BACKGROUND:Knee osteoarthritis can be treated by total knee arthroplasty. To improve therapeutic effect and promote postoperative recovery, we should take effective measures to improve the joint space and postoperative range of motion.
OBJECTIVE:To explore the effectiveness and feasibility of posterior composite release of the knee joint after total knee arthroplasty.
METHODS:118 knee osteoarthritis patients undergoing unilateral total knee arthroplasty in two hospitals from December 2009 to December 2013 were selected, and were randomly divided into control group (59 cases) and observation group (59 cases). After osteotomy during operation, the control group underwent bone removal of conventional condylar hyperplasia. Observation group underwent posterior composite release of the knee joint. Postoperative extension, flexion gap and the time required for postoperative active flexion 90° and 120° were observed in the two groups. Hospital for Special Surgery Knee Score and maximum flexion angle were recorded in 3 months of fol ow up, and compared between the two groups. RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference in flexion gap was found between the two groups (P>0.05). However, significant differences in extension gap, the time for active flexion 90° and 120°and the maximum flexion angle were detectable between the two groups, and above indexes were better in the observation group than in the control group (P<0.05). Hospital for Special Surgery Knee Score of each index and total score were significantly higher in the observation group than in the control group (P<0.05). These results suggest that rear joint composite release after total knee arthroplasty has certain validity and feasibility, can effectively improve knee extensor gap and the postoperative range of motion during replacement, but does not impact flexion gap during replacement.

Objective To explore bladder carcinoma eystectomy and orthotopic ileal neobladder postoperative,the impact of new bladder on upper urinary function.Methods Twenty-eight patients with muscle invasive bladder urothelial carcinoma undergoing cystectomy W-shaped orthotopic ileal neobladder in Department of Urology of the Nuclear Industry 215 Hospital of Shaanxi Province(Mar.2006-Jun.2010)were investigated.All patients were followed for over 2 years.Assessment items included creatinine determination,urinary B-Ultrasound determination of the amount of residual urine volume and hydronephrotic cystography.Results Four weeks after the operations,all patients were removed bladder catheter angiography and found no obvious contrast extravasation.After 3 months mild hydronephrosis was found in 8 cases (28.6％),including 2 cases (7.1％) before surgery associated with hydronephrosis,the difference being not statistically significant(x2=0.49,P ＞ 0.05).The mild hydronephrosis was found in 5 cases (17.9％) 2 years postoperation,whithout statistically significant difference compared with preoperation (x2 =0.22,P ＞ 0.05).Preoperative serum creatinine was (72.92 ± 14.58) mmol/L,while 3 months after surgery serum creatinine was (83.42 ± 15.18) mmol/L (t =-6.43,P ＜ 0.05).Preoperative and postoperative serum creatinine was within the normal range.Two years after surgery serum creatinine was (82.50 ± 14.39) mmol/L,with significant difference compared with that of preoperation (t =-4.67,P ＜ 0.05),but were in the normal range,no clinical significance,the postoperative 3 months bladder capacity (160 ± 23) mL,while 2 years later bladder capacity residual urine volume of (58.7 ± 9.7) mL and (430 ± 21) mL,residual urine volume (61.3 ± 37.1) mL(t =-0.37,P＞ 0.05).Conclusion Orthotopie ileal bladder ideal substitute for postoperative cystectomy with less impact on the upper urinary tract function.

Objective To evaluate the difference of PC values based on GBZ 97-2002 and on GBZ 97-2009 for lung cancer cases in Chinese uranium miners.Methods Using 19 lung cancer data ascertained in the past epidemiological study,PC values were calculated according to GBZ 97-2002 and GBZ 97-2009.Results In the 19 lung cancer cases,those cases that could not be judged as radiogenic cancers based on GBZ 97-2002,but may be judged as radiogenic cancers with GBZ 97-2009.The probability was enlarged by 1.1 times at least.The major reason was that the used value was the upper limit of 95％ in GBZ 2009 but the median in 2002.Conclusions Compared to GBZ 97-2002,the criteria value of PC in GBZ 97-2009 drops obviously.

Objective To explore the bone marrow pathology ,diagnosis and differential diagnosis of Waldenstrom macroglobulinemia(WM). Methods 19 WM patients was examined by bone marrow aspiration (BMA) and bone marrow biopsy (BMB) for morphology. Flow cytometry (FCM) and immunohistochemistry (IHC) for immunophenotyping. Results Plasmacytoid lymphocytes were identified in 11 BMA. All of 19 BMB were involved by lymphoma cells. 17 cases showed a predominance of small lymphocytes and 2 of plasmacytoid lymphocytes. Typically plasmacytoid lymphocytes were not seen in 4 cases. Patterns of bone marrow involvement were as follow: diffuse (12 cases), nodular (4 cases), interstitial (3 cases). Immunophenotypically, FCM showed all cases were CD_(19)~+, CD_(20)~+, CD_(22)~+, CD_5~- and CD_(10)~-. IHC revealed small lymphocytes and plasmacytoid lymphocytes were Pax5~+ CD_(20)~+ and plasma cells were CD_(38) CD_(138)~+ CD_(20)~- Pax5~-. Conclusion Small lymphocytes proliferation with plasmacytic differentiation is the typical bone marrow pathologic features of WM. IHC is benefit for identifying lymphocytes and plasma cells components. The Combination of morphology, FCM and IHC is contributive to the diagnosis and differentiation of WM.

