Indications and contraindications for double-bundle ACL reconstruction

Over recent years, double-bundle reconstruction has gained popularity after studies showed significant advantages of adding a second bundle with regard to outcomes and biomechanics; in particular, it resulted in less rotational instability than after reconstruction with a traditional single-bundle technique. As the focus shifted further towards the restoration of the native anatomy, both single-bundle and double-bundle ACL reconstruction were performed in an anatomical fashion and yielded similar results. To date, no consensus has developed as to whether double-bundle reconstruction is better than single-bundle reconstruction or vice versa. However, after surgeons started to individualise their surgical approach to the patient, it has been found that both the anatomical single- and double-bundle techniques have their own set of indications and contraindications. Reconstruction of the ligament should focus on restoration of the native functional and anatomical properties and should take the size, shape and orientation of the ACL into account. When indications and contraindications for the technique used are based on native anatomical characteristics, either a single-bundle or a double-bundle procedure can be performed according to the same double-bundle concept.     

Resistin expression correlates with steatohepatitis in morbidly obese patients

Background

Morbidly obese patients are at risk for nonalcoholic steatohepatitis (NASH) even in the absence of risk factors for liver disease. Unfortunately, NASH is usually not clinically evident, and a definitive, noninvasive test for NASH does not exist. Resistin, a cytokine originating from adipose tissue, is involved in insulin resistance and also initiates proinflammatory signaling from hepatic stellate cells. This study explores the relationship between resistin expression and liver pathology in bariatric surgery patients.

Methods

Blood samples from 30 patients undergoing bariatric surgery were collected. Total RNA was extracted and cDNA was synthesized. Quantitative RT-PCR was used to quantify relative gene expression using 18s rRNA gene as an internal control. Wedge liver biopsies from these patients were sectioned and stained. Based on a previously published scoring method, biopsies were assigned an overall NASH severity score and subscores for steatosis, inflammation, and fibrosis. Results were analyzed by using Student’s t test.

Results

Resistin mRNA levels ranged from 0.5 to 9.7. A group of five patients with very high resistin expression (>4) was identified. These patients had a significantly higher average NASH score compared with the rest of the group (7.9 vs. 4.48, p = 0.019). Steatosis and inflammation scores were significantly higher in the high-resistin group (p < 0.05 for both comparisons). There also was a trend toward higher fibrosis score in this group, which approached statistical significance (p = 0.051).

Conclusions

In morbidly obese patients, high resistin expression in serum is associated with hepatic steatosis, inflammation, and fibrosis. The development of elevated resistin expression may represent a link between obesity and the onset of steatohepatitis.     

Repair of hand defects by transfer of free tissue flaps from toes

Introduction

There are very few reports on the use of a free composite flap from the toe to repair small tissue defects in the hand. Here, we describe our experience using a free composite flap from the great toe and second toe.

Method

Fifteen patients sought surgical treatment for tissue defects of the hand at our medical institution from July 2008 to December 2010. These defects included: dorsal defect of the distal thumb, dorsal-radialis defect of the proximal thumb, degloving injury of distal index finger, pulp defect of the middle finger and these were repaired with toe side pulp flaps. In five subjects, treatment of the metatarsophalangeal joint (MPJ) or proximal interphalangeal joint (PIPJ) involved a combined extensor tendon defect with a composite flap with MPJs and PIPJs and the extensor tendon of the second toe. All flaps were transferred as free flaps.

Results

All flaps survived. At 34.8 months of follow-up, the average subjective satisfaction score was 8. Eleven patients (73.3 %) experienced cold intolerance, and one patient (6.7 %) dysesthesia. The Semmes–Weinstein Sensitivity Score was 3.48–4.71 at the flap and 0–4.21 at the donor site. The mean two-point discrimination was 7.13 mm. Grip strength was 10 % less than in the unaffected hand. Mobility loss in the MPJ and PIPJ was <10°. No patients had complications at the donor sites.

Conclusion

Based on the unique characteristics of the free flap from toes, we consider them to be good options for reconstruction of small tissue defects in the hand according to various sizes, shapes, and sites.     

Nodal Skip Metastasis is not a Predictor of Survival in Thoracic Esophageal Squamous Cell Carcinoma

Background

The presence of nodal skip metastasis (NSM) has been found to be of clinical importance in non-small cell lung cancer, but the study of this phenomenon in esophageal carcinoma is relatively rare. The purpose of this study was to identify risk factors influencing NSM and to assess its prognostic value in thoracic esophageal squamous cell carcinoma (ESCC).

Methods

A total of 207 patients with thoracic ESCC who underwent three-field lymphadenectomy and who had lymph node metastasis were reviewed. Associations of NSM occurrence with the clinicopathological characteristics of patients and primary tumors were evaluated using logistic regression analysis. The influence of NSM on the overall survival (OS) was assessed by log-rank tests and Cox regression analysis.

Results

NSM were present in 58 (26 %) patients. No factor was significantly associated with the incidence of NSM except for the location of primary tumor. There were no NSMs in the 29 patients from our study with upper thoracic ESCC, and the rates of tumors occurrence in the middle and lower third of the esophagus were 38.9 and 14.9 %, respectively. The median OS was 30 months, and no significant difference in OS was found between the patients with or without NSM (p = 0.767). Only N status was found to be the independent risk factor for OS by Cox multivariate analysis.

Conclusions

NSM is common in thoracic ESCC, especially in patients with tumors located in the middle and lower third of the esophagus. However, the presence of NSM did not predict prognosis.     

Colletotrichum species associated with cultivated citrus in China

There have been considerable advances in the understanding of species concepts in the genus Colletotrichum. This has lead to the need to carry out fresh surveys of Colletotrichum species associated with important hosts. Colletotrichum species are associated with Citrus plants as saprobes, important pre-harvest and post-harvest pathogens, as well as endophytes. In this study, a total of 312 Colletotrichum strains were isolated from leaves, shoots and fruits of cultivated Citrus and Fortunella species with or without disease symptoms across the main citrus production areas in China. The morphology of all strains were studied and multilocus (ACT, TUB2, CAL, GAPDH, GS, ITS) phylogeny established. Strains were from four important species complexes of Colletotrichum, namely C. gloeosporioides species complex, C. boninense species complex, C. acutatum species complex and a final group including C. truncatum, which was rare on Citrus species. The species belonging to the C. gloeosporioides species complex comprised C. gloeosporioides and C. fructicola, the C. boninense complex comprised C. karstii and a new species C. citricola and the C. acutatum complex included a new species, C. citri. The ability of strains to cause anthracnose on citrus fruits was tested by inoculation and strains of Colletotrichum gloeosporioides, C. fructicola and C. truncatum were pathogenic.     

缝隙扩压叶栅近壁流场与流动损失实验

为了探索缝隙射流对高负荷扩压叶栅气动性能与近壁流场结构的影响机制,实验研究了设计冲角下有/无缝隙结构的高负荷弯曲扩压叶栅近壁流场结构与出口气动损失分布规律,获得了叶片近壁压力场数据、流动图谱以及叶栅出口流动损失参数。结果表明,缝隙两端压差导致的从叶片压力面到吸力面的射流能够增加附面层高熵流体的能量,缝隙射流将局部积聚的低能流体及时引向主流,减小高熵流体在叶展中部或端区掺混撞击,抑制了栅后尾迹高熵流体的过度聚集,从而有效提高高负荷压气机叶栅气动性能。 