Objective： To investigate whether endogenous hydrogen sulfide (H2S) was involved in the pathogenesis of osteoarthritis (OA) and its underlying mechanism, to detect H2S and its synthases expression in knee cartilage in patients diagnosed with different severity of OA, and to explore the transcription and expression of gene MMP-13 in chondrocytes treated with IL-1β or H2S. Methods: Synovial fluids of the in-patients with different severity of OA hospitalized in Peking University First Hospital were collected for measurement of H2S content using methylene blue assay. Articular cartilages of the patients who underwent knee arthroplasty were collected for the cell culture of relatively normal chondrocytes. The chondrocytes were cultured to the P3 generation and H2S molecular probes were used for detection of endogenous H2S generation in the chondrocytes. Immunocytochemistry was used to detect the localization of H2S synthases including cystathionine β-synthase (CBS), cystathionine-γ-lyase (CSE), and mercaptopyruvate sulfurtransferase (MPST) in OA chondrocytes. Western blot was used to quantify the protein expressions of CSE, MPST, and CBS in cartilage tissues of the patients who were diagnosed with OA and underwent knee arthroplasty. The relatively normal human chondrocytes were cultured to passage 3 and then divided into 4 groups for different treatments: (1)the normal control group, no reagent was added; (2)the IL-1β group, 5 μg/L of IL-1β was added; (3)the IL-1β+H2S group, 200 μmol/L of NaHS was added 30 min before adding 5 μg/L of IL-1β；(4)the H2S group, 200 μmol/L of NaHS was added. The transcription and expression of gene MMP-13 in chondrocytes of each group were determined with Real-time PCR and Western blot, respectively. And the total NF-κB p65 and phosphorylated NF-κB p65 in chondrocytes were detected with Western blot.  Results: The content of H2S in the synovial fluid of degenerative knee was (14.3±3.3) μmol/L. Expressions of endogenous H2S and its synthases including CBS, CSE and MPST were present in the cytoplasm of chondrocytes.CSE protein expression in Grade 3 (defined by outerbridge grading) cartilage tissues was significantly increased as compared with that of Grade 1 cartilage tissues (1.67±0.09 vs. 1.26±0.11, P< 0.05). However, no significant difference of CBS or MPST expression among the different groups was observed. The expression of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (1.87±0.67 vs. 0.22±0.10, P＜0.05), and that in the IL-1β+H2S group was significantly decreased than that in the IL-1β group (0.55±0.11 vs. 1.87±0.67, P＜0.05), and that in the H2S group had no significant difference compared with that in the normal control group. The transcription of MMP-13 protein in the IL-1β group was significantly higher than that in the normal chondrocytes (31.40±0.31 vs. 1.00±0.00, P＜0.05), and that in the IL-1β+H2S group was significantly decreased than that in the IL-1β group (24.41±1.28 vs. 31.40±0.31, P＜0.05), and that in the H2S group had no significant difference compared with that in the normal control group. The total NF-κB p65 in the IL-1β group was significantly higher than that in the normal chondrocytes (2.13±0.08 vs. 0.73±0.08, P＜0.05), and that in the IL-1β+H2S group was significantly decreased than that in the IL-1β group (1.24±0.13 vs. 2.13±0.08, P＜0.05), and that in the H2S group had no significant difference compared with that in the normal control group. The phosphorylated NF-κB p65 in IL-1β group was significantly higher than that in the normal chondrocytes (1.30±0.13 vs. 0.19±0.04, P＜0.05), and that in IL-1β+H2S group was significantly decreased than that in the IL-1β group (0.92±0.26 vs. 1.30±0.13, P＜0.05), and that in the H2S group had no significant difference compared with that in the normal control group. Conclusion: H2S affected the cartilage degeneration by partly inhibiting the degradation of extracellular matrix.

Objective：To evaluate the effects of intraarticular injection of bevacizumab、sodium hyalu-ronate (SH) and 0.9% sodium chloride injection in the treatment of osteoarthritis (OA) in a rabbit model. Methods: Twenty-four male rabbits were randomly divided into bevacizumab group,SH group and control group after the model of OA had been made. The bevacizumab group and control group received intraarticular bevacizumab (4 mg) and 0.9% saline injection respectively once per three weeks for 2 times. The SH group received intraarticular SH once a week for 6 weeks. After 6 weeks, the histological examinations of cartilage and synovium,electron microscopy and expression of vasculan endothelial growth factorl (VEGF）, for the synovium, expression of MMP-1, Mankin’s scale, macroscopic observation for cartilage were performed. Results: The histological observation of the bevacizumab group and the SH group showed that bevacizumab could decrease the synoviocytes and inhibit fibrous hyperplasia in synovial underlayer compard with the control group. Reduced apoptosis of chondrocytes and more integrated structure of matrix and more glycosaminoglycan were also found in the bevacizumab group and the SH group compared with control group. The expression of VEGF and MMP-1, Mankin’s scale, macroscopic observation were significantly decreased in the bevacizumab group compared with the SH group and the control group (P<0.05). Conclusion: Intraarticular injection of bevacizumab and SH can relieve inflammation of OA and alleviate the pathologic process of OA. The Bevacizumab was better than the SH in therapeutic effect, which maybe implicate a better choice for the treatment of OA.

Objective： To retrospectively analyze the clinical data of the patients with reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments, with previous open-door expansive laminoplasty, and to evaluate the outcomes. Methods: From May 2006 to July 2012, a retrospective study was performed on a consecutive series of 17 patients with previous open-door expansive laminoplasty, who had received the reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments. The reoperation was performed based on the clinical manifestations and segments of responsibility. The anterior approaches were performed in 12 cases, and the posterior approaches in 5 cases. The correlation between the clinical factors and Japanese Orthopedic Association (JOA) scores or the JOA recovery rate was evaluated by Pearson or Spearman correlation test. The pre-and post-operative JOA scores were analyzed by repeated measures ANOVA and the JOA recovery rates were compared with paired t test. Results: The mean follow-up was 137.5 months (range 60-348 months). There were no serious complications after surgical procedures. There was one case that had C5 palsy in the first operation and had recovery after one week. Another case had C5 palsy in the reoperation with posterior approach, which had recovery at the end of 6 months post-operation. Three cases had the cerebrospinal fluid leakage of the reoperation, with two cases in the anterior approaches and one case in the posterior approach. There was no significant correlation between the clinical variables and JOA scores or JOA recovery rates. The JOA scores of the patients in the first operation were improved from 9.4±4.1 to 12.8±2.8 (P<0.01), and the JOA recovery rate was 45.6%. The JOA scores of the reoperation were improved from 10.2±2.8 to 12.7±2.4 (P<0.05) at the end of  6 months and 14.3±1.9 (P<0.01) by the last follow-up. There were significant differences between the JOA recovery rates by the last follow-up (63.2%) and at the end of 6 months (39.3%) of the reoperation or 45.6% of the first operation (P<0.01). Conclusion: The reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments can significantly promote the recovery of the spinal cord, based on the clinical manifestations combined with segments of responsibility of the imaging.

Objective：To measure the clivo-axial angle (CAA) and cervicomedullary angle (CMA) in upper cervical deformity patients who underwent computer-assisted posterior upper cervical reduction and fixation surgery, and analyze their correlation. Methods: In the study, 25 patients with symptomatic upper cervical deformity were chosen for measurement of preoperative and postoperative CMA and CAA using magnetic resonance imaging (MRI) and intraoperative C-arm. The angle between the clivus plane and the straight line parallel to that of the posterior margin of the C2 vertebral body was defined as CAA; moreover, the angle between the straight line parallel to the ventral side of the cervical spinal cord and the straight line parallel to that of the ventral side of the medulla oblongata was defined as CMA. Two experienced spinal surgeons performed the measurements. The CAA and CMA were measured three times, and the mean value was considered as the result.  Results: Analyses of the CAA and CMA were performed with Wilcoxon rank test, which showed that there was consistency between the CAAs measured with MRI and intraoperative C-arm. The result showed that the postoperative CAA and CMA increased significantly compared with preoperation (P<0.001). Through Spearman rank correlation analysis, the preoperative CAA was positively correlative with the CMA (r=0.902, P<0.001), and so was the postoperative CAA (r=0.921, P<0.001). Conclusion: Preoperative and postoperative CAA in upper cervical deformity patients is significantly correlative with preoperative and postoperative CMA. CAA can be measured during surgery using intraoperative CT or C-arm based three-dimension navigation, and may predict the patient’s CMA, which cannot be measured during operation, but is essential for evaluating the decompression and reduction of the spinal cord.

