Treatment of iatrogenic injury to medial collateral ligament in total knee arthroplasty / 中华创伤骨科杂志

Objective:To explore the treatment of iatrogenic injury to the medial collateral ligament (MCL) in total knee arthroplasty (TKA).Methods:From January 2009 to December 2016, 14 patients were treated at Department of Arthropathy, Zhengzhou Orthopedics Hospital for iatrogenic MCL injury in primary TKA (injury group). They were 3 males and 11 females with an age of (72.6±3.9) years. The MCL injury was body rapture in 9 cases and avulsion of femoral insertion in 5 ones. Interlacing suture was used for body rapture and reparative reconstruction with wire anchors or nails was performed for avulsion of femoral insertion. A restrictive condylar prosthesis was used instead in the 4 patients whose medial stability failed to be restored after repair of body rapture. A control group of 21 cases was enrolled who had suffered from no iatrogenic MCL injury in primary TKA at the corresponding period. There were 5 males and 16 females with an age of (73.2±3.9) years. The 2 groups were compared in terms of American Knee Society Score (KSS) and knee flexion.Results:There was no significant difference between the 2 groups in preoperative general data, showing comparability between groups ( P>0.05). The injury group was followed up for 18 to 36 months (mean, 33 months). Joint loosening was observed at 18 months after operation in 3 patients with nonrestrictive prosthesis who had to receive secondary revision. At the 36-month follow-up of the remaining 11 patients, normal knee extension and flexion was observed, the stress test of valgus showed no inner relaxation, their KSS increased significantly from preoperative 50.0±22.7 to 93.3±4.7, and their knee flexion was improved significantly from 90.4°±10.3° to 110.7°±8.8° ( P<0.05). There were no significant differences in KSS score or knee flexion between the 2 groups at 3, 6, 12 or 36 months after operation ( P>0.05). Conclusion:Iatrogenic MCL injury in primary TKA should be repaired and reconstructed by one-stage surgery because the patients can achieve curative results similar to those for the patients free from iatrogenic MCL injury in primary TKA.

Efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty / 中南大学学报(医学版)

OBJECTIVES@#To evaluate the efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty (TKA).@*METHODS@#A total of 50 patients with knee osteoarthritis treated by TKA from July to September 2018 were randomly divided into two groups (=25). The Group 1 underwent anterior intra-articular injection before prosthesis implanted while the Group 2 underwent posterior intra-articular injection before prosthesis implanted. Visual Analogue Scale (VAS) of all patients for pain during activity and at rest, maximal flexion degree of the knee at the 48th h and the 72th h after surgery, the time of raise leg, usage rate of patient-controlled analgesia (PCA), and complications were evaluated and analyzed.@*RESULTS@#VAS for pain at rest of patients in the Group 1 was significantly less than that in the Group 2 at the 6th, 12th, and 24th h after surgery (all <0.05). Maximal flexion degree of the knee at the 48th h and the 72th h after surgery in the Group 1 was better than that in the Group 2 (both <0.05). The Group 1 costed less time than the Group 2 on the ability to perform an active straight leg raise (=0.027).@*CONCLUSIONS@#The anterior intra-articular cocktail analgesic mixture injection can strongly relieve the pain early after TKA, which can improve knee function and achieve painless rehabilitation in most patients, with safety.

