Accelerated rehabilitation after arthroscopic meniscal repair: A clinical and magnetic resonance imaging evaluation

Twenty-two patients who underwent meniscal repair using the outside-in technique combined with anterior cruciate ligament (ACL) reconstruction were submitted to an accelerated rehabilitation protocol that included immediate full range of motion and weightbearing. The patients were reviewed postoperatively by means of clinical assessment and magnetic resonance imaging (MRI) after an average of 28 months. Clinical evaluation was performed according to the International Knee Documentation Committee form, and sagittal knee laxity was measured with a KT-2000 arthrometer (MedMetric Corp, San Diego, CA). The MRI scans were obtained using a 0.2-T high-resolution MRI unit dedicated to the study of limbs, and the meniscal signal was graded according to a modified Crues classification. Overall, 77.3% of patients reported clinically good results. Loss of extension of <5° was detected in only 2 patients (9.1%). Three out of 22 patients showed clinical signs of meniscal retear. One of these patients had a second operation for a bucket-handle tear. The presence of a full-thickness rim at MRI evaluation, present in 10 patients (45.5%), did not correlate with the presence of clinical symptoms of retear. Instead, the 3 symptomatic patients presented a complete rim with a gap>1 mm between the meniscal wall and the fragment of the posterior horn. This finding is believed to be a more reliable indicator for retear following meniscal repair. The low failure rate in this series suggests that an aggressive rehabilitation regimen may be prescribed without deleterious effects in subjects undergoing ACL reconstruction and concomitant meniscus repair.     

Meniscal repair: Outcomes and clinical follow-up

A retrospective study of arthroscopic meniscal repair in 101 consecutive patients was conducted. Sixty-three patients constituted our study group. The arthroscopic technique used for meniscal repair was the inside-out method using malleable cannulas. Forty-five patients were available for clinical examination, with a mean follow-up of 27 months. Tegner and Lysholm scores were comparable to those previously reported for arthroscopic meniscal repair. The HSQ (similar to the SF-36) scores were equal to those from an age- and sex-matched normal population, indicating that individuals with repaired menisci do not have any residual negative effects on global health at mean 26.9 months' follow-up. The physical functioning subscale of the HSQ was found to be sensitive to patient perception of results. Complications included one case of restricted knee range of motion requiring arthroscopy and lysis of adhesions. Overall clinical results were 64% excellent, 27% good, and 9% failure. Age, sex, and length of the meniscal tear had no affect on clinical outcome.     

Tissue fixation security in transosseous rotator cuff repairs: A mechanical comparison of simple versus mattress sutures

The primary purpose of this investigation was to compare tissue fixation security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair by one mattress suture. The repairs were loaded to failure in a servohydraulic materials test system. Rotator cuff repair by simple sutures was found to be significantly stronger than repair by mattress sutures (P = .0007). The average ultimate load to failure for the simple suture construct (189.62 N) was 39.72% greater than that for the mattress suture construct (135.71 N). Most of the failures occurred by suture breakage at the knot. Load-sharing by multiple suture tails and multiple knots in the simple suture configuration likely contributed to its superior strength characteristics compared with the mattress suture configuration.     

Trephination and suturing of avascular meniscal tears: A clinical study of the trephination procedure

On the basis of animal studies, an arthroscopic surgical system and procedure of trephination plus suturing were designed for clinical practice. The system consists of a trephine with a tooth-like tip, a guide, and an ordinary arthroscopic power handle. The guide introduces the trephine to the tear without abrading articular cartilage and controls the depth of the trephination. The power handle connected to a suction system provides an inside-out cut core of meniscal tissue. Thirty-six patients with meniscal tears underwent arthroscopic trephination plus suturing (group TS) and 28 patients had suturing alone (group S). The follow-up was 25 to 78 months. Two symptomatic retears have occurred in group TS and 7 symptomatic retears in group S. The symptomatic retear rate of group TS was significantly smaller than group S (P < .01). It is indicated that the patients treated with trephination have fewer symptoms and lower clinical failure rate. Arthroscopic trephination is a safe and easy procedure.     

