Objective To analyze the causes for failed treatments of proximal femoral fractures and to evaluate the curative results of total hip replacement(THR)to salvage the failures.Methods A retrospective study was conducted for 23 consecutive cases of THR to salvage failed treatments of proximal femoral fractures from February 2002 to April 2005.There were 17 cases of femoral neck fracture,five cases of intertrochanteric frac- ture,and one case of femoral head fracture.Results Inadequate reduction after inadequate fixation,incorrect materials or technical errors in internal fixation were the most significant reasons for the failure of early treatment. Twenty-one of the 23 patients were available for fullow-up that ranged from 8 to 46 months(mean,32 months). No such complications as wound infection,hip dislocation,prosthesis breakage or deep venous thrombosis were found.Their mean Harris score increased from 48.3 preoperatively to 87.6 postoperatively.Condusions Re- duction,internal fixation,and fixation technique are very important to treatments of proximal femoral fractures. High energy trauma in young patients and osteoporosis in old patients make treatment of proximal femoral fractures even more difficult.THR is a satisfactory and safe way to salvage a failed treatment of proximal femoral fracture.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Humans ; Male ; Middle Aged ; Motor Activity ; Urban Population ; Young Adult

AIM:To investigate the changes of Wnt signaling pathway in catalpol-induced proliferation of rat bone marrow mesenchymal stem cells (BMSCs).METHODS:The BMSCs were isolated from SD rats , purified by differ-ential time adherent method and divided into control group and catalpol (1.0 mg/L) group.Flow cytometry was used to de-tect the proliferation index of BMSCs .The mRNA levels of Wnt3a, Wnt5a, Wnt11 and β-catenin was evaluated by real-time PCR.In addition, the protein expression level of β-catenin was determined by Western blotting .RESULTS:Prolife-ration index was increased from 8.90%±0.46% to 17.93%±1.68% after treatment with catalpol (P<0.01).Com-pared with control group , the mRNA expression of Wnt5a, Wnt11 andβ-catenin was all increased with catalpol treatment . No difference of Wnt3a mRNA expression between control group and catalpol group was observed .Meanwhile, the protein expression of β-catenin was increased in catalpol group compared with control group .CONCLUSION:Catalpol promotes BMSCs going into the cell cycle .Classical and non-classical Wnt signaling pathways are activated in this process .

ObjectiveTo evaluate prognostic factors affecting local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).MethodsA total of 246 HCC patients (343 lesions) underwent RFA treatment in our department and were enrolled into this study.The average tumor size was 3.7 cm ( range 0.9 ～ 3.7 cm).Regular follow-up with enhanced CT was performed to evalutate the treatment results.Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analysis to identify risk factors for local tumor progression.ResultsThe local tumor progression rate was 11.4％ (39/343 lesions),and the average time from initial RFA to local tumor progression was 12.0 months.Univariate analysis indicated tumor size ( P ＜0.001 ),close to intrahepatic vessels ( P ＜0.001),tumor boundary ( P =0.020),pathological grade( P =0.010) and CEUS before RFA ( P =0.001) as risk factors for local progression.The following factors were identified as independent prognostic factors for local tumor progression by multivariate model:tumor size (P ＜ 0.001),isolated or close to intrahepatic vessels( P ＜0.001) and CEUS before RFA(P =0.018).ConclusionsTumor size,CEUS before RFA and close to intrahepatic vessels are the most important factors for local progression after RFA.Being awaring of possible risk factors for local tumor progression may increase the treatment efficacy and help to promote the use of RFA technique.