Objective：To study a new positioning method of elbow external fixation rotation axis, and to evaluate its feasibility. Methods: Four normal adult volunteers and six Sawbone elbow models were brought into this experiment. The kinematic data of five elbow flexion were collected respectively by optical positioning system. The rotation axes of the elbow joints were fitted by the least square method. The kinematic data and fitting results were visually displayed. According to the fitting results, the average moving planes and rotation axes were calculated. Thus, the rotation axes of new kinematic methods were obtained. By using standard clinical methods, the entrance and exit points of rotation axes of six Sawbone elbow models were located under X-ray. And The kirschner wires were placed as the representatives of rotation axes using traditional positioning methods. Then, the entrance point deviation, the exit point deviation and the angle deviation of two kinds of located rotation axes were compared. Results: As to the four volunteers, the indicators represented circular degree and coplanarity of elbow flexion movement tra-jectory of each volunteer were both about 1 mm. All the distance deviations of the moving axes to the ave-rage moving rotation axes of the five volunteers were less than 3 mm. All the angle deviations of the mo-ving axes to the average moving rotation axes of the five volunteers were less than 5°. As to the six Sawbone models, the average entrance point deviations, the average exit point deviations and the average angle deviations of two different rotation axes determined by two kinds of located methods were respectively 1.697 2 mm, 1.838 3 mm and 1.321 7°. All the deviations were very small. They were all in an accep-table range of clinical practice. Conclusion: The values that represent circular degree and coplanarity of volunteer's elbow single curvature movement trajectory are very small. The result shows that the elbow single curvature movement can be regarded as the approximate fixed axis movement. The new method can replace the traditional method in accuracy. It can make up the deficiency of the traditional fixed axis method.

Objective：To introduce the surgical techniques and treating results of the old “terrible triad” of the elbow. Methods: A retrospective analysis of 11 cases of old “terrible triad” of the elbow treated by the author from March 2009 to February 2014 were performed， with 9 males and 2 females; mean age was (31.82±8.66) years (17-45 years). The average time after injury was (6.36±2.50) weeks (4-12 weeks), with 7 cases on the left and 4 right. The combined injury included 2 cases with distal radius fractures, 1 with ankle fractures, fractures of the distal radius and the head injury (minor epidural hematoma, no surgery), and 1 with Pilon fractures and L4 fractures (fixed at local hospital). All the patients had elbow stiffness and joint dislocation, and 2 patients had symptoms of ulnar nerve. Mason classification of radial head fractures: 2 cases were type Ⅰ, 5 were type Ⅱ, 4 were type Ⅲ. Classification of the coronoid process: Regan & Morrey: 1 was type Ⅰ, 10 were type Ⅱ; according to O’Driscoll classification, all the fractures were tip fracture, one was the first subtype, 10 were the second subtype. The elbow were released, the coronoid process were fixed by lasso suture combined with Kirschner wires. Radial head fractures were resected in 1 case, and replaced in 1 case, 3 cases with no treatment, 6 cases with osteotomy and 3.0 mm headless compression screw (HCS) fixation. The lateral collateral ligament complex and the common extensor tendon were repaired to the humeral lateral epicondyles, No.2 Ethibon was used in 2 cases through bone holes, and suture anchorsin the other 9 cases. All the patients were fixed by Stryker DJD Ⅱ hinged external fixator to protect the bone and soft tissue.  Results: The average follow-up time was (38.36±21.92) months (19-77 months). All the patients had no obvious pain, instability and ulnar nerve symptoms in the last follow-up. The average elbow flexion was 134.09°±12.41° (100°-140°), average extension was -15.91°±14.46° (-40°-0°), range of flexion and extension was 118.18°±23.80° (70°-140°). Average pronation was 70.91°±26.63° (20°-90°), supination was 70.91°±26.63° (20°-100°). The range of motion (ROM) of forearm rotation was 150.91°±43.00° (40°-180°). Average Mayo elbow performance score (MEPS) was 96.36±5.04 (85-100).X-ray showed that no degenerative changes. Five patients had heterotopic ossifications, according to Hastings and Graham grading: 1 case was grade Ⅰ, 3 cases were grade ⅡA, 1 case was ⅡB. Conclusion: The old “terrible triad” of elbow with no operative history is difficult to treat. The elbow’s functions and stabilization can be recovered by thorough elbow release, repair of coronoid process and anterior capsule, radial head fractures, lateral collateral ligament and the common extensor tendon insertion, combined with hinged external fixator. Joint stiffness and heterotopic ossification are common complications.

Objective：To discuss the effect of single low dose local radiotherapy and indomethacin together in the prevention of recurrence of ectopic ossification around the elbow after resection. Methods: From Jun. 2009 to Dec. 2011, we performed excision of ectopic ossification around the elbow in 78 stiff elbows. For each case, we used both medial and lateral approaches, and we performed both anterior and posterior capsulectomies and removal of ectopic ossification. In the lateral approach, we started proximally, the lateral supracondylar ridge of the humerus was exposed from the interval between extensor carpi radialis longus (ECRL) and triceps, and then distally passed the interval between ECRL and extensor carpi radialis brevis (ECRB). With the medial approach, after releasing the ulnar nerve, the pronator teres muscle origin was reflected from the medial epicondyle, and then the common flexor-pronator tendon was split longitudinally distally and the brachalis and the anterior portion of the flexor-pronator group were dissected off the anterior humerus. If there was forearm rotation dysfunction, we used extensive lateral approach, the anconeus muscle was reflected from the ulna and the scar tissue and ectopic ossification around the proximal radioulnar joint were resected. The important structures, such as the lateral ulnar collateral ligament (LUCL) and the anterior part of the medial collateral ligament (AMCL), should be carefully protected, because they were important for the elbow stability. Anterior transposition of the ulnar nerve depended on the patients’ condition. We performed low dose radiotherapy 4 hours before operation, and we used indomethacin for 6 weeks after operation. In these patients, there were 46 males and 32 females, whose age averaged (35.8±7.9) years (16-65 years). According to Hastings-Graham classification, there were 56 ⅡA, 5 ⅡB, 6 ⅡC and 11 Ⅲ before operation.  Results: We followed up these patients for 26 months with an average of 24-36 months, all the patients improved their elbow function, and no recurrence of ectopic ossification appeared except for 1 patient. For this patient, his elbow function was excellent, and according to Hastings-Graham classification, his ectopic ossification was of type Ⅰ. Conclusion: Single low dose local radiotherapy and indomethacin together are effective in the prevention of recurrence of ectopic ossification around the elbow after excision.

Objective：To evaluate the outcomes of lesser arc perilunate injuries (Perilunate dislocations) treated with arthroscopically assisted mini-invasive reduction and fixation. Methods: Between 2012 and 2014, 5 patients who had a perilunate dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 17.8 months (range, 10 to 32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo wrist score; Quick disabilities of the arm, shoulder and hand questionnaire; and patient-rated wrist evaluation score. Radiographic evaluations included carpal alignments and any development of arthritis. Results: The range of flexion-extension motion of injured wrist averaged 84% of the values for contralateral wrist. The grip strength of the injured wrist averaged 90% of the values for the contralateral wrists. The mean Quick Disabilities of the arm, shoulder and hand score was 1, and the mean Patient-Rated Wrist Evaluation score was 5. According to the Mayo wrist scores, the overall functional outcomes were rated as excellent in all the patients. Reduction obtained during the operation was maintained within normal ranges in all the patients. Arthritis had not developed in any patient at the end of the follow-up. Conclusion: Arthroscopic mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate dislocations according to our early results.

