Single-bundle modified patellar tendon versus double-bundle tibialis anterior allograft ACL reconstruction: a prospective randomized study.

PURPOSE: The purpose of this study was to prospectively compare the outcomes of single-bundle (SB) anterior cruciate ligament (ACL) reconstruction with modified bone-patellar tendon-bone (BPTB) allograft and double-bundle (DB) reconstruction with tibialis anterior allograft. METHODS: With 94 patients enroled in the study, 43 subjects who had SB ACL reconstruction with modified BPTB allograft (group S) and 41 subjects of DB ACL reconstruction with tibialis anterior allograft (group D) were followed up for a minimum of 2 years. Clinical outcomes including Lachman and pivot-shift tests, KT-1000 arthrometer measurements, and the International Knee Documentation Committee (IKDC) classification, Lysholm and Tegner activity scores were compared between the two groups at the last follow-up. RESULTS: The mean graft size of the group S, the anteromedial bundle and posterolateral bundle in group D were 9.9 ± 0.2, 7.5 ± 0.4 and 6.6 ± 0.4 mm, with statistically significant difference between the group S graft to either bundle of group D grafts (p < 0.001). At the last follow-up, there was no statistical difference between the two groups for the Lachman test, pivot-shift test and side-to-side difference. Substantial improvements in the subjective knee function scores were achieved in both groups, but without significant difference between the two groups. CONCLUSIONS: After a 2-year minimum follow-up, SB ACL reconstruction based on modified BPTB allograft achieved similar clinical outcomes to DB reconstruction with tibialis anterior allograft in knee stability, both anterior-posterior and rotational, as well as knee function. The modified BPTB allograft was recommended as an ideal graft option for the SB ACL reconstruction. LEVEL OF EVIDENCE: Therapeutic, randomized controlled study, Level II.

The horizontal Y-shaped graft with respective graft tension angles in anatomical two-bundle medial patellofemoral ligament reconstruction.

PURPOSE: Various techniques for medial patellofemoral ligament (MPFL) reconstruction have been described with two bundles of graft tensioned simultaneously. The present study was to introduce an anatomical reconstruction procedure using a horizontal Y-shaped graft with respective graft tension angles and report the preliminary results. METHODS: A surgical technique for MPFL reconstruction using a horizontal Y-shaped semitendinosus tendon autograft with two bundles tensioned at 0° and 30° of knee flexion was described in detail. The patellar stability was evaluated with the apprehension test and an axial computed tomography (CT) scan at 30° of knee flexion. The knee function was evaluated using the Lysholm and Kujala scores. RESULTS: No recurrent dislocation or subluxation was reported for 45 patients at a mean of 33.7-month follow-up. On CT images, congruence angle, patellar tilt angle, lateral patellar angle and lateral displacement were restored to the normal range. At the last follow-up, the mean Lysholm score improved from 51.8±6.2 to 91.7±4.1 and mean Kujala score was from 53.4±5.3 to 90.9±6.6 (P<0.01). CONCLUSIONS: The present anatomical MPFL reconstruction technique with a horizontal Y-shaped two-bundle graft tensioned at respective knee flexion angles could not only recreate the fan-shape of MPFL but also mimic the function bundles of native ligament. Clinical follow-up confirms the good restoration of the patellar stability and significant improvement of knee function without special complications. LEVEL OF EVIDENCE: Therapeutic, Level IV.

Suppression of KIF14 expression inhibits hepatocellular carcinoma progression and predicts favorable outcome.

The mitotic kinesin superfamily protein KIF14 is essential for cytokinesis and chromosome segregation and increased KIF14 expression is related to a variety of human cancers. In this study, we investigate KIF14 expression in association with clinical variables and the role of KIF14 during tumorigenesis. We found that KIF14 is overexpressed in most primary hepatocellular carcinoma (HCC) tissues compared with the adjacent normal liver tissues and KIF14 overexpression is associated with tumor grade (P = 0.002), stage (P = 0.013) and poor survival (P < 0.001). Downregulation of KIF14 decreased the capacity of proliferation both in vitro and in vivo. Furthermore, suppression of KIF14 not only decreases cancer cell migration but also induces apoptosis of cells with inactivation of the phosphatidylinositol 3-kinase-Akt signaling pathway. Therefore, our current study indicates that KIF14 promotes HCC carcinogenesis and may serve as a potential therapeutic target for human HCC.

