OBJECTIVETo investigate the relationship between expression of angiogenic factors and invasion and proliferation of pancreatic cancer cell.

METHODSThe three pancreatic cancer cell lines of SW1990, Panc-1 and PCT-3 were divided into four groups respectively: control group, VEGF siRNA group, bFGF siRNA group and VEGF siRNA + bFGF siRNA group. The expression and the secretion of VEGF and bFGF in the three cell lines were inhabited by VEGF siRNA and bFGF siRNA. The proliferation and the invasion of the three cell lines were determined by CCK-8 and Boyden Chamber invasion tests.

RESULTSExpressions of VEGF and bFGF in three cell lines were significantly inhibited by VEGF siRNA and bFGF siRNA. The proliferation was inhabited by VEGF siRNA and bFGF siRNA in SW1990 and Panc-1 (P < 0.05), while was not in PCT-3 (P > 0.05). The invasion was inhabited significantly by VEGF siRNA and bFGF siRNA in the three cell lines (P < 0.05). Combination of VEGF siRNA and bFGF siRNA resulted in more efficient influence in inhibition of invasion in Panc-1 and proliferation in PCT-3 and SW1990 than VEGF siRNA or bFGF siRNA individually.

CONCLUSIONThe decreased expression of VEGF and bFGF can inhabited the ability of invasion and proliferation of pancreatic cancer cell.

Cell Line, Tumor ; Cell Proliferation ; Fibroblast Growth Factor 2 ; genetics ; Humans ; Neoplasm Invasiveness ; Pancreatic Neoplasms ; pathology ; RNA, Small Interfering ; genetics ; Vascular Endothelial Growth Factor A ; genetics

OBJECTIVETo study the biomechanical characteristics of antegrade intramedullary fixation for metacarpal fractures.

METHODSFrom March to May 2008, both the 4th and 5th metacarpals from 25 formalin embalmed cadaver hands had three-point bending test after transverse osteotomy followed by randomly fixation with one of the following three methods: plate and screw, antegrade intramedullary K-wire, crossed K-wire. While, both the 2nd and 3rd metacarpals had torsional loading test after the same management as the 4th and 5th metacarpal had undergone.

RESULTSIn the three-point bending test, both the maximum bending moment (M(max)) and bending rigidity (EI) of the antegrade intramedullary K-wire were comparable with those of the plate and screw, and were significantly larger than those of the crossed K-wire. In the torsional loading test, the antegrade intramedullary K-wire had a statistically smaller maximum torque (T(max)) than the plate and screw, and had a comparable T(max) with the crossed K-wire; while, the torsional rigidity (GJ) of the intramedullary K-wire was statistically weaker than that of both the plate and screw and the crossed wire.

CONCLUSIONSOne single antegrade intramedullary K-wire can provide a satisfactory M(max) and EI for metacarpal fixation and shows relatively weak in the torsional loading test. The injured finger should be well protected to avoid torsional deformity in clinical practice.

Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Bone Wires ; Cadaver ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Metacarpal Bones ; injuries ; Osteotomy

OBJECTIVETo evaluate the effects of cementless revising cup or acetabular reinforcement cages for reconstructing the massive acetabular deficiency.

METHODSFrom September 2001 to September 2008, 22 loosening acetabular cases (24 hips) were revised using cementless revising cup or acetabular reinforcement cases for reconstructing massive bone defect after particulate bone grafting. There were 2 cases (2 hips) using Lima cementless revising cup, 2 cases (2 hips) using Kerboull ring, and 18 cases (20 hips) using restoration GAP cages. Six cases (6 hips) were male, and 16 cases (18 hips) were female. The mean age was 62 years old (34 - 79 years old). Septic loosening was in 2 cases (2 hips), and aseptic loosening in 20 cases (22 hips). The mean follow-up was 48 months (18 - 84 months).

RESULTSThere was no clinical or radiological evidence of loosening for the revising acetabular components at the last follow-up point. The mean Harris hip score was improved significantly from 56 points (44 - 75) before revision to 89 points (78 - 94) at the last follow-up after revision. Excellent and good rate was 95.5% (21/22 cases). The average abduction angle of the three types of acetabular reconstructive cages were 50.1 degrees (39.0 degrees - 66.0 degrees), and almost all cases of the hip rotation center were restored after revision surgery. At the last follow-up, the reinforcement cages were no immigration and breakup, and there was no radiolucent line around the acetabular components. The bone graft integrated well into surrounding acetabular bone.

