Table of Content

28 December 2012, Volume 1 Issue 2 Previous Issue    Next Issue

Reviews

Select

On principal aspects in hand surgery Gu Yu-Dong 2012, 1 (2):  97-98.  Abstract ( 150 )   PDF (766KB) ( 303 )   Save Related Articles | Metrics

Experts’ forum

Select

More attention should be paid to the diagnosis and treatment of midfoot injuries Yu Guan-Rong 2012, 1 (2):  99-102.  Abstract ( 158 )   PDF (734KB) ( 316 )   Save Midfoot in a special area of the foot and ankle.It is involved in the formation of both the longitudinal and transverse arch.And it participates in both weight-bearing and buffer functions.It plays a crucial role for the maintenance of the normal morphology and functions of the foot.However,midfoot injuries are easily ignored because this area is relative small.Some common injuries will be elaborated and discussed here in order to provide a basis for clinical treatment. References | Related Articles | Metrics

Original articles

Select

DNMT3B regulates osteogenesis of Human Umbilical Mesenchymal Stem Cells Wu Zhou-Rui, Hu Xiao, Xu Wei, Sun Xiao-Qing, Guan Xiao-Fei, Cheng Li-Ming 2012, 1 (2):  103-107.  Abstract ( 200 )   PDF (2368KB) ( 303 )   Save Objective To elucidate the roles of DNMT3B in the osteogenesis of hUMSCs.Methods Knockdown DNMT3B in hUMSCs was gained via RNA interference technology.After confirming the decrease of DNMT3B in mutant hUMSCs by immunostaining and qPCR, osteogenesis differentiation was carried out.To identify the phenotype of osteogenesis in both bone formation ability and function of bone,immunostaining,qPCR and functional test was preformed,compared to widetype hUMSCs.Results The mutant hUMSCs showed lower DNMT3B expression level by qPCR.Compared to widetype cells,the DNMT3B expression level were 12.67±0.45% and 35.60±0.76%in two mutant hUMSCs (P<0.05).Furthermore,the expression level of CD73 and CD90 that were two mesenchymal specific markers were 15.83±0.44% and 16.60±0.37% of widetype hUMSCs (P<0.05).Immunostaining showed Osteocalcin positive cell was significant less in DNMT3B mutant cells.qPCR demonstrated that RUNX2,IBSP and ALPL mRNA level were decreased in mutant cells (P<0.01).Moreover,alizarin red staining performed that functional impairment lacking of DNMT3B in hUMSCs.Conclusion The osteogenesis differentiation of hUMSCs is impaired in the absence of DNMT3B. References | Related Articles | Metrics

Select

Mechanical analysis of human pelvic stability by using digital marker tracing method combined with center-of-mass algorithm method Yu Yan, Jia Yong-Wei, Zeng Zhi-Li, Wang Jian-Jie, Wu Zhou-Rui, Wu Yang-Chun, Xu Wei, Hu Xiao, Cheng Li-Ming 2012, 1 (2):  108-111.  Abstract ( 139 )   PDF (1580KB) ( 262 )   Save Objective To analyze mechanical stability of human pelvis and to provide the pelvic surgery with biomechanical data.Methods six cadaveric specimens of the L3 to the proximal 1/3 part of femur were used and fixed on a custom experimental rig.The specimens had no structural abnormality and partial soft tissues were dissected,reserving the hip joint capsules and the ligaments of the pelvic ring.Markers with black dots against white background were used to mark the kinematic key points of the pelvis.Axial loadings from the L3 were applied by material testing machine in the gradient of 0 N to 500 N.Images of the front and lateral views were obtained using two Charge Coupled Device (CCD) cameras.Based on Image J software,relative distance of L5,the abduct degree in coronal plane and rotational degree in vertical plane were calculated by measuring the marker’s movement.Results Under a vertical loading of 500 N,the average relative distance of L5 was 1.157±0.794 mm,the average abduct degree in coronal plane was 0.370±0.260° and the average rotational degree in vertical plane was 1.051±1.728°.Conclusion Human pelvis shows optimal mechanical stability according to the displacement calculation of pelvic specimen,digital marker tracing method and the center-of-mass algorithm method are applied in combination. References | Related Articles | Metrics

