Crossed renal ectopia with rectal cancer: A case report.

BACKGROUND: Crossed renal ectopia (CRE) occurs when one kidney crosses the midline from the primary side to the contralateral side while the ureter remains on the primary side. Rectal cancer, one of the most common malignant tumors of the digestive tract, refers to cancer from the dentate line to the rectosigmoid junction. The concurrent presentation of CRE alongside rectal cancer is an uncommon clinical observation. CASE SUMMARY: Herein, we report a 69-year-old male patient with rectal cancer who was diagnosed with CRE via computed tomography during hospitalization. Following thorough preoperative evaluations, the patient underwent Dixon surgery. CONCLUSION: We performed laparoscopic radical resection of rectal cancer and adequate lymph node removal in a patient with CRE with no postoperative discomfort.

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis.

BACKGROUND: The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS. METHODS: Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test. RESULTS: The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ±â€Š5.4 mm vs. 47.5 ±â€Š7.6 mm, t = -8.066, P < 0.001), PT (14.7 ±â€Š1.8° vs. 29.1 ±â€Š3.4°, t = -13.277, P < 0.001), and SS (39.8 ±â€Š7.2° vs. 26.1 ±â€Š3.3°, t = 6.175, P < 0.001) between the long and short fusion groups. All patients had improved ODI, JOA, and VAS scores post-operatively (all P < 0.001), with no significant difference between the groups (all P > 0.05). The post-operative LSDI score was 3.5 ±â€Š0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ±â€Š0.7; P < 0.001). CONCLUSIONS: The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.

[Projection of potential geographic distribution of Apocynum venetum under climate change in northern China].

Apocynum venetum belongs to apocynaceae and is a perennial medicinal plant, its stem is an important textile raw materials. The projection of potential geographic distribution of A. venetum has an important significance for the protection and sustainable utilization of the plant. This study was conducted to determine the potential geographic distribution of A. venetum and to project how climate change would affect its geographic distribution. The projection geographic distribution of A. venetum under current bioclimatic conditions in northern China was simulated using MaxEnt software based on species presence data at 44 locations and 19 bioclimatic parameters. The future distributions of A. venetum were also projected in 2050 and 2070 under the climate change scenarios of RCP2.6 and RCP8.5 described in 5th Assessment Report of the Intergovernmental Panel on Climate Change (IPCC). The result showed that min air temperature of the coldest month, annual mean air temperature, precipitation of the coldest quarter and mean air temperature of the wettest quarter dominated the geographic distribution of A. venetum. Under current climate, the suitable habitats of A. venetum is 11.94% in China, the suitable habitats are mainly located in the middle of Xinjiang, in the northern part of Gansu, in the southern part of Neimeng, in the northern part of Ningxia, in the middle and northern part of Shaanxi, in the southern part of Shanxi, in the middle and northern part of Henan, in the middle and southern part of Hebei, Shandong, Tianjin, in the southern part of Liaoning and part of Beijing. From 2050 to 2070, the model outputs indicated that the suitable habitats of A. venetum would decrease under the climate change scenarios of RCP2.6 and RCP8.5.

Effect of vitamin D3 on maturation and antigen-presenting function of dendritic cells treated with Mycobacterium tuberculosis.

OBJECTIVE: To investigate the phenotypic characteristics and functional capability differences of mouse bone marrow-derived dendritic cells after stimulation with Mycobacterium tuberculosis in the presence or absence of vitamin D3. METHODS: Mouse bone marrow-derived cells were cultured with GM-CSF (20 ng/mL). Then, one was added with 100 nmol/L of 25(OH)D3, while the other did not. On day 6, 5 µg/mL of BCG was added to stimulate the cells for 24 h. On day 7, suspension cells were harvested for phenotypic and functional analyses. RESULTS: The percentages of CD86 dendritic cells (DCs) in the control group and 25(OH)D3 group were 66.97% ± 8.29% and 52.18% ± 8.52%, respectively; the mean fluorescence intensities of MHC-II in the control group and 25(OH)D3 group were 1 102.16 ± 371.02 and 681.62 ± 292.71. The expression levels of MHC- II and CD86 on the surface of the DCs in 25(OH)D3 group were significantly lower than those of the control group. The ability of the DCs to stimulate proliferation of T-lymphocytes was also significantly lower than that of the control group. CONCLUSIONS: These findings suggest that 25(OH)D3 modulates the immune response by affecting the maturation and function of DCs in Mycobacterium tuberculosis period.

One-stage surgery by a combined anterior-posterior approach to treat ankylosing spondylitis complicated by a multiple-level cervical vertebral chance fracture.

OBJECTIVES: This study aimed to investigate the outcomes after using a combination of anterior-posterior approaches to treat ankylosing spondylitis (AS) complicated by a multiple-level cervical vertebral Chance fracture. METHODS: We retrospectively analyzed 11 patients with AS complicated by a multiple-level cervical vertebral Chance fracture. RESULTS: After surgery, the average follow-up period was 25 months (24-27 months). No injury to the spinal cord, nerve roots, or vessels was caused by screw insertion during the operation. The incisions for all the patients healed by primary intention. These fractures generally required 4-6 months (average, 4.5 months) to heal, and there was no loosening, pullout or collapse of the bone graft, loosening or breaking of the internal fixators, nonunion, or other complications. CONCLUSIONS: Therefore, management with a combination of anterior-posterior approaches is feasible for treating AS complicated by a multiple-level cervical vertebral Chance fractures.

Vitamin D deficiency affects the immunity against Mycobacterium tuberculosis infection in mice.

The aim of the study is to investigate the immunological changes after stimulation with bacillus Calmette-Guerin (BCG) in mice with vitamin D deficiency. After weaning, mice were divided into the vitamin D-deficient group (-D group), the normal group (N group), and the vitamin D-supplemented group (+D group). Twelve-week-old mice were intraperitoneally injected with 0.5 mg/ml BCG (≥1.0 × 10(6) CFU/mg) and maintained for 6 weeks. Spleen lymphocytes were isolated, and the percentages of CD4(+) and CD8(+) lymphocytes were determined by flow cytometry. IFN-γ levels, IL-10 levels, and the TB-PPD-specific antibody titer were determined by ELISA. The inter-group difference was analyzed using one-way ANOVA, and multiple comparisons were analyzed using the LSD test. The percentage of CD4(+) cells was 27.1 ± 0.6 in the -D group, 23.62 ± 0.42 in the N group, and 19.46 ± 0.32 in the +D group (P < 0.05). The percentage of CD8(+) lymphocytes was 12.15 ± 0.61 in the -D group, 8.7 ± 0.64 in the N group, and 7.12 ± 0.48 in the +D group (P < 0.05). The CD4(+)/CD8(+) ratio was 2.23 ± 0.15 in the -D group, 2.71 ± 0.21 in the N group, and 2.73 ± 0.31 in the +D group (P < 0.05). The plasma IFN-γ levels were 416.42 ± 16.42 pg/ml in the -D group, 325.41 ± 11.16 pg/ml in the N group, and 276.26 ± 25.32 pg/ml in the +D group (P < 0.005). The plasma IL-10 levels were 16.45 ± 1.58 pg/ml in the -D group, 24.31 ± 2.16 pg/ml in the N group, and 26.28 ± 0.42 pg/ml in the +D group (P < 0.005). The serum TB-PPD-specific antibody level was significantly higher in the -D group than in the N and +D groups. Vitamin D deficiency affects the immunity against Mycobacterium tuberculosis infection in mice.

25(OH)D(3) affects the maturation and function of mouse bone marrow-derived dendritic cells stimulated by Mycobacterium bovis BCG.

It has been shown that vitamin D deficiency increases an individual's susceptibility to tuberculosis (TB). However, very little is known about the effect of vitamin D on the immune response to Mycobacterium tuberculosis (M. tb) in dendritic cells (DCs). Because DCs play an important role in TB infection, we investigated the phenotypic characteristics and functional capabilities of mouse bone marrow-derived dendritic cells (BMDCs) after stimulation with Bacillus Calmette-Guérin (BCG) in the presence or absence of 25(OH)D(3)(100 nM). Bone marrow cells from mice were cultured with GM-CSF (20 ng/ml) and were then treated with 25(OH)D(3) for 7 days. On day 6, 5 µg/ml of BCG (≥1.0×10(6) CFU/mg) was added to the cells for 24 hours, and on day 7, the non-adherent cells were harvested for phenotypic and functional analyses. After incubation with 25(OH)D(3), the expression levels of MHC-II and CD86 on the surface of the dendritic cells (DCs) and the ability of the DCs to stimulate proliferation of allogeneic mixed lymphocytes were lower than control cells (p<0.05). Furthermore, the level of Interleukin (IL) -4 secreted by the BMDCs in the 25(OH)D(3) culture was lower than that in the control culture (p<0.01). However, the BMDCs cultured with 25(OH)D(3) produced significantly higher levels of IL-2, IL-6, IL-10 and interferon gamma(IFN-γ) than those in the control culture (p<0.05). These findings suggest that 25(OH)D(3) modulates the immune response during mycobacterial infection by affecting the maturation and function of DCs.

MRI findings for frozen shoulder evaluation: is the thickness of the coracohumeral ligament a valuable diagnostic tool?

BACKGROUND: Recent studies have demonstrated that the coracohumeral ligament (CHL) is shortened and thickened in a frozen shoulder. We analyzed the rate in CHL visualization between patients with frozen shoulder and normal volunteers using Magnetic Resonance Imaging (MRI) to determine the CHL thickness in the patients with a frozen shoulder. METHODS AND FINDINGS: There were 72 shoulder joints in 72 patients (50 femles and 22 males with a mean age of 53.5 years) with clinical evidence and MR imaging evidence of frozen shoulder. These were prospectively analyzed to identify and measure the maximum thickness of the CHL. The control group, which included 120 shoulder joints in 60 normal volunteer individuals (30 females and 30 males with a mean age of 50.5 years) was also referred for MR imaging. A chi-square test was used to analyze the data of the rate of CHL visualization between the patients with frozen shoulder and the control group. A two-way ANOVA was used to analyze the mean maximal thickness of CHL. The CHL was visualized in 110 out of 120 shoulders in the control group (91.7%), and in 57 out of 72 shoulders for the frozen shoulder group (79.2%), there was significant difference, using a chi-square test (P<0.05). The CHL was not visualized in 10 out of 120 shoulders in the control group (8.3%), and 15 out of 72 shoulders in the frozen shoulder group (20.8%), there was a significant difference (P<0.05). The CHL thickness (3.99±1.68 mm) in the patients with frozen shoulder was significantly greater than that thickness (3.08±1.32 mm) in the control group, using a two-way ANOVA (P<0.001). The CHL thickness (3.52±1.52 mm, n = 97) in the female shoulders was no significantly greater than that thickness (3.22±1.49 mm, n = 70) in the male shoulders, using a two-way ANOVA (P>0.05). CONCLUSIONS: MR Imaging is a satisfactory method for CHL depiction, and a thickened CHL is highly suggestive of frozen shoulder.

[Effects of different cyclic mechanical stretching loads on human tenocytic cytoskeleton in vitro].

OBJECTIVE: To investigate the human tenocyte cytoskeleton under different in vitro stretching conditions and analyze the relations between the changes of tenocytic cytoskeleton and different stretching loads. METHODS: Human tenocytes, cultivated for 5 -7 passages, were stretched under 4%, 8% and 12% cyclic mechanical stretching with a duration of 2, 4, 8, 12, 24 hours and a frequency of 0.5 and 1.0 Hz. Laser scanning confocal microscope was used to examine the changes of F-actin and nucleus after immunofluorescent staining at different cyclic mechanical stretching loads on human tenocyte. The uni-cell average fluorescence intensity was measured with an image analysis system by the photos of human tenocyte cytoskeleton and analyzed by the single factor analysis of variance. RESULTS: After cyclic stretching under 4% stretching with a duration of 2 hours at 0.5 Hz, the microfilament of human tenocyte had an irregular and dim alignment. F-actin was thicker and ruptured under 4% stretching with a duration of 4 hours. Under 8% stretching with a duration of 4 hours at 0.5 Hz, all actin microfilaments ruptured, but part of membrane microfilament remained intact. There was a rising trend of actin filament fracturing under 12% stretching with a duration of 2, 4, 8, 12, 24 hours at 1.0 Hz. And all actin filaments fractured at 24 hours. In the control group, the fluorescent intensity of F-actin was at the highest and the filament remained intact. Under the same stretching frequency, the fluorescent intensity of F-actin had a declining trend and significant differences existed under different stretching loads with different durations (P < 0.05). The fluorescent intensity of F-actin increased in all experimental groups, but it was lower than that of the control group with a duration of 8 hours. The expression of F-actin decreased with a longer duration and reached its lowest at 24 hours. The most obvious phenomenon of nuclear condensation and apoptotic body formation was observed under 4% stretching with a duration of 4 hours at 0.5 Hz. CONCLUSION: Different cyclic mechanical stretching may cause the in vitro breakage and depolymerization of human tenocytic F-actin. Such an effect correlates with stretching force and its duration.

