Preparation of healing-promoting and fibrosis-inhibiting asymmetric poly(ethylene glycol-b-L-phenylalanine)/cRGD-modified hyaluronate sponges and their applications in hemorrhage and nasal mucosa repair.

Acute or chromic bleeding, such as epistaxis, requires hemostatic materials to assist hemostasis. Even in complex cases, hemostatic materials must have other functions, including the promotion of healing and prevention of adhesion. Herein, a series of fibrosis-suppressive functional cRGD-modified crosslinking hyaluronic acid sponges were prepared. The in vitro hemostatic efficiency and mechanism were determined using blood clotting time, blood coagulation index, lactate dehydrogenase (LDH) and thromboxane B2 (TX-B2) ELISA, and proteomics. Among the prepared sponges, both poly(ethylene-b-L-Phe) (PEBP)-and cRGD contained SPN4 and exhibited the highest platelet concentration and activation efficiency as well as the most effective coagulative effect. In addition, no significant cytotoxicity was observed for the sponges in rat airway epithelial cells. The in vivo hemostatic and adhesion-preventive effects of the sponges were evaluated using rat models of liver injury and sidewall defect-cecum abrasion. PEBP-containing sponges effectively prevented postoperative adhesion and cRGD-modified sponges exhibited excellent hemostatic effects. Finally, the comprehensive repair effects of the sponges were evaluated using a rabbit maxillary sinus mucosal injury model, based on CT, MRI examination, and pathological staining. SPN4 exhibited the best comprehensive reparative effects, including the promotion of mucosal repair and infection inhibition. Thus, SPN4 is a promising multifunctional hemostatic material.

Study on the effect of different angles on the propagation characteristics of acoustic emission signals in wood.

To explore the propagation characteristics of acoustic emission (AE) signals in wood at different angles. The AE signals at different angles were obtained by changing the angle of incidence by sawing the inclined surfaces at different angles. The Zelkova schneideriana specimen was sawn 5 times with an increment of 15°, and 5 different incidence angles were obtained. AE signals were collected by 5 sensors arranged equally on the surface of the specimen, AE energy and energy attenuation rate were calculated. The reflection signals corresponding to different angles were collected on the uncut specimen by changing the position of the sensors, and the propagation speed of the AE signals at different angles was calculated. The results showed that the kinetic energy provided by the external excitation is small, and the AE energy is mainly provided by the displacement potential energy. With the change of the incidence angle, the AE kinetic energy changes significantly. With the increase of the reflection angle, the speed of the reflected wave also continued to increase, and finally stabilized at 4600 m/s.

Study on Attenuation Characteristics of Acoustic Emission Signals with Different Frequencies in Wood.

To study the effect of frequency on the attenuation characteristics of acoustic emission signals in wood, in this paper, two types of hard wood and soft wood were studied separately, and the energy attenuation model of the propagation process of AE sources with different frequencies was established. First, using the piezoelectric inverse effect of the AE sensor, an arbitrary waveform generator was used to generate frequency-tunable pulses in the range of 1 kHz to 150 kHz as the AE source, where the AE source energy could be regulated by the output voltage level. Then, five AE sensors were placed at equal intervals of 100 mm on the surface of the specimen to collect AE signals, and the sampling frequency was set to 500 kHz. Finally, the energy value of AE signal of each sensor was calculated based on the AC principle, and the energy attenuation model was established by exponential fitting. The results showed that both the amplitude and energy of the AE signals of different frequencies showed negative exponential decay with the increase of propagation distance, and, at the same frequency, the change of AE source energy level had no significant effect on its attenuation rate. Compared with hard wood, the energy attenuation of the AE signal of soft wood was more sensitive to the change of frequency, and, at the same frequency, the attenuation rate of soft wood was smaller than that of hard wood.

Early variations in lymphocytes and T lymphocyte subsets are associated with radiation pneumonitis in lung cancer patients and experimental mice received thoracic irradiation.