Objective：To describe the clinical results of a one-stage operation for posterior cruciate ligament reconstruction and a posterolateral corner reconstruction of popliteus tendon reconstruction, compared with an open popliteofibular ligament reconstruction. Methods: Our study included 33 patients who had undergone posterior cruciate ligament reconstruction with use of an achilles tendon-bone allograft and posterolateral corner reconstruction with arthroscopic anatomical reconstruction of popliteus tendon or open reconstruction of popliteofibular ligament. The patients were assessed for knee instability with use of the dial test at 30° and 90°, together with posterior stress radiography and KT-1000 measurement.  Results: The mean time of follow-up was more than 2 years. At the final follow-up evaluation, the tibial posterior translation as measured by stress radiography at 90° of knee flexion, the anterior-posterior translation as measured by KT-1000, and the external rotation of tibia as measured by dial test were reduced postoperatively (P<0.001) in both groups. Between the two groups, the preoperative tibial posterior translation as measured by stress radiography and the preoperative mean anterior-posterior translation as measured by KT-1000 in the popliteofibular ligament group were a little more than those in the popliteus tendon group (P=0.014, P<0.001). But the other comparisons were not significantly different (P>0.05). The final flexion losses were 3.33°±4.88° and 3.06°±3.38° for the two groups. Conclusion: Combined with posterior cruciate ligament reconstruction, anatomical posterolateral corner reconstruction of the popliteus tendon and open reconstruction of popliteofibular ligament showed similar outcomes. This study demonstrated that both posterolateral corner reconstruction techniques were a reliable alternative method in addressing posterolateral corner and posterior cruciate ligament insufficiency of the knee.

Objective：To discuss the result of treating valgus or varus knee deformity with fixator assist nailing (FAN) technique and distal femur osteotomy(DFO). Methods: In this retrospective study, 14 patients with 17 limbs, 12 valgus and 5 varus knee deformity were treated with DFO and FAN. The average age of the patients was 23 (17-44) years . The unilateral external fixator was mounted on the lateral side of femur, the minimal invasive distal femoral osteotomy was performed. After the deformity was corrected, the intramedully nail was inserted to fix the femur. None of the patients need bone autograft. The preoperation and postoperation lateral distal femur angle (LDFA), mechanical axis deviation (MAD) and range of motion (ROM) were measured and analyzed. Results: All the 14 patients were followed-up for 12-72 months (average 34 months). The osteotomy site united in 3-5 months (average 3.5 months) post-operatively. According to Paley’s functional scores, 12 patients were excellent, 2 patients were good. We achieved desired postoperative MAD ( from medial 15 mm to lateral 10 mm) in 15 limbs of 12 patients. The LDFA in 11 limbs was corrected to normal (84°-90°). The ROM was not significantly changed before and after operation in the both groups. No infection or neuro-vascular injury occurred. Conclusion: The FAN technique is an effective method to treat valgus knee or varus knee deformity in young patients with DFO.

Objective： To evaluate the over 5-year follow-up clinical outcomes of degenerative lumbar scoliosis treated with operation of decompression and fusion, and the effectiveness and risks factors about revision surgery cases. Methods: A total of 47 cases of diagnosis of degenerative lumbar scoliosis treated with posterior decompression and instrument fusion recorded from Jun. 2003 to Jun. 2008 were analyzed. Lumbar Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were applied to evaluate the improvement of the clinical effect after surgery treatment, and the clinical effect and reasons of revising operation were recorded and analyzed. Results: All the 47 patients had finished the over 5-year followed-up time with an average time of (8.2±3.6) years (range from 5.2 years to 12.5 years). The patient’s mean age was (67.0±9.6) years and the age of patient range from 56 years to 81 years. There were 10 patients who underwent revision surgery since primary operation, in whom 8 cases because of proximal failure of internal fixation and the other 2 cases because of distal failure of fusion segment. The average clinical improvement excellent rate was 83.3% after 5 years since primary operation of 37 cases while the average fine rate of revision operation was 67.6%. Conclusion: In the over 5-year follow-up, there was a better clinical outcome of degenerative lumbar scoliosis treated with posterior decompression and instrumented fusion, which had a certain rate of revision operation and had a worse effect of clinical results compared with primary operation. The risks of revision surgery included the poor bone quality of patients, with fusion to L1 at proximal terminal and the fusion end to S1 at distal terminal.

Objective：To collect comprehensive data of the physical function of the end-stage osteoarthritis (OA) patients, and compare it with patients with mild OA. To evaluate the correlations among pain, self-reported questionnaire, performance based physical function and actual daily life activity level. Methods: In this prospective study, the comprehensive physical function parameters of 87 end stage OA patients waiting for total knee replacement, and that of 60 patients with mild OA ［Kellgren-Lawrence (K-L) grade 0-2］ were collected. The comprehensive physical function parameters including: age, height, body weight, 30 s chair stand test (30-CST), 40 m fast-paced walk test (40-FPWT), 12 steps stair climb test (12-SCT), timed up & go test (TUG), 6 minutes walk test (6-MWT), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee society score (KSS), visual analogue scale (VAS) pain scale, and everyday steps counts for continuous 7 days. The data were analyzed with the soft ware SPSS 22.0. The descriptive report of all the parameters was made. Because the Kolmogorv-Smirnov test results for all the parameters were negative for normal distribution, nonparative Mann-Whitney test was used to analysis the differences between the two groups, as well as the Spearman test for the correlations.  Results: All the parameters of the mild OA group were better than those of the end stage group, and the differences were significant (P<0.05). In the mild OA group, there were no correlations or weak correlations between all the physical function test and questionnaire, however, in the end stage group, the correlations were weak, moderate, or strong. Conclusion: The usage of lots of different physical parameters from Chinese OA patients were reported in this study. The results showed that there are no good correlations among performance based physical function test, actual daily activity level, self reported questionnaires, and the pain scales. More comprehensive evaluation for the OA patients needs to be made, in order to make better decision for arthroplasty.

Objective：To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures. Methods: From January 2013 to December 2014, 8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were retrospectively reviewed after the final follow-up. There were 1 man and 7 women with a mean age of (58.5±6.4) years, of whom 3 left shoulders and 5 right shoulders were involved. There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures, and 6 patients with humeral head necrosis as well as implant-associated infection after open reduction internal fixation for proximal humeral fractures with the locking plate. The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery. At the first-stage surgery, all the patients underwent a thorough debridement, and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate. During the second-stage surgery, the cement spacer was removed, and then a revision shoulder arthroplasty with the reverse shoulder prosthesis was performed in all the patients who were routinely followed up after the second-stage surgery. The visual analogue score (VAS), Constant score and University of California Los Angeles (UCLA) score were employed to evaluate the postoperative shoulder function. Results: The mean follow-up time was (19.9±8.0) months (range 12 to 35 months). At the end of the follow-up, the median forward elevation ［100° (60°, 140°) vs. 25° (0°, 90°), P=0.011］, the median external rotation ［15° (0°, 50°) vs. 5° (0°, 20°), P=0.048］, and the median internal rotation ［L4 (buttock, T12) vs. buttock (buttock, L3), P=0.041］ were all significantly improved postoperatively. The median Constant score ［53.5 (32, 74) vs. 29.0 (10, 57), P=0.012］, the median UCLA score ［20.5 (9, 26) vs. 9.5 (5, 15), P=0.012］, and the median VAS score ［1.5 (0, 5) vs. 5.0 (0, 8), P=0.018］ were all significantly improved after the surgery. No recurrence of infection, prosthetic loosening or neurovascular injury was noted by the last follow-up. Conclusion: Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures. The shoulder function was postoperatively improved to a certain degree.