Expressions of genes related to genome stability and DNA repair in nasopharyngeal carcinoma clustering families

Objective： The aim of the study was to observe the expressions of genes related to genome stability and DNA repair in the members of nasopharyngeal carcinoma （NPC） clustedng families. Methods： In the Zhongshan City where there is highly incidence rate of NPC, we chose the members of the NPC clustering families as objects, and the patients of nasopharyngitis and NPC as the control group. We isolated the RNA from the nasopharyngeal tissue, and synthesized its cRNA, the genome stability and DNA repair genes chip technique, chemiluminescent detection and real-time fluorescence quantita- tive technique were used to examine the genome stability and DNA repair genes in the nasopharyngeal tissue. Results： More genome stability and DNA repair genes were up-regulated in the members of the NPC clustering families than the NPC patients, and the range of up-regulated was high, with the over up-regulated 100 times genes including TEP1, MSH4, PMS2LI. Fewer genome stability and DNA repair genes were down-regulated in the members of the NPC clustering families than the NPC patients, the ubiquitin genes almost were down-regulated, the results also could be confirmed by real-time fluorescence quantitative PCR. Conclusion： There are specially expression character of genome stability and DNA repair genes in the members of NPC clustering families.     

0.35TMRI对肩袖撕裂的应用价值研究

目的探讨0.35TMRI各方位各序列扫描对肩袖撕裂的诊断价值。方法对2010年3月2011年4月就诊的38例肩关节疼痛患者,分别在斜冠状位、斜矢状位及横轴位行T1加权像（T1weighted image,T1WI）、T2加权像（T2weighted image,T2WI）、质子密度加权像（proton density weighted image,PWI）及脂肪抑制像（turboinversion recovery magnitude,TIRM）扫描。将38例患者的冈上肌及冈下肌肌腱合并为A组、肩胛下肌及小圆肌肌腱合并为B组进行研究,分别比较A、B组采用各方位的扫描表现;再将A组患者分为斜冠状位T1WI＋T2WI组与斜冠状位PWI＋TIRM组,将B组患者分为横轴位T1WI＋T2WI组与横轴位PWI＋TIRM组,分别比较各序列组的扫描表现。结果 A组患者在3个方位扫描像以及斜冠状位T1WI＋T2WI组与PWI＋TIRM组之间诊断准确度差异有统计学意义（P〈0.05）,其斜冠状位诊断肩袖撕裂的灵敏度为88.9%,特异度为81.8%,准确度为86.8%,为最佳扫描方位,而PWI＋TIRM组诊断肩袖撕裂的灵敏度为88.9%,特异度为90.9%,准确度为89.5%,为优选扫描序列;B组患者在3个方位扫描像以及横轴位T1WI＋T2WI组与PWI＋TIRM组之间诊断准确度差异有统计学意义（P〈0.05）,其横轴位诊断肩袖撕裂的灵敏度为87.5%,特异度为86.4%,准确度为86.8%,为最佳扫描方位,而PWI＋TIRM组诊断肩袖撕裂的灵敏度为100%,特异度为83.3%,准确度为94.7%,为优选扫描序列。结论低场MRI诊断冈上肌、冈下肌肌腱撕裂以斜冠状位PWI及TIRM扫描序列为首选,诊断小圆肌、肩胛下肌肌腱撕裂则以横轴位PWI及TIRM扫描序列为主。     

DeepSMILE: Contrastive self-supervised pre-training benefits MSI and HRD classification directly from H&E whole-slide images in colorectal and breast cancer

