Objective To explore the cytological mechanism of bi ological reaction of prosthetic loosening mediated by wear particles from joint prosthesis. Methods Three special particles of UHMWPE, Ti- 6Al-4V and Co-Cr-Mo with the same average size of 2.5 ?m were injected respe ctively into rabbit knee joint to induce synovitis, in which the changes of syno vial cells and its cytoplasm as well as ultrastructure were observed by transmis sion electron microscopy. Results Three kinds of particles mainly induced type A synovial cell reaction with proliferation of subsynovial h istocytes. Wear particles and lysosomes existed in the cytoplasms of the synovia l cells and histocytes. Co-Cr-Mo particles could also accelerate infiltrating reaction of regional cytoplasms. Conclusions The biological effect of wear particles inducing prosthetic loosening is mainly non-immunolog ic inflammatory reaction. Certain immunologic factors may involve in biological reaction induced by Co-Cr-Mo wear particles.

Objective To explore the way of soft tissue balance in total knee arthroplasty for patient with flexion contracture. Methods A relevant protocol of soft tissue balance was designed and used in 33 TKA cases with knee flexion contracture of at least 20? (from 20? to 60? ). Tight medial collateral ligament or lateral collateral ligament was released firstly, followed by the release of posterior capsule. Osteotomy or a second osteotomy at tibial or femoral side were performed at final step. Results Twenty cases (60.6%) whose flexion deformities could be corrected solely by soft tissue release, the rest 13 (

Objective To explore the surgical technique and its promising future of coblation in knee arthroscopic surgery. Methods Twenty cases of different knee problems were treated arthroscopically for partial meniscectomy, cartilage or ligament trimming, synovictomy or lateral retinaculum release with usage of ArthroCare 2000 radiofrequency machine. Arthroscopic diagnosis for these 20 cases were as follows, meniscus tear 6 cases, degenerative cartilage injury on femoral condyle 6 cases, patellar subluxation 5 cases, inflammatory synovitis 2 cases and partial injury of anterior cruciate ligament 1 case. Results The clinic results showed that treatment of injured tissue handled by coblation technique was much precise than that handled by the conventional technique, the former was featured by relative less invasive to the near normal areas and spontaneous coagulation function. No compression wraps were needed to be applied during operation. All patients were comfortable postoperatively with their pain- free and no swelling knees. Conclusion Less pain and easy for early rehabilitation for all ArthroCare 2000 treated cases imply that coblation technique could greatly enhance the clinic results of arthroscopic surgery for knee diseases.

Background and purpose:Bladder cancer radical surgery is dififcult with many perioperative complications, and the learning curve is long. To introduce the clinical application of complete retrograde radical cystectomy and consequent abdominal cavity reconstruction in male bladder cancer, and to provide a standardized surgical procedure with minimum perioperative complications and short learning curve. Methods:From Apr. 2012 to Apr. 2013, 110 cases of male patients with bladder cancer received this procedure in our department, with a median age of 64 (35-83) years;Preoperative characters, surgical parameters, perioperative complications, pathology, long-term complications and short-term prognosis were collected and analyzed. Results:The median number of lymph nodes resected in operation was 12 (8-16);Neurovascular bundles were reserved bilaterally in 65 cases, and unilaterally in 31 cases;The complete procedure including urinary diversion took 4.4 (2.2-6.0) hours, with a median time of opened abdominal cavity of 43.0 (5.0-75.0) minutes;The median blood loss was 140.0 (50.0-600.0) mL, and 4 patients needed transfusion; Median time of abdominal and pelvic drainage was 10.0 (6.0-15.0) days, the median gastrointestinal recovery time was 2.5 (1.0-12.0) days, and the median postoperative hospital stay was 17.0 (10.0-39.0) days;Grade 2 Clavien-Dindo classiifcation (CDC) of surgical complications that required medical intervention were found in 19 cases, CDC grade 3 or above were found in 8 cases;Mild to moderate postoperative ileus happened in 5 cases, all recovered in median 2 (1-4) weeks with supportive treatments;There were no perioperative deaths. All samples were sent to pathological analyses. After a median follow-up of 9 (3-15) months, no complications of or above CDC grade 3 happened, and there were no recurrence. Conclusion:Complete retrograde radical cystectomy in male bladder cancer provided clear anatomical approach, reliable neurovascular bundle preservation, less blood loss, limited abdominal organs disturbance and better surgical exposure; With respect to tumor control, more peritoneal was retained for subsequent abdominal cavity reconstruction. The introduced procedure effectively speeded up gastrointestinal recovery, reduced postoperative complications, especially the incidence of ileus and its severity, and shortened hospital stay. The learning curve of this procedure for urologists was short, and further investigation was warranted.