There were no ideal markers to predict the development of radiation pneumonitis (RP). We want to investigate the value of variations of lymphocytes and T lymphocyte subsets in predicting RP after radiotherapy (RT) of lung cancer based on previous clinical findings. A total of 182 lung cancer patients who received RT were retrospectively analyzed. Circulating lymphocytes and T lymphocyte subsets were measured before, during, and after RT. Patients were evaluated from the start of RT to 6 months post-RT. A mice model with acute radiation-induced lung injury was established and circulating lymphocytes were measured weekly until 8 weeks after irradiation. Univariate and multivariate analyses were adopted to identify risk factors of RP. Lymphocyte levels significantly decreased (P < .001) in patients before RP symptoms developed that also was able to be seen in the mice model and the values recovered during remission of symptoms. The decrease in lymphocyte count reflected the severity of RP. Meanwhile, CD4+  T lymphocyte count was significantly lower during the occurrence of symptoms in patients with RP than in those without RP (P < .001), and it improved along with RP recovery. Levels of lymphocytes and CD4+  T lymphocyte subsets proved as independent predictors of RP. Here we showed that lower peripheral blood levels of lymphocytes and CD4+  T lymphocyte were associated with an increased risk of RP, which was validated by this mice model, and thus are associated with differences in radiation-induced lung toxicity among individuals and help identify those who are susceptible to developing RP after RT.

Stereotactic Body Radiotherapy Is Effective in Modifying the Tumor Genome and Tumor Immune Microenvironment in Non-Small Cell Lung Cancer or Lung Metastatic Carcinoma.

Background and Purpose: To directly reveal the change in genome mutation, RNA transcript of tumor cells, and tumor microenvironment (TME) after stereotactic body radiotherapy (SBRT) in paired human lung tumor specimens. Materials and Methods: Paired tumor samples were collected from 10 patients with non-small cell lung cancer (NSCLC) or lung metastatic carcinoma within a week before and after SBRT. DNA and RNA of tumor tissues was extracted from the paired samples. Whole-exome and RNA sequencing assays were performed by next-generation sequencing. Gene mutation, genomic expression, T-cell receptor (TCR) repertoire, and profiling of tumor-infiltrating immune cells were analyzed through bioinformatics analysis in paired tumor samples. CD8+ T-cell infiltration and PD-L1 expressions were detected by immunostaining in tumor tissues. Results: The diversity of TCR repertoire and PD-L1 expression increased significantly in the TME, and the most enriched term of the gene ontology analysis was the immune response gene after receiving SBRT. SBRT induced neo-mutation of genes in tumor cells but did not increase tumor mutation burden in tumor tissues. TME displayed complex immune cell changes and infiltration and expression of immune-regulating factors such as C-X-C motif chemokine (CXCL) 10, CXCL16, interferons (IFNs), and IFN receptors. CD8+ T-cells in tumor tissues did not improve significantly after SBRT while the infiltrating TH1 and TH2 cells decreased remarkably. Conclusion: SBRT improved the TCR repertoire diversity and PD-L1 expression in the TME and induced neo-mutation of genes in tumor cells but did not increase CD8+ T-cell infiltration and IFN expression in the tumor tissue within a week.

LITAF Enhances Radiosensitivity of Human Glioma Cells via the FoxO1 Pathway.

Lipopolysaccharide-induced tumor necrosis factor alpha factor (LITAF), also called p53-induced gene 7 (PIG7), was identified as a transcription factor that activates transcription of proinflammatory cytokines in macrophages in response to lipopolysaccharide (LPS). Previous studies have identified LITAF as a potential tumor suppressor in several neoplasms, including prostate cancer, B-NHL, acute myeloid leukemia, and pancreatic cancer. However, the expression and function of LITAF in human glioma remain unexplained. The present study aimed to analyze the regulation of LITAF in gliomas. Data from The Cancer Genome Atlas (TCGA) database revealed that LITAF mRNA expression in glioma tissues was higher than that in normal brain tissues, and lower LITAF expression in gliomas showed a good prognosis in patients who received radiotherapy, by Kaplan-Meier analysis. In our collected specimens, however, LITAF showed low expression in glioma tissues compared to that in the normal brain tissue. Proliferation and apoptosis of glioma cells were not affected by knockdown or overexpression of LITAF in glioma U251, U373, and U87 cells, but LITAF was able to enhance the radiosensitivity of glioma cells. Furthermore, we found that LITAF enhanced radiosensitivity via FoxO1 and its specific downstream targets BIM, TRAIL, and FASLG. Taken together, our present results demonstrate that LITAF expression is decreased in glioma tissues and might enhance radiosensitivity of glioma cells via upregulation of the FoxO1 pathway.

