ABSTRACT
Objective:To study the collapse of the contralateral femoral head after the total hip arthroplasty (THA) in patients with bilateral steroid-induced femoral head necrosis leg-length discrepancy (LLD) influences.Methods:A total of 108 patients with bilateral steroid-induced femoral head necrosis who were treated in Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2014 to June 2016 underwent THA surgery on the hip joints that had symptoms and developed to Association Research Circulation Osseous (ARCO) Ⅲ. At the same time, the non-surgical hip-preserving treatment of the non-collapsed femoral head developed to the ARCO Ⅱ stage was performed. The follow-up period was 2 years, and 98 cases were finally included. According to the size of the leg-length discrepancy [LLD<3 mm group ( n=50), LLD≥3 mm group ( n=48)] and the type of leg-length discrepancy[non collapse side longer group ( n=58) and shorter group ( n=58)], the collapse of the femoral head and the THA were observed. Results:Finally, a total of 56 cases of femoral head collapse occurred in the non collapse side of the hip, of which 50 cases underwent THA within 24 months. There were significant statistical differences in THA and femoral head collapse between LLD<3 mm group and LLD≥3 mm group, non collapse side longer group and non collapse side shorter group ( P<0.05). The 2-year survival rate without collapse in the LLD<3 mm group and LLD≥3 mm group were 52.1% and 34.0%, respectively, and the 2-year survival rates in the longer and shorter non-collapsed limb groups were 56.9% and 22.5%, respectively. Compared with patients with moderate lesions, the survival rate of femoral heads in patients with larger lesions was lower ( OR: 4.25, 95% CI: 1.55-11.26; P=0.003). LLD<3 mm group ( OR: 0.24, 95% CI: 0.06-0.50; P<0.01) or non collapse side longer group ( OR: 0.13, 95% CI: 0.04-0.29; P<0.01) had lower risk of contralateral femoral head collapse after THA. Conclusions:For patients with bilateral steroid-induced femoral head necrosis who have collapsed lateral THA, postoperative leg-length discrepancy extremities is a potential risk factor for collapse of non-collapsed femoral head. LLD<3 mm and avoiding shortening of the uncollapsed limb may reduce the risk of collapse of the uncollapsed femoral head.
ABSTRACT
Objective:To observe the effect of bilateral thoracoscopic surgery for invasive thymoma complicated with myasthenia gravis,and to explore feasibility of surgical procedure.Methods:Bilateral thoracoscopic extended thymectomy was performed in one patient with invasive thymoma complicated with myasthenia gravis,with complete resection of thymus and anterior mediastinal adipose tissue through bilateral approach,and the curative effect was observed.Results:Bilateral thoracoscopic thymectomy for invasive thymoma had radical effects with rapid recovery after surgery,avoiding large surgical trauma and more complications in open surgery and flawed in removing contralateral fat and ectopic thymus with unilateral thoracoscope.Conclusion:Bilateral thoracoscopic extended thymectomy has radical effects for invasive thymoma complicated with myasthenia gravis,confirming its feasible surgical procedure.
ABSTRACT
Objective To evaluate the effect ofJiawei-Danggui-Buxue decoction in the treatment for the patients with hemorrhagic anemia after total knee arthroplasty (TKA).Methods A total of 63 TKA patients with hemorrhagic anemia were included, and were divided into the treatment group (31 patients) and the control group (32 patients). All patients started to take medicine the second day after surgery. The control group took the Ferrous Succinate Tablets and the treatment group took Jiawei-Danggui-Buxue decoction in the following 4 weeks. The Hb and Hct were detected,and the changes of TCM syndrome scores and the total effect rates of anemiawere observed.Results The total effect rate of TCM syndrome scores in the treatment group was 93.54%, which was significantly higher than control group 83.87% (P<0.05); The total effect rate of anemia in the treatment group was 90.32%, which is significantly higher than control group 75.00% (P<0.05). At the fifteenth day after operation,. And at the postoperative 29th day, the levels of Hemoglobin (129.61 ± 13.02 g/Lvs. 113.35 ± 15.46 g/L,t=6.245) and Hematocrit (0.45% ± 0.03 %vs. 0.41% ± 0.04%,t=5.962) in the treatment group were significantly higher than those in the control group (P<0.05).Conclusions TheJiawei-Danggui-Buxue decoctionimprovethe Hb, HCT and the clinical effect rates of anemia and TCM syndromes for the patients with hemorrhagic anemia after TKA.
