Great and extensive progress has been made in joint surgery in the last decade. With the evolution of surgical concepts and the development of operational technique and equipment, indications, selective range for surgica l operation and management in the period of perioperation have been surveyed in new perspectives and with deeper insights. This article introduces the situation of joint surgery of China in these years, briefly reviews the latest progresses in the fields of the arthroscopy, the arthroplasty and the joint cartilage repa ration, and thus suggests developmental strategies for Chinese joint surgery in the future.

AIM:To explore the surgical effect of total hip joint replacement on the severe degenerative arthritis secondary to congenital hip dysplasia.METHODS:The experiment was carried out in the Department of pedics,General Hospital of Chinese PLA between June 1998 and December 2005.①116 adult patients(128 hips) with arthritis secondary to dysplastic hip received total hip replacement,including 13 males(15 hips) and 113 females(106 hips),aged from 16 to 66 years(average of 42.6 years).According to Crowe classification system,there were 57 cases(60 hips) of typeⅠ,20(23 hips) of typeⅡ,16(20 hips) of type Ⅲ and 23(25 hips) of type Ⅳ.②The acetabula were reconstructed at the true acetabular location.Except one case,all patients were given biological fixation of cementless acetabular cups including 83 hips with routine total hip replacement,and 27 hips with smaller cup;11 hips with routine total hip replacement after granular bone grafting,and 7 hips with a smaller cup after autologous femoral grafting on the superior margin of acetabula.119 biological prostheses were used to reconstruct the femoral cups including 4 common cemented shafts,6 long cemented shafts,and 4 S-ROM prostheses.③Harris hip score was adopted to evaluate the hip function,and X-ray photographs were used to observe the location of prostheses.RESULTS:①The Harris hip scores increased from 38.5 preoperatively to 88.5 postoperatively.②No prosthesis displacement,dislocation of hip joint or repair was found in patients,and the length of treated limbs meanly prolonged by 2.3 cm.Additionally,the incision healed primarily.③Radiographically,the positions of the prostheses were normal,and the bone grafts fused with the host bone successfully.The average bone coverage was 95%(90%-100%);radiolucentline was observed at between the acetabular cup and host acetabula in 2 cases,and 1 at femur.④Adverse effects:Sciatic nerve tension injury was found in 1 case and recovered in 4 months,the femoral nerve tension injury in 1 case and recovered in 3 months,and hip rest pain remained in 4 cases.CONCLUSION:In the treatment of arthritis secondary to dysplastic hip with total hip replacement,it is better to reconstruct the acetabulum at the true acetabular location.Moreover,the individualized appropriate selection of femoral prostheses is a key factor to obtain good curative effects.

BACKGROUND:The main factors that influence revision of acetabular bone defects include evaluation of acetabular bone defects,reconstruction of acetabulum and appropriate acetabular cups used in revision.OBJECTIVE:The review from the three aspects will help to choose an appropriate cup in revision and to formulate the best revision protocols.METHODS:A computer-based online search of PubMed was performed for English articles published from January 1900 to June 2009 with the key words of acetabulum,revision,bone defect,in English and Chinese.Clinical studies published in core periodicals of the latest twenty years were reviewed.Articles regarding primary joint replacement,femoral prosthesis revision and animal experiments were excluded.RESULTS AND CONCLUSION:A total of 61 articles were analyzed,31 were excluded,and 30 mainly published in 5 years,were included.Reconstruction of acetabular bone structure,restoration of original rotation center of hip joint are key factors for repair.Moreover,appropriate prosthesis further benefits the repair effect.Bone transplantation for bone defect and cementedless prosthesis have become favorable methods for revision of acetabular bone defects.

Objective To assess the predictive and prognostic role of the alteration of serum carcinoembryonic antigen (CEA),squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragment (CYFRA21-1) during chemotherapy in patients with advanced esophageal squamous cell carcinoma (ESCC).Methods The serum levels of CEA,CYFRA21-1 and SCC-Ag were measured in 50 patients with advanced ESCC at baseline and after first line chemotherapy.The data was correlated with objective efficacy and overall survival.To evaluate the role of tumor marker change in predicting response to therapy,receiver operating characteristic (ROC) curves were constructed.Results CEA,SCC-Ag and CYFRA21-1 increased higher than the cutoffs in 22.0 %,34.0 %,and 44.0 % of tested patients,respectively.Statistically significant correlations were observed between CYFRA21-1 and SCC responses and objective efficacy evaluated by RECIST criteria (Z =3.181,2.389; P = 0.001,0.017).Based on the ROG curve analysis,a post treatment 32 % and 38 % increase in serum concentration was used as cut-off level for defining CYFRA21-1 and SCC-Ag change,respectively.When the cut-off levels were used to predict chemotherapy efficacy,the accuracy for CYFRA21-1 and SCC-Ag were 76 % and 70 %.In the univariate survival analysis,a statistically significant prognostic impact on survival from the change of CYFRA21-1 and SCC-Ag was observed.Conclusion CYFRA21-1 and SCC-Ag are useful for diagnosis,predicting chemotherapy objective efficacy and prognosis in advanced ESCC.

OBJECTIVEThis study aims to do the following: construct a three-dimensional finite element model of an labial inverted impacted maxillary central incisor and its supporting tissues, analyze stress distribution in the periodontal tissue when various tractions are exerted, and provide references for treating impacted maxillary central incisor.

METHODSA three-dimensional finite element model oflabial inverted impacted maxillary central incisor and its periodontal tissues was established using Mimics 10.01 and Ansys 14.0 software based on original cone beam computed tomography (CBCT) data. Various traction values (20, 30, 40, 50, 60, and 70 g) were exerted on the incisal margin in the direction perpendicular to the impacted tooth. Different Von Mises stress values were determined.

RESULTSStress distribution on the periodontal ligament increased with traction size. When 30 g traction was exerted on the labial inverted impacted maxillary central incisor, the Von Mises stress was 24 919.0 Pa, which was within the range of the optimum force and close to its maximum value.

CONCLUSIONThe optimum traction for early orthodontic treatment of labial inverted impacted maxillary central incisor is nearly 30 g.

ObjectiveTo investigate the changes of hepatitis B sarfaceantigen (HBsAg) titer in hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogs and pegylated interferon alfa-2a (PEG IFNα-2a) sequential therapy.Methods Among 6 HBeAg positive CHB patients,3 patients were treated with nucleos(t)ide analogs followed by PEG IFNα-2a for 48 weeks,3 patients were treated with nucleos(t)ide analog monotherapy.The serum HBsAg,anti-HBs,HBeAg,anti-HBe andanti-HBcweredetectedusingthetime-resolved immunofluorometric assay and serum hepatitis B virus (HBV) DNA levels were determined by Taqman polymerase chain reaction (PCR) every 12 weeks.Results HBsAg loss were achieved in three patients after 48-week nucleos(t)ide analogs and PEG IFNα-2a sequential therapy.However,the HBsAg titers of another 3 patients varied from 100 IU/mL to 320 IU/mL.ConclusionIn HBeAg positive CHB patients who obtain virologic response accompanied with HBsAg titer decreasing dramatically by nucleos(t) ide analog treatment,PEG IFNα-2a sequential treatment can increase HBsAg clearance rate.

Objective To evaluate the helical CT diagnostic value of primary retroperitoneal neoplasm(PRN). Methods 32 cases of PRN confirmed by operation and pathology were retrospectively analyzed. Plain and enhanced CT scan were perfomed in 28 cases,and only 4 cases underwent plain CT scans. Results Of 32 cases,15 were benign tumor and 17 cases were malignant tumor.Among them ,16 cases were mesenchymal tissue-origin(11 cases were malignant neoplasm), 10 cases were nervous tissue-origin(3 cases were malignant neoplasm),3 cases were rudimental embryonal tissue-origin(all benign), and the source of unknown-origin were 3cases(all malignant neoplasm).To be correctly localized was 28 cases(87.5%) and correctly qualitative diagnosis of the tumor was 20 cases (62.5%) by CT before operation. Conclusion PRNs have many typies, helical CT provides informations in both position and characteristics before operation.

Objective To investigate the effect of TGIF on apoptosis of TGF-?-induced gastric canceer cell.Methods After TGIF was stably transfected into gastric cancer cell line BGC823,apoptosis was examined with flow cytometry,and the expressions of TGIF,caspase8 and caspase9 were analyzed with Western blot.Results The apoptosis rate of BGC823 cells with the treatment of TGF-? obviously increased,and was accompanied by activation of caspase9 but not caspase8.Moreover,compared with controls,pcDNA3.1-TGIF-transfected BGC823 cells significantly decreased the sensitivity of TGF-?-induced apoptosis.Conclusions TGF-? induced the apoptosis of gastric cancer cell BGC823 via caspase9 pathway;furthermore,TGIF could inhibit TGF-?-induced apoptosis.