Diagnosis and treatment of biliary pancreatic duct dilatation / 中华消化外科杂志

Objective@#To summarize the diagnosis and treatment of biliary pancreatic duct dilatation.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 22 patients with biliary pancreatic duct dilatation who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine between October 2013 to September 2017 were collected. There were 6 males and 16 females, aged from 33 to 82 years, with an average age of 66 years. Surgical exploration was decided according to clinical symptoms, results of laboratory test and imaging examinations. For patients with space occupying lesions, surgical procedure was selected based on results of pathological examination. Patients without surgical exploration or space occupying lesions were allocated into follow-up. Observation indicators: (1) surgical exploration; (2) relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions; (3) surgical treatment; (4) follow-up. Follow-up using outpatient examination was performed on patients up to October 2018. Follow-up was performed on patients with positive surgical exploration to detect postoperative complications.For patients with positive results of imaging examinations, no jaundice, normal laboratory indicators or mild abnormality, liver function, tumor markers and B-ultrasound were re-examined each month, and computed tomography (CT) and magnetic resonance imaging (MRI) was performed once every 3 months. Surgical exploration was performed when total bilirubin (TBil) or tumor markers showed a progressive increase. Follow-up was performed on patients with negative results of imaging examination, jaundice, and mildly elevated CA19-9. TBil and CA19-9 were re-examined monthly, and if they were progressively elevated, patients were transferred to surgical exploration. For patients with negative results of imaging examination, no symptoms, and negative laboratory test, liver function, tumor markers, and B-ultrasound were re-examined once every 3 months, and enhanced CT and MRI were re-examined once every 6 months within one year. Follow-up was performed once every 6 months during the second year, and once a year after two years. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were descibed as absolute numbers, and they were analyzed using the chi-square test under R×C chart or Fisher exact probability.@*Results@#(1) Surgical exploration: of 22 patients, 11 underwent surgical exploration, and 11 underwent follow-up. Of the 11 patients with surgical exploration, 4 were positive for space occupying lesions including 1 of false negative, and 7 were negative for space occupying lesions. (2) Relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions. ① Relationship of clinical symptoms and laboratory test with surgical exploration positive for space occupying lesions: juandice was significantly associated with surgical exploration positive for space occupying lesions (P<0.05), and elevated TBil and DBil were significantly associated with surgical exploration positive for space occupying lesions (χ2=0, 0, P<0.05), with a sensitivity of 75.0% and specificity of 100.0%. ② Relationship between imaging examination and surgical exploration positive for space occupying lesions: results of CT, MRI, endoscopic retrograde cholangio-pancreatography, endoscopic ultrasonography, PET-CT, and combined imaging examinations had no significant association with surgical exploration positive for space occupying lesions (χ2=0, 0.77, 0, 0, 1.00, 0, 0, 0, 0, P>0.05). PET-CT had no significant association with surgical exploration positive for space occupying lesions (P>0.05). ③ Relationship of imaging examination and laboratory test with surgical exploration positive for space occupying lesions: positive imaging examination combined with elevated TBil and CA19-9 was significantly associated with surgical exploration positive for space occupying lesions (P<0.05), with a sensitivity of 50.0% and specificity of 100.0%. ④ Relationship of preoperative diameters of biliary ducts and pancreatic ducts with surgical exploration positive for space occupying lesions: of 22 patients, the diameters of biliary ducts and pancreatic ducts were (13.8±4.3)mm and (4.6±1.5)mm for patients with positive surgical exploration, (13.0±2.8)mm and (3.5±0.5)mm for patients with negative surgical exploration, (11.6±2.4)mm and (3.2±0.4)mm for patients with follow-up, respectively, showing no significant difference between them (t=0.22, 0.36, P>0.05). (3) Surgical treatment: 9 of 11 patients with surgical exploration followed the standard procedure. Of the 9 patients, 4 were found space-occupying lesions at the choledocho-pancreatico-duodenal junction (3 undergoing pancreaticoduodenectomy and 1 undergoing duodenal papilla partial resection), 5 with negative exploration underwent common bile duct incision and T-tube drainage (one patient was unable to pinch the T-tube one month after operation and detected obstruction at the lower end of the bile duct by radiography, and was confirmed pancreatic head cancer by reoperation 3 months after the first operation). Two patients didn′t follow the exploratory procedure, and underwent the child operation only based on the preoperative imaging findings, without intraoperative pathological examination. Postoperative pathological examination showed chronic ampulla and chronic pancreatitis, respectively. (4) Follow-up: 22 patients were followed up for 12-60 months, with a median follow-up time of 36 months. Two of 11 patients with surgical exploration had postoperative gastroplegia, 1 had bile leakage, 1 had incisional infection, and they were improved after symptomatic treatment. Four patients undergoing surgeries for positive exploration had no recurrence during follow-up. Of 5 patients with negative exploration undergoing common bile duct incision and T-tube drainage, 1 was confirmed pancreatic head cancer and underwent pancreaticoduodenectomy, 4 were removed T-tube after by T-tube cholangiography at 2 months after surgery. During the follow-up, no positive signs showed in laboratory test or imaging examination. No recurrence occurred in the two patients undergoing pancreaticoduodenectomy. Of 11 patients with follow-up, 10 had abdominal pain before surgery, including 3 with pain during follow-up and 7 with symptoms disappeared. There was no abnormalities in the laboratory test.@*Conclusions@#The positive imaging examinations combined with jaundice and elevated CA19-9 is an absolute indication for surgical exploration in patients with biliary duct dilatation. Those patients who do not meet this criteria should be distributed into the follow-up. If no positive pathological results were obtained during the operation, the surgery should be terminated and the patients should be transferred into follow-up. The reckless biliary anastomosis or biliary stents placement is opposed.

