retrospectively studied.Univariate analysis and multivariate analysis were carried out to study factors related to postoperative survival outcomes and recurrence.The impact of MVI on patients with ICC after R0 resection was studied.Results The incidence of MVI was 13.6％ in the study cohort.MVI was correlated with HBV infection (P ＜ 0.05),liver cirrhosis (P ＜ 0.05) and tumor differentiation (P ＜ 0.05).The 1-,3-,5-year overall survival (OS) between the MVI positive and negative groups were 50.0％,20.9％,12.2％ and 63.9％,33.1％,22.0％ respectively (P ＜ 0.05),and the median survival time was 13 months and 18.5 months (P ＜0.05).The 1-,3-,5-year recurrence free survival (RFS) rates between the MVI positive and negative groups were 29.7％,12.7％,8.5％ and 50.6％,26.9％,18.4％,respectively (P ＜0.05),and the median recurrence free survival time was 8 months and 12.5 months (P ＜ 0.05).Multivariate analysis showed that MVI was an independent risk factor affecting recurrence after R0 resection (HR 1.852,95％ CI:1.075 ～ 3.195,P ＜ 0.05).Conclusions The occurrence of MVI in ICC patients was associated with hepatitis B infection.MVI was an independent risk factor affecting recurrence in ICC patients after R0 resection.However,it was not an independent risk factor of overall survival in patients after R0 resection.The clinical impact of MVI on patients with ICC was not as strong as for hepatocellular carcinoma.

Anterior controllable anteriodisplacement and fusion for treatment of severe cervical ossification of posterior longitudinal ligament / 第二军医大学学报

Objective To report a novel technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of severe ossification of the posterior longitudinal ligament of the cervical spine, which allows for direct decompression of the nerve without resection of the ossification, making up for deficiencies in traditional anterior or posterior decompression. Methods The main surgical procedures of the ACAF included treatment of intervertebral space, removal of the anterior part of vertebrae, installation of titanium plate and interbody fusion cages, bilateral osteotomies of the vertebrae, and antedisplacement of the vertebrae ossification complex. The clinical data of two patients undergoing this surgery for severe ossification of the posterior longitudinal ligament of cervical spine were collected and analyzed. Results ACAF enabled direct decompression of spinal cord and nerve root through antedisplacement of the vertebrae ossification complex. The two patients who underwent ACAF gained satisfactory restoration with decompression of spinal cord and good recovery of neurological function, with no specific complications. Conclusion ACAF surgery takes into account the effectiveness of anterior direct decompression and the safety of posterior indirect decompression. Preliminary results shows that it can be used for severe cervical ossification of the posterior longitudinal ligament.

25G intraocular illumination aided scleral buckling for treatment of rhegmatogenous retinal detachment / 中华眼底病杂志

Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegrmatogenous retinal detachment (RRD).Methods This is a retrospective case control study.Fifty-seven RRD patients (57 eyes) were enrolled in this study.There were 35 males (35 eyes) and 22 females (22 eyes).The patients were randomly divided into ophthalmoscope group (29 patients,29 eyes) and illumination group (28 patients,28 eyes).There was no differences in the data of gender,age,onset time,logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P＞0.050).The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope.The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system.The follow-up was ranged from 6 to 12 months.The BCVA,intraocular pressure,fundus examination and complications were observed and recorded.Results The difference of operation time between two groups was significant (t=2.124,P=0.031).In the ophthalmoscope group,26 eyes (89.7％) achieved retinal reattachment,3 eyes (10.3％) failed in retinal reattachment.In the illumination group,26 eyes (92.8％) achieved retinal reattachment,2 eyes (7.2％) failed in retinal reattachment.There was no difference of retinal reattachment rate (P=I.000).Five eyes failed in retinal reattachment,3 eyes received sclera buckling surgery,2 eyes received vitrectomy with silicone oil tamponade.The final reattachment ratios were both 100％.BCVA increased in both groups compared with pre-surgery BCVA (t=4.529,5.108;P＜0.001).The difference of BCVA between two groups was not significant (t=0.559,P=0.458).There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=-1.386,-1.437;P=0.163,0.149).The difference of intraocular pressure between two groups was not significant (t=0.277,P=0.730).Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group.There was no iatrogenic retinal break,choroidal hemorrhage and endophthalmitis in the two groups.Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast,safe and effective.

Preparation and in vitro mucosal penetration evaluation of ph-sensitive thiolated chitosan nanoparticles for low molecular weight heparin delivery / 中国药学杂志

METHODS: The pH-sensitive thiolated chitosan nanoparticles were prepared by ionic cross-linking reaction and characterized for the shape, particle size, Zeta potential, drug entrapment efficiency and loading capacity. In vitro release of low molecular weight heparin from the prepared nanoparticles was evaluated in 0.1 mol•L-1 HCl solution and phosphate buffered saline (PBS) at pH 6.8 using the dialysis method. The intestinal permeability was estimated utilizing Franz diffusion cell system.

