Meliasanines A-L, tirucallane-type triterpenoids from Melia toosendan with anti-inflammatory properties via NF-κB signaling pathway.

Meliasanines A-L, twelve previously unreported tirucallane-type triterpenoids, together with fifteen known ones, have been isolated from the stem bark of Melia toosendan. Their structures and absolute configurations were determined based on HRESIMS, and NMR, combined with calculated ECD and single-crystal X-ray diffraction analyses. Subsequently, all compounds except 10 were evaluated for their inhibitory effect on the production of nitric oxide induced by lipopolysaccharide in RAW264.7 macrophage cells. The results indicated that seven compounds (1, 13, 14, 16, 20, 22, and 23) exhibited significant NO inhibitory effects, with IC50 values ranging from 1.35 to 5.93 µM, which were more effective than the positive control indomethacin (IC50 = 13.18 µM). Moreover, the corresponding results of Western blot analysis revealed that meliasanine A (1) can significantly suppress the protein expression of inducible nitric oxide synthase and cyclooxygenase 2 in a concentration-dependent manner. The mechanism study suggested that meliasanine A exerts an anti-inflammatory effect via the nuclear factor-κB signaling pathway by suppressing phosphorylation of P65 and IκBα.

Copper-Catalyzed Selective Oxidative Cross-Coupling of Tryptophols and Tryptamines To Access Heterocyclic 3a,3a'-Bisindolines.

The first example of cyclization cross-coupling of tryptophols and tryptamines has been realized by copper catalysis with air or oxone as the terminal oxidant, resulting in the direct construction of a new class of heterocyclic 3a,3a'-bisindolines in moderate to good yields with high chemoselectivities. A series of mechanistic control experiments were also conducted, indicating that the copper catalyst selectively coordinates with the nitrogen moiety of the tryptamine to initiate the oxidation, and a nucleophilic-alkylation process is proposed for the carbon-carbon bond-forming in the reaction. The novel synthetic strategies and molecular skeletons outlined in this work provide new ideas and concepts for the design of other useful reaction and potential drugs.

Copper-Catalyzed Cyclization/Dimerization of Tryptamines with O2/Air as the Sole Oxidant: Direct Access to Complex Bispyrrolidino[2,3-b]indoline.

The first transition metal catalytic one-step synthesis of the 3a, 3a'-bispyrrolidino [2,3-b] indoline scaffold via tandem cyclization/dimerization of tryptamines has been realized with the environmentally friendly O2/air as the sole oxidant. Different from the traditional direct oxidation of indole "N-H" group by excess amount of metal salts, a copper-catalyzed oxidative cyclization reaction is developed for the formation of the radical pyrrolidinoindoline intermediate in the current strategy. The robustness and practicality of this methodology is demonstrated by the step-economic, divergent total synthesis of natural products (±)-folicanthine and meso-folicanthine.

Demand for longer quarantine period among common and uncommon COVID-19 infections: a scoping review.

BACKGROUND: As one of the non-pharmacological interventions to control the transmission of COVID-19, determining the quarantine duration is mainly based on the accurate estimates of the incubation period. However, patients with coarse information of the exposure date, as well as infections other than the symptomatic, were not taken into account in previously published studies. Thus, by using the statistical method dealing with the interval-censored data, we assessed the quarantine duration for both common and uncommon infections. The latter type includes the presymptomatic, the asymptomatic and the recurrent test positive patients. METHODS: As of 10 December 2020, information on cases have been collected from the English and Chinese databases, including Pubmed, Google scholar, CNKI (China National Knowledge Infrastructure) and Wanfang. Official websites and medias were also searched as data sources. All data were transformed into doubly interval-censored and the accelerated failure time model was applied. By estimating the incubation period and the time-to-event distribution of worldwide COVID-19 patients, we obtain the large percentiles for determining and suggesting the quarantine policies. For symptomatic and presymptomatic COVID-19 patients, the incubation time is the duration from exposure to symptom onset. For the asymptomatic, we substitute the date of first positive result of nucleic acid testing for that of symptom onset. Furthermore, the time from hospital discharge or getting negative test result to the positive recurrence has been calculated for recurrent positive patients. RESULTS: A total of 1920 laboratory confirmed COVID-19 cases were included. Among all uncommon infections, 34.1% (n = 55) of them developed symptoms or were identified beyond fourteen days. Based on all collected cases, the 95th and 99th percentiles were estimated to be 16.2 days (95% CI 15.5-17.0) and 22.9 days (21.7‒24.3) respectively. Besides, we got similar estimates based on merely symptomatic and presymptomatic infections as 15.1 days (14.4‒15.7) and 21.1 days (20.0‒22.2). CONCLUSIONS: There are a certain number of infected people who require longer quarantine duration. Our findings well support the current practice of the extended active monitoring. To further prevent possible transmissions induced and facilitated by such infectious outliers after the 14-days quarantine, properly prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources.

