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 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 investigate the effect of DHA on proliferation and killing activity of γδT cells against SW1990 cells in vitro.Methods γδT cells were generated in vitro by stimulating peripheral blood mononuclear cells of healthy donors in RPMI 1640 completed medium containing IPP and IL-2 for 8 d,and then co-cultured with different concentrations of DHA for 48 h.Proliferation rates of γδT cells for each group were detected by MTT method.The perforin,granzyme B and CD107a expression in γδT cells were verified by flow cytometer.The cytotoxic activity of γδT cells against SW1990 cells were analyzed by CCK-8 kit.Results The purity of γδT cells in each group reached 75.46％ ±5.32％ after 8 d of culture.Compared with the control group,the proliferative capability of γδT cells were enhanced significantly after treated with 50-100 μmol/ml DHA for 48 h,moreover,cytotoxicity against SW1990 cells and perforin,granzyme B and CD107a expression of the γδT cells treated with DHA were higher than the control group.Conclusion DHA could enhance the antitumor activity of γδT cells,which may be associated with the upregulation of perforin and granzyme B expression in γδT cells.

Objective To investigate the early changes of CD4 + T cells and the relevant cytokines in blood of patients with severe trauma.Methods Sixty-one consecutive patients with trauma admitted into the 97th Hospital of PLA from September 2009 to November 2011 were enrolled in this study.The exclusion criteria included:① Patients were younger than 18 or older than 75 years.②Patients received blood transfusion.③Those suffered from immune system disorders,tumors or diabetes,or recent history of virus,bacteria or parasites infections.④ Those had current or recent treatment with corticosteroids or immunosuppressive drugs.According to ISS score ≥ 16,there were 61 traumatic patients divided into mild trauma group and severe trauma group.Seventeen healthy volunteers were taken as control subjects.At admission,the peripheral venous blood samples of patients were taken to count the number of CD3+,CD4 +,CD8 + T cells by flow cytometry and to detect TNF-α,INF-γ,IL-1,IL4,IL-6 and IL-12 levels in plasma by enzyme linked immunosorbent assay,meanwhile the ratio of Th1 / Th2 type cytokine were calculated.Data were analyzed with t test and ANOVA or Kruskal-Wallis test by using SPSS version 16.0package.P value ＜ 0.05 was considered to be statistical significance.Results Compared with control group,mild trauma and severe trauma groups showed a similar decrease in number of CD3 + T cells,and severe trauma group showed a most significant decrease in number of CD4 + T cells.Severe trauma group had a lower INF-γ level compared with control group; IL-1 level in both mild trauma and severe trauma groups were lower than that in the control group; INF-γ/ IL-6 in severe group was significantly lower than that in the mild group.However,INF-γ IL-6 in mild group was higher than that in the control group.Conclusions The early stage of severe trauma exhibits a significant decrease in number of both CD3 + and CD4 +T cells,accompanied by a significant reduction in most of cytokines,and has a tendency of shift to Th2 type cytokine.Therefore,the changes of immune cells should be promptly and successively monitored after severe trauma.

Objective: To evaluate renal tissue oxygenation level and its correlation with blood glucose level after hypoglycemic therapy in diabetic patients using BOLD-MRI. Methods Renal BOLD-MRI scans were performed on 23 patients with type 2 diabetes (diabetic group) before and after hypoglycemic therapy and 23 normal controls (control group). R2* values of renal cortex and medulla were measured and statistically analyzed. Results R2* value of renal cortex in diabetic group and control group were lower than that of renal medulla (all P<0.001). R2* value of renal medulla in diabetic group before hypoglycemia was higher than that after hypoglycemia and in control group (both P=0.001), and there was no significant difference of R2* value of renal medulla between diabetic group after hypoglycemia and control group (P=0.941). There was no significant difference in renal cortical R2* value among diabetic group before and after hypoglycemia and control group (P=0.572). R2* value of renal medulla was positively correlated with blood glucose level (r=0.365, P=0.002), while of renal cortex had no correlation with blood glucose level (r=-0.014, P=0.908). Conclusion: Hypoglycemic treatment can help to improve oxygenation of renal medulla in diabetic patients. BOLD-MRI can be used to evaluate changes of renal oxygen content before and after hypoglycemic treatment.