Objective：To discuss the diagnosis, differential diagnosis, classification methods and treatment of the capitellar fractures of the distal humerus. Methods: In the study, 28 adult patients with the capitellar fractures were treated in Beijing Jishuitan Hospital from Sep. 2008 to Jan. 2014. There were 10 females and 18 males with an average age of 34 years (range: 14-66 years). According to Dubberley classification: ⅠA type in 6 cases, ⅠB type in 2 cases, ⅡA type in 8 cases, ⅡB type in 4 cases, ⅢA type in 4 cases, and ⅢB type in 4 cases. Sixteen patients were treated with a single Kochr approach, 1 with a lateral approach combined with a medial approach, 2 combined with anterior elbow approach and 9 combined with posterior median approach. All of the fractures were fixed with Herbert screws, 7 cases with support plates, and 4 cases with the hinged elbow external fixator. All of the patients were followed up for clinical examination and radiograph check. They were evaluated with Broberg-Morrey score system. Results: The average follow-up time was 28.5 months (range 12-72 months). The average bone union time was 8 weeks. The average ulnohumeral motion was 112°(60°-150°) and forearm rotation was 145°(100°-170°). The average Broberg-Morrey score was 92.5 points (range: 62-100 points). The excellent and good rate was 91.8%. The complications of traumatic arthritis was in 2 cases and elbow stiffness was in 2 cases. Conclusion: Attention should be paid to the diagnosis and differential diagnosis of capitellar fractures without missing the combined injury. According to Dubberley classification, appropriate surgical approach and the internal and external fixed methods could be chosen. Early postoperative, reasonable and effective exercise is helpful to the recovery of elbow joint function.

Objective：To analyze morphological character of lateral tibial plateau fracture fragment, and its correlation to the presence of a meniscus injury in tibial plateau fractures. Methods: A total of 79 consecutive patients of the simple lateral tibial plateau fractures from July 2011 to July 2015 were inclu-ded in this study, with 65 males and 14 females with an average age of (34.3±7.2) years and 22-61 years. According to Schatzker classification, 21 cases were of Type Ⅰ, 41 cases Type Ⅱ, and 17 cases Type Ⅲ. The characteristics of lateral tibial plateau fractures were evaluated by plain X-ray and magnetic resonance imaging (MRI). The type and severity of meniscus injury were diagnosed by MRI scan. Three-dimensional measurements of the lateral fragment width (LFW), the lateral plateau depression (LPD), the coronal angulation of lateral fragment (CALF), and tibial plateau widening (TPW) were measured with Picture Archiving and Communication Systems(PACS) software. The patients with and without meniscus injuries were divided into different groups and analyzed respectively. Comparison of the above measurements between the two groups was analyzed by independent t test.  Results: In all the 79 lateral tibial plateau fracture patients, 26 cases (32.9%) of meniscus injuries were detected by MRI. Among all the meniscus injury cases, 3 were of Schatzker Ⅰ, 16 Schatzker Ⅱ, and 7 Schatzker Ⅲ. In meniscus intact group, the average LFW was (22.0±2.8) mm while in meniscus injury group it was (21.3±3.3) mm (t=-1.008, P=0.317).The average LPD of non meniscus injury group was (5.4±2.8) mm, while in meniscus injury group was (8.7±2.8) mm (t=4.98, P=0.001). The average CALF of the two groups were 9.1°±6.1°and 10.6°± 7.1°, and there was no significant dif-ference between the two groups (t=0.38, P=0.831). The average TPW was (3.0± 1.1) mm, and (4.8±1.7) mm of the two groups. There were significant differences between the two groups (t=5.216, P=0.001).Conclusion: There was no obvious correlation between the LFD and meniscus injury. The CALF of lateral tibial plateau fracture had no significant correlation with meniscus injury either. The degree of LPD and TPW may indicate injury of the meniscus in tibial plateau fractures.

Objective：To find out whether it is accurate to estimate femoral version based on femoral broach after femoral neck osteotomy using computed tomography scans. Methods: In 32 total hip arthroplasty (THA), we performed CT scans before and after operation. Four possible levels (lesser trochanter, 5 mm above, 10 mm above and 15 mm above the lesser trochanter) of broach version were calculated based on the pre-operative CT scan. Stem versions were measured on the post-operative CT scan. We determined the difference between the preoperative broach version and the postoperative stem version using the Student’s t-test for paired samples assuming equal variance. Results: For the operated hips, pre-operative hip version differed according to the level of measurement. Our findings showed that the average femoral version was 37.0°±11.0° at the level of the lesser trochanter (section 1), 34.3°±10.6° at 5 mm above the lesser trochanter (section 2), 28.1°±10.9° at 10 mm above the lesser trochanter (section 3), and 22.4°±13.7° at 15 mm above the lesser trochanter (section 4), and that the average version for the femoral neck (FNV) was 12.9°±13.8°. The postoperative hip version was the stem version (FSV), which we found to be an average of 26.1°±11.0°. The mean femoral version for section 1 and 2 was larger than the mean postoperative stem version (P<0.01); the mean version for sections 3 and 4 did not differ from the mean postoperative stem version (P>0.05). The mean femoral neck version was less than the mean postoperative stem version (P<0.01); the difference was 13.2°±11.1° of the increased anteversion on average for the FSV compared with FNV. Conclusion: The accuracy of estimated femoral version after arthroplasty depends on broach level. When it is 10 mm above the lesser trochanter, stem version estimation is accurate, but below that level, there is a tendency to overestimate.

Objective：To observe the clinical effect of different background volumes of ropivacaine in continuous tibial nerve block of postoperative analgesia after calcaneal surgery. Methods: This study was a prospective, randomized, controlled study. Sixty cases of calcaneal visual analogue scale (ASA) Ⅰor Ⅱ undergoing elective surgery were selected and randomly assigned to two groups, thirty cases in each group. The patients received popliteal fossa posterior tibial nerve block using ultrasound guided. The continuous stimulation catheter was inserted after successful position and the 0.2% ropivacaine was injected. The background volumes of the A and B groups were 5 mL/h and 3.2 mL/h. The VAS score, the sensory block and motor block of tibial nerve and common peroneal nerve, and the satisfaction of the patients at h 12, h 24 and h 48 were recorded after catheter insertion. Results: The VAS scores at the three time points (h 12, h 24 and h 48) on the two groups of the patients were compared, and the difference was not statistically significant (P > 0.05). The difference of the sensory block and the motor block of the tibial nerve at the three time points (h 12, h 24 and h 48) on the two groups of the patients were also compared, and the difference was not statistically significant (P> 0.05). The difference of the sensory block and the motor block of common peroneal nerve at h 48 hs was statistically significant, group A was higher than the group B (P< 0.05). The difference of the patient satisfaction at the three time points (h 12, h 24 and h 48) on the two groups was not statistically significant (P> 0.05). Conclusion: The use of 0.2% ropivacaine with the background volume of 3.2 mL/h in continuous tibial nerve block can provide good analgesia and reduce the incidence of the sensory block and motor block of the common peroneal nerve.

