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To describe a non-anatomic arthroscopic all-inside repair technique for middle-aged and older patients with medial meniscus posterior root tears (MMPRTs) and to evaluate the short- to mid-term clinical and radiologic results. The hypothesis was that this procedure would yield good clinical outcome results and structural healing in middle- and older-aged patients.This was a retrospective study evaluating patients who had undergone MMPRT repair by suturing the meniscal root directly to the capsule, rather than by the transtibial technique, between 2013 and 2016. This all-inside repair technique was performed for patients with type II MMPRTs who were over 40 years old. Exclusion criteria included tibial osteotomy due to malalignment, concomitant multiple-ligament injuries and follow-up time less than 2 years. The Lysholm score, Tegner activity score and International Knee Documentation Committee (IKDC) score were evaluated preoperatively and at the final follow-up. Medial meniscal extrusion, the International Cartilage Repair Society (ICRS) grades of the medial compartment, and the healing status of the medial meniscus root were assessed on magnetic resonance imaging preoperatively and at the final follow-up.Twenty-nine patients (mean age 61.7 ± 7.9) were included; the mean follow-up duration was 46.2 ± 7.9 months. The mean Lysholm score significantly improved from 33.7 ± 20.9 preoperatively to 81.7 ± 19.9 at the final follow-up (p 0.001), the median Tegner activity score improved from 1.0 (range 1-4) to 3.0 (range 2-4, p 0.001), and the mean IKDC score improved from 20.1 ± 16.4 to 69.6 ± 16.2 (p 0.001). On MRI, 9 (31%) cases had complete healing; 17 (59%) had partial healing; and 3 (10%) had failed healing (ICCs ≥ 0.92). Mean meniscal extrusion significantly increased from 2.3 ± 1.7 mm preoperatively to 3.5 ± 1.5 mm postoperatively (p 0.001, ICCs ≥ 0.92).Non-anatomic arthroscopic all-inside repair of MMPRTs to the posterior capsule yielded good to excellent clinical results and a high rate of healing in the medial meniscus root on MRI in middle-aged and older patients at short- to mid-term follow-up, despite increased meniscal extrusion. This method is an alternative to the transtibial pullout repair technique for treating MMPRTs in middle- and older-aged patients.Level IV.

Background Vascular injury is a very rare complication following arthroscopic knee surgery. This is the first report of pseudoaneurysm at the saphenous branch of the descending genicular artery complicating semitendinosus tendon harvest in arthroscopic anterior cruciate ligament reconstruction. Case presentation A 19-year-old male had developed large ecchymosis, focal swelling and tenderness around his posteromedial knee after an arthroscopic anterior cruciate ligament reconstruction. Compartment syndrome of the lower leg and deep vein thrombosis were ruled out. A pseudoaneurysm formation was confirmed through an angiography and coil embolization was performed. At one year follow up, the patient reported improved functional outcome with good stability of the knee. However, mild paresthesia over the posteromedial calf was noted due to the compression injury of the saphenous nerve by the hematoma. Conclusions The pseudoaneurysm was presumed to result from accidental vascular injury while dissecting the accessory bands of the semitendinosus and was successfully treated by coil embolization. Care must be taken to section the expansions of the hamstring tendon, especially when the patient presents with underlying coagulopathy or vascular disease.

Background Pelvic ring injuries constitute only 2 to 8% of all fractures; however, they occur in 20% of polytrauma patients. High-energy pelvic fractures often result in mechanical instability of the pelvic ring. Successful treatment of unstable pelvic ring fractures remains a challenge for orthopedic surgeons. This study presents a novel internal fixation method for stabilizing unstable anterior pelvic ring fractures using a minimally invasive modified pedicle screw-rod fixation (MPSRF) technique. Methods This retrospective study included six patients with unstable pelvic ring injuries who underwent MPSRF, with or without posterior fixation. Intraoperative parameters such as blood loss, operative time, complications, and quality of reduction (Matta criteria) were recorded and evaluated by a blinded reviewer. Results In the present clinical series, the mean operative times and mean blood loss for unilateral versus bilateral anterior ring fixations were 176.0 min versus 295.6 min, and 153.3 mL versus 550.0 mL, respectively. No iatrogenic neuropraxia of the lateral femoral cutaneous nerve or femoral nerve palsy occurred. The reduction quality, graded by the Matta criteria, was excellent in five patients and good in one patient. Conclusions There were no infections, delayed unions, nonunions, or loss of reductions during the follow-up period. Only one patient suffered from a broken rod at 4 months postoperatively. The modified technique represents a novel, minimally invasive procedure for the treatment of anterior pelvic ring fractures and offers a reliable and effective alternative to currently available surgical techniques.