Copper-catalyzed aerobic oxidative radical alkoxycyclization of tryptamines to access 3-alkoxypyrroloindolines.

We report a copper-catalyzed alkoxycyclization of tryptamine derivatives with O2 as the sole oxidant, leading to a variety of C3a-alkoxypyrroloindolines in good yields with high diastereoselectivities. This reaction involves an interesting double catalytic cycle in which copper-catalyzed carboamination cyclization is favored to form the C-3 radical pyrrolidinoindoline intermediate, then a copper-catalytic radical alkoxylation reaction proceeds smoothly.

[Clinical results of arthroscopic anterior cruciate ligament reconstruction with short femoral tunnel].

OBJECTIVE: To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with short femoral tunnel. METHODS: From May 2013 to June 2017, 128 patients with anterior cruciate ligament reconstruction were performed with Transportal technique. Among them, 32 cases had short femoral tunnel were included, including 13 males and 19 females, aged 25.8 (17 to 43) years old, with a mean history of (4.5±1.1) months. The tibial tunnels were drilled in the middle of the footprint of the ACL, and femoral tunnels were drilled by transportal technique. Grafts were fixed with Endobutton at the femoral side and with interference screw at the tibial side. The changes of symptoms and signs were observed and the anterior tibial displacement was measured. The function of knee joint was evaluated by Lysholm score and Tegner score. RESULTS: All patients were followed up for over 2 years. At the latest follow-up, 30 patients were negative and 2 patients were positive in knee shift test; 28 patients were negative in Lachman sign, 4 patients were positive in degree I; 30 patients were negative in anterior drawer test, 1 patient was positive in degree I and 1 patient was positive in degree II. The anterior displacement of the tibia increased by (2.6±1.8) mm compared with the healthy side, which was significantly different from that before operation (t=19.77, P<0.05). Lysholm score of 82.2±6.1 was significantly higher than that before operation (t=17.33, P=0.001). According to Lysholm score evaluation, 15 cases got an excellent result, 10 were good, 7 were fair, and no bad results, with a significant difference compared with that before operation (z=-7.151, P<0.05). Tegner motor function score of (7.4±0.6) was significantly different from that before operation (t=9.11, P=0.000 5). After operation, the knee joint movement ability of the patients improved significantly. Twelve patients could participate in antagonistic sports and 15 patients could participate in non-antagonistic sports. Fifteen patients were very satisfied with the curative effect, 13 patients were satisfied with the curative effect. CONCLUSIONS: The incidence of short femoral tunnel in anterior cruciate ligament reconstruction with transportal technique is 25%. At present, the clinical effect of patients with short tunnel is acceptable. However, due to the lack of comparative study, the effect of short tunnel on the curative effect is still unclear.

Oxazoline-/Copper-Catalyzed Alkoxyl Radical Generation: Solvent-Switched to Access 3a,3a'-Bisfuroindoline and 3-Alkoxyl Furoindoline.

We report the first example of oxazoline-/copper-catalyzed alcohol oxidation to generate the alkoxyl radical under additive-free conditions. The resulting alkoxyl radical addition to alkene enables useful C-O bond-forming and selective C(sp3)-C(sp3) radical-radical dimerization/radical-trapping reactions, providing direct access to the 3a,3a'-bisfuro[2,3-b]indoline scaffold for the first time and a wide range of 3-alkoxyl furoindolines with high efficiency.

Signaling pathways involved in p38-ERK and inflammatory factors mediated the anti-fibrosis effect of AD-2 on thioacetamide-induced liver injury in mice.

