Anatomic classification of the sustentaculum tali and its characteristics analysis / 解剖学报

Objective To explore the anatomical morphology and characteristics of the sustentaculum tali based on CT three⁃dimensional reconstruction, so to provide anatomical support for the treatment of calcaneal fractures with screw implantation. Methods From March 2019 to March 2020, a total of 336 adult calcaneal CT three⁃dimensional reconstruction images from the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University were collected after exclusion of inclusion criteria. The CT three⁃dimensional reconstruction of calcaneus was classified according to the β, the prolate axial intersection between sustentaculum tali and calcaneus on the normal posterior. Reference points, β; AB, the distance from the inside of sustentaculum tali to the inside of posterior talar articular surface; AC, the distance from the inside of sustentaculum tali to the outside of posterior talar articular surface; AD, the distance from the inside of sustentaculum tali to lateral of calcaneal; AE, the distance from the inside of sustentaculum tali to medial process of calcaneal tuberosity; AF, the distance from the inside of sustentaculum tali to calcaneal tuberosity; AG, the distance from the inside of sustentaculum tali to lateral process of calcaneal tuberosity. The results were statistically analyzed according to type, sex and body side. Results Under the β, the sustentaculum tali was classified into three types: typeⅠ(β<70°, 68 cases, 20.24%), type Ⅱ(70°≤β<80°, 153 cases, 45.54%), type Ⅲ(80°≤β<90°, 115 cases, 34.23%). For the distance of β, AB, AF, there were statistical differences between type Ⅲ and other types (P<0.05). For the distance of AE, there were statistical differences between type Ⅲ and typeⅠ(P<0.05). Meanwhile, for the distance of AB, AC, AD, AE, AF, AG, there were statistical differences between male and female (P<0.05). For the distance of β, AB, there were statistical differences between right and left (P<0.05). Conclusion Under the β, the sustentaculum tali is classified into three types, with the typeⅡas the main type. When treating calcaneal fractures with internal fixation, direction of screw implant can choose between 70° to 80° as soon as possible. The morphology and classification of sustentaculum tali are of certain clinical implication to treat calcaneal fractures.

Anatomical morphometry of coracoclavicular ligament based on fresh cadaver and clinical significance / 解剖学报

Objective To measure the anatomical morphology of coracoclavicular ligament based on fresh cadavers, and to provide anatomical basis for anatomical reconstruction of coracoclavicular ligament. Methods A total of 52 the acromioclavicular joints (fresh body specimen) was dissected, and the anatomical characteristics of coracoclavicular ligament were observed by dissecting acromioclavicular joint specimens. The anatomic data of which the length of the conoid ligament (QR), the length of the trapezoid ligament (ST) ; the distance from the conoid ligament attachment on coracoid to coracoid tip (RV), the distance from the trapezoid ligament attachment on coracoid to coracoid tip (TV), the distance form conoid ligament attachment on the clavicular to acromioclavicular joint (QU), the distance form the trapezoid ligament attachment on the clavicular to acromioclavicular joint (SU), the distance from supraclavicular plane to subcoracoid plane (WX) were measured ; and the mean diameter of the trapezoid ligament attachment on the clavicular (ā), the mean diameter of the conoid ligament attachment on the clavicular(b¯), the mean diameter of the trapezoid ligament attachment on the coracoid (c¯), the mean diameter of the conoid ligament attachment on the coracoid (d¯) were calculation. The measurement result underwent statistical analysis. Results The minimum diameter of the trapezoid ligament attachment on the clavicular and coracoid on the left and right sides, respectively. There were no significant differences in those anatomical morphology of the coracoclavicular ligament (P>0.05). The anatomical morphology of the diameter of coracoclavicular ligament attachment on the male and female had no significant difference (P>0.05). The maximum length of the conoid ligament was (14.19±2. 43/15. 87±2. 99) mm on the left and right sides, respectively. The distance from the conoid ligament attachment on coracoid to coracoid tip was ( 36. 66 ± 4. 25/33. 61 ± 3. 45 ) mm on the left and right sides, respectively. The mean diameter of the conoid ligament attachment on the clavicular and coracoid was (11.95± 1.43/ 11.23± 1.12)mm and (9.20± 1.60/7.90±0.76) mm on the left and right sides, respectively. There were significant differences in those anatomical morphology of the coracoclavicular ligament(P 0.05). The anatomical morphology of the coracoclavicular ligament on the male and female had no significant difference (P>0.05). Conclusion The comprehensive measurement of anatomical morphology of coracoclavicular ligament can provide an anatomical basis for shoulder joint diseases related to coracoclavicular ligament injury. It will help surgical staff perform a complete anatomic reconstruction of coracoclavicular ligaments for the surgical treatment of dislocation of the acromioclavicular joint.

