BACKGROUND: With the development of new materials and the improvement of prosthesis design, total knee arthroplasty(TKA), a commonly used surgery, has exhibited satisfying effect on the treatment of rheumatoid arthritis and osteoarthrosis. However, many problems still remain a headache to operation performers.OBJECTIVE: To discuss how to select the prosthesis for total knee replacement and to summarize the key factors that affect the curative effect.DESIGN: A controlled study of the effect before and after the operation.SETTING: Department of Orthopedics, First Hospital of Xi'an Jiaotong University.PARTICIPANTS: Thirty-six patients(24 males and 12 females) who received TKA in the Department of Orthopaedics, First Hospital of Xi'an Jiaotong University during February 2000 to September 2003 were included in this study.METHODS: A retrospective study was carried out. Thirty-six patients(48knees) underwent total knee replacement, and the knee joint function was evaluated with American John N Install scoring system. The post-operation effect was evaluated by comparing the scores of each diseased knee before and after the operation.MAIN OUTCOME MEASURES: The function of knees and the score of every knee before and after operation were evaluated.RESULTS: The mean score before operation was 39, but it was 85 after follow-up visit. Totally 95% of them were up to the standard. The pain was reduced after the operation. The flexion-extension function and mobility of the knee joints improved obviously.CONCLUSION: TKA with posterior stabilized prosthesis and resection of posterior cruciate ligament(PCL) improved the function of the diseased knees after the operation. And the operation was simple and without complications. The key factors that affect the curative effect include the mechanical balance of the soft tissues during the operation, perioperative anticoagulant treatment for the prevention of deep vein thrombosis(DVT) and postoperative rehabilitation training. Peripheral tissue of knee joints should be released adequately; otherwise, it may cause unstable joint or limitation of joint activity.

15 ml/s). Conclusions Combined use of mini-incision open cystolithotomy and TURP can be the first choice for the management of BPH complicated with large or multiple bladder stones.

Objective To summarize the causes, diagnosis and treatment of transurethral resection syndrome (TURS) during the transurethral vaporization of the prostate (TUVP). Methods Among 322 consecutive patients who underwent TUVP, TURS happened in 27 patients (8.4%). Their clinical data on the operation, monitoring and treatment were retrospectively reviewed. Results Of the 27 patients, the mean operative time was 95 min (52~170 min), the mean blood loss was 251 ml (100~700 ml), and the mean weight of resected prostate was 36.1 g (16~82 g). During the operation the prostatic capsule was perforated in 21 patients (78%). Postoperatively, all the patients had yawning, hypotension and bradycardia. Their serum sodium concentrations during TURS were 122.3?9.6 mmol/L, which was 16.3?4.5 mmol/L lower than before the operation, with significant difference ( t=)14.211,P90 min). Close attention and assessment of the patient’s) vital signs and mental status can increase the early detection and treatment of TURS.

Objective To sum up the effect and experience in radiofrequency ablation(RFA) for liver cancer(LC). Methods The clinical data of 102 patients with LC treated by percutaneous and intraoperative RFA were analysed retrospectively. Results RFA was used to treat 195 tumors (median diameter 5.6 cm,ranging from 1.5 to 9.5 cm) in 102 patients.Of them, primary liver cancer was found in 80 patients( 78.4%),and metastatic liver tumor was in 22 patients(21.6%). Percutaneous RFA(PRFA) and intraoperative RFA(IRFA) was performed in 77 patients(75.5%) and 25 patients(24.5%) respectively. There was no severe complications after RFA in this series. All of the 102 cases had been followed up for 3～24months,AFP positive returned to negative in 70.3%(52/74)of the patients.The rate of concreted necrosis of liver cancer showed by CT was 88.2%(90/102). The 1 year survival rate was 93.8%.Conclusions RFA is a safe and effective treatment for patients with LC. Patients with small and readily accessible tumor are the indications of PRFA;while the patients with large,multiple,perivascular or otherwise inaccessible liver tumor are also the indications for IRFA.The adoption of the TACE and other methods to occlude the vascular inflow can improve the efficacy of RFA.

Objective To investigate the effect and the prognostic factors of radiofrequency ablation(RFA) for primary liver cancer(PLC).Methods RFA was performed in 195 patients with PLC,and the efficency was evaluated with univariate analysis.Cox′s regression analysis model was used to analyze the factors affecting the prognosis.Results In the whole group of patients,the 1,2,3 and 5-year overall survival rate was 80.5%,67.4%,49.1% and 32.7% respectively,and in the patients with small PLC(the size≤3 cm),the 1,2,3 and 5-year overall survival rate was 91.7%,81.2%,60.5% and 40.4% respectively.The Cox regression models indicated that the independent factors in determining the prognosis were: Liver function of Child-Pugh stage,tumor size and occlusion of hepatic inflow during RFA.Conclusions RFA is an effective mini-invasive treatment for patients with PLC,and especially for the patients with small PLC.The efficency of RFA for small PLC has the same outcome as that of surgical resection of the tumor.Liver function of Child-Pugh stage,tumor size and occlusion of hepatic inflow during RFA are the independent prognostic factors.