Objective To discuss cause and treatment measures of the postoperative failed to fully automatic nail in patients with circumcision by disposable circumcision suture device, so as to improve the quality of the circumcision.Methods 182 cases received circumcision by disposable circumcision suture device were randomly selected from September 2014 to March 2015 in the hospital and divided into control group ( n =86 ) and treatment group (n=96).All the patients received oral antibiotics for three days conventionally.Patients in control group were dressing with 0.1%iodine after treatment, dressing change every two or three days, while the treatment group soaking with 30 mL to 40 mL compound prescription cortex phellodendri chinensis fluid for 15 min two times per day.The postoperative wound anastomosis nail loss effect in two groups were compared.Results The time of complete nail loss in patients soaking with compound prescription cortex phellodendri chinensis fluid was significantly shorter than that in patients dressing with 0.1% iodine (P<0.05), but there was no significantly difference of the first time to lose nail between two groups.The rate of complete nail loss in treatment group was 94 cases (97.9%), which was significantly higher than 68 cases (79.1%) in control group (χ2 =16.47,P<0.05). The adverse reactions were mild of two groups.Conclusion The compound prescription cortex phellodendri chinensis fluid has exact effect on postoperative wound anastomosis nail loss and recovery in patients’ with circumcision by disposable circumcision suture device.

Primary myelofibrosis (PMF) is a chronic myeloproliferative disorder in human bonemarrow. Over 50% of patients with myelofibrosis have mutations in JAK2, MPL, or CALR. However,these mutations are rarely detected in children, suggesting a difference in the pathogenesis ofchildhood PMF. In this study, we investigated the response to drug treatment of a monozygotic twinpair with typical childhood PMF. The twin exhibited different clinical outcomes despite following the same treatment regimen. The transcriptomic profiles of patient samples after drug treatment (E2and Y2) were significantly different between the twin pair, which is consistent with the observationthat the drug treatment was effective only in the younger brother, despite the twin being geneticallyidentical. Bioinformatics analysis of the drug-responsive genes showed that the JAK-STAT pathwaywas activated in the cured younger brother, which is opposite to the pathway inhibitionobserved in adult PMF cases following treatment. Moreover, apoptosis and cell cycle processes wereboth significantly influenced by drug treatment in the sample of younger brother (Y2), implyingtheir potential association with the pathogenesis of childhood PMF. Gene mutations in JAK2,MPL, or CALR were not observed; however, mutations in genes including SRSF2 and SF3B1occurred in this twin pair with childhood PMF. Gene fusion events were extensively screened inthe twin pair samples and the occurrence of IGLV2-14-IGLL5 gene fusion was confirmed. The currentstudy reported at transcriptomic level the different responses of monozygotic twin brothers withchildhood PMF to the same androgen/prednisone treatment regimen providing new insights into thepotential pathogenesis of childhood PMF for further research and clinical applications.

Objective To observe the effects of Tocilizumab on white blood cell (WBC) after acute myocardial infarction (MI) and explore its potential to treat MI.Methods Rats were divided into 3 groups:control,MI,and MI treated.Serum from individual mouse was collected before and after subcutaneously Tocilizumab treatment.The level of interleukin-6 (IL-6),the number of WBC and the ratio of active hematopoietic stem cell (HSC)was tested by ELISA,flow cytometry and blood routine examination.The fibrosis of heart tissue was observed by immunohistochemistry.Results The IL-6 level and the number of the WBC were reduced after Tocilizumab treatment.It indicates the effect of inhibiting the activity of HSC and improving the situation of cardiocytes remodeling.Conclusion Tocilizumab could inhibit the generation of WBC and re-construct myocardium after MI.