Select

Extended type philos locking plate for treatment of proximal humerus and humeral shaft fractures Ma Ning, Yuan Feng 2012, 1 (2):  112-114.  Abstract ( 143 )   PDF (1962KB) ( 307 )   Save Objective To investigate the treatment effect of the extended type proximal humeral internal locking system (PHILOS) with proximal humeral and ipsilateral humeral shaft fractures.Methods From 2008 to 2010,9 patients with proximal humeral and ipsilateral humeral shaft fractures were treated with extended type PHILOS and followed.There were 5 men and 4 women,aged from 40 to 67 years (average 55.4 years).According to Neer classification,7 cases were two-part fractures,2 cases three-part fractures; According to AO classification,there were 5 cases of type A1,3 cases of type B1,1case of type C1.Postoperatively the shoulder functions were evaluated using Neer scoring system,Elbow functions were evaluated by the Mayo system.Results All patients were followed up for 14-36 months ( average 24 months),which showed fracture healing in all patients,There was no radial nerve palsy or other complications occurred.According to the Neer scoring system:4 were excellent,4 good,and 1 fair,and the excellent and good rate was 88.9%.According to the Mayo score system:8 were excellent,1good,and the excellent and good rate was 100%.Conclusion The treatment of proximal humeral and ipsilateral humeral shaft fractures with extended type PHILOS is good with the advantage of stable fixation,and less complications. References | Related Articles | Metrics

Select

Technical tips with the nailing of proximal femoral nail antirotation Asian version (PFNA-2) in the treatment of geriatric intertrochanteric hip fractures Zhu Xiao-Zhong, Zhang Shi-Min, Huang Yi-Gang, Wang Xin 2012, 1 (2):  115-120.  Abstract ( 422 )   PDF (7844KB) ( 316 )   Save Objective Cephalomedullary nails are becoming more and more popular in the treatment of per/inter-trochanteric fractures.However,difficulties in nailing process and unsatisfied fixation are not so rare in clinic.Our purpose is to investigate the technical tips and skills with proximal femoral nail antirotation Asian version (PFNA-II).Methods Through summary of our experiences and lessons,with review of related literatures,we gather ten tips regarding successful nail insertion and stable fixation.Result These include patient position in fracture table,medial shift of entry point from the exact trochanteric tip,use of laterally curved guide wire,hand press over lateral wall to avoid wedge opening effect,hand insertion of nail without hammer blow,use TAD to control the position of helical blade in femoral head,awareness of the impingement between femoral anterior cortex and nail tip,awareness of the prominence of proximal nail end,and last,prepare side-plate instrument for obese female with short stature.Conclusion Paying attention to the structure chaeacteristic of cephalomedullary nail and technical skill can improve the nailing success rate and fication quality. References | Related Articles | Metrics

Select

The learning curve of holmium laser enucleation of the prostate Shan Yong, Chen Qi, Wang Zhong, Cai Zhi-Kang 2012, 1 (2):  121-124.  Abstract ( 153 )   PDF (796KB) ( 403 )   Save Objective To reveal the learning curve of holmium laser enucleation of the prostate (HoLEP).Methods Eighty patients with BPH underwent HoLEP were enrolled in study.To reflect our learning curve of HoLEP,we separated the patients into two groups (initial 40 cases and last 40 cases).Results The operation time was shorter and enucleation rate was higher in the second group (last 40 cases).The first group (initial 40 cases) had a higher rate of switching to plasmakinetic resection of the prostate (PKRP) during operation and a higher decrease in Hb postoperatively.Complications such as blood transfusion,bladder injury during morcellation,hematuria,urethral stricture,stress urinary incontinence between two groups were comparable.Both two groups had a significant improvement in IPSS and Qmax and a 70% decrease in PSA at three month follow-up.And the mean improvement between two groups was statistically nonsignificant.Conclusion After 40 cases of learning HoLEP,the new learner had a significant improvement in surgical technique and safety. References | Related Articles | Metrics