ABSTRACT
Objective To explore the influence of OPN in eutopic glandular epithelial cells of endometriosis on the NF-κBp65 expression and its relationship with the cell invasion .Methods The eutopic primary glandular epithelial cells in 12 cases of endome-triosis were performed the primary isolation and culture .The cells were collected after 24 h OPN siRNA intervention .Western blot and RT-PCR methods were adopted to detect the expressions of OPN ,NF-κBp65 protein and its mRNA before and after interven-tion .The Transwell experiment was used to detect the change of cell invasiveness before and after intervention .Results The ex-pression of OPN protein and mRNA after interfering primary glandular epithelial cells by OPN siRNA was significantly decreased , and the difference was statistically significant (t1 =7 .92 ,t2 =9 .87 ,P<0 .05) .the expression of NF-κB p65 protein and mRNA after OPN siRNA interfering primary glandular epithelial cells was obviously weakened ,the difference was statistical significant (t=2 .38 ,P<0 .05) .the invasiveness of primary glandular epithelial cells after OPN siRNA intervention was significantly decreased ,the difference was statistically significant(t=2 .38 ,P<0 .05) .The expression of OPN and NF-κBp65 had a significantly positive corre-lation in eutopic endometrial glandular epithelial cells (r=0 .87) .Conclusion The expression of OPN and NF-κBp65 is significantly decreased after OPN siRNA interfering eutopic endometrial glandular epithelial cells ,therefore OPN most likely lead to the occur-rence and development of endometriosis via the NF-κB pathway .
ABSTRACT
<p><b>BACKGROUND</b>The acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty (THA). Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation. Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method.</p><p><b>METHODS</b>A total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers, cup inclination, and anteversion were measured radiographically. The paired t-test was used to compare left and right hip center heights. Scatter plots and Pearson's correlation coefficients were used to evaluate differences in hip center heights, cup anteversion, inclination angles, and medialized cup center distance compared to the contralateral hip joint.</p><p><b>RESULTS</b>Cup center height was significantly greater (P < 0.01) than contralateral hip joint center height (93.4% in the 0-5 mm range, 6.6% >5 mm). There was a weak correlation between hip center height difference and inclination (r = 0.376, P < 0.01) and between difference and anteversion (r = 0.310, P < 0.01) but no correlation between difference and outer cup diameter (r = 0.184, P = 0.058) or difference and medialized cup center distance (r = -0.098, P = 0.318).</p><p><b>CONCLUSIONS</b>Although this method did not exactly replicate anatomic hip center height, the clinical significance of cup center height and anatomic hip center height differences is negligible. This acetabular component placement method has high simplicity, reliability, and stability.</p>
Subject(s)
Humans , Arthroplasty, Replacement, Hip , Methods , Hip Joint , General Surgery , Retrospective StudiesABSTRACT
Objective To evaluate clinical safety and efficacy of autologous tissue antigens loaded dendritic cells (DC)in the treatment of elderly patients with gastric cancer.Methods Fresh tumor cells were isolated from surgical specimens in twenty patients with gastric cancer. Single cell suspensions were obtained and induced to apoptosis by heat shock. The apoptotic tumor cells were frozen before use.Peripheral blood mononuclear cells were isolated and cultured with recombinant human granulocyte macrophage-colony stimulating factor (GM-CSF) and interleukin-4 (IL-4).DCs were loaded with apoptotic tumor cells. The immunological and clinical responses were examined after the final vaccination. ResultsVaccination of dendritic cells was well tolerated and no toxicity was observed. The cytokine levels in serum such as IL-2(46 pg/mg vs 89 pg/mg), IL-12(44 pg/mg vs. 86 pg/mg) and IFN-γ(38 pg/mg vs.82 pg/mg) were increased after vaccinations as compared with pretherapy. DTH test were positive in five patients (5/10). The antigen special cells for CD8+/ IFN-γ+ were increased in five patients(5/10). The size of retroperitoneal lymph node of one patient was reduced. The tumor marker CEA level were decreased in five patients, stable in eight patient and increased in two patients.Conclusions Autologous DC vaccines loaded with autologous tumor antigens could improve function of non specific immunity and elicit specific T cells immunologic response and is one of safe and effective treatments for gastric cancer.
