Objective To evaluate the clinical outcome associated with the core decompression in combination with the nano-hydroxyapatite/collagen composite rod combined with decalcified bone matrix in a consecutive series of patients with osteonecrosis of femoral head,especially the prevention of collapse of femoral head and its predisposing factors.Methods From August,2012 to May,2013,46 pationts (50 hips) who had undergone core decompression in combination with nano-hydroxyapatite/collagen composite rod insertion in corporated with decalcified bone matrix in our hospital were involved in this study.Postoperative care consisted of prophylactic intravenous antibiotic and anticoagulation therapy.Patients were instructed to be non-weight-bearing for 3 weeks,to partial weight-bear for the next 3 weeks,and to weight bear as tolerated thereafter.All patients were evaluated both clinically and radiographically.The primary clinical outcome of this study was functional improvement assessed with the Harris hip score.Serial radiograms of the pelvis were taken at 1,3,6,12 months post-operatively to analyze the process of osteonecrosis.Results All patients followed up for 12 months,no one suffer complications.The mean Harris score pre-operation was 65.6 ± 10.6,post-operation score was 87.5 ± 15.3,with a mean improvement of 21.8 ± 13.2 (P ＜ 0.05).According to Harris hip score system,excellent for 30 hips,good for 14 hips,fair for 2 hip and poor for 4 hips.Refer to the Kaplan-Meier survivorship curve,the success rate at 12 months post-operatively was 92％.Radiological changes coincided with clinical changes.Conclusion Core decompressionin combination with nano-hydroxyapatite/ collagen composite rod insertion in corporated with decalcified bone matrix provided a minimally invasive surgical treatment option to treat early stage osteonecrotic hips(stage Ⅰ and Ⅱ) and to prevent femoral heads from collapsing,with clinical outcomes and success rates priorto other commonly used surgical procedures.

The present study examined the role of Wnt/β-catenin signaling pathway in the degeneration of nucleus pulposus cells and the protective effect of DKK1 on nucleus pulposus cells. The model of nucleus pulposus cell degeneration was induced by intra-disc injection of TNF-α, and the expression of β-catenin protein was detected by Western blotting. The cultured rabbit nucleus pulposus cells were divided into 4 groups. In group A, the cells were cultured with normal medium and served as control group. In group B, the cells were cultured with TNF-α and acted as degeneration group. In group C, the cells were cultured with TNF-α and transfected with Adv-eGFP and was used as fluorescence control group. In group D, the cells were cultured with TNF-α and transfected with Adv-hDKK1-eGFP, serving as intervention group. The expression of type II collagen, proteoglycan, β-catenin, and MMP-13 in each group was detected by immunocytochemistry and RT-PCR. The result showed that TNF-α increased the expression of β-catenin and MMP-13, and significantly inhibited the synthesis of type II collagen and proteoglycan, which resulted in the degeneration of nucleus pulposus cells. This effect could be obviously reversed by DKK1. We are led to concluded that TNF-α could activate the Wnt/β-catenin signaling pathway, and increase the expression of MMP-13, thereby resulting in disc degeneration. Specifically blocking Wnt/β-catenin signaling pathway by DKK-1 could protect the normal metabolism of intervertebral disc tissue. The Wnt pathway plays an important role in the progression of the intervertebral disc degeneration.

Objective To analyze and summarize the treatment strategies for unstable angina with no-reflow phenomenon after PTCA during early percutaneous interventional procedures.Methods A total of 32 cases with unstable angina were divided into two groups:one group with drug therapy and the other group with drug therapy and thrombus aspiration catheter.The patients were chosen when there was no-reflow phenomenon after PTCA during early percutaneous interventional procedures and their clinical data were compared and analyzed.Blood flow TIMI grade,myocardial perfusion grade (MBG),TIMI myocardial perfusion (TMP) grade and other indexes were observed and recorded.Results The general conditions had no statistical difference between two groups.Compared with the drug therapy group,the proportion of patients with TIMI,MBG and TMP grade 3 was higher in aspiration and drug therapy group (89％ VS 71％ P＜0.05).Conclusion Drug therapy and thrombus aspiration catheter in treatment helps to improve myocardial perfusion level for unstable angina with no no-reflow phenomenon after PTCA during early percutaneous interventional procedures.