Objective:To summarize the clinical phenotype of patients with developmental and epileptic encephalopathy 85 caused by SMC1A gene truncating variation.Methods:The clinical data of 4 patients with epileptic encephalopathy caused by SMC1A gene truncating variation from August 2016 to June 2020 were analyzed retrospectively. Related literatures up to October 2021 with the key words "SMC1A" "Developmental and epileptic encephalopathy 85" "SMC1A, epilepsy" and "SMC1A, truncating" in PubMed, CNKI, and Wanfang databases were searched. Relevant literature was summarized and reviewed.Results:These 4 patients were all female. The onset age of seizure were all in the infantile period. They were admitted to the hospital at 3, 2, 11 and 18 months respectively. Focal seizures occurred in all 4 patients, while 1 of them experienced infantile spasm. The characteristic of cluster was observed in all of them with an interval of 14 days to 5.0 months. The seizures were all refractory to different kinds of anti-seizure medications. All 4 patients had severe developmental retardation with microcephaly (head circumference<-2 s). The interictal electroencephalogram (EEG) was characterized by diffuse slow wave. The 4 SMC1A gene variants were p.Gly655fs, p.Glu811fs, p.Arg412fs and p.Ile143fs, all of which were de novo frameshift variation after parental validation. There were another 17 cases with SMC1A gene truncating variation reported in 6 English articles and 1 Chinese article. Among these 21 patients, who were all female, the onset of seizures occurred between 0.5 and 18.0 months of age. Seventeen cases (81%) had the characteristics of cluster attacks, and the intervals of attack cycles were different. Seizure types included generalized tonic-clonic seizure (12 cases (57%)), focal seizure (11 cases(52%)), myoclonic(4 cases(19%)), spasm (4 cases(19%)), atypical absence (3 cases(14%)), tonic seizure (2 cases (10%)), and atonia (1 case(5%)). In addition, 4 cases (19%) had status epilepsy. All patients had moderate to severe mental retardation. Microcephaly was found in all patients. Among 18 cases,EEG in 8 cases had diffuse slow wave background. Brain magnetic resonance imaging (MRI) was normal in 13 cases (62%). Other MRI changes included cerebellar atrophy (3 cases), thin corpus callosum (3 cases), and lateral ventricular enlargement (2 cases). Twenty patients did not respond well to antiepileptic drugs. Conclusions:The clinical phenotypes of patients with epilepsy encephalopathy 85 caused by SMC1A gene truncating variation are characterized by female, early-onset, clustering of seizures, development delay and microcephaly. Diffuse slow waves are shown in interictal EEG in partial. Response to treatment and prognosis are poor.

Objective: To study the clinicopathologic features of plasma cell myeloma(PCM) with bone marrow fibrosis (MF). Methods: The clinicopathologic data of 175 cases of newly diagnosed PCM patients were retrospectively analyzed. Based on reticular fiber staining, these cases were divided into PCM-MF and non-PCM-MF groups. Results: Sixty-three cases were PCM-MF(36%), 112 were non-PCM-MF (64%). No statistical difference in gender, age, hemoglobin level, platelet counts, the classification of immunoglobulin, ISS staging, immunohistochemical phenotypes and genetic features was found between PCM-MF and non-PCM-MF groups (P>0.05). Compared to non-PCM-MF group, lactate dehydrogenase (LDH)level and renal impairmentrate were higher in PCM-MF group (P<0.05). The degree of bone marrow hyperplasia, the percentage of myeloma cells and cells with plasmablastic morphology were significantly higher in PCM-MF group(P<0.05). Conclusion The higher LDH level, renal impairment rate, and more significant bone marrow hyperplasia, proliferation of plasma cells and plasmablastic myeloma cells infiltration indicate poor prognosis of PCM-MF patients.

OBJECTIVETo investigate pathologic and differential diagnostic features of pediatric Burkitt lymphoma (BL).

METHODSA total of 20 cases of pediatric BL were retrospectively reviewed for their clinical and pathologic profiles. Bone marrow aspiration specimens were available in all cases and bone marrow biopsies were available for immunohistochemical study in 18 cases. Flow cytometry study was available in 16 cases. MYC translocation by FISH method was performed in 11 cases.

RESULTSAtypical lymphocytes with cytoplasmic vacuoles were found in bone marrow smears in all 20 cases and peripheral blood films in all 19 available cases. The bone marrow biopsies showed infiltration by uniform medium-sized atypical lymphocytes with multiple small nucleoli but without the starry-sky pattern in all 18 cases. Immunohistochemistry showed the following results in all 18 cases: positive for CD20, PAX-5, CD10, CD34 and TdT, but negative for bcl-2 and CD3 with Ki-67 > 95%.Flow cytometry showed CD19+CD20+CD10+FMC7+CD22+TdT-CD3- in 16 cases, including κ+ in 8 cases, λ+ in 7 cases, and κ-λ- in 1 case. MYC gene rearrangement by FISH was observed in 10 of the 11 cases.

CONCLUSIONSThe histopathology of BL is distinct, including atypical lymphocytes with cytoplasmic vacuoles in bone marrow aspirate, lack of starry-sky patternin bone marrow biopsy. Generally, the diagnosis should be made with a combined immunophenotype and FISH approach. Pediatric BL must be distinguished from DLBCL and B-cell lymphoma, unclassifiable, which has intermediate features between DLBCL and Burkitt lymphoma.

Biopsy ; Bone Marrow ; pathology ; Burkitt Lymphoma ; genetics ; pathology ; Child ; Diagnosis, Differential ; Female ; Flow Cytometry ; Genes, myc ; Humans ; Immunohistochemistry ; Immunophenotyping ; In Situ Hybridization, Fluorescence ; Lymphocytes ; pathology ; Lymphoma, B-Cell ; pathology ; Lymphoma, Large B-Cell, Diffuse ; pathology ; Male ; Retrospective Studies ; Translocation, Genetic