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Objective:To evaluate the application of 3D printed osteotomy template in total knee arthroplasty (TKA) for valgus knee.Methods:A retrospective analysis was performed of the 21 patients with valgus knee who had undergone TKA at Department Ⅰ of Joint Surgery, Orthopaedics Hospital of Zhengzhou from March 2016 to February 2018. They were 5 males and 16 females, aged from 62 to 78 years (average, 66.7 years). TKA was performed with the assistance of a 3D printed personalized osteotomy template for each patient. The efficacy of the personalized osteotomy templates was evaluated by comparing the femorotibial angle, knee range of motion, Hospital for Special Surgery (HSS) knee scores of the patients between preoperation and postoperation.Results:The 21 patients were followed up for a mean duration of 16.3 months(range, from 10 months to 4 years). All incisions healed by the first intention. The last follow-ups showed that their preoperative femorotibial angle 17.6°±5.7° was improved significantly to 6.3°±1.2°, their preoperative knee range of motion 71.3°±5.8° increased significantly to 102.4°±7.5°, and their preoperative HSS scores 38.2±5.7 increased significantly to 87.5±3.5 ( P<0.001). Their radiographic evaluation at the last follow-up showed stable prosthetic components with no implant loosing or osteolysis. Conclusion:A personalized 3D printed osteotomy template can be used in TKA for valgus knee, leading to accurate osteotomy, effective correction of mechanical alignment and satisfactory clinical outcomes.
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Objective To investigate the treatment of urinary tract obstruction after kidney transplantation, and to introduce the novel ‘antegrade percutaneous urinary tract throughout guidance technique’ with guide wire in selected patients. Methods 43 cases of renal transplantation patients due to urinary tract obstruction (ureteral stenosis and hydronephrosis in 24 cases, urinary calculi with or not ureteral stenosis in 19 cases) received endourological treatment. Retrograde pathway was tried firstly, if failed, antegrade pathway was adopted with‘antegrade percutaneous urinary tract throughout guidance technique’, 18 Fr percutaneous tract was established if necessary, endoscopy was needed in antegrade or combine with retrograde pathway. Results Of the 43 patients, 9 (20.9 %) patients were managed directly through the retrograde ureteroscopy, 28 (65.1 %) patients were managed with anterograde percutaneous technique in 18 Fr tract, 6 (14.0 %) patients were treated with ‘antegrade percutaneous urinary tract throughout guidance technique’. Operation time was (72.0 ± 16.0) (45 ~ 95) minutes. Postoperative stone clearance rate of 89.5 % (17/19). Of 32 cases with ureteral stricture, 6 (6/32, 18.8 %) cases were cured after one time of dilation and JJ stent indwelling for 2 months, 18 (56.3%) cases with stable hydronephrosis after 2-3 times of dilation and JJ stent indwelling, 5 cases (15.6 %) needed long-term repeated stent indwelling for drainage, 3 (9.4%) cases required nephrostomy tube drainage. Conclusion Minimally invasive treatment of urinary tract obstruction after renal transplantation is effective. Antegrade percutaneous urinary tract throughout guidance technique provided a powerful guarantee for retrograde operation and avoided the bleeding risk following percutaneous renal surgery, when combined with flexible ureteroscopy, urinary calculi in patients with kidney transplantation can be effectively managed with little trauma.
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BACKGROUND: Total hip arthroplasy is an effective method to treat hip disease caused by ankylosing spondylitis. Long-term fol ow-up studies have shown that there have been hip function problems after total hip arthroplasy, and it stil lacks of perfect rehabilitation programs. OBJECTIVE: To systematical y review the influential factors for dysfunction after total hip arthroplasy in ankylosing spondylitis patients. METHODS: The first and second authors retrieved PubMed and Sciencedirect Databases, CNKI, and Wanfang digital database for relevant articles published from January 1970 to July 2015. The key words were “arthroplasty, replacement, hip, spondylitis, ankylosing, function”. Final y, relevant articles were included. RESULTS AND CONCLUSION: A total of 40 articles were summarized, including 8 Chinese articles and 32 English articles. After total hip arthroplasy, hip function problems were mainly associated with patient’s factors, disease, surgery, prosthesis, postoperative recovery and postoperative complications. Avoiding above relevant factors can improve joint function after total hip arthroplasy for ankylosing spondylitis patients, and improve patient’s quality of life.