Objective： To investigate the feasibility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters in differentiating musculoskeletal tumors with different behaviours of pathological findings before therapy. Methods: A total of 34 subjects of musculoskeletal tumors were involved in this retrospective analysis. DCE-MRI was performed using a fat-saturated 3D VIBE (volumetric interpolated breath-hold exam) imaging sequence with following parameters: FA, 10 degree; TR/TE, 5.6/2.4 ms; slice thickness, 4.0 mm with no intersection gap; field of view, 310 mm×213 mm; matrix, 256×178; voxel size, 1.2 mm×1.2 mm×4.0 mm; parallel imaging acceleration factor. The actuation time for the DCE-MRI sequence was 255 s with a temporal resolution of 5 s and 40 image vo-lumes. Using pathological results as a gold standard, tumors were divided into benign, borderline and malignant tumors. Toft’s model was used for calculation of Ktrans (volume transfer constant), Ve (extravascular extracellular space distribute volume per unit tissue volume) and Kep (microvascular permeability reflux constant). Those parameters were compared between the lesions and the control tissues using paired t-tests. The one-way analysis of variance was used to assess the difference among benign, borderline and malignant tumors. P values ＜0.05 difference was statistically significant. Results: Based on the WHO Classification of Tumours of Soft Tissue and Bone(2012) criteria, 34 patients were divided into three groups: 11 for benign tumors, 12 for borderline tumors, and 11 for malignancies. Compared with control tissues, Ktrans and Kep showed no difference, but Ve was increased in benign tumors, Kep showed no diffe-rence, but Ktrans and Ve were increased in borderline tumors,Ktrans, Kep and Ve were increased in malignant tumors. Ktrans (P<0.001) and Kep (P<0.01) were significantly higher in malignant tumors than in benign and borderline tumors, but did not show any difference between benign tumors and borderline tumors. Ve was significantly higher in malignant tumors than in benign (P<0.05), but did not show any difference between malignant and borderline tumors, benign tumors and borderline tumors (P>0.05). Conclusion: DCE-MRI technique is useful to evaluate the pathological behaviour of musculoske-letal tumors. The quantitative analysis of DCE parameters in conjunction with conventional MR images can improve the accuracy of musculoskeletal tumor qualitative analysis.

Objective：To analyze the clinical parameters of the patients with femoral neck fracture such as general condition, therapy method, hospitalized expense so as to provide more effective management plan for the clinical work. Methods: The patients with femoral neck fracture above 50 years who received in-patient treatment from 2008 January to 2012 December were admitted into this study. We collected and analyzed the information, such as age, chronic medical disease, therapy method, hospitalized duration and expense and so on. Results: There were 1 794 femoral neck fracture patients above 50 years (male/female=1/2.06) in our hospital in recent 5 years and the annual average rate of increase was 7.3%. The average age of the patients was (69.9±10.7) years and the annual average rate of increase was 0.6%. The chronic medical disease diagnosis ratio was 55.0%. The average waiting time for operation was (6.8±4.2) days and the average hospitalized duration was (12.9±4.9) days which showed downward trend in recent years. The most popular operations were cannulated screw internal fixation (41.8%) and artificial femoral head replacement (34.1%). In the study, 146 cases (7.9%) received nonsurgical treatment which showed downward trend. The average hospitalized expense was (35 075.7±11 343.2) yuan which showed no obvious change in recent years. The cost for the females was more than that for the males. The expense for hemiarthroplasty and total hip arthroplasty increased while that for cannulated screw internal fixation decreased gradually. Conclusion: The cannulated screw internal fixation and artificial femoral head replacement were the most important operations for the patients with femoral neck fracture. The number and the average age of the patients were on the rise while the expense showed no obvious change in recent years.

Objective： To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials, so as to provide evidence in making anesthesia plan for intraspinal tumor surgery. Methods: In the study, 48 patients scheduled to undergo intraspinal tumor surgery ［American Society of Anesthesiology,(ASA) Ⅰ-Ⅱ, 18-65 years old］ were enrolled. After general anesthesia induction, the patients were assigned to receive sevoflurane anesthesia of increa-sing end-tidal concentration in the sequence of 0.0%, 0.5%, 1.0% and 1.5% respectively, under a background of propofol and remifentanil. All the observations were done before the important steps of surgery. Remifentanil infusion rate was 0.2 μg /(kg·min), while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30-50. At each concentration, 4 stimulation voltages of 300 V, 400 V, 500 V and 600 V were employed to elicit motor evoked potentials (MEPs). The amplitude and latency of each MEP were compared. The success ratio was also recorded. Results: The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs. Under each stimulation voltage, the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations, and significant differences were found in comparing 1.5% sevoflurane (left 20.50 μV, 70.71 μV, 135.97 μV, 190.00 μV , right 14.29 μV, 50.71 μV, 73.10 μV, 77.50 μV) with 0.0% sevoflurane (left 143.00 μV, 388.10 μV, 484.53 μV, 500.00 μV, right 176.00 μV, 407.60 μV, 384.35 μV, 451.00 μV) and 0.5% sevoflurane (left 100.00 μV, 362.57 μV, 444.05 μV, 435.00 μV, right 115.00 μV, 207.15 μV, 258.34 μV, 358.50 μV), left χ2= 27.46,P<0.01, right χ2= 60.49,P<0.01；left χ2= 20.73,P<0.01, right χ2= 55.05,P<0.01；left χ2= 34.25,P<0.01,right χ2=33.58,P<0.01；left χ2= 28.61,P<0.01 ,right χ2= 49.04,P<0.01; while there were no statistical differences in the latency changes (P=0.26). Under each end-tidal sevoflurane concentration, the MEPs amplitude increased following increasing stimulation voltages, and significant differences were found in comparing 300 V (left 143.00 μV, 100.00 μV, 61.50 μV, 20.50 μV , right 176.00 μV, 115.00 μV, 41.07 μV, 14.29 μV) with 400 V (left 388.10 μV, 362.57 μV, 198.81 μV, 70.71 μV, right 407.60 μV, 207.15 μV, 89.00 μV, 50.71 μV) and 500 V (left 484.53 μV, 444.05 μV, 216.24 μV, 135.97 μV, right 384.35 μV, 258.34 μV, 187.50 μV, 73.10 μV) and 600 V (left 500.00 μV, 435.00 μV, 344.00 μV, 190.00 μV, right 451.00 μV, 385.50 μV, 156.00 μV, 77.50 μV), left χ2= 45.55,P<0.01, right χ2= 25.73,P<0.01; left χ2= 46.67,P<0.01, right χ2= 55.30,P<0.01；left χ2= 47.36,P<0.01,right χ2= 47.82,P<0.01; left χ2= 38.67,P<0.01, right χ2= 45.87,P<0.01; while the latencies were decreased， and significant dif-ferences were found in comparing 300 V with 400 V and 500 V and 600V（left F=7.50，P=0.01 , right F=13.33，P<0.01）, but the differences had little clinical significance. The success ratio decreased by increasing end-tidal sevoflurane concentration, and significant differences were found in comparing 1.5% sevoflurane (left 43.8%，70.8%，77.1%，81.3%, right 37.5%，60.4%，75.0%，66.7%) with 0.0% sevoflurane (left 79.2%，87.5%，95.8%，93.8%, right 75.0%，95.8%，95.8%， 95.8%) and 0.5% sevoflurane (left 72.9%，89.6%，95.8%，95.8%, right 66.7%，89.6%，95.8%， 97.9%); the success ratio increased by increasing stimulation voltage, and significant differences were found in comparing 300 V（left 79.2%，72.9%，62.5%，43.8%, right 75.0%，66.7%，60.4%， 37.5%）with 400 V（left 87.5%，89.6%，77.1%，70.8% , right 95.8%，89.6%，79.2%，60.4%）and 500 V（left 95.8%，95.8%，91.7%，77.1%, right 95.8%，95.8%，81.3%，75.0%）and 600 V (left 93.8%， 95.8%，89.6%，81.3%, right 95.8%，97.9%，89.6%，66.7%）, but there were no statistical differences in the success ratio of MEPs between the group with stimulation voltage of 600 V , end tidal sevoflurane concentration of 1.5% and the group with stimulation voltage of 300 V, end tidal sevoflurane concentration of 0.0% (P=0.22). Conclusion: Sevoflurane inhibited MEPs in a dose-dependent manner. It can decrease the amplitudes and prolong the latencies. But increasing stimulation voltage will facilitate MEPs monitoring and increase the success ratio. Sevoflurane can be used in larger parts of MEPs monitoring surgery by increasing the stimulation voltage.

