Three-dimensional finite element models of the large defect of proximal femur were reconstructed with allograft prosthesis composite in clinical bone-healing phase; current model was under the given conditions of 138mm-intramedullary stem-length of host bone and 135mm defect-length of proximal femur. The femur was constructed with efilm software from CT data, then three-dimensional concrete models were created by using Proe-Wildfire software; the three-dimensional finite element models of allograft prosthesis composite were made in ANSYS11 software. Loads were simulated using the peaking values during stance walking. The stress on femur-cement-callus-prostheses and the influence of stress on the clinical bone-healing phase were analysed. The highest stress value of femur is on the medial side of the tip of the prostheses. The highest stress value of cement mantle is on the medical side of the cement mantle at the tip of the stem. The highest stress value of the prostheses is on the medial side near the upper 4cm of the stem tip. The highest stress value on the callus is at the medial side of the callus layer. The highest stress value on every part is under the corresponding fatigue strength. Clinical bone-healing phase model is well enough for stance walking.
Biomechanical Phenomena ; Female ; Femoral Neoplasms ; diagnostic imaging ; surgery ; Finite Element Analysis ; Hip Prosthesis ; Humans ; Imaging, Three-Dimensional ; Male ; Osteosarcoma ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; Weight-Bearing ; physiology ; Wound Healing

Objective To explain the concept and surgical technique of 3D printing uncement radius distal prosthesis,evaluate and discuss the medium-term outcome of the prosthesis for giant cell tumor in distal radius.Methods From September 2015 to March 2017,13 patients diagnosed as giant cell tumor in distal radius were performed with en bloc resection combined with 3D print uncement prosthesis.All patients graded Campanacci Ⅲ or occurred local recurrence.Two patients with local recurrence had a local lesion curettage,inactivation and bone cement filling.There were 7 males and 6 females,with an average age of 37.8 years.Through the preoperative three-dimensional CT data,the 3D model of the distal radius was obtained based on the contralateral radius and the 3D printing uncemented distal radius prosthesis was made.Directly reconstrucion was conducted if the wrist joint ligament and joint capsule can be preserved.The surrounding soft tissue,remaining joint ligament and joint capsule were sutured to the prosthesis together combined with a brace if the wrist joint ligament and joint capsule can be only preserved partially.Radiocarpal joint was temporarily fixed by Kuntscher pin if the wrist joint ligament and joint capsule can't be preserved completely.Results In our series,the average resection length of the distal radius measured from the radial styloid process was 65.54±6.70mm.The length of prosthesis was consistent with the resection length and the length ratio of prosthesis to prosthetic stem is 1:1.The follow-up time was 17.77±4.97 months.There were no local recurrence and metastasis.At the end of the followup,except waist flexion,the wrist extension,wrist pronation,wrist supination,hand grip strength and Mayo wrist were significantly improved from 41.69°± 11.35°,41.92°± 11.09°,40.00°±7.64°,16.84±6.28 mmHg,47.69±9.27 points preoperatively to 57.46°±17.18°,55.00°±17.91°,53.46°±19.30°,23.08±6.29 mmHg,70.00±11.55 points,respectively.The DASH score was significantly decreased from 32.07±6.71 points to 19.15±8.41 points postoperatively.During surgery,there was one patient received temporary wrist fixation with kirschner's needle,which got a relatively poor postoperative function.Excluding this patient,comparing the resuits of 8 cases with directly suturing of wrist joint ligament and joint capsule and that of 4 cases with reconstructing by suturing and fixing with a brace,there were no statistical differences.There were no wrist dislocation or subluxation,aseptic prosthesis loosening,wrist joint degenerative changes or other prosthesis related complications.Conclusion 33D printing uncemented distal radius prosthesis is a good choice for the Campanacci grade Ⅲ or recurrent giant cell tumor in distal radius,because of its personalized design and uncemented fixation;in clinical application,we should pay attention to the evaluation of preoperative wrist joint capsule and surrounding ligament and the intraoperative soft tissue repair techniques.

