Objective To study the operative methods and therapeutic effects of acetabulum reinforcement ring in the reconstruction of acetabular defects in primary and revisional artificial hip replacement. Methods From November 2000 to July 2005, 14 cases (15 hips) of severe acetabular defects in artificial hip replacement were treated with acetabulum reinforcement ring combined autogenous or allogenic bone transplantation, including 7 males and 8 females aged 34-72 years with an average of 55 years. Among them, 9 cases (9 hips) underwent artificial hip joint revision, which was 3-22 years (average8.9 years) far away from their primary replacement, and 5 cases (6 hi ps) received primary replacement, including 1 case of rheumatoid arthritis of both hips, 1 osteoarthritis caused by acetabular dysplasia, 1 femoral head resection due to debridement of hi p infection, 1 nonunion of acetabulum old fracture with the center dislocation of femoral head and 1 old acetabulum fracture. The disease course was 2-25 years (average 11.6 years). According to the American Academy of Orthopaedic Surgeons (AAOS) classification, the acetabulum defects of 7 hips were categorized into Type II, 6 hips were Type III and 2 hips were Type IV. Harris score was (59.1 ± 15.4) points preoperatively. Results All wounds were healed by first intention. The symptom of sciatic nerve simulation was occurred in 1 case and was rel ieved after taking neuroprotective drug for 5 months. All the cases were followed up for 33-90 months (average 51.3 months). Harris score at the final follow-up was (81.9 ± 10.4) points, indicating there was a significant difference between before and after operation (P lt; 0.01). X-ray film demonstrated that the displacement of acetabulum reinforcement ring and acetabular cup was less than 5 mm, the rotation was less than 5°, and there was no progressive radiolucent zone around acetabulum and screw. Conclusion Acetabulum reinforcement ring is beneficial to reconstruct severe acetabular defects, improve hip joints’ function and provide primary stabil ity for putting acetabular cup into an ideal biomechanical position.
Objective To establish a new method for detection of β-glucuronidase (β-G) mRNA in human liver and kidney tissues. Methods β-G mRNA expression was detected by reverse transcription polymerase chain reaction(RT-PCR) in 10 cases of normal liver tissues, 10 cases of normal kidney tissues and 8 cases of hepatocellular carcinoma tissues. Results The expand products of β-G mRNA were expressed in liver and kidney tissues with similar size of 422 bp. The expression contents of β-G mRNA in liver and kidney normal tissues were different (1.71±0.32 vs 1.83±0.22) but without statistical significance (Pgt;0.05). However, the expression content of β-G mRNA in hepatocellular carcinoma tissues was 3.88±0.86， which was significantly higher (P＜0.01) than that in normal liver tissues. Conclusion β-G mRNA determination is feasible by checking β-G gene alignment in gene bank and designing draw matter in the tissue of liver and kidney. It may be very significant to explore the change of β-G mRNA in various tissues in studying of molecular mechanism.
Objective To explore the surgical method and cl inical short-term outcomes of internal fixation combined closed reduction with arthroscope aid in treating patellar fracture. Methods From June 2004 to July 2008, 42 patients with fresh simple patellar fracture underwent internal fixation combined closed reduction with arthroscope aid, included28 males and 14 females, aged 16-59 years (35 years on average). The locations were 19 left knees and 23 right knees. Injury was by traffic accident in 21 cases, by fall ing in 11 cases, by sports in 7 cases and by crush in 3 cases. All the patients had fresh closed fracture, including 38 cases of transverse fracture and 4 cases of stellate fracture. The Lysholm score was 68.60 ± 15.20; the proprioceptive function of the knee joints was (3.72 ± 0.12)°. The time from injury to operation was 3-42 hours (12 hours on average). After the treatment of affil iated injury under the arthroscope, patellar fracture was reduced with manipulation method, fracture was fixed with tensile force screw or modified tension band. Results All incisions obtained heal ing by first intention after operation, 42 patients were followed up for 12-39 months (16 months on average). The X-ray films showed callus at the fracture and the smooth cartilage surface 6-9 weeks (7 weeks on average) after operation. The flexed motion range of knee joint at last follow-up was at normal range in 38 cases, was l imited in 4 cases. Circumference of suffered l imbs 15 cm above the patella was the same as normal ones in 23 cases, atrophied 0.7 cm in 19 cases. There were no breakage of internal fixation and shift of fracture and patellofemoral arthritis at last follow-up. The proprioceptive function of the knee joints was (2.06 ± 0.11)° and the Lysholm score was 95.10 ± 3.92; all showing statistically significant differences when compared with preoperation (P lt; 0.05). Conclusion This treatment method has advantages as follows: mini-wound, early exercises and few compl ications, which can rinse articular cavity and repair the affil iated injury at the same time.
