Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.@*METHODS@#This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.@*RESULTS@#At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t  = 0.221, P  = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U  = 789.500, P  = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P  > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P  > 0.05).@*CONCLUSIONS@#Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .

Risk factors for contralateral anterior cruciate ligament injury after primary anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction.@*METHODS@#A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups ( P>0.05). However, the proportion of female in the injured group was significantly higher than that of male ( P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group ( P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values.@*RESULTS@#Univariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury ( P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury ( P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] ( χ 2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years]( χ 2 =302.479, P<0.001).@*CONCLUSION@#Female and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.

The clinical effect of microwave ablation in the treatment of pelvic metastases / 中华骨科杂志

Objective:To evaluate the therapeutic effect and safety of microwave ablation plus curettage.Methods:Clinical data of a single group of 12 patients admitted to our hospital from June 2015 to June 2019 who underwent microwave ablation for bone metastasis were retrospectively analyzed. There were 7 males and 5 females, with an average age of 59.5±10.1 (range from 43 to 79) years old. Curettage plus bone cement after microwave ablation was performedand when the lesion involved the sacroiliac joint surface and impaired the bearing arch, the internal fixation was performed with plate and screws. 8 among the 12 patients underwent curettage, bone cement and metal internal fixation after microwave ablation. After microwave ablation, and 4 patients underwent curettage and reconstruction with bone cement alone. The patients were followed up aftersurgery. The observational indicators included: patient survival rate, local recurrence rate, perioperative complications, Operation time, intraoperative blood loss, VAS score, SF-36 score, and MSTS function score. VAS scores and SF-36 scores were recorded before surgery, 1 week after surgery and 3 months after surgery.Results:12 patients were followed up for 4-27 months, with an average follow-up time of 14.2 months and a median follow-up time of 9 months. During the follow-up, 7 patients died and 5 survived, with a 6-month survival rate of 81.8%, a 1-year survival rate of 40.9% and a 2-year survival rate of 27.3%. The mean survival time of the dying patients was 8.8 months (5-18 months), and the median survival time was 7 months. Operation time was 101±21 min and intraoperative blood loss was 295±108 ml. During the follow-up period, local recurrence rate was 8.3% (1/12), and the average postoperative time to recurrence was 4 months. There were no complications such as wound nonunion, wound infection, deep infection, vascular nerve heat injury and internal fixation failure. VAS score before surgery was 7.5 (7, 8) points, VAS score 1 week after surgery was 5 (4, 5) points, and VAS score 3 months after surgery was 5 (4, 5.75) points ( P<0.05). Preoperative SF-36 score was 23 (21, 24.75) points, 1 week after surgery SF-36 score was 47 (46, 54) points, and 3 months after surgery SF-36 score was 50.5 (47, 55.25) points ( P<0.05). 3 months after the operation, the MSTS score was 20.5 (16.25, 21.75) points, of which excellent 16.7% (2/12), good 50% (6/12), medium 16.7% (2/12), poor 16.7% (2/12), and the overall excellent and good rate was 66.7% (8/12). Conclusion:Microwave ablation plus curettage for pelvic metastasis of malignant tumor can significantly relieve local pain, rebuild limb function and improve patients' quality of life, and it`s an alternative treatment for pelvic metastases.

Buyang Huangwu Decoction and Guipi Decoction Treat Sequelae of Craniocerebral Trauma / 浙江中医药大学学报

[Objective] To explore the clinical effect of Buyang Huangwu Decoction and Guipi Decoction together on BTS. [Method] Select 48 cases of BTS in accordance of diagnosis standard, divide them into treatment group 48 cases(take revised Buyang Huangwu Decoction and Guipi Decoction ) and control one 20(routine western medicine), judge their cure effect after 2~4 courses. [Result] The cure rate and total effective rate were respectively 60.42%and 87.50% for treament group, for control one, they were respectively 30.00% and 65.00%; with χ2 test, their differences were respectively of marked statistical meaning and statistical meaning. [Conclusion] Buyang Huangwu Decoction and Guipi Decoction together had definite cure effect on BTS.

Dynamic contrast-enhanced MRI of breast disease: correlation of MR findings with vascular endothelial growth factor and microvessel density / 医学研究生学报

Objective: To determine the relation dynamic contrast-enhanced magnetic resonance imaging (MRI) and histologic features and angiogenesis of breast disease. Methods: Forty patients with breast disease, diagnosed by histopathology were reviewed, including imaging and pathological data. Dynamic MRI was performed by a fat-suppressed 3D-FSPGR sequence ,Time-Signal curve was acquired by Functool 2 software, then early-phase enhancement rate and E max , T max were acquired. The mean MVD and VEGF expression of the lesions were measured with immunohistology. Evaluation of inflammatory changes was assessed by histology. Results: The MVD , VEGF expression and inflammatory scores of malignant tumor were significantly higher than that of benign tumor(P0.05), The Time-SI curve between malignant and benign was significant different(P

The use of nutritional support in treatment of chylous leakage after thyroid carcinoma operation / 肠外与肠内营养

Objective: To observe the role of nutritional support in treatment of chylous leakage after thyroid carcinoma operation.Methods: The parenteral nutrition combined with somatostatin and re-operation was used in treatment of 2 cases of chylous leakage after thyroid carcinoma operation.Fluid volume from neck drainage catheter and plasma albumin concentration were determined in 2 cases.Results: Fluid volume from neck drainage catheter rapidly reduced in 2 cases after using somatostatin and parenteral nutrition.1case was cured after conservative treatment.1 case was cured after re-operation combined with nutrition support.Conclusion: By using nutrition support,fluid volume from neck drainage catheter can be obviously reduced and serum albumin or nutritional state improved in chylous leakage patients after thyroid carcinoma operation.

Progress in the study of triple negative breast cancer / 医学研究生学报

Triple-negative breast cancer (TNBC) is a subgroup of breast cancers defined by a lack of the expressions of estrogen,progesterone and HER2 receptors,with more aggressive biological and clinicopathological characteristics and a close relationship with basal-like and breast cancer susceptibility gene-1 (BRCA1)-related breast cancers.TNBC is insensitive to most available hormonal or standard therapeutic agents,associated with increased risk for distant metastases and with poorer prognosis than other types of breast cancer.A deeper insight into the biology of TNBC may lead to improved therapies and better clinical outcomes of the disease.

Sentinel lymph node biopsy in patients with operable breast cancer after neoadjuvant systemic therapy / 医学研究生学报

Objective: To investigate the feasibility and accuracy of sentinel lymph node biopsy(SLN) following neoadjuvant chemotherapy.Methods:Sentinel lymph node biopsy was evaluated following two or three cycles of neoadjuvant chemotherapy with pharmorubicin /cyclophosphamide/5-FU(CEF,48 patients) or pharmorubicin /cyclophosphamide / taxotere(CET,12 patients).Two ml 1% methylene blue was subcutaneously injected at 4 sites of the skin over the tumor before radical operation.Pathohistological results were assessed for all the specimen including blue lymph node and other axillary lymph node(ALND). Results:Among the 66 patients SLN was identified in 60 of them(90%).Residual metastatic disease was identified in 23 cases on SLN,including 15 positive and 8 negative node on ALND,37 cases were completely negative on SLN including 35 negative and 2 positive node on ALND,and SLN was falsely negative in 2 cases(8%).Conclusion:The success rate of sentinel node identification and the predict ability of the SLN for the pathologic status of the adjacent non-SLNs do not seem to be altered after neoadjuvant therapy.

Clinical analysis of primary bilateral breast cancer / 医学研究生学报

Objective:To explore the clinical diagnosis,therapy and pathologic characteristics of primary bilateral breast cancer in order to improve the survival of breast cancer patients.Methods:Eleven cases of primary bilateral breast cancer patients were retrospective analysised.Results:Among the 11 cases of primary bilateral breast cancer patients,2 cases were dead for multi organ metastasis;9 cases survived.Among which one has been alive for 6 years after operation.Conclusion:The early diagnosis and treatment of the second primary cancer remain the key factor to improve the outcome of the bilateral breast cancer patients.

Diagnosis and treatment of primery breast lymphoma / 医学研究生学报

Objective:To explore the clinic and pathologic characteristics of primary breast lymphoma(PBL) for its diagnosis and treatment.Methods: Five cases of PBL that has been diagnosed during 1998-2005 were analyzed.Results: One patient died 1 month after her final diagnosis.Tow patients have survived 4 and 3 years,respectively,after radical operation plus chemotherapy,although inguinal lymphatic metastasis was found in the later one 2 years after her operation.Another two patients have been accepting chemotherapy for 3 months after their local resection.Conclusion: PBL is diagnosed basically by methods of pathology and immunohistochemistry,and treated mainly by chemotherapy combining with other therapies.

The role of ~(99)Tc~m-Sandostatin somatostatin receptor imaging in the evaluation of primary breast cancer / 医学研究生学报

1.20 was defined as posi-tive imaging.Results:Out of46 patients,40 were malignant tumors;6 had benign lesions.The sensitivi-ty,specificity and accuracy of99Tcm-Sandostatin in the detection of breastcancer were 87.5%,83.33%,86.96%,respectively.99Tcm-Sandostatin imaging was false negative in 5 patients with breast cancers.In6 patients with benign lesions,5 patients was true negative,but one patient with chronic breast abscess.T/N ratio was 2.370?0.933,1.295?0.648 in breast cancer and benign lesion respectively.The T/Nratio was higher in breast cancer than benign lesion(P

Expression of somatostatin receptor in primary invasive ductal carcinoma of breast / 医学研究生学报

Objective: To determinate whether human primary breast invasive ductal carcinoma((HPBIDC)) express somatostatin receptor(SSTR). Methods: SSTR expression in 82 patients with invasive duct carcinoma of breast was determined by immunohistochemistry and its correlation with clinical and pathological facts was analysed. Results: IHC analyses revealed that SSTR was expressed in HPBIDC (61/82, 74.4%). A significant correlation was found between SSTR expression and tumor stage (P

Down-regulation of telomerase activity reflects neoadjuvant chemotherapy effect in invasive ductal carcinoma of breast / 医学研究生学报

Objective:To investigate the significance of telomerase activity in infiltrating ductal carcinoma with respect to neoadjuvant chemotherapy effect. Methods:Fine needle aspiration (FNA) specimens were obtained from twenty nine patients with primary breast cancer pre neoadjuvant chemotherapy.All patients were given neoadjuvant chemotherapy(CEF regimen, Cyclophosphamide 500 mg/m 2 ; Epirubicin 50～60 mg/m 2 , Fluorouracil 500 mg/m 2 ) and were performed operation on post chemotherapy 3th day to 5th day,cytology and telomerase activity of specimens were analyzed. The telomerase activity was measured Telomerase PCR ELISA based on a polymerase chain reaction (PCR) assay known as TRAP (telomeric repeat and amplification protocol) assay. Results:The optic density (OD) of telomerase activityis is 1.172?0.501 pre chemotherapy whereas post chemotherapy that is 0.771 ?0.442 ( P

Bioelectrical impedance analysis of the therapeutics of upper limb lymphedema following mastectomy / 医学研究生学报

Objectives: To investigate the effect of bioelectrical impedance analysis in assessing upper limb lymphedema after mastectomy for breast cancer. Methods: Nineteen breast cancer patients with upper limb lymphedema received a micronized flavonoid fraction(Daflon 500 mg). Body composition was evaluated by multiple frequency bioelectrical impedance analysis, and the ratio of extracellular water/intracellular water (ECW/ICW) and extracellular water/total body water (ECW/TBW) were calculated. Results: At the end of the therapy, water content of upper limb with lymphedema( P

Prognostic value of the somatostatin receptor expression in human primary breast invasive ductal carcinoma / 医学研究生学报

Objective: To investigate the relationship of the expression of the somatostatin receptor(SSTR) with tumor stages,tumor differentiation and the survival time in patients with human primary breast invasive ductal carcinoma(HPBIDC) and to provide theoretical evidence for the diagnosis,prognosis and treatment of the disease based on the SSTR expression.Methods: We detected the SSTR expression in the tumor tissues of 82 HPBIDC patients,and analyzed the relationship of the SSTR expression with the prognosis and survival time of the patients.Results: In the HPBIDC patients,the 5-year overall survival(OS) rates of the negative,weakly positive,moderately positive and strongly positive SSTR expression groups were 59.1,76.2,85.2 and 100.0%,those of the well,moderately and poorly differentiated groups were 94.1,90.6 and 60.0%,and those of the TNM Ⅰ,TNM Ⅱ,TNM Ⅲ and TNM Ⅳ groups were 100.0,86.0,56.3 and 25.0%,respectively.Conclusion: The expression of SSTR is significantly correlated with the prognosis of human primary breast invasive ductal carcinoma.

Fiberoptic ductoscopy in the diagnosis and treatment of nipple discharge / 医学研究生学报

Objective:Nipple discharge is a common complaint in women.There were no accurate techniques in detecting ductal lesions in nipple discharge patients before the application of fiberoptic ductoscopy.The aim of this study was to evaluate fiberoptic ductoscopy in the diagnosis and treatment of nipple discharge.Methods: From June 2007 to November 2008,a total of 95 patients with nipple discharge were submitted to fiberoptic ductoscopy,and 50 of them underwent surgery and pathological examination.Results: Of the 95 cases,2 diagnosed as breast cancer,58 intraductal papilloma,23 mammary duct ectasia,and 10 inflammatory disease of the mammary duct.Compared with the results of pathological examination,the accuracy of the fiberoptic ductoscopy was 81% for intraductal papilloma and 100% for breast carcinoma.Conclusions:Fiberoptic ductoscopy,as a convenient,safe and accurate method for the diagnosis and treatment of nipple discharge,can be used to confirm etiological factors and locate the site of the complaint.

Diagnosis and treatment of male breast cancer / 医学研究生学报

Objective: The morbility of male breast cancer is lower than female breast cancer.The treatment effectiveness of male breast cancer is worse than female breast cancer.There were fewer studies on male breast cancer.The aim of the paper was to study the clinical characteristics,diagnosis,treatment and the prognostic factors of male breast cancer.Methods: To analyze the clinical data of 2 cases of male breast cancer and 409 cases collected from past articles retrospectively.Results: All cases received surgery treatment.After operation,all cases were treated by adjuvant treatment including radiotherapy or/and chemotherapy or/and endocrine treatment.The major pathological type was infiltrative non-specific cancer.Estrogen receptor and progesterone receptor are positive in most cases.Cases in stage Ⅰ were fewer,more cases were in stageⅡor stage Ⅲ and stage Ⅳ.Prognosis are more better in stage Ⅰ patients than in stageⅡ、Ⅲ、Ⅳ patients.Conclusion: Male breast cancer has the following clinical characteristics: lower incidence,older age,longer course,higher malignancy and poor prognosis.The operation combined with radiotherapy and chemotherapy and endocrine treatment was a better method to treat male breast cancer.

Prognosis and effect of conservative surgery in 20 cases of breast cancer / 医学研究生学报

Objective: Breast conserving surgery has been proved to be a safe strategy and widely applied to the treatment of early breast cancer.The aim of this work is to evaluate the operational techniques and effect of conservative surgery for breast cancer.Methods: We analyzed the clinical data of 20 patients with breast cancer that underwent conservative surgery from January 2004 to December 2007.All the tumors were found to be solitary,less than 3 cm in diameter,and treated by postoperative chemotherapy and radiotherapy.All the patients were followed for 5 to 52(mean 28) months.Results: During the follow-up,2 cases experienced local recurrence and received modified radical mastectomy.All the 20 patients remained alive up to the present study.Conclusion: The principle of specific procedures for specific cases counts quite a lot for satisfactory prognosis and outcomes of breast conservative surgery.

Association between the expression of telomerase activity and apoptosis in primary breast cancer patients / 医学研究生学报

Objectives:To investigate the association and the prognostic significance of the expression of telomerase activity (TA) and apoptosis (APO) in tissues of primary breast cancer.Methods:TRAP-PCR and ELISA were developed to detect the expression of TA,and make quantitative and qualitative analysis respectively.TUNEL was also used to evaluate apoptosis cells in cancer lesions and count apoptosis index (AI).The expression levels of proteins of oncogene Bcl-2 and p53 were measured by means of S-P immunohistochemistry.Results:The mean TA positive expression rate was 89.8%,and its mean optic density was (A) 0.63±0.29,which were significantly higher than those of normal tissues and benign breast lesions (P<0.05).The 5 years survival rate of patients with positive TA expression was lower (60.3%) than those of negative expression (77.4%).There were no relations between TA expression and patients ages,TNM staging,lymph nodes metastasis,size,locations and pathological types of cancer.But TA was positively correlated with APO (r=0.733 1,P<0.05) and the protein expression of oncogene Bcl-2 (r=0.781 4,P<0.05) and negatively correlated with that of p53 (r=-0.625 5,P<0.05).Moreover,in patients receiving preoperative chemotherapy,the levels of TA expression were much lower than those without chemotherapy (64.7% vs 85.1%),and the former had higher AI than the latter (7.19±3.75% vs 3.23±2.04%),intraarterial chemotherapy group were superior significantly to adjuvant group (P<0.05).Multivariate Cox Regression Analysis showed that only TA and AI influenced the survival time of primary breast cancer patients,and patients with higher positive TA expression and AI>4.0% had shorter survival time than those of negative TA expression and AI<4.0% patients.Conclusions:There was a significant correlation between TA and APO and its related oncogene Bcl-2,p53.TA and APO are of great diagnostic values,therapeutic helps and prognostic significance in the formation and the development of primary breast cancer.

Pathological and clinical effects of preoperative arterial infusion chemotherapy on the breast cancers / 医学研究生学报

Objectives：To investigate the pathological and clinical effect of preoperative arterial infusion chemotherapy on breast cancers.Methods:Twenty patients with breast carcinoma received regional arterial angiography by Seldinger's procedure followed by arterial infusion chemotherapy.Sixteen patients who didn't undergo preoperative chemotherapy were selected as controls.All the operation specimens were analyzed by the same pathologist.Results:Histological analysis of the two groups revealed the following results:① cancer tissue necrosis increased in the arterial chemotherapy group;②karyopyknosis,karyorrhexis coagulation and necrosis of cytoplasm around the vascular vessels as well as interstitial edema were found in the tumor tissue,invasion of inflammatory cells,intimal proliferation thrombus and inflammation of vessels could also be seen.All the changes were much severe in the infusion chemotherapy group than in the controlled group;Conclusions:Histological changes are significant after preoperative arterial infusion chemotherapy for breast carcinoma.