Objective To investigate the protective effects and mechanism of Pentoxifylline(PTX) on rats with renal interstitial fibrosis following unilateral ureteral obstruction(UUO).Methods The rats were randomly divided into 5 groups: Sham operation group(group A),UUO group(group B),Enalapril group(group C),PTX group(group D) and PTX plus Enalapril group(group E).On the 3th,7th and 14th day after operation,5 rats of each group were sacrificed by exsanguinations,respectively.The concentration of hydroxyproline was measured,and the ratio of collagen and renal weight was tested.The expressions of transforming growth factor-?1(TGF-?1),tissue inhibitor of metalloproteinase-1(TIMP-1),vascular endothelial growth factor(VEGF),bone morphogenetic protein-7(BMP-7),NF-?B and CD34 were measured by immunohistochemistry.The peritubular capillary index(PCI) was regarded as the expression of CD34.Results The ratio of collagen and renal weight in the rats of group B was higher than that of other 4 groups(P

Objective The color of the syphilis quality control material adopted by most detection institutes was the same with the detected serum sample and they were all colorless,transparent or light yellow.There were cases of wrong adding,missing adding or insufficient adding due to the color of quality control materials which was hard to distinguish with naked eyes.To avoid this phenomenon,a new method was established for the distinction of quality control materials.Methods A new method of syphilis quality control materials that had been improved three concentrations control materials:0.125,0.250 and 0.500 NCU/mL.The syphilis diagnostic kit that was created by Shanghai Kehua and Xiamen Yingke was adopted to conduct detection and compare results.Results The difference between stained quality control material and unstained quality control materials had no statistical significance (P＞0.05).Two different reagents were used to detect quality control materials of different concentration for 20 times and the CV were 11.7 ％-13.4％ and 9.3 ％-12.9 ％ respectively.Two different reagents were used to detect quality control materials of different concentration for 30 days and the CV range were 10.1 ％-13.4 ％ and 8.08 ％-12.8 ％.Conclusion Citric yellow staining does not influence the properties of syphilis control materials and it can be used stably for a long time.It is suitable for clinical lab application and promotion.

Objective To investigate effects of different doses of recombinant human bone morphogenetic protein-2 (rhBMP-2) on vascular endothelial growth factor (VEGF) expression in fetal mouse osteoblasts.Methods Calvaria osteoblasts of fetal mice of 19 days were cultured.The effects of rhBMP-2 at different doses and different action times on VEGF expression patterns in fetal mouse osteoblasts were observed with reverse transcrip- tion-polymerase chain reaction (RT-PCR) and Western blot staining.Results In the present study,RT-PCR detected a steady expression of VEGF mRNA in the control fetal mouse osteoblasts.The levels of VEGF mRNA increased in an apparent biphasic manner with a maximum stimulation (about 2-fold above the control,P＜0.05 ) in both VEGF mRNA species observed at 300 ng/mL of rbBMP-2.After 48 h of rhBMP-2 treatment,the VEGF mRNA levels approached those in the control.The VEGF mRNA levels appeared to be biphasic in rhBMP-2-treated cultures,showing peak induction at 3 and 24 h and remaining elevated at 48 b.Compared with the individual control value at each time point,an apparent maximum increase (about 2.5-fold above the control,P＜0.05) occurred at 6 h.The second peak induction,about 2-fold above that in the control,occurred at about 36 h.Conclusions The expression of VEGF mRNA is steady in the control fetal mouse osteoblasts.RhBMP-2 can promote the expression of VEGF in dose-dependent and time-dependent manners.

Objective To survey the biliary flora in patients with obstructive jaundice due to pancreatic head cancer,also the multiple factors which affect the positive findings of bile culture in these patients.Methods The information of 65 patients with obstruetive jaundice due to pancreatic head eancer,who admitted to surgery in Huashan Hospital from Oetober 2007 to October 2008 were reviewed retrospectively.The factors which may potentially affect the detection of bile pathogen in patients with malignant obstructive jaundice were studied with univarite analysis and muhivariate analysis,including age,history of biliary surgery,yellow stained time,serum alanihe aminotransferase level,serum bilirubin level,CA19-9 level,tumor size,site of obstruction,with or without clinical manifestations of biliary infection,and APACHE Ⅱ score.Results Twenty-five positive cultures happened in 65 bile samples (38.5％),including 21 strains of Gram-negative baeilli (72.4％),6 strains of Gram-positive bacteria (20.7％),and 2 strains of fungi (6.9％).Univariate analysis showed that the relevant factors which may affect the rate of positive bile culture in patients with malignant obstructive jaundice were age,history of biliary surgery,biliary obstruction site,biliary tract infection symptoms and APACHE Ⅱ score.Multivariate analysis showed that age,history of biliary surgery,biliary obstruction site and APACHE Ⅱ seore were independent risk factors.Conctusion Age,history of biliary surgery,biliary obstruction site and APACHE Ⅱ score were independent risk factors which led to positive findings of bile cultures in patients with obstructive jaundice due to pancreatic head cancer.