Research progress of immune-inflammatory mechanism in Parkinson's disease / 中华神经科杂志

Pathogenesis of Parkinson's disease (PD),a common neurodegenerative disease,is not well established.Immune-inflammatory responses are considered to be important in the development and progression of PD,including over-activated microglia,increased inflammatory cytokines,changes in compositions and phenotypes of T lymphocytes,increased antibodies produced by B lymphocytes.Recent studies have found that T cells in PD patients can recognize α-synuclein peptides and become a research hotspot.In this review,we summarize the research progress in innate and adaptive immune-inflammatory responses in pathogenesis of PD.

Diagnosis and treatment of biliary pancreatic duct dilatation / 中华消化外科杂志

Objective To summarize the diagnosis and treatment of biliary pancreatic duct dilatation.Methods The retrospective and descriptive study was conducted.The clinical data of 22 patients with biliary pancreatic duct dilatation who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine between October 2013 to September 2017 were collected.There were 6 males and 16 females,aged from 33 to 82years,with an average age of 66 years.Surgical exploration was decided according to clinical symptoms,results of laboratory test and imaging examinations.For patients with space occupying lesions,surgical procedure was selected based on results of pathological examination.Patients without surgical exploration or space occupying lesions were allocated into follow-up.Observation indicators:(1) surgical exploration;(2) relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions;(3) surgical treatment;(4) follow-up.Follow-up using outpatient examination was performed on patients up to October 2018.Follow-up was performed on patients with positive surgical exploration to detect postoperative complications.For patients with positive results of imaging examinations,no jaundice,normal laboratory indicators or mild abnormality,liver function,tumor markers and B-ultrasound were re-examined each month,and computed tomography (CT) and magnetic resonance imaging (MRI) was performed once every 3 months.Surgical exploration was performed when total bilirubin (TBil) or tumor markers showed a progressive increase.Follow-up was performed on patients with negative results of imaging examination,jaundice,and mildly elevated CA19-9.TBil and CA19-9 were re-examined monthly,and if they were progressively elevated,patients were transferred to surgical exploration.For patients with negative results of imaging examination,no symptoms,and negative laboratory test,liver function,tumor markers,and B-ultrasound were re-examined once every 3 months,and enhanced CT and MRI were re-examined once every 6 months within one year.Follow-up was performed once every 6 months during the second year,and once a year after two years.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Count data were descibed as absolute numbers,and they were analyzed using the chi-square test under R×C chart or Fisher exact probability.Results (1) Surgical exploration:of 22 patients,11 underwent surgical exploration,and 11 underwent followup.Of the 11 patients with surgical exploration,4 were positive for space occupying lesions including 1 of false negative,and 7 were negative for space occupying lesions.(2) Relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions.① Relationship of clinical symptoms and laboratory test with surgical exploration positive for space occupying lesions:juandice was significantly associated with surgical exploration positive for space occupying lesions (P＜0.05),and elevated TBil and DBil were significantly associated with surgical exploration positive for space occupying lesions (x2 =0,0,P＜0.05),with a sensitivity of 75.0％ and specificity of 100.0％.