Salmonella enterica serotype typhimurium and S. Stanley differ in genomic evolutionary patterns and early immune responses in human THP-1 cell line and CD14+ monocytes.

Salmonella Typhimurium and S. Stanley are the most prevalent serogroup B serovars to infect humans in Taiwan. The aim was to determine possible factors to influence the prevalence between S. Typhimurium and S. Stanley. Genotypes were determined by pulsed field gel electrophoresis (PFGE) analysis and the intracellular survival, phagocytosis, reactive oxygen species (ROS) production of human monocyte THP-1 cell and tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and IL-1ßexpression in peripheral blood CD14+ cells after infection were analyzed. 182 S. Stanley was clonal disseminated with main pulsotypes 2 from 2004 to 2007. Overall S. Typhimurium evolved more genotypes, while S. Stanley conserved in genotypes. Human blood CD14+ monocytes expressed TNF-α, IL-6 and IL-1ß differently among serovars and bacterial conditions (live vs. killed). Live S. Stanley and S. Typhimurium suppressed the TNF-α and IL-6 expression compared to killed bacteria. However, live S. Typhimurium stimulated more IL-1ß expression than the killed bacteria, but S. Stanley expressed similar IL-1ß levels in both conditions. Furthermore, S. Stanley and S. Typhimurium differed in intracellular survival in the THP-1 cells, an early decrease for S. Stanley, not for S. Typhimurium. Additionally, higher reactive oxygen species (ROS) production in THP-1 cells was found agsinst S. Stanley infection, not found in S. Typhimurium. However, some isolates of S. Stanley could recover from early loss to become more in the monocytes than S. Typhimurium. Difference in phagocytized number, intracellular survival, ROS production and IL-1ß expression may contribute to prevalence different between two serovars.

Overexpression of centrosomal protein 55 regulates the proliferation of glioma cell and mediates proliferation promoted by EGFRvIII in glioblastoma U251 cells.

The epidermal growth factor receptor (EGFR) is often amplified in glioma, with the most common extracellular domain mutation being EGFR variant III (EGFRvIII). Abnormal EGFRvIII signaling has been shown to be important in driving tumor progression. Centrosomal protein 55 (CEP55), a member of the centrosomal relative proteins family, participates cytokinesis in the cell cycle. It exists in a few normal tissues and various tumor cells. The expression and function of CEP55 in human glioma cells need to investigate. In this study, the expression of CEP55 was detected in 40 cases of glioma tissues and 10 cases of non-tumor brain tissue. The proliferation of glioblastoma U251 cells was analyzed after transfection with EGFRvIII and CEP55 siRNA. We found that the expression of CEP55 was increased significantly in the glioma tissues than in normal brain tissue. The proliferation of U251 cells increased remarkably after transfection with EGFRvIII. Knockdown of CEP55 inhibited proliferation of U251 cells and was able to eliminate the effect of promoting proliferation induced by EGFRvIII in U251 cells. CEP55 played a key role in the proliferation of glioma cells and mediated EGFRvIII-stimulated proliferation in glioma cells. CEP55 might be a novel molecular therapeutic target in patients with gliomas expressing EGFRvIII.

Paeoniflorin inhibits IL­1ß­induced expression of inflammatory mediators in human osteoarthritic chondrocyte.