CONCLUSIONThe method of revising the massive acetabular bone defect by cementless revising cup and acetabular reinforcement cages restores the normal hip rotation center, supplies the primary stability of the revising component, and protects the bone graft from mechanical overload during its revascularization phase, which is a reliable method for revising the massive acetabular deficiency after total hip arthroplasty.

Acetabulum ; surgery ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Female ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Reoperation ; methods ; Stents

OBJECTIVETo explore an effective and reasonable surgical strategy for active spinal tuberculosis with severe kyphotic deformity (kyphotic angle >or= 45 degrees).

METHODSFrom January 2004 to January 2008, 30 consecutive patients of active spinal tuberculosis complicated with significant angulation were enrolled in this study, including 8 male and 22 female. The average age was 35 years (range, 7 - 60 years), with average angle of kyphosis of 58 degrees (range, 45 degrees - 70 degrees). There were 28 patients complicated with intraspinal abscess, of which 10 patients presented with incomplete paraplegia. According to the Frankel's scoring system, there were 2 patients with Frankel Grade B, 6 with Grade C, 2 with Grade D. After antituberculous chemotherapy (HREZ) for at least 2 weeks, all patients underwent posterior multiple-level pedicle screw instrumentation and kyphotic correction, and then received anterior debridement, decompression and supportive bone grafting, all of which were completed in the same day. The postoperative standardized chemotherapy was 6HREZ/6-12HRE. The angle of kyphosis, curve correction after surgery, and recovery of paraplegia were analyzed. Fusion status and erythrocyte sedimentation rate were recorded to determine the presence of active disease.

RESULTSOperative time was 4 to 6 hours (average 5.2 h), blood loss was 600 to 900 ml (average 760 ml). No perioperative severe complications occurred. The kyphotic angle was corrected to 0 degrees - 10 degrees, and the maximum corrected angle was 65 degrees . The average follow-up duration was 18 months (range, 12 - 48 m). All patients showed evidence of solid fusion and healing of the active disease at 6 months follow-up. Neurologic deficits were improved: 2 patients from B to D, 6 patients from C to E, 2 patients from D to E. No recurrence of the tuberculosis infection or instrumentation failure happened at final follow-up.

CONCLUSIONCombined posterior instrumentation and anterior debridement, fusion surgery in one stage is proved to be successful in treating spinal tuberculosis, correcting the kyphosis, and providing solid fusion.

Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; complications ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; complications ; surgery ; Young Adult

OBJECTIVETo explore the clinical efficacy of the percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures with osteonecrosis.

METHODSThe clinical data of 31 patients with osteoporotic vertebral compression fractures associated with osteonecrosis from January 2005 to January 2008 were analyzed retrospectively. There were 13 male and 18 female in this study. The mean age of the patients was 71 years (range from 57 to 84 years). The back pain lasted for 4.2 months (from 1 month to 10 years). Radiography, MRI and CT examination were performed. The patients were treated by percutaneous balloon kyphoplasty and the vertebral body tissue was extracted to perform common pathological examination. The anterior vertebral height was measured on a standing lateral radiograph before operation, after operation (one day after operation) and at the final follow-up. A Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) were chosen to evaluate pain status and functional activity.

RESULTSThe mean follow-up was for 27 months (range, 18 to 48 months). The anterior vertebral body height of fracture vertebra was restored from (34.7 +/- 3.1)% preoperatively to (71.4 +/- 2.3)% postoperatively, and to (70.2 +/- 2.5)% at the final follow-up. There was a significant improvement between preoperative and postoperative values (P < 0.05) and no difference between postoperatively and at the final follow-up (P > 0.05). The VAS was 8.7 +/- 0.4 preoperatively, 2.3 +/- 0.7 postoperatively, and 1.9 +/- 0.2 at the final follow-up; and the ODI was 89.1 +/- 2.7 preoperatively, 31.7 +/- 3.1 postoperatively, and 29.1 +/- 2.7 at the final follow-up. There was statistically significant increment in the VAS and ODI postoperatively compared with preoperatively (P < 0.05), while there was no statistically significant differences between postoperatively and at the final follow-up (P > 0.05). There was a significant increment between preoperative and final follow-up values (P < 0.05). Asymptomatic cement leakage occurred in two cases. New vertebral fracture occurred in one case.

CONCLUSIONBalloon kyphoplasty is a safe and effective procedure for osteoporotic vertebral compression fractures with osteonecrosis.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Fractures, Compression ; complications ; etiology ; Humans ; Kyphoplasty ; methods ; Male ; Middle Aged ; Osteonecrosis ; etiology ; surgery ; Osteoporosis ; complications ; Retrospective Studies ; Spinal Fractures ; complications ; etiology ; Vertebroplasty

OBJECTIVETo summarize the experiences in high-risk renal transplant recipients for ketter long-term survival.