A nude mouse model of hepatocellular carcinoma single cell-derived organ site-specific metastasis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To establish a single cell-derived organ site-specific metastatic model of human hepatocellular carcinoma (HCC) in the nude mouse.</p><p><b>METHODS</b>Using the limited dilution method, HCCLM3-R-LM1 and HCCLM3-R-LnM1 cell lines were used to generate eight (LM1-S2, -S3, -S4, -S5, -S11, -S15, -S21, and -S23) and five (LnM1-S7, -S11, -S13, -S17, and -S20) single cell-derived monoclonal cell lines, respectively. The monoclonal cell lines were seeded into 4-week-old nude mice, and three weeks later the resultant subcutaneous tumor tissues were orthotopically transplanted into the livers of nude mice. At six weeks after implantation, lung and lymph node were extracted for analysis of the metastatic foci fluorescence area and pathology to assess the number of metastatic foci.</p><p><b>RESULTS</b>Among the 13 mice implanted with the established monoclonal cell lines, six grew subcutaneous tumors. When orthotopically transplanted, the six tumors showed remarkably different metastatic potential and organ site-specific tropism. The fluorescence areas of lung metastatic foci were: LM1-S3, 80 923+/-10 162; LM1-S4, 1506 000+/-297 064; LM1-S5, 36 140+/-8 210; and LM1-S11, 508 448+/-134 272 (P less than 0.01); no lymph node metastases were found for these lines. For LnM1-S11, the fluorescence areas of lung and lymph node metastatic foci were 435 062+/-206 620 and 1 254 000+/-225 171, respectively.</p><p><b>CONCLUSION</b>We successfully established several monoclonal cell lines and nude mouse models of HCC with different metastatic potential and organ tropism. Among them, LM1-S3, LM1-S4, LM1-S5, and LM1-S11 have metastasis organotropism to lung. The LnM1-S11 line exhibits dual metastasis organotropism to lung and lymph node. These monoclonal cell lines and nude mouse models may represent useful tools for study of HCC metastasis organotropism.</p>

Influence of apolipoprotein E and its receptors on cerebral amyloid precursor protein metabolism following traumatic brain injury / 中华创伤杂志(英文版)

Traumatic brain injury (TBI) is the leading cause of mortality and disability among young individuals in our society, and globally the incidence of TBI is rising sharply. Mounting evidence has indicated that apolipoprotein E (apoE: protein; APOE: gene) genotype influences the outcome after TBI. The proposed mechanism by which APOE affects the clinicopathological consequences of TBI is multifactorial and includes amyloid deposition, disruption of lipid distribution, dysfunction of mitochondrial energy production, oxidative stress and increases intracellular calcium in response to injury. This paper reviews the current state of knowledge regarding the influence of apoE and its receptors on cerebral amyloid beta-protein precursor metabolism following TBI.

Treatment of contracture of achilles tendon with minimally invasive achilles tendon lengthening and system rehabilitation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of minimally invasive achilles tendon lengthening and system rehabilitation for the treatment of contracture of achilles tendon.</p><p><b>METHODS</b>From January 2002 to December 2010, 27 patients (31 feet) with contracture of achilles tendon were treated with minimally invasive achilles tendon lengthening and system rehabilitation. There were 11 males and 16 females with an average age of 35.5 years (ranged 3 to 65 years). Right foot was in 13 cases, left foot was in 10 cases, both feet were in 4 cases. Course of disease was from 1 to 5 years with an average of 2.3 years. The cause of contracture included postoperative complication of tibia fractures treated with intramedullary nailing in 7 feet, sequelae of lower leg compartment syndrome in 11 feet, congenital talipes equinovarus in 13 feet (both feet in 4). Before operation, all the patients walked with limping, plantar flexion anomaly was from 15 degrees to 50 degrees with an average of 35.5 degrees. The strength of quadriceps muscle of thigh was grade V in 27 feet, grade IV in 4 feet, the strength of musculus triceps surae was grade V in 24 feet, grade IV in 7 feet.</p><p><b>RESULTS</b>All the patients were followed-up for 6-24 months with an average of 11.3 months. According to standard of Arner-Lindholm to evaluate function of ankle joint, 29 feet obtained excellent results and 2 feet good. No infection, re-rupture or re-contracture was found.</p><p><b>CONCLUSION</b>Minimally invasive achilles tendon lengthening and system rehabilitation in treating contracture of achilles tendon has advantage such as simple operation, less complication, lower recurrence rate, which is favourable for thoroughly rehabilitation of patients. But, the case in which the strength of quadriceps muscle of thigh or musculus triceps surae still less than grade III after preoperative rehabilitation care should not choose the method.</p>

The establishment of a systematic site-specific metastasis model of human hepatocellular carcinoma in nude mouse / 中华肝脏病杂志

To establish a systematic site-specific metastatsis model of human hepatocellular carcinoma (HCC) in nude mouse. HCCLM3-R cells were seeded into mice liver to establish xenograft mouse models. With the help of RFP, metastasis foci in lungs and lymph nodes in mice were detected using fluorescent stereomicroscopy and were removed. Cells derived from the metastasis foci were named HCCLM3-R-LM1 and HCCLM3-R-LnM1 respectively. HCCLM3-R-LM1 and HCCLM3-R-LnM1 cells were seeded into mice livers to analyze the lung and lymph node metastasis. Lungs of all tested mice were collected, examined by pathological evaluation and counted lung metastasis. Both lung and lymph node metastasis were found in HCCLM3-R-LM1, HCCLM3-R and HCCLM3-R-LnM1 cells and a significant difference was found between the lung and the lymph node metastasis levels in the three cells. The fluorescent areas (pixels) of lung and lymph node metastasis were 8687.00+/-1844.63 versus 2570.00+/-318.20 (P = 0.0031) in HCCLM3-R-LM1 cells, 6457.67+/-832.62 versus 10 994.33+/-2 212.31 (P = 0.0036) in HCCLM3-R cells, and 2968.67+/-2571.00 versus 24 416.00+/-7 186.13 (P = 0.0094) in HCCLM3-R-LnM1 cells, respectively. The middle numbers of microscopic lung metastatic foci were 775, 430 and 310 in HCCLM3-R-LM1, HCCLM3-R and HCCLM3-R-LnM1 cells (P less than 0.001), respectively, consist with the results quantified by RFP. We established the systematic site-specific metastasis models which demonstrates lung- and lymph node-specific metastasis potential in nude mice and can be used as a model for researches on site-specific metastasis of HCC.