Objective To compare the clinical outcomes and safety of synchronous vs staged bilateral total hip arthroplasty (THA).Methods Fifty-eight cases (116 hip joints) undergone bilateral THA from January 2008 to January 2010 were reviewed retrospectively.Follow-up period was postoperative 2 years,including synchronous bilateral THA in 29 cases (synchronous group) and staged bilateral THA in 29 cases (staged group).The two patient groups were compared in aspects of total operation time,total amount of blood loss,total amount of blood transfusion,duration and cost of hospitalization,postoperative discrepancy in bilateral leg length,preoperative and postoperative function score and perioperative complications.Results During the follow-up,no complications of incision infection,deep vein thrombosis and prothesis dislocation or loosening were noted.And postoperative delirium symptoms occurred only in four cases (three in synchronous group and one in staged group).There were no statistical differences between synchronous group and staged group in aspects of total operating time [(117.9 ± 23.8) minutes vs (124.1 ± 18.8) minutes],total amount of blood loss [338.1 ml (180-720 ml) vs 303.9 ml (200-600 rnl)],total amount of blood transfusion [227.6 ml (0-800 ml) vs 189.7 ml (0-400 ml)],postoperative function score.However,differences of the following data were considered statistical significance between synchronous group and staged group:expense of hospitalization [9.5 ten thousand yuan (7.0-11.3 ten thousand yuan) vs 10.5 ten thousand yuan (8.8-11.0 ten thousand yuan)],length of hospitalization [(12.1 ±3.2) days vs (20.1 ±3.5) days],postoperative discrepancy in bilateral leg length [(0.11 ± 0.22) cm vs (0.42 ± 0.44) cm].Conclusions Synchronous bilateral THA is safe and feasible as far as the patients' physical condition is allowed,perioperative management is rational and physicians have mature surgical techniques.Moreover,it gains advantage over staged bilateral THA considering cost of hospitalization,length of hospitalization and postoperative discrepancy in bilateral leg.

Antigens, CD ; metabolism ; Antigens, CD1 ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Diagnosis, Differential ; Histiocytosis, Langerhans-Cell ; metabolism ; pathology ; Histiocytosis, Sinus ; pathology ; Humans ; Infant ; Langerhans Cells ; pathology ; Lymph Nodes ; pathology ; Lymphohistiocytosis, Hemophagocytic ; pathology ; Male ; S100 Proteins ; metabolism

ObjectiveThe number of positve axillary lymph nodes(ALNs) is one of the most important factors affecting prognosis of patients with breast cancer.The resected lymph nodes number( LNN)can affect the number of positive ALNs.In this study,we aim to evaluate the influence of LNN on the progonosis of breast cancer patients with positive ALNs.Methods449 breast cancer patients with positive ALNs who underwent total mastectomy and axillary dissection were divided into 2 groups:group A (LNN ＜ 10)and group B (LNN ≥ 10).The clinicopathological features of the 2 groups were compared.Kaplan-Meier method and Cox proportional hazard method were respectively used to make univariate and multivariate survival analysis for disease-free survival (DFS).ResultsThe median follow-up was 43.59 months for group A and 41.34 months for group B.Group A had a significantly higher proportion of patients in pN1,with lymph node metastasis and adjuvant radiotherapy than group B.Univariate analysis showed pN stage,LNN,lymph nodes metastasis rate,HER-2,adjuvant chemotherapy regime and adjuvant radiotherapy were factors influencing DFS. Multivariate analysis showed that pN stage,LNN,lymph nodes metastasis rate,adjuvant chemotherapy regime and adjuvant radiotherapy were factors influencing DFS.We performed analysis stratified by adjuvant chemotherapy regime containing taxan and adjuvant radiotherapy.Stratified analysis showed patients with adjuvant chemotherapy regime containing taxus and adjuvant radiotherapy showed significantly higher DFS rate than those without taxus in adjuvant chemotherapy regime or without adjuvant radiotherapy in group A.However,the 2 different treatment regime had no difference in DFS rate for patients in group B.ConclusionsThe decrease of LNN may affect the diagnosis and therapeutic selection of breast cancer patients with positive ALNs.LNN is an inexpensive and easily available factor for predicting DFS of breast cancer patientswithpositiveALNs.Adjuvant chemotherapy regime containing taxus and adjuvant radiotherapy can improve DFS rate of patients with LNN ＜ 10.

