Objective To study the curative effect of prosthetic replacement for femoral neck frac-tures at the hemiplegic extremity in the elderly with previous stroke. Methods From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement. 29 cases were of previous stroke with femoral neck fractures (Garden type Ⅲ and type Ⅳ) at hemiplegic extremity. 30 non-hemiplegia cases were adopted randomly as control. Two group patients were subjected to a follow-up study for 2 years and 3 months to 8 years and 2 months(average 4 years and 11 months) to compare the differences of ages, hospitalization days, operation time, blood loss, blood transfusion, complications during perioperative period and short-term complications with each other as well as the results of femoral head re-placement versus total hip replacement in treatment of hemiplegia group. Results Two group patients sur-vived during perioperative period. The ages, hospitalization days, operation time, blood loss and blood trans-fusion were of no significant difference in two groups, while complications during perioperative period were of significant difference. 5 patients died in hemiplegia group and 2 patients died in non-hemiplegia group at 11 months to 5 years follow-up. Mortalities were 17.2% and 6.7% respectively. Short-term complication rate was of no significant difference in 2 groups. In hemiplegia group, short-term complication rate of femoral head replacement were significantly higher than that of total hip replacement. Conclusion Prosthetic re-placement is reliable to treat Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic ex-tremity in the elderly with previous stroke. Complications during perioperative period are more in hemiplegia group, but short-term complications are of no significant difference in 2 groups. Mortality of hemiplegia group is higher than in non-hemiplegia group in 5 years after operation. Total hip replacement should be in-dicated in treatment of Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic extremity in the elderly with previous stroke on condition that hip muscular strength is beyond Ⅳ degree.

Objective To evaluate the life quality in the elderly who underwent internal fixation with cannulated screws and bipolar hemiarthroplasty for the displaced femoral neck fractures. MethodsA retrospective study was performed on 141 cases older than 60 years treated from 1993 to 2004. All cases were followed up for mean 40.2 months to evaluate the differences in regard of pain and daily living at one and three years. Results The daily living in hemiarthroplasty group possessed better outcome than that in internal fixation group at one year, with statistical difference but without statistical difference at three years. There was no statistical differences in postoperative pain relief between both groups. Conclusions Both internal fixation and hemiarthroplasty can relieve pain and revive the life quality of the elderly.

Objective To analyze the radiographical and histological features of implanted composites of decalcified bone matrix(DBM) impregnated with calcium phosphate cement(CPC) and recombinant human bone morphogenetic protein-2(rhBMP-2) in bone defect,and evaluate its biodegradation properties.Methods By prefabricating the rabbit DBM,the CPC/DBM/rhBMP-2 composites were prepared in a DBM/CPC ratio of 2∶8 and the rhBMP-2 content of about 1.2mg/cm3.Twenty-four rabbits were divided into groups A and B(12 each).Animals in group A were implanted with the composites in the bone defects at femoral condyle and femoral muscle,and the rabbits in group B CPC was implunted in the same place.Animals were sacrificed at 6,12 and 24 weeks after operation(4 each),and the implants were examined radiographically and histologically.Results It was shown by radiography that,in group A,the margin of implants in femoral condyle defects became irregular 6 weeks after operation;the appearance of the implants appeared hazy and shrunken in size 12 weeks after operation;and most of the implant was absorbed and the medullary cavity became partly rediotransparent 24 weeks after operation.The density of the implants in muscles beoame less dense gradually during 6 to 24 weeks after operation.While in group B,the appearance and density of the implants in femoral condyle defects and muscles were not obviously changed during 6-24 weeks after operation.Histological observation showed that,in group A,the interface between the implants in the bone defects was filled with newly formed bone grown into the composites 6 weeks after operation.New bone formed inside the composites 12 weeks after operation,and the bone defect was repaired,and most of the implants were replaced by new bones,with a little portion of it remained 24 weeks after operation.Fibrous tissue was seen to grow into the composites in muscles during 6-12 weeks after operation,and only a little of the composites remained 24 weeks after operation.In group B,no fibrous tissues or new bones grew into composites implanted in femoral condyle defects or muscles 6-12 weeks after operation,and the bone defects was still filled with materials of CPC,and no new bone or fibrous tissue was found inside CPC 24 weeks after operation.Conclusion Compare with CPC,the DBM with an optimal formula is are easy biodegradable and can be replaced by autologous bone.

