BACKGROUND:It is crucial to determine the location of the rotation center of the hip joint using X-ray.Ranawat's triangle is commonly used to define the hip rotational center in bilateral developmental dysplasia of the hip and revision hip surgery especialy in cases with bone stock deficiency,but there are rare articles about its value in normal hip.OBJECTIVE:To compare the difference between Ranawat's triangle method and Mose circle method in determining the healthy hip joint rotational center.METHODS: We selected 30 patients with normal traumatic femoral neck fracture,who underwent unilateral total hip arthroplasty.Ranawat's triangle method and Mose circle method were applied to measure the anteroposterior radiographs of the pelvis after arthroplasty and to compare the distance between the hip rotational center and the reference lines (X-axis: teardrop line; Y-axis: a line perpendicular to the X-axis,drawn from the intersection of theKohler line and the teardrop line.The distance from the hip joint rotational center to X-axis is dx1,dx2 and the distance to Y-axis is dy1,dy2 in Ranawat's triangle and Mose circle respectively.).We also compared the ratios (dx1/H,dy1/W; dx2/H,dy2/W) in the pelvic height (H: the distance between the highest point on the iliac wing and the lowest point on the ischial tuberosity) and width (W: the distance between the most lateral points on the iliac crests).RESULTS AND CONCLUSION:When the values were compared with both methods,highly significant differences were observed for both X and Y,Ranawat's triangle method dx1=(19.52±3.03) mm,dy1=(24.43±2.26) mm; and Mose circle method dx2=(11.90±3.55) mm,dy2=(34.29±3.79) mm (P＜0.001) and these ratios (dx1/H=0.0992±0.0133,dy1/W=0.0855±0.0069; dx2/H=0.0611±0.0194,dy2/W=0.1201±0.0178) in pelvic height and width (P＜ 0.001).Scatterplot results demonstrated that the hip rotational center identified by Ranawat's triangle method is near to the proximal end and medial end,which may affect mechanical environment surrounding the joint.For cases of bilateral hip dysplasia and joint revision,because of the changes in structure surrounding the acetabulum,Ranawat's triangle method can be a feasible method to identify the hip rotational center.For cases of unilateral lesion,Mose circle method can exactly identify the hip rotational center taking healthy side as a control.

Objective To assess and compare the roles of plasma concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis and treatment of septic acute kidney injury (AKI) in adult Surgical critically ill patient . Methods One hundred patients were divided into two groups ,the group of 63 cases of AKI and AKI group of 37 cases ,plasma NGAL and Cystatin C level of the 2 groups were determined by the method of enzyme‐linked immunosorbent (ELISA) ,latex en‐hanced immune turbidimetry (PETIA) respectively on arrival in the surgical intensive care unit(SICU) (T0 ) and 24 h after arrival in SICU(T1 ) .Results Compared with patients in non AKI group ,both plasma NGAL and Cystatin C level of patients in AKI group on T0 and T1 increased significantly ,the difference between the two groups had significant statistical difference (P<0 .01);Although ,plasma NGAL on T1 performed less well (AUC=0 .69) ,with a threshold value of 92 ng/mL(70 .3% sensitivity ,57%specificity) .Plasma NGAL showed significant discrimination for AKI diagnosis (AUC=0 .85) with a threshold value of 65 .95 ng/mL(81 .8% sensitivity ,76 .2% specificity) on T0 .Both plasma Cystatin C on T0 and T1 worked well for the diagnosis of AKI (AUC=0 .90 ,0 .88 ,thresholds 1 .49 and 1 .47 mg/L ,respectively) ,with diagnostic sensitivity of 89 .2% ,82 .5% respectively ,speci‐ficity of 83 .8% ,76 .2% respectively .Conclusion Plasma NGAL and Cystatin C are useful markers in predicting AKI in surgical critically ill patients ,the early diagnosis value of plasma Cystatin C for AKI is better than plasma NGAL on arrival in the surgical intensive care unit .

Objective To evaluate contrast-enhanced MRI sequence for diagnosing cholangiocarcinoma.Methods Cholangiocarcinoma was confirmed by surgery and pathology in 17 cases,all underwent preoperative CT and MRI T1-VIBE scan with contrast-enhancement sequence.We retrospectively analyzed imaging signs in two scan methods,including lesion position,number,size,enhancement degree,expansion degree of bile duct,invasion of adjacent artery and portal vein,and portal vein tumor thrombosis.The differences on detecting lesions between two methods were compared.Results The contrast to noise ratio (CNR) between tumor and liver tissue in MRI T1-VIBE images was obviously superior to that in CT images.Peripheral lesion boundary in T1-VIBE enhanced images was clearer than CT.One hemorrhage lesion was shown in T1-VIBE images,and tumor thrombosis was visible in the left branch of portal vein in 1 case.Bile duct wall lesions in T1-VIBE enhanced images was more evident than CT in hilar cholangiocarcinoma and extrahepatic cholangiocarcinoma.The VIBE enhanced images find more lesions in 9 out of 11 multiple focus cases,compared with CT images.Conclusions Contrast-enhanced MRI T1-VIBE sequence can give more comprehensive and clear evaluation on cholangiocarcinoma,and has important clinical diagnostic values.