Objetive To observe the incidence of extraocular extension of malignant uveal melanoma, the relationship between the incidence and histopathologic type, the characters of clinical manifestation and iconography, and the factors influencing prognosis. Methods Nine cases of extraocular extension of malignant uveal melanoma within last 20 years were analyzed retrospectively. All cases were diagnosed by histopathological examination and most of them had undergone ultrasound and CT examinations. Results The incidence of extraocular extension of malignant uveal melanoma was 15%. Tumors of 6 patients were flat and 2 nodular in shape, 4 epithelial cell and 1 spindle cell in type. The follow-up results of 5 patients in this series indicated that the prognosis was related to the size of the tumor, the degree of extraocular extension, and histopathologic type. Conclusion Extraocular extension of malignant uveal melanoma might happen in early case and the occurrence is usually related to the histopathologic type of the tumor. Iconographic examination is very helpful for diagnosis in extraocular extension of this tfumor. (Chin J Ocul Fundus Dis,1999,15:30-32)
【摘要】 目的 应用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）探讨α-L-岩藻糖苷酶（AFU）对恶性腹水和非结核良性腹水的诊断价值。 方法 2004年7月—2008年1月对213例诊断明确的良、恶性腹水（其中良性腹水117例、恶性腹水96例）AFU活性进行检测。采用ROC曲线评价AFU的诊断灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及Youden指数，评价其诊断效率。 结果 恶性腹水组AFU水平（164.96±87.72） μmol/（L•h），良性腹水组（104.02±62.07） μmol/（L•h），两者比较差异有统计学意义（Plt;0.01）。AFU诊断恶性腹水的ROC 曲线下面积为0.754±0.034，最佳分界值101.95 μmol/（L•h）。以AFU≥101.95 μmol/（L•h）来预测恶性腹水，其诊断的灵敏度为82.3%，特异度为63.2%，准确性为72.8%、阳性预测值为65.3%、阴性预测值为83.1%、阳性似然比为2.23、阴性似然比为0.28及Youden指数为0.455。 结论 腹水AFU活性检测有助于恶性腹水和非结核良性腹水的鉴别诊断，是一个比较理想的实用指标，适合于基层医院的临床应用。【Abstract】 Objective To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. Methods Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. Results The average level of AFU in the malignant group [(164.96±87.72) μmol/(L•h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L•h)] (Plt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L•h). When an AFU level equal to or higher than 101.95 μmol/(L•h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. Conclusion Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.
During the past decades, the field of hip preservation in China has achieved great improvements. Theoretically, the blood supply of the femoral head and the acetabulum along with the mechanism of early-stage hip osteoarthritis has been gradually cleared. The knowledge and application of the periacetabular osteotomy, surgical hip dislocation, and hip arthroscopy has been vigorously promoted. Improved understanding of the mechanism, pathology, and prevention protocols of the secondary hip dysplasia have been obtained, despite the fact that lack of awareness of some mechanism and detail, for example, hip instability or borderline dysplasia, etc. On the basis of summing up those clinical progress, this article further elaborated the historical development of hip preservation through the review of several traditional treatment, and made objective assessment about the follow-up, evaluation, minimally invasive surgery, and individualized treatment newly reported.
Objective To investigate the etiology and the clinical features of obliterative bronchiolitis (OB). Methods Sixteen admitted patients were diagnosed as OB in Peking Union Medical College Hospital from Jan 1990 to May 2018. The case records were reviewed retrospectively. Results Twelve patients were female and 4 patients were male. The median age was 33.5 years (ranged from 17 to 55). The common symptoms included: exertional dyspnea in 15 patients (94%), cough in 10 patients (63%), phlegm production in 8 patients (50%). All of the 16 patients had associated conditions: paraneoplastic pemphigus in 6 patients (Castleman’s disease, lymphoproliferative disorder, inflammatory myofibroblastic tumor and follicular dendritic cell tumor respectively), chronic graft-versus-host disease after hematopoietic stem-cell transplantation in 3 patients, thymoma in 2 patients, Behcet’s disease, Sjögren syndrome, multiple myeloma, myasthenia gravis, and oral lichen planus in 1 patient respectively. The pulmonary function tests revealed severe or very severe obstructive ventilatory defect in all 16 patients. The CT scans showed slight ground-glass opacities in 10 patients, decreased attenuation of lung in 9 patients, mosaic attenuation in 8 patients, bronchiectasis in 7 patients, and air trapping in 3 patients. Conclusions OB is a clinical syndrome characterized by progressive airway obstruction, resulting from a variety of exposures or diseases. In most cases, diagnosis can be obtained on the basis of typical clinical, physiological, and radiological features, combined with OB-related diseases or exposures. Surgical lung biopsy can help diagnosis but risk-benefit should be taken into consideration seriously.
ObjectiveTo compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty.MethodsWe conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed.ResultsThere was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05).ConclusionDa Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.
Objective To assess the anal sphincteric function after intersphincteric resection for low rectal cancer by vectorial manometry. Methods Maximal anal pressure, vector volume, vector symmetric index and rectal anal inhibitory reflex were assessed in 16 patients underwent intersphincteric resection for low rectal cancer from 1999 to 2006. Thirty patients with low anterior resection for rectal cancer and another 30 healthy individuals were selected as control. Results The patients in intersphincteric resection group were subdivided into soiling group and defecation function good group. Maximal pressure, vector volume and vector symmetric index of the patients in soiling group and defecation function good group were significantly lower than those of the healthy and low anterior resection controls (P＜0.001). The maximal systole pressure, systole vector volume and vector symmetric index in soiling group were significantly lower than those in function good group (P＜0.001). The 25.0% patients in intersphincteric resection group had rectal anal inhibitory reflex， was significantly lower than that of the low anterior resection control group (93.3%, P＜0.001). Conclusion The maximal pressure and vector volume are compromised in patients underwent intersphincteric resection . The vectorial manometry can be an objective comprehensive tool for the evaluation of anal sphincter function in patients with intersphincteric resection.
Objective To examine the effects of TGF-β1 on epithelial-myofibroblast transition ( EMT) of A549 cells and its relationship with extracellular regulating kinase1/2 ( ERK1/2) signaling system. Methods Cultured A549 cells were divided into one negative control group and four groups incubated with TGF-β1 for 48 hours at different concentration ( 0.05, 0. 5, 5, 10 μg/L, respectively) . The protein expressions of E-cadherin, α-smooth muscle actin ( α-SMA) , vimentin and fibronectin were assessed by indirect immunofluorescence and Western blot. In the other experiment, cultured A549 cells were incubated with TGF-β1 for different time. The protein and mRNA expressions of E-cadherin and α-SMA were assessed by Western blot and RT-PCR. The protein expressions of vimentin, fibronectin, ERK1 /2, and p-ERK1 /2 were detected by Western blot. Results By indirect immunofluorescence, Western blot, and RT-PCR analysis, E-cadherin expression significantly decreased and α-SMA expression significantly increased in A549 cells treated with TGF-β1 compared with negative controls in a time- and concentrationdependent manner ( Plt;0.05 ) . Vimentin and fibronectin protein expressions significantly increased simultaneously ( Plt;0.05) . The concentration of 5 ng/mL of TGF-β1 was most effective. The ratio of p-ERK1 /2 and ERK1/2 was significantly increased in the TGF-β1 treated cells in a time-dependent manner ( P lt;0. 05) . Conclusions TGF-β1 can induced EMT in A549 cells in vitro in a time- and concentrationdependant manner. This effect may involve in upregulation of ERK1/2 signaling system.