Interleukin (IL)-1ß serves an important role in the promotion of the growth of osteoarthritis (OA) lesions. Paeoniflorin (PF) has been identified to exert anti­inflammatory and anti­arthritic effects. However, it is uncertain whether PF may affect the expression levels of inflammatory mediators in OA chondrocytes. Therefore, the objective of the present study was to determine the effects of PF on the expression levels of inflammatory mediators in IL­1ß­stimulated human OA chondrocytes. The results of the present study determined that PF inhibited the production of nitric oxide and prostaglandin E2 induced by IL­1ß, and the expression of inducible nitric oxide synthase and cyclooxygenase­2 in chondrocytes. Additionally, PF significantly inhibited the IL­1ß­stimulated production of metalloproteinase­3 (MMP­3) and MMP­13 in chondrocytes. PF inhibited the expression of nuclear factor­κB (NF­κB), p65 and NF­κB inhibitor α degradation was induced by IL­1ß in chondrocytes. The results of the present study suggest that PF may inhibit IL­1ß­induced expression of inflammatory mediators in human OA chondrocytes by suppressing the activation of the NF­κB signaling pathway. Therefore, PF may be a potential agent in the future treatment of OA.

Inhibition of EGR1 inhibits glioma proliferation by targeting CCND1 promoter.

BACKGROUND: Gliomas are the most common primary tumors in central nervous system. The prognosis of the patients with glioma is poor regardless of the development of therapeutic strategies. Its aggressive behavior mainly depends on the potent ability of proliferation. The transcription factor EGR1 (early growth response 1) is a member of a zinc finger transcription factor family which plays an essential role in cell growth and proliferation. METHODS: EGR1 expression levels in 39 glioma tissues and 10 normal brain tissues were tested by RT-qPCR and Western-blotting. The effects of EGR1 on U251 cells, U251 stem-like cells (GSCs), and U87 cells proliferation were assessed using in vitro and in vivo cell proliferation assays. The specific binding between EGR1 and CCND1 promoter was confirmed by CHIP assay. EGF was used to improve EGR1 expression in this assay. RESULTS: EGR1 expression levels in human gliomas are decreased compared with normal brain tissues, however, the patients with low EGR1 expression level showed significantly enhanced patient survival in all glioma patients. EGR1 silencing inhibited proliferation and induced G1 phase arrest in glioma cells. EGR1 contributed to proliferation by directly raising CCND1. Meanwhile, EGR1 overexpression induced by EGF was able to promote the proliferation of glioma cells. CONCLUSIONS: Our results show that stable knockdown EGR1 would inhibit glioma proliferation. The results suggest EGR1 showing lower expression in cancer tissues compared with normal tissues maybe still play an important role in tumor proliferation.

Prospective cohort study of the risk factors for stress fractures in Chinese male infantry recruits.

OBJECTIVE: To determine potential risk factors that could predict stress fractures over an 8-week basic military training in Chinese male infantry recruits. METHODS: Recruits from three infantry units enrolled in this prospective study. At baseline, demographic data, personal history of stress fractures, mean duration of weekly exercise and smoking history were recorded on questionnaires and blood samples taken for analysis of bone turnover biomarkers and genetic factors. RESULTS: Of the 1516 male recruits who volunteered to participate in the study, 1398 recruits provided data for analysis. In total, 189 stress fracture cases were observed (incidence rate: 13.5%) during the 8-week training period. Recruits with stress fractures had a significantly higher incidence of prior fracture history and lower exercise level prior to enrolment compared with those without stress fractures. A significant difference in both allelic frequency and genotypic distribution of the growth differentiation factor 5 (GDF5) gene rs143383 polymorphism was observed between recruits with and without stress fractures. However, no difference in serum bone turnover biomarkers was detected between groups. CONCLUSION: This prospective, cohort study indicates that fracture history, lower exercise level and GDF5 rs143383 may be predictive risk factors for stress fractures in Chinese male infantry recruits.

A SNP in the 5'UTR of GDF5 is associated with susceptibility to symptomatic lumbar disc herniation in the Chinese Han population.