METHODSFrom April 1991 to December 2008, a total of 921 kidney recipients with high-risk factors were divided into six groups as following: (1) pediatric patients (< 18 years old) (GI, n = 34); (2) retransplant recipients (GII, n = 169); (3) high sensitized patients (PRA> 30% or peak PRA > 50%)(GIII, n = 35); (4) elderly recipients (> 60 years old) (GIV, n = 297); (5) diabetic patients (GV, n = 112); (6) patients with HBV/HCV infection or HBV/HCV carrier (GVI, n = 274). Each group was compared to a control of 807 recipients without any above risk factor for patient and graft survival at 1, 3 and 5 years. Incidences of acute rejection (AR), chronic rejection (CR) and complication were analyzed and compared respectively between the studied subjects and the control group as well.

RESULTSCompared with the control group, patient/graft survivals were lower in GII, GIII and GVI (all P < 0.05), GIV had worse patient survival (P < 0.05); AR and CR incidences were greater in GI and GIII (all P < 0.05); GIV, GV and GVI had more complications.

CONCLUSIONSThis study suggests the benefits for long-term outcome in high-immunological risk renal transplant recipients of low acute selection incidence rate, and reduction of complication incidences is the key to long term results for non-immunological high risk recipients.

Adolescent ; Adult ; Aged ; Child ; Female ; Graft Rejection ; epidemiology ; Graft Survival ; Humans ; Kidney Transplantation ; statistics & numerical data ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome ; Young Adult

OBJECTIVESTo evaluate efficacy of microsurgical hemilaminectomy approach and use of intraoperative indocyanine green videoangiography for patients with intradural dorsal arteriovenous fistula.

METHODSMedical records and follow-up data of 24 patients who were microsurgically treated at a single institution for intradural dorsal arteriovenous fistula between January 2004 and August 2008 were retrospectively reviewed. Preoperatively DSA was performed for definite diagnosis. All patients were evaluated with the Aminoff and Logue scale. Preoperative, 4 patients had excellent spinal condition having mean score of 1.0; 8 cases had good spinal condition with mean score of 3.4; 9 cases had average spinal condition with mean score of 6.9; 3 cases had poor spinal condition with mean score of 10.0. Twenty two cases had one feeder while 2 cases had two feeding arteries. All the patients underwent microsurgical hemilaminectomy via a posterior approach. Two patients received complemented surgery because of the recurrence of the lesion after embolisation failed. Three patients received intraoperative indocyanine green videoangiography. Combined followed-up imaging and myelonic function were used for evaluating followed-up data.

RESULTSMean follow up was done up to 36 months. Followed-up imaging didn't reveal any residual lesion or its recurrence. Spinal functional assessment using Aminoff and Logue scale showed 16 patients of excellent outcome and had mean score of 0.7; 4 had good outcome having mean score of 4.8; 3 was of average nature with mean score of 6.7; 1 had poor outcome with 9.0 scores. With the surgical treatment, 16 cases were cured, 6 were improved and 2 cases had no change according to synthetic curative effect.

CONCLUSIONSMicrosurgical treatment, especially the microsurgical hemilaminectomy via a posterior approach, is effective treatment intradural dorsal arteriovenous fistula. Intraoperative indocyanine green videoangiography is a simple auxiliary tool for intraoperative quality control and favorable surgical outcomes.

Adult ; Aged ; Arteriovenous Fistula ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; Middle Aged ; Retrospective Studies ; Spinal Cord ; blood supply ; Treatment Outcome ; Young Adult

OBJECTIVESTo discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting (CAS) in patients with carotid artery stenosis.

METHODSFrom January 2003 to August 2009, 403 patients with carotid artery stenosis that were performed CAS, intracranial hemorrhage occurred in 5 cases after the procedure. We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure.

RESULTSCerebral hemorrhage were found 30 min after CAS in 2 cases, 5 days in 2 cases and 3 days in 1 case. One patient was treated conservatively whose hemorrhage was about 2 ml, one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress. The position of hemorrhage were all in the side of carotid artery stenosis, and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction. One patient was cured conservatively, the one who was performed draining of ventricle died. Among the other three cases performed craniotomy, one recovered with light neurological deficit and two died of multiple organ failure.

CONCLUSIONIntracranial hemorrhage is the most serious complication of CAS of carotid artery, and general measure should be taken to prevent it from occurring.

