OBJECTIVETo explore clinical significance of rotational axis of distal femur on Chinese adults in total knee arthroplasty (TKA).

METHODSThere were 86 Chinese adults (106 normal knees) including 47 males (53 knees) and 39 females (53 knees), 54 knees were on left and 52 on right. The CT scan was employed in the distal femur. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the femoral. The CT images of cross sections across lateral and medial femoral epicondyle were moved to personal computer,lateral angle between anterior posterior line (APL) and surgical transepicondylar axis (STEA) (ATA),lateral angle between posterior condylar line (PCL) and APL (APA), angle between perpendicularity of APL and PCL (A-PA), posterior condylar angle (PCA), condylar twist angle (CTA), angle between clinical transepicondylar axis (CTEA) and STEA (CSA) were measured. These values were divided into different groups according to gender and side, the values of CTA, PCA, A-PA, angle PT (varus of tibia plateau), constant 3, ATA, APA and constant 90° were compared by statistically. A-PA and PCA, and CTA were analysed statistically with the liner regression, the relationship among CTEA, STEA ,PCL, APL and PLP were performed to assess by liner regression.

RESULTSATA was (89.79 ± 1.22)°, APA was (84.84 ± 1.83)°, A-PA was (5.16 ± 1.83)°, PCA was (4.80 ± 1.23)°, CTA was (8.23 ± 1.40), CSA was (3.45 ± 0.68)°. All the parameters had no differences on sex and side,but CSA had difference on male and female. There was no difference among angle PT, PCA, A-PA. There was significant difference in CAT, constant 30 and angle PT, PCA,A-PA. There was no difference between ATA and constant 90°, but there was difference between APA and constant 90°. There was relativity between PCA and CTA, and also PCA and A-PA, CTA and A-PA. There was significant relativity between STEA and CTEA, between STEA and APL, between STEA and PCL, and also between APLP, APL and PCL, but there was no significant relativity between PCL and CTEA.

CONCLUSIONTKA for Chinese, the section of femoral posterior condyle should be external 5° to obtain the optimum rotational orientation. The property is different entirely between STEA and CTEA, the rotational alignment is not performed according to parallel to the CTEA in distal femur. Among STEA, APL, PCL, the STEA is the most reliable mark ofrotational alignment of the distal femur, and the PCL is the less reliable mark.

Adult ; Arthroplasty, Replacement, Knee ; Female ; Femur ; anatomy & histology ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Rotation ; Tomography, X-Ray Computed

BACKGROUNDIt is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD.

METHODSFrom January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221) of the cohort. All these patients were divided into two groups: CE + CABG group (Group A) and CABG alone group (Group B). All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively.

RESULTSDiabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38), which was more often than that in Group B (3/183). At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50). There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention.

CONCLUSIONSCoronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

Aged ; Coronary Artery Bypass ; adverse effects ; methods ; Coronary Artery Disease ; surgery ; Endarterectomy ; methods ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; surgery ; Postoperative Complications ; Treatment Outcome

OBJECTIVETo study the pathological change of rats' benign hyperplastic prostate (BHP) after radical denervation.

METHODSA total of 65 male spontaneous hypertension rats (SHR) at 30 weeks age were randomly assigned into treatment group, sham surgery control group and normal control group. In surgery group, all the axonal branches of the major pelvic ganglion (MPG) supplying the bilateral prostate were truncated, followed performing of cystostomy; In sham surgery control group, only cystostomy was performed; In normal control group, no procedure was performed. The rats were sacrificed at 3, 7, 11, 15 and >or= 21 d post-operation respectively. The gross morphological changes of prostate in all animals were observed.

RESULTSIn treatment group, the prostate in 3 d post-operation showed granular solidification and shrunken volume and the changes occurred gradually over time. The glandular epithelial cells showed gradual degeneration, necrosis and detachment. The glandular epithelium became progressively thinner, the smooth muscles elongated and thinned progressively and the stromal components showed mild to moderate overgrowth. At the later stage, the glandular epithelium, glandular lumen and smooth muscles gradually disappeared and the prostate was largely replaced by connective tissues. Electron microscopic study showed that the glandular cells gradually underwent vacuolar degeneration and the structures of basement membrane became fuzzy. The smooth muscles cells degenerated overtime and the fibroblasts and collagenous fibers in the stroma overgrew slowly. At the late stage, most of the glandular cells became necrotic, the basal membrane and smooth muscle cells disappeared and collagenous fibers were highly hyperplasic. In surgery group in 3 d post-operation, the S-100 staining of nerve fiber was diffuse and disappeared after 11 d while it persisted normally in other groups. The two values in sham surgery control group showed no significant changes post-operatively.

CONCLUSIONSAfter radical denervation, the rat prostate with benign hyperplasia (gland and smooth muscles) undergoes dramatic atrophic changes and the volume decreases significantly. It suggests that this treatment may represent a novel therapy for BPH.

Animals ; Denervation ; methods ; Disease Models, Animal ; Male ; Microscopy, Electron, Transmission ; Prostate ; innervation ; pathology ; ultrastructure ; Prostatic Hyperplasia ; pathology ; surgery ; Random Allocation ; Rats ; Rats, Inbred SHR

OBJECTIVE: To observe the expression of discs large homolog 4 (DLG4) protein in hippocampus, amygdala and frontal cortex of rats and evaluate postsynaptic density in heroin dependence. METHODS: The rat heroin dependent model was established by increasing intraperitoneal injection of heroin. DLG4 proteins in hippocampus, amygdala and frontal cortex of heroin dependent 9, 18, 36 days rats were detected with immunohistochemical staining and compared with that in the control group. RESULTS: DLG4 proteins in hippocampus, amygdala and frontal cortex were gradually reduced with extension of heroin dependent time. CONCLUSION Heroin dependence can affect postsynaptic density of hippocampus, amygdala and frontal cortex. The changes become more apparent with extension of heroin dependence time.
Amygdala/metabolism* ; Animals ; Disks Large Homolog 4 Protein ; Frontal Lobe/metabolism* ; Heroin/pharmacology* ; Heroin Dependence ; Hippocampus/metabolism* ; Injections, Intraperitoneal ; Intracellular Signaling Peptides and Proteins/metabolism* ; Membrane Proteins/metabolism* ; Rats

OBJECTIVETo discuss the surgical treatment of the giant aneurysms of middle cerebral artery.

METHODSClinical data, surgical methods and outcomes were analyzed in 17 giant aneurysms of middle cerebral artery treated from January 2001 to March 2008. CT scan, CTA, MRA, DSA and 3D-DSA were performed before operations so that we could comprehend the location, size, and shape of aneurysms and compensatory circulation of collateral branches to design the individualized treatment options. All patients had been surgically treated mostly by modified pterional approach, of which, direct clipping of the aneurysms was accomplished in 4 patients, aneurysms trapping or removal after trapping in 4, aneurysms excision or trapping combined with vessels reconstruction in 7, and aneurysms wrapping in 2 cases.

RESULTSCT and MRI revealed the shape and size of aneurysms clearly, while DSA and 3D-DSA could demonstrate the aneurysm's neck and relationship with the adjacent structure. Postoperative neurological function was evaluated according to Glasgow Outcome Scale when patients were discharged. Twelve patients had excellent neurological outcomes. However 4 patients were moderately disabled and one were severely disabled. No patient was dead postoperatively.

CONCLUSIONSIt is necessary to perform elaborate imaging before operations for individualized surgical planning. The temporary occlusion of the parent artery and elimination of intra-aneurysmal thrombus are helpful to clipping the aneurysmal neck. Vessels reconstruction is a new and effective method of treating the giant aneurysms of middle cerebral artery.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; diagnosis ; surgery ; Male ; Middle Aged ; Middle Cerebral Artery ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo Evaluate four kits for screening HIV antibody by comparing and analyzing the HIV antibody screening positive results and Western Blot (WB) test results.

METHODSFrom January 2004 to June 2009, three ELISA kits (Zhongshan, Biomérieux and Livzon) were used for initial screening HIV antibody. The reactive positive samples were reexamed by initial ELISA kit and a rapid kit (Abbot Determine HIV-1/2). All repeatedly reactive positive screening results were followed by WB test.

RESULTSA total of 193 (0.094%) WB confirmed positive results were obtained from 206 151 specimens. The sensitivities and predictive values of negative test result (PVN) of three ELISA kits were all 100% and those of Abbot Determine HIV-1/2 were 93.93%, and 91.67% respectively. All false negative results from Abbot were WB indeterminate. The specificities of Zhongshan, Biomérieux, Livzon and Abbot were 99.88%, 99.89%, 99.96% and 89.38%; the study predictive values of a positive test result (PVP) were 35.58%, 46.46%, 76.61% and 92.20%; the efficiencies were 99.88%, 99.89%, 99.96% and 91.98%; the areas under ROC curve of the three ELISA kits were 0.93, 0.99, and 0.95 respectively. PVP of Livzon was obviously higher than those of Zhongshan (chi(2) = 45.804, P = 0.000), Biomérieux (chi(2) = 25.231, P = 0.000) and Biomérieux was higher than Zhongshan (chi(2) = 2.488, P = 0.115). PVP of Abbot was highest (chi(2) = 18.633, P = 0.000, vs Livzon). There were some specimens with S/CO (optical density of sample/cut off) ratio < 6 or > or = 6 in all three groups with positive, indeterminate and negative WB results. The S/CO ratio from Zhongshan in confirmed positive group (14.29 + or - 2.63) was higher than in positive-negative group (2.80 + or - 3.25) (t = 17.652, P = 0.000). The S/CO ratio from Biomérieux in confirmed positive group(16.09 + or - 2.35) was higher than in positive-negative group (2.14 + or - 1.91) (t = 31.622, P = 0.000). The S/CO ratio from Livzon in confirmed positive group (11.54 + or - 1.95) was higher than in positive-indeterminate group (5.54 + or - 3.57) (t = 6.386, P = 0.000), positive-negative group (3.25 + or - 2.41) (t = 21.772, P = 0.000) and positive-indeterminate group was higher than positive-negative group (t = 2.301, P = 0.033).

CONCLUSIONThe performances of four HIV antibody screening kits are good but estimating WB confirming result in line with S/CO ratio is not available. All repeated screening positive results should be followed by confirmatory tests.

AIDS Serodiagnosis ; methods ; Blotting, Western ; methods ; Enzyme-Linked Immunosorbent Assay ; methods ; statistics & numerical data ; HIV Antibodies ; blood ; HIV Seropositivity ; diagnosis ; Humans ; Indicators and Reagents ; Mass Screening ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

Aged ; Female ; Femoral Neck Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome

BACKGROUNDMinimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.

METHODSThirty catechumen, included 17 attending physicians and 13 associate chief physicians, were selected for study. The trainees first underwent 1-hour basic training to get familiar with the instrument and basic procedures, then followed by 4-hour practice on virtual reality simulators. Before and after the 4-hour training, all trainees undertake an assessment with task 7 program (right low pole calyces stone management). We documented for each trainee the total time of procedure, time of progressing from the orifice to stone, stone translocation and fragmentation time, laser operate proficiency scale, total laser energy, maximal size of residual stone fragments, number of trauma from the scopes and tools, damage to the scope and global rating scale (GRS). The proficiency of this training program was analyzed by the comparison of the first and second assessment outcomes.

RESULTSSignificant improvement was observed in retrograde flexible ureteroscopy management of renal stone on virtual reality simulators after finishing the 4 hour special-purpose training. This was demonstrated by improvement in total procedure time ((18.37±2.59) minutes vs. (38.67±1.94) minutes), progressing time from the orifice to stone ((4.00±1.08) minutes vs. (13.80±2.01) minutes), time of stone translocation ((1.80±0.71) minutes vs. (6.57±1.01) minutes), fragmentation time ((4.43±1.25) minutes vs. (13.53±1.46) minutes), laser operate proficiency scale (8.47±0.73 vs. 3.77±0.77), total laser energy ((3231.6±401.4) W vs. (5329.8±448.9) W), maximal size of residual stone fragments ((2.66±0.39) mm vs. (5.77±0.63) mm), number of trauma from the scopes and tools (3.27±1.01 vs. 10.37±3.02), damage to the scope (0 vs. 0.97±0.76) and GRS (29.27±2.95 vs. 9.87±2.21). The differences between the first and the second assessment were all statistically significant (all P < 0.01).

CONCLUSIONThe virtual reality simulator training program can help the trainees to rapidly improve their retrograde flexible ureteroscopy skill in renal stone treatment.

Adult ; Computer Simulation ; Humans ; Kidney Calculi ; Male ; Ureteroscopy ; education ; Urology ; education

OBJECTIVETo observe changes of plasma polypeptide hormone levels in rats with gastric ulcer after exposure to intense noise, and to discuss their mechanism.

METHODS80 Wistar rats were used in the study. Plasma levels of rat gastrin (GAS), motilin (MTL), osteocalcin (BGP), substance P (SP), neurotensin (NT) and somatostatin (SS) in rats were measured by radioimmunoassay.

RESULTS(1) In non-noise-exposure but with gastric ulcer group, the plasma MTL [(160.70 +/- 40.34) pg/ml] and BGP [(27.63 +/- 13.13) pg/ml] levels on 10 d after gastric ulcer model operation were remarkably higher than those in control group [(89.21 +/- 49.94) pg/ml, (9.10 +/- 1.38) pg/ml respectively] (P < 0.05 and P < 0.01), while the GAS level was remarkably descended [(107.00 +/- 21.75) vs (158.48 +/- 20.92) pg/ml] (P < 0.01). (2) In noise-exposure but without gastric ulcer group, the plasma MTL [(312.80 +/- 207.42) pg/ml] and BGP [(17.76 +/- 12.33) pg/ml] levels on 10 d were also significantly increased as compared with the control group (P < 0.01 and P < 0.05 respectively), while the GAS levels didn't change. (3) In noise-exposure + gastric ulcer group, the areas of gastric ulcer on 10 d and 40 d after noise and operation [(15.33 +/- 7.26) and (15.11 +/- 12.45) mm(2) respectively] were significantly larger than those of the control [(8.22 +/- 6.66), (3.67 +/- 9.90) mm(2)] (P < 0.05). The plasma MTL levels on 10 d and 40 d [(244.44 +/- 68.11) and (191.20 +/- 60.50) pg/ml respectively] were higher than those in control group [(160.70 +/- 40.34) and (93.10 +/- 52.90) pg/ml respectively] (P < 0.01).

CONCLUSIONIntense noise exposure may make the rat gastric ulcer worsened and induce negative effect on healing of it. The gastrointestinal endocrine would be disturbed by combined effect of intense noise exposure with gastric ulcer in rats.

Animals ; Male ; Noise ; Peptides ; blood ; Rats ; Rats, Wistar ; Stomach Ulcer ; blood ; etiology

OBJECTIVETo investigate the differential expression of the hyaluronic acid synthase (HAS) family in human bladder transitional cell carcinoma (BTCC) and its potential clinical significance.

METHODSThe relative quantitative detection of the expression of HAS isoforms (HASs) was performed in 78 human BTCC tissues (mRNA & protein) and 12 normal human bladder mucosa (protein) by real-time RT-PCR and Western blot, and the results were statistically analyzed according to the clinical data.

RESULTSAll the BTCC tissues expressed three HAS isoform mRNA and protein, but to a different extent, as for mRNA, HAS3 > HAS2 > HAS1 (P < 0.001), with a significant difference in HAS1/HAS2, HAS1/HAS3 and HAS2/HAS3 (P = 0.003, < 0.001, 0.006, respectively). Among the proteins, the HAS2 expression was the highest, with a significant difference in HAS1/HAS2, and HAS2/HAS3 (P = 0.004, 0.001, respectively), but not in HAS1/HAS3. The elevation of HAS1 mRNA and protein expression was significantly related with the tumor malignancy, tumor initial onset/recurrence, T1/T2 and T1/T3-4 stags, and tumor grading (P = 0.02, < 0.001, 0.038, < 0.001; 0.025, 0.031, 0.023, 0.002; respectively). The HAS2 mRNA expression was significantly related with tumor size (diameter ≤ 3.0 cm/> 3.0 cm), tumor number (single or multiple), tumor initial onset/recurrence, T-staging, and histopathological differentiation (low grade/high grade) (P = 0.012, 0.004, < 0.001, < 0.001, < 0.001, respectively), but its protein expression was not significantly different in all subgroups except with the tumor size (mass diameter > 3.0 cm/≤ 3.0 cm). However, HAS3 mRNA and protein expression had no significant difference among all the subgroups. In normal human bladder mucosa, no HAS expressions were detected.

CONCLUSIONSThe abnormally high expression of the HASs further indicate the reliability of hyaluronan as a urinary marker for human BTCC. Compared with HAS1 and HAS3, HAS2 as a marker may have more usefulness in studies on human BTCC carcinogenesis or development. The high expression of HAS1 protein seems to play a more important role in the BTCC tumorigenesis, and may indicate a poor prognosis of the BTCC patients.

Biomarkers, Tumor ; Blotting, Western ; Carcinoma, Transitional Cell ; genetics ; metabolism ; Glucuronosyltransferase ; metabolism ; Humans ; Hyaluronan Synthases ; Hyaluronic Acid ; metabolism ; Neoplasm Recurrence, Local ; RNA, Messenger ; biosynthesis ; Reproducibility of Results ; Urinary Bladder Neoplasms ; genetics ; metabolism