Shaoyangzhugu Formula regulates p19-p53-p21 signaling pathway to ameliorate cartilage degeneration in aged cynomolgus monkeys with knee osteoarthritis / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of Shaoyangzhugu (SYZG) Formula (a formula consisting of 9 traditional Chinese drugs) in delaying the degeneration of articular cartilage and the role p19-p53-p21 signaling pathway in mediating this effect.</p><p><b>METHOD</b>Thirteen aged cynomolgus monkeys with degenerative knee joints were selected based on X-ray findings, and one of them was randomly selected for pathological observation. The other monkeys were randomized equally into SYZG Formula group (treated with SYZG decoction), ammonia moxime group and saline group. All the monkeys were sacrificed after 8 weeks of treatment with intragastric administration of the drugs or saline. The pathology in the knee joint articular cartilage was observed and the mRNA and protein expressions of p19, p53, and p21 in the articular cartilage were detected using RT-qPCR and Western blotting.</p><p><b>RESULTS</b>The pathological findings of the articular cartilage in old cynomolgus monkeys were consistent with the characteristics of knee osteoarthritis (KOA). Mankin scores of the cynomolgus monkeys were 7.38∓0.52 in SYZG Formula group, 7.88∓0.83 in ammonia moxime group, and 8.38∓0.74 in saline group, showing a significant difference between SYZG Formula group and saline group (P<0.05). The expressions of p19, p53, and p21 were the lowest in SYZG Formula group and the highest in saline group with significant differences among the 3 groups (P<0.05).</p><p><b>CONCLUSION</b>SYZG Formula can delay chondrocyte senescence by regulating p19-p53-p21 signaling pathway to delay articular cartilage degeneration in aged cynomolgus monkeys.</p>

Effect of Duhuojisheng Decoction on primary knee osteoarthritis in macaca fascicularis / 中国组织工程研究

BACKGROUND:Meta-analysis results have shown that Duhuojisheng Decoction can improve the symptoms and relieve the pain of patients with knee osteoarthritis, but the mechanism and pathway are not very clear.OBJECTIVE:To further verify the curative effect of Duhuojisheng Decoction for primary knee osteoarthritis in macaca fascicularis. METHODS: Under natural conditions, 6 clean young macaca fascicularis (aged 3-5 years, normal group) and 6 elderly macaca fascicularis (aged more than 20 years, model group) were selected from 24 macaca fascicularis. The models of primary knee osteoarthritis were established in the model group,then aged animals were randomly divided into control and intervention(given the treatment of Duhuojisheng Decoction) groups. The number of whole blood leukocytes, C-reactive protein, erythrocyte sedimentation rate, properties of the joint fluid and expression level of tumor necrosis factor-α were compared between the control and intervention groups. RESULTS AND CONCLUSION: The aged macaca fascicularis was characterized by a typical osteoarthritis similar to human. Treatment with Duhuojisheng Decoction significantly down-regulated the expression level of tumor necrosis factor-α and significantly reduced the levels of whole blood leukocytes, and C-reactive protein. Our results suggest that the aged macaca fascicularis model of primary knee osteoarthritis is an effective animal model to simulate the occurrence and development of human primary knee osteoarthritis.Duhuojisheng decoction alleviates the progression of primary knee osteoarthritis probably by inhibiting the expression level of tumor necrosis factor-α and decreasing the levels of inflammatory factors in the articular cartilage. Additionally, the levels of whole blood leukocytes and C-reactive protein are important parameters for the prediction of curative effects.