Objective：To detect the proportion of lymphocyte subsets in peripheral blood of the advanced breast cancer patients before and after chemotherapy with docetaxel and thiotepa, as well as the association between the proportion of peripheral blood lymphocyte subsets with the response rate and prognosis. Methods: The proportions of lymphocyte subsets (CD3+ T cell, CD3+/CD4+ T cell, CD3+/CD8+ T cell, CD3-/CD16+56+ NK cell, CD3+/CD16+56+ T cell, CD19+ B cell, CD4+/CD25+ T cell, CD8+/CD28- T cell, CD8+/CD28+ T cell) in the peripheral blood of 86 patients were analyzed with flowcytometry before and after chemotherapy. The result was analyzed in combination with clinicopathological data.  Results: The proportion of regulatory T cells (Treg) after chemotherapy in the disease control patients decreased significantly compared with that of the progressive patients (P=0.034). The difference of the proportions of Treg before and after chemotherapy affected significantly the overall survi-val (OS). The OS of the patients with decreased proportion of Treg was significantly longer than that of the patients with increased proportion of Treg, which was 23.5 and 9.4 months respectively (P<0.05). Conclusion: The patients with decreased proportion of Treg after chemotherapy had higher response rate and better survival benefit.

Objective：To assess the differences among the expressions of p38 mitogen activated protein kinases (MAPK), phospho-p38MAPK and nuclear factor kappa B (NF-κB) in oral lichen planus (OLP) and oral squamous cell carcinoma(OSCC).Methods:In the study, 53 cases of OLP, 45 of OSCC, and 18 controls were obtained and 4-μm-thick histological sections were prepared from formalin-fixed paraffin-embedded tissue blocks.The expressions of p38MAPK,phospho-p38MAPK and NF-κB were detected by immunohistochemistry staining. Furthermore, the expressions of p38MAPK and phospho-p38MAPK were detected using Western blotting analyses in the fresh tissues from 11 cases of OLP, 5 cases of OSCC, and 7 cases of the controls. Results:p38MAPK was over-expressed in the lamina propria, but lowly expressed in the epithelium in OLP group. Phosphop38MAPK was lower expressed in OLP group than in OSCC and control groups.NF-κB was found over-expressed in the lamina propria in OLP group.p38MAPK was found expressed in all the samples in the 3 groups. The expression of phospho-p38MAPK was observed in 8 (8/11) OLP samples, 5 (5/5) OSCC samples and 4 (4/7) controls by Western blotting, but no significant differences were found within the 3 groups. Conclusion:p38MAPK can be detected in normal oral mucosa, OLP and OSCC.phospho-p38MAPK may be related to the onset and progression of OSCC. The role of p38MAPK in OLP is yet to be revealed.

Objective：To study the colonization ability of Streptococcus oligofermentans (S. oligofermentan) in the condition of high sucrose in oral cavity of rats. Methods: In this study, 48 SPF-SD rats aged 21 days were selected. From 24th to 27th days, the rats were fed with water of antibiotic and fed with high glucose diet continuously. On the 28th day, the rats were divided into four groups randomly, 12 rats per group. From the 28th day to 30th day, the first group (SM group) was inoculated with S. mutans, the second group (SO group) with S. oligofermentan, the third group (SO+SM group) with mixture of S. mutans and S. oligofermentan, the control group not with any bacteria. On the next day and the 10th day after inoculation of bacteria, the samples of dental plaque of the rats were acquired by scrubbing occlusal, buccal and lingual surfaces of bilateral mandibular molars with sterile swabs. The samples of SM group were inoculated on MSB and BHIS, of SO group on MSAE, of SO+SM group on MSB, MSAE and BHIS,of the control group on MSB and MSAE. S. mutans were screened and calculated on MSB, the suspected colonies of S. oligofermentan were screened and identified by the analysis of 16S rDNA. Results:On the next day, the detection rate of S. oligofermentan was 33.3% (4/12) in the group of SO; in the group of SO+SM, the detection rate of S. oligofermentan was 0, the detection rate of S. mutans 100.00%, and the proportion of S. mutans 14.70%±4.53%; in the group of SM, the detection rate of S. mutans was 100.00%, the proportion of S. mutans 12.42%±4.27%. On the 10th day, in the group of SO, the detection rate of S. oligofermentan was 0; in the group of SO+SM, the detection rate of S. oligofermentan was 0, the detection rate of S. mutans 100.00%, and the proportion of S. mutans 15.78%±5.10%; in the group of SM, the detection rate of S. mutans was 100.00%,and the proportion of S. mutans 17.08%±5.75%. Conclusion: In the condition of the experiment where high glucose was maintained in the oral cavity in rats, S. oligofermentan appeared transiently and couldn’t colonize in the rats.

Objective：To analyze the plaque staining image by using image analysis software, to verify the maneuverability, practicability and repeatability of this technique, and to evaluate the influence of different plaque stains. Methods:In the study, 30 volunteers were enrolled from the new dental students of Peking University Health Science Center in accordance with the inclusion criteria. The digital images of the anterior teeth were acquired after plaque stained according to filming standardization.The image analysis was performed using Image Pro Plus 7.0, and the Quigley-Hein plaque indexes of the anterior teeth were evaluated. Results:The plaque stain area percentage and the corresponding dental plaque index were highly correlated,and the Spearman correlation coefficient was 0.776 (P<0.01). Intraclass correlation coefficients of the tooth area and plaque area which two researchers used the software to calculate were 0.956 and 0.930 (P<0.01).The Bland-Altman analysis chart showed only a few spots outside the 95% consistency boundaries. The different plaque stains image analysis results showed that the diffe-rence of the tooth area measurements was not significant, while the difference of the plaque area measurements significant (P<0.01). Conclusion:This method is easy in operation and control,highly related to the calculated percentage of plaque area and traditional plaque index, and has good reproducibility.The different plaque staining method has little effect on image segmentation results.The sensitive plaque stain for image analysis is suggested.

Objective：To study the biological characteristics of new retrograde filling materials iRoot BP plus and iRoot FS. Methods: (1) The roots were cut into 3 mm in length, and the root canals were prepared to 1 mm in diameter, followed by being filled with iRoot BP plus, iRoot FS, or mineral trioxide aggregate (MTA). The specimens were immersed in simulated body fluid (SBF). The ability of mineralization in vitro was detected through three studies. First, the mineralization of specimens was analyzed through scanning electron microscope observations and energy dispersive X-ray spectrometer. Then, the pH of SBF was monitored using pH meter. (2) The extracts were gained by immersing blocks of iRoot BP plus, iRoot FS, and MTA (8 mm diameter and 2 mm height) into dulbecco’s modified eagle medium (DMEM). The effects of the extracts on proliferation of MG63 cells were detected through MTT assay. The gene expression level of alkaline phosphatase (ALP) was analyzed by quantitative real-time PCR, and the expression of ALP activity was observed by ALP activity staining. Results: (1) The formation of minerals could be observed on the surfaces of iRoot BP plus, iRoot FS, and MTA at the end of 24 h, and there were more amounts of apatite aggregated after 14 days. The values of Ca/P ratios of apatites were 1.43, 1.39, and 1.51, respectively. (2) The pH of SBF could be raised to 8.09±0.07, 7.91±0.06, and 8.11±0.06, respectively, significantly higher than the blank. (3) The extracts of iRoot BP plus, iRoot FS, and MTA of dilutions of 1∶5 and 1∶10 presented no effect of proliferation of MG63 cells. (4) iRoot BP plus and iRoot FS could significantly upregulated the levels of ALP messenger RNA expression, while there was no obvious difference in ALP staining among the iRoot BP plus, iRoot FS, MTA, and the blank. Conclusion: The present study shows that iRoot has displayed good mineralization capability in vitro and capability to promote differentiation and mineralization of MG63 cells, inferring that iRoot may have good bioactivity.