Objective To determine medium-term curative effect of extensively coated non-modular femoral stems in twostage infection revision after joint replacement.Methods We retrospectively analyzed 33 patients (33 hips) who had a two-stage infection revision after total hip replacement arthroplasty from March 2005 to December 2006.Among of them,there were 20 men (20 hips) and 13 women (13 hips).Their mean age was 66.1±7.2 years with a range from 52 to 80.The two-stage revision protocol consisted of joint prosthesis taken out in the first stage,thorough debridement,hand-molded antibiotic bone cement spacer,and two-stage joint revision after anti-infective therapy.Anti-infective therapy included intravenous antimicrobial therapy for 4 weeks and oral antibiotics for 6 weeks.Harris hip score (HHS) was used to evaluate functions of hip joint.X-ray films were used to perform clinical and radiological evaluations of prosthesis stability,displacement and looseness.Reinfection criteria were the same as the criteria used to diagnose the joint infection.Results Follow-up visit was carried out for all patients for 5-9 years (6.1±1.7 years on the average).No infection or prosthesis looseness happened after two-stage revision.Microculture of samples taken during two-stage revision or pathological examination was negative.Harris hip joint score rose to 89.1 ±8.5 in the last follow-up visit from preoperative 42.3±6.5.30 patients achieved stable bone ingrowths and the remaining three had stable fibrous ingrowths.Impacted bone graft at acetabulum side for 11 patients and all impacted bone graft in marrow cavity were fused well with the host bones.Allogeneic cortical bone plate grafts were used in 10 hips on the femoral side.Nine of these cortical bone plates fused with the host bones after postoperative 1 year,whereas one fused after 2 years.Conclusion Using extensively coated non-modular femoral stems combined with intramedullary allograft in two-stage revision for treating infection can achieve satisfactory medium-term survival rate of prosthesis and infection clearance rate.

Objective To investigate the effects of hydrocortisone (HC) on proliferation and killing activity of NK cells against pancreatic cancer SW1990 cells in vitro.Methods Peripheral blood mononuclear cells of healthy people were isolated and cultured with NK cells medium containing IL-1S.When the purity of NK cells reached above 70％,different concentrations of HC (10-6,10-5,10-4,10-3 μmol/L) were added and co-cultured with NK cells for 7 days.And NK cells without HC were used as control.CD3-CD56 + NK cell numbers of each group were countered by trypan blue staining.Perforin,granzyme B and IFN-γ expression of CD3-CD56+ + NK cells were verified by flow cytometry.NK cells and SW1990 cells were co-cultured with a 20∶1effector to target ratio,then the cytotoxic activity of NK cells against SW1990 cells were analyzed by CCK-8 kit.Results After treatment with different concentration of HC for 7 days,NK cells purity of each group reached 70.72％ ～ 76.39％,and it was not significantly different with that in control group [(72.61 ± 3.76) ％].The proliferation folds of NK cells treated with 10-6,10-5,10-4,10-3 μmol/L HC were (9.13 ± 0.94),(9.67 ±1.51),(10.33±1.07),(8.40±1.47) times,respectively,while it was (4.23 ±0.82) times in control group (all P ＜0.01).The killing effects of NK cells on SW1990 cells were (58.58 ± 4.89) ％,(62.27 ± 5.63) ％,(64.02 ± 5.79) ％,(63.88 ± 3.61) ％,which were higher than that in control group [(57.46 ± 5.11) ％],moreover,the difference between NK cells of 10-4 μmol/L HC treatment group and control group was statistically significant(P ＜ 0.05).The expressions of perforins of 10-4,10-3 μmol/L HC treatment group were (96.71 ± 3.04) ％,(97.56 ± 2.18) ％,which were significantly higher than that in control group [(92.40 ±3.53)％,P ＜0.05 or 0.01].The expression of granzyme B in 10-5 μmol/L HC treatment group was (78.23 ±2.94)％,which were significantly higher than that in control group [(73.68 ±3.52) ％,P ＜0.05].The expressions of IFN-γ in 10-5,10-4,10-3 μmol/L HC treatment group were (96.61 ±2.04)％,(97.58 ± 2.17)％,(98.00 ± 1.77)％,which were significantly higher than that in control group [(92.44 ± 2.74)％,P＜0.01].Conclusions HC can promote IL-15 activated NK cells proliferation and enhance NK cells mediated killing activity against SW1990 cells with proper concentration,and up-regulation of perforin,granzyme B and IFN-γ expression may be the main mechanisms.