PURPOSE: The aim of the present study is to assess whether the single nucleotide polymorphism in the GDF5 (+104T/C; rs143383) is associated with the symptomatic lumbar disc herniation in the Chinese Han population and the identification of the mechanisms of its action. METHODS: This study consisted of 231 patients with symptomatic lumbar disc herniation as the case group and 370 patients who had a lifetime lack of symptoms as the control group. PCR products were genotyped. Thirty-eight disc specimens derived from the cases were analyzed by immunohistochemical staining. The stain intensity of immunohistochemistry was quantified using a computerized image analysis system. RESULTS: Significant differences in genotypic and allelic frequencies were found between case group and control group (TT genotype P < 0.001; CC genotype P = 0.002; T allele P < 0.001). The T allele was more frequent in the case group regardless of gender (Female P = 0.018; Male P < 0.001). Significant differences were found in the genotype frequencies when stratified by gender except the comparison between the CC genotype and other genotypes combined among the female samples (P > 0.05). A semi-quantification of collagen protein in the nucleus pulposus showed that the average collagen protein content in TC group was higher than in TT group (P < 0.05). CONCLUSION: Our results suggested that the GDF5 polymorphism is associated with a susceptibility to symptomatic lumbar disc herniation in the Chinese Han population and type II collagen in the nucleus pulposus may be a key factor in susceptibility to symptomatic lumbar disc herniation.

Effects of vibration in forced posture on biochemical bone metabolism indices, and morphometric and mechanical properties of the lumbar vertebra.

Epidemiological studies have shown a relatively strong association between occupational lower back pain (LBP) and long-term exposure to vibration. However, there is limited knowledge of the impact of vibration and sedentariness on bone metabolism of the lumbar vertebra and the mechanism of bone-derived LBP. The aim of this study was to investigate the effects of vibration in forced posture (a seated posture) on biochemical bone metabolism indices, and morphometric and mechanical properties of the lumbar vertebra, and provide a scientific theoretical basis for the mechanism of bone-derived LBP, serum levels of Ca(2+), (HPO4)(2-), tartrate-resistant acid phosphatase (TRAP), bone-specific alkaline phosphatase (BALP), and bone gla protein (BGP),the pathological changes and biomechanics of lumbar vertebra of New Zealand white rabbits were studied. The results demonstrate that both forced posture and vibration can cause pathological changes to the lumbar vertebra, which can result in bone-derived LBP, and vibration combined with a seated posture could cause further damage to bone metabolism. Serological changes can be used as early markers for clinical diagnosis of bone-derived LBP.

Effects of pulse current on endurance exercise and its anti-fatigue properties in the hepatic tissue of trained rats.

Fatigue is synonymous with a wide spectrum of familiar physiological conditions, from pathology and general health, to sport and physical exercise. Strenuous, prolonged exercise training causes fatigue. Although several studies have investigated the effects of electrical stimulation frequency on muscle fatigue, the effects of percutaneous pulse current stimulation on fatigue in the hepatic tissue of trained rats is still unclear. In order to find an effective strategy to prevent fatigue or enhance recovery, the effects of pulse current on endurance exercise and its anti-fatigue properties in exercised rats were studied. Rats were subjected to one, three or five weeks of swimming exercise training. After exercise training, rats in the treated group received daily applications of pulse current. All rats were sacrificed after one, three or five weeks of swimming exercise, and the major biochemical indexes were measured in serum and liver. The results demonstrate that pulse current could prolong the exhaustion swimming time, as well as decrease serum ALT, AST and LD levels and liver MDA content. It also elevated serum LDH activity, liver SOD activity and glycogen content. Furthermore, pulse current increased the expression of Bcl-2 and decreased the expression of Bax. Taken together, these results show that pulse current can elevate endurance capacity and facilitate recovery from fatigue.

Analysis of association between IL-1ß, CASP-9, and GDF5 variants and low-back pain in Chinese male soldier: clinical article.

OBJECT: Recent studies have suggested that genetic risk factors play an important role in the occurrence of low-back pain (LBP) and lumbar disc disease. The authors' study aimed to assess the association between 3 single-nucleotide polymorphisms (SNPs) and susceptibility to LBP related to military training. METHODS: In this case-control study, data from 892 Chinese male soldiers were retrospectively reviewed. The case group was made up of 305 soldiers with LBP related to military training and a control group of 587 soldiers without constant LBP for more than 2 weeks. Genomic DNA was extracted from peripheral blood leukocytes of all subjects and polymerase chain reaction products were genotyped. RESULTS: No association was found between the SNP of interleukin-1ß (IL-1ß; +3954C/T) and LBP at both the genotypic (p = 0.104) and the allelic (p = 0.098) level. However, the G allele of caspase-9 (CASP-9) and the T allele of growth differentiation factor 5 (GDF5) were more common in patients with LBP than in patients without LBP (p < 0.001). CONCLUSIONS: The findings in a Chinese military cohort indicated that CASP-9 (-1263A/G) and GDF5 (+104T/C) polymorphisms are associated with a susceptibility to LBP related to military training.

