Great and extensive progress has been made in joint surgery in the last decade. With the evolution of surgical concepts and the development of operational technique and equipment, indications, selective range for surgica l operation and management in the period of perioperation have been surveyed in new perspectives and with deeper insights. This article introduces the situation of joint surgery of China in these years, briefly reviews the latest progresses in the fields of the arthroscopy, the arthroplasty and the joint cartilage repa ration, and thus suggests developmental strategies for Chinese joint surgery in the future.

Objective To assess the predictive and prognostic role of the alteration of serum carcinoembryonic antigen (CEA),squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragment (CYFRA21-1) during chemotherapy in patients with advanced esophageal squamous cell carcinoma (ESCC).Methods The serum levels of CEA,CYFRA21-1 and SCC-Ag were measured in 50 patients with advanced ESCC at baseline and after first line chemotherapy.The data was correlated with objective efficacy and overall survival.To evaluate the role of tumor marker change in predicting response to therapy,receiver operating characteristic (ROC) curves were constructed.Results CEA,SCC-Ag and CYFRA21-1 increased higher than the cutoffs in 22.0 %,34.0 %,and 44.0 % of tested patients,respectively.Statistically significant correlations were observed between CYFRA21-1 and SCC responses and objective efficacy evaluated by RECIST criteria (Z =3.181,2.389; P = 0.001,0.017).Based on the ROG curve analysis,a post treatment 32 % and 38 % increase in serum concentration was used as cut-off level for defining CYFRA21-1 and SCC-Ag change,respectively.When the cut-off levels were used to predict chemotherapy efficacy,the accuracy for CYFRA21-1 and SCC-Ag were 76 % and 70 %.