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Objective To evaluate the efficacy and safety of retrograde flexible ureteroscopic lithotripsy ( RFUL) with holmium:YAG laser for the treatment of renal stones with a large series.Methods The data of 466 patients who underwent RFUL with holmium:YAG laser for the treatment of kidney stones between January 2013 and December 2013 were collected.The maximum diameter of stone was 23 ±16 mm.The stone free rate, complications, retreatment rate were evaluated.Results Out of the 466 patients, the mean operative time and postoperative hospital stay were 33.5 ±18.8 min and 2.3 ±2.0 d.The stone free rate was 67.6% ( 315/466 ) after single procedure, which increased to 69.5% ( 324/466 ) via re-treatments after 3 months.The retreatment rate was 4.3%(20/466), with a total of 493 RFUL procedures performed and 1.06 times per patient.There were 67 (14.4%) cases undergoing complications.Five cases had false passage of ureter orifice causing slight ureteral wall injuries.Steinstrasse occurred in 9 cases, ureteral perforation in 3 cases and perirenal hematoma in 1 case.Overall postoperative fever rate was 10.7%(50/466) with urosepsis in 16 cases (3.4%).When the stone size was≤10, 11-20, 21-30, 31-40, and >40 mm, the stone free rates after a single procedure were 97.0% ( 65/67 ) , 84.2% ( 160/190 ) , 63.1%(70/111), 29.2%(14/48), 12.0%(6/50) (P<0.001), and the postoperative fever rates were 1.5%(1/67), 9.5%(18/190), 13.5% (15/111), 14.6% (7/48), 18.0% (9/50), respectively. The postoperative fever rates were 19.3%(27/140) and 7.1%(23/326) (P<0.001) in the patient with positive and negative preoperative urine leukocyte, and 22.0% ( 22/100 ) and 7.7% ( 28/366 ) ( P <0.001) in patients with positive and negative preoperative urine culture.Conclusions RFUL with holmium:YAG laser is a safe and effective treatment for kidney stones.The postoperative fever rate would increase and stone free rate would reduce with the increased stone size.
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@#Folic acid(FA)was conjugated with bovine serum albumin(BSA)to form targeting material. BSA-coated cationic nanostructure lipid carriers(BSA-cNLCs)and folate-BSA-coated cationic nanostructure lipid carriers(FA-BSA-cNLCs)were prepared by film dispersion. The particle sizes of BSA-cNLCs and FA-BSA-cNLCs were 81. 4 nm and 79. 8 nm, while their Zeta potentials were +5. 12 mV and +3. 74 mV. Both nanostructure lipid carriers showed spherical shape. Paclitaxel encapsulation efficiency of them were more than 97%, with drug loading efficiency of about 3. 7%. In vitro experiments confirmed that the uptake of FA-BSA-cNLCs by overexpressed folate receptor SKOV3 cells was significantly higher than that of BSA-cNLCs, demonstrating that FA-BSA-cNLCs were obviously targeted to SKOV3. Blood and tumor pharmacokinetics showed that there was no significant differences between BSA-cNLCs and FA-BSA-cNLCs. This suggested that modified FA on the surface of the preparation had no effect on its in vivo behavior. Tumor inhibition of BSA-cNLCs and FA-BSA-cNLCs were 72. 08% and 80. 75%, repectively, which indicateds that FA-BSA-cNLCs improve anticancer efficacy in vitro and in vivo, and that it could be a potential preparation for the treatment of cancer.
