The efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma / 中华泌尿外科杂志

Objective:To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.Methods:A total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis (77 males and 29 females) admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients. Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The recurrence sites were divided into renal fossa recurrence (33 cases), renal fossa±retroperitoneal lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary surgery to local recurrence was 14.8 (7.3, 35.8) months. Two treatment groups were identified as systemic therapy alone (Group A) and local therapy with or without systemic therapy (Group B). The Kaplan-Meier method was used to compare the progression free survival (PFS) and overall survival (OS) between Group A and Group B. The Cox model was used to perform univariate and multivariate analysis. Results:Of all the 106 patients, 33 patients were in Group A and 73 patients were in Group B. In Group A, 29 patients (87.9%) received targeted therapy, and 4 patients (12.1%) received targeted therapy combined with immunotherapy. In Group B, 34 patients (46.6%) received surgery or ablation and 39 patients (53.4%) received SBRT, of which 62 patients (84.9%) received concurrent systemic therapy. Among them, 58 patients (93.5%) received targeted therapy, and 4 patients (6.5%) received targeted therapy combined with immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64 patients progressed on tumor including 28 patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate analysis showed local therapy with or without systemic therapy was significantly reduced 56% risk of tumor progression ( HR=0.44, P=0.003) and reduced 60% risk of death ( HR=0.40, P=0.028). The multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002). Conclusion:Compared with systemic therapy alone, local therapy with or without systemic therapy can effectively improve the PFS and OS of patients with locoregional recurrence after nephrectomy.

Research progress on bile acid metabolism mediated by uridine diphosphate glucuronic acid transferase and its endogenous and exogenous influencing factors / 中国临床药理学与治疗学

Uridine diphosphate glucuronic acid transferase (UDP-glucuronosyltransferases, UGT) is an important Ⅱmetabolic enzymes in the body. It is invovled in the metabolism of exogenous compounds, and also in endogenous substances such as bile acid metabolism and regulation. Parsing uridine diphosphate glucuronic acid transferase mediated bile acid metabolism and its influence factors can help enhance related disease treatment and prevention. Studies have shown that the interaction between UGT and bile acids is influenced by many endogenous and exogenous factors. This paper will focus on the effects of internal and exogenous factors such as nuclear receptors, genetic factors, xenobiotics and liver-related diseases on the action of UGT enzyme, and discuss the potential mechanism of bile acid balance intervention.

Multi-disciplinary management for metastatic renal cell carcinoma in the ear of targeted therapy: a single center experience / 中华泌尿外科杂志

Objective@#To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.@*Methods@#Data of 168 mRCC patients treated by multi-disciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified, including 76 patients with 55 males and 21 females, received anti-angiogenic agents alone (Group A), 66 patients with 55 males and 11 males, received anti-angiogenic agents plus local therapy (Group B)and 26 patients, with 19 males and 7 females, received anti-angiogenic agents plus immunotherapy and local therapy (Group C). The Sunitinib, Sorafenib, Axitinib were chosen for the TKI. The Pembrolizumab was used for immunotherapy. The stereotactic body radiation therapy and surgical excision were considered as the local therapy. The study aims to compare the age, gender, IMDC score, pathology, nbephrectomy, adverse events, progression-free survival and overall survival (OS).@*Results@#Of all patients, the median follow-up duration was 23 months (ranging 6-117 cmonths). The PFS was 18.3 months and median OS was 33.5 months. The 2 years and 5 years survival rate was 66% and 35%, respectively. The median OS of Group A, B and C were 29.8 months, 44.6 months and not reached. 2y-OS was 58%, 67% and 89%, while 5y-OS 12%, 46% and 57%.There was no difference in age, gender, IMDC score, pathology, synchronous metastases or nephterectomy between the three groups. The prognostic result in TKI based combination therapy was superior to TKI therapy alone, which the 5y-OS was 51% and 11%, respectively. The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B. The median OS in TKI+ DC and CIK+ Pembrolizumab was 49.1 months and 53.1 months. On univariate analyses, IMDC score, nephrectomy and treatment group was associated with OS (P<0.05). On multivariate analyses, treatment group, nephrectomy was associated with OS (P<0.05). The risk of death of Group C decreased about 60% [HR 0.39 (0.17, 0.89), P=0.026]. 78 (46.4%) patients on TKI alone and 16 (61.5%) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events. 16 (20.3%) patients had Clavien Ⅲ-Ⅳ toxicity after surgical procedures. 6 (5.7%) patients had Grade 3 toxiciy after SBRT.@*Conclusions@#Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone. MDT approach could bring survival benefit to mRCC patients.