Objective：To compare the accuracyof interactive closet point (ICP) algorithm, Procrustes analysis (PA) algorithm,andalandmark-independent method to construct the mid-sagittal plane (MSP) of the cone beam computed tomography.To provide theoretical basis for establishing coordinate systemof CBCT images and symmetric analysis. Methods: Ten patients were selected and scanned by CBCT before orthodontic treatment.The scan data was imported into Mimics 10.0 to reconstructthree dimensional skulls.And the MSP of each skull was generated by ICP algorithm, PA algorithm and landmark-independent method. MSP extracted by ICP algorithm or PA algorithm involvedthree steps. First, the 3D skull processing was performed by reverse engineering software geomagic studio 2012 to obtain the mirror skull. Then, the original and its mirror skull was registered separately by ICP algorithm in geomagic studio 2012 and PA algorithm in NX Imageware 11.0. Finally, the registered data were united into new data to calculate the MSP of the originaldata in geomagic studio 2012. The mid-sagittal plane was determined by SELLA (S), nasion (N), basion (Ba) as traditional landmark-dependent methodconducted in software InVivoDental 5.0. The distance from 9 pairs of symmetric anatomical marked points to three sagittal plane were measured and calculated to compare the differences of the absolute value. The one-way ANOVA test was used to analyze the variable differences among the 3 MSPs. The pairwise comparison was performed with LSD method. Results: MSPs calculated by the three methods were available for clinic analysis, which could be concluded from the front view.However, there was significant differences among the distances from the 9 pairs of symmetric anatomical marked points to the MSPs (F=10.932，P=0.001).LSD test showed there was no significant difference between the ICP algorithm and landmark-independent method (P=0.11), while there was significant difference between the PA algorithm and landmark-independent methods (P=0.01) .Conclusion: Mid-sagittal plane of 3D skulls could be generated base on ICP algorithm or PA algorithm. There was no significant difference between the ICP algorithm and landmark-independent method. For the subjects with no evident asymmetry, ICP algorithm is feasible in clinical analysis.

Objective： It has been demonstrated that anesthetics exposure may lead to neurocognitive impairment in developing brain of animal models. However, for the limitation that the animal models cannot fully mimic the dose and duration in clinical settings especially for dental general anesthesia, the cli-nical significance of anesthetics exposure on developing central nervous system remains undetermined. Therefore, we conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia comparing to that before surgery. We conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia compared with that before surgery. Methods: Thirty two patients, ASA Ⅰ, who were exposed to dental general anesthesia in Department of Pediatric Dentistry Peking University School and Hospital of Stomatology, aged 4 to 6.5 years, were enrolled in this prospective study. Patients with severe learning difficulties or communication disorders were excluded. Written and informed consent was obtained from each patients’ family which was fully explained of the purpose and method of study. Their intelligence quotients were evaluated with the Chinese Wechsler young children scale of intelligence (Urban version) before and 2 weeks after dental anesthesia. They were treated by experienced pediatric dentists and the sevoflurane, propofol and nitrous oxide were used for general anesthesia by anesthetist. Articaine hydrochloride and epinephrine tartrate injections were used for their pulp treatment or extraction. The examiners and scorers for IQ had technical training in the test administration. All the patients were tested by the same examiner and with standardized guide language.  Each subtest was scored accor-ding to the tool review. Verbal IQ and performance IQ consisted of relevant 5 subtests and full scale IQ. Statistical analyses were performed by SPSS 18.0. All the scores of subtests and 3 types of IQ were expressed as ±s. Paired two-tailed t test was applied and P<0.05 was accepted as statistically significant.  Results: The results of intelligent assessment from 28 subjects were collected. The anesthetic time was (163.4±32.6) min and the number of treated teeth was 12.1±2.3, mean age (4.60±0.41) years; age range=4.04 to 5.44 years. Among the patients, there were 13 girls and 15 boys. There was no significant difference in gender distribution. The postoperative full IQ (128.46±10.85) was higher than that before surgery (124.64±11.46, P= 0.017). We found that the elevation of performance IQ, to a large extent, contributed to this change in full IQ (P= 0.007). Correspondingly, there was no statistical difference in the verbal IQ, which was 119.68±11.74 to 120.21±15.61 (P= 0.854).  Conclusion: Dental general anesthesia has no negative effect on the intelligence of preschool children, who were treated under general anesthesia by sevoflurane, propofol and nitrous oxide for 2 to 4 hours. The full IQ and performance IQ were slightly enhanced after treatment which can be explained by the memory effect.

Objective： To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS). Methods: In this study, 48 patients (unilateral hand) with CTS were analyzed. The thickness of transverse carpal ligaments at the pisiform bone was measured using high-frequency ultrasound. Open carpal tunnel release procedure was performed in the 48 CTS patients, and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under direct vision. The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound. High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the hamate hook bone and pisiform bone, and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC) curve, sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS) analyzed. Results: The thickness of transverse carpal ligaments in the CTS patients were (0.42±0.08) cm (high-frequency ultrasound) and (0.41±0.06) cm (operation) at hamate hook bone, and there was no significant difference between the two ways (t=0.672, P>0.05). The optimal cutoff value of the transverse carpal ligaments at hamate hook bone was 0.385 cm, the sensitivity 0.775, and the specificity 0.788. The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950, and the specificity 1.000. The transverse carpal ligaments thickness and wrist-index finger sensory nerve conduction velocity (SCV), wristmiddle finger SCV showed a negative correlation. Conclusion: High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.

Objective：To investigate the outcomes of applying microvascular anastomotic coupling devices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical outcome. Methods: From March to September 2013, 19 injured arteries from 18 male patients who  presented at Department of Hand Surgery, Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures. COUPLER, a microvascular anastomotic coupling device was applied in these artery injury repair operations. The 19 repaired arteries included 3 brachial arteries, 6 ulnar arteries and 10 radial arteries. After the procedures, all the 18 patients were then followed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality.  Results: The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was (71.5±40.9) d with the longest follow-up time as 116 d and shortest as 14 d. No patient returned to the opera-ting room after the procedures and after being dismissed from the hospital. None of the 18 cases were reported to have problems with circulation and thrombosis formation in their upper extremities. Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends. Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis; while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery. These evidences indicated that the outcomes of our initial evaluation for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were positive. Conclusion: Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures. The procedures are quick, effective and safe. The clinical application of this microvascular anastomotic coupling device in artery injures is promising, however, additional evidences through further clinical investigation with more cases are warranted.

Objective： To evaluate the efficiency of the tibial coronal alignment after total knee arthroplasty with the extramedullary cutting system guided by the tibial tubercle and anterior tibial tendon, and to discuss the potential risk factors for the postoperative malalignment. Methods: A retrospective study of 212 primary unilateral TKA surgeries (in 188 patients) in our hospital between June to December in 2014 had been analysed. All the cases were performed by one surgical group. An extramedullary tibial cutting guide system had been used, with a landmark of one third inner-medial tibial tubercle as a proximal anatomy reference, and anterior tibial tendon as a distal marker. The mechanical axis of lower extremity in full-length X-ray was measured before surgery, and the tibial prosthetic coronal alignment was checked two weeks postoperation, evaluating the accuracy of this extramedullary cutting system guided by our method. Results: Since good alignment was defined as an angle within 3 degrees of the perpendicular to the mechanical axis, the tibial component positions were acceptable in 191 knees (90.1%), five knees were in valgus postoperative, and sixteen knees were in varus. There were seventeen(8.7%) in 179 knees with a preoperative varus presented malalignment after surgery, and four in 12 preoperative valgus kneess howed malalignment also, no statistical difference was found by Chi-square test(χ2=2.778，P=0.096), which cannot define the relationship between the varus or valgus deformity preoperation and the malalignmentposition in tibial prosthesis after surgery. Twenty-two knees suffered a severe preoperative deformity as a varus or valgus angle larger than 20 degrees with absolute value of mechanical axis before surgery and tibial prosthetic coronal alignment were 21.95°（20.00°，26.90°）and 1.85°(0.10°, 7.10°), showed a significant difference (Z=2.11，P=0.035) compared with the data ［10.65°（0.50°，19.80°）in preoperative mechanical axis and 1.10°（0.00°，4.60°）in the tibial prosthetic coronal alignment］of 190 knees who presented a mild deformity before surgery(less than 20 degrees), the result indicated the severe preoperative deformity might be  a potential mal-alignment risk factor  within this cutting system in TKA surgery.Conclusion: The tibial coronal alignment after total knee arthroplasty could achieve good results with extramedullary cutting guide, by using one third inner-medial tibial tubercle and anterior tibial tendon as a proximal and distal anatomy marker. Postoperative varus might occur in this system, and tibial prosthetic malalignment appeared more often in the patients who suffered a severe deformity before surgery.