Objective To evaluate the efficiency of our self-designed enriched filtrator of stem cells in screening and collecting enriched human bone marrow stem cells (BMSCs) for rapid construction of bioactive materials.Methods Bone marrow blood from 32 patients was circulated in our self-designed enriched filtratorand filtered through beta-tricalcium phosphate(β-TCP).The numbers of BMSCs were counted pre-and post-filtration to assess the enrichment efficiency.The numbers of nucleated cells,red blood cells and platelets were compared pre-and post-filtration to assess the effects of the enriched filtrator of stem cells on blood cells.Bacteriological examinations were performed to test the safety of the device.Scanning electron microscopy was carried out to observe the adhesion of BMSCs on β-TCP.Results There was a significant difference between the pre-fihration colony number of BMSCs cultured (232.8 ± 128.6/mL) and the post-filtration one (37.8 ± 34.9/mL) (t =10.743,P ＜ 0.001).The efficiency of BMSCs enrichment of the device was 85.6％ ±8.4％ (from 63.8％ to 97.1％).There were no significant differences between pre-filtration and post-filtration in the numbers of nucleated cells [(16.8 ± 5.4) × 109/mL versus (16.3 ±5.0) ×l09/mL],red blood cells [(3.9±0.6) ×1012/mL versus (3.8±0.6) ×1012/mL] and platelets [(120.4 ± 54.6) × 109/mL versus (123.0 ± 51.8) × 109/mL] (P ＞ 0.05).All the bacteriological examinations of the bone marrow samples were negative.After in vitro osteogenic induction culture,formation of numerous BMSCs colonies was observed on the β-TCP by scanning electron microscopy.Conclusion Since our self-designed enriched filtrator can efficiently collect enriched BMSCs and combine them with β-TCP simultaneously,the device is capable of rapid and safe construction of bioactive materials.

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.

Objective To introduce the technical improvements in retroperitoneal laparoscopic radical nephrectomy and discuss their roles in decreasing the perioperative complication. Methods Sixty-one patients with localized renal cell carcinoma were treated with retroperitoneal laparoscopic radical nephrectomy from December 2006 to March 2008. Pre-operative CT scan was performed to evaluate the renal vessel status. Thirty degree laparoscope was used together with self-made balloon dilator to establish the retroperitoneal space. Harmonic scalpel was used in dissection and removal of the extra-peritoneal fat. Cautions were taken during the separation of peritoneum. The renal artery and vein were separated and ligated with Hem-o-lok clips. Complications such as vessel split and intes-tinal injury were recorded. Operation time, estimated blood loss, drainage volume, and length of hos-pital stay were analyzed as well. Results The operation time was 50-135 min, estimated blood loss during operation was 20-170 ml, post-operative drainage volume was 20-210 ml, mean post-opera-tive length of hospital stay was 5 d. Two complications occurred during the operation: one was a vena eava injury, and another was a minor duodenum wall perforation. Conclusions Retroperitoneal lapa-roscopic radical nephrectomy is an effective and safe surgical option for localized renal cell carcinoma. Improvements in this surgical technique bring more safety and convenience and could decrease perio-perative complications relatively.

Objective To discuss the function of pelvic lymphadenectomy in radical cystectomy. Methods Ninety-five patients with bladder cancer (76 males and 19 females) underwent radical cys-tectomy. Clinical data were reviewed. Median age was 62 years old (25-78). Among all patients, 49 were newly diagnosed and 46 had recurrent disease. Of 95 patients, 87 were urothelial cell carcinoma, 5 were adenocarcinoma, and 3 were squamous cell carcinoma. Of 87 urothelial cell carcinoma cases, 17 were grade 1, 39 were grade 2, and 31 were grade 3. Of 95 patients, 10 were Ta-T1,54 were T2 ,26 were T3 ,and 5 were T4 according to AJCC classification. All cases accepted bilateral pelvic lymphade-nectomy according to standard protocol. Results Bilateral lymphadenectomy was taken an average time about 20 min. No important vessels and nerves injury occurred and average bleeding volume was 25 ml during procedure. A median of 10 lymph nodes were removed (range, 1-20). The nodal posi-tive rate was 17.9% (17/95) with 58.8% (10/17) bilateral lymph nodes positive. Short-term opera-tion-related complication rate was 12.6% (12/95). No operation-related death happened. Median fol-low up time was 34 months (3 to 64 months). Sixteen cases died during followup and the 3-year over-all survival rate was 84.5%. Conclusions Bilateral pelvic lymphadenectomy should be routinely per-formed during radical cystectomy. Standard lymphadenectomy could document accurately the staging and improve the overall survival in radical cystectomy without severe complications.

Objective To investigate the toxicities of sorafenib in the treatment of advanced re-nal cell carcinoma, and discuss the management. Methods Fifty-eight patients with advanced renal cell carcinoma were treated with sorafenib from March 2006 to February 2008. Of them, 44 were males and 14 were females with the average age of 50 years. Single agent of sorafenib 400 mg twice daily was administrated to 49 patients, and the other 9 patients were given sorafenib and Interferon-a as a combination therapy. The main toxicities such as hand-foot syndrome, alopecia, rash, mucositis, fatigue, diarrhea, weight loss, hypertension, hemoptysis, liver dysfunction, hypophosphatemia and anemia were analyzed for their occurrence time, duration, and grade. Results The toxicities of sor-afenib included hand-foot skin reaction (75.9%), alopecia (67.2%), rash (39.7%), mucositis (24.1%), fatigue (74.1%), hypertension (24.1%), and liver dysfunction (13.8%). Twelve cases (20.7%) experienced grade 3 toxicities and had dose reduced; and two cases encountered grade 4 tox-icities and had permanent withdraw. Conclusions There is peculiarity in treating Chinese advanced renal cell carcinoma patients with sorafenib. The incidences of major toxicities of sorafenib are higher in Chinese patients than what have been observed in studies conducted in US and Europe. Toxicities such as hemorrhage and angina could also appear and need carefully monitored. Generally, most of the toxicities of sorafenib are grade 1 and 2, and easy to be managed in clinic.