Clinical analysis of TKIs combined with SBRT in the treatment of renal cell carcinoma with bone metastasis / 中华泌尿外科杂志

Objective:To evaluate the efficacy and safety of Tyrosine Kinase Inhibitors (TKIs) combined with stereotactic body radiation therapy(SBRT) in the treatment of renal cell carcinoma (RCC) patients with bone metastasis.Methods:The clinical data of 80 RCC patients with bone metastasis in Sun Yat-sen University Cancer Center from April 2010 to April 2020 were analyzed retrospectively. Among them, 64 patients were medium or high risk according to the International Metastatic Renal Cell Carcinoma Database Consortium(IMDC) score. Twenty-four patients received TKI therapy alone(Group A), and the other 56 cases received TKIs combined with SBRT to bone metastastic lesions (Group B).Results:The median follow-up period was 20.7 months (4.8-115.6 months), 70 patients received second or third-line targeted drug therapy, and 4 patients in group A and 15 patients in group B received TKI plus immunotherapy. Fifty-four patients had symptoms of bone pain before radiotherapy, 46 patients were satisfied with the analgesic effect after SBRT treatment. Twelve patients got complete response (CR) after bone lesions, and 32 patients achieved partial response (PR). Forty patients died of disease progression during follow-up. The median OS was: 20.7 months vs not reached(Group A vs. Group B), and the 2-y OS and 5-y OS were 50% vs. 62%, and 19% vs. 56%, respectively ( P=0.006). There were only 2 patients (3.6%) had grade 3 SBRT related adverse events. Conclusions:SBRT combined with TKIs improved the quality of life and prolonged the overall survival of RCC patients with bone metastasis.

Multi-disciplinary management for metastatic renal cell carcinoma in the ear of targeted therapy: a single center experience / 中华泌尿外科杂志

Objective To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.Methods Data of 168 mRCC patients treated by multidisciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified,including 76 patients with 55 males and 21 females,received anti-angiogenic agents alone (Group A),66 patients with 55 males and 11 males,received anti-angiogenic agents plus local therapy (Group B)and 26 patients,with 19 males and 7 females,received anti-angiogenic agents plus immunotherapy and local therapy (Group C).The Sunitinib,Sorafenib,Axitinib were chosen for the TKI.The Pembrolizumab was used for immunotherapy.The stereotactic body radiation therapy and surgical excision were considered as the local therapy.The study aims to compare the age,gender,IMDC score,pathology,nbephrectomy,adverse events,progression-free survival and overall survival (OS).Results Of all patients,the median follow-up duration was 23 months (ranging 6-117 cmonths).The PFS was 18.3 months and median OS was 33.5 months.The 2 years and 5 years survival rate was 66％ and 35％,respectively.The median OS of Group A,B and C were 29.8 months,44.6 months and not reached.2y-OS was 58％,67％ and 89％,while 5y-OS 12％,46％ and 57％.There was no difference in age,gender,IMDC score,pathology,synchronous metastases or nephterectomy between the three groups.The prognostic result in TKI based combination therapy was superior to TKI therapy alone,which the 5y-OS was 51％ and 11％,respectively.The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B.The median OS in TKI + DC and CIK + Pembrolizumab was 49.1 months and 53.1 months.On univariate analyses,IMDC score,nephrectomy and treatment group was associated with OS (P ＜ O.05).On multivariate analyses,treatment group,nephrectomy was associated with OS (P ＜ O.05).The risk of death of Group C decreased about 60％ [HR O.39 (0.17,0.89),P =O.026].78 (46.4％)patients on TKI alone and 16 (61.5％) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events.16 (20.3％) patients had Clavien IⅢ-V toxicity after surgical procedures.6 (5.7％) patients had Grade 3 toxiciy after SBRT.Conclusions Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone.MDT approach could bring survival benefit to mRCC patients.