ABSTRACT
Objective To investigate the effect of Da-Cheng-Qi decoction on enteric functional disturbance in rats with acute experimental pancreatitis and its potential mechanism. Methods Seventy-two SD rats were randomly divided into sham operation group, acute pancreatitis (AP) group and Da-Cheng-Qi decoction treated group with 24 each. The AP model was induced by retrograde injection of sodium taurocholate (0.1 ml/100 g) into bitiopancreatic duet. Before modeling, the rats in treatment group received Da-Cheng-Qi decoction (2 g/100 g), and the rats in other two groups received 0.9% NaCl solution. The rats were sacrificed at 3, 6 and 12 hours with 8 each, and the blood samples were taken for detecting the level of amylase and the contents of 5-hydroxytryptamine (5-HT) by enzyme-linked immunosorbent assay. The colonic tissues 10 cm apart from trans-ligament incluing jejunum, terminal ileum and sigmoid colon were collected for examining the expressions of 5-HT_3 and 5-HT_4mRNA and proteins by RT-PCR and Western blotting respectively. Results ① The levels of serum amylase and 5-HT in AP group and treatment group were significantly higher than those in sham operation group (P<0. 01), but they were lower in treatment group than in AP group at each time points (P<0. 05). The level of 5-HT was increased in the initial stage and then decreased gradually both in AP group and treatment group. ③ The expressions of 5-HT_3 and 5-HT_4 mRNA and proteins were significantly decreased in the jejunum, terminal ileum and sigmoid colon in AP group compared with sham operation group (P<0. 01). Whereas the expressions of 5-HT_3 mRNA and protein,but not 5-HT_4, were increased in the treatment group in comparison with AP group (P<0.05). Conclusions The level of 5-HT is significantly increased in acute pancreatitis, but its receptors (5-HT_3 and 5-HT_4) are decreased, which may induce enteric functional disturbance. The Da-Cheng-Qi decoction may improve enteric dynamic failure by increasing the expression of 5-HT_4 and may be a choice for treatment of acute pancreatitis with enteric dynamic failure
ABSTRACT
Objective To determine the level and clinical significance of 5-hydroxytryptamine (5-HT) and intestinal fatty acid binding protein (iFABP) in patients of severe acute pancreatitis (SAP) with intestinal dysfunction. Methods The serum and urine in 42 cases of SAP with intestinal dysfunction were collected at day 1, 3 and 7 after admission, respectively. The numbers of bowel sounds were recorded. 20 health subjects were selected as the control. Results The numbers of bowel sounds in health subjects were 5.6 ± 2.3/min. The numbers of bowel sounds in SAP patients at day 1,3 and 7 were 2.3 ± 0.7/min, 1.7 ± 0.2/min and 3.1 ± 1.1/min, respectively;which were significantly lower than that in the control group (P < 0.01). The level of 5-HT in the control group was(86.7 ± 9.5)ng/ml, while the levels of 5-HT in the SAP patients at day 1, 3 and 7 were (112.0 ± 17.8) ng/ml, (130.5 ± 19.7) ng/ml, (107.9 ± 16.3) ng/ml. The level of urine iFABP in the control group was (90.5 ± 19.8) pg/ml, while the levels of urine iFABP in the SAP patients were (1250.2 ± 425.3) pg/ml, (1586.9 ± 523.4) pg/ml, (1154.6 ± 394.0) pg/ml. The levels of 5-HT and urine iFABP in the SAP patients all were significantly higher than those in the control group (P <0.01). The levels of 5-HT and urine iFABP in the SAP patients at day 3 were significantly higher than those in the day 1 and day 7, while there was no significant difference between the two groups. Conclusions Determination of serum 5-HT and urine iFABP in patients with early SAP could effectively evaluate the intestinal function, and it may have potential clinical significance.
