[Objective]To retrospectively analyze 39 cases of surgical treatment of fibrous dysplasia of proximal femur,in order to propose a partition method which can be used to guide the surgical treatment,and probe the surgical treatment strategy according to the partition method of fibrous dysplasia of proximal femur. [Methods]The data on 39 cases of fibrous dysplasia of proximal femoral from 1998 to 2009 were retrospectively analyzed.The study determined extent of the lesion according to preoperative X-ray film and proposed partitioning method in accordance with the scope of proximal femoral involvement,analyzed the relation of partition type and surgical treatment,and evaluated the effect of surgical treatment through the postoperative localized lesions control and functional score(MSTS 93).[Results]According to the scope of 39 cases of lesions,combined with characteristics of proximal femoral anatomy,proximal femur was divided into four zones: area I,femoral shaft(below small protuberance);area II,intertrochanteric(small rotor to the neck base division);area III,femoral neck;area IV,the femoral head.Based on the above partition,lesions were divided into 7 types,type I,type II,type III,type I + II,type II + III,type II + III + IV,type I + II + III,type I + II + III + IV.Surgical treatment was performed mainly with curettage of bone lesions,bone grafting and fixation.Internal fixation included DHS,intramedullary nails,and artificial joint replacement,DHS was most common in area II involvement(57.58%),followed by area III involvement(24.24%).Intramedullary nail was most common in area I involvement(64.70%) and area II involvement(35.30%).For lesions involving ≥3 zones,joint replacement was carried out.The patients were all followed up,with a median time of 6.3 years(0.5-11 years).Local recurrence rate was12.82%(5 / 39),local deformity was not found deterious.The followed up results were satisfactory.The selected treatment was reasonable.[Conclusion]When making a surgical treatment regimen for fibrous dysplasia of the proximal femur,Surgeons should consider lesion characteristics,and choose a reasonable internal fixation to achieve better surgical results.Partition method proposed in this paper can be formulated as one of preoperative surgical treatment options.

OBJECTIVETo investigate the clinical application of free superficial iliac circumflex artery skin flaps, as well as the management of donor site defects.

METHODS17 free superficial iliac circumflex artery skin flaps were applied for the traumatic defects or deformities on face, neck, foot, hand, ankle and lower leg, respectively. The donor site defects were closed directly or covered by paraumbilical island flaps.

RESULTSThe 17 flap size ranged from 5 cm x 3 cm to 19 cm x 14 cm. 16 flaps survived completely except 1 flap with partial necrosis, which was closed by free skin graft. The donor site defects were closed directly in 10 cases, and covered by paraumbilical island flaps in 7 flaps without no flap necrosis. The abdomen had a good appearance.

CONCLUSIONSGood appearance can be achieved with free superficial iliac circumflex artery skin flaps for the defects on face, neck, foot, hand, ankle and lower leg. Paraumbilical island flap can be used for the donor site defects.

Arteries ; Foot ; Free Tissue Flaps ; blood supply ; transplantation ; Humans ; Reconstructive Surgical Procedures ; Skin ; Skin Transplantation ; Transplant Donor Site ; surgery ; Wounds and Injuries ; surgery

Objective To explore the change of plasma orexin A concentration and the correlation between plasma orexin A concentration and energy intake in obese children.Methods Fasting plasma orexin A concentrations,boaly mass index(BMI) and energy intake were measured in 48 obese children(obese group) and 48 healthy children(healthy control group),and these indexes were compared,the correlation between plasma orexin A concentration and BMI,energy intake were analyzed.Results 1.The plasma orexin A concentration in obese group was significantly lower than that in healthy control group(F=5.632 P=0.008).2.In obsess group,there were negative correlation between plasma orexin A concentration and BMI(r=-0.478 P=0.012),positive correlation between plasma orexin A concentration and total energy intake(r=0.503 P=0.007),fat intake(r=0.659 P=0.006) and protein intake(r=0.381 P=0.026),and there was negative correlation between plasma orexin A concentration and carbohydrate(r=-0.316 P=0.022).3.In healthy control group,there were negative correlation between plasma orexin A concentration and BMI(r=-0.491 P=0.018),positive correlation between plasma orexin A concentration and total energy intake(r=0.512 P=0.009),fat intake(r=0.406 P=0.005),protein intake(r=0.313 P=0.020),and carbohydrate(r=0.432 P=0.025).Conclusions Orexin A may be involved in regulation of energy metabolism in obese children,and the interaction between plasma orexin A and energy intake might be different in different nutritional status in children.

OBJECTIVETo compare the difference in the clinical efficacy on posterior circulation ischemia between acupuncture at stellate ganglion and conventional acupuncture as well as the impacts on blood pressure.

METHODSEighty cases of posterior circulation ischemia were randomized into an observation group (40 cases) and a control group (40 cases). In the observation group, acupuncture was applied to the bilateral stellate ganglions on the neck, stimulated with reinforcing technique by rotating the needles. In the control group, the acupuncture of reducing technique was applied to Fengchi (GB 20), Baihui (GV 20), Neiguan (PC 6) and Taichong (LR 3) in the excess syndrome. The even needling or reinforcing technique was applied to Fengchi (GB 20), Baihui (GV 20), Ganshu (BL 18), Shenshu (BL 23) and Zusanli (ST 36) for the deficiency syndrome. The treatment was given once every 3 days and 4 treatments were required totally in the two groups. The changes in total syndrome score, peak Systolic blood flow velocity (Vp) of vertebral artery and basilar artery, systolic and diastolic blood pressures were compared before and after treatment in the two groups. The clinical efficacy was compared between the two groups.

RESULTSThe total syndrome score was reduced apparently after treatment compared with that before treatment in the two groups (P < 0.01), and the reducing was more obvious in the observation group as compared with that in the control group (P < 0.01). The total effective rate was 87.5% (35/40) in the observation group, higher than 67.5% (27/40, P < 0.05) in the control group. After treatment, the reduced Vp of vertebral artery was not improved apparently as compared with that before treatment in the control group, Vp in blood velocity abnormality (including vascular spasm, stenosis or reduced velocity) of vertebral artery and basilar artery was all improved as compared with that before treatment in the two groups (P < 0.01), and the improvements in the observation group were more obvious than those in the control group (P < 0.01). After treatment, the systolic and diastolic pressures were reduced as compared with those before treatment in the two groups, and the reduced systolic and diastolic pressures in the observation group were more apparent than those in the control group (P < 0.01).

CONCLUSIONAcupuncture at stellate ganglion achieves the satisfactory efficacy in the treatment of posterior circulation ischemia and the significant efficacy of reducing blood pressure, more advanced than the conventional acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Blood Pressure ; Brain Infarction ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stellate Ganglion ; physiopathology ; Treatment Outcome

Objective To investigate the influence of motor impersistence on functional recovery and prog- nosis of patients with left hemiplegia. Methods A total of 64 in-patients with left side hemiplegia who were able to understand the oral instructions were assigned into a motor impersistence group (n = 31 ) and a control group (n = 34) , respectively, according to the assessment with Scale of Motor Impersistence developed by Joynt. Both groups were comparable in terms of the basic clinical characteristic and motor function of patients except motor impersis- tence. The conventional rehabilitation training programs were adopted for all patients in this study. Brunnstrom func- tional category, Ueda Satoshi hemiplegic finger function assessment scale, upper limb function assessment scale, Berg balance scale, Functional ambulatory category, Modified Barthel Index were employed to evaluate the subjects before and after 1 and 2 months of treatment, with regard to the motor function of their upper limbs, walking ability, activities of daily living performance and balance ability. Results After 1 month of treatment, the patients in the M1 group were significantly improved with regard to the motor function of upper limbs, hand function, standing ba- lance and activity of daily living performance( P0.05 ) , while those in the control group were improved with all the parameters except the lower limb function. After 2 months of treatment, patients in both groups were all significantly improved ( P