Select

Comparison of robotic-assistant laparoscopic radical prostatectomy and retropubic radical prostatectomy Sheng Lu, Chen Ran, Zhang Hao-Jie, Qian Wei-qing 2012, 1 (2):  125-128.  Abstract ( 149 )   PDF (741KB) ( 322 )   Save Objective To compare the perioperative clinical statistics between Robotic-assistant Laparoscopic Radical Prostatectomy (RALRP) and Retropubic Radical Prostatectomy (RRP).Methods We retrospectively review the 24 cases who accepted RALRP in our center from May 2010 to November 2011.The total operative time,blood loss,transfusion rate,the pathological outcome,urinary continence outcome etc were analyzed,and were compared with the data of 38 cases which underwent RRP accomplished by the same doctors in the same period.Results The mean operative time was 4.85 hours (3.15~7.5hours) in RALRP group and 3.60±1.27 hours in RRP group.In the RALRP group,the mean operative time of the earlier 8 cases (RALRP1 group) and later 16 cases (RALRP2 group) was respectively 5.30±1.56 and 3.96±1.09 hours.The blood loss in RALRP was 100~1 200 ml,and the mean blood loss in RALRP1 and RALRP2 was 625±200 ml and 155±103 ml.In RRP group,the mean blood loss was 655±270 ml.The blood transfusion rate in RALRP and RRP was 33.3 % (7/24) and 42.1 % (16/38).The blood transfusion rate in RALRP1 and RALRP2 was 75 % (6/8) and 12.5 % (2/16) (P<0.01).The continence rate at 1 month after surgery was better in RALRP than in RRP group.The rate was respectively 62.5 % (5/8) and 81.3 % (13/16) in RALRP1 and RALRP2,and 57.9 % (22/38) in RRP.The overall margin positivity rate was respectively 20.8% and 26.3% in RALRP and RRP group.The mean hospital stay was 15 days and 21 days in RALRP and RRP group.Conclusions RALRP has a short learning curve for urologists,which has more advantage in decreasing blood loss,avoiding blood transfusion,recovering continence etc compared with RPP.However,whether RALRP has long-term advantages still needs long-time follow-up. References | Related Articles | Metrics

Select

Videourodynamic analysis on complex lower urinary voiding dysfunction:a report of 78 cases Liu Ying, Xu Yue-Min, Gu Bao-Jun, Fei Xiao-Fang 2012, 1 (2):  129-134.  Abstract ( 170 )   PDF (932KB) ( 933 )   Save Objective To investigate the videourodynamic study(VUDS) characteristics of various complex lower urinary tract voiding dysfunction and the diagnostic value of videourodynamic examination.Methods From May 2009 to June 2012,78 patients with complex lower urinary tract voiding dysfunction were included in our study.There were 38 males and 40 females,aged 19-75(mean,47) years.All patients had chief complaints of various lower urinary tract symptoms(LUTS),accompanying anatomical abnormalities or other chronic nervous system diseases history,or had a history of failed surgery planning for further surgery treatments.All patients underwent thorough VUDS(uroflowmetry,cystometrogram,pressure-flow study and urethral pressure profile).Results 4 males were removed who couldn’t be intubated the bladder pressure catheter.The remaining 74 cases underwent complete VUDS.8 cases were neurogenic bladder,including DU (3 cases),DO (2 cases),bladder low compliance with uronephrosis(2 cases) and DESD (1 cases).59 cases were non-neurogenic voding dysfunction,including BOO (29 cases),DU (13cases,with 5 female patients who couldn’t void voluntarily in PFS),DO (3 cases),real urinary incontinence(4 cases),stress urinary incontinence after prostatectomy(10 cases).BOO were classified into BPO (3 cases),POP (5 case),bladder neck obstruction (13 cases),posterior urethral obstruction (3 cases) and dysfunctional voiding(5 cases).7 cases were diagnosed normal in VUDS.8 cases changed their previous clinic diagnosis after VUDS.Conclusion Videourodynamic examination provides precise evidence of diagnosis for complex lower urinary tract voiding dysfunction.It can evaluate anatomic abnormalities sites and the function of detrusor/urethral sphincter.It also provides preliminary classification of lower urinary tract diseases and reliable references for the following treatments. References | Related Articles | Metrics