Ginseng is a type of medicinal and edible homologous plant that is very common in medicine, food and even cosmetics. Ginsenosides are the main active constituents of ginseng, which has many pharmacological activities. AD-2 is a type of ginsenoside extracted from ginseng and prepared in large quantities in our laboratory. However, the anti-fibrosis effects and mechanism of ginsenosides are rarely reported. In this study, the anti-fibrosis pharmacodynamics of AD-2 were evaluated. The results revealed that AD-2 could reduce the expression of collagen I, TIMP-1 and MMP-13, inhibit the deposition of extracellular matrix, and play an role in anti-hepatic fibrosis. The mechanism and related pathways of AD-2 against liver fibrosis have also been studied. Inflammatory factors (including TNF-α, IL-1ß, caspase-1 and IL-6) associated with hepatic fibrosis, and the p-JNK and the p38-ERK pathways, have been shown to be associated with the anti-fibrotic effect of AD-2. In conclusion, our study reveals that AD-2, as a small-molecule, targeted drug for improving liver function, needs further study.

[Clinical results of needle Dao for the treatment of subacromial impingement syndrome].

OBJECTIVE: To study the clinical results of needle Dao for the treatment of subacromial impingement syndrome. METHODS: From September 2013 to August 2014, 90 patients with subacromial impingement syndrome were treated, including 61 females and 29 males, with the average age of (55.21±8.30) years old(ranged, 45 to 65 years old), and mean course of disease (3.49±2.98) months (ranged, 4 weeks to 7 months). Twenty-six patients had pains in left shoulder, and 64 patients had pains in right shoulder. Under local anesthesia, needle Dao was performed to release the pain point at the lower edge of the acromion and the subacromial adhesion. By observing the abduction of shoulder joint, anterior flexion and lifting, internal rotation and external rotation, shoulder pain score, the number of cases cured, markedly effective, effective and ineffective after treatment were counted, and the curative effect of needle Dao for the treatment of subacromial impingement syndrome was evaluated. RESULTS: All the patients completed the treatment successfully without obvious adverse reactions. All the patients were followed up for more than 12 months. The visual analogue scale(VAS) decreased from preoperative 7.72±5.42 to postoperative 1.35±0.78(t=15.89, P<0.01). The Constant score at the 12th month after operation increased from preoperative 58.89±15.63 to 83.17±19.11(t=28.48, P<0.01). Overall efficacy evaluation was that, 46 cases were cured, 33 cases were markedly effective, 11 cases were effective, and 0 cases were invalid. CONCLUSIONS: The advantage of needle Dao in the treatment of subacromial impingement syndrome is the minimally invasive treatment of the underlying lesions. The disadvantage is that it can not deal with the impact caused by bone abnormalities.

[Radiologic observation of the blood supply changes around the knee with osteoarthritis].

OBJECTIVE: To compare blood supply changes around the knee joint between normal and osteoarthritis knee. METHODS: From June 2014 to June 2015, 30 patients with knee osteoarthritis and 30 healthy adults were recruited. In osteoarthritis group, there were 9 males and 21 females, with a mean age of (65.967±7.132) years old(ranged, 53 to 82 years old), and the mean arterial pressure was(93.462±7.633) mmHg. In control group, there were 9 males and 21 females, with a mean age of (62.867±6.356) years old(ranged, 50 to 75 years old), and the mean arterial pressure was (92.122±9.675) mmHg. Inspection methods included color ultrasonic and computed tomography angiography of lower limbs. The patients were observed with: (1)collateral circulation; (2)artery circuity; (3)artery malformation; (4)artery stenosis; (5)arterial wall plaque formation. Stenosis was divided into 5 levels: level 1 as no narrow, level 2 as mild stenosis (1% to 49%), level 3 as moderate stenosis (50% to 70%), level 4 as severe stenosis (70% to 99%), level 5 as total obstruction. Diameter and blood flow dynamics of popliteal artery, pretibial artery, and posterior tibia artery in two groups were measured and compared. RESULTS: The study was accomplished with complete data collection, none of the patients was eliminated, and there were no loss of follow up. There were 3 cases in OA group and 4 cases in control group with the formation of collateral circulation, and the difference had no statistically significance. There was none in OA group and 2 in control group with the formation of artery circuity, and the difference had no statistically significance. There were no cases in both groups with artery malformation. In OA group, there was mild in 14 cases, moderate in 7 cases, severe in 9 cases. In control group, there was no arterial stenosis in 9 cases, mild in 10 cases, moderate in 6 cases, severe in 4 cases, total obstruction in 1 case. The difference between two groups was statistically significant; artery stenosis in OA group was more severe than that of the control group. Artery plaque formed in 30 cases in OA group and in 20 cases in control group. The difference between two groups was statistically significant; the rate of artery plaque formation in OA group was obviously higher than that of control group. In OA group, plaque calcification rate was 100% while 63% in control group. Difference of pretibial artery diameter was statistically significant, pretibial artery diameter is larger in OA group. Difference of popliteal artery flow velocity was statistically significant; velocity was faster in OA group. Difference of the posterior tibial artery flow velocity was statistically significant; velocity was faster in OA group. The differences of the three arteries had no statistical significances in related to arterial flow. CONCLUSIONS: Local artery system changes with the onset of knee joint osteoarthritis. Main pathological changesof local blood vessels were stenosis and plaque formation, but the amount of local artery blood flow was roughly the same as the control group. Possible mechanism is that the local artery stenosis speed up the artery blood flow velocity, resulting local perfusion. The local tissue ischemia and hypoxia caused a series of pathological changes. It is better to improve local vascular lesions than to accelerate the blood flow velocity in clinical treatment. Further more, interventional therapy for vascular pathology will be a new trend of osteoarthritis treatment.