[Triple arthrodesis with osteotomy for the treatment of stage IIB and stage III adult-acquired flatfoot deformity].

OBJECTIVE: To analyze the clinical outcomes of triple arthrodesis with osteotomy in the treatment of Stage IIB and Stage III adult-acquired flatfoot. METHODS: The authors reviewed 10 cases of adult-acquired flatfoot, including 3 cases of stage IIB adult-acquired flatfoot and 7 cases of stage III adult-acquired flatfoot. They were treated by triple arthrodesis with osteotomy of subtalar joint (STJ), talonavicular joint (TNJ) and calcaneocuboid joint (CCJ). The combined medial and lateral incisions were used to obtain adequate exposure for CCJ, STJ and TNJ. Then the cartilages of CCJ, STJ and TNJ were completely denuded and osteotomies to restore their proper alignments. The optimal positioning of hindfoot could be achieved and fixed by Kirschner wires. Two cannulated screws of 7.3 mm were delivered through the plantar aspect of heel to fix STJ. And then two 4.5 mm cannulated screws individually fixed TNJ and CCJ distal to proximal. Clinical evaluations were based on the AOFAS ankle-hindfoot scale and subjective assessments of pains, function, cosmesis and overall satisfaction. Radiographic evaluations included measurements of anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle, lateral talo-first metatarsal angle and an assessment of time to union for all arthrodeses. RESULTS: All patients were followed-up with a mean time of 13.2 (6 - 21) months. The average AOFAS ankle-hindfoot scale improved from 39.4 ± 4.4 preoperatively to 83.7 ± 2.6 postoperatively (P < 0.01). And the patients experienced subjective improvements in pain, function and cosmesis. Overall, all patients were satisfied. Radiographically, the rate of bone healing was 100%. The anterior-posterior talo-first metatarsal angle, lateral talocalcaneal angle and lateral talo-first metatarsal angle statistically improved. No complication, such as infection and un-union, was reported. CONCLUSION: Triple arthrodesis with osteotomy is an effective procedure for the treatment of stage IIB and III adult-acquired flatfoot deformity. It may relieve pains, correct structural deformities and obtain excellent clinical outcomes.

[Medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction].

OBJECTIVE: To investigate the clinical outcomes of medial displacement calcaneal osteotomy with mini-incision for the treatment of acquired flexible flatfoot caused by posterior tibial tendon dysfunction. METHODS: From 2005 to 2009, 10 patients (13 feet) of acquired flexible flatfoot with obvious heel valgus underwent medial displacement calcaneal osteotomy with mini-incision. The lateral skin incision of 3.0 - 4.5cm was made to explore the lateral calcaneal wall. Calcaneal osteotomy was performed from inferior and lateral to superior and medial, perpendicular to the longitudinal axis of calcaneal body. The distal segment was displaced medially for 1/3-1/2 width of calcaneal body and fixed by two parallel cannulated screws. All patients were evaluated at 6 weeks, 3 months, 6 months, 12 months and every 6 months pre- and post-operatively by clinical examinations and radiological studies. All patients were physically examined with an extended protocol of questionnaires and the AOFAS Ankle & Hindfoot Scales. The lateral view of full foot allowed an assessment of bone healing, calcaneus inclination angle (CI), talocalcaneal angle (TC) and talar first metatarsal angle (TMT). The AP view of full foot allows assessment of TC and TMT. The heel varus/valgus alignment could be evaluated on the axial radiographs of hindfoot. RESULTS: With a mean postoperative follow-up period of 20.3 months (range 7 - 55 Ms), all patients had bone union as confirmed by clinical examination and radiology. The AOFAS rating scale improved from a pre-operative mean of 50.3 to a mean of 80.2 at 6 months and a mean of 84.2 at last follow-up, without any complication of infection, nerve injure and so on. All radiographic parameters were statistically significant (P < 0.001), including CI, TC and TMT on the lateral view and TC and TMT on the AP view. The heel varus/valgus was corrected on the axial view. CONCLUSION: The medial displacement calcaneal osteotomy with mini-incision is a recommended procedure for the treatment of acquired flexible flatfoot with excellent clinical outcomes, correction of deformity and fewer complications.