Select

Effects of epristeride on human prostate carcinoma cell Line DU-145 Li Tao, Li Yu-Hua, Li Run-Sheng, Gui Ya-Ping, Bian Cui-Dong, Huang Shen-Song, Wu Deng-Long 2012, 1 (2):  135-138.  Abstract ( 154 )   PDF (1182KB) ( 284 )   Save Objective To study the possibility and potential mechanisms of epristeride treatment of prostate cancer,and to investigate the effect of epristeride on the growth of DU-145 cells in vitro.Method We used different concentration of epristeride (2.5,5,10,20,40mM) to interfere DU145 cells and used an inverted microscope to observe the cell morphology.We used Sulforhodamine B(SRB) to evaluate the growth curve characterized by the inhibition of in vitro proliferation of DU145 cells caused by epristeride.We applied flow cytometry to evaluate cell cycle arrest of DU145 induced by epristeride.Results An obvious cell shrinkage and apoptosis was observed three days after the interference of epristeride with the concentration of 40mM and 20mM.Epristeride shows a conspicuously concentration-dependent inhibition of in vitro proliferation of DU145 cells.Through flow cytometry,we found that epristeride demonstrated a highly Concentration dependent effect of causing cell cycle arrest in DU145 cell line. References | Related Articles | Metrics

Select

The protective effect of Tetramethylpyrazine on kidney while performing ESWL(Extracorporeal Shock Wave Lithotripsy) Gui Ya-Ping, Wu Qiang, Li Tao, Wu Deng-Long 2012, 1 (2):  139-140.  Abstract ( 143 )   PDF (699KB) ( 413 )   Save Objective Explore the effect of tetramethylpyrazine on protecting rabbit’s renal function after ESWL.Methods Rabbits (20,2~3 kg) were randomly divided into the experimental group (10 rabbits,20% tetramethylpyrazine,4 ml/kg,IM) and the control group (10 rabbits).We used thiopental sodium 50 mg/kg to anesthetize rabbits,then resected the right kidney and placed a silver clip on the left renal hilum to obtain nephrolithiasis animal models.ESWL was performed after 2 weeks.We measured serum creatinine,urea nitrogen and nitric oxide 1,3,5 days before and after ESWL,and executed 3 rabbits each time from each group on day 3 and 7 after ESWL.We observed the morphology and structure of the renal tissue.Results The experimental group shows no obvious elavation of serum Cr Bun NO after ESWL while the control group has a significantly increased serum Cr,Bun,NO (P<0.05); Light and Electron microscopy shows a lower tissue damage in the experimental group than in the control group.Conclusion Tetramethylpyrazine can improve renal blood flow,increase prostaglandin synthesis in kidney,reduce angiotensin and promote scavenging oxygen free radicals.Hence Tetramethylpyrazine thas a protective effect on the acute renal injury caused by ESWL. References | Related Articles | Metrics

Select

The clinical study on sclerotherapy with stylolitic suture and inside constrictor cut in the treatment of rectocele Guo Song-Ming, Shao Qi-Hui, Tong Hong-Bin 2012, 1 (2):  141-143.  Abstract ( 138 )   PDF (716KB) ( 698 )   Save Objective To evaluate the cIinical efficacy of sclerotherapy with stylolitic suture and inside constrictor cut in the treatment of rectocele.Methods A total of 64 patients with rectocele were allocated randomizedly to the study group and the control group.The study groups (32 cases) received sclerotherapy with styIoIitic suture and inside constrictor cut ,the controI group (32 cases) received the operation of rectum incision and repair.The treatment effect and complications were compared between the groups.Results Score on symptom was lower in the study group than in the control group.The treatment effect was simiIar in the two groups.Conclusion Sclerotherapy with stylolitic suture and inside constrictor cut is a simpIe and effective method for the treatment of rectocele. References | Related Articles | Metrics