Objective To evaluate the efficacy of the new treatment regimen versus the standardized scheme for the initial treatment of smear-positive tuberculosis in the elderly.Methods A total of 302 elderly patients meeting the inclusion and exclusion criteria were selected from 14 tuberculosis-designated medical institutions in Beijing.The patients received the initial treatment of smear-positive tuberculosis from January 2014 to August 2016 in the combined prospective and retrospective study.All patients were divided into observation group(n=63)receiving treatment with 6L2 HELfx regimen from August 1,2015 to August 31,2016,and control group (n =239) receiving treatment with 6L2HELfx regimen from January 1,2014 to January 31,2015.The nation-unified standard chemotherapy regimen 2RHZE/4RH was used in tuberculosis medical service institutions for all patients.The differences between the two groups were analyzed and compared in the completion of treatment,negative conversion of sputum culture or smear,adverse drug reactions and treatment outcome.Results The completion rate of long-course therapy was significantly higher in the observation group than in control group [90.5％ (57/63) vs.79.5％ (190/239),x2 =4.034,P =0.045].The rate of negative conversion of sputum culture or smear at the end of the 2nd month was higher in the observation group than in control group,but had no significant difference[87.0％ (47/54)vs.81.6％(155/190),x2 =0.879,P=0.349].The incidence of adverse reactions was much lower in observation group than in control group[46.0％ (29/63) vs.65.3％ (156/239),x2 =7.777,P =0.005].The success rate of treatment(cure or completion of long-course therapy)was higher in observation group than in control group [90.5％ (57/63) vs.77.4％ (185/239),x2 =5.350,P =0.021].ConclusioNS As compared with the standard chemotherapy regimen,the L and Lfxcontaining treatment regimen has better effects,higher success rate of treatment and less adverse reactions in elderly patients with the initial treatment of smear-positive tuberculosis.

OBJECTIVETo observe the effect of fluid shear stress on the eNOS gene expression and NO production in endothelial progenitor cells (EPCs).

METHODSThe peripheral blood mononuclear cells from healthy volunteers were inducted into EPCs and divided into stationary group (0 dyn/cm(2), 1 dyn/cm(2) = 0.1 Pa), low-flow shear stress group (5 dyn/cm(2)), medium-flow shear stress group (15 dyn/cm(2)) and high-flow shear stress group (25 dyn/cm(2)). The effects of shear stress on the endothelial nitric oxide synthase (eNOS) gene expression and nitric oxide (NO) production in human EPCs were measured.

RESULTSTypical "spindle-shaped" appearance was shown in EPCs derived from peripheral blood mononuclear cells and were positively labeled by acetylated-LDL, lectin, FLK-1 and vWF. After 4 hours treatment with various shear stresses, the ratio of eNOS/beta-actin mRNA expression by human EPCs in low, medium and high-flow shear stress group was 0.364, 0.505 and 0.548 respectively, which was significantly higher than that in stationary group (0.183, all P < 0.05) and the NO secretion in human EPCs in low, medium and high-flow shear stress group was also significantly higher than that in stationary group (all P < 0.05).

CONCLUSIONFluid shear stress enhances the eNOS mRNA expression and NO secretion in human EPCs, therefore, shear stress could potentiate the repair efficacy of EPCs for endothelial injury.

Cell Differentiation ; Cells, Cultured ; Endothelial Cells ; cytology ; metabolism ; secretion ; Humans ; Nitric Oxide ; metabolism ; Nitric Oxide Synthase Type III ; genetics ; metabolism ; Stem Cells ; cytology ; metabolism ; secretion ; Stress, Mechanical

OBJECTIVETo analyze the full nucleotide sequence of a null allele of major histocompatibility complex class I chain-related gene (MICA).

METHODSA sequence-based typing method was used to determine the nucleotide sequence of the MICA gene. Potential alleles were identified with a computer program.

RESULTSThe identified allele has possessed a sequence similar to that of MICA*027 except for a C→T substitution at position 184 in codon 62 (CAG→TAG) of exon 2. As a stop codon, this may result in a truncated protein.

CONCLUSIONA null allele of MICA gene has been identified. The sequence has been submitted to the Genbank nucleotide sequence database (submission No. HWS10011131), which was officially named as MICA*063N by the WHO Nomenclature Committee in October 2010.

Alleles ; Base Sequence ; Codon, Terminator ; Exons ; Female ; Histocompatibility Antigens Class I ; genetics ; Humans ; Middle Aged ; Molecular Sequence Data ; Sequence Analysis ; methods

OBJECTIVETo investigate the roles of different cells in the pulmonary lesions in the severe acute respiratory syndrome (SARS) patients.

METHODSThe monoclonal antibodies of CD8, CD20, CD34, LCA, CD56, CD68, and AE1/AE3 are used to demonstrate the different cells in the lung specimens of SARS patients in order to study the patterns of cell responses in this new disease. Meanwhile the HE stained slides were also carefully studied to compare with the results of immunohistochemical staining.

RESULTSThe number of capillaries increased and the capillaries clearly outlined the contour of alveolar wall from beginning to early stage of organization, the number of lymphocytes decreased sharply while the number of macrophage remarkably increased, together with proliferation of type II pneumocytes. The numbers of blood vessels decreased in the fibrotic and consolidated lung tissue, and the vessel cavities enlarged, losing the normal contour of alveolar septa.

CONCLUSIONSThe lesions in the lung from SARS patients are consisted of the tissue reaction to the inflammatory injury, including extensive exudation, capillary proliferation, fibrosis, and obvious infiltration of macrophages which may play a key role in the pathogenesis of pulmonary lesions of SARS.

Adult ; Antigens, CD ; immunology ; Antigens, CD20 ; immunology ; Antigens, CD34 ; immunology ; Antigens, Differentiation, Myelomonocytic ; immunology ; Capillaries ; pathology ; Edema ; pathology ; Female ; Fibrosis ; pathology ; Humans ; Immunohistochemistry ; Lung ; blood supply ; pathology ; Macrophages, Alveolar ; pathology ; Male ; Middle Aged ; Pulmonary Alveoli ; pathology ; Severe Acute Respiratory Syndrome ; pathology

Objective:To observe the short-term efficacy of 3D-printed custom-made hemipelvic prosthesis in the treatment of primary malignant bone tumors of the pubis.Methods:From June 2017 to May 2019, a total of 5 patients with pubic primary malignant tumor received type Ⅲ hemipelvectomy and reconstruction with a 3D-printed custom-made hemipelvic prosthesis at Department of Orthopedics, West China Hospital. They were 3 males and 2 females with an average age of 36.3 years (range, from 26 to 46 years). Of them, 3 underwent resection of the upper pubic ramus and 2 resection of both pubic rami. All their tumors were chondrosarcomas, with one case of Enneking stage Ⅱa and 4 cases of Enneking stage Ⅱb. Preoperative CT/MRI image fusion was used to determine the tumor-free resection margin, design guide templates for osteotomy and prosthesis, and simulate surgical procedures. A total of 5 3D-printed custom-made hemipelvic prostheses were designed, including 3 ones with an intramedullary stem to preserve partial pubis and 2 ones with a non-intramedullary stem not to preserve the pubis. The functional recovery was assessed by Musculoskeletal Tumor Society (MSTS) scores. The prosthetic position and osseointegration were evaluated by imaging examination. Oncological outcomes and complications were recorded.Results:R0 resection and precise reconstruction were accomplished in all patients. Their intraoperative blood loss ranged from 300 to 3, 700 mL (mean, 1, 680 mL), operation time from 180 to 430 min (mean, 294 min), and follow-up time from 13 to 29 months (mean, 20.6 months). All the 5 patients were alive with no evidence of disease or tumor recurrence. The functional MSTS scores at the final follow-up ranged from 29 to 31 (mean, 29.8). One male patient complained of erectile dysfunction. Fretting wear around the prosthetic stem was found in 3 patients while bone wear on the normal pubic side in 2. Osseointegration was observed in all patients with no complications like deep infection, prosthesis dislocation, prosthetic or screw breakage.Conclusion:Since 3D-printed custom-made hemipelvic prostheses can result in fine short-term efficacy for pubic primary malignant bone tumors, they may be a reliable method to reconstruct pelvic malignant tumors.