As the new development of scientometrics and informetrics, knowledge graph has infiltrated into the financial, industrial and medical fields, and become a hot issue in the real world research. In this article, the concept and features of knowledge graph, construction and the existing softwares, the application status and development prospect in the TCM field were reviewed, which may provide references for research on the knowledge graph in the TCM field.

10.3969/j.issn.2095-4344.2013.24.017

Objective To provide a theoretical basis for the pulmonary enteric therapy in treating intestinal dysbacteriosis complicating allergic asthma according to the traditional theory of Lung and Large intestine are interiorly-exteriorly.Methods The experiment included the blank group,model group,positive control group and three kinds of traditional Chinese medicine compound administration group;the intestinal dysbacteriosis in SD rats was duplicated by adopting cefoperazone and candida albicans gavage.On this basis ovalbumin injection sensitization and nebulization were applied to induce asthma.Meanwhile Jia-Wei-ShengJiang Powder(SJS),Guizhi-Jia-Houpu-Xingzi Decoction(GHX) and Zeng-Ye-Cheng-Qi Decoction(ZYCQ) were orally administered for treatment of lung-intestine combine therapy,lung therapy and intestine therapy.The respiratory function was analyzed by using the Buxco whole body plethysmography.The variety of intestinal flora were analyzed by using 16SrDNA.Results Analyzing the specieces composition of intestinal flora in each group by the OUT value found that the recovery of Lactobacillus in each group was close to that in the blank group and better than that in the positive group,meanwhile,3 treatment groups all could promote the recovery of Proteobacteria and bacteroidetes,but the lung-intestine combine therapy had optimal effect,the Alpha diversity analysis found that the intestinal microflora diversities from high to low were in turn the intestinal therapy group,lung therapy group,lungintestine combined therapy group and model group;the respiratory frequency and airway hyperreactivity in the model group was 260.56(1.28),which in the lung-intestine combined therapy group,lung therapy and intestine therapy after treatment were 141.79 (0.93),137.25 (1.30) and 203.16 (0.84) respectively,the rat respiratory frequency in each treatment group was lower than that in the model group,while the airway hyperreactivity only in the lung-intestine combined therapy group and intestinal therapy group was lower than that in the model group,moreover showing statistical significance.Conclusion The lung-intestine combine therapy method for treating rat intestinal dysbacteriosis complicating allergic asthma is superior to simple lung therapy method or intestine therapy method.

ObjectiveTo explore the proliferation of human degenerate nucleus pulposus and annular fibrosus cell in vitro and compare the different biological behavior between the two kinds of cell after degeneration,and provide the new theoretical basis for the prevention and treatment of degenerative disc disease.MethodsThe samples of intervertebral disc tissue were collected from patients with lumbar disc herniation.The degree of degeneration was assessed by the pathological diagnosis and degenerate nucleus pulposus and annular fibrosus cell were cultured by enzymatic digestion and identified.In each case,the control groups of the nucleus pulposus cells and annulus fibrosus cells were cultured to the fifth generation.The inoculation density of cells was 1×105.The cell morphology of each generation was observed,while the proliferation of cells was detected by flow cytometry after 48h culture with the same conditions.ResultsThe degenerate nucleus pulposus cell and annular fibrosus cell were in good condition in vitro.The percentages of S phase cell and proliferation index (PI) were both on the rise with the subculture.The PI of nucleus pulposus cells reached the peak in the 3rd generation; The PI of annulus cells was the highest in the generation 5.The proliferation activity of degenerate nucleus pulposus cell in 2～4 generations was higher than the degenerate annular fibrosus cell within the same generations (P＜0.05).ConclusionDifferent proliferative characteristics of the degenerate nucleus pulposus and annular fibrosus cell confirmed that the disc degeneration is reversible.The response mechanisms to the degenerate micro-environment are completely different in vivo and affects the entire disc degeneration progress.