Arthroscopic single-bundle ACL reconstruction with modified double-layer bone-patellar tendon-bone allograft.

PURPOSE: The objective of present study was to introduce a modified double-layer bone-patellar tendon-bone (BPTB) allograft for arthroscopic single-bundle ACL reconstruction and investigate the clinical outcomes. METHODS: From 2007 to 2009, a total of 136 patients underwent arthroscopic single-bundle ACL reconstructions with BPTB allograft. Of which, 66 patients were with double-layer BPTB allograft (Group 1), and 70 patients were with conventional BPTB allograft (Group 2). Clinical outcomes including Lachman and pivot-shift tests, KT-1000 arthrometer measurements, and Lysholm and Tegner activity scores were compared between the two groups at a 2-year minimum follow-up. RESULTS: Forty-six patients in each group were at a two-year minimum follow-up. The mean side-to-side difference on the KT-1000 arthrometer was 1.2 ± 1.2 mm for group 1 and 2.1 ± 1.9 mm for group 2, with significant difference between the two groups (p = 0.017). The knee function was significantly better for group 1 than for group 2, because the mean Lysholm score was 94.2 ± 4.8 points versus 86.6 ± 7.1 points (p = 0.000), and the median Tegner score was 8 (range 5-10) points versus 6 (range 4-10) points (p = 0.001). CONCLUSIONS: On the basis of the KT-1000 arthrometer evaluation and clinical measures, single-bundle ACL reconstruction with double-layer BPTB allograft achieves significantly lesser anterior laxity and better knee function than a single-layer allograft reconstruction. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study, Level III.

[Clinical observation of Stark cesarean section as secondary abdominal surgery].

OBJECTIVE: To analyze secondary abdominal surgery after Stark cesarean section. METHODS: A retrospective analysis of the secondary operation after cesarean section was performed. Group A was Stark cesarean section (n = 89), group B was the longitudinal incision cesarean section (n = 212), and group C was Pfannenstiel incision cesarean section (n = 52). Stark cesarean section was compared with Pfannenstiel incision cesarean section and the longitudinal incision cesarean section in abdominal wall scar healing, adhesion of rectus muscles, peritoneum, omentum, and healing or adhesion of visceral peritoneum. RESULTS: The rate of good abdominal incision healing and slender scar was 86.5% (77/89) in group A, 29.3% (62/212) in group B, and 75.0% (39/52) in group C, respectively. The rate of adhesion of rectus muscles was 25.8% (23/89) in group A, 53.8% (114/212) in group B, and 13.5% (12/89) in group C, respectively. The rate of adhesion of omentum was 13.5% (12/89) in group A, 56.1% (119/212) in group B, and 25.0% (13/52) in group C, respectively. The rate of peritoneal adhesion was 15.7% (14/89) in group A, 46.2% (98/212) in group B, and 11.5% (6/52) in group C, respectively. Only one case in group C the peritoneum was not healed. The rate of adhesion of visceral peritoneum was 15.7% (14/89) in group A, 55.2% (117/212) in group B, and 13.5% (7/52) in group C, respectively. Abdominal wall scar healing, adhesion of rectus muscles, omentum, peritoneum, and visceral peritoneum in group A were all better than group B. The difference was statistically significant (P < 0.05). There were no differences between group A and group C (P > 0.05). CONCLUSIONS: The study shows that the Stark cesarean section is better than the longitudinal incision cesarean section in healing of abdominal wall scar, adhesion of rectus muscles, omentum, peritoneum, and visceral peritoneum, but compared with Pfannenstiel incision cesarean section, there is no difference statistically. However, the advantages of the Stark cesarean section lie in short surgical time, few injury, little bleeding, quick recovery, and short hospital stay time, thus it should be further popularized.

[Risk factors of renal failure in the early post-liver transplantation period].