Objective:To investigate the efficacy of oblique lumbar interbody fusion (OLIF) combined with percutaneous transforaminal endoscopic decompression (PTED) and posterior pedicle fixation through Wiltse approach in the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis.Methods:From June 2017 to February 2022, 103 patients (50 males and 53 females) of lumbar spondylolisthesis accompanied with lumbar spinal stenosis were performed with OLIF combined with PTED and posterior pedicle fixation. The mean age was 64.1±5.2 years (range, 42-87 years). All involved cases were single-segment and included 83 cases of L 4, 5, 17 cases of L 3, 4, and 3 cases of L 2, 3. Among them, 94 cases were performed for the first time, and other 9 were revision surgery treated by posterior lumbar laminectomy previously. The visual analog scale (VAS) was used to evaluate the low back pain and leg pain, and the Oswestry disability index (ODI) was used to evaluate the lumbar function. The VAS and ODI scores were recorded respectively before the operation, at discharge, 1, 3, 6 months after the operation and at the last follow-up. Macnab criteria was used to evaluate the clinical efficacy at the last follow-up. At the same time, imaging measurements were conducted, including the anterior and posterior disc height, segmental lordotic angle, percentage of slip on lateral X-ray film and the vertebral canal area on axial MRI before and after surgery. Results:All of 103 patients were successfully operated in one stage with an average operation time of 177.7±21.5 min (range, 155-220 min), and an average intraoperative blood loss of 55.9±18.3 ml (range, 30-150 ml). The mean follow-up time were 15.1±2.6 months (range, 6-36 months). There were significant differences in both VAS scores of back and leg and ODI scores at each postoperative time point when compared with preoperative ( F=508.25, F=1524.82, F=1148.68, P<0.001). Macnab criteria of the last follow-up was evaluated as follow: excellent in 85 cases, good in 14, fair in 4, and the excellent and good rate was 96.1%. The radiographic results showed the mean immediate postoperative anterior disc height, posterior disc height, segmental lordotic angle, percentage of slip and axial area of the vertebral canal were 15.23±2.97 mm, 9.32±2.31 mm, 14.36°±4.18°, 3.89%±3.11%, 113.37±47.27 mm 2, and thus all of those increased significantly compared to the mean preoperative 11.93±3.17 mm, 7.21±2.03 mm, 6.15°±3.99°, 23.66%±7.79%, 57.63±28.91 mm 2, respectively ( t=7.84, t=7.07, t=14.91, t=27.62, t=9.68, P<0.001). All cases achieved bony fusion during 6-12 months after operation. The incidence of surgery-related complications was 10.7% (11/103). There were 3 cases of end plate fracture and 2 cases of dural injury, which had no complaint after operation. There was 1 case of pedicle screw entering into the spinal canal by mistake, and the symptoms of nerve damage appeared after operation. After 1 year it basically returned to normal. There were 2 cases of thigh numbness and 1 case of psoas major weakness after operation, all of which relieved after 4 weeks. There was 1 case continuous pain of abdominal incision after surgery. There was 1 case of cage subsidence at the last follow-up. Conclusion:OLIF combined with PTED and posterior pedicle fixation through Wiltse approach is a minimally invasive surgical method for the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis. With the combined minimally invasive techniques, the decompression, fusion and fixation of the lumbar spine can be fulfilled perfectly. It has the advantages of minimally invasive, good clical outcome, few complications and rapid rehabilitation.