Acquired resistance to HSP90 inhibitor 17-AAG and increased metastatic potential are associated with MUC1 expression in colon carcinoma cells.

Heat shock protein 90 (HSP90) is a molecular chaperone required for the stability and function of many proteins. The chaperoning of oncoproteins by HSP90 enhances the survival, growth, and invasive potential of cancer cells. HSP90 inhibitors are promising new anticancer agents, in which the benzoquinone ansamycin 17-allylamino-17-demethoxygeldanamycin (17-AAG) is currently in clinical evaluation. However, the implications of acquired resistance to this class of drug remain largely unexplored. In the present study, we have generated isogenic human colon cancer cell lines that are resistant to 17-AAG by continued culturing in the compound. Cross-resistance was found with another HSP90 inhibitor 17-dimethylaminoethylamino-17-demethoxygeldanamycin. The resistant cells showed obvious morphology changes with a metastatic phenotype and significant increases in migration and adhesion to collagens. Western blotting analysis of epithelial-mesenchymal transition molecular markers found that expression of E-cadherin downregulated, whereas expression of N-cadherin and ß-catenin upregulated in the resistant cells. Mucin 1 (MUC1) has been reported to mediate metastasis as well as chemical resistance in many cancers. Here, we found that MUC1 expression was significantly elevated in the acquired drug resistance cells. 17-AAG treatment could decrease MUC1 more in parental cells than in acquired 17-AAG-resistant cells. Further study found that knockdown of MUC1 expression by small interfering RNA could obviously re-sensitize the resistant cells to 17-AAG treatment, and decrease the cell migration and adhesion. These were coupled with a downregulation in N-cadherin and ß-catenin. The results indicate that HSP90 inhibitor therapies in colon carcinomas could generate resistance and increase metastatic potential that might mediated by upregulation of MUC1 expression. Findings from this study further our understanding of the potential clinical effects of HSP90-directed therapies in colon carcinomas.

[Arthroscopic reduction and utilization of Suture Bridge tech reconstructing footprint area structure for the treatment of anterior cruciate ligament avulsion fracture].

OBJECTIVE: To evaluate the preliminary curative effect of arthroscopic reduction and utilization of Suture Bridge tech reconstructing footprint area structure for anterior cruciate ligament avulsion fracture. METHODS: From March 2010 to September 2012, 6 patients suffered anterior cruciate ligament avulsion fracture were treated with arthroscopic Suture bridge fixation for anterior cruciate ligament tibial side footprint reconstruction. There were 2 males and 4 females, ranging in age from 14 to 52 years old. There were 2 cases of type III and 4 cases of type IV displaced fractures classified by Meyers-McKeever-Zaricznyj. Preoperative ADT and Lachman tests were positive. RESULTS: All the patients was follow up more than 2 years. Postoperative ADT and Lachman tests were negative without limitation of knee extension. Postoperative X ray and MRI showed that displaced fracture with a good reduction and union, recovered normal shapeness of ACL. The postoperative Lysholm and IKDC scores at different time points(3 months, 1 year, 2 years after operation) improved significantly comparing with preoperative, and the differences were statistically significant (P<0.01). CONCLUSIONS: Suture Bridge tech reconstructing footprint area structure for ACL avulsion fracture is an effective and safe method, especially for adolescent patients with unclosed epiphysis and comminuted avulsion fracture.