Long-term outcomes of combined treatment of bladder-preserving surgery and adjuvant intraarterial chemotherapy for patients with stage T2 bladder cancer / 中华泌尿外科杂志

Objective To evaluate the efficacy of patients with stage T2 bladder cancer who underwent combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy.Methods The survival data of bladder cancer paients from January 2000 to December 2014 with stage T2N0M0 were retrospectively analyzed.Thirty-five patients of cT2N0M0 receive combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy(group A),and 80 patients of pT2N0M0 underwent radical cystectomy (RC) (group B).The pathological diagnosis of all patients was urothelial carcinoma.In group A,there were 33(94.2％) males and 2 (5.8％) females;20 (57.1％) tumor size less than 3 cm and 15 (42.9％) larger than 3 cm;24 (68.6％) with single tumor and 11 (31.4％) with multiple tumors;11 (31.4％) patients with primary tumors and 24 (68.6％) recurrent tumors.In group B,there were 71 (88.7％) males and 9 (11.3％) females;35 (43.8％) tumor size less than 3 cm and 45(56.2％) larger than 3 cm;44 (55.0％) with single tumors and 36 (45.0％) with multiple tumors;22(27.5％) patients with primary tumors and 58 (72.5％) recurrent tumors.Results Groups A and B consisted of 35 and 80 patients and median follow-up time was 68 (13-157)and 67 (4-198)months,respectively.There was no significantly statistical difference in disease-specific survival (DSS) between the two groups(P =0.888),76.5％ for group A and 60.6％ for group B respectively.In group A,26 (74.3％) patients achieved complete response (CR) to intra-arterial chemotherapy.Additionally,amounts of 21 (60.0％) patients preserve their functional bladder successfully and their median follow-up time was 69 (13-134)months.8 patients receive delayed radical cystectomy when suffered tumor recurrence and none of them had lymph node metastases.Of those pathological stage was presented as stage T2 5 cases,T3 2 cases and T4 1 case.Importantly,the 8 patients who receive delayed RC did not confer worse DSS when compared with those underwent immediate RC in group B (P =0.809).Cox proportional hazards model showed that tumor number and CR to intra-arterial chemotherapy was independent prognostic factor for disease-free survival (HR =0.238,P =0.007) and DSS(HR =0.085,P =0.004) respectively.During the period of intra-arterial chemotherapy,we did not observe hematological toxicity of grade Ⅳ and the hematological toxicity of grade Ⅰ-Ⅲ was 9 (25.7％),6 (17.1％) and 4 (11.4％).Conclusions For patients with T2N0M0,combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy could be a therapy with long-term survival outcome and safety.The therapy could be offered as alternative treatment option for patients who were unsuitable for receiving RC.