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Objective To observe the change of serum smooth muscle myosin heavy chain (smMHC) level in the patients with aortic dissection (AD),and evaluate the effect of smMHC in the early diagnosis and prognosis of AD.Methods Forty-two patients with AD were selected as AD group,30 healthy subjects were selected as control group.Blood samples were collected at four time periods (within 3 h of onset,6 h,12 h,24 h),and serum smMHC level were measured by enzyme-linked immunosorbent assay.Results Serum smMHC level of AD group,which collected (within 3 h of onset,6 h,12 h) were significantly higher than that of control group [(88.6 ±21.7),(59.4 ± 18.7),(41.3 ± 10.7) ng/L vs.(17.2 ± 8.3) ng/L,P ＜ 0.01].There was no significant difference between the serum smMHC level of AD group and control group at 24 h after onset [(18.9 ±9.5) ng/L vs.(17.2 ±8.3) ng/L,P ＞ 0.05].Serum smMHC level of Stanford A type group (25 cases) was higher than that of Stanford B type group (17 cases) within 3 h of onset [(95.4 ± 17.8) ng/L vs.(78.5 ± 18.3) ng/L,P＜0.01],and there was no significant difference bewteen the two groups which collected at 6,12 h and 24 h after onset (P ＞ 0.05).Preoperative serum smMHC level was significantly higher than that after intracavitary isolation operation [(58.6 ± 15.9) ng/L vs.(30.1 ± 12.5) ng/L,P ＜ 0.01].Serum smMHC level decreased rapidly after the operation,and there was no significant difference between the two grougs when 12 h after operation [(18.7 ± 8.9) ng/L vs.(17.2 ± 8.3) ng/L,P ＞ 0.05].The serum smMHC level of the deaths (7 cases),which collected within 3 h of onset,6 h,12 h,was significantly higher than that of the survivors (35 cases) [(101.2 ± 20.7) ng/L vs.(86.1 ± 18.9) ng/L,(65.2 ± 16.7) ng/L vs.(58.2 ± 14.2) ng/L,(50.4 ± 10.8) ng/L vs.(39.5 ± 8.3) ng/L,P ＜ 0.05],and there was no significant difference at 24 h after onset (P ＞ 0.05).Detecting serum smMHC level within 3 h of onset,the area under the receiver operating characteristic curve was 0.913,with 51.7 ng/L as a diagnostic critical value,sensitivity and specificity respectively was 88.1％ (37/42) and 96.7％ (29/30).When detecting at 6 h after onset,the area under the curve was 0.865,with 38.5 ng/L as a diagnostic critical value,sensitivity and specificity respectively was 90.4％(38/42) and 90.0％ (27/30).Conclusions The level of serum smMHC in patients with AD increase rapidly after onset,and detecting serum smMHC level within 6 h of onset have important clinical significance in early diagnosis and prognosis of AD.
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Objective To evaluate the efficacy and advantages of the technique by combined PCNL and retrograde intrarenal surgery (RIRS) in a second stage to treat the complex renal stones in solitary kidney cases.Methods PCNL most with a single 18-24 F tract was performed first and RIRS was carried out at a second stage in solitary kidneys of 21 patients,of which congenital in 14.3％ (3 cases),contralateral nephrectomy in 42.8％ (9 cases),and functional solitry kidneys in 42.8％ (9 cases).Of the 21 patients,the average age was 45 years with 15 males and 6 females.The stones were 8 multiple,6 partial staghorn,and 7 complete staghorn with a mean size of 4.6 (3.8-6.8) cm.Results Of the 21 PCNL cases,a single tract,double,triple tracts were established in 18 (85.7％),2 (9.5％),1 (4.8％) cases,respectively.Mean operation time of PCNL was 95 (45-175) min.After 1 day of PCNL,all case had residual stones with a mean size of 1.9 (1.0-3.5) cm.Two case occurred fever after PCNL and one case presented bleeding resolved by selective renal artery embolization.The mean operation time of RIRS was 72 (35-95) min.Stone-free rate after RIRS was 85.7％ (18/21).The final stone free rate increased to 95.2％ (20/21) after one case received a second-look PCNL and two cases accepted ESWL.Two cases occurred fever and steinstrasses after RIRS resolved by rigid ureteroscopy.At the 3 months follow-up,renal function became stable,improved and worse in 71.4％ (n=15),23.8％ (n=5),and 4.8％ (n=l) of patients.Conclusions PCNL combined with RIRS could be an effective and safe option for complex stones in solitary kidneys with less bleeding,reduced tracts,minor complications and good renal function preservation.
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Objective To report our experience with minimally invasive percutaneous nephrolithotomy (MPCNL) in treatment of renal calculi in solitary kidneys. Methods From August 2000 to August 2010, 242 patients with renal calculi in solitary kidneys were treated by MPCNL, the data were reviewed retrospectively. Results The mean operative time was 68 min, the clearance rates were 79.3% (192/242) after first session and 88. 0% (213/242) after second-look MPCNL and ESWL, respectively. Postoperative fever happened in 18 cases. Twenty-one cases required transfusion, 10 cases received angiography and embolization. One case experienced perirenal hematoma and 1 case had pneumatothorax. Conclusions MPCNL has the advantages of less bleeding, high clearance rate and short hospital stay. MPCNL is an effective and feasible treatment option for renal calculi in solitary kidneys and should be the first line choice.
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Objective To determine the effects of polymorphism of A9570G in angiotensin I converting enzyme 2 gene ( ACE2) gene on cardiac dysfunction and ventricular remodeling after myocardial infarction. Methods 252 patients with old myccardial infarction were included in this study. They were classified according to their polymorphisms of ACE 2 gene analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Echocardiograms were used to determine left ventricular end diastolic diameters (LVEDd) , Left ventricular mass index (LVMI) , mitral flow pattern early diastolic and late diastolic peak flow ratio (E/A) and left ventricular ejection fraction ( LVEF). Results In male, LVEDd, LVMI, and LVEF had significant difference among ACE2 genotypes ( t = 2. 609,3.527and 2.063, P =0.010,0.001 and 0.041), and no significant differences in E/A( t =0.689,P =0.492). In female,LVEDd, LVMI, E/A and LVEF had no significant difference among ACE2 genotypes( F =0. 848, 0.077,0. 985 and 1.611, P = 0. 432,0. 926,0. 377 and 0. 205 ). Conclusion The polymorphism of A9570G in ACE2 gene may be associated with cardiac dysfunction and ventricular remodeling after myocardial infarction in male. ACE 2 gene polymorphism may be a genetic factor on cardiac dysfunction and ventricular remodeling after myocardial infarction.
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Objective To evaluate the clinical efficacy of endourologic treatment of benign uret-erointestinal anastomotic strictures in patients with urinary diversion. Methods Nine cases of benign ureterointestinal anastomotic strictures with a length of 1-3 cm following radical cystectomy and uri-nary diversion accepted endourologic treatment. 8 cases were treated by antegrade percutaneous ap-proach, 1 case by retrograde ureteroscopic approach. The strictures received balloon dilation, and ure-teral stents indewelled. Results In a follow up of 0.5-5.0 years, 1 case received percutaneous ne-phrostomy for complete ureterointestinal anastomotic atresia and refused to open operation reconstruc-tion. 5 cases had no recurrence after 2-3 endoscopic sessions. 3 cases needed long time ureteral stents indwelled. Conclusion Endourological technique for ureterointestinal strictures following urinary di-version avoided the disadvantages of open operation.
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Objective To study the association of the polymorphism of A9570G in ACE2 gene with the genetic predisposition of diabetic nephropathy (DN). Methods 312 patients with type2 diabetes(T2DM) were included in the study. All the patients were divided into DM group and DN group according to if onset of DN. PCRRFLP were used to observe the association of polymorphisms of A9570G in ACE2 gene with DN. Results G allele frequencies of male subjects were 57.9% in DM patients and 67.5% in DN patients (X2 = 1. 559 ,P =0.212) ,52. 4% and,52.1% in female DM and DN patients (X2 =0. 003 ,P =0.955). In female patients,genetype in DN patiants had no difference from that in DM patients (X2 = 0. 109, P = 0. 947). Conclusion The polymorphism of A9570G in ACE2 gane may not associated with the genetic predisposition of DN.
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OBJECTIVE To investigate the clinical features and causes of nosocomial infection in schizophrenics with tuberculosis so as to take effective measures for better prevention and treatment.METHODS A retrospective investigation was used to analyze the clinical features and causes of nosocomial infection in 207 schizophrenics with tuberculosis.RESULTS The rate of nosocomial infection in schizophrenics with tuberculosis was 39.13%.The main infection way was via respiratory tract,followed by skin,soft tissue and gastrointestinal tract.The period and degrees of tuberculosis,the history of smoking,psychiatric symptoms and the complications were the causes of nosocomial infection.CONCLUSIONS Controlling psychiatric symptoms actively,preventing and treating somatic complications,using antibiotics rationally and less or no smoking are the effective measures to avoid nosocomial infection in schizophrenics with tuberculosis.