Objective To establish the method of gene mutation screening for HME and investigate the relationship between genotype and clinical phenotype in HME patients. Methods Fifteen cases of HME probands were divided into the following four subgroups: mild (M) and severe ( Ⅰ S, Ⅱ S, Ⅲ S) according to the clinical diagnosis. DNA samples were obtained from the probands and family members. All of the EXT1 and EXT2 gene exons and their boundary sequences were amplified by PCR, and sequenced by directsequencing. Then the relationship between the genotypes and clinical phenotype was analyzed. Results Among the fifteen cases of HME probands, nine harbored EXT1 gene mutation, while the other 6 were positive for EXT2 gene mutation. Moreover, six novel mutations in EXT1 gene, including I8 + 2T ＞ G, c. 1182delG,c. 1108G ＞T(p. E370X) ,c. 335delA,c. 361C ＞T(p. Q121X) and c. 1879_1881delCAC were identified. In 9 patients with EXT1 gene mutation, 2 (22. 2% ) were M-type, 2 (22. 2% ) were Ⅰ S -type, 4 (44. 4% )were Ⅱ S-type,and 1 ( 11.1% ) was ⅢS-type. Whereas, 5 cases (83.3%) were M-type and only one case was Ⅱ S-type( 16. 7% ) in 6 patients with EXT2 gene mutation. Conclusions An accurate and simple gene diagnostic method for HME was established. Six novel EXT1 gene mutations, including I8 + 2T ＞ G,c. 1182delG, c. 1108G ＞T(p. E370X), c. 335delA, c. 361C ＞T(p. Q121X)and c. 1879_1881delCAC were identified as well. The clinical phenotype of the patients with EXT1 gene mutation was more severe compared to those with EXT2 gene mutations.

Objective To explore and evaluate the clinical value of MRI for status of axillary lymph node after neoadju-vant chemotherapy (NAC) in patients with breast cancer. Methods Forty-four patients with 1ocally advanced breast cancer (LABC) were underwent NAC for four cycles. The longest diameter of axillary lymph node (ALN) measured by MRI scan. Val-ue of apparent diffusion coefficient (ADC) and their correlation were compared before NAC and four cycles after NAC. Re-sults of MRI and pathological data for ALN were compared between two groups of patients. Results All patients finished four cycles of NAC. The total response rate (CR+PR) was 72.7% (32/44), and the total non-response rate (SD+PD) was 27.3%(12/44). The longest diameter of ALN was significantly shortened in response group. The longest diameter was (1.37± 1.06) cm before NAC and (0.90±0.76) cm after NAC (P<0.01). The ADC value of the tumor was significantly increased in re-sponse group [(0.91±0.28) ×10-3 mm2/s before NAC and (1.01±0.32)×10-3 mm2/s after NAC, P<0.01)]. There was no signifi-cant correlation between ADC value change (△ADC) and the longest diameter change of ALN (△L, r=0.131, P=0.413). The sensitivity, specificity and Kappa value of ALN evaluation after NAC were 100%, 62.5%and 0.68 measured by MRI. Con-clusion The change of tumor longest diameter reflects the effect of chemotherapy directly. The tumor ADC value of MRI can not be used as an independent indicator of chemotherapy effect of ALN, eventhouth MRI was the sensitive index for eval-uating the status of axillary lymph node after neoadjuvant chemotherapy for breast cancer.

