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Objective:To investigate the correlation between basal ganglia (BG) enlarged perivascular space (EPVS; BG-EPVS) and cognitive and motor longitudinal changes in patients with newly diagnosed Parkinson′s disease and its different motor subtypes [tremor dominant (TD), postural instability and gait disorder (PIGD)].Methods:A total of 131 Parkinson′s disease patients from the Parkinson Progression Markers Initiative (PPMI) database were screened and their clinical data were collected at baseline, 1 year and 2 years of follow-up. The number of EPVS in different brain regions was assessed on axial T 2-weighted images by cranial imaging data, and they were divided into two groups according to the degree of EPVS: BG-EPVS- and BG-EPVS+. Parkinson′s disease patients were divided into TD and PIGD groups by Movement Disorder Society Unified Parkinson′s Disease Rating Scale (MDS-UPDRS) score, and the number and clinical data of EPVS were compared between the two groups, and the correlation between the number and degree of BG-EPVS at baseline and longitudinal changes in clinical outcome measures of Parkinson′s disease and its different motor subtypes (TD, PIGD) was analyzed. Results:BG-EPVS was positively correlated with age ( r=0.32, P<0.01), Hoehn & Yahr stage ( r=0.21, P<0.05), serum neurofilament light chain ( r=0.18, P<0.05) and Epworth Sleepiness Scale score ( r=0.20, P<0.05) in all Parkinson′s disease patients. At baseline and 2 years, the number of BG-EPVS was more in the PIGD group than in the TD group (11.0±4.2 vs 9.0±3.8, t=2.18, P=0.03; 16.3±6.7 vs 12.6±4.6 , t=2.71 , P=0.007;after correction).At baseline, more BG-EPVS in patients with Parkinson′s disease and its motor subtypes (TD, PIGD) was significantly associated with baseline motor outcomes ( β=0.66, P=0.01; β=0.64, P=0.008; β=0.91, P=0.009), but not with cognitive outcomes. By linear mixed effects model analysis, BG-EPVS numbers and moderate to severe BG-EPVS were positively correlated with motor outcomes over time in patients with Parkinson′s disease and its motor subtypes (TD, PIGD) ( β=0.51, P=0.008; β=0.59, P=0.025; β=0.80, P=0.038). After dividing BG-EPVS in Parkinson′s disease patients into different degrees, moderate to severe BG-EPVS was positively correlated with motor outcomes over time ( β=3.30, P=0.031). Conclusion:In this longitudinal study, bigger baseline BG-EPVS numbers were found to be positively associated with longitudinal changes in dyskinesia severity in Parkinson′s disease patients, not with cognitive changes, and be able to predict decline in motor function over a 2-year follow-up period.
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Objective@#To understand the relationship between lipid metabolism and heart rate deflection point (HRDP) in Tibetan children in the high altitude area of Ganzi, and to provide reference for effective obesity prevention and physical exercise intervention for Tibetan children.@*Methods@#From September to October 2019, 284 Tibetan primary school students living in Ganzi area were randomly selected. HRDP and deflection point speed with different body mass index (BMI) by increasing load method, as well as serum lipid metabolism were assessed. The correlation between the HRDP and lipid metabolism level was analyzed.@*Results@#There were statistically significant differences in serum leptin, adiponectin, total cholesterol, and triglyceride levels among the first and second grade Tibetan primary school students in the Ganzi high altitude area with different nutritional status ( F =22.16, 10.12, 11.24, 4.35, P <0.05). The heart rate values at the HRDP in the first and second grades, the third and fourth grades, and the fifth and sixth grades under different nutritional status were compared, and the differences were statistically significant ( F =3.35, 4.76, 4.68, P <0.05). Pearson correlation analysis showed that there were statistically significant correlations between HRDP and serum leptin in the obese, overweight, normal, and lean groups in the first and second grades of primary school ( r =0.66, 0.14, 0.45, 0.65 , P <0.05).@*Conclusion@#There is a close relationship between HRDP and lipid metabolism of Tibetan children in the high altitude area of Ganzi, and the heart rate at the deflection point can be used as an effective reference intensity for exercise intervention in plateau children.