Objective：To observe the difference of the human telomeres RNA component (hTERC) genes’ amplification in the cervical tissue by applying the environment-friendly fixative poly hydroxy acrylic acid and the transparent dewaxing solution Van-clear separately or jointly to replace the traditional fixative 4% (volume fraction) neutral buffered formalin and the conventional transparent dewaxing solution xylene in the use of fluorescence in situ hybridization (FISH) for detection. Methods: In the study, 255 cases of cervical tissue specimens submitted by the Department of Gynecology in Zhongshan Boai Hosipital were collected from Mar. 2013 to Apr. 2015. Four samples were taken from the same lesion site. All the cases were divided into 4 groups and named group A, B, C, and D. Group A used 4% neutral buffered formalin fixed and xylene dewaxing to make slices. Group B used poly hydroxy acrylic fixed and xylene dewaxing to make slices. Group C used 4% neutral buffered formalin fixed and Van-clear transparent to make slices. Group D used poly hydroxy acrylic fixed and Vanclear transparent dewaxing to make slices. The amplification of hTERC genes in the four groups of cervical specimens was also detected by FISH technique. Results: When the hTERC genes were detected by FISH method under the fluore-scence microscope, it was obvious that the tissue profile and the background of group A, B, C and D were all clear. The probe was fixed in the accurate position so that the bright red or green fluorescence signals were easily found in these four groups. Compared with the positive rate of group A, there was no statistical significance in that of group B, C and D (P>0.05). At the same time, the coincidence rate of the FISH results was high, which showed that the new environment-friendly reagent had no significant difference in the detection of cervical hTERC genes by FISH technique. Conclusion: It is possible for the environment-friendly reagent poly hydroxy acrylic acid and Van-clear to replace 4% neutral buffered formalin and xylene separately or jointly to detect the cervical hTERC genes by adopting FISH technique.

Ankle joint fracture is one of the most common types of fracture. There are many researches on the injury mechanism, treatment principles and surgical techniques. A type of injury which combines posterior dislocation of fibula, known as the Bosworth injury, is relatively rare. In 1947, Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture dislocation of the distal part of the fibula. In this type of fracture, the proximal fibular shaft fragment locks behind the tibialis posterior tubercle. This rare ankle fracture variant is often not recognized in initial radiographs and requires a computed tomographic (CT) scan for verification. But there are already many reports, discussing the injury mechanism, treatment principles and surgical techniques. However, there are few reports of anterior dislocation of the fibula, caused by either injury or surgery. The mechanism of the injury is still not clear. This article reports a case of anterior dislocation of the fibula. We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ, Gustilo ⅢA). Open reduction and internal fixation was done in the initial surgery, but ended up with poor reduction, resulting in fibula anterior dislocation, anterior dislocation of talus and tibia fibular dislocation. The fibula was dislocated anteriorly of the tibia, which rarely happened. The patient suffered severe ankle joint dysfunction. The second operation took out the original internal fixation, reduced the fracture, and reset the internal fixation. The function of ankle joint was improved obviously after operation. But because of the initial injury and the two operations, the soft tissue around the fracture was greatly damaged. 6 months after the second operation, and the fracture still not healed, so the bone graft was carried out in the third surgery. Two months after the third surgery, the function of the ankle was significantly better than before, but the fracture healing was poor, which needed further review. Through this case, we understand the rare type of ankle fracture with anterior dislocation of the fibula, and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.

Behcet’s disease (BD) is a chronic vascular inflammatory disease of unknown causes. It is called intestinal BD, when digestive tract is involved. To investigate small bowel feature of intestinal BD, we now report 5 intestinal BD cases undergone capsule endoscopy from December, 2010 to April, 2014 in Peking University People’s Hospital. General information, clinical feature and endoscopic feature were presented, and literatures were reviewed. There were 3 male and 2 female patients. Age range was from 23 to 55 years old (median age 40 years old). Disease course was from 3 days to 28 years (median course 9 years). 4 patients were diagnosed as systemic BD, and the rest independent intestinal BD. 4 systemic BD patients all presented as recurrent oral aphthous as initial symptom and had history of vulvar ulcer and skin lesion. They all had gastrointestinal symptoms, including retrosternal pain (2 cases), hematochezia (3 cases), diarrhea (3 cases) and abdominal pain (2 cases). 1 patient had a history of fistula of ileocecal junction and underwent caecectomy. 5 patients all underwent whole digestive tract examination by endoscopy, including gastroscopy, colonoscopy and capsule endoscopy.Except of 1 normal result of colonoscopy, all endoscopy results revealed lesions. Capsule endoscopy results of all patients were abnormal. Types of small intestinal lesion were various, including ulceration, erosion, protrusion and vasculopathy. All digestive tract can be involved in BD patients. Capsule endoscopy can evaluate lesions throughout whole digestive tract, especially in small intestine. As a consequence, it is helpful to explain gastrointestinal symptom, increase early diagnostic rate. Intestinal BD (IBD) mainly involves small bowel, and ileum is the major involved segment, not only limited in ileocecum. The updated perspective of IBD lesion distribution will contribute to differential diagnosis between IBD and Crohn’s disease.This is the first time to report capsule endoscopic feature of BD patients in China.

Pheochromocytoma is rare in pregn’ancy. Clinical features of a case of pheochromocytoma during pregnancy in the Peking University People’s Hospital was investigated and the literature reviewed to discuss the diagnosis and treatment of this disease. The patient manifested with hypertension and proteinuria, who was easily misdiagnosed with gestational hypertension disease. When she was transferred to our hospital, the symptoms such as, paroxysmal palpitation, dizziness, vomiting were noticed, and the possibility of pheochromocytoma was considered due to the accompanying abdominal mass. An emergent cesarean section was performed successfully due to preterm labor during the treatment of the disease. After the delivery the drug preparation continued. And the laparoscopic resection of pheochromocytoma proceeded when the blood pressure was steady. The patient recovered fully after the surgery. The final diagnosis of pheochromocytoma was confirmed with the pathology. Its diagnosis and treatment experiences could improve our understanding and treatment of secondary hypertension due to pheochromocytoma in pregnancy.

Regeneration of bone tissue, as well as other tissues, requires involvement and interaction of cells, scaffolds and relevant growth factors, among which growth factors play a crucial role in maintaining the stability of microenvironment. Nel-like-type 1 molecule (NELL-1), a novel growth factor in tissue engineering, has been studied intensively in recent years. Researches mainly covered gene and protein structure and their expression profiling, biological function, molecular mechanisms and disease relevance. NELL-1 expressed in embryonic tissue is essential for growth and development of bone tissue. NELL-1 presents excellent abilities of inducing bone and cartilage regeneration，especially with high specificity to chondrocyte lineage. Compared with classic osteogenic growth factor bone morphogenetic protein 2 (BMP-2）, the process of osteogenesis interacted with NELL-1 exhibits stronger specificity, higher bone density and fewerside effects. Furthermore, a recent study shows synergistic effects of NELL-1 and BMP-2. NELL-1 enhances the osteogenic reaction induced by BMP-2 of cells and notably declines inflammation response caused by BMP-2. This review evaluates the current research progress of the function and application of NELL-1 by the systematic method of evidence-based medicine.