(② Relationship between imaging examination and surgical exploration positive for space occupying lesions:results of CT,MRI,endoscopic retrograde cholangiopancreatography,endoscopic ultrasonography,PET-CT,and combined imaging examinations had no significant association with surgical exploration positive for space occupying lesions (x2 =0,0.77,0,0,1.00,0,0,0,0,P＞0.05).PET-CT had no significant association with surgical exploration positive for space occupying lesions (P＞0.05).③ Relationship of imaging examination and laboratory test with surgical exploration positive for space occupying lesions:positive imaging examination combined with elevated TBil and CA19-9 was significantly associated with surgical exploration positive for space occupying lesions (P＜0.05),with a sensitivity of 50.0％ and specificity of 100.0％.④ Relationship of preoperative diameters of biliary ducts and pancreatic ducts with surgical exploration positive for space occupying lesions:of 22 patients,the diameters of biliary ducts and pancreatic ducts were (13.8±4.3)mm and (4.6±1.5)mm for patients with positive surgical exploration,(13.0±2.8)mm and (3.5±0.5) mm for patients with negative surgical exploration,(11.6±2.4) mm and (3.2±0.4) mm for patients with follow-up,respectively,showing no significant difference between them (t =0.22,0.36,P＞0.05).(3) Surgical treatment:9 of 11 patients with surgical exploration followed the standard procedure.Of the 9 patients,4 were found space-occupying lesions at the choledocho-pancreatico-duodenal junction (3 undergoing pancreaticoduodenectomy and 1 undergoing duodenal papilla partial resection),5 with negative exploration underwent common bile duct incision and T-tube drainage (one patient was unable to pinch the T-tube one month after operation and detected obstruction at the lower end of the bile duct by radiography,and was confirmed pancreatic head cancer by reoperation 3 months after the first operation).Two patients didn't follow the exploratory procedure,and underwent the child operation only based on the preoperative imaging findings,without intraoperative pathological examination.Postoperative pathological examination showed chronic ampulla and chronic pancreatitis,respectively.(4) Follow-up:22 patients were followed up for 12-60 months,with a median followup time of 36 months.Two of 11 patients with surgical exploration had postoperative gastroplegia,1 had bile leakage,1 had incisional infection,and they were improved after symptomatic treatment.Four patients undergoing surgeries for positive exploration had no recurrence during follow-up.Of 5 patients with negative exploration undergoing common bile duct incision and T-tube drainage,1 was confirmed pancreatic head cancer and underwent pancreaticoduodenectomy,4 were removed T-tube after by T-tube cholangiography at 2 months after surgery.During the follow-up,no positive signs showed in laboratory test or imaging examination.No recurrence occurred in the two patients undergoing pancreaticoduodenectomy.Of 11 patients with follow-up,10 had abdominal pain before surgery,including 3 with pain during follow-up and 7 with symptoms disappeared.There was no abnormalities in the laboratory test.Conclusions The positive imaging examinations combined with jaundice and elevated CA19-9 is an absolute indication for surgical exploration in patients with biliary duct dilatation.Those patients who do not meet this criteria should be distributed into the follow-up.If no positive pathological results were obtained during the operation,the surgery should be terminated and the patients should be transferred into follow-up.The reckless biliary anastomosis or biliary stents placement is opposed.