Aged ; Aged, 80 and over ; Carotid Stenosis ; surgery ; Female ; Humans ; Intracranial Hemorrhages ; etiology ; prevention & control ; Intraoperative Complications ; etiology ; prevention & control ; Male ; Middle Aged ; Retrospective Studies ; Stents

OBJECTIVETo compare a side-to-side esophagogastric anastomosis with conventional hand-sewn or stapled esophagogastrostomy for prevention of anastomotic stricture by randomized clinical trial.

METHODSBetween November 2007 and September 2008, 160 patients with esophageal carcinoma or gastric cardia cancer were consecutively admitted and underwent surgical treatment. After excluding 5 patients (2 refused to participate in and 3 did not meet inclusion criteria), the remaining 155 patients were completely randomized to receive either a side-to-side esophagogastric anastomosis (SS group), or the conventional hand-sewn (HS group), or a circular stapled (CS group) anastomosis, after the removal of esophageal tumor. The primary outcome measured the incidence of anastomotic stricture at 3 months after the operation (defined as the diameter of the anastomotic orifice

RESULTSThere was 1 operative death (in HS group) and 1 simple exploration (in SS group). The anastomotic leakage was observed in 4 patients (2 cervical and 1 intrathoracic leaks in HS group, and 1 intrathoracic leak in CS group). The follow-up rate was 96.1% (1 patient in SS group, 3 in HS group, and 2 in CS group were lost). Finally 45 patients in SS group, 52 in HS group, and 47 in CS group were included in the analysis. The 3 groups were preoperative similar. The anastomotic stricture rate was 0% (0/45) in SS group, 9.6% (5/52) in HS group, and 19.1% (9/47) in CS group, respectively (Fisher exact probability test, P = 0.005). The reflux/regurgitation score among 3 groups was similar (chi(2) = 1.681, P = 0.432).

CONCLUSIONThe side-to-side esophagogastric anastomosis could prevent stricture formation, without increasing gastroesophageal reflux.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; adverse effects ; methods ; Cardia ; Constriction, Pathologic ; etiology ; prevention & control ; Esophageal Neoplasms ; surgery ; Esophagus ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Stomach ; surgery ; Stomach Neoplasms ; surgery

OBJECTIVETo study the anatomical characteristics about ascending aortic and aortic arch in Chinese population by CT.

METHODSFrom September 2006 to September 2007, 388 patients free of current known aortic pathology undergone thoracic aorta CTA. The diameter of ascending aorta, aortic arch, and branch vessels of aortic arch were measured respectively by AW4.2 work station. The data base about all the measurements was set up. The CHISS statistical software was used to analysis data.

RESULTSThe aortic diameter above coronary artery (CA), the level at origin of and brachiocephalic trunk (BCT), the halfway of the ascending aorta, the level at origin of left common carotid artery (LCCA), the level at origin of left subclavian artery (LSA) and the level at distal of origin of LSA respectively were (34 +/- 5) mm, (34 +/- 5) mm, (33 +/- 4) mm, (30 +/- 4) mm, (28 +/- 3) mm and (26 +/- 3) mm. The diameters of two level between the origin of BCT and right subclavian artery (RSA) were (13.1 +/- 1.9) mm and (12.8 +/- 2.3) mm. Diameters of two level at LCCA were (8.7 +/- 1.5) mm and (7.9 +/- 1.0) mm. The diameters of two level between the origin of LSA and left vertebral artery were (10.7 +/- 1.7) mm and (9.3 +/- 1.3) mm. The aortic lumina length between the origin of CA and BCT was (5.3 +/- 1.2) cm, the aortic lumina length between the origin of BCT and LCCA was (1.3 +/- 0.4) cm, the lumen length between origin of BCT and RSA was (4.1 +/- 0.8) cm, the lumen length between origin of LSA and left vertebral artery was (3.8 +/- 0.8) cm. The distance between the wall of BCT and LCCA was (0.4 +/- 0.2) cm, the distance between the wall of LCCA and LSA was (0.7 +/- 0.6) cm.

CONCLUSIONSModular branched stent-graft system is fit for most part of the Chinese. The size fit for human could be got on this basic.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aorta ; anatomy & histology ; Aorta, Thoracic ; anatomy & histology ; diagnostic imaging ; Aortography ; Blood Vessel Prosthesis ; Brachiocephalic Trunk ; anatomy & histology ; diagnostic imaging ; Carotid Artery, Common ; anatomy & histology ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Subclavian Artery ; anatomy & histology ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult