Correlation between the expression of androgen receptor mRNA and the long-term tumor-specific and recurrence-free survival rate in patients with T1 bladder cancer / 国际外科学杂志

Objective To investigate the predictive value of androge receptors in stage pT1 non-muscle-invasive bladder cancer.Methods A total of 196 patients with stage pT1 non-muscle-invasive bladder cancer who underwent a transurethral resection of the bladder in Baoji People's Hospital from February 2003 to June 2012 were recruited to carry a retrospective analysis.The mRNA expression of the androge receptors transcript variants 1 (AR1) and 2 (AR2) was measured by quantitative real-time PCR.Spearman's correlation coefficient was used to analysis the correlation of androge receptors mRNA level to KRT5 and KRT20 mRNA.Results Kaplan-Meier analysis indicated that the recurrence-free survival,progression-free survival and cancer specific survival of patients with high AR1 mRNA expression (≥35.47) were significant better than patients with low AR1 mRNA expression (P ＜0.05).Multivariate COX regression analysis revealed that high AR1 mRNA expression was an independent prognostic marker for recurrence-free survival and cancer specific survival (P ＜ 0.05).Spearman rank correlation revealed a significant positive association between mRNA expression of AR1 and KRT5 (rs =0.3171,P ＜ 0.001) as well as a negative association with multifocal tumors (rs =0.1478,P ＜ 0.05).Conclusion Androge receptors mRNA expression can predict recurrence-free survival and cancer specific survival in patients with stage T1 nonmuscle-invasive bladder cancer.Further studies on the levels of androge receptors mRNA tend to be particularly important.

Effect of ceramic on ceramic total hip arthroplasty in Crowe IV developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH).</p><p><b>METHODS</b>From April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed.</p><p><b>RESULTS</b>The mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(=0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees.</p><p><b>CONCLUSIONS</b>Ceramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.</p>

Clinical observation on the treatment of periprosthetic infection of coagulase-negative staphylococci by two-stage revision / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision.</p><p><b>METHODS</b>From January 2005 to June 2015, 57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of (61.3±11.9) years old. According to the drug resistance of methicillin, the patients were divided into methicillin sensitive group(MSCoN) and methicillin resistance(MRCoN) group, 25 cases in MSCoN group(9 knees and 16 hips) included 12 males and 13 females, 32 cases in MRCoN group(11 knees and 21 hips) included 14 males and 18 females. Follow-up for at least 2 years, the inflammatory markers, incidence rate of sinus and the duration of the symptoms, reinfection or persistent infection rate after two-stage revision were compared between two groups.</p><p><b>RESULTS</b>MSCoN group and MRCoN group were followed up(81.7±38.3) months and(65.9±33.8) months, respectively;23 cases and 27 cases were successfully treated;there was no significant difference between two groups(=0.643). The patients who had surgery history were 4.04 times higher of failure than the patients without a history of surgery[OR=4.04, 95%CI(0.62, 26.5)]. Patients who had sinus were 4.26 times higher of failure than the patients without sinus[OR=4.26, 95%CI(0.7, 25.9)].</p><p><b>CONCLUSIONS</b>Two-stage revision is an effective procedure in treating patients infected by MSCoN and MRCoN. There is no significant difference of treatment failure rate between MSCoN and MRCoN group by two-stage revision. Surgery history and sinus maybe the risk factors of treatment failure, while methicillin-resistance is not.</p>

Mechanical complications with self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement / 中国骨伤

<p><b>OBJECTIVE</b>To study the complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.</p><p><b>METHODS</b>Between January 2006 and July 2016, 265 patients (266 hips) received a self-made, antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among those patients, there were 143 males(144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinman pins were made by a self-made mold system. Meanwhile, another antibiotic was added to the spacers according to the drug sensitivity test. Record if the infected prosthesis was removed, related complication with spacer(breakage and dislocation), Harris score, and control rate of infection.</p><p><b>RESULTS</b>The mean age of two-stage revision operation was(57.4±14.2) years. Thirty-nine patients(14.7%) used extended trochanteric osteotomy(ETO) to remove the infected prosthesis. And 38 patients occurred mentioned complications(14.3%). Spacer breakage occurred in 28 cases(10.5%) and dislocation occurred in 10 cases(3.8%). The mean follow-up time was(83.4±14.6) months. The Harris hip score was from 47.56±14.23 preoperatively to 86.43±12.84 at final follow-up(<0.05). The infection of 256 cases(96.6%) got control after revision operation. However, during postoperative follow-up, 4 cases occurred re-infection, and they were reoperated, and the infections obtained effective control after the operation. Thus total infection control rate was 95.1%(252/265).</p><p><b>CONCLUSIONS</b>Antibiotic-loaded cement articulating spacer made by a self-made mold system is effective in controling infection caused by hip replacement. Related complication is less with spacer by a mould enclosing two Steinman pins. Using metallic internal fixation or allograft bone combined with spacer does not affect infection control.</p>