AIM: RNAⅢ inhibiting peptide (RIP) has been previously proved to possess good histocompatibility and safety for preventing and curing staphylococcal infection, and this study evaluated histocompatibility of polyaiticglycolic acid/RIP (PLGA/RIP) sustained release microsphere. METHODS: The experiment was performed in the Orthopedic Institute, Pharmacologic Research Institute and Animal Experimental Center of General Hospital of Chinese PLA from October 2005 to October 2007.①Preparation of PLGA/RIP: The solid-phase synthesis (Fmoc) method was used to synthesize RIP from C end to N end, then the synthesized peptide was purified by the reverse phase high performance liquid chromatography, and composition was collected by means of ultraviolet absorption peak. The purified RIP was obtained after freezing and drying. Liquid-phase multiple emulsion method was used to synthesize PLGA/RIP microsphere of 50-70 ?m diameter.②Acute general toxicity test was studied in PLGA/RIP. Effect of PLGA/RIP on the cell proliferation was detected with cytotoxicity test by MTT method. Intramuscular implanting test was used to observe the irritation reaction of muscles by implantation materials. Sensitivity test was used to observe the sensitization of PLGA/RIP. Changes of animal's body temperature were determined with pyrogen test. RESULTS: ①Acute general toxicity test: Neither toxicosis reaction nor animal death was found after animals were injected with 100% and 50% eluents of PLGA/RIP peritoneally. Animal's body weight was not changed significantly.②Cytotoxiciity test by MTT method: The average proliferation rate of cell in two kinds of eluents exceeded 85% and cytotoxicity was graded in 1 rank, indicating no cytotoxicity.③Intramuscular implanting test: At 4 weeks after RIP and PLGA/RIP were implanted into the animals, there was not obvious synathresis, denaturation or necrosis in tissues. No inflammatory cell infiltration occurred around the materials. There had been the fibrous capsules around the materials.④Sensitivity test: Average primary irritation index of three groups were 0.38, 0.33 and 0.31 respectively. There was no significant difference among three groups.⑤Pyrogen test: Fervescence of each animal in the experiment was under 0.5 ℃, confirming that the materials had no pyrogenic characteristics. This was in coincidence with evaluation criterion of pyrogen test. CONCLUSION: PLGA/RIP has good histocompatibility and safety, without general toxic reaction, cytotoxicity, immunological rejection, hypersensitive response or pyrogenic characteristics.

OBJECTIVE:To evaluate the histocompatibility of poly(lactic-co-glycolic acid)/RNA Ⅲ inhibiting peptide(PLGA/RIP)sustained release microspheres.METHODS:The crude peptide comprising N to C-terminals was synthesized using Fmoc method.The crude synthetic RNAIII peptide was purified by reverse phase high performance liquid chromatography,followed by component harvesting according to ultraviolet absorption peak,and freeze-drying.PLGA/RIP sustained release microspheres with a diameter of 50-70?m were prepared using liquid-phase multiple emulsion method.The histocompatibility of PLGA/RIP sustained release microscopes were preliminarily evaluated through the use of acute general toxicity test,MTT cytotoxicity test,intramuscular implantation test,sensitivity test,and pyrogen test.RESULTS:Acute general toxicity test results showed that all included animals survived and presented with no toxicosis reaction and obviously changed body mass.MTT cytotoxicity test results revealed that the average relative growth rate of cells from two eluents was over 85%,with cytotoxicity grade 1,which indicates no cytotoxicity.Intramuscular implantation tests showed that at 4 weeks after implantation of RIP powder or PLGA/RIP microscopes,no obviously congested,degenerated,or necrotic tissue was observed.All RIP powder and a part PLGA/RIP microscopes were degraded.Fibroblasts accounted for a large proportion in all cells.No inflammatory cell infiltration,involving neutrophils and multinucleated giant cells,was observed.Sensitivity test results displayed that the average primary irritation index was 0.38,0.33,and 0.31 in the eluent stock solution,2% dinitoflruorobenzene,and physiological saline-administerd groups,respectively.Pyrogen test results showed that fervescence of each rabbit in the experiment was under 0.5℃ and the sum of fervescence was under 1.3℃.This is in coincidence with evaluation criteria of pyrogen test.CONCLUSION:PLGA/RIP sustained release microspheres exhibit good histocompatibility.