Objective To evaluate the safety and effectiveness of multi-mode interventional therapy for complications occurring after renal transplantation.Methods The clinical data of 26 patients with complications occurring after renal transplantation were retrospectively analyzed.Vascular and non-vascular complications were treated with different interventional techniques,and the curative effects were analyzed.Results Vascular complications were observed in 19 patients and non-vascular complications were seen in 7patients.The technical success rate of interventional therapy was 100％.One week after the treatment,the total creatinine level (SCr) was significantly improved,which decreased from preoperative (372.7±295.5)μmol/L to postoperative (184.3±138.4) μmol/L (P＜0.001).No severe complications occurred.Further analysis indicated that no statistically significant differences in patient's general condition,kidney donor source,anastomosis method existed between vascular intervention group and non-vascular intervention (P＞0.05).However,the onset time of vascular complications was markedly earlier than that of non-vascular complications (1.8± 1.4 months vs.118.3 ±54.4 months),the difference was statistically significant (P＜0.001).During the follow-up period lasting for 4-55 months (mean of 18.6 months),3 patients developed recurrence of complications;interventional therapy had to be carried out in 2 patients and their creatinine level returned to normal after treatment,and transplanted renal artery embolization had to be performed in the other patient as whose pseudoaneurysm became enlarged.Conclusion For the treatment of complications occurring after renal transplantation,interventional therapy is less-invasive,rapidly-effective and safe,this technique can timely and effectively improve the renal function and save the transplanted kidney.

Objective To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-transforaminal lumbar interbody fusion (MED-TLIF) with mobile microendoscopic discectomy (MMED) technique. Methods The MMED includes outer working canal and inner operating canal. Large working canals and endoscopic chisel were fabricated for MMED-TLIF,which was designed as follow:the pedicles and index level were located with fluoroscopy, and a 2.5 cm incision was made between pedicle punctures sites on the symptomatic side. Working canal was inserted, and the facet was exposed,the inferior articular process and medial part of superior articular process were resected. The disc and cartilage endplates were curettage, and the intervertebral space was released and tested. The inner operating canal was removed and the interbody space was grafted and supported with suitable cage. Percutaneous pedicles screws were inserted and the residual displacement was evaluated under fluoroscopy, followed by the install of connecting rods for reduction and fixation. Fifty-six patients with lumbar stenosis including 32 cases of instability and spondylolisthesis (1 degree in 15 cases and 2 degree in 9 cases) were treated with this technique. The ODI index and VAS score were compared in patients before and after surgery. The efficacy was evaluated by Macnab standard. Results Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was (120±30) min (range, 90–180 min),with a mean blood loss of (120±50) mL (range,50–200 mL). The post-operative X-ray and CT scans showed improvement of spinal alignment with mean reduction ratio of 72%. Patients were followed up for 6 to 36 months. The ODI score decreased from 50.1±11.2 to 5.8±5.6. The VAS score of lumbar decreased from 7.1±4.2 to 1.2±1.0 and VAS score of leg decreased from 4.1±2.5 to 1.1±0.9 at final follow-up. The clinical results were excellent in 36 cases,good in 20 according to the Macnab scale. Conclusion MED-TLIF can easily perform with MMED technique,with sufficient decompression and reduction, and providing satisfactory results with less invasive procedure.

Objective To investigate the results and complications in the treatment of the mechanically unstable fractures of the distal femur when Less Invasive Stabilization System (LISS) is used.Methods From September 2011 to July 2014,81 patients with mechanically unstable fractures of the distal femur were treated with the LISS,according to the inclusion criteria and exclusion criteria,59 patients meet the condition including 31 male and 28 female.The mean age of the patients was 49.8 years (range 18-80 years).The fractures occurred on the left side in 40 cases and on the right side in 19 cases.According to AO classification,27 type 33A2,14 type 33A3,13 type 33C2,5 type 33C3.2 cases combined with ipsilateral fractures of the femoral shaft,according to AO classification,1 type 32A1,1 type 32C1.The mechanism of injury was a fall from the height in 8 cases,a traffic accident in 18 cases,a crush injury in 7 cases,a fall injury in 26 cases.55 fractures were closed,and 4 were open.According to the Gustilo-Anderson classification,there were 3 type Ⅰ,1 type Ⅱ.Results The 7-hole plate were used in 21 patients,9-hole plate in 26 patients and 13-hole plate in 12 cases.The 3.5 mm or 6.5 mm lag screw were placed around the LISS plate to stabilized the articular fracture fragment in 11 cases.The mean operation time was 105.2 min (85-145 min),the mean bleeding volume was 203 ml (130-315 ml).All patients were followed up 11-27 months (average 13.2 months).1 delayed union(13 months),the average time to union was 16 weeks (range 12-21 weeks).The average flexion of the knee was 116 degree,0 degree in extension.The functional outcome:32 had an excellent result,19 had a good result and 8 had a fair result,with 86.4％ excellent and good results.No deep infections occurred.No loss of reduction.3 cases had malalignment,2 failed fixation,4 patients with symptomatic hardware irritation.27 cases underwent implants removal after union,cold-welding occurred in 4 cases (9 screws) which resulted in difficult removal.Conclusion LISS is one of the reliable and effective methods in fixation of mechanically unstable fractures of the distal femur.However,its operation indications and operating instructions should be strictly followed.