Objective:To investigate the mechanisms of TWS119 induced CCR5 expression in hunman γδT cells. Methods:After treatment with various concentrations of TWS119 for 48h, the expression of CCR5 in γδT cells were detected by flow cytometry. The p-STAT3 and GAPDH expression were examined by Western blot analysis. Results: TWS119 could upregulate the expression of CCR5 in dose dependent manner. Western blot analysis revealed that TWS119 inhibit phosphorylation of STAT3,but had no significant impact on GAPDH. In addition, pretreatment of γδT cells with 0. 5 μmol/L STAT3 specific phosphorylation inhibitor Stattic could upregulate the expression of CCR5 and enhance the TWS119 induced CCR5 expression. Conclusion: TWS119 could upregulate CCR5 expression of γδT cells by inhibiting STAT3 phosphorylation in vitro.

Objective To investigate and discuss the limb salvage strategies of malignant bone tumors in region S2 of shoulder girdle.Methods The data of 17 patients(13 males and 4 females)were retrospectivelv analyzed.All of them had malignant scapular tumor at least in region S2,and underwent limb salvage between January 2005 and January 2009.They aged from 14 to 55 years old(mean,32.6 years).The histologic types of them were chondrosarcoma in 6 patients,osteosarcoma in 4,fibrosareoma in 1,myeloma in 1,Ewing's sarcoma in 1,rhabdomyosarcoma in 1,non-Hodgkin lymphoma in 1,malignant giant cell tumor of bone in 1 and recurrent chondrosarcoma in 1.The tumors were staged according to Enneking surgical staging system:IB in 4 and IIB in 13.According to the MSTS classification system,the region S2 and lateral 1/3 of region S1 were effected in 11 cases,the region S2 and large part of region S1 were effected in 6 cases.The rotator cuff was involved to some extent in all patients,and the articular capsule were involved in 8 cases.Neo-adjuvant chemotherapy was given to 14 patients.The surgical strategies were depended on the range of tumor and preservation of articular capsule.The scapular prosthetic replacement was done in 8 cases with a relatively large range of tumor or resection of articular capsule,otherwise the scapular allograft replacement was done.Among the 11 cases with region S2 and lateral 1/3 of region S1 effected,the scapular allograft replacement was done in 9 cases with articular capsule preserved and the prosthetic replacement was done in 2 cases with articular capsule resected.And the prosthetic replacement was done in the other 6 cases.The articular capsule and partial rotator cuff were preserved and reconstructed preferentially.Results All patients were followed up 16-62 months (mean,35.1 months).Postoperative complications were noted in 9 patients, including mild allograft rejection and mild allograft resorption in 1 patient,allograft rejection in 1,prosthetic acromion exposure in 3,allograft resorption in 4.Local recurrence were noted in 1 patients.Three patients were dead because of extensive metastasis.The average function scores were 74.1%(range,53.3%-93.3%).Conclusion During the limb salvage surgery.it's very important to guarantee the en bloc resection of the tumor.In the meanwhile,the en bloc resection and functional reconstruction should be well balanced.