Clinical outcome of postchemotherapy retroperitoneal lymph node dissection and predicting retroperitoneal histology in advanced nonseminomatous germ cell tumours of the testis / 中华外科杂志

Objective@#To explore the clinical outcome of advanced testicular nonseminomatous germ cell cancer patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and to analyze the relevant prognostic factors of lymph node pathological.@*Methods@#A total of 43 consecutive testicular nonseminomatous germ cell cancer patients underwent PC-RPLND between March 2001 and December 2014 in Department of Urology at Sun Yat-sen University Cancer Center were retrospectively reviewed. The average age of the patients was (29.0±11.5) years (ranging from 12 to 58 years). Before PC-RPLND, 22 patients were classified as phase Ⅱ, while 21 were phase Ⅲ. Primary tumor histology revealed seminomatous elements in 19 cases, embryonal cell carcinoma in 22 cases, yolk sac tumor in 13 cases, chorionic carcinoma in 3 cases, mature teratomatous elements in 11 and immature teratomatous elements in 2 cases. Patients were treated with cisplatin-based chemotherapy after orchectomy and then underwent surgical resection of retroperitoneal lymph nodes.After PC-RPLND, all patients underwent a periodic review including the blood routine, biochemistry routine and computed tomography or ultrasonograph of the chest, the abdomen and the pelvis. The association of pathological data with patient′s clinic features and the correlations between molecular features detected with each other were assessed by the t test, χ2 and Fisher′s exact test. Multivariate logistic regression were used to assess prognostic factors.@*Results@#The median operative time was 278 minutes (ranging from 50 to 715 minutes). Median blood loss was 425 ml (ranging from 50 to 5 000 ml). Eight patients received blood transfusion intra-operatively, 2 patients underwent adjunctive surgical procedures, 4 patients developed ileus and 4 had an ascites chylosus following PC-RPLND, 1 patient had a postoperative hyperthermia and retrograde ejaculation was present in 10 patients. The transverse diameter of the residual tumor in patients ranged from 0.8 to 18.2 cm. Necrosis, teratoma and viable germ cell tumors were found in 15, 17 and 11 of all patients. The median follow-up time was 46 months (ranging from 6 to 169 months). There were 39 patients had no tumor recurrence, 7 patients were found recurrence after PC-RPLND, 5 died of malignant germ cell tumor. The normal serum lactate dehydrogenase (LDH) level before chemotherapy (HR=25.811, 95%CI: 0.678 to 982.624, P=0.017) and relative changes more than 50% in retroperitoneal lymph node size (HR=0.016, 95%CI: 0 to 0.698, P=0.032) were statistically significant prognostic factors of the presence of necrosis.@*Conclusions@#Since most residual masses are not sensitive to chemotherapy, PC-RPLND is still an essential part of the treatment of metastatic testicular nonseminomatous germ cell cancer. Patients with the normal serum LDH level before chemotherapy and a shrinkage of 50% or more in retroperitoneal mass have a considerably chance of having necrosis in the retroperitoneum resection. This may help to refine the selection of candidates for PC-RPLND.