Osteoarthritis (OA) a disease associated with joints and become severe with age, due to softening, inflammation and degradation of cartilage in joints. The agents that can target OA is needed, specifically without any side effects. Garcinia mangostana L. (Mangosteen) a tropical fruit used to treat many skin and stomach associated ailments. γ- Mangostin (γ-MS) a key bioactive substance present in mangosteen. Here, we aimed to explore γ-MS potential in targeting the pro-inflammatory cytokine, factors and miRs in OA progression. Significantly, γ-MS suppresses the inflammatory cytokines (IL-6, TNF-α, and INF- γ) and factors (NF-κB, STAT3, and COX-2) which regulates/participate in the catabolic process of cartilage destruction. Result of Hematoxylin-eosin (H&E) staining of tissue sections of OA joints of γ-MS treated and non-treated mice confirm γ-MS improves the signs of injuries, and maintains the structural integrity of the articular cartilage (epiphyseal disk joints and bone marrow) and reduces inflammation. Mechanistically, γ-MS targets miR-98-5p and miR-124-3p which are found to suppress the expression IL-6 and NF-κB, respectively. But in OA these miRs are inhibited, especially miR-124-3p which regulates not only NF-κB but also TNF-α, IL-6 and MMP7. With a further investigation underway, γ-MS represents an important source for treating and managing OA.

Background When lowlanders rapidly ascend to altitudes > 2500 m, they may develop acute mountain sickness (AMS). The individual susceptibility, ascending velocity, time spent at altitude, activity levels and altitude reached are considered risk factors for AMS. However, it is not clear whether sex is a risk factor. The results have been inconclusive. We conducted a meta-analysis to test whether there were sex-based differences in the prevalence of AMS using Lake Louise Scoring System. Methods Systematic searches were performed in August 2019 in EMBASE, PubMed, and Web of Science for prospective studies with AMS data for men and women. The titles and abstracts were independently checked in the primary screening step, and the selected full-text articles were independently assessed in the secondary screening step by the two authors (YPH and JLW) based on pre-defined inclusion criteria. The meta-analysis was performed using by the STATA 14.1 software program. A random-effects model was employed. Results Eighteen eligible prospective studies were included. A total of 7669 participants (2639 [34.4%] women) were tested. The results showed that there was a statistically significant higher prevalence rate of AMS in women than in men (RR = 1.24, 95%CI 1.09–1.41), regardless of age or race. Howerver, the heterogeneity was significant in the analysis (Tau2 = 0.0403, Chi2 = 50.15, df = 17; I2 = 66.1%, P = 0.000), it was main caused by different numbers of subjects among the studies (coefficient = − 2.17, P = 0.049). Besides, the results showed that there was no evidence of significant publication bias in the combined studies on the basis of Egger’s test (bias coefficient = 1.48, P = 0.052) and Begg’s test (P = 0.130). Conclusions According to this study, the statistically significant finding emerging from this study was that women have a higher prevalence of AMS. However, the authors could not exclude studies where patients were on acetazolamide. Our analysis provided a direction for future studies of the relationship of sex and the risk of AMS, such as the pathological mechanism and prevention research.