ABSTRACT
Objective: To evaluate the prognostic factors of patients with stage Ⅳ gastric cancer. Meth-ods: A total of 138 patients with stage Ⅳ gastric cancer treated with platinum-based chemotherapy were ana-lyzed. Survival rate was estimated by Kaplan-Meier method. The prognostic factors were analyzed by univari-ate (Log rank) and multivariate (Cox model) analysis methods. Results: Univariate analysis and multivariate analysis showed that poor performance status (P=0.001), weight loss (P=0.001), depth of invasion (P=0.000), presence of peritoneal metastasis (P=0.005), more than 1 metastatic site (P=0.029) and elevated total biliru-bin (P=0.018) were independent prognostic factors. According to the outcomes of the Cox model analysis, a formula of the prognostic index was developed. According to the values of PI, 16 patients were categorized as the high-risk group (PI≤9.817), 28 patients were categorized as the moderate-risk group (9.817<PI<12.256) and 8 patients were categorized as the poor-risk group (PI≥ 12.256), respectively. The overall survival ratios of the 3 groups were compared. Conclusion: Poor performance status, depth of invasion, elevated total biliru-bin, more than 1 metastatic site, presence of peritoneal metastasis and weight loss were independent prog-nostic factors. A formula of the prognostic index was developed and it could help clinicians in decision-making and treatment tailoring based on the prognosis evaluation.
ABSTRACT
Objective To investigate the therapeutic effect of Da-Cheng-Qi Decoction on gut dysfunction in patients with severe acute pancreatitis (SAP). Methods Forty-eight SAP patients complicated with gut dysfunction were randomly divided into two groups according to the number of admission, which were treatment group and control group. The therapy in t reatment group was Da-Cheng-Qi Decoction infusion through gastric tube (one paste/day, b. i. d), however the therapy of control group was normal saline infusion through gastric tube (the amount was the same as the former, b. i. d), and other management in the two groups was similar. The first passage of gas by anus and defecation after treatment was observed. Serum amylase, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were examined before and one week after treatment;complications and mortality were compared between the two groups. Results The first passage of gas by anus and defecation in the treatment group was ( 12.3 ± 5.7 ) h and ( 24.8 ± 11.2 ) h, respectively, and shorter than ( 22. 1 ± 9.7 ) h and 46.2 ± 17.4) h of control group ( P <0.01) ;the numerical values of serum amylase, CRP, TNF-α and IL-6 one week after treatment were ( 120.3 ± 35.8 ) U/L, ( 10.8 ±2.0) ng/ml, (36.3 ± 5.8) U/L and (4.8 ± 1.0) U/L, which were significantly decreased when compared with the values before treatment, and these values were significantly lower than (267.2 ± 78.9 )U/L, ( 19.5 ± 2.7 ) ng/ml, (80.1 ± 9.0) U/L, ( 10.5 ± 1.2 ) U/L of the control group ( P < 0.05 ). The total complications and mortality of treatment group was 12.5% and 4.4%, respectively, which were significantly lower than those in the control group (37.5% and 25%, P <0.05). Conclusions Treatment with Da-Cheng-Qi Decoction in SAPpatients complicated with gut dysfunction was effective to reverse gut dysfunction and reduce total complications and mortality.
ABSTRACT
A study of the lymphatic drainage of the ovary in 90 infant cadavers was carried out by injecting into the lymphatics. The specimens were divided into threegroups: in 30 cases the Prussian Blue was injected into the substance of the ovary; in the other 30 cases the infundibulopelvic ligaments were ligated before injection; in the remainder the infundibulopelvic and utero-ovarian ligaments were ligated before injection.The first group: 4-10 lymphatics emerging from the hilus of the ovary ascend along the ovarian blood vessels and terminate in the lumbar nodes. The lymphatics. from the right ovary mostly open into the interaorticocaval nodes and some of them end in the laterocaval nodes, the precaval nodes and the subaortic nodes. The lymphatics from the left ovary mostly end in the lateroaortic nodes and some of them empty into the preaortic nodes.The second group: in 26 sides of the specimens (43%); 1-2 lymphatics emerging from the ovary reach the pelvic wall through the broad ligament and terminate in the interiliac nodes, the internal iliac nodes or the external iliac nodes.The third group: in 19 sides of the specimens (32%), the lymphatics of the ovary also open into the interiliac nodes, the external iliac nodes or the internal iliac nodes.The results demonstrate that the lymph of the ovary drains into the lumbar nodes under normal conditions, and when the primary pathway is ligated the lymph of the ovary may drain into the pelvic nodes.