OBJECTIVE: To explore the role of hydrogen sulfide (H2S) in acute liver injury induced by crushing hind limbs of rats. METHODS: The rats were randomly divided into the following groups: control, crushing, H2S donor sodium hydrosulfide (NaHS) + crushing, H2S inhibitor propargylglycine (PAG) + crushing group. The acute liver injury model was established by 'crushing the hind limbs of rats with standard weight. Rats were sacrificed at 30 min and 120 min after the crush. The activities of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured by colorimetric method, and the content of H2S in plasma and the contents of malondialdehyde (MDA), protein carbonyl, glutathione (GSH) in the liver and the activity of H2S generating enzyme (cystathionine y-lyase, CSE) were determined by chemical method. The expression of CSE mRNA in liver was detected by RT-PCR. RESULTS: For crush injury group, the levels of AST and ALT in serum, MDA and protein carbonyl in liver increased. The levels of GSH, CSE, CSE mRNA in liver and H2S in serum decreased. The administration of NaHS before limbs crush could attenuate the changes of liver injury, but the pre-treatment with PAG could exacerbate the changes. CONCLUSION The decrease of H2S production could involve in mediating the acute liver injury induced by traumatic stress in rats.
Alanine Transaminase/blood* ; Alkynes/pharmacology* ; Animals ; Aspartate Aminotransferases/blood* ; Cystathionine gamma-Lyase/metabolism* ; Glutathione/metabolism* ; Glycine/pharmacology* ; Hydrogen Sulfide/pharmacology* ; Liver/injuries* ; Malondialdehyde/metabolism* ; Protein Carbonylation ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Sulfides/pharmacology*

Objective To clarify the role ofzonula occludens-1 (ZO-1) in early brain injury (EBI) after subarachnoid hemorrhage (SAH) and regulatory mechanism of c-Jun N-terminal kinase (JNK)to discuss the molecular mechanism of SAH-induced blood-brain barrier (BBB) dysfunction. Methods Seventy-two male SD rats were randomly assigned to sham-controlled, SAH, SAH+SP600125 (the inhibitor of JNK) and SAH+ dimethyl sulfoxide (DMSO) groups. SAH models were induced by injection of autologous blood into the cisterna magna of rats, and they were subsequently sacrificed 24 h later. The brain water content was measured, and BBB disruption was evaluated by Evans blue dye;immunohistochemistry was employed to compare the expressions of ZO-1 and JNK. Results As compared with the sham-controlled group, the SAH group 24 h after the success of model making was detected a significant increase of water content, obviously increased Evans blue dye extravasation,especially in the brain stem and cerebellum (P＜0.05) and both structural damage and neuronal damage were noted; the mean optical density of immunohistochemistry showed a strong increase of JNK expression while a obvious decrease of ZO-1 expression was noted in the SAH group 24 h afar the success of model making (P＜0.05). Treatment with SP600125 could significantly reduce the water content, decrease the Evans blue dye extravasation, inhibit the JNK expression and increase the ZO-1expression as compared with those in the SAH and SAH+DMSO groups (P＜0.05), while no significant difference was noted as compared with those in the sham-controlled group (P＞0.05). Conclusion SAH activates the phosphorylation of JNK, and represses the transcription and translation of ZO-1,subsequently, opens the tight junction and causes brain edema by redistribution of transmembrane proteins and rearrangement ofcytoskeletal proteins, therefore, EBI appears. However, treatment with SP600125 can reverse the above-mentioned processes and improve the outcome of EBI.

Objective To measure and analyze cardiac ventricular sizes of acute pulmonary embolism patients,and compared with normal group,to investigate the morphological changes of heart in patients with acute pulmonary embolism.Methods 75 patients with acute pulmonary embolism were analyzed retrospectively and were divided into two groups according to the score of embolism index:more than or equal to 50％ (group c,33 cases) and less than 50％ (group b,42cases) and compared with normal group (group a,56 cases) to analyze the changes of cardiac ventricular transversal diameter(LR) and anteroposterior diameter (AP).Results The group c compared with group a and b,the right ventricular LR and AP,and the right atrium LR increased significantly (P＜0.05),the left ventricular LR decreased significantly (P＜0.05).The group b compared with the group a,the right ventricular LR and the right atrium AP increased significantly (P＜0.05),the left atrium LR decreased significantly (P＜0.05).The left atrial AP,group b was larger than that of group a and group c (P＜0.05).The left ventricular AP,there was no significant difference between the three groups.The atrial ratio (RA/LA) and the ventricle ratio (RV/LV)of the three groups were significantly different (P＜0.05).According to the product of two lines of the same heart cavity (RL × AP),compared with group a and b,the left atrium and ventricle of group c decreased (P＜0.05),the right atrium and ventricle enlarged (P＜0.05).Compared with group a,the left ventricular angle of group c decreased significantly (88.97±5.47 vs 97.91±7.66,P＜0.001),there was no significant difference between the group b and c (P＞0.05).After the treatment of acute pulmonary embolism,the right ventricular RL × AP is significantly reduced(4 209.57±844.63 vs 5 090.58±1312.69,P=-0.002),the ventricle ratio (RV/LV) is significantly reduced(0.80±0.13 vs 0.93±-0.19,P=0.003.Conclusions The size and shape of heart cavity varied with different pulmonary embolism index,and we can make preliminary observation and evaluate treatment efficacy by using chest CT scan.