Select

Surgical therapeutic strategy and prognostic factors analysis for pulmonary metastasis Wang Hai-Bing, Chen Xiao-Feng, Zhang Hui, Zhou Wen-Yong, Zhao Ming-Chuan 2012, 1 (2):  144-148.  Abstract ( 164 )   PDF (778KB) ( 502 )   Save Objective To investigate the indications of resection for lung metastasis and the surgical procedure and factors affecting the survival.Methods The clinical data of 154 patients of pulmonary metastases after surgical intervention were analyseds retrospectively.Results After surgery,the cumulative 1-,3- and 5-year survival rates were 87.7%,55.3%,37.8%,respectively in our clinical data,of which 3 patients survived for more than 20 years,with an overall median survival of 38.9 months.Mortality and complication rates after surgery were 3.2% (5/154) and 5.8% (9/154).Whether complete resection of lung metastases or not,the number of lung nodules,whether other organs metastasis besides the lung or not,operative modus (thoracotomy and VATS) are prognostic factors.The patients with one latus total pneumonectomy have a shorter survival than the ones with pneumectomy or pulmonary lobectomy.Preoperative pulmonary function is a prognostic factor for the patients with pulmonary lobectomy or one latus total pneumonectomy.Complete resection of pulmonary metastases,a single nodule,no other organs metastasis except the lung and thoracotomy predicts a longer survival whereas disease-free interval (DFI),metastatic locus,pulmonary metastasis size,the status of mediastinal lymph node removal,age,gender,symptom and pathology of the primary tumor were found statistically insignificant prognostic factors.Conclusion Surgical intervention should be undertaken for the indication patients who fit these criteria and thoracotomy is a better choice.For the patients with abnormal preoperative pulmonary function,pulmonary lobectomy or one lateral total pneumonectomy should be attempted with prudence. References | Related Articles | Metrics

Select

Diagnosis and treatment of traumatic manubriosternal joint dislocation Chai Xiao-Jun, Ruan Zheng, Zhen Jian, Yu Xiao-Bo, Zhang Xiao-Miao, Huang Hai-Hua 2012, 1 (2):  149-151.  Abstract ( 169 )   PDF (1115KB) ( 630 )   Save Objective To survey the diagnosis and treatment of traumatic manubriosternal joint dislocation.Method A retrospective study was made on 4 cases of traumatic manubriosternal joint dislocation hospitalized from Sep 2007 to Aug 2012 in our hospital they were treated with operation and conservative treatment.Result All patients got clinical cure after treatment.The patitents treated with operation recovered more quickly than the one with conservative method.Conclusion Internal fixation is an effective method to cure traumatic manubriosternal joint dislocation. References | Related Articles | Metrics

Summaries

Select

Osteochondral lesions of the talus Aubeeluck Ashwin, Yu Guang Rong 2012, 1 (2):  152-157.  Abstract ( 311 )   PDF (835KB) ( 356 )   Save This narrative review aims to present the current concepts about classification,diagnosis and treatment of osteochondral lesions of the talus (OCL).OCL is a more common source of ankle those previously recognised and often present as complications of ankle injuries.No time restriction was applied in the English literature search in Pubmed and EMBASE,and focus was laid on the classification,diagnosis and treatment of OCL.An acute OCL will mimic the clinical picture of a sprained ankle,therefore if symptoms persist after 2~3 weeks,AP,lateral and mortise X-Ray views of the ankle are indicated.If these are negative,a CT scan will rarely miss the lesion,but the most accurate imaging is the MRI,which can accurately assess cartilage damage.Debridement and bone marrow stimulation is according to available information,the surgical technique which currently yields best results for small lesions(<15 mm) while ACI or osteochondral transplantation are recommended by several authors for large lesions.In view of OCL are easily missed in clinical practice,we recommend that there should be a high index of suspicion especially in forceful inversion injuries of ankle in dorsiflexion or plantarflexion. References | Related Articles | Metrics