We propose a Deep learning-based weak label learning method for analyzing whole slide images (WSIs) of Hematoxylin and Eosin (H&E) stained tumor tissue not requiring pixel-level or tile-level annotations using Self-supervised pre-training and heterogeneity-aware deep Multiple Instance LEarning (DeepSMILE). We apply DeepSMILE to the task of Homologous recombination deficiency (HRD) and microsatellite instability (MSI) prediction. We utilize contrastive self-supervised learning to pre-train a feature extractor on histopathology tiles of cancer tissue. Additionally, we use variability-aware deep multiple instance learning to learn the tile feature aggregation function while modeling tumor heterogeneity. For MSI prediction in a tumor-annotated and color normalized subset of TCGA-CRC (n=360 patients), contrastive self-supervised learning improves the tile supervision baseline from 0.77 to 0.87 AUROC, on par with our proposed DeepSMILE method. On TCGA-BC (n=1041 patients) without any manual annotations, DeepSMILE improves HRD classification performance from 0.77 to 0.81 AUROC compared to tile supervision with either a self-supervised or ImageNet pre-trained feature extractor. Our proposed methods reach the baseline performance using only 40% of the labeled data on both datasets. These improvements suggest we can use standard self-supervised learning techniques combined with multiple instance learning in the histopathology domain to improve genomic label classification performance with fewer labeled data.     

超声引导下PRP注射治疗肩袖损伤对局部炎症因子表达的影响

目的探讨超声引导下富血小板血浆(PRP)注射在部分肩袖损伤患者治疗中的安全性和有效性,及其对局部炎症因子表达的影响。方法选择2018年10月至2019年10月部分肩袖损伤患者84例,随机分为对照组和观察组,每组各42例。对照组采用超声引导注射玻璃酸钠,观察组注射等量自体PRP,1次/周,连续3周。比较两组治疗前,治疗结束后1、3和6个月疼痛视觉模拟量表(VAS)评分和上肢功能Fugl-Meyer量表(FMA)评分,治疗前及治疗结束后1周和1个月局部炎症因子白介素(I)-6、肿瘤坏死因子(TNF)-α、IL-10和转化生长因子(TGF)-β,随访6个月肩袖再撕裂率。结果观察组治疗结束后1、3、6个月VAS评分逐渐降低,上肢FMA评分逐渐升高,且同时间点观察组VAS评分比对照组降低,FMA评分比对照组升高,差异有统计学意义(P<0.05)。进一步发现,观察组治疗结束后1周和1个月局部IL-6和TNF-a水平明显低于对照组,而IL-10和TGF-β水平明显高于对照组(P<0.05)。随访观察组肩袖再撕裂率低于对照组(P<0.05)。结论超声引导下PRP注射治疗部分肩袖损伤有较好的安全性和有效性,能显著降低关节疼痛,改善关节功能,降低复发率,可能与抑制局部炎症反应,促进关节修复有关。     

脐带间充质干细胞分泌的外泌体对骨性关节炎模型大鼠的镇痛作用

目的:观察脐带间充质干细胞分泌的外泌体对骨性关节炎模型大鼠疼痛行为、软骨修复及背根神经节(DRG)中转录激活因子3(ATF-3)及生长相关蛋白43(GAP-43)表达的影响,并探讨外泌体治疗关节炎疼痛的可能机制。方法:采用随机数字表法将54只雄性SD大鼠分为假手术组、模型组和外泌体组,每组18只,除假手术组外,其余2组...     

住院成人患者血压测量袖带尺寸选择的最佳证据总结

目的 根据上臂围选用合适尺寸袖带测量血压的最佳证据进行总结,为临床提供理论参考。方法 根据循证护理的方法确立问题,利用计算机按“6S”证据模型,检索有关血压测量袖带尺寸的选择,包括指南、专家共识、临床决策和证据总结,由4名完成循证护理培训的研究员对纳入的文献独立评价,并对选取出符合质量标准的文献进行证据提取。结果 该研究纳入证据7篇,其中临床实践指南4篇、专家共识2篇、系统评价1篇,对相关证据进行汇总,总结了3方面内容。结论 应加强对医护人员血压测量规范流程的培训,根据患者的上臂围选用尺寸适合的袖带进行血压测量,减少因袖带不当带来的测量误差以减少高血压误诊和漏诊。