[Total hip arthroplasty for patients with failed internal fixation of acetabular fractures].

OBJECTIVE: To observe the clinical result and healing of meniscal suture under arthroscopy for the treatment of the middle aged patients with meniscal injury. METHODS: From March 2014 to January 2015, 40 middle-aged patients included in the standard with injury of meniscus, which were repaired by meniscal suture technique under arthroscopy, involving 24 males and 16 females with an average age of (52.65±3.63) years ranging from 50 to 60 years; 28 cases were on left knee, 12 cases were on right knee. Average flexion angle averaged (117.50±7.16) ° ranging from 110° to 130°. Lysholm knee score averaged 54.30±14.72 ranging from 23 to 71; IKDC score averaged 50.65±15.95 ranging from 18 to 78; the WOMAC score averaged 23.80±19.39 ranging from 2 to 75. All-inside meniscus suture under arthroscopy was performed. RESULTS: All operations were successful without serious complications. Postoperative follow-up was 6 to 12 months, none of the patients lost to follow-up. All patients maintain a category 5 degree muscle strength, normal knee joint mobility, can completely straight and completely buckling. Average flexion angle was (125.00±5.13) ° (110° to 130°) (t=3.47, P=0.003). Final Lysholm scale, IKDC scores and WOMAC scores averaged 79.50±8.70 (t=7.790, P=0.000), 79.40±10.40 (t=8.431, P=0.000), 8.15±6.77 (t=3.988, P=0.001) separately. Follow-up MRI showed that meniscus healed in 4 cases, partially healed in 22 cases, haven't healed in 14 cases. Failure rate of small lesion was 27.3%(6/22), and failure rate of large lesion was 44.4%(8/18). CONCLUSIONS: Clinical effect of meniscal suture under arthroscopy for the treatment of the middle aged is good. The failing rate was 35% because of healing ability is poor in middle-aged adults. Failure rate of large lesion was higher than that of small lesion.

[Arthroscopic rotator cuff repair using a suture-bridge technique in late middle-aged adults].

OBJECTIVE: To evaluate the clinical results after arthroscopic rotator cuff repair using a suture-bridge technique in late middle-aged adults. METHODS: A retrospective analysis of 30 patients with rotator cuff tears, who were treated consecutively between December 2012 and December 2013 at our clinic, was carried out to evaluate the outcome of arthroscopic suture-bridge technique. The visual analogue scale (VAS), the range of motion (ROM), the rating scale of the University of California at Los Angeles (UCLA), and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) were determined as the evaluation criteria. RESULTS: The mean follow-up period was 13 months. The follow-up rate was 100%. The study included 0 small, 16 medium, 12 large and 2 massive rotator cuff tears. At the latest follow-up, the VAS score decreased significantly from preoperative 6.3±3.2 to 0.8±1.4 at rest,and from preoperative 7.7±2.1 to 1.7±1.6 during motion. The UCLA score improved significantly from 15.1±4.6 preoperatively to 31.2±5.0 at follow-up. The ASES shoulder index improved significantly from 30.2±16.0 preoperatively to 80.4±13.0 at follow-up. The ROM improved significantly. The satisfactory rate was 94%. There were no complications. CONCLUSION: The results of this study indicate that the arthroscopic suture-bridge technique is an effective and reliable treatment for patients with rotator cuff tear in late middle-aged adults.

[Arthroscopic partial meniscectomy for medial meniscal tear in late middle-aged adults].

OBJECTIVE: To study the results of arthroscopic partial meniscectomy for medial meniscal tear in late middle-aged adults. METHODS: From October 2010 to October 2012,49 patients meeting inclusion criteria were treated with arthroscopic partial meniscectomy for medial meniscal tear. There were 31 males and 18 females,with an average age of (55.3±2.8) years old. There were 22 left knees and 27 right knees. The average flexion angle was (116.01±12.03)°. The pre-operative HSS Knee Score was 48.73±8.43, and the Lysholm score was 63.95±5.45. The patients were followed up and evaluated. All the patients received a standard surgery, in which the torn tissue was removed, and the anterior part of the meniscus was left in situ. RESULTS: All the surgeries were successful with no serious complications. All the patients were followed up,and the duration ranged from 12 to 36 months. All the patients had 5 degrees of muscle strength. The average flexion angle was (136.77±18.56)°. There was significant difference between the two angles before operation and after operation. The pre-operative HSS Knee Score was 90.17±4.10, and the Lysholm score was 87.84±5.16. Statistically, the difference between preoperative score and the postoperative score was significant. CONCLUSION: Arthroscopic partial meniscectomy is a good option for medial meniscal tear in late middle-aged adults. Operative indication is crucial and the excellent surgical technique is also critical for the good clinical outcome. All the patients could get good clinical results, although there are some patients with motion restrictions in the early stage after operation.