Objective To review the clinical presentation of patients with hepatobiliary stones (HS).Method 2 359 patients with HS were divided into group A and B according to the presentation of these patients before or after 2002.Their clinical data were retrospectively analyzed.Results The age,the percentage of patients with a case history ＞ 10 years,the admission rate for relapse,the intrahepatic to extrahepatic stone ratio,the number of patients complicated with liver cirrhosis/portal hypertension,the elective operation rate,the ratio of biliary drainage operation,or the ratio of biliary drainage combined with hepatic resection in group B were 54.02 ± 13.54 years,68.99％,53.07％,73.18％,13.41％,80.80％,83.81％,44.74％,respectively.The corresponding figures for group A were 48.65 ± 14.47 years,46.25％,32.0％,62.02％,4.63％,63.92％,41.45％,19.05％,all P ＜0.01.However,the rates of biliary ascariasis,acute cholangitis of severe type (ACST),hepatic abscess,bleeding or perforation of the biliary tract,non-operative mortality,emergency operation rate and stone residual rate in group B were 6.56％,6.15％,0.84％,0,0,1.71％,5.18％,18.70％,respectively.All these were significantly lower than those in group A (12.11％,33.72％,1.95％,0.37％,0.67％,25.62％,respectively,all P ＜ 0.01).Conclusions The popularization of medical insurance and the increase in hospital admission rate,but not the actual increase in HS,led to the increase in hospitalization of patients.There was a tendency of less patients presenting with severe disease due to delay in treatment.Routine choledochoscopic stone extraction intraoperatively or postoperatively and the increased liver resection rate had decreased the residual stone rate.There should be a strict restriction on the use of choledochojejunostomy.

Brain Injuries ; etiology ; Humans ; Hypoglycemia ; complications ; Infant, Newborn

Objective To investigate the curative effect of arthroscopic treatment for lateral dis-cord meniscus tear in children. Methods The study involved 229 child patients with lateral discord meniscal tear treated arthroscopically from March 1996 to March 2008. There were 133 males and 96 fe-males, at age of (9±3.5) years (range 4-14 years). The treatment methods included meniscus-plasty in 219 patients (including two children with postoperative recurrence), meniscus-plasty-suture in eight and partial meniscectomy in two. The function of the knees was assessed pre-operationally and post-operation-ally by using Lysholm score. Results Of all, 221 patients were followed up for a period of (65±48.9) months (range 5-144 months). The pain and swelling were alleviated, with obvious improvement in range of motion and knee function in all patients six months after operation. There were no complica-tions including intra-articular infection, iatrogenic injury, fibroarthritis or loss of range of motion. Ly-sholm score was (61.85±7.65) points (range 45-73) before operation, which was improved to (95.30±3.50) points (range 87-100 points) six months after operation (t= 26.778, P < 0.01). Conclusion Treatment of lateral discord meniscus tear under arthroscopic guidance in children has the advantages of minor trauma, satisfactory results, can maintain good shape of the meniscus and good func-tion of knee and reduce incidence rate of osteoarthritis.

Objective To investigate the effects of tagged fluid and substraction in CT virtual colonoscopy (CTVC) on the conspicuity of polyps and to confirm the optimal attenuation value and the optimal viewing window. Methods Polyps measured 3-10 mm were created in fresh porcine colon in vitro and submerged in saline and mixed with positive contrast medium for the CT values of 200 HU, 400 Hu, 600 HU, and 800 HU. Polyps were measured before and after substraction and compared with those in the control group. The effects of different viewing windows and different attenuation values on the measurement and conspicuity of polyps were analyzed. Results The optimal attenuation value of tagged fluid was 800 HU and the optimal viewing window was colon (-150 HU, 1 500 HU) and bone (500 HU, 2 500 HU). Conclusion The combination of tagged fluid and CT substraction can improve the conspicuity of small polyps covered by colonic fluid.

With the approaches of lifecycle, structurizing and prototype applied, the dynamic management subsystem for medical equipment is developed, and thus the management level and economic benefit can be improved.