Whether aging or Parkinson's disease (PD) affects the responses of peripheral blood mononuclear cells (PBMCs) to immunosuppression by bone marrow-derived mesenchymal stem cell (BM-MSCs) and which cytokines are more effective in inducing BM-MSCs to be immunosuppressive remains to be elucidated. PBMCs were isolated from healthy young (age 26–35), healthy middle-aged (age 56–60) and middle-aged PD-affected individuals. All the recruits were male. The mitogen-stimulated PBMCs and proinflammatory cytokine-pretreated BM-MSCs were co-cultured. The PBMC proliferation was measured using Cell Counting Kit-8, while the cytokine secretion was assayed by cytometric bead array technology. The immunosuppressive ability of BM-MSCs was confirmed in young healthy, middle-aged healthy and middle-aged PD-affected individuals. Among the three groups, the PBMC proliferation and cytokine secretion of the young healthy group were suppressed more significantly compared with those of the middle-aged healthy and middle-aged PD-affected group. No significant differences were identified in the PBMC proliferation and cytokine secretion between the patients with PD and the middle-aged healthy subjects. Interferon (IFN)-γ synergized with tumor necrosis factor (TNF)-α, interleukin (IL)-1α or IL-1β was more effective than either one alone, and the combinations of IFN-γ + IL-1α and IFN-γ + IL-1β were more effective than IFN-γ + TNF-α in inducing BM-MSCs to inhibit PBMC proliferation. The results of the present study suggested that aging, rather than PD, affects the response of PBMCs toward the suppression of BM-MSC, at least in middle-aged males. Patients with PD aged 56–60 remain eligible for anti-inflammatory BM-MSC-based therapy. Treatment of BM-MSCs with IFN-γ + IL-1α or IFN-γ + IL-1β prior to transplantation may result in improved immunosuppressive effects.

The study aim was to determine the extent and determinants of reporting depressive symptoms in caregivers for persons with intellectual disabilities based on assessment of the 9-item Patient Health Questionnaire (PHQ-9). A cross-sectional study was conducted, recruiting 455 caregivers for adults with ID who were providing care in community residences, with complete PHQ-9 data being analyzed. The results indicated that the mean of each item scored on the PHQ-9 varied from 0.3 (Q9) to 1.1 (Q4). For two items (Q3 - "sleeping difficulties" and Q4 - "fatigue"), the respondents reported occurrence during several days in the previous two weeks. However, after scrutinizing the distribution of each item in the PHQ-9, 3.3-14.5% respondents reported that each item happened nearly every day, and 4.0-17.8% expressed that each happened more than half of the days in the previous two weeks. With respect to difficulties examined on the PHQ, 47% of cases expressed that it was somewhat difficult, 8.2% expressed that it was very difficult, and 4.5% felt that it was extremely difficult to work, care for things at home, or get along with others. Finally, a logistic regression model revealed that only one factor of self-perceived health status (fair/poor vs. excellent/very good, OR=7.519, 95% CI=3.03-18.68, p

Purpose The purpose of this study was to objectively evaluate whether double-bundle anterior cruciate ligament (ACL) reconstruction can better restore the normal translational and rotational laxities than the conventional single-bundle ACL reconstruction among the reported biomechanical studies. Methods A systematic literature search was conducted to identify in vitro and in vivo (intraoperative) biomechanical studies that compared the laxities (anterior or anteroposterior or rotational) between single- and double-bundle ACL reconstructions. Because of large variability among the loading conditions and testing methods used to determine the rotational laxities among the studies, a meta-analysis of rotational laxities was not feasible. Results Seven in vitro and three in vivo studies were included in this analysis based on the predefined inclusion criteria. The overall mean differences calculated by the random effects model in anteroposterior laxity between the single-bundle and double-bundle ACL reconstruction techniques at 0°, 30°, 60°, and 90° of flexion were 0.99 mm, 0.38 mm, 0.34 mm, and 0.07 mm, respectively. No statistically significant difference was noted between the 2 treatments at all flexion angles. Among the 9 studies that compared the rotational laxity of single-bundle and double-bundle ACL reconstructions, 4 reported that double-bundle reconstruction can provide better rotational control than single-bundle reconstruction. The other 5 studies could not identify any significant difference between the 2 reconstructions in terms of rotational laxity. Conclusions Both single- and double-bundle treatment options for ACL injury result in similar anteroposterior knee joint laxity at time 0. No conclusive evidence on the superiority of 1 reconstruction technique over the other in terms of rotation laxity can be obtained because of several variations in the experimental protocol and the kinematics used to measure the rotational laxity among the studies. Level of Evidence Level III, meta-analysis.