OBJECTIVE: To study the risk factors of renal failure in the early post-liver transplantation period. METHODS: 92 consecutive liver transplantation cases were reviewed and a multi-factor analysis of presumed risk factors of early post-transplantation period renal failure was conducted. The factors analyzed were total bilirubin level, prothrombin activity, onset of structural renal disease, onset of gastrointestinal hemorrhage, whether the patient underwent large-volume paracentesis, or underwent plasmapheresis therapy, needed renal replacement therapy, the operation method used, the bleeding volume during operation and the immunosuppressive agents used. RESULTS: Of the 92 patients, 29 (31.5%) developed acute renal failure (ARF) in the early postoperative period. Multi-factor analysis revealed a high pre-transplantation serum creatinine level and low prothrombin activity as risk factors for development of ARF. CONCLUSION: ARF is a frequent medical complication after liver transplantation. A high pre-transplantation serum creatinine level and low prothrombin activity are risk factors of its development.

Guanxinkang Decoction Exerts Its Antiatherosclerotic Effect Partly through Inhibiting the Endoplasmic Reticulum Stress.

Purpose. To investigate the antiatherosclerotic effect of Guanxinkang (GXK) decoction on the apoptosis, mitochondrial membrane potential (MMP), and endoplasmic reticulum stress (ERS) of human umbilical vein endothelial cells (HUVEC) pretreated with homocysteinemia (HCY). Materials and Methods. HUVEC were randomly divided into 5 groups: (1) blank control group (control), (2) model control group (model), (3) GXK low dose group, (4) GXK medium dose group, and (5) GXK high dose group. For the three GXK groups, HCY was given to reach the concentration of 3.0 mmol/L after HUVEC had been incubated with rabbit serum containing GXK for two hours. At 3, 6, 12, and 24 h after HCY had been incubated with the cells, the HUVEC were collected for test of the apoptosis rate, MMP, and GRP78 protein (reflecting ERS). Results. In the model control group, the apoptosis rate and GRP 78 protein expression of HUVEC significantly increased (P < 0.05), while MMP significantly decreased (P < 0.05) compared with the blank control group. After GXK treatment of medium and high doses, the apoptosis rate and the GRP 78 protein expression significantly (P < 0.05) decreased, while MMP significantly increased (P < 0.05) in a time-dependent manner compared with the model control group. Conclusion. GXK can antagonize the injury of HUVEC caused by HCY and the antagonism effect increases with the concentration and treatment duration of GXK, with the possible mechanism of GXK antagonism being through inhibiting ERS caused by HCY.

MiR-223 modulates multidrug resistance via downregulation of ABCB1 in hepatocellular carcinoma cells.

Multidrug resistance (MDR) has become a major impediment to a successful treatment for liver cancer patients, and one of the common reasons for MDR is the activation of ABCB1 gene, leading to the over-expression of P-glycoprotein (P-gp), which conferred cancer cells be resistant to a broad range of anticancer drugs. MicroRNAs (miRNAs) are a class of short, non-coding RNA moleculars that can regulate gene expression at the post-transcriptional level. In the current study, the aim is to explore whether miRNA participates in the regulation of MDR mediated by ABCB1. We found that the expression of ABCB1 was correlated with the doxorubicin IC50 dose in eight hepatocellular carcinoma (HCC) cell lines: Hep3B, HCC3, LM-6, SMMC7721, Huh-7, SK-Hep-1, HepG2 and BEL-7402. Using the bioinformatics, we discovered that there were several miRNAs that can bind to the 3'UTR of ABCB1 gene. Among these candidate miRNAs, miR-223 was chosen for further study. Then, EGFP reporter assay, real-time PCR and Western blot were performed to verify that miR-223 targeted ABCB1 3'UTR directly, and miR-223 downregulated ABCB1 at both mRNA and protein levels. Finally, we found that the over-expression of miR-223 increased the HCC cell sensitivity to anticancer drugs, and the inhibition of miR-223 had the opposite effect. Importantly, the over-expression or silencing of ABCB1 can rescue the cell response to the anticancer drugs mediated by miR-223 over-expression or inhibition, respectively. In conclusion, our findings indicated that miR-223 played an important role in the regulation of MDR mediated by ABCB1, and it suggests that miR-223 may be considered as a therapeutic biomarker for HCC patients who had MDR problems induced by high expression of ABCB1.