Clinical results in early and mid term of using the S-ROM femoral stem in revision / 中国骨伤

<p><b>OBJECTIVE</b>To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty.</p><p><b>METHODS</b>From January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe IV), 5 cases for femoral neck fracture, 2 cases for necrosis of femoral head, 2 cases for proximal femoral deformity caused by early infection. The femur bone defects included Paprosky II in 11 cases, IIIa in 9, and IIIb in 1. Harris hip score , pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up.</p><p><b>RESULTS</b>The operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup, the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (=11.42,=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (=9.73,=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(=15.33,=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (=4.59,=0.00). The mean subjective satisfaction was 9.48(10 points system), 14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth, and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture, 3 cases of lesser trochanter fracture, 2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis, there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture, open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury, dislocation, infection and lower limb deep vein thrombosis and other complications at the final follow-up.</p><p><b>CONCLUSIONS</b>S-ROM prosthesis has satisfactory results in hip revision arthroplasty with Paprosky II and III femoral defects. Especially for patients with Crowe IV DDH and other proximal femoral deformities, it is possible to adapt to the medullary cavity morphology. Excellent initial stability, less complications and long-term biological fixation can be achieved with S-ROM in femur revision.</p>

New classification of Crowe type IV developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To compare differences between Crowe IV developmental dysplasia of the hip (DDH) with secondary acetabulum and Crowe IV DDH without secondary acetabulum,and determine whether it is necessary to divide Crowe IV DDH into two subtypes.</p><p><b>METHODS</b>From June 2007 to May 2015,145 hips of 112 Crowe N patients who underwent total hip arthroplasty (THA) using S-ROM stem were divided into two groups: secondary acetabulum formaton group (group A) and no secondary acetabulum formaton group (group B). In group A,there were 12 females, 96 males,with an average age of (39.38 ± 11.19) years old. In group B, there were 2 females, 35 males, with an average age of (38.19 ± 10.92) years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up. The differences between two groups were compared on dislocation height, canal flare index (CFI), subtrochanteric shortening osteotomy (SSTO) usage, pre- and post-operation Harris scores, complications.</p><p><b>RESULTS</b>The dislocation height for group A was (4.74 ± 1.57) cm, while the dislocation height for group B was (3.12 ± 1.15) cm. Significantly difference was detected between two groups. The CFI for group A was 2.69 ± 0.68, while the CFI for group B was 3.42 ± 0.79, and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18 ± 15.67 preoperatively to 91.20 ± 3.79 post-operatively and the difference was significant. Pre-operative Harris scores was 58.1 ± 15.3 in group A, 58.3 ± 16.9 in group B. Post-operative Harris scores was 91.0 ± 4.1 in group A, 91.0 ± 5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post-operatively. Complications of 4 cases peri-prosthesis fracture, 4 cases dislocation and 4 cases nerve injury occur in group A; While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected.</p><p><b>CONCLUSION</b>Crowe IV DDH with secondary acetabulum is significantly different from Crowe IV DDH without secondary acetabulum on dislocation height and femoral morphology, which causes the different selections of surgical techniques (SSTO usage or not). These important differences in fundamental parameters indicate the necessity to further divide Crowe IV DDH into IVA and IVB two subtypes.</p>

Relationship between screw numbers and severity of tibial bone defect in primary total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To summarize experience of using screws and cement to rebuild tibial bone defect in primary total knee arthroplasty (TKA) and to discuss the relationship between the number of required screws and the severity of tibial bone defects.</p><p><b>METHODS</b>From July 2009 to May 2015, 34 patients (40 knees) with varus knees underwent TKA, and the screw and cement technique was used to rebuild medial tibia plateau during operation. There were 8 males (8 knees) and 26 females (32 knees), and the average age was (65.00 +/- 7.25) years old (ranged,55 to 82 years old). One to 6 screws were used in each case. Extension stems were used in 2 cases (4 and 5 screws was used respectively). The area percentages of the bone defects measured as defect area/tibia plateau area, depth of each defect, the number of screws needed in each case, were all used to determine the relationship between the number of screws and the area percentage in certain depth of bone defect by statistic methods, as well as the relationship between screw number and defect depth.</p><p><b>RESULTS</b>All the patients were followed up and the average duration was 24 months (ranged, 1 to 72 months). The average preoperative HSS score was 43.33 +/- 6.11 (ranged, 32 to 51 scores). Whereas the average postoperative HSS score was 92.15 +/- 4.64 (ranged,83 to 96 scores). The preoperative individual scores including pain, function, activity, nuscle strength, flexion deformity and stability were all improved compared with preoperation,and the differences were statistically significant. All the patients received normal alignment postoperatively, femoraltibial angle was improved from (167.00 +/- 6.39) degrees preoperatively to (175.00 +/- 2.69) degrees postoperatively, the tibial angle was improved from (78.09 +/- 4.51) degrees preoperatively to (88.75 +/- 1.24) degrees postoperatively. Both area percentage and depth of bone defect in a fitting Ologistic model had a significant statistical relationship with the screw number, and a rectangular coordinate system could be formed according to the relationship.</p><p><b>CONCLUSION</b>Screws and cement technique is a simple, safe and convenient method to rebuild tibial bone defects in primary TKA and its short-term and midterm effect are both reliable. During opera- tion, according to the rectangular coordinate system, the screw number needed in the operation can be inferred form th area and depth of tibia defect, which could have a guiding function in surgery.</p>

