OBJECTIVETo study short-term results and clinical application of Tri-lock BPS in total hip arthoplasty.

METHODSFrom May 2010 to July 2011, 32 hips in 31 patients (18 males and 13 females, ranging in age from 50 to 77 years old, with an average of 60.5 years old) were treated by total hip arthroplasty with Tri-lock BPS, including 8 patients with osteonecrosis (ON), 13 patients with fresh femoral neck fracture, 10 patients with developmental dysplasia of the hip (DDH). The therapeutic effects were evaluated by self assessment form, preoperative and postoperative Harris hip score, radiographs, Engh score and bone in growth of femoral side described by Gruen. Based on the short-term results,its design characteristic and clinical properties were analyzed.

RESULTSAll the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. All the patients were followed up with an average time of 12.2 months (ranged, 10 to 14 months). All the joints had good or excellent clinical results. The Harris score increased from preoperative 38.3 +/- 4.9 to 92.5 +/- 11.2 at the latest follow-up (t = 27.53, P < 0.01). Radiographically, the positions of the prostheses were normal,the average limbs length and femoral eccentricity recovered to normal. X-ray of the hips showed that the femoral stem prosthesis was in line with good initial fixed standard. At 3 months after surgery, X-ray of the hips showed that bone in growth in Gruen II and VI of femoral side.

CONCLUSIONShort-term results show that the design of Tri-lock BPS is more in line with human anatomy, and has the advantages in rapid recovery of hip function and retains more bone mass. It offers a newly valuable technology for the treatment of osteonecrosis, femoral neck fracture and DDH and so on.

Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Recovery of Function ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: The purpose of this study was to observe the effects of metformin on human esophageal cancer cell and to investigate its possible mechanisms. MATERIALS AND METHODS: Cell viability was detected by using a Cell Counting Kit-8, while cell cycle and apoptosis were assessed by flow cytometry and western blot was used to measure the expression of the related proteins. RNAi was used to knockout pyruvate kinase muscle isozyme 2 (PKM2). An Eca109 tumor model was established to evaluate the antitumor effect in vivo. Immunohistochemistry was determined based on the expression of PKM2 and Bim in tumor tissues. Tunnel was used to assess tumor cell apoptosis. RESULTS: Esophageal cancer cells viability was reduced after metformin treatment. The cell cycle was arrested in the G0/G1 phase, apoptosis was induced, caspase 3 was activated, caspase 9 was downregulated, and the pro-apoptotic protein Bim increased. Further study revealed that metformin could suppress the expression of insulin-like growth factor 1 receptor and its downstream proteins, phosphoinositide 3-kinase (PI3K), protein kinase B (AKT/PKB), phosphorylation of AKT (pAKT), mammalian target of rapamycin (mTOR), p70S6K, and PKM2. Insulin-like growth factor 1 partly reversed metfromin-induced apoptosis and attenuated the repression effect of metfomin to PI3K, pAKT, and PKM2. Knockout PKM2 resulted in the activation of caspase 3, down-regulation of caspase 9, and increased expression of Bim. In the Eca109 xenograft model, metformin significantly reduced tumor growth. Furthermore, we found that metformin treatment increased the rate of apoptosis, down-regulation of PKM2, and up-regulation of Bim in tumor tissues. CONCLUSION: Metformin restrained esophageal cancer cell proliferation partly by suppressing the PI3K/AKT/mTOR pathway.
Apoptosis ; Blotting, Western ; Caspase 3 ; Caspase 9 ; Cell Count ; Cell Cycle ; Cell Proliferation ; Cell Survival ; Down-Regulation ; Esophageal Neoplasms* ; Flow Cytometry ; Heterografts ; Humans ; Immunohistochemistry ; In Vitro Techniques* ; Metformin* ; Phosphorylation ; Proto-Oncogene Proteins c-akt ; Pyruvate Kinase ; Repression, Psychology ; Ribosomal Protein S6 Kinases, 70-kDa ; RNA Interference ; Sirolimus ; Up-Regulation

PURPOSE: The purpose of this study was to observe the effects of metformin on human esophageal cancer cell and to investigate its possible mechanisms. MATERIALS AND METHODS: Cell viability was detected by using a Cell Counting Kit-8, while cell cycle and apoptosis were assessed by flow cytometry and western blot was used to measure the expression of the related proteins. RNAi was used to knockout pyruvate kinase muscle isozyme 2 (PKM2). An Eca109 tumor model was established to evaluate the antitumor effect in vivo. Immunohistochemistry was determined based on the expression of PKM2 and Bim in tumor tissues. Tunnel was used to assess tumor cell apoptosis. RESULTS: Esophageal cancer cells viability was reduced after metformin treatment. The cell cycle was arrested in the G0/G1 phase, apoptosis was induced, caspase 3 was activated, caspase 9 was downregulated, and the pro-apoptotic protein Bim increased. Further study revealed that metformin could suppress the expression of insulin-like growth factor 1 receptor and its downstream proteins, phosphoinositide 3-kinase (PI3K), protein kinase B (AKT/PKB), phosphorylation of AKT (pAKT), mammalian target of rapamycin (mTOR), p70S6K, and PKM2. Insulin-like growth factor 1 partly reversed metfromin-induced apoptosis and attenuated the repression effect of metfomin to PI3K, pAKT, and PKM2. Knockout PKM2 resulted in the activation of caspase 3, down-regulation of caspase 9, and increased expression of Bim. In the Eca109 xenograft model, metformin significantly reduced tumor growth. Furthermore, we found that metformin treatment increased the rate of apoptosis, down-regulation of PKM2, and up-regulation of Bim in tumor tissues. CONCLUSION: Metformin restrained esophageal cancer cell proliferation partly by suppressing the PI3K/AKT/mTOR pathway.
Apoptosis ; Blotting, Western ; Caspase 3 ; Caspase 9 ; Cell Count ; Cell Cycle ; Cell Proliferation ; Cell Survival ; Down-Regulation ; Esophageal Neoplasms* ; Flow Cytometry ; Heterografts ; Humans ; Immunohistochemistry ; In Vitro Techniques* ; Metformin* ; Phosphorylation ; Proto-Oncogene Proteins c-akt ; Pyruvate Kinase ; Repression, Psychology ; Ribosomal Protein S6 Kinases, 70-kDa ; RNA Interference ; Sirolimus ; Up-Regulation

Objective To explore the association of HbA1C with microvascular complications,and to evaluate the diagnostic value of HbA1C in diabetes mellitus in high-risk populations of Guangzhou.Methods HbA1C,blood glucose,fundus photography,and microalbuminuria were detected in 208 permanent residents with high-risk factors of diabetes.The receiver operating characteristiC(ROC)curves were used to estimate the area of HbA1C,fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2hPG)under the curve for discriminating microvascular complications.Results There were 14.9% adults suffering from diabetic retinopathy and 12% microalbuminuria in high risk populations of diabetes.The optimal cutoff points of HbA1C,FPG,and 2hPG in detecting retinopathy were 5.8%,7.0 mmol/L,and 10.9 mmol/L respectively.The thresholds for increasing prevalence of microalbuminuria were5.8% for HbA1C,6.4 mmol/L for FPG,and 10.7 mmol/L for 2hPG.Conclusions The prevalence of diabetic microvascular complications increases dramatically at the concentration of HbA1C 5.8%.As a diagnostic value for microvascular complications,there is no significant difference between HbA1C and 2hPG.

OBJECTIVETo investigate the effect of antisense KLF4 (Krüppel-like factor 4) gene on the expression of vWF and PAI-1 in endothelial cells.

METHODSHuman umbilical vein endothelial cells (HUVEC) were isolated from umbilical vein and cultured in endothelial cell medium. The recombinant adenoviral plasmid carrying the antisense KLF4 gene was constructed by homologous recombination. KLF4, PAI-1 and vWF mRNAs and proteins expression were detected by real time-PCR, Western blot, and confocal laser microscopy.

RESULTSRecombinant adenoviral plasmid carrying the antisense KLF4 gene (Ad-KLF4AS) was constructed successfully. Compared with the control Ad-GFP infection group, Ad-KLF4AS at a 200 MOI can down-regulate the expression of KLF4 gene in HUVEC (from 0.59 ± 0.01 to 0.44 ± 0.06) (P < 0.05), and increase vWF mRNA (from 1.04 ± 0.03 to 1.17 ± 0.05) and protein expression (P < 0.05). PAI-1 mRNA and protein of Ad-KLF4AS infection group was higher than that of Ad-GFP infection group. PAI-1 mRNA between the two groups had no significant difference (P > 0.05).

CONCLUSIONSDown-regulation of KLF4 leads to increase in expression of vWF and PAI-1 in endothelial cells. KLF4 might play an important role in regulation of endothelial coagulant function.

Cells, Cultured ; Down-Regulation ; Endothelial Cells ; metabolism ; Endothelium ; Endothelium, Vascular ; metabolism ; Humans ; Plasminogen Activator Inhibitor 1 ; RNA, Messenger ; genetics

OBJECTIVETo explore the relations between fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c) and glycosylated serum protein (GSP).

METHODSFBG, HbA1c and GSP were measured in 303 patients with diabetic nephropathy and in 167 non-diabetic patients with comparable baseline data, and the correlations between FBG, HbA1c and GSP were analyzed.

RESULTSGSP levels were significantly higher in patients with diabetic nephropathy than in the non-diabetic patients (P<0.01). In patients with diabetic nephropathy, GSP levels were found to positively correlate to FBG (r=0.606) and HbA1c (r=0.733).

CONCLUSIONPatients with diabetic nephropathy show strong correlations between FBG, HbA1c and GSP. GSP detection is convenient, stable, and practical in evaluating the average FBG over a short term, which reduces the interference by FBG fluctuations in conventional blood glucose monitoring.

Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; analysis ; Blood Proteins ; analysis ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; blood ; Diabetic Nephropathies ; blood ; Female ; Glycated Hemoglobin A ; analysis ; Glycoproteins ; analysis ; Humans ; Male ; Middle Aged ; Serum ; metabolism

OBJECTIVETo study the ultrasonographic and morphologic features of intestinal lymphoma.

METHODSThe ultrasonographic and morphologic features of 19 patients with intestinal lymphoma were retrospectively analyzed. RESULTS All the patients were confirmed as non-Hodgkin's lymphoma by endoscopy or pathology. Of these 19 cases,the involved locations included ileum(n=14),duodenum(n=3),and ileocecum(n=2). The main sonographic types included mass type(n=12),bowel wall thickening type(n=1),and nonspecific signs(n=6). The mass type was characterized by solid and cystic-solid hypoechoic(including marked hypoechoic)foci,with well-defined margin,and rich blood signals were visible in large masses. The bowel wall thickening type was characterized by the thicking of bowel walls,showing hypoechoic(including marked hypoechoic),along with posterior acoustic enhancement. The nonspecific signs included e.g. dilatation of intestine and mesenteric lymph node enlargement. Morphologically,the tumor was featured by intestinal mass in intestinal mucosa or the circumferential thickening of intestinal wall.

CONCLUSIONSmall intestinal lymphoma has typical ultrasonographic features,and ultrasonography can provide useful information in the diagnosis of small intestinal lymphoma.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intestinal Neoplasms ; diagnostic imaging ; pathology ; Intestine, Small ; diagnostic imaging ; pathology ; Lymphoma ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Ultrasonography ; Young Adult

OBJECTIVETo discuss the primary stability of the fixed interface between the cementless prosthesis and femur, and its influence on bone ingrowth and secondary stability under the roughened surface and press fit of different prostheses by finite element analysis.

METHODS:A three-dimensional finite element module of total hip arthroplasty (THA) was developed with Mimics software. There was a collection of data when simulating hip arthroplasty. The frictional coefficient between the fixed interface was 0,0.15,0.40 and 1.00 representing the roughness of prosthesis surface. The press fit was 0, 0.01,0.05 and 0.10 mm according to the operation. The Vion Mises stress distribution and the contact pressure,friction stress and relative sliding displacement between the interface were analysed and compared when simulating the maneuver of climbing stairs.

RESULTSAt a fixed press fit of 0.05 mm,the contact pressure between the interface was 230 , 231, 222 and 275 MN under four different frictional coefficient (0,0. 15,0.40 and 1.00) with little change; the relative sliding displacement was 0.529, 0.129, 0.107 and 0.087 mm with a consistent and obvious decline. As the fixed frictional coefficient was 0.40,the contact pressure between the interface were 56.0,67.7 ,60.4 and 49.6 MN under four different press fit (0, 0.01, 0.05 and 0.10 mm) with a reduction; the relative sliding displacement was 0.064,0.062,0.043 and 0.042 mm with an obvious decline, and there was a maximal friction stress when press fit of 0.01 mm.

CONCLUSIONThere is a dynamic process of the bone remodeling and bone integration between the interface after hip replacement, determining the long-term outcome. The interface clearance and the frictional coefficient are the key factors of the bone integration.

Arthroplasty, Replacement, Hip ; Biomechanical Phenomena ; Bone Remodeling ; Bone and Bones ; chemistry ; physiopathology ; surgery ; Elasticity ; Finite Element Analysis ; Humans ; Models, Biological ; Stress, Mechanical

OBJECTIVETo approach the short-term result and clinical application of metal on metal total hip arthroplasty with large diameter heads and evaluate its safety and efficacy clinically.

METHODSFrom January 2007 to March 2008, 39 hips in 37 patients (24 males and 13 females,ranging in age from 43 to 75 years, with an average of 58.5 years) were treated with metal on metal total hip arthroplasty with large diameter heads (ASRTM XL) included 14 cases of osteonecrosis (ON), 2 cases of osteoarthritis (OA), 18 cases of fresh femoral neck fracture, 3 cases of developmental dysplasia of the hip (DDH). All patients were evaluated by self assessment form, hip function examination, radiographs, preoperative and postoperative Harris hip score. Based on the short-term results, its design characteristic and clinical properties were analyzed.

RESULTSAll the incision healed well and there were not any complications such as femoral fracture, infection, dislocation and neurovascular injury. All patients obtained the follow-up and an average time was 16.5 months (12 to 19 months), all the joints had good or excellent clinical results. Radiographically, the positions of the prostheses were normal, the average limbs length and femoral eccentricity recovered as normal. The average range of motion of the hip improved remarkable, such as flexion improved from (20.1 +/- 8.2) degrees to (85.7 +/- 9.8) (t = 32.86, P < 0.01), abduction improved from (10.2 +/- 4.4) degrees to (41.5 +/- 9.1) degrees (t = 19.34, P < 0.01), adduction improved from (16.3 +/- 8.8) degrees to (40.3 +/- 10.4) (t = 11.00, P < 0.01),external rotation improved from (12.3 +/- 5.2)0 to (42.0 +/- 7.7) degrees (t = 19.96, P < 0.01), internal rotation improved from (3.4 +/- 1.1) degrees to (23.0 +/- 9.8) degrees (t = 12.41, P < 0.01). The Harris score rose from preoperative (39.3 +/- 5.6) to (91.4 +/- 10.3) at the latest follow up (t = 27.75, P < 0.01).

CONCLUSIONShort-term results show that metal on metal hip joint prosthesis with large diameter heads has advantages of small deformation of acetabular cup, lower wearing, large range of motion and few dislocation. It offers a newly valuable technology for treatment of osteonecrosis, osteoarthritis, femoral neck fracture and DDH with the higher requirement of movement after the operation.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Humans ; Joint Diseases ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Male ; Metals ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo explore the role of reconstruction of the posterior capsule and external rotators in prevention of postoperative dislocation in total hip arthroplasty revision following the posterolateral approach.

METHODSForty-five patients (47 hips) with the mean age of 65 years (55 to 78 years)of failed total hip arthroplasty were revised following the posterolateral approach. Posterior capsule was sutured to the anterosuperior portion of the capsule from where it had been detached, and the external rotators were then reattached to the soft tissue at the tip of the greater trochanter using 1.0 silk suture in surgery. The dislocation rate and risk factors were reviewed retrospectively to determine if closing the posterior capsule resulted in fewer dislocations. The femoral prosthesis and acetabular prosthesis were revised in 29 patients (31 hips), the liner was exchanged in 5 patients (5 hips), and the acetabular prosthesis or femoral components were revised in 10 patients (10 hips) and one patient (one hip) respectively. The procedure was the patient's first revision in 29 patients (30 hips), the second revision in 15 patients (16 hips), and the third revision in one patient(one hip). Radiographic evaluation included lower limb discrepancy, acetabular phase, femoral offset, anteversion angle, prosthetic loosening before and after revision. Function evaluation based on Harris score system.

RESULTSAll patients were followed up with an average of 2.7 years. None of the patients sustained dislocation or infection, except one patient felt the anterior instability but without dislocation, X-ray revealed the acetabular component was in excessively anteversion. Lower leg discrepancy, acetabular abduction, anteversion femoral offest and collodiaphyseal angle were restored to normal level after operation on the basis of X-ray. One of the acetabular components and one of the femoral components were loose without dislocation. The Harris hip score improved from (49.13 +/- 15.53) points preoperatively to (83.59 +/- 6.93) points at the final follow-up (P < 0.05). According to Harris functional evaluation, 36 hip got an excellent result, 5 good, 5 fair and 1 bad.

CONCLUSIONThe historically high dislocation rate with the posterolateral approach for total hip arthroplasty revision can be reduced by careful soft tissue balancing,correction of implant alignment, meticulously closure of the posterior capsule, and reattaching the external rotators.

Aged ; Arthroplasty, Replacement, Hip ; instrumentation ; Female ; Follow-Up Studies ; Hip ; diagnostic imaging ; surgery ; Hip Dislocation ; prevention & control ; Hip Prosthesis ; adverse effects ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prosthesis Failure ; Radiography ; Retrospective Studies