Select

Clinical application of the blood supply to the femoral head and neck Liu Shi-Wei, Jia Guang-Yao, Mei Jiong 2012, 1 (2):  158-161.  Abstract ( 149 )   PDF (731KB) ( 858 )   Save In terms of distribution of blood supply to the femoral head and neck (FHN),schematic diagrams or planar graphs are expressed in all classical works and textbooks of anatomy and orthopedics.An exact presentation of intra-and extraosseous blood supply to FHN can not be provided which leads to poor understanding of 3D vasculature.On one hand,it is of disadvantage for new learners to know the real circulation to FNN; on the other hand,it makes against reasonable judgment of the severity of local vessels and logical treatment of femoral neck fractures for orthopedic surgeons.To achieve the accurate 3D vasculature networks of FHN through contemporary techniques of radiography and computer image processing.The computer-aided technique of virtual reality is employed for clinical cases of various femoral neck fractures,and further combined with radiographic and histopathological methods to focus on the damaging effect of various femoral neck fractures on the blood supply to the femoral head,and designing individual and optimal treatment protocols for different femoral neck fractures. References | Related Articles | Metrics

Select

Application progress of arthroscopy for correction of hallux valgus Yu Tao,Yu Guang-Rong 2012, 1 (2):  162-164.  Abstract ( 163 )   PDF (715KB) ( 572 )   Save With the introduction of new instruments and techniques,the arthroscopy of small joints has been rapidly developing.The first metatarsophalangeal arthroscopic treatment is used for treatment of hallux valgus more and more,and good results have been achieved.It has been used for both diagnostic and therapeutic indications.As a new technology,it is also inevitable that there are some problems and limitations of it.Application progress of arthroscopy for correction of hallux valgus will be elaborated and discussed. References | Related Articles | Metrics

Select

Current therapy for hilar cholelangiocarcinoma Lin Rui, Liu Zhong-Yan, Chen Quan-Ning, Shi Bao-Ming 2012, 1 (2):  165-168.  Abstract ( 182 )   PDF (742KB) ( 381 )   Save Background Hilar cholangiocarcinoma (HC) originates in the main extrahepatic left or right duct or their confluence It’s still considered to be hard to treat or cure.Data source:We reviewed the medical literatures on HC and we analysis the relevant and updated information in a concise and easy-to-read manner.Result The selection and timing of management options for HC are determined by the diagnosis,the underlying liver function,the general condition of the patients and the stage of the disease.Nowadays,the treatment of HC can be divided into curative and palliative treatment.For the curative treatment,local excision should only be used on Bismuth I papillary carcinoma.Combined partial hepatectomy should be combined with caudate lobe resection and porta-hepatis lymph node dissection.The results of these surgical selections can be improved by portal vein embolization,staging laparoscopy and laparoscopic ultrasound.The role of preoperative biliary drainage is controversial.Autotransplantation for HC gave disappointing results while the Mayo Protocol of chemoradiation for selecting patients with unresectable HC for orthotopic liver transplantation has been widely accepted.Palliative treatment included bypass surgery,endoscopic or percutaneous stenting,photodynamic therapy,intraluminal brachytherapy,and external radiation and systemic therapy.Conclusions:Adequate surgery with R0 resection should be the main goal of treatment.For patients with unresectable HC,treatment aims to improve the quality and quantity of their survival. References | Related Articles | Metrics

Case Report

Select

Analysis on a medical malpractice case caused by “breast cancer”pathological misdiagnosis Chen Quan, Tan Ming 2012, 1 (2):  169-170.  Abstract ( 185 )   PDF (687KB) ( 413 )   Save Based on the analysis on a rank 3 class D medical malpractice case caused by “breast cancer”pathological misdiagnosis,to clarify the importance of standardization management of pathology department,implement quality control requirements,improve the level of the pathological diagnosis,strengthen communication with clinicians,so medical quality and safety can be ensured,medical accident can be prevented. References | Related Articles | Metrics