OBJECTIVETo study the morphological features of the lungs obtained from autopsies of severe acute respiratory syndrome (SARS) patients.

METHODSBilateral lungs from 7 patients died from SARS were carefully studied grossly and microscopically. All tissues from these cases were routinely processed and carefully studied.

RESULTSAll lungs from these cases were extremely expanded and became solid. Microscopically, the edema and fibrin exudates in the alveoli was the most common findings, especially in the early phase of the disease. The hyaline membrane was almost always present in the lungs of these cases. The organization of intra-alveolar fibrin exudates along with the interstitial fibrosis led to obliteration of alveoli and consolidation of lungs. The desquamation and hyperplasia of alveolar lining cells was also apparent. Foci of haemorrhage and lobular pneumonia, even diffuse fungal infection were frequently seen in these specimens. Micro-thrombus were easily found in these lungs.

CONCLUSIONSThe lung of SARS from autopsy is characterized by edema, intra-alveolar fibrin exudates, hyaline membrane formation, organization of intra-alveolar exudates and fibrosis, which lead to the obliteration of alveoli and consolidation of lungs.

Adult ; Female ; Humans ; Lung ; pathology ; Male ; Middle Aged ; Pulmonary Fibrosis ; pathology ; Severe Acute Respiratory Syndrome ; pathology

OBJECTIVESeven cases of autopsy from SARS patients are studied to investigate the pathogenesis and the pathologic changes of the major organs.

METHODSDetailed gross and microscopic examination of the autopsy specimen is performed, including lung, heart, liver, kidney, spleen and lymph nodes.

RESULTSAll of the lungs are markedly enlarged and consolidated. Microscopically, pulmonary edema is a prominent finding, especially at the early stage of the disease (5 days after the onset). The alveolar spaces are filled with fibrinous exudates and lined with hyaline membrane. In 5 cases that undergo over 3 weeks of the course, the main pattern is organization of intra-alveolar deposit, along with fibroblastic proliferation in the alveolar septa, which leads to obliteration of alveolar space and pulmonary fibrosis. All of the lungs show bronchopneumonia, scattered hemorrhage, and proliferation of alveolar epithelial cells with desquamation. Microthrombi are seen in 6 cases. Fungal infection is noted in 2 cases. One of them is disseminative, involving bilateral lungs, heart, and kidney; the other one is diagnosed in hilar lymph nodes. In immune system, hilar and abdominal lymph nodes are usually congested and hemorrhagic, with depletion of lymphocytes, and accompanied with subcapsular sinus histiocytosis. One of the cases shows enlargement of abdominal lymph nodes, which have reduced number of germinal centers. Spleen exhibits atrophy of white pulps, and even lost of white pulps in some areas. The red pulp is markedly congested and hemorrhagic. In 5 cases, cardiomegale is prominent. Thrombosis (2 cases), focal myocarditis (1 case), and fungal myocarditis (1 case) are observed. In addition, liver shows massive necrosis (1 case) and nodular cirrhosis (1 case).

CONCLUSIONSLung is the major organ affected by SARS, demonstrated as diffuse alveolar damage. It is postulated that viral infection induces severe damage of alveolar epithelial and capillary endothelial cells, leads to pulmonary edema, intra-alveolar fibrin deposit, and hyaline membrane formation. Consequently, intra-alveolar organization and alveolar septal fibrosis causes loss of alveolar spaces, eventually, pulmonary fibrosis and atelectasis. The immune system is often affected, and presented as depletion of lymphoid tissue in lymph nodes and spleen. Secondary infection is a common complication, which should be paid close attention in the management of SARS patients.

Adrenal Glands ; pathology ; Adult ; Autopsy ; Bone Marrow ; pathology ; Female ; Humans ; Kidney ; pathology ; Liver ; pathology ; Lung ; pathology ; Male ; Middle Aged ; Myocardium ; pathology ; Severe Acute Respiratory Syndrome ; pathology ; Spleen ; pathology