Effect of pushing manipulation on Qiaogong acupoint on hemodynamics in cynomolgus monkeys with mild carotid atherosclerotic plaques / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the hemodynamic changes in cynomolgus monkeys with mild carotid atherosclerotic (CAS) plaques after therapy with pushing manipulation on Qiaogong acupoint (MPQ).</p><p><b>METHODS</b>Nine cynomolgus monkeys were equally randomized into MPQ group, mild CAS model group and blank control group. Mild CAS models were established in the monkeys in MPQ and model groups, and the monkeys in MPQ group received treatment with MPQ intervention after the modeling. The conditions of the carotid artery and the hemodynamic changes in the 3 groups were evaluated after the treatment.</p><p><b>RESULTS</b>Formation of CAS plaques was detected in monkeys in both MPQ and model groups. The vascular cross?sectional area, plaque cross?sectional area and stenosis rate of the plaques in the two groups all differed significantly from those in the blank control group (P<0.05), but these parameters were similar between MPQ group and the model group (P>0.05). Compared with those in the blank control group, the hemodynamic parameters showed significant changes in MPQ and the model groups (P<0.05) but remained similar between the latter two groups (P>0.05).</p><p><b>CONCLUSION</b>CAS plaques can cause changes in hemodynamic parameters. Short?term therapy with MPQ does not affect the stability of the plaques or cause adverse effects on hemodynamics in cynomolgus monkeys with mild CAS plaques.</p>

Sciatic nerve regeneration in a rat model of brain injury at different locations / 中国组织工程研究

BACKGROUND:Previous studies have shown that traumatic brain injury can promote the regeneration of peripheral nerve by reducing scar collagen in nerve endings.OBJECTIVE:To investigate the effect of brain injury at different locations on the ipsilateral rat sciatic nerve regeneration.METHODS:Ninety-nine healthy male Sprague-Dawley rats were equivalently randomized into three groups:group A,right sciatic nerve transection;group B,right sciatic nerve transection combined with right brain injury;and group C,right sciatic nerve transection combined with left brain injury.All of transected nerves were sutured under microscope.Classical Feeney method was used to establish a model of traumatic brain injury.At 4,6,8,10 and 12 weeks after modeling,the sciatic functional index (SFI) was calculated by measuring footprint.At 4,8 and 12 weeks after modeling,the bilateral gastrocnemius were harvested for determining wet weight and calculate wet weight ratio,followed by acetylcholinesterase staining at the motor end plate to detect the absorbance values.At 4,8 and 12 weeks after modeling,fluoro-gold retrograde tracing was used to trace L4-5 vertebrae for 1 week,and the number of spinal cord anterior horn motor neurons positive for fluoro-gold was detected and calculated by fluorescence microscope.RESULTS AND CONCLUSION:The SFI value in each group was gradually improved with time.The SFI value was significantly higher in the groups B and C than the group A at 4 and 6 weeks after modeling (P ＜ 0.05),and was further improved in the group B at 8 weeks compared with the groups A and C (P ＜ 0.05).The wet weight ratio of gastrocnemius showed no significant difference among groups at 4 weeks after modeling (P ＞ 0.05),and the group B showed a significantly higher wet weight ratio than the other groups from the 8th week (P ＜ 0.05).Compared with the groups A and C,the absorbance values of motor endplate in group B appeared to be a significant increase at the beginning of the 8th week (P ＜ 0.05).At 4 and 6 weeks after modeling,the number of spinal cord anterior horn motor neurons positive for fluoro-gold was significantly nigher in the groups B and C than in the group A,and the number was significantly higher in the group B than the groups A and C at 12 weeks (all P ＜ 0.05).These finding manifest that brain injury can promote the repair of ipsilateral sciatic nerve injury,thus proving theoretical reference for unveiling the mechanism by which traumatic brain injury promotes peripheral nerve regeneration.

Effect of electroacupuncture on proprioception in cynomolgus monkeys after unilateral anterior cruciate ligament injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of electroacupuncture on proprioception in cynomolgus monkeys after unilateral anterior cruciate ligament (ACL) injury.</p><p><b>METHODS</b>Twenty-seven cynomolgus monkeys were randomized equally into 3 groups, namely unilateral ACL injury with electroacupuncture group, unilateral ACL injury model group and blank control group. One week after modeling, the monkeys in electroacupuncture group were treated daily for 12 weeks with electroacupuncture at the acupoints Wei Yang, Yin Gu, Xi Yangguan and Qu Quan. At 4, 8, and 12 weeks during the treatment, the changes in the somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV) of the nerves of the ACL were examined with neural electrophysiological method; the changes in the morphology and the total and variable number of the proprioceptors in the ACL were observed with gold chloride staining. RESULTS; In the mokeys in the model group, the incubation period of the SEPs and MCV on the injured side of the knee were significantly extended and the amplitudes were decreased with the passage of time (P<0.05). Intervention with electroacupuncture significantly reduced the incubation period and increased the amplitudes of the SEPs and MCV (P<0.05). The total number of the proprioceptors in the ACL was significantly decreased and the variable number of the proprioceptors in ACL was increased with time in the monkeys in the model group (P<0.05); electroacupuncture intervention obviously slowed the reduction rate of total number of the proprioceptors (P<0.05) but without affecting the variable number of the proprioceptors (P>0.05). CoONCLUSION: ACL injury causes attenuation of the proprioception on the injury side, and electroacupuncture intervention can produce a positive effect on the proprioception in cynomolgus monkeys.</p>