Objective To evaluate the results of liver carcinoma treated by radiofrequency ablation(RFA) with color Doppler ultrasonography(CDU). Methods Hemodynamic changes of the interior and periphery of 212 nodules of liver carcinoma in 152 patients were investigated by CDU one week before and one month after RFA. Results Blood flow signals were found in 187 cancerous nodules before RFA, and were chiefly from mixed arterio-venous blood supply. After RFA, the blood flow signals of these 187 cancerous nodules completely disappeared in 133, were reduced in 40 and did not change in 14. Peripherar blood flow did not change in 51.2% of the tumors. Conclusions CDU is useful in evaluating the therapeutic effect of RFA in patients with liver carcinoma and may provide information for further treatment.

Objective To analyze the ultrasound imaging features and clinical characteristics in patients with hepatocellular carcinoma ( HCC ) , and assess the value of ultrasound in preoperatively predicting microvascular invasion ( M VI) of HCC . Methods One hundred and seventy‐one patients with HCC were retrospectively collected from January 2016 to July 2018 . T he ultrasound imaging features and clinical data that may be associated with M VI were analyzed by univariate and multivariate analyses ,and the diagnostic efficacy of independent risk factors was further evaluated . ROC curves were plotted to compare the diagnostic efficacy of combined diagnostic mode 1 ,mode 2 ,peritumoral enhancement ,and tumor margin . Results Univariate analysis showed that the serum AFP level ,tumor size ,peritumoral hypoechoic halo , peritumoral enhancement , and tumor margin were significantly correlated with M VI ( P ＜ 0 .05 ) . M ultivariate logistic regression analysis further indicated that peritumoral enhancement and non‐smooth tumor margin were the independent risk factors for predicting M VI . T he sensitivity ,specificity ,positive predictive value and negative predictive value of peritumoral enhancement and non‐smooth tumor margin were 51 .4% vs 83 .8% ,81 .4% vs 48 .5% ,67 .9% vs 55 .4% ,and 68 .7% vs 79 .7% ,respectively . T he AUC of mode 1 ,mode 2 ,peritumoral enhancement and tumor margin were 0 .741 ,0 .716 ,0 .664 ,and 0 .661 , respectively . Conclusions Preoperative ultrasound is valuable in predicting M VI of HCC . Peritumoral enhancement and non‐smooth tumor margins are independent risk factors for predicting M VI of HCC . T umor size ,hypoechoic halo around the tumor ,and serum AFP levels must be taken into account w hen predicting MVI of HCC by using preoperative ultrasound .

NUT carcinoma is a rare, high lethal cancer which feature as the rearrangement of the nuclear protein in testis (NUT) gene on chromosome 15q14, and its pathogenesis and treatment is not yet clear, the prognosis is poor. Due to NUT carcinoma often occurred on the middle position of the body, such as eyes, nose and palate, mediastinum, so it is also called NUT midline carcinoma (NMC). In this case, we report a 70 years old man who was diagnosed as primary pulmonary NUT carcinoma in the Department of Thoracic Oncology, West China Hospital of Sichuan University. A tumor was found at the left hilus pulmonis when his physical examination without any symptom. Postoperative pathological showed poorly differentiated carcinoma, confirmed by fluorescence in situ hybridization technique for the NUT carcinoma. After operation, chemotherapy, antiangiogenesis therapy, and radiotherapy were given, and he got a long lifetime. Combined with the literature review, we report the clinical and pathological features, and treatment strategies of the rare pulmonary NUT carcinoma case.
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ObjectiveStudies have shown that nuciferine has anti-cerebral ischemia effect， but the specific mechanism of action has not been elaborated. Based on the transcriptome results， the pharmacological mechanism of nuciferine against cerebral ischemia was analyzed from multiple dimensions including tissue， cell， pathological process， biological process and signaling pathway. MethodsThirty SD rats were randomly divided into the sham group， model group and nuciferine group（40 mg·kg^-1） according to weight. Except for the sham group， the model of middle cerebral artery occlusion（MCAO） was established by thread embolization method after 30 min of administration in the other two groups. Twenty-four hours after surgery， transcriptome sequencing was used to detect the gene expression profiles in the cortex penumbra of rat cerebral tissue， and gene ontology（GO） and kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis were performed for differentially expressed genes. The mechanismof nuciferine against cerebral ischemia was analyzed from 5 dimensions of tissue， cell， pathological process， biological process and signaling pathway by the transcriptome-based multi-scale network pharmacology platform（TMNP）. ResultsTranscriptome sequencing and gene quantitative analysis showed that 667 genes were significantly reversed by nuciferine. Further enrichment analysis of KEGG and GO suggested that the pathways of nuciferine involved regulating stress response， ion transport， cell proliferation and differentiation， and synaptic function. TMNP research found that at the tissue level， nuciferine could significantly improve the cerebral tissue injury caused by ischemia. At the cellular and pathological levels， nuciferine could play an anti-cerebral ischemia role by improving the state of various nerve cells， mobilizing immune cells， regulating inflammation. And at the level of biological processes and signaling pathways， nuciferine mainly acted on the processes such as vascular remodeling， inflammation-related signaling pathways， and synaptic signaling. ConclusionCombined with the results of transcriptome sequencing， gene quantitative analysis and TMNP， the mechanism of nuciferine against cerebral ischemia may be related to processes such as intervening in stress response and inflammation， affecting vascular remodeling and regulating synaptic function. These results can provide a basis and reference for further study of the pharmacological mechanism of nuciferine against cerebral ischemia.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*