Objective To investigate the value of intravoxel incoherent motion (IVIM) model of diffusion weighted MRI in assessing grades and enhancement patten of uterine cervical cancer. Methods Thirty one patients with pathologically proven cervical cancer, who underwent MRI scan preoperatively, were analyzed retrospectively and were divided into 3 groups according to their pathological grading of cacer, including 6 with G1 cancer, 17 with G2 and 8 with G3. The diameter of each lesion was≥1 cm. 10 b values (0, 30, 50, 100, 150, 200, 400, 800, 1 000, 1 500 s/mm2) were used in DWI, and DCE-MRI was performed with a time resolution of 9.8 s. Parameters of DWI (ADC, D, f, D*) and semiquantitative parameters of DCE-MRI (Slop, Maxslop, CER, Washout, AUC90) were measured. One-way ANOVA analysis of variance and Pearson correlation were used to analyze normally distributed continuous data. Kruskal-Wallis H test and Spearman correlation were used to analyze abnormally distributed continuous data. Tumor volume and all of the MRI parameters were compared as well as correlated with pathological grading.The perfusion parameters derived from IVIM were correlated with those derived from dynamic enhanced MR imaging. The sensitivity and specificity of f value to to diagnose G3 cervical cancer and the best cutoff were calculated from areas under the ROC curves.Results Tumor volume of G1,G2 and G3 cancers were(33.8±31.1),(19.6±16.9)and(31.2±29.1)cm3(F=1.147,P=0.332), respectively.ADC values of the three groups were(1.03 ± 0.11)× 10-3,(1.00 ± 0.10)× 10-3 and(0.90 ± 0.05)× 10-3mm2/s,respectively(F=4.619,P=0.018).D values of the three groups were (0.80 ± 0.11) × 10-3, (0.77 ± 0.06) × 10-3and (0.69 ± 0.06) × 10-3mm2/s ,respectively(F=5.272, P=0.011).f values of the three groups were 0.20±0.02, 0.22±0.03 and 0.24± 0.03, respectively (F=3.524, P=0.043).All of the others were of no significant difference (P>0.05).Both ADC and D correlated negatively with tumor grading (r=-0.464 and-0.493, P=0.009 and 0.005, respectively). f value correlated positively with tumor grading (r=0.436, P=0.014).Areas of ADC, D and f value under ROC curves to diagnose G3 cancers were 0.179, 0.147 and 0.690, respectively. While the cut-off value of f was 0.22, the diagnostic performance for G3 cancer was with a sensitivity of 75.0% (6/8) and a specificity of 60.9% (14/23). The value of f had weak positive correlations with Slop, Maxslop, CER and AUC90 of semiquantitative analysis of DCE-MRI (r=0.319, 0.337, 0.293 and 0.344, respectively, P<0.01). Conclusion IVIM model of multi-b value DWI may provide information in the assessment of differentiation and en hancement pattern of cervical cancer.

Objective This study was purposed to analyze and summarize the vein temporary cardiac pacing therapy in patients with acute inferior wall myocardial infarction complicated by high degree atrioventricular block (AVB) . Methods One hundred and twelve patients with acute inferior wall myocardial infarction complicated by high degree AVB were selected as observation and research subjects, and they were treated by vein temporary cardiac pacing therapy. The safety, availability of different kinds of this surgical methods and the relationship between these surgical methods and complication were observed. Results Three out of 60 patients who were treated by ordinary temporary pacing electrode catheter were suffering from cardiac tamponade. No serious complications occurred when 52 patients were treated by floating temporary pacing electrode catheter. Conclusion Floating temporary pacing electrode catheter have already proved safe and effective in the treatment of acute inferior wall myocardial infarction complicated by AVB, and it could decrease the incidence of serious complications such as myocardial perforation.

Objective To evaluate the clinical efficacy of total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip.Methods From September 2003 to September 2012,21 patients (24 hips) underwent total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip in our hospital.There were 3 males and 18 females,aged from 28 to 71 years (average,54±10 years).The ceramicpolyethylene articulation was used in 17 patients (20 hips),and metal-polyethylene articulation in 4 patients (4 hips).The osteotomy site was treated with autologous bone graft in 18 patients (21 hips) and allogeneic bone graft in 3 patients (3 hips).The Harris hip score was used to assess the clinical results.Results A total of 18 patients were followed up for 0.5 to 9 years (average,3.5 years).The Harris hip score was improved from preoperative 47.9±9.1 to 88.4±3.5 at 6 months postoperatively.For most patients,hip pain relieved significantly; range of motion of the hip was improved,and the gait returned to normal.Sciatic nerve palsy occurred in 1 patient.There was no wound infection.X-rays 6 months after operation showed that the position of prostheses was satisfactory,without loosening of prostheses and bone block resorption.Conclusion Total hip arthroplasty with subtrochanteric femoral shortening osteotomy can achieve good clinical effect in Crowe Ⅳ developmental dysplasia of the hip.Moreover,it can improve leg length discrepancy and decrease the risk of sciatic nerve injury.