Dentin barrier cytotoxicity test with three-dimensional cell cultures / 北京大学学报(医学版)

Objective:To evaluate the cytotoxicity of four dentin filling materials and two dentin adhe-sives with a dentin barrier test and to compare the results with those in a conventional filter diffusion test in order to investigate the advantages of the dentin barrier test.Methods: Eugenol cement, zinc phos-phate cement, adhesive glass ionomer cement, composite resin and two self-etching adhesives ( REMI BOND and Adper Easy One) were tested.In the dentin barrier test, L929 mouse fibroblasts were three-dimensional cultured in polystyrene meshes.The dentin disks were cut from the human third molars, near the pulp and in parallel with the occlusal surface, and their permeability within the measurement area was evaluated by a hydraulic permeability device.A mesh with the cells was placed in the “pulp cavity” of the chamber and one dentin disk was put on the cell mesh and its “pulp side” was in contact with the mesh.The test materials and controls were in contact with the“occlusal side” of the dentine disks for 24 h.The cell viability was obtained with MTT assay and the results were expressed as a percentage of con-trol tissues.The Mann-Whitney U test was used to make the statistical analyses.In the filter diffusion test, after a 24 h contact between the test materials and the filters with monolayer cells, the filters were dyed and the grades of cytotoxicity were decided.Results:A mean permeability of the dentin disks near the pulp was 0.293 μL/(min· cm2· cmH2O)(1 cmH2O=0.098 kPa);In the dentin barrier test, Eu-genol cement, REMI BOND and Adper Easy One respectively reduced the cell survival rates to 82%, 63%and 54%.Other materials showed no or very low toxic reactions; In the filter diffusion test, the light-curing composite resin was moderately cytotoxic, the dental adhesive glass ionomer cement was mild-ly cytotoxic and the others were severely cytotoxic;All the six materials in the dentin barrier test had low-er cytotoxicity than in the filter diffusion test.Conclusion:The cytotoxicity of the test materials using the dentin barrier test with three-dimensional cell cultures is lower than that in the filter diffusion test, which has good correlation with the clinical situation.

Effect of SiO₂-ZrO₂slurry coating on surface performance of zirconia ceramic / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of SiO₂-ZrO₂slurry coating on surface performance of zirconia ceramic.</p><p><b>METHODS</b>Seventy pre-sintered zirconia discs were randomly divided into seven groups with 10 discs per group. Sample discs in each group received one of the following seven different surface treatments, namely, sintered (group AS), sand blasting after sintered (group SB), coated with slurry of mole ratio of SiO₂to ZrO₂2:1 (group 2SiO₂-1ZrO₂), coated with slurry of mole ratio of SiO₂to ZrO₂1:1 (group 1SiO₂-1ZrO₂), coated with slurry of mole ratio of SiO₂to ZrO₂1:2 (group 1SiO₂-2ZrO₂), coated with slurry of mole ratio of SiO₂to ZrO₂1:3 (group 1SiO₂-3ZrO₂), coated with slurry of mole ratio of SiO₂to ZrO₂1:4 (group 1SiO₂-4ZrO₂). Profilometer, X-ray diffractometer (XRD), energy dispersive spectrometer, scanning electron microscopy (SEM) were used to analyze surface performance.</p><p><b>RESULTS</b>The surface roughness of the discs in group AS was lower than those in the other groups [(0.33 ± 0.03) µm] (P < 0.05), there was no statistically significant difference (P > 0.05) among group 2SiO₂-1ZrO₂[(3.85 ± 0.38) µm], group 1SiO₂-1ZrO₂[(3.78 ± 0.56) µm] and group 1SiO₂-2ZrO₂[(4.06 ± 0.48) µm], and no difference (P > 0.05) was observed between group 1SiO₂-3ZrO₂[(1.02 ± 0.09) µm] and group 1SiO₂-4ZrO₂[(1.53 ± 0.23) µm] either. However, surface roughness in all coating groups was higher than those in group SB [(0.86 ± 0.05) µm] (P < 0.05). According to the XRD pattern, group AS and all coating groups consisted of 100% tetragonal airconia and monoclinic zirconia was detected at surface of group SB. Contents of surface silicon of coating groups increased significantly, however, no silicon was detected at sample surface of group AS and group SB. SEM showed that zirconia grains of coating exposed since part of silicon was etched by hydrofluoric acid, a three-dimensional network of intergrain nano-spaces was created.</p><p><b>CONCLUSIONS</b>SiO₂-ZrO₂slurry coating could make surface of zirconia rough and increase Si content without creating monoclinic zirconia.</p>