Clinical outcomes of femoral revision using restoration modular stem / 中华骨科杂志

Objective To investigate the early outcomes of revision hip arthroplasty using restoration modular (RM) stem.Methods Fifty-nine patients underwent revision hip arthroplasty with RM stem from April 2012 to June 2015 in our center with a minimal of two years follow-up.The patients including 24 male and 35 female had a median age of 61.0 (56,66) years.The median BMI was 24.0 (22.5,26.0) kg/m2,while the median interval from the primary surgery was 10.5 (6.0,14.5) years.The rea sons for revision inculded infection in 8 patients,aseptic loosening in 45,recurrent dislocation in 1,and periprosthetic fracture in 5.There were 3 cases of type B2 and 2 cases of B3 periprosthetic fracture according to Vancouver classification.The bone defects severity was conducted according to Paprosky classification that 14 patients in type Ⅱ,31 in type ⅢA,8 in type ⅢB,and 1 in type Ⅳ.Acetabular component were revised in 56 cases.Patients were followed up at 3 months,6 months,1 year and annually thereafter for clinical and radiological evaluation.Results All the patients were followed up with a median duration of 30.4 (27.3,37.9)months,the median Harris score significantly improved from 37 (31,53) points preoperatively to 84 (80,95) points at the last follow up (Z=-6.681,P=0.000).There were 3 patients had perforation or fracture intra-operatively,two of them were fixed by strut allograft.The other one who did not compromise the implant stability was not fixed.Extended trochanteric osteotomy was applied in 14 cases and they healed well at 3-6 months during follow-up.There was one case of early dislocation at 6 days postoperatively,which was treated with close reduction and immobilization without recurrence.No infection,stem fracture,hematoma formation and sciatic nerve injury were reported.No femoral component loosening was identified at the latest follow-up.Median subsidence was 1.0 (0,2.0) mm with the maximum case 6.0 mm and 3 cases 3.5 mm.All of subsidence developed within the first year postoperatively but without further aggravation.The affected leg lengthened 17.5± 10.1 mm (range 2-40 mm) after operation.The affected leg was shorter 17.5± 12.6 mm (shorter 44.4 mm to longer 3.0 mm) than that in the normal side pre-operatively.However,the distinction decreased to 0.1±9.6 mm postoperatively (shorter 24.8 mm to longer 22.4 mm,t=-10.538,P=0.000).Conclusion Early satisfactory results are achieved in hip revision using RM modular stem at the femoral side.The modular design could simplify the surgical procedure with better control of leg length and joint stability.Long-term follow-up is still required for further evaluation.

Estimation of femoral version based on broach geometry after femoral-neck osteotomy / 北京大学学报(医学版)

Objective:To find out whether it is accurate to estimate femoral version based on femoral broach after femoral neck osteotomy using computed tomography scans.Methods:In 32 total hip arthro-plasty (THA),we performed CT scans before and after operation.Four possible levels (lesser trochan-ter,5 mm above,10 mm above and 15 mm above the lesser trochanter)of broach version were calculated based on the pre-operative CT scan.Stem versions were measured on the post-operative CT scan.We de-termined the difference between the preoperative broach version and the postoperative stem version using the Student’s t-test for paired samples assuming equal variance.Results:For the operated hips,pre-operative hip version differed according to the level of measurement.Our findings showed that the average femoral version was 37.0°±11.0°at the level of the lesser trochanter (section 1),34.3°±10.6°at 5 mm above the lesser trochanter (section 2),28.1°±10.9°at 10 mm above the lesser trochanter (sec-tion 3),and 22.4°±13.7°at 15 mm above the lesser trochanter (section 4),and that the average ver-sion for the femoral neck (FNV)was 12.9°±13.8°.The postoperative hip version was the stem version (FSV),which we found to be an average of 26.1°±11.0°.The mean femoral version for section 1 and 2 was larger than the mean postoperative stem version (P0.05).The mean femoral neck version was less than the mean postoperative stem version (P<0.01);the difference was 13.2°±11.1°of the in-creased anteversion on average for the FSV compared with FNV.Conclusion:The accuracy of estimated femoral version after arthroplasty depends on broach level.When it is 10 mm above the lesser trochanter, stem version estimation is accurate,but below that level,there is a tendency to overestimate.

Early outcomes of reconstruction of Paprosky Ⅲ acetabular bone defects using tantalum trabecular metal cup combined with tantalum augment / 中华骨科杂志