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Objective@#To analyze the negative emotions of college students men who have sex with men (MSM) and associated factors, so as to provide reference for alleviating MSM anxiety and depression.@*Methods@#A total of 198 young MSM who had homosexual sex in recent 6 months during June 2019 to June 2020 were selected. Negative emotions were assessed by using Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). Logistic regression analysis was used to explore the related factors of negative emotion of young MSM in school.@*Results@#The proportion of young MSM with anxiety or depression was 42.93% ( n = 85). In the negative emotion group, score of specialty and social support rating scale (SSRS) <20 points, no publicity intervention, high number of anal sex (>2), occasional or non condom use in recent anal intercourse were 50.59%, 41.18%, 54.12%, 69.14 %, 77.64%, respectively, which were significantly higher than in the non negative emotion group (32.74%, 18.58%, 30.09 %, 47.79%, 57.52%) ( χ 2=6.15, 12.21, 5.20, 9.26, 10.11, P <0.05). Junior college, SSRS score <20, no publicity intervention, high number of anal intercourse (>2), occasional or non condom use in recent anal intercourse were positively correlated with negative emotions of young MSM in school ( OR values were 1.65, 1.14, 1.90, 2.15, 1.21, P <0.05).@*Conclusion@#Anxiety and depression are prevalent among young MSM in schools, which are closely related to educational background, SSRS score, the number of anal sex and condom use during anal intercourse.
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Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians’ ability to distinguish this disorder.
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Dendritic cells (DCs), a type of antigen-presenting cells (APC), are recognized as an important regulator of immune response and immune tolerance, and play a critical role in the host innate immunity and adaptive immunity. Previous studies have shown that the long-term parasization of Echinococcus in the host is strongly associated with the host immune tolerance induced by DCs. This review summarizes the research progress of the role of DCs in host immune tolerance caused Echinococcus infection, aiming to provide the theoretical basis and insights into the management and immunotherapy of Echinococcus infections.
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@#Objective To investigate the effect of ozone on oxidative stress and energy metabolism change of blood from aortic dissection (AD) patients for providing preliminary evidence of application of ozonated autohemotherapy (ozone-AHT) in AD patients. Methods Twenty AD patients (16 males and 4 females with a mean age of 48.51±10.21 years) were consecutively included in the First Affiliated Hospital of Harbin Medical University from March 2016 to August 2016, and blood samples were collected from all participants and ozonized in vitro at different ozone concentrations (0 μg/ml, 40 μg/ml, 60 μg/ml, 80 μg/ml, 160 μg/ml). Malondialdehyde (MDA), red blood cells (RBCs) superoxide dismutase (SOD), Na+-K+-ATP, 2,3-bisphosphoglyceric acid (2,3-DPG) at different ozone concentrations were evaluated by enzyme-linked immunosorbent assay (ELISA). Results In the control group (0 μg/ml), the content of postoperative MDA was significantly higher than that of preoperation (P<0.05). The contents of postoperative SOD, Na+-K+-ATP and 2,3-DPG were significantly lower than that of preoperation (P<0.05). The content of MDA at the concentrations of 40 μg/ml, 60 μg/ml, 80 μg/ml group increased after the operation (P>0.05), and the SOD, Na+-K+-ATP, 2,3-DPG decreased compared with the preoperation (P>0.05). But all the values were not statistically significant at the concentrations of 40 μg/ml, 80 μg/ml and 160 μg/ml respectively between preoperation and postoperation (P>0.05). Compared with other concentration groups, the content of preoperative and postoperative MDA increased in the ozone group (160 μg/ml), and oppositely, the contents of preoperative and postoperative SOD, Na+-K+- ATP and 2,3-DPG decreased (P<0.05). Conclusion The concentrations of 40 to 80 μg/ml of ozone can improve the antioxidant capacity of erythrocyte membrane, reduce oxidative stress in blood samples of AD patients and improve the energy metabolism of erythrocyte membranes, so the concentration range of ozone is safe and feasible for the ozone-AHT of perioperative AD.
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BACKGROUND: Postoperative anticoagulant therapy after hip and knee arthroplasties has been included in the perioperative management guidelines. However, the application of anticoagulant drugs accompanies with the risk of bleeding. Routine coagulation tests provide limited information about the quality of clots because they identify only the first stage of clotting, while thrombelastography provides a comprehensive assessment of coagulation function. But its practicality remains controversial and the research for bleeding after joint replacement is little reported. OBJECTIVE: To explore the distribution of thrombelastography parameters (time to initial fibrin formation, clotting time, α angle, and maximum amplitude) and to analyze the correlation of the four parameters with postoperative blood loss, thereby providing guidance for improving the safety and effectiveness of anticoagulant therapy. METHODS: Totally 148 patients with detection of thrombelastogram after arthroplasty from August 2015 to March 2017 in Sun Yat-sen Memorial Hospital, Sun Yat-sen University were enrolled, including 76 cases of total hip arthroplasty and 72 cases of total knee arthroplasty. Thrombelastography data were collected on day 1 postoperatively, and the perioperative blood loss was calculated. Structural equation modeling of each group was constructed to investigate the relationship of four parameters and total blood loss. RESULTS AND CONCLUSION: (1) In the structural equation modeling of hip and knee arthroplasties, the root mean square error of approximation was less than 0.08, goodness-of-fit index, adjusted goodness-of-fit index, normed fit index and comparative fit index was all higher than 0.9, and Parsi-mony goodness-of-fit index was less than 2, so the theoretical model was matched with the data. (2) There was a correlation of postoperative hemorrhage with time to initial fibrin formation, clotting time, α angle, and maximum amplitude. (3) That is to say, thrombelastogram can be used as an efficient tool in predicting bleeding after hip and knee arthroplasties. Future study based on this research will further verify the correlation and provide more information for its clinical practice.
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Objective To improve the detection accuracy of cerebral venous thrombosis (CVT) in the first imaging examination and to guide the treatment and improve the outcome. Methods Imagings of 17 CVT cases were retrospectively analyzed and the missed diagnosis and misdiagnosis reasons were summarized. Results All the 17 cases were taken CT examination. 7 cases were missed diagnosed and misdiagnosed. 2 of 7 cases were diagnosed as subarachnoid hemorrhage. 1 of 7 cases was diagnosed as the left occipital subacute subdural hematoma. 1 of 7 cases was diagnosed as the right frontal and parietal and occipital lobes cerebral hemorrhage. 1 of 7 cases was diagnosed as the left parietal and occipital lobes cerebral hemorrhage and broken into ventricles. 2 of 7 cases were diagnosed as negative. Conclusion To summerize the reasons of missed diagnosis and misdiag aosis of CVT can improve the detection accuracy in the first imaging examination.
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AIM To investigate the effects of drying temperature,growing area and plucking time on hederacoside C,α-hederin from leaves of Hedera helix L..METHODS Three batches of H.helix leaves plucked in different time from two growing areas were dried in a vacuum oven to the constant weight at 60 ℃,70 ℃,80 ℃,90 ℃ and 105 ℃,respectively.Two saponins in the processed leaves were determined by HPLC.The powders of the processed H.helix leaves of different batches were mixed with proper ratios,which were determined by least squares optimization method with constraints.RESULTS The content of hederacoside C in the processed H.helix leaves of the three batches increased while that of α-hederin decreased with increasing temperature.The relative error between measured value and desired contents of hederacoside C and α-hederin in the mixed H.helix leaves was less than 5.5％.CONCLUSION The effects of three factors on the content of two saponins in the H.helix leaves are in the order of drying temperature,growing area and plucking time.Mixing processed H.helix leaves of different quality statues reasonably can control the contents of two saponins in a certain range.
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Objective To study the effects of maca extract on exercise endurance and blood hormone levels in the rats. Methods Wistar rats treated with maca extract (2. 0, 4. 0, 8. 0 g/kg body weight) were freely swimming in the cir-culating water flow daily for 15 days. On the 16th day of experiment, the exercise endurance and blood noradrenaline (NA), estradiol (E2), and testosterone (T) levels of the rats were determined. Results The rats administered with maca extract at the doses of 2. 0, 4. 0, 8. 0 g/kg body weight for 15 d showed that the swimming time before sinking was in-creased by 32. 51%, 60. 04%, 106. 52%, the total swimming time was extended by 16. 99%, 56. 50%, and 101. 73%respectively ( P<0. 01 ); while the number of sinking was decreased by 18. 89%, 35. 89%, and 58. 06%, respectively (P< 0. 01), compared with those swimming rats without maca extract treatment. The noradrenaline level in the blood of rats treated with maca extract 2. 0, 4. 0, 8. 0 g/kg body weight was increased by 3. 30%, 6. 60%, and 16. 50%, respec-tively, compared with the control group, and increased by 42. 49%,47. 05%, and 60. 70%, respectively, compared with the swimming rats without extract treatment;the E2 level was increased by 132. 83%,102. 72%, and 62. 26% (P<0. 01) respectively, compared with the control group, while decreased by 23. 88%, 33. 72%, and 46. 95% (P<0. 01) respec-tively, compared with the swimming rats without extract treatment. The blood testosterone level was increased by 5. 11%, 37. 65%, and 123. 16% (P<0. 01) respectively, compared with the control group, and increased by 28. 98%, 68. 92%, and 173. 85%, (P<0. 01) respectively, compared with the swimming rats without extract treatment. Conclusions The results of this study demonstrate that maca extract has effect to resist fatigue and enhance exercise capacity in rats. The mechanism is associated with reduced blood E2 , and increased noradrenaline and testosterone levels in the blood of rats.
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Objective To study the effects of maca extract on exercise endurance and blood hormone levels in the rats. Methods Wistar rats treated with maca extract (2. 0, 4. 0, 8. 0 g/kg body weight) were freely swimming in the cir-culating water flow daily for 15 days. On the 16th day of experiment, the exercise endurance and blood noradrenaline (NA), estradiol (E2), and testosterone (T) levels of the rats were determined. Results The rats administered with maca extract at the doses of 2. 0, 4. 0, 8. 0 g/kg body weight for 15 d showed that the swimming time before sinking was in-creased by 32. 51%, 60. 04%, 106. 52%, the total swimming time was extended by 16. 99%, 56. 50%, and 101. 73%respectively ( P<0. 01 ); while the number of sinking was decreased by 18. 89%, 35. 89%, and 58. 06%, respectively (P< 0. 01), compared with those swimming rats without maca extract treatment. The noradrenaline level in the blood of rats treated with maca extract 2. 0, 4. 0, 8. 0 g/kg body weight was increased by 3. 30%, 6. 60%, and 16. 50%, respec-tively, compared with the control group, and increased by 42. 49%,47. 05%, and 60. 70%, respectively, compared with the swimming rats without extract treatment;the E2 level was increased by 132. 83%,102. 72%, and 62. 26% (P<0. 01) respectively, compared with the control group, while decreased by 23. 88%, 33. 72%, and 46. 95% (P<0. 01) respec-tively, compared with the swimming rats without extract treatment. The blood testosterone level was increased by 5. 11%, 37. 65%, and 123. 16% (P<0. 01) respectively, compared with the control group, and increased by 28. 98%, 68. 92%, and 173. 85%, (P<0. 01) respectively, compared with the swimming rats without extract treatment. Conclusions The results of this study demonstrate that maca extract has effect to resist fatigue and enhance exercise capacity in rats. The mechanism is associated with reduced blood E2 , and increased noradrenaline and testosterone levels in the blood of rats.
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BACKGROUND:Ankylosing spondylitis is an autoimmune disease at high inflammatory state, and its pathogenesis is stil unclear. Besides, there is a lack of entirely satisfactory curative strategies. OBJECTIVE: To explore the immunoregulation capability of bone marrow mesenchymal stem cels from ankylosing spondylitis patients on macrophages and the potential therapeutic use of bone marrow mesenchymal stem cels from healthy donors on ankylosing spondylitis. METHODS: Bone marrow mesenchymal stem cels were extracted from 21 healthy donors and 25 ankylosing spondylitis patients respectively, and passage 4 cels were used in subsequent experiments. A human monocytic cel line was induced to differentiate into macrophages. The phenotypic markers of bone marrow mesenchymal stem cels and macrophages were detected by flow cytometry. Expressions of tumor necrosis factor-α and tumor necrosis factor-α-stimulated gene 6 (TSG-6) proteins in the supernatant of co-culture system were detected by ELISA. Quantitative real-time PCR was applied to detect the mRNA level of cytokines secreted by bone marrow mesenchymal stem cels and macrophages. RESULTS AND CONCLUSION:The typical mesenchymal stem cel surface markers were expressed in both bone marrow mesenchymal stem cels from healthy donors and patients with ankylosing spondylitis, and CD68 was detected positively in induced macrophages. The protein and mRNA levels of tumor necrosis factor-α secreted by macrophages co-cultured with bone marrow mesenchymal stem cels from patients with ankylosing spondylitis were obviously higher than those from healthy donors (P < 0.05). TSG-6 secreted by bone marrow mesenchymal stem cels from patients with ankylosing spondylitis was lower than that by bone marrow mesenchymal stem cels from healthy donors in both RNA transcriptional and protein levels (P < 0.05). Our study demonstrates that bone marrow mesenchymal stem cels from patients with ankylosing spondylitis shows abnormal immunoregulatory function on inhibiting the tumor necrosis factor-α secretion from macrophages, which reveals a mechanism of immune disorder in ankylosing spondylitis. The therapeutic mechanism of bone marrow mesenchymal stem cels from healthy donors may work by secreting enough TSG-6 to inhibit the activation of macrophages in patients with ankylosing spondylitis, and thereby to decrease the secretion of tumor necrosis factor-α. Cite this article:Sun SH, Wang P, Su CY, Xie ZY, Li YX, Li D, Wang S, Su HJ, Wu XH, Deng W, Wu YF, Shen HY. Bone marrow mesenchymal stem cels derived from patients with ankylosing spondylitis show abnormal immunoregulation capability on macrophages. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(1):13-19.