Objective To observe the clinical effect of early diabetic nephrosis treated with Danhong injection and Losar- tan Potassium Tablets.Methods 60 patients were randomly divided into treatment group (n=30) and control group (n=30).Both grougs take orally medicine or insulin for normal blood sugar,the control group were treated with con- ventional treatment.On the basis of conventional treatment,the treatment group were treated with Danhong injection and Losartan Potassium.Results After treated for 28 days,the UAER,BUN,SCr and hemorheology were significantly improved in the treatment group than in the control group (P

Objective To investigate the prognosis of patients with nasal NK/T cell lymphoma receiving different treatment modalities. Methods From 1990 to 2004, 85 patients with stage ⅠE and ⅡE primary nasal NK/T cell lymphomas were retrospectively studied. Twenty patients received chemotherapy of CHOP regimen alone, 11 patients received radiotherapy only, 6 patients received radiotherapy followed by more than 2 cycles of chemotherapy, and 48 patients received more than 2 cycles of chemotherapy followed by radiotherapy. Survival analysis was performed by the Kaplan-Meier method, the difference between groups was evaluated by the Log-rank test, and the Cox regression model was used for multivariate analysis. Results The 5-year overall survival rate (OS) was 40%. The 5-year OS was 57% and 28% for limited stage ⅠE and extended stage ⅠE(X2 =8. 87, P =0. 003), and 23% for stage ⅡE, which was similar to extended stage ⅠE (X2 =0. 19, P-0. 664). The 5-year OS was 13%, 54% and 47% for chemotherapy alone, radiotherapy followed with or without chemotherapy, and chemotherapy followed by radiotherapy, respectively. The last two groups had better OS than chemotherapy alone (P = 0. 030 and 0.049). The 5-year OS was 58% and 12% for patients achieving complete response (CR) and uncomplete response (X2 = 30.68, P = 0. 000).The CR rate was 56% and 86% for radiotherapy of ≤50 Gy and >50 Gy (X2 =6.11, P=0. 013). The corresponding 5-year relapse-free survival rate was 89% and 84% (X2 =0.36, P=0.551). Of 68 patients receiving initial chemotherapy, the CR rate of those who received ≤2, 3-4 and ≥5 cycles was 0, 20%and 3 3 % , respectively (X2 = 7.65 , P = 0. 022) . For 5 0 patients who received ≥ 3 cycles of initial chemotherapy and 17 patients who received initial radiotherapy of ≥40 Gy, the CR rate was 28% and 88%(χ2= 18. 75, P= 0. 000). In patients with pathological nodular and ulcer type, the CR rates with radiotherapy were higher than with chemotherapy (100%: 38%, χ2 = 7.92, P = 0. 005; and 100%: 11%,χ2 = 14.40, P = 0. 000). Multivariate analysis showed that stage and recent effect were the independent prognostic factors. Conclusions The initial radiotherapy with 50 Gy is appropriate for early stage nasal NK/T cell lymphomas. Combined chemotherapy could be used for extended stage ⅠE and ⅡE, but the outcome of CHOP regimen is poor.

Objective To investigate the response of multiple myeloma (MM) cells to 8-chloroadenosine 3',5'-monophosphate (8-Cl-cAMP) and the impact of arsenic trioxide (As2O3) on the above reaction.Methods MM-derived cell lines RPMI8226 and U266 were used as in vitro models.Cell apoptosis was evaluated according to cellular morphology and DNA content measured by flow cytometry.Meanwhile,rhodamine 123 (Rh123) staining and flow cytometry assay were used to detect the changes of mitochondrial transmembrane potentials (△ψm) in MM cells before and after the treatment.The synergic effects of 8-Cl-cAMP and As2O3 were evaluated by King' s formula.Results The 8-Cl-cAMP could induce growth inhibition of RPMI8226 and U266 cells in dose and time-related manners.The 8-Cl-cAMP could trigger apoptosis and △ψm collapse in MM cells through cellular morphology and flow cytometry analysis.As2O3 accelerated 8-Cl-cAMP-mediated apoptosis of RPMI8226 cells,but there were few synergic effects observed.Conclusion 8-Cl-cAMP could induce cell proliferation inhibition and apoptosis in MM cells.Mitochondria may be one of targets in 8-Cl-cAMP-mediated apoptosis.Furthermore,As2O3 catalyzes 8-Cl-cAMP-induced apoptosis.

BACKGROUND:Bone cement solidification can improve the stability, strength and mechanical support of fractured vertebrae. However, there are few studies on the effect of bone cement dispersion within the fracture line on percutaneous vertebroplasty. OBJECTIVE:To analyze the effect of bone cement dispersion within the fracture line of thoracolumbar osteoporotic vertebral compression fractures on percutaneous vertebroplasty. METHODS:Totaly 90 patients with thoracolumbar osteoporotic vertebral compression fractures were enroled, 53-80 years old, including 42 males and 48 females. Al these patients underwent percutaneous vertebroplasty with bone cement injection, and divided into two groups according to bone cement dispersion conditions: study group with good bone cement dispersion (n=60) and control group with poor bone cement dispersion (n=30). Visual analogue scale scores, Oswestry dysfunction index, Cobb's angle and adverse reactions were recordedbefore and after treatment. RESULTS AND CONCLUSION:There were no differences in the visual analogue scale score and Oswestry dysfunction index between the two groups before treatment (P > 0.05). The visual analogue scale scores were significantly lower in the study group than the control group at 3 days after treatment and at the last folow-up (P < 0.05); the Oswestry dysfunction index and Cobb's angle were also lower in the study group than the control group at 3 days after treatment (P < 0.05). However, no difference was found in the Oswestry dysfunction index, Cobb's angle and bone cement leakage between the two groups at the last folow-up. These findings indicate that the percutaneous vertebroplasty show better effects on pain relief in patients with good bone cement dispersion that those with poor bone cement dispersion, and the vertebral stability is better as wel as the short-term effect is more obvious.

Objective To evaluate the clinical efficacy and toxicity of EPOCH regimen in the treatment of elderly patients with peripheral T-cell lymphoma. Methods Twenty-eight elderly patients with pathologically diagnosed peripheral T-cell lymphoma were treated with EPOCH regimen, including 96-hour continuous infusion of etoposide 50 mg/m2, epirubincin 12 mg/m2 and vincristin 0.4 mg/m2 on daysl through 4,cyclophosphamide 750 mg/m2 given as intravenous bolus on day 5 and prednisone 60 mg/m2 administered orally on daysl through 5. The EPOCH regimen was repeated very 21 days. Clinical efficacy and safety profiles of EPOCH regimen was systemically reviewed and analysed. Results All the 28 patients received a total of 85 cycles of EPOCH regimen. The median cycles was two courses. Fifteen patients achieved complete response, while five cases obtaining partial response. The overall response rate was 71.4 %. The median survival time was 20 months. In newly diagnosed patients, complete response rate (CR) as well as partial response (PR) and overall response rate (OR) reached 64.7 %, 23.5 % and 88.2 %, respectively, which was significantly higher than that in refractory cases, whose CR, PR and OR were 36.4 %, 9.1% and 45.5 %(λ 2 = 5.99, P ＜0.05). In addition, the median survivalduration of newly diagnosed patients was longer than that of refractory cases, whose median survival time was 24 and 13 months, respectively. The major adverse events was myelosuppression with grade 3-4 neutropenia and thrombocytopenia in 53.6 % and 50.0 % cases.Non-hematologic toxicities were moderate and uncommon. The frequency of adverse effects in de novo patients showed little difference in comparison with that in refractory ones (P＞0.05). Conclusion EPOCH regimen was an effective and well tolerated therapeutic schedule for elderly patients with peripheral T-cell lymphoma.

10.3969/j.issn.1007-3969.2013.04.010