Objective To investigate the early outcomes of reconstruction of severe acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment in total hip replacement.Methods From April 2014 to December 2015,23 patients (24 hips) underwent total hip arthroplasty by the use of tantalum trabecular metal cups combined with tantalum augments.There were 11 males (12 hips) and 12 females (12 hips),with the average age 54 years (range,38-65 years).We tried to reconstruct an annular support for the cup.If an annular support cannot be reconstructed,the cup obtains primary stability based on the three point fixation rationale.Flexible placing of the TM cup combined with the augments helped reconstruction of the socket ring or supporting points,thus achieving rigid primary stability of the cup and restoring center of rotation.Harris hip score and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index score were recorded.Any severe intraoperative complications including vascular or nerve injury and severe postoperative complications such as periprosthetic joint infection,dislocation or periprosthetic fracture were reported.The vertical position of the center of rotation from the interteardrop line and the horizontal position of the center of rotation from the teardrop were measured and analyzed.Results The average follow-up duration was 16 months (range,7-28 months).The mean Harris hip score was 35.3±12.1 preoperatively and 82.7±8.3 postoperatively (t=-16.991,P＜0.001).The mean WOMAC score was 39.1 ±24.0 preoperatively and 87.2± 11.4 postoperatively (t=-7.671,P＜ 0.001).The average vertical location of the center of rotation was 44.02± 11.65 mm preoperatively and 22.96±8.24 mm postoperatively.All the tantalum cups and augments were stable.There was no periprosthetic joint infection,dislocation,nerve injury or periprosthetic fracture.Conclusion Reconstruction of Paprosky Ⅲ acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment can achieve good primary stability and restore the center of rotation with almost normal hip biomechanics.The short-term outcomes are satisfied.

Clinical analysis of pediatric testicular benign tumors / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the diagnosis, treatment and prognosis of testicular benign tumors in children.</p><p><b>METHODS</b>The clinical data of 37 boys (aged between 3 months to 12 years) with testicular tumors treated in our center between August 2000 and August 2013 were retrospectively analyzed. The median age was 14 months and 21 boys were less than 2 years old. The tumors were on the left side in 18 cases, on the right side in 15 cases, and on both sides in 4 cases (adrenal residue testis tumor). Thirty-five patients presented with painless scrotal mass; in the other two cases, testicular residue tumor was found in routine medical examination in one case and testicular mature teratoma was found due to perineal pain in the other; both of the boys underwent ultrasound or CT examination. Thirty-three boys had tumor marker detection. Of the 37 boys with benign testicular tumors, 25 underwent radical inguinal orchiectomy and 12 had testis-sparing surgery.</p><p><b>RESULTS</b>The boys were followed up for 3-107 months (median 46 months). No patients were found to have tumor recurrence, metastasis or such complications as testicular atrophy; 3 boys had natural fertility later in adutthood.</p><p><b>CONCLUSIONS</b>A high proportion of testicular tumors in children are benign. Preoperative ultrasound or CT combined with detection of tumor markers such as serum AFP can be important in the diagnosis of pediatric testicular tumors, for which testis-sparing surgery should be considered.</p>

CT study of normal patellar anatomical morphology / 中华骨科杂志

Objective To investigate normal patellar morphology,then to explore its possible instructive significance in the design of patella prosthesis for Chinese people and in the process of resurfacing patella.Methods CT scan examinations were performed in 60 normal knees (left or right knee was selected randomly； scan region,from half proximal tibia to half distal femur) of 60 healthy Chinese adults (32 males,28 females； age range,18-54 years； mean age,33.7 years),then mimics software was used to reconstruct the 3-D morphology of each patella and new coronal and sagittal planes were created.Each patella's height,width,thickness,the position of the dome,the ratio of height/width,and the residual thickness after patella was resected at the level of the subchondral bone of the lateral facet during the stimulating process of patella resurfacing were measured or calculated.Results Patella of Chinese male:height 31.95±2.77 mm,width 45.02±2.70 mm,thickness 22.38 ±1.63 mm,the residual thickness after patella was resected 13.18±1.62 mm； Patella of Chinese female:height 28.72±2.17 mm,width 39.57±2.57 mm,thickness 19.88±1.36 mm,the residual thickness after patella was resected 11.20±1.20 mm.Significant differences existed between male and female for all the above four parameters.Patella of Chinese male:the ratio of width/height 1.42 ±0.11,the position of the dome (medial 42.9％)； Patella of Chinese female:the ratio of width/height 1.38±0.10,the position of the dome (medial 42.6％).No significant differences existed between male and female for the above two parameters.Conclusion The patella of Chinese people is small,thin and slim,especially in Chinese female.These findings should be considered in selecting or designing patella prosthesis to fit the Chinese people.For Chinese female,more attention should be paid to keep appropriate residual thickness after the patella was resected during the process of patella resurfacing.

Mechanism of Growth of Human Prostate Cancer Cells Inhibited by DATS / 中山大学学报(医学科学版)

[Objective]This study was designed to determine growth inhibition of diallyl trisulfide(DATS)in human prostate cancer cells by inducing apoptosis and further to investigate the mechanism underlying such effect.[Methods]Growth inhibition by DATS was estimated by the tetrazolium(MTr)assay.Apoptosis induction in DATS-treated cells was assessed by fluorescence microscopy analysis of cells with condensed and segmented nuclei following staining with DAPI and flow cytometric analysis of cells with sub-G1 DNA content following staining with propidium iodide.Protein levels of apoptosis regulating proteins were determined using western blot.The activity of caspase-3 was measured using a colorimetric assay.[Result]DATS showed tumor growth inhibition in a time-and dose-dependent manner,IC_(50) of DATS was 14 μmol/L at 72 h.DATS evoked apoptosis as confirmed by cell morphology and by the analysis of flow cytometry.The expression of Bcl-2 and Bcl-xL,the apoptosis-suppressing proteins,was more down-regulated.The activity of caspase-3 was enhanced by DATS.[Conclusion]DATS inhibits growth of prostate cancer cells by inducing apoptosis in association with down-regulation of Bcl-2 and Bcl-xL and activation of caspase-3.

The influence of soft tissue release on the tension around hip joint through posterolateral hip approach / 中华骨科杂志

ObjectiveTo investigate the influence of selective soft tissue release on the tension around hip joint through posterolateral approach, and to ascertain the sequence of soft tissue release in total hip arthroplasty. MethodsFive fresh frozen cadavers with ten intact lower extremities were used in the study. All the pelves of cadavers were fixed on the operating table by a special designed fixer on a lateral position. Femoral supracondylar bone traction was employed for axial traction. The force for traction was 15 kg. Posterolateral approach was used for exposure and two sequences for soft tissue release were studied. One Kirschner wire was fixed at the bone near the anterior superior iliac spine, and the wire was perpendicu-lar to the operating table. Another Kirschner wire was fixed into the bone at lateral femoral shaft. The two Kirschner wires were parallel to each other. The distance between the two Kirschner wires was measured be-fore and after each soft tissue structure release. ResultsThere were no significant changes of the distance measured before and after applying traction alone, releasing external rotation muscles, opening the posterior capsule and releasing the gluteus maximus insertion. There were significant changes of distance measured before and after resection of femoral head, release of tensor fasciae latae and/or iliotibial band, excision of anterior capsule, and release of iliopsoas tendon had. The average lengthened distance was 1.5 mm (range, 1-3 mm) after resection of femoral head, and 8.0 mm (range, 2-19 mm) after release of tensor fasciae latae and/or iliotibial band, 5.5 mm (range, 1-13 mm) after excision of anterior capsule, and 1.8 mm (range, 1-3 mm) after release of iliopsoas tendon respectively. The distance lengthened after both release of tensor fasci-ae latae (and/or iliotibial band) and excision of anterior capsule was the most significant, average 13.5 mm (range, 11-20 mm). ConclusionRelease of anterior capsule, tensor fasciae latae and/or iliotibial band, and iliopsoas tendon will decrease the soft tissue tension around hip joint. Among all the soft tissue structures we investigated, the anterior capsule and tensor fasciae latae (iliotibial band) make the most effective result. To maintain the soft tissue tension around hip joint depends on different structures working together, releasing one structure alone may not obtain the optimal result. Careful evaluation of tension of tensor fasciae latae and iliotibial band can help avoiding the limb length discrepancy during hip arthroplasty surgery.