Objective To investigate the treatment outcome and failure in patients with primary mediastinal large B-cell lymphoma(PMBL). Methods Between Jan. 1992 and Oct. 2006, a total of 46 patients with pathologically confirmed PMBL were reviewed, including 14 with Ann Arbor Stage I disease, 23 with Stage Ⅱ disease,3 with Stage Ⅲ disease and 6 with Stage Ⅳ disease. Stage Ⅰ+Ⅱ disease was present in 80% of the patients. All patients were treated with chemotherapy ,and 29 also received radiotherapy. Twenty-seven patients(59%) were treated with first generation regimen(CHOP),9(20%) with third generation regimens (MACOP-B, ProMACE/CytaBOM, m-BACOD, or ProMACE-MOPP), and 10(22%) with high-dose chemotherapy (HDCT/APBSCT). Rituximab was administered to 16 patients (35%). For most patients who received radiotherapy,an involved field was used with a median dose of 45 Gy in 23 fractions.Results The rate of complete remission, partial remission and progression disease was 41%, 30% and 24% ,respectively. The 5-year overall survival rate(OS) for all patients was 35%. The 2- and 5-year OS was 79% and 63% for stage Ⅰ+Ⅱ and 51% and 0 for stage Ⅲ+Ⅳ ,respectively(X2=4.35 ,P=0. 037).The 2-year progression free survival rate was 63 % and 11%, respectively (X2=17.77, P=0.1300). The 5-year OS was 80% for the patients with CR,50% for those with PR,and 0 for those with progression disease(X2= 19.58 ,P=0.003 ). With a median follow-up of 22 months, progression disease and relapse occurred in 19 patients. Conclusions Survival of patients with advanced stage PMBL is poor. Further studies areneeded to confirm the optimal treatment. Radiotherapy often plays a pivotal role in local control.

Objective To analyze the clinical features and prognosis of patients with stage Ⅰ_E/Ⅱ_Enongastric mucosa-associated lymphoid tissue (MALT) lymphoma. Methods Between 2000 and 2006, 40 patients with previously untreated nongrastric MALT lymphoma were retrospectively reviewed. The primary site of lymphoma was the intestinal tract in 10 patients, the orbit in 9, the thyroid in 8, the lung in 5, the Waldeyer ring in 2, and the others organs in6. At diagnosis, 27 patients had stage Ⅰ_E, and 13 had stage Ⅱ_E disease. Seventeen patients were treated with radiotherapy with or without chemotherapy, 18 with chemotherapy without radiotherapy, and 5 with surgery alone. The median age was 54 years. The ratio of male to female was 2: 1. Results With a median follow-up of 58 months, the estimated 5-year overall survival (OS) rate and progression-free survival (PFS) rate were 86% and 82%, respectively. The 5-year OS and PFS rates were 92% and 85% for stage Ⅰ_E, 76% and 82% for stage Ⅱ_E disease, respectively (χ~2 =3.66,P =0. 060;χ~2 =1.04,P=0. 300). The 5-year OS and PFS rates were both 100% for patients with MALT lymphoma of the orbit and ocular adnexa. None of the 17 patients with radiotherapy had locoregional relapse, whereas 3 of 23 (13%) patients without radiotherapy had locoregional relapse. Conclusions Patients with stage Ⅰ_E nongastric MALT lymphoma have a favorable prognosis. Radiotherapy is still a standard care for early stage disease. The treatment outcome of patients with MALT lymphoma of the orbit and ocular adnexa is even better.

Objective To analyze the clinical features and treatment outcomes of extranodal diffuse large B-cell lymphoma(DLBCL). Methods Ninety-nine consecutively diagnosed patients with extranodal DLBCL were reviewed. All patients were confirmed by a combination of morphologic and immunohistochemi-cal evaluation. The primary sites of extranodal DLBCL were the gastrointestine(n = 32) ,central nerve system (CNS)/testis(n=14) ,and other sites (n = 53). Results Extranodal DLBCL was characterized by a pre-dominance in old males,less frequency of B symptorns,a large proportion of stage Ⅰ-Ⅱ disease and low in-ternational prognostic factor(IP1) score. The 5-year overall survival(OS) rate for all patients was 78.9%. The corresponding OS rate was 82.5% for gastrointestinal origin, 37.0% for CNS and testis origin and 74.6% for other organ origin, respectively. On univariate analysis, performance status, IPI score and more than one extranedal site involvement were the prognostic predictors for 5-year OS. Conclusions Being a heterogeneous group of lymphomas, extranedal DLBCL has good prognosis except those derived from the CNS and testis.

erall survival.