An anatomic and histologic study of the coracohumeral ligament.

Although the anatomy and histology of the coracohumeral ligament (CHL) play an important role in the diagnosis and treatment of frozen shoulder, they remain unclear. Our objective was to study the anatomic features of the CHL and analyze its histology. Twenty-six fresh-frozen, normal cadaveric shoulders were used to examine the position and morphology of the CHL and their relationship with the superior glenohumeral ligament and to determine the CHL's histologic features in comparison with the joint capsule and coracoacromial ligament. The CHLs were all located in the rotator interval, with an irregular trapezoidal structure. The subacromial bursa was above the CHL, and the subcoracoid bursa was below the it. The CHLs in all shoulders originated from the lateral aspect of the base of the coracoid process. In 11 shoulders, it inserted into the supraspinatus tendon, whereas in 11 other shoulders, it inserted into the rotator interval. In 3 shoulders, the CHLs were split and inserted into both the supraspinatus and subscapularis tendons, respectively. Finally, the CHL in 1 shoulder only inserted into the subscapularis tendon. We also observed that the pectoralis minor tendons in 4 shoulders passed over the coracoid process top and inserted into the CHLs. In 11 shoulders, a complex of the CHL and the superior glenohumeral ligament was formed. Histologically, the CHL was found to be similar to the joint capsule without any ligament features. The position, morphology, and origin of the CHL did not change much, but its insertion varied greatly. In addition, the CHL had the histologic feature of a capsule, not a ligament.

[Expression and significance of aquaporin 3 and aquaporin 9 in colonic mucosa of patients with functional constipation].

OBJECTIVE: To study the expression and distribution of aquaporin 3 (AQP3) and aquaporin 9 (AQP9) in colonic mucosa of patients with functional constipation, and to examine the relationship of constipation with AQP3 and AQP9. METHODS: Immunohistochemistry and semi-quantitative Western blotting were used to detect the expression and distribution of AQP3 and AQP9 in colonic mucosa of 45 patients with functional constipation (trial group) and 21 cases without constipation (control group). Gray scale ratios of AQP3 and AQP9 to beta-actin protein as interior reference were relative amounts of AQP3 and AQP9. RESULTS: Immunohistochemistry showed that AQP3 was distributed mainly in basement and cavosurface membrane of epithelial cell of colonic mucosa and AQP9 mainly in basement membrane of goblet cell in cavosurface colonic mucosa. Western blotting revealed that the average values of gray scale ratios of AQP3 in ascending colon of trial group and control group were 0.905 and 0.798 (P<0.05),while those of AQP9 were 0.544 and 0.543 (P>0.05), respectively. The average values of gray scale ratios of AQP3 in descending colon of trial group and control group were 0.697 and 0.701 (P>0.05), while those of AQP9 were 0.575 and 0.732 (P<0.05), respectively. CONCLUSIONS: Up-regulated expression of AQP3 in ascending colon and down-regulated expression of AQP9 in descending colon are presented in patients with functional constipation as compared to patients without functional constipation. AQP3 and AQP9 may play a significant role in the onset and development of constipation.

[Arthroscopic Bankart lesion repair by double-row vertical mattress suture with anchors for anteroinferior glenohumeral instability].

OBJECTIVES: To introduce a new arthroscopic Bankart repair by vertical mattress suture with anchors, and to evaluate its clinical effectiveness. METHODS: A new arthroscopic Bankart repair by vertical mattress suture with anchors was performed, including to insert only 2 anchors at 3 o'clock and 5 o'clock position and make vertical mattress suture of labrum-ligament complex at 2, 4 and 6 o'clock of labrum, and to shift up the anterior-inferior capsule. Nine cases of anterior glenohumeral instability without severe glenoid bone defect were followed-up for an average period of 14 months (range from 6 to 26 months). The average surgery age was 28 years (range from 21 to 46 years). RESULTS: The average surgery time was 51 min (40 - 75 min). Clinical scores as evaluated by the modified Rowe score advanced from 40 +/- 16 points to 92 +/- 19 points (75 - 94). There was no any recurrence and complication. External rotation was reduced by 5 degrees at 0 degrees adduction and by 3 degrees at 90 degrees of abduction. CONCLUSIONS: The arthroscopic Bankart repair by vertical mattress suture with anchors for anteroinferior glenohumeral instability is favorable as an easy, short-time surgery with excellent clinical results in short-term follow-up.