[Relationship between CNTF gene polymorphism and athletes training adaptation of muscle tissue].

OBJECTIVE: To explore the relationship between CNTF gene polymorphism and athletes training adaptation of muscle tissue. METHODS: A total of 215 new students without a training history CNTF genotype were recruited from a sports college. During training, the changes in test object biceps muscle belly cross-sectional area, muscle fatigue and muscle damage related biochemical indices were detected. And the impact of gene polymorphism was analyzed on the detection results. RESULTS: After training, biceps brachii muscle cross-sectional areas showed different degrees of growth and the GG gene type growth was greater than other genotypes (P < 0.05) . At post-training physical examination, all subjects of muscle fatigue and muscle damage index were higher than those of the control group, but no obvious difference existed between examination groups.In basic training at the end of physical examination, the related indices of each group were higher than those of the control group, but the values of lactic acid, blood urea nitrogen and serum CK value were lower for object type GG than those for the other groups [ (234.7±57.5) vs (84.7±24.7) U, (5.8±0.8) vs (4.3±0.6) mmol/L, (271.5±98.7) vs (59.2±35.6) U] (P < 0.05). CONCLUSION: During training, muscle cross-sectional area of GG genotype grows more while the serum levels of muscle injury are significantly lower than those of other groups. In summary, GG genotype has better muscle training adaptation than GA and AA.

[Treatment of unstable middle 1/3 of clavicular fractures with composite external fixator in adult patients].

OBJECTIVE: To explore methods and clinical effects of composite external fixtor in treating adult patients with unstable middle 1/3 of clavicular fractures. METHODS: From March 2008 to March 2011,36 patients with unstable middle 1/3 of clavicular fractures were treated with composite external fixtor. There were 24 males and 12 females, aged from 18 to 55 years old with an average of 43 years old. Twenty cases on the left side and 16 cases on the right side. Time from injury to operation was 2 to 6 days (averaged 3.5 days). According to Robinson classification, there were 7 cases with type 2A2, 18 cases with type 2B1, and 11 cases with type 2B2. No vessels and nerve damage occurred before opreation. The clinical effects were evaluated according to Neer scoring. RESULTS: All cases were followed up from 6 to 12 months with an average of 8 months. The mean Neer score was 88.3 +/- 6.2, which included pain 31.6 +/- 3.2, functional score 25.7 +/- 2.2, range of motion score 21.1 +/- 1.7, and anatomy score 8.8 +/- 0.8. There were 22 cases in excellent, good in 13, fair in 1. Two cases occurred pin tract infection. CONCLUSION: Composite external fixtor is an optional method in treating unstable middle 1/3 of clavicular fracture, and can obtain a good clinical effects.

ACTN3 R577X polymorphism and performance phenotypes in young Chinese male soldiers.

Alpha-actinin-3 (ACTN3) is absent in 18% of healthy Caucasian individuals owing to homozygosity for a premature stop codon (X) at amino acid 577 (rs1815739). Previous studies have shown a strong association between ACTN3 genotype and human athletic performance. In a study of 452 young Chinese male soldiers, we examined the distribution of ACTN3 genotypes and alleles and analysed the association between ACTN3 genotypes and athletic performance. We found that the frequencies of the ACTN3 R577X genotype (RR 39.8%, RX 43.4%, and XX 16.8%) and R577X allele (R 61.5%, X 38.5%) in young Chinese males were not significantly different from those in Caucasians. We only observed a significant association (P = 0.025) between ACTN3 R577X genotypes and grip strength. Participants with the XX genotype displayed significantly lower handgrip strength than individuals with the RR genotype (P = 0.021), but the difference between XX and RX means (P = 0.258) and that between RR and RX means (P = 0.42) was not significant. We did not observe a strong association between the ACTN3 R577X genotypes and sprint phenotypes or endurance phenotypes. In conclusion, our results indicate that the ACTN3 R577X polymorphism is most strongly associated with grip strength in young Chinese male soldiers.

