Objective To investigate the roles of integrin-linked kinase (ILK) protein and mRNA in the development of human bladder transitional cell carcinoma (BTCC). Methods The expressions of ILK protein and ILK mRNA in specimens from 56 cases of human BTCC and from 30 cases of adjacent normal bladder were detected by immunohistochemistry S-P method and reverse transcription polymerase chain reaction (RT-PCR), respectively. The correlation of the expressions of ILK protein and mRNA to the clinicopathological parameters of human BTCC was analyzed statistically. Results The positive rates of ILK protein and mRNA in malignant specimens were 53.6% (30/56) and 58.9% (33/56), respectively, while those in the adjacent normal bladder tissue were 10% (3/30) and 13.3% (4/30), respectively. Significant difference was found in the expressions of ILK protein and mRNA between BTCC and adjacent normal bladder specimens (P0.05). Conclusion ILK gene transcription and protein expression may be involved in the developmental process of BTCC. ILK might be a new marker for early diagnosis of BTCC and a new target gene for BTCC treatment.

Objective To isolate and identify prostate cancer stem-like cells from human prostatic carcinoma cell line PC-3,in order to set a foundation for further investigation of human prostate cancer stem cells (hPCSC). Methods Prostatic carcinoma cells line PC-3 was cultivated in serum-free medium (SFM) supplemented with growth factor,with the same cells cultivated in serum-supplemented medium (SSM) supplemented with growth factor to serve as the control. The proportion of prostate cancer stem-like cells was detected by flow cytometry,and prostate cancer stem-alike cells were identified by cell immunofluorescence,then the proliferating potentiality and doubling time with prostatic carcinoma cells PC-3 were compared by MTT. The process of inducing differentiation and the dual immunofluorescence expression after differentiation of prostate cancer stem-alike cells were observed. Results In SFM consisting of human epidermal growth factor (EGF),human basic fibroblast growth factor (bFGF) and human leukaemia inhibitory factor (LIF),a few PC-3 cells could survive and form suspended cell spheres,and the proportion of prostate cancer stem-alike cells (1.43%) was significantly increased compared with that cultured in SSM (0.41%,P

Objective To evaluate the results of using focus clearance and morselized bone graft to treat a well-fixed socket osteolysis after total hip arthroplasty (THA) during cementless acetabular revisions.Methods From March 2006 to March 2009, 23 patients (23 hips) who had an acetabular revision hip arthroplasty of well-fixed socket for osteolysis were retrospectively reviewed, including 13 males and 10 females with an average age of 46.6 years (range, 39-54), and the mean interval from primary to revision THA was 5.5 years (range, 4.6-7.4). The preoperative Harris hip score was 74. The operative technique included debridement of soft tissues with removal of granulomata and packed tightly with morselized cancellous allograft through ilioinguinal approach, and exchanging the liner and femoral head through the posterior-lateral approach of the hip. Results The mean duration of follow-up after revision was 28 months (range, 8-38). At final follow-up, all hip were functioning well and the average Harris hip score was 93.8. Osteogenesis in bone graft were well-developed in 16 patients. Twelve bone grafts were completely incorporated into surrounding bone through creeping substitution. All acetabular components remain radiographically well-fixed and no loosening and shifting. There were no new osteolytic lesions, ectopic ossification, deep venous thrombosis, hip dislocation or infection during follow-up. Conclusion Our revision strategies included debridement and bone grafting, a revision of femoral heads and polyethylene liner and retention of the cups and femoral stems. The method can reduce the amount of the wear particle from polyethylene. The short-term outcome is excellent.

Objective To retrospectively analyze the diagnosis and treatment of the extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty (THA).Methods From March 2006 to June 2011,7 patients (7 hips) who presented with a progressive pain and/or swelling,discomfort in groin or upper thigh after metal-polyethylene THA were admitted to our hospital.There were 2 males and 5 females,with an average age of 48.8 years (range,32-65 years).All 7 patients were identified with a periprosthetic osteolysis at the acetabular and/or femoral components and a mass in the iliac fossa or the thigh; however,the components were all well-fixed.The masses were confirmed by CT scanning and/or ultrasound examination.The revision procedures were done through ilioinguinal approach and posterior-lateral approach,and the pseudotumors were excised and osteolytic lesions were debrided and packed tightly with morselized cancellous allograft.The liner and femoral head were also exchanged at the same time.Clinical and radiographic outcomes of revision THA were evaluated.Results All 7 patients were followed up for 3-42 months (average,30 months).At final follow-up,all hips were functioning well and the average Harris hip score was 92.4.All acetabular components remained radiographically well-fixed.All cavitary defects had complete radiographic incorporation of the bone grafts.There were no new pseudotumor or osteolytic lesions identified,and no revision of the components.Conclusion The presence of abdominal or pelvic pseudotumor in patient with a THA may be associated with polyethylene wear.Once the extra-articular pseudotumor and the periprosthetic osteolysis are identified,the surgical treatment,including pseudotumor excise,osteolytic lesion debride and bone defect grafting and bearing surface exchange,can achieve retention of well-fixed components.

Objective To retrospectively analyze the short-term clinical effects of the two-stage cementless total hip arthroplasty in the treatment of chronic infection after the internal fixation of the adult proximal femoral fracture.Methods From June 2006 to June 2011,9 patients who had suffered a chronic infection after an internal fixation of the proximal femoral fracture,including 8 males and 1 female,aged from 31 to 74 years (average,52.6 years),were treated with two-stage cementless total hip arthroplasty.There were 3 cases of femoral neck fracture,and 6 cases of intertrochanteric fracture.In the first stage,after surgical debridement and thorough removal of all the implants,an antibiotic-loaded cement spacer was implanted.All patients postoperatively underwent intravenous and oral antibiotics,and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested.When the values of ESR and CRP become normal,the second stage operation using cementless components was performed.Results The presence of infection was confirmed by a positive culture of joint fluid obtained intraoperatively in two cases;one case was staphylococcus aureus and another one was staphylococcus epidermidis.The second stage arthroplasty was performed 6-14 months (average,9 months) after the first stage operation.All 9 patients were followed up for an average of 23.2 months (range,6 to 50 months).No recurrent infection,component loosening,bone osteolysis and cement spacer or component dislocation occurred.The Harris score improved from 74.6 (range,64 to 86) before the first stage operation to 90.9 (range,86 to 97) at the final follow-up.Conclusion The two-stage cementless total hip arthroplasty is an effective strategy for the treatment of chronic infection after the internal fixation of the adult proximal femoral fracture.

Objective To investigate the middle-term results of anti-protrusio cage combining with allograft bone graft for revision arthroplasty of Paprosky type Ⅲ acetabular bone defect.Methods A retrospective analysis was done for 19 patients (20 hips) with Paprosky type Ⅲ acetabular bone defect who received acetabular revisions using anti-protrusio cage from January 2002 to December 2009.There were 11 males and 8 females,aged from 42 to 76 years (average,57.4 years).There were 7 hips (35％) of Paprosky type ⅢA acetabular bone defect,and 13 hips (65％) of type ⅢB.The follow-up time was (5.8±2.4) years.Hip function of patients was judged by Harris hip scores pre-and post-operation.The outcome of acetabular prostheses and bone grafts were assessed by radiologic evaluation.The five-year cage failure-free survival rate was assessed by Kaplan-Meier survivorship analysis.Results The Harris hip scores improved from preoperative 14.6±4.3 to 83.5±7.9 at the final follow-up.Lower limb discrepancy improved from preoperative (26.3±9.1) mm to postoperative (1.2±3.4) mm.The hip rotation center was reconstructed from preoperative(23.6±7.4) mm up-toward and (4.4±14.7) mm lateral-toward dislocation to inside Ranawat triangle.All the allograft bone was incorporated with host bone.None of cage displacement,screw fracture,progressive radiolucency and cement fracture was observed.Mild allograft bone resorption was observed in 3 hips (15％).There was no moderate or severe bone resorption found at the final follow-up.The five-year cage failure-free survival rate was 100％ (95％ CI,0.95-1.00).Conclusion The revision using anti-protrusio cage combined with allograft bone graft shows satisfying middle-term clinical and radiological results in the treatment of Paprosky type Ⅲ acetabular bone defect.

Objective To study whether 3D computerized pre?operative planning is accuracy and reliability in CroweⅣtype developmental dysplasia of the hip (DDH) patients undergoing total hip arthroplasty (THA). Methods Between September 2009 and February 2011, 20 CroweⅣtype DDH patients (20 hips) were included in this study. The 3D pre?operative planning was performed using Mimics software to predict the acetabular component size, acetabular component abduction angle, hip rota?tion center position, the acetabular component coverage and number of patients received structural bone graft. The results were compared with traditional acetate templating technique and post?operative results. Results 70%(14/20) components were pre?dicted exactly and 30%(6/20) components were predicted with one size using 3D computerized planning, comparing with 25%(5/20) components were exactly, 45%(9/20) components were with one size and 30%(6/20) were with two size or more using conven?tional acetate templating technique. Statistically analysis revealed that 3D planning was more accuracy than templating technique regarding acetabular component prediction (t=-4.66, P=0.00). There was no significant difference between the 3D computerized planned acetabular component abduction angle (3D plan 41.10°±4.87°, postoperative 44.98°±10.83°, t=0.88, P=0.42), hip rota?tion center distance (horizontal distance:3D plan 77.51 ± 7.78 mm, postoperative 79.85 ± 8.61 mm, t=-1.95, P=0.11;vertical dis?tance:3D plan 42.79±8.22 mm, postoperative 44.98±10.83 mm, t=-1.27, P=0.26), acetabular component host coverage (3D plan 77.73%± 10.51%, postoperative 78.98%± 10.24%, t=-1.84, P=0.09), and that found post?operatively. Five patients were consid?ered to need structural bone graft according to 3D computerized planning, which was highly coincident with the intraoperative find?ings in all five cases. Conclusion 3D computerized pre?operative planning using Mimics software is an accurate and reliable technique in treating CroweⅣtype DDH patients undergoing THA.

Objective To evaluate clinical and radiographic outcomes associated with total hip arthroplasty (THA) using metal-on-metal prosthesis with large diameter femoral head.Methods From October 2007 to December 2007,41 patients (49 hips) underwent large diameter femoral head metal-on-metal THA in our hospital were involved in this study.Clinical outcomes measures were Harris score,hip range of motion and incidence of complications.Abduction angle and anteversion angle of cup were measured on radiological films.The radiolucent line and osteolysis around the prosthesis were also recorded.Results Thirty-nine patients (47 hips) were followed up at least 2 years.The average Harris hip score had improved from (43.8±13.1) points preoperatively to (92.0±5.4) points at final follow-up.All the patients had attained satisfactory results.No late complication happened.For the rang of motion at final follow-up:flexion of the hip had improved from 79.8° to 113.2°,abduction had improved from 20.9° to 40.2°,external rotation had improved from 12.0° to 30.8°.Radiological measurement showed the mean abduction angle of cup was 39.5°±4.9°,the mean anteversion angle of cup was 14.5°±2.1°.No radiolucent line and osteolysis were found after THA.Conclusion The short-term effects of THA using metal-on-metal prosthesis with large diameter femoral head is encouraging,especially for young patients.

Objective To analysis the influence of component design and related surgical technique on knee range of motion (ROM) after total knee replacement using Innex knee system. Methods Between September 2003 and December 2005, 88 patients with 98 knees had consecutively undergone posterior cruciate-sacrificing TKA with Innex systems. The posterior condylar offset, post-operative tibial slope and knee ROM were measured in 63 patients (70 knees). The relationship of the change in posterior condylar offset and postoperative tibial slope with knee ROM was assessed using a scatterplot graph and Pearson's regression analysis. According to change of posterior condylar offset, which was measured by postoperative minus preoperative posterior condylar offset, patients were divided into 4 groups. The preoperative body mass index,flexion contracture, knee ROM, HSS score and the postoperative knee ROM of four groups were evaluated.Results The mean knee ROM had improved from 96.2°±11.9° preoperative to 109.8°±13.0° at final followup. The mean pre- and post-operative posterior condylar offset was (24.0±3.5) mm and (24.5±3.3) mm, respectively. The mean postoperative tibial slope was 5.5°±1.8°. There was statistical correlation between the difference in the posterior condylar offset and the change in knee ROM after TKA and no correlation between the postoperative tibial slope and knee ROM postoperatively. The preoperative body mass index, flexion contracture, knee ROM, HSS score did not show difference among four groups. There was a statistically difference in postoperative knee ROM among groups. Conclusion Restoration of posterior condylar offset is important to the maximum range of postoperative knee ROM when Orthopedic surgeons perform TKA with Innex systems.There was no correlation between the postoperative tibial slope and postoperative ROM.

Objective To evaluate mid?term clinical outcomes associated with total hip arthroplasty using metal?on?met?al prosthesis with large diameter femoral head. Methods From March 2007 to December 2009, 153 patients (177 hips) with ad?vanced hip diseases undergoing large diameter femoral head metal?on?metal total hip arthroplasty in our hospital were retrospec?tively analyzed in this study. Clinical physical examination and radiographic examination were used to evaluate hip function and the incidence of complications (implant loosening and inflammatory pseudotumor);ICP?MS method was used to determine serum cobalt ion and chromium ion levels and compare with normal values;revision was set as the prosthesis endpoint to evaluate the five year survival rate of implant. Results A total of 145 patients (169 hips) were followed up for average 72.4 months (67-80 months), the follow?up rate was 94.8% (145/153). For the involved patients, 85 were male (104 hips), 60 were female (65 hips);age 20-78 years old, average 49.3±12.6 years old. All patients received ASRTM?XL large femoral head metal?on?metal to?tal hip arthroplasty operation. At the end of follow?up, the average Harris hip score improved from 44.2±12.6 points preopera?tively to 91.5±5.7 points. A total of 8 patients received revision, 3 for acetabular implant spinout?out and 5 for hip inflammato?ry pseudotumor. The prosthetic survival rate 5 years after operation was 95.3% (161/169) for revision. Serum cobalt (2.89 μg/L) and chromium (3.31 μg/L) ion levels were significantly increased compared with normal value (<0.5 μg/L). Conclusion For the fixation and friction interface disadvantages, acetabular implant spinout?out and inflammatory pseudotumor might occur for patient receiving large femoral head metal?on?metal THA. The mid?term prosthetic survival rate was also low, with metal ion levels increased significantly. For primary THA, large femoral head metal?on?metal prosthesis cannot be the first choice.