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BACKGROUND:It is the key point to choose the right size of the prosthesis, and grasp the direction and thickness for osteotomy during total knee arthroplasty. In order to achieve the goal, accurate preoperative planning is very important. OBJECTIVE:To compare the accuracy of preoperative templating in total knee arthroplasty using conventional two-dimensional (2D) and computed tomography (CT)-based three-dimensional (3D) procedures (templating on 3D image&surgical rehearsing on rapid prototype technology-models), and to confirm the necessity of 3D evaluation for preoperative planning. METHODS:A total of 25 patients undergoing primary total knee arthroplasty were randomly selected, including 10 males and 15 females, at the age of 58 and 79 years old. 2D and 3D images were col ected from al patients. Preoperative templating was performed for each total knee arthroplasty using both conventional 2D radiographs and a CT-based 3D image model. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure. RESULTS AND CONCLUSION:The 3D procedure was found to be more accurate in predicting implant size of 80%femoral and 72%tibial components than those of the 2D procedure (4%femoral and 12%tibial components). Significant differences in the consistent rate of femoral and tibial prosthesis models were detected significantly (P<0.05). Kappa coefficient statistics demonstrated that goodness of fit of prosthesis model was good in 3D preoperative templating. Results confirmed that the superiority of 3D preoperative templating over 2D conventional evaluation is in predicting implant size, and provides more comprehensive information on skeletal anatomy.
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Collagen triple helix repeat containing 1 (CTHRC1) can repair the injured vessel by limiting the deposition of collagen and promoting cell migration.CTHRC1 is mainly regulated by Wnt-PCP signaling pathway,transforming growth factor (TGF)-bone morphogenetic protein (BMP) signaling pathway and extracellular signal-regulated kinase (ERK)-matrix metalloproteinase 9 (MMP9) signaling pathway.Recent studies have identified that CTHRC1 is aberrantly expressed in gastrointestinal cancers and associated with the occurring and development of cancers.
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BACKGROUND:Posterior stabilized femoral knee prosthesis needs additional condyle osteotomy to accommodate the tibial post and femur fossa structures. Intercondylar fossa on both sides connected at the femoral body with concentrated stress is a place easily affecting fractures. Differences in bone mass between different models of different brands did not have specific data, which was not convenient to select prosthesis for clinicians. OBJECTIVE: To compare the difference of intercondylar osteotomy data among clinical commonly used posterior stabilized knee prostheses (six imported and domestic brands), and to provide basis for the selection and application of the prostheses. METHODS:The current commonly used posterior stabilized knee prostheses (six imported and domestic brands) were used, including Zimmer NexGen LPS, Stryker Scrorpio NRG Knee-Flexed, Depuy PFC Sigma, Smith & nephew Genesis-2 PS, United-U1 and Wego GKPS. According to the osteotomy template, the osteotomy-surfaces consisting of femoral condyle starting section and cross section, distal section of femoral condyle, and back-oblique section were identified. The corresponding femoral prosthesis diameter lines included condylar ambilateral and anteroposterior diameters, width and depth of femoral intercondylar fossa. The above data were compared and measured. RESULTS AND CONCLUSION:The six kinds of knee femoral prostheses were different in ratio of ambilateral diameter and anteroposterior diameter, bone resection of intercondylar fossa, and geometry. Imported prostheses carry shorter diameters in femoral starting and cross sections, so it can catch more posterior condylar osteotomy. With increasing prosthesis sizes, the ratio of bone loss causing by width of intercondylar osteotomy is decreased among six brands. In al sizes, Stryker Scrorpio NRG Knee-Flexed catches shorter width of intercondylar osteotomy. Knee prosthesis osteotomy among six brands is different. The result of this study is not sufficient to evaluate the pros and cons between different prostheses, but as reserving bone is concerned, the design of less intercondylar osteoomy catches more advantages.
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Objective To analyze the relationship between UDP-glucuronosyltransferase 1A1 (UGT1A1)gene polymorphism and delayed diarrhea caused by FOLFIRI treatment.Methods Two hundred and one blood samples were taken from patients with metastatic digestive tract tumor before chemotherapy by FOLFIRI and then the UGT1A1 * 28 genetic polymorphism was performed.All the cases treated with FOLFIRI were chosen to be observed and recorded by situation of the delayed diarrhea during chemotherapy,and to analyze the relationship between UGT1A1 * 28 genetic polymorphism and grade 3 and 4 delayed diarrhea.Results The distributions of the genotypes in 201 metastatic digestive tract tumor patients were as follows:UGT1A1 * 28 wild-type genotype TA6/6 (155,77.11％),heterozygous genotype TA6/7 together with homozygous genotype TA7/7 (46,22.89％).In the 201 cases,the incidences of grade 1 and 2 delayed diarrhea in the patients carrying wild-type genotype and mutant type were respectively 45.16％ (70/155),39.13％ (18/46).The incidences of grade 3 and 4 delayed diarrhea were respectively 9.68％ (15/155),19.57％ (9/46),with no statistical difference (x2 =3.318,P =0.190).Conclusion The UGT1A1 * 28 polymorphism TA6/7 or TA7/7 can not increase the risk of grade 3 or more severe delayed diarrhea for the patients with metastatic digestive tract tumor after receiving FOLFIRI treatment.
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Objective To investigate the perioperative risk of deep vein thrombosis (DVT) in patients with hepatic cirrhosis that underwent total hip arthroplasty (THA), and to evaluate the safety and feasibility of individualized anti-coagulation treatment.Methods There were 25 patients complicating hepatic cirrhosis that underwent THA (from Jan.to Dec.2014), including 17 males and 8 females, aged 57.9t9.2 years.The primary causes of THA were avascular necrosis of the femoral head (eighteen cases) and osteoarthritis of the hip (seven cases).Low molecular weight heparin (LMWH) was applied for anti-coagulation treatment.Parameters of hepatic function and coagulation function of THA cases (randomized thirty cases, from Jan.2008 to Dec.2008) without hepatic cirrhosis were used as reference for monitoring.For the cases of massive blood loss or upper gastrointestinal hemorrhage, a LMWH administration pause and an administration of fresh frozen plasma and clotting factors were performed in order to maintain a hemorrage/coagulation balance.The clinical outcome of the hip joint was evaluated and complications were treated.A subsequent follow-up was also carried out after perioperative period.Results All cases received successful surgeries and followed up.The follow-up duration was 34± 15.7 months.The preoperative Harris hip score was 32.4± 10.2 points, while the most recent follow-up score was 82.9±6.1 points, which was statistically significant.Dislocation, periprosthetic fracture and periprosthetic infection were absent.All cases received individualized anti-coagulation treatments during peripoerative period.A hemorrage/coagulation balance was achieved.The dynamic parameter curves did not present excessive deviation from reference.One case encountered intermuscular hematoma of the lower limbs 48 hours postoperatively, which was solved by a LMWH pause and administration of fresh frozen plasma and clotting factors.One case suffered upper gastrointestinal hemorrhage five days postoperatively, which was controlled by a LMWH pause and the administration of somatostatin and proton pump inhibitor.Jaundic got worse in one case three days postoperatively but got relieved after treatment.Overt blood loss was 686t141.8 ml.Perioperative death, hepatic failure, hepatic encephalopath, hepatorenal syndrome were absent.No DVT was observed.Conclusion There are risks of DVT in patients of hepatic cirrhosis.Individualized anti-coagulation treatment is needed during perioperative period of THA.
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BACKGROUND:The anatomical structure of acetabulum is different for the developmental dysplasia of the hip, which is smal and shal ow, with abundant cal us and scar tissue. It is difficult to determine the diameter of cup and instal ation of the cup during arthroplasty. Loosening and survival of postoperative prosthesis were influenced by local mechanical changes. OBJECTIVE:Using the three-dimensional finite element analysis, the stress distribution in acetabular cup-bone interface after implanting cups with different diameters was studied during total hip replacement in treating the dysplasia of hip. METHODS:Pelvis of developmental dysplasia of the hip patients was selected in this study. Acetabulum in the dysplasia was scanned by spiral CT. The computer simulation technology was applied to reconstruct the three-dimensional model of the pelvic for observing the dysplasia of hip from CT scan picture. Implanting cups with different diameters were simulated. Then the pelvis and acetabular cup model were meshed. The mechanics analysis tool was used to analyze three-dimensional model. RESULTS AND CONCLUSION:For the developmental dysplasia, we chose cup with smal diameter that could lead to better bone bed inclusion of cup during total hip replacement. Smal diameter cup induced a smal contact area and increased unit area stress. On the other hand, with implanting the larger cup and increasing degree of acetabular grinding, the acetabular wal bone breaks more obvious, so that the stress (compressive stress and shearing force) concentration at the top of the acetabulum and uneven stress in the rest were apparent increasingly. Thus, in clinical practice, under the premise of the bone bed inclusion, a large diameter cup is helpful to good distribution of stress during total hip replacement, but the perforation of acetabular wal induced by enlarged bone bed should be avoided or minimized.
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BACKGROUND:There is a high risk for the elderly cervical spine surgery combined with cerebral infarction, whereas conservative treatment is often unable to resolve serious cervical lesions. OBJECTIVE:To discuss the surgical effects of anchor fixation via posterior approach on cervical spinal canal stenosis combined with cerebral infarction. METHODS:A total of 21 patients with cervical spinal canal stenosis combined with cerebral infarction who were admitted over the past 5 years accepted cervical posterior expensive open-door laminoplasty and fixation with wire anchors. Therapeutic effects were evaluated according to the Japanese Orthopaedic Association (JOA) scores. RESULTS AND CONCLUSION:Al the patients were fol owed up 6 to 24 months, averagely 15 months. Al patients were smoothly through the perioperative period. There were no acute severe cerebral infarction cases. Preoperative JOA score was (7.6±2.0) points averagely, and postoperative JOA score was (13.3±1.8) points averagely, showing a significant difference (P<0.01). Of the 21 patients, excellent effects were in 11 cases and good in 7 cases. The effective rate was 95%(20/21), and the excellent-good rate was 86%(18/21). The risk of surgical treatment of patients with cerebral infarction is higher, but it is not the absolute contraindication. Choosing the proper operation way is highly important. Cervical posterior expensive open-door laminoplasty and fixation with wire anchors can be used to reduce the risk of cerebrovascular accidents to some extent, and obtain an excellent clinical effect.
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BACKGROUND:Hepatic cirrhosis may adversely affect the outcome of major orthopedic surgery, such as total hip arthroplasty. Peri-operative treatment is the chal enge for al orthopedic surgeons. OBJECTIVE:To analyze the safety and feasibility of hip replacement surgeries in patients with hepatic cirrhosis. METHODS:Thirteen patients with hepatic cirrhosis that underwent hip replacement were retrospectively analyzed to evaluate the treatments and their efficacy before and after replacement. RESULTS AND CONCLUSION:Al 13 surgeries were successful y performed. Al cases were fol owed up for more than five months and were graded according to Child-Pugh Criteria for hepatic functional reserve preoperatively and postoperatively. Five cases of the seven preoperative grade A cases preserved grade A postoperatively during a two-week observation, while another two cases rose to grade B and needed hepatic conservation treatment before discharge. Two cases of the six preoperative grade B cases rose to grade C with developed jaundice and ascites. Of the two, one even suffered a complication of upper gastrointestinal hemorrhage 5 days after surgery. Somatostatin and proton pump inhibitors were administered to stop bleeding. Al cases gained a satisfying recovery. Harris hip score at fol ow-up showed favorable hip function. Hip replacement is safe and feasible for patients with hepatic cirrhosis when ful evaluation of hepatic function and appropriate perioperative management are ensured.