Diagnosis and treatment of excessive lateral pressure syndrome of the patellofemoral joint caused by military training.

OBJECTIVE: To investigate the diagnosis and surgical treatment of excessive lateral pressure syndrome of the patellofemoral joint caused by military training. METHODS: Fifteen patients (patient group) and 18 healthy volunteers (control group) were involved in this retrospective study. Radiographs of the knee joints of all patients and volunteers were taken. The bone architecture was assessed, the trochlear angle, coincidence angle and patellofemoral joint index measured in both groups, and the resulting data compared. All 15 patients (17 knees) were treated by lateral collateral retinaculum release. Pre- and post-operative pain was evaluated with a visual analog scale (VAS). RESULTS: The differences between the two groups in coincidence angle (patient group: 7.67°± 5.81°; control group: -2.2°±-2.71°) and patellofemoral joint index (patient group: 2.49 ± 1.40; control group: 1.25 ± 0.15) were statistically significant. Subchondral bone sclerosis and osteophytosis in the patellofemoral joint were more pronounced in the patient group than in the control group. The VAS was higher preoperatively (7.06 ± 0.85) than postoperatively (6 months postoperatively: 3.87 ± 0.24; 1 year postoperatively: 3.01 ± 0.17), and the differences between preoperative and postoperative were statistically significant. CONCLUSIONS: Apart from the case history, typical symptoms and physical signs, X-ray examination is the most basic way to diagnose excessive lateral pressure syndrome of the patellofemoral joint, and the patellofemoral joint index is the most reliable for diagnosis. Lateral collateral retinaculum release with a small-incision is an effective treatment for this disease.

[Influences of perioperative metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery].

OBJECTIVE: To observe the influences of metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery. METHODS: Thrity patients (60 approximately 75 years) undergoing elective noncardiac surgery were randomly divided into a metoprolol group (n = 15) and a control group (n = 15). In the metoprolol group, metoprolol (0. 5 mg and 1.5 mg) was slowly injected into the vein of patients before the induction of intravenous anesthesia and after the tracheal intubation. The hemodynamic indice (invasive BP, HR and rate pressure product-RPP), the myocardial ischaemia indice (reversible ST segment depression of ECG II, V5 leads more than 0.1 mv or reversible ST segment elevation more than 0.2 mv from the baseline, ST segment depression or elevation over 1 min), the myocardial damage indice (serum cardiac troponin I, cTn I), and the indice of metoprolol cardiac and the respiratory adverse effects (incidence of HR below 50 beats/min, average doses of atropine, airway peak pressure) were observed intraoperatively. RESULTS: The HR and RPP were lower before the tracheal induction than the baseline (before anesthesia) in all patients, but there is no significant difference between the two groups (P > 0.05). During the tracheal intubation, the HR and RPP of the control group significantly increased, compared with the baseline (P < 0.05) and those of metoprolol group (P < 0.05). The incidence of perioperative hypertension was higher in the control group than that in the metoprolol group. The incidence of myocardical ischaemia episode was 30% in the control group, and 13% in the metoprolol group (P < 0.01). The release of cTn I was detected in 5 patients in the control group, and 2 patients in the metoprolol group (P < 0.05). The incidence of HR < 50 beats/min, and the average doses of atropine had no statistic difference between the two groups, but a tendency of high incidence of bradycardia in the metoprolol group occurred when abdominal viscera was tracted by surgical manupilation. There was no significant difference in airway peak pressure, SpO2 and PET CO2 between the two groups (P > 0.05). CONCLUSION: Intravenous administration of 0.5 mg and 1. 5 mg metoprolol before the induction of anesthesia and after the tracheal intubation has several advantages, including the decrease of myocardial oxygen consumption, the improvement of hemodynamic stability, and the lowering perioperative incidence of myocardial ischeamia and damage, but the tendency of high bradycardia incidence caused by peritoneal traction should be noticed.