OBJECTIVETo study the clinicopathologic features of intraductal papillary mucinous neoplasm (IPMN) and its distinction from mucinous cystic neoplasm of pancreas.

METHODSThe clinical, radiologic and histologic features of 17 cases of IPMN and 13 cases of mucinous cystic neoplasm (MCN) were reviewed. Mucin profiles (MUC1, MUC2 and MUC5AC) were studied by histology (HE) and immunohistochemistry (EnVision).

RESULTS10 of the 17 cases of IPMN were males. 13 cases of the IPMN were located in head of pancreas. Communication with the main pancreatic duct was demonstrated in 15 cases. Histologically, there were mild to severe papillary ingrowths of dysplastic epithelial cells, associated with intervening normal or atrophic pancreatic parenchyma. Ovarian-like stroma was not seen. Ancillary investigations showed that MUC2 and MUC5AC were detected in tumor cells of 9 and 4 cases respectively. The 4 cases with invasive component showed MUC1 positivity. On the other hand, 11 of the 13 cases of MCN occurred in middle-aged to elderly females and were located in the body and tail of pancreas. Ovarian-like stroma was commonly seen and there was no connection with the main pancreatic duct. All non-invasive MCN, regardless of the degree of cytologic atypia, were positive for MUC5AC (but not MUC2). In the 2 cases with invasive component, MUC1 expression was observed, as in IPMN.

CONCLUSIONSThe age and sex of patients, tumor location, absence of ovarian-like stroma, communication with main pancreatic duct and characteristic mucin profiles represent useful parameters in distinguishing IPMN from MCN of pancreas. The tumor cells of IPMN express mainly MUC2, while those of MCN express MUC5AC. MUC1 may also be a useful marker in demonstration of stromal invasion in these tumors.

Adult ; Age Factors ; Aged ; Antigens, Neoplasm ; metabolism ; Biomarkers, Tumor ; metabolism ; Carcinoma, Pancreatic Ductal ; diagnosis ; metabolism ; pathology ; Carcinoma, Papillary ; diagnosis ; metabolism ; pathology ; Cystadenocarcinoma, Mucinous ; diagnosis ; metabolism ; pathology ; Cystadenoma, Mucinous ; diagnosis ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucin 5AC ; Mucin-1 ; Mucin-2 ; Mucins ; metabolism ; Pancreas ; metabolism ; Pancreatic Neoplasms ; diagnosis ; metabolism ; pathology ; Precancerous Conditions ; diagnosis ; metabolism ; pathology ; Sex Factors

BACKGROUND: Computed tomography (CT) and magnetic resonance imaging (MRI) data can be fused to identify the tumor boundaries. This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely. This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia. METHODS: Between September 2008 and December 2015, 24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation. The cohort comprised 16 males and eight females with a median age of 19.5 years (range: 12-48 years). The tumor location was the femoral diaphysis in three patients, distal femur in 19, and proximal tibia in two. The tumors were osteosarcoma (n = 15), chondrosarcoma (n = 3), Ewing sarcoma (n = 3), and other sarcomas (n = 3). We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation. RESULTS: Pathological examination verified that all resected specimens had appropriate surgical margins. The median distance from the tumor resection margin to the joint was 30 mm (range: 13-80 mm). The median follow-up duration was 62.5 months (range: 24-134 months). Of the 24 patients, 21 remain disease free, one is alive with disease, and two died of the disease. One patient developed local recurrence. Complications requiring additional surgical procedures occurred in six patients, including one with wound hematoma, one with delayed wound healing, one with superficial infection, one with deep infection, and two with mechanical failure of the prosthesis. The mean Musculoskeletal Tumor Society score at the final follow-up was 91% (range: 80%-100%). The 5- and 10-year implant survival rates were 91.3% and 79.9%, respectively. CONCLUSIONS Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.
Adolescent ; Adult ; Child ; Computers ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; Prostheses and Implants ; Sarcoma ; Young Adult