[Arthroscopic anterior cruciate ligament reconstruction with remnant preserving technique].

OBJECTIVE: To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with remnant preserving technique. METHODS: From May 2008 to October 2010,68 patients with ACL deficiency (33 males and 35 females, with an average age of 25.8 years, ranged from 17 to 43 years) were treated with arthroscopy. The average duration of the disease was (4.5 +/- 1.1) months. The pivot shift test showed positive results in 55 cases, Lachman test showed positive results in 68 cases, and the ADT (anterior drawer test) showed positive results in 68 cases. The anterior transition of the tibia measured by KT2000 instrument was (7.2 +/- 2.3) mm (5 to 9 mm) more than that of the opposite knee. The average Lysholm score was 55.7 +/- 5.4 (45 to 67). The average Tegner activity scores was 3.1 +/- 0.6 (2 to 4). The tibial tunnels and femoral tunnels were drilled in the middle of the footprint of the ACL, and the graft was wrapped by the remnant. Grafts were fixed with cross pin at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed in the follow-up duration. The anterior transition of the tibia was measured by KT2000, the Lysholm and Tegner scores were used to evaluate knee functions. RESULTS: All the patients were followed up, and the duration ranged from 24 to 42 months, with a mean of (31.5 +/- 2.4) months. At the latest follow-up, there was no patients had positive result by civot shift test, while the Lachman test showed results of negative or positive of grade I, and the ADT test showed results of negative or positive of grade I or II. The anterior transition of the tibia measured by KT2000 instrument decreased to (1.9 +/- 0.7) mm (0 to 3 mm) more than that of the opposite knee (t = 21.15, P = 0.000 1). The postoperative Lysholm score 86.0 +/- 5.1(81 to 97) and Tegner score 7.8 +/- 0.3 (6 to 9) all increased compared with preoperative 55.7 +/- 5.4 and 3.1 +/- 0.6 (t = 18.55, P = 0.001 0; t = 9.11, P = 0.000 5). According to Lysholm score, excellent results were obtained in 55 cases, good in 10, poor in 3 and no bad results. CONCLUSION: The ACL remnant provide vascular and nerve supply for the graft, promoting union and remodeling of grafts.

[Combined closing-wedge high tibial osteotomy with arthroscopy for varus knee and medial compartment osteoarthritis: clinical results at a minimum follow-up for five years].

OBJECTIVE: To study the results of closing-wedge high tibial osteotomy and arthroscopy for the treatment of medial compartment osteoarthritis of the knee. METHODS: From October 2005 to June 2007, 25 patients met with our inclusion criteria. All the patients with medial compartment knee osteoarthritis were treated with arthroscopy and closing-wedge high tibial osteotomy. There were 11 males and 14 females,with a mean age of 53 years old. The pre-operative HSS knee score was 67.6 +/- 2.8, FTA was (185.54 +/- 1.11) degrees, and aLPTA was (96.54 +/- 0.52) degrees in average. The patients were followed up and evaluated according to HSS knee score. The efficacy of the osteotomy was evaluated by FTA and aLPTA. RESULTS: All surgeries were successful without serious complication. All the patients were followed up, and the duration ranged from 5 to 7 years. The HSS was 85.5 +/- 3.7 at the 1st year and 80.3 +/- 5.4 at the latest follow-up. There was significant difference between every two scores of before operation and the two after operation (t = -33.135, P = 0.000; t = -13.215, P = 0.000). The FTA was (173.65 +/- 0.92) degrees at the 1st year and (174.34 +/- 0.53) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 28.739, P = 0.000; t = 2.331, P = 0.048). The aLPTA was (87.32 +/- 0.33) degrees at the 1st year and (87.67 +/- 2.82) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 37.264, P = 0.000; t = 2.469, P = 0.039). CONCLUSION: Indication is important and good surgical technique is critical for good clinical outcome. A detailed plan before operation is essential for the operation. Arthroscopy is helpful for treating the intra-articular pathology. The osteoarthritis is still in progress but in a slow mode. The combined method of arthroscopy and closing-wedge high tibial osteotomy is a reliable way for medial compartment osteoarthritis of the knee.