Therapeutic Observation of Needle Knife and Governor-Vessel Moxibustion plus Medication for Ankylosing Spondylitis / 上海针灸杂志

Objective To observe the clinical efficacy of needle knife, Governor-Vessel moxibustion plus medication in treating ankylosing spondylitis (AS).Method Forty AS patients were randomized into a treatment group and a control group, 20 cases in each group. The control group was intervened by intravenous administration of Ossotide injection, while the treatment group was by needle knife and Governor-Vessel moxibustion in addition to Ossotide injection. Before and after the intervention, the symptoms and body signs, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI) were observed in the two groups, and the clinical efficacies were compared between the two groups.Result The total effective rate was 90.0% in the treatment group versus 75.0% in the control group, and the between-group difference was statistically significant (P<0.05). After the intervention, the symptoms and body signs (spinal pain score, Schober test, morning stiffness duration, chest expansion degree, and occiput-wall distance) were changed significantly in both groups (P<0.05). The BASDAI and BASFI scores were significantly changed after the intervention in both groups (P<0.05). The BASDAI and BASFI scores in the treatment group were significantly different from those in the control group after the intervention (P<0.05).Conclusion Needle knife plus Governor-Vessel moxibustion and medication is an effective approach in treating AS.

Status analysis of prevailing strains of non-EV71 and non-CA16 enteroviruse / 重庆医学

Objective To investigatethe constituents of enteroviruse which can cause hand‐foot‐and‐mouth disease(HFMD) ,and prevent against the development of new prevailing strains and provide basis for prevention and control of HFMD in Luoyang city . Methods Reverse‐transcription polymerase chain reaction (RT‐PCR) was used to identify the type of RNA of stool specimen of HFMD cases in Luoyang ,to distinguish the subtype of strain ,9 enterovirus‐positive specimens which coxcackie virusA16(CA16)‐and enterovirus71(EV71)‐negative were selected randomly for 5′UTR sequencing .strain‐specific primers were used to detect posi‐tive samples in 75 CA16‐ and EV71‐negative but other enterovirus‐positive specimens by using real time RT‐PCR .Composition characteristics of CA6 were further analyzed .Results Primary screening was conducted with the results of 5′UTR sequencing of 9 commonent erovirus‐positive specimens and there were 5 CA6‐positive ,which were prevailing strains;there were 20 CA6‐positive of 75 commonenterovirus‐positive specimens ,the proportion of CA6‐positive in enterovirus‐positive specimens was 29 .76% (25/84) . Thirteen samples were collected from male and 12 from female ,2 cases resulted in severe symptoms ,5 from city and 20 from coun‐try .Conclusion The composition of commonent erovirus which results in HFMD was complex and the proportion of CA6 was higher ,which should be pay more attention .

Effects of adiponectin on the phosphorylation of adenosine monophosphate-activated protein kinase and the cell proliferation of osteosarcoma MG-63 cells / 中国医师杂志

Objective To investigate the effect of adiponectin on the phosphorylation of adenosine monophosphate-activated protein kinase (AMPK) and the cell proliferation of osteosarcoma MG-63 cells.Methods The MG-63 cells were seeded in 6-cm board with a inoculum density of 1 × 105 cells/ml.When the cells grew up to about 80％,a volume (5 ml) of medium containing adiponectin (concentration 1 μg/ml) was added to each plate and incubated for 0 min,15 min,30 min,60 min,and 120 min,respectively ; and Western Blotting was used to detect the levels of AMPK phosphorylation,and the optimal time point processed by adiponectin was selected.The control and adiponectin groups were set (0,0.001,0.01,0.1,1 μg/ml) according to the optimal processing time of adiponectin,respectively; and Western blotting was used to detect the levels of AMPK phosphorylation and determine the optimal concentration of adiponectin.Based on the optimal processing time and optimal concentration,PBS was used as a control,the corresponding concentrations of adiponectin were used as the experimental group.Western blotting was used to detect the levels of AMPK phosphorylation to determine the effect of adiponectin on AMPK phosphorylation of osteosarcoma MG-63 cells.CCK-8 assay was used to investigate the effect of adiponectin on the cell proliferation of MG-63 cells.The MG-63 cells were seeded in the 96-well plates (5,000 cells/well) and cultured overnight.The experiment was set as blank control group and adiponectin-recombinant groups with 5 different concentration gradients (0.001,0.01,0.1,1,10 μg/ml).Five parallel wells were set for each group,and the cells were cultured for 24 h.During the last 4 h of culturing,a volume (10 μl) of CCK-8 reagent was added to each well,and the cells were cultured for another 2.5 h.The optical density (OD490) was obtained.Results When the concentration of adiponectin was greater than 0.01 μg/ml,the level of AMPK phosphorylation in MG-63 cells were significantly elevated (t =5.894,P =0.007).The short-time stimulation of adiponectin did not inhibit the proliferation of MG-63 cells (F =6.335,P =0.072).Conclusions Adiponectin can enhance the AMPK phosphorylation.The short-time stimulation of adiponectin did not inhibit the proliferation of MG-63 cells.

Reasons and prevention of residual stones after choledo-choscopic treatment of cholelithiasis / 中国现代普通外科进展

Objective: To study the reasons and prevention of residual stones after choledo- choscopic treatment of cholelithiasis. Methods:The clinical data of 219 patients who had under- gone choledochoscopic treatment were analyzed retrospectively. Results: 21 cases were found with residual stones in the bile duct after the operations. Residual stone rate was to 9.58% . Bile duct stones of 8 patients could not be removed completely during operations. 13 patients were proved that stones still remain in their bile ducts by T-tube cholangiography and choledochoscope after opera- tions. There were 5 patients with acute obstructive suppurative cholangitis accompanying septic shock, 5 patients with stenosis in intrahepatic bile ducts, 4 patients with stones of in trahepatic bile duct and variation of bile duct, 2 patients with stones in sphincter of duodenal papilla,2 patients withstones and stenosis at the inferior segment of choledochus,3 patients were founded residual stones in bile duct obviously after the operations. Conclusions: B-type ultrasonic scanning and T-tube cholangiog- raphy are useful to reduce the rate of residual stones.