Objective To assess the efficacy and safety of tacrolimus (TAC) combined with methotrexate (MTX) for the treatment of refractory rheumatoid arthritis (RA),and to compare it with cyclophosphamide (CTX) added to MTX for the treatment of refractory RA.Methods Thirty-six cases of refractory RA patients were divided into the observation group and the control group.TAC+MTX were used in the observation group,and CTX+MTX were used in the control group.We used repeated measures to analyze the variance and Fisher exact probability method to analyze the efficacy at 8 weeks and 24 weeks.Results The effective rate of the observation group in 8 weeks,24 weeks were 77.8％(14 cases) and 100％(18 cases) respectively,while those of the control group were 11.1％ (2 cases) and 44.4％(8 cases),it showed that both TAC+MTX and CTX+MTX in the treatment of refractory RA were effective,but the efficacy of TAC+MTX was better than CTX+MTX,the difference of C reactive protein (CRP) and disease activity score (DAS)28 was statistically significant (P＜0.05),and it could significantly improve the clinical symptoms and laboratory indexes.Conclusion TAC+MTX is effective and safe in treating refractory RA,and is worth of spreading.

OBJECTIVETo observe features of Icariin in promoting osteogenic differentiation of SD rat bone marrow mesenchymal stem cells (BMSCs) in vitro.

METHODS(1) SD rats' BMSCs were isolated and purified by mechanically isolated and cultured by whole bone marrow adherent method. Effects of various concentrations Icariin on serum activities of alkaline phosphatase (ALP) were detected using amino antipyrine phenol determination method at day 3, 6, 9, 12, 15, 18, and 21. Calcium nodes of each groups were detected using alizarin red staining. Roles of various concentrations Icariin in promoting osteogenic differentiation of BMSCs were observed. (2) BMSCs were divided into the blank control group, the osteogenic induced group, and the Icariin group (0.5 microg/mL). ALP activities were detected at day 7, 14, and 21 of culture. Meanwhile, ALP positive staining rate and calcium nodes were detected at day 14 and 21 respectively. Additionally, mRNA expressions of Runt-related transcription factor-2 (Runx2) and Osteocalcin were detected at day 7, 14, and 21 by real-time fluorescent quantitative PCR.

RESULTS(1) 0.05-5.0 microg/mL Icariin could significantly elevate serum ALP activities. Of them, 0.2-2.0 microg/mL Icariin significantly increased calcium nodes numbers (P < 0.01). (2) When Icariin promoted osteogenic differentiation of BMSCs, Runx2 mRNA expression levels and ALP activities increased earlier and then decreased, while osteocalcin mRNA expression levels continued to increase (P < 0.01). Compared with the osteogenic induced group, ALP activities and ALP positive staining rate were both elevated after 14 days of Icariin treatment in the Icariin group (P < 0.05, P < 0.01).

CONCLUSIONSIcariin could promote the differentiation of BMSCs to osteoblasts by up-regulating Runx2 mRNA expression levels. It also could promote the mineralization by increasing ALP secretion and Osteocalcin mRNA expression levels, thereby promoting mature of newly generated osteoblasts.

Animals ; Bone Marrow Cells ; Cell Differentiation ; drug effects ; Flavonoids ; pharmacology ; Hematopoietic Stem Cells ; Mesenchymal Stromal Cells ; physiology ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Rats ; Rats, Sprague-Dawley