Comparison of outcomes after surgery between adenocarcinoma of the esophagogastric junction and lower thoracic esophageal squamous cell cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the differences in biological behavior and clinical features between adenocarcinoma of the esophagogastric junction (AEG) and lower thoracic esophageal squamous cell cancer (LESC), and to explore reasonable procedures for each cancer.</p><p><b>METHODS</b>Clinical data of 111 patients with AEG and 126 patients with LESC who underwent surgery from January 2004 to April 2012 were retrospectively reviewed. Data pertaining to resection rate, lymph node metastasis, and postoperative complication rate were analyzed.</p><p><b>RESULTS</b>The resection rate was 94.6% for AEG and 97.6% for LESC, and the difference was not statistically significant (P<0.05). The rate of lymph node metastasis in the mediastinum in patients with AEG was significantly lower [6.3%(7/111) vs. 32.5%(41/126), P<0.01], while the rate of lymph node metastasis in the abdomen was significantly higher [57.7%(64/111) vs. 34.1%(43/126), P<0.01]. The rate of lymph node metastasis in mediastinum of AEG was 12.5%(4/32) for Siewert I and 4.7%(3/64) for Siewert II, and there was no lymph node metastasis in Siewert III (n=15). For AEG patients who underwent trans-abdominal surgery, the rate of positive lymph node in the middle and lower mediastinum was significantly lower than trans-thoracic surgery [0/22 vs. 7.9% (7/89), P<0.05]. LESC via right thorax with two-field or three-field lymph node dissection was associated with a significantly higher rate of positive lymph node metastasis in the upper mediastinum than that of single incision via left thorax [17.9%(12/67) vs. 0/59, P<0.01]. The postoperative complication rates were 23.4%(26/111) and 27.0%(34/126) respectively, and the difference was not statistically significant(P>0.05).</p><p><b>CONCLUSIONS</b>AEG and LESC show different lymph node metastasis pattern and should be operated differently. Lymphadenectomy in mid-lower mediastinum should be emphasized in Siewert I and Siewert II type cancers.</p>

Comparison of surgical outcomes after different surgical approach for middle or lower thoracic esophageal squamous cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare outcomes of left and right thoracic incision for middle and lower thoracic esophageal squamous cancer, and to determine reasonable surgical approach for thoracic esophageal squamous carcinoma.</p><p><b>METHODS</b>One hundred and twenty patients with middle or lower thoracic esophageal squamous cancer who received esophagectomy plus lymphadenectomy between January 2004 and December 2007 were divided into two groups including left(n=60) and right thoracic(n=60) approach. Clinical data were analyzed including the results of surgical resection, lymphadenectomy, postoperative complication, recurrence, and survival.</p><p><b>RESULTS</b>The rate of surgical resection was 91.7%(55/60) in the left approach group and 95%(57/60) in the right approach group. There was no significant difference(P>0.05). But the average number of lymph nodes resected (4.60 vs. 8.32) and metastatic lymph nodes(0.57 vs. 1.33) were both significantly higher in the right approach group(P<0.01). There was no statistical difference in postoperative complications[26.7%(16/60) vs. 31.7%(19/60), P>0.05] between the two groups. However, the incidence of local recurrence was lower[43.3%(26/60) vs. 23.3%(14/60), P<0.05] in the right approach group than that in left-approach group. There was no significant difference in distant metastasis(P>0.05).</p><p><b>CONCLUSIONS</b>The resection rate is comparable between left and right approach for thoracic esophageal cancer. However, it is easier to perform systemic lymphadenectomy via right thoracic approach and therefore the local recurrence is reduced and long-term survival improved.</p>

Clinical implications of the new TNM staging system for thoracic esophageal squamous cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate THE clinical significance of the 2009 UICC staging system for thoracic esophageal squamous cell carcinoma.</p><p><b>METHODS</b>Two hundred and nine patients with thoracic esophageal squamous cell carcinoma undergone selective cervico-thoraco-abdominal lymphadenectomy were reviewed retrospectively and restaged according to the new 2009 UICC staging system. The relationship between individual stages and survival were analyzed accordingly.</p><p><b>RESULTS</b>The five-year overall and cause-specific survivals were 35.0% and 38.8%, respectively. Depth of invasion (T, P = 0.004), number of metastatic lymph nodes (N, P < 0.001), distant lymph node metastasis (M, P = 0.003), complete resection (R, P = 0.005) were significantly related to postoperative survival. On the other hand, location of primary tumor (L, P = 0.743) and histological grade (G, P = 0.653) were not significantly related to long-term prognosis. Upon stratification, the 5-year survival for T4a (32.0%) was significantly better than that of T4b (0, P < 0.001), but was similar to that of T3 (28.4%, P = 0.288). Patients without nodal involvement (47.8%, P < 0.001) and those with single station nodal disease (37.5%, P < 0.001) had significantly better survival than patients having 2 or more stations of lymph node metastasis (11.3%). Also patients without nodal involvement and those with metastasis confined to a single field (34.2%) had significantly better survival than patients having nodal diseases in 2 fields (12.1%) and 3 fields (0, P < 0.001). The 5-year survival for cervical metastasis after complete resection was 20.0%. Upon multivariate analysis, depth of tumor invasion (P = 0.001, RR = 1.635), numbers of metastatic nodal stations (P = 0.043, RR = 1.540) and fields (P = 0.010, RR = 2.187) were revealed as independent risk factors for long-term survival.</p><p><b>CONCLUSIONS</b>The new UICC staging system effectively predicts long-term prognosis for thoracic esophageal squamous cell carcinoma. Depth of tumor invasion and extent of lymph node involvement are two most important prognostic factors. To improve surgical outcomes, much effort is needed to increase the accuracy of preoperative staging and to include effective induction therapies into a multidisciplinary setting.</p>

Case-control studies on complex tibial plateau and posterior condylar fractures treated through combined anterior-posterior (small incision or micro-incision) approach / 中国骨伤

<p><b>OBJECTIVE</b>To study the therapeutic effects of combined anterior-posterior (small incision or micro-incision) approach for complex tibial plateau and posterior condylar fractures.</p><p><b>METHODS</b>From 2000 to 2008, 79 patients (81 limbs) with complex tibial plateau and posterior condylar fractures were reviewed. There were 45 males and 34 females, ranging in age from 19 to 66 years, with an average of 40.6 years. Thirty-nine limbs were treated using small incision through combined anterior-posterior approach, in which 13 limbs were Schatzker type IV, 15 limbs were type V ,and 11 limbs were type VI. Other 42 limbs were treated using micro-incision through combined anterior-posterior approach, in which 18 limbs were Schatzker type IV, 16 limbs were type V, and 8 limbs were type VI. The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment. The complications such as cutaneous necrosis and incision infection were observed.</p><p><b>RESULTS</b>All the patients were followed up. According to Rasmussen criterion, in small incision group, 16 limbs got an excellent result, 13 good, 7 fair and 3 bad; in micro-incision group,above data were 19, 11, 8 and 4 respectively. Comparison between the two groups, P = 0.924. Comparison of complications such as cutaneous necrosis and incision infection: in small incision group,10 limbs had the complications, and in micro-incision group were 4 limbs; the occurrence rate of small incision group were higher than that of micro-incision group (P = 0.047).</p><p><b>CONCLUSION</b>There are no significant differences between the two groups in the knee joint function rehabilitation; however, there is smaller rate for cutaneous necrosis and incision infection in micro-incision group.</p>

Study on the theory of "Shaoyang Meridians being in charge of the bone" / 中国针灸

To explore the theory of "Shaoyang Meridians being in charge of the bone" in Huangdi's Internal Classic, which has been buried for long time. With citation of Huangdi's Internal Classic and exposition of famous experts, speculate on the contents and meanings systematically. Results indicate that the theory of "Shaoyang Meridians being in charge of the bone" possibly first in the world recognizes osteoporosis being a general bony disease, and articulates that the Foot-Shaoyang Meradians can modulate bony strength under physiological and pathological conditions, and treat osteoporosis which mainly manifests as ostealgia and easy fracture.