[Clinical results of anatomical reconstruction of the lateral ligaments for chronic ankle instability].

OBJECTIVE: To investigate the clinical and radiological results of lateral stabilization with reconstruction of the lateral ligaments for the treatment of chronic lateral instability of the ankle. METHODS: From September 2005 to March 2010, 29 patients with chronic lateral instability of the ankle were reviewed. There were 24 males and 5 females with an average age of 24 years (15 to 35 years). The duration of the disease ranged from 7 to 10 years, averaged 10 months. The main symptom was repeated ankle sprain. During physical examination, ankle varus and the anterior talar transition were conducted. There was (12.5 +/- 3.2) degrees more inversion activity than the contralateral ankle. Arthroscopy was performed for the chondral injury, and anatomic reconstruction of the lateral ligament with an autologous gracilis tendon graft was performed for lateral instability of the ankle. Clinical and radiological evaluations were performed before surgery and at the most recent follow-up. RESULTS: All the patients with successful surgery, there was no fracture or infection. All the patients were followed up,and the duration ranged from 16 to 60 months, with an average of 28 months. There was no ankle instability or limited mobility of the 29 cases at the latest follow-up. According to the American Orthopedic Foot and Ankle Society ankle-hind foot scale, the mean score was 48.0 +/- 6.7 before surgery and 92.8 +/- 6.2 at the most recent follow-up (P = 0.010). The talar tilt angles on standard stress radiography were (12.5 +/- 3.2) degrees before surgery and (2.5 +/- 0.8) degrees at the most recent follow-up (P = 0.012). The mean distance of anterior talar translation was (16.3 +/- 4.0) mm before surgery and (3.5 +/- 0.8) mm at the most recent follow-up (P = 0.002). There were no severe complications, the results were satisfactory. CONCLUSION: Anatomical reconstruction of the lateral ligament with autologous gracilis tendon graft for the treatment of chronic lateral instability of the ankle can be recommended.

[Double-bundle reconstruction of anterior cruciate ligament using hamstring auto graft under arthroscopy].

OBJECTIVE: To evaluate the clinical effects of double-bundle reconstruction of anterior cruciate ligament (ACL) using hamstring tendon auto graft under arthroscopy. METHODS: From April 2009 to March 2010, 25 patients (13 males and 12 females) with ACL deficiency were treated with arthroscopy, ranging in age from 17 to 43 years, with an average of 25.8 years. There were 17 patients caused by sports injuries, 6 patients caused by accidental falling, and 2 patients caused by traffic injury. The average duration of the disease was 3 months. The main symptom was knee instability in 8 patients, and knee pain and swelling in other patients. Pivot shift test was positive in 15 cases, and Lachman test was positive in 25 cases, the ADT (anterior drawer test) was positive in 25 cases. The anterior transition of the tibia measured by KT2000 instrument was (7.1 +/- 2.4) mm more than the contralateral knee. The average Lysholm score was 40.0 +/- 5.4. The Tegner activity scores averaged 3.2 +/- 0.7. The double tibial tunnels and double femoral tunnels were drilled on the footprint of the ACL to reconstruct the anteromedial and posterolateral bundles under arthroscopy. Tendons were fixed with Endo-buttons at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed during follow-up period. The anterior transition of the tibia was measured by KT2000, and the Lysholm score and Tegner scores were used for evaluating knee function. Statistically analyzed was performed with SPSS 15.0. RESULTS: All the patients were followed up, and the duration ranged from 24 to 35 months (averaged, 27 months). At the latest follow-up, there was no positive pivot shift, while the Lachman test and ADT were negative or positive of grade I. The average Lysholm score of the 25 cases was 40.0 +/- 5.4 before operation, and 85.0 +/- 4.5 at the latest follow-up, 3.2 +/- 0.7 before operation and 7.5 +/- 0.2 at the latest follow-up for Tegner activity score. Statistically, the difference between preoperative score and the postoperative score was significant. CONCLUSION: Double-bundle reconstruction of ACL with hamstring tauto graft under arthroscopy is effective and reliable to restore the stability of the knee, and the clinical effect is good to excellent.