Failure to diagnose injury to the posterolateral structures has been found to increase the forces experienced by the anterior cruciate ligament (ACL) and ACL grafts which may cause their subsequent failure. An isolated injury to the popliteus complex (PC) consisting of the popliteus tendon and popliteofibular ligament is not uncommon. Therefore, the purpose of this study was to discover if an isolated injury to the PC can significantly affect the forces experienced by the ACL graft under external loading conditions. We hypothesised that, under external tibial torque, the ACL graft will experience a significant increase in force, in knees with PC injury compared to the intact PC condition. Under varus tibial torque (10 N m), we observed minimal changes in the varus tibial rotation due to isolated sectioning of the PC in an ACL reconstructed knee (P > 0.05). Consequently, no significant increase in the ACL graft force was observed under varus tibial torque. In contrast, sectioning the PC resulted in a significant increase in the external tibial rotation compared to the intact PC knee condition under the external rotational tibial torque (5 N m) at all flexion angles (P

Background: The function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) during gait has not been reported. Hypothesis: The AM and PL bundles have distinct functional behavior during the stance phase of treadmill gait. Study Design: Descriptive laboratory study. Methods: Three-dimensional models of the knee were created by magnetic resonance images from 8 healthy subjects. The contour of the 2 bundle attachments were constructed on each model. Each bundle was represented by a straight line connecting its tibial and femoral attachment centroids. Next, the knee kinematics during the stance phase of gait was determined with a dual fluoroscopic imaging system. The relative elongation, sagittal plane elevation, coronal plane elevation, and transverse plane deviation of the 2 bundles were measured directly from heel strike to toe-off. Results: At heel strike, the AM and PL bundles had first peak elongation of 9% ± 7% and 9% ± 13%, respectively. At 50% progress of the stance phase, both bundles were maximally elongated, 12% ± 7% for the AM bundle and 13% ± 15% for the PL bundle. No significant difference was found for each bundle between 40% and 60% of the stance phase ( P > .05). With increasing knee flexion, the sagittal plane and coronal plane elevations of the 2 bundles decreased, whereas the deviation angles increased. Conclusion: Both bundles are anisometric and function in a similar manner during the stance phase of gait. They were maximally elongated throughout the midstance where they were stretched maximally to resist anterior tibial translation. Clinical relevance: This information can be useful for further improving anatomical ACL reconstructions to better reproduce the 2 bundle functions. It may also be useful for designing postoperative rehabilitation regimens to prevent overstretch of the grafts.

Background: Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies. Purpose: To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions. Study Design: Controlled laboratory study. Methods: Ten human cadaveric knees were tested with a robotic testing system under 4 conditions: intact, ACL deficient, single-bundle reconstructed with a quadrupled hamstring tendon graft, and double-bundle reconstructed with 2 looped hamstring tendon grafts. Knee kinematics and forces of the ACL or ACL graft in each knee were measured under 3 loading conditions: an anterior tibial load of 134 N, a simulated quadriceps muscle load of 400 N, and combined tibial torques (10 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of knee flexion. Results: The double-bundle reconstruction restored the anterior and medial laxities closer to the intact knee than the single-bundle reconstruction. However, the internal rotation of the tibia under the simulated quadriceps muscle load was significantly decreased when compared with the intact knee after both reconstructions, more so after double-bundle reconstruction ( P < .05). The entire graft force of the double-bundle reconstruction was more similar to that of the intact ACL than that of the single-bundle reconstruction. However, the posterolateral bundle graft in the double-bundle reconstructed knee was overloaded as compared with the intact posterolateral bundle. Conclusion: The double-bundle reconstruction can better restore the normal anterior-posterior and medial-lateral laxities than the single-bundle reconstruction can, but an overloading of the posterolateral bundle graft can occur in a double-bundle reconstructed knee. Clinical relevance: Both single-bundle and double-bundle techniques cannot restore the rotational laxities and the ACL force distributions of the intact knee.

The purpose of this study was to review the correlation between the imaging studies and the histological findings in the diagnosis of this disease. We retrospectively reviewed 21 lesions in 20 patients (median age, 23.7 years old) who had been diagnosed with cavernous haemangiomas (n=11), capillary (n=6), and mixed (n=3) types. The imaging studies were obtained with plain film radiography (n=20), Tc-99 m bone scans (n=5), angiography (n=7) and magnetic resonance imaging (MRI; n=20). All the patients underwent marginal to wide excision. Based on the imaging studies, the rate of accurate prediction of intramuscular haemangioma using MRI in our study was 90%. Using the preoperative imaging studies and surgical excisions, only one (5%) local recurrence happened 2 years after marginal excision. The remaining patients were free of disease. For the avoidance of recurrence, wide excision is necessary with the help of the imaging studies, which can provide more specific information, making possible the preoperative identification of characteristic features of the tumuor.

Objective The visual analog score (VAS) is widely used in clinical medicine to evaluate the severity of subjective symptoms. There is substantial literature on the application of the VAS in medicine, especially in measuring pain, nausea, fatigue, and sleep quality. Hypobaric chambers are utilized to test and exercise the anaerobic endurance of athletes. To this end, we evaluated the degree of AMS using the visual analog scale (VAS) in a hypobaric chamber in which the equivalent altitude was increased from 300 to 3500 m. Methods We observed 32 healthy young men in the hypobaric chamber (Guizhou, China) and increased the altitude from 300 to 3500 m. During the five hours of testing, we measured the resting blood oxygen saturation (SaO2) and heart rate (HR). Using the VAS, we recorded the subjects' ratings of their AMS symptom intensity that occurred throughout the phase of increasing altitude at 300 m, 1500 m, 2000 m, 2500 m, 3000 m, and 3500 m. Results During the phase of increasing altitude in the hypobaric chamber, the patients' SaO2 was 96.8±0.8% at 300 m and 87.5±4.1% at 3500 m (P

For evaluation of specificity and sensitivity of flowcytometric determination of HLA‐B27 antigen, we determined the HLA‐B27 on lymphocytes using HLA‐B27 monoclonal antibody by flow cytometer. Data were compared to those by conventional Terasaki microlymphocytoxicity test and DNA genotyping Polymerase Chain Reaction (PCR) method. One hundred and ninety four patients with various forms of arthritis were included in this study. Forty one of them were HLA‐B27 positive, confirmed by three methods concomitantly with complete accordance. None of serological B27 negative, B7 CREG positive cells were found to be flowcytometric fluorescence positive. Furthermore, there was no significant difference of B27 intensity between different B27 DNA subtypes, nor was there any difference between primary ankylosing spondylitis (AS) and other secondary spondylitis patients as measured by mean channel of fluorescence. It is suggested that flowcytometric measurement of HLA‐B27 antigen is a rapid and reliable method for HLA‐B27 determination. J. Clin. Lab. Anal. 11:369–373, 1997. © 1997 Wiley‐Liss, Inc.

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR=3.807, p=0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.

To investigate levels of antibodies against type A and type C influenza viruses and those against the 2009 H1N1 influenza A virus (before and after the 2009 H1N1 pandemic) among residents in Wuxi. To compare levels of antibodies against the 2009 H1N1 influenza virus (one year after the pandemic) in the unvaccinated population with those in the population who received vaccine.Serum samples were collected from subjects (aged 1-60 years) during September 2008 to May 2009, and during September 2010 to January 2011. Also collected were serum samples from adults who had received vaccines for pandemic (H1N1) 2009 for one year. Antibody response to influenza viruses was measured using hemagglutination inhibition (HI) assay. Seropositivity rate, seroprotection rate and geometric mean titer (GMT) were compared for each age group during different periods.Before the outbreak of the 2009 H1N1 pandemic, seropositivity rate, seroprotection rate and GMT among the study subjects in were 2.86% (4/140), 0.71% (1/140) and 5.23, respectively. One year after the outbreak, seropositivity rate, seroprotection rate and GMT among the study subjects were 66.33%, 37.76% and 19.17, respectively. Among them, adult subjects showed 50.00% seropositivity rate, 19.44% seroprotection rate and 13.09 GMT, while adult subjects who had received vaccine for one year showed 61.36% seropositivity rate, 22.73% seroprotection rate and 14.14 GMT. No significant difference was observed between these two populations (P0.05 for all three indexes). Furthermore, before the outbreak of the 2009 H1N1 pandemic, levels of antibodies against seasonal influenza viruses among the study subjects were as follows: for H1N1 virus, seropositivity rate, seroprotection rate and GMT were 55.00%, 35.00% and 16.90, respectively; for H3N2 virus, seropositivity rate, seroprotection rate and GMT were 86.40%, 84.30% and 58.56, respectively.One year after the 2009 H1N1 influenza A virus had spread to Wuxi, the population levels of antibodies against this virus have approached those against seasonal influenza viruses, as reflected by seropositivity rates, seroproection rates and GMT. Moreover, considerable levels of antibodies against seasonal influenza viruses were observed in populations, indicating no seasonal influenza outbreak would occur recently.

The present study analyzed national data from "Domestic Violence Report System" derived primarily from the Council of Domestic Violence and Sexual Assaults Prevention, Ministry of the Interior, Taiwan, to describe the reported prevalence of domestic violence in people with disabilities and to examine the time-effect on the prevalence from years 2006 to 2009. The annual reported prevalence of domestic violence victims in people with disabilities was slightly lower than the general population. However, the reported rate changed significantly in people with disabilities over the period of 2006-2009, the victim number and rate (per ten-thousand) of reported cases in different years were 1260 (12.84), 1725 (16.90), 2163 (20.79) and 3157 (29.48). People with voice or speech disability, chronic psychosis and intellectual disability were the most domestic violence reported prevalence among the disabilities in the study. Those disabilities, such as chronic psychosis, intellectual disability, vision disability, hearing disability and multi-disabilities show increased significantly in annual reported rate in curve estimation for linear model over the period of 2006-2009. Finally, we found the average increase rate of annual reported prevalence in people of disabilities was 3.7 times of the general population (9.79% vs. 36.08%). Intellectual disability (41.52%), vision or speech disability (38.59%) and chronic psychosis (37.96%) were the most increasing disability type in average of annual reported prevalence of domestic violence among disabilities during the period of 2006-2009. The present study suggests health and welfare authorities should play vital roles in identifying and providing appropriate services for people with disabilities who encounter domestic violence.

Background Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. Hypothesis Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. Study Design Controlled laboratory study. Methods Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Results Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament—intact knee with no significant differences between these 3 knee conditions at 0° and 30° of flexion (P > .05). The increased medial tibial shifts of the anterior cruciate ligament—deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. Conclusion Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. Clinical Relevance Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction.

To monitor the seasonal distribution of influenza types and subtypes in Wuxi area during 2005-2008, and to investigate the variation in hemagglutinin (HA) genes of A/H3N2 strains in 2008.Nose-throat swab specimens were collected in Wuxi area from flu-like patients from outpatient departments of hospitals as well as from clustering flu-like outbreak patients from workspace, followed by MDCK cell inoculation. Types and subtypes of positive influenza isolates were identified using standard antiserum. We then sequenced the HA genes for H3 subtype influenza viruses isolated from 2008 specimens to investigate the variation in HA genes.During 2005 and September 2008, 435 strains of influenza viruses were isolated from flu-like patients in Wuxi Area, among which 164 isolates are of A/H1N1 subtype, 80 isolates are of A/H3N2 subtype, and 191 isolates are of B type. These types/subtypes have significant seasonal distributions. Sequences of HA genes for H3 subtype show that the 9 strains isolated in Wuxi area are similar to those of strains isolated in Shanghai within the same period. Many of the sequences belong to the same branch of the phylogenetic tree, and are similar to sequences of vaccine strains in WHO 2008-2009 repositories.A/H1N1, A/H3N2 and B still attribute to most of the sporadic and local outbreaks of influenza infection in Wuxi area in recent years. HA genes of A/H3N2 strains isolated in Wuxi area are similar to those of strains isolated in Shanghai in the same period, and also similar to those of vaccine strains recommended by WHO for 2008-2009.

BackgroundThe in situ forces of the anteromedial (AM) and posterolateral bundles (PL) of the anterior cruciate ligament (ACL) under simulated functional loads such as simulated muscle loads have not been reported. These data are instrumental for improvement of the anatomical double-bundle ACL reconstruction.HypothesisThe load-sharing patterns of the 2 bundles are complementary under simulated muscle loads.Study DesignDescriptive laboratory study.MethodsEight cadaveric knees in this study were sequentially studied using a robotic testing system. Each knee was tested under 3 external loading conditions including (1) a 134-N anterior tibial load; (2) combined rotational loads of 10 N·m of valgus and 5 N·m internal tibial torques; and (3) a 400-N quadriceps muscle load with the knee at 0°, 15°, 30°, 60°, and 90° of flexion. The in situ forces of the 2 bundles of ACL were determined using the principle of superposition.ResultsUnder the anterior tibial load, the PL bundle carried peak loads at full extension and concurrently had significantly lower force than the AM bundle throughout the range of flexion (P < .05). Under the combined rotational loads, the PL bundle contributed to carrying the load between 0° and 30°, although less than the AM bundle. Under simulated muscle loads, both bundles carried loads between 0° and 30°. There was no significant difference between the 2 bundle forces at all flexion angles (P > .05).ConclusionUnder externally applied loads, in general, the AM bundle carried a greater portion of the load at all flexion angles, whereas the PL bundle only shared the load at low flexion angles. The bundles functioned in a complementary rather than a reciprocal manner to each other.Clinical RelevanceThe data appear to support the concept that both bundles function in a complementary manner. Thus, how to re-create the 2 bundle functions in an ACL reconstruction should be further investigated.

Background Stress fractures rarely occur in the forearms. These injuries usually occur in healthy young patients, which are usually neglected by patients or physicians. Early diagnosis and treatment are important to avoid late complications of these fractures. The purpose of this study was to analyze a case series of military recruits who participated in rifle drill training and presented with forearm stress fractures at our institution. Methods We evaluated 216 military recruits of rifle drill training. Twelve patients were diagnosed with forearm stress fractures by typical history, physical examination, laboratory studies, serial radiographs, and bone scan examinations. Results Eighteen fractures were found in 12 patients. On initial radiographs, 11 had periosteal reactions, 4 had callus formation with complete fracture lines, and 3 were normal. All 18 fractures had increase radioactivity in the involved middle (15 of 18) or distal (2 of 18) ulnae and one middle radius (1 of 18). Conclusions Stress fractures of the forearms in military rifle drill training usually occur in middle ulnae. Fifty percent of them were bilateral fractures. A high index of suspicion is the key to diagnosis. Early diagnosis with conservative treatment can achieve satisfactory results and avoid late complications of stress fractures.

To investigate the effects of Chinese kidney-tonifying drugs on bone mineral density, biomechanics, 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 of ovariectomized osteoporosis rats, and explore the mechanism of treating osteoporosis with the drugs.Thirty-six female SD rats (four months) were randomly divided into model group, sham group and treatment group. All the rats had been ovariectomied except those in sham group. Selecting 4, 8, 12 weeks in the experiment, the value of bone mineral density (BMD) was measure by dual energy X-ray absorptiometry (DEXA) of femoral head, while the biomechanics machine was applied to analysis femoral head biomechanics index and ELISA method was used to detect the content of 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 discern in blood-serum, liver and kidney.Treatment group rats' BMD of femoral head was enhance compared with model group, significant differences were absent (P0.05), and the maximal load and maximal stress measurement were improved, significant differences were absent (P0.05). As the content of 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 discern in blood-serum, liver and kidney were elevate, furthmore there were significant differences in group comparison, all significant differences were absent (P0.05). But those compared with sham group, there was no significant difference (P0.05).In the early period in absence of estrogenic hormone, the Chinese kidney-tonifying drugs could activate bone metabolism to raise BMD and reinforce quality of bone through up-regulating expression of 25-hydroxy Vitamin D3 and 1,25-dihydroxy Vitamin D3 at protein level.

To determine the ventilation resistance of the Eustachian tube (VRET) and the lowest positive pressure to maintain the opening of the tube. Through which to elucidate the mechanism of positive ventilation.To determine the tissue tension, 24 male flyers. Middle ear pressure was measured by a Zodiac 901 analyzer. To determine the VRET: when the Eustachian tube was opened, the change of pressure in the nasopharynx during the change of pressure in the external auditory canal was the VRET. In order to understand the relationship between middle ear barotraumas and VRET, 160 ears were tested in flight, and 60 ears were tested in the hypobaric chamber.The Eustachian tube ventilation resistance was found to have a large respective divergence (1.20-6.86 kPa). When the tube was opened, the pressure of the middle ear changed with the change of the mask pressure. When the mask pressure dropped to 0.70 kPa, the middle ear pressure dropped down to 0 kPa. The individual difference was comparatively small. Among 160 ears of 80 combat aircraft flyers in flight, 19 ears had presentations of middle ear barotalgia. 141 ears had no presentation of barotalgia. The VRET's were significantly different (P0.001). Among the 60 ears of 30 flyers tested in the low-pressure chamber, 9 ears had presentations of middle ear barotraumas. 51 ears had no presentation of barotalgia. The difference between the VRET's were also significant (P0.001).If there is enough positive pressure in the mask, it will open the Eustachian tube. Then, it needs only a small positive pressure (about 0.70 kPa) to maintain the tube open. The airflow in the tube follows the law of pneumatics. The occurrence of barotalgia and VRET are correlative.

Background Pertussis (whooping cough) caused by Bordetella pertussis (B.p), continues to be a serious public health threat. Vaccination is the most economical and effective strategy for preventing and controlling pertussis. However, few systematic investigations of actual human immune responses to pertussis vaccines have been performed. Therefore, we utilized a combination of two-dimensional electrophoresis (2-DE), immunoblotting, and mass spectrometry to reveal the entire antigenic proteome of whole-cell pertussis vaccine (WCV) targeted by the human immune system as a first step toward evaluating the repertoire of human humoral immune responses against WCV. Methodology/Principal Findings Immunoproteomic profiling of total membrane enriched proteins and extracellular proteins of Chinese WCV strain 58003 identified a total of 30 immunoreactive proteins. Seven are known pertussis antigens including Pertactin, Serum resistance protein, chaperonin GroEL and two OMP porins. Sixteen have been documented to be immunogenic in other pathogens but not in B.p, and the immunogenicity of the last seven proteins was found for the first time. Furthermore, by comparison of the human and murine immunoproteomes of B.p, with the exception of four human immunoreactive proteins that were also reactive with mouse immune sera, a unique group of antigens including more than 20 novel immunoreactive proteins that uniquely reacted with human immune serum was confirmed. Conclusions/Significance This study is the first time that the repertoire of human serum antibody responses against WCV was comprehensively investigated, and a small number of previously unidentified antigens of WCV were also found by means of the classic immunoproteomic strategy. Further research on these newly identified predominant antigens of B.p exclusively against humans will not only remarkably accelerate the development of diagnostic biomarkers and subunit vaccines but also provide detailed insight into human immunity mechanisms against WCV. In particular, this work highlights the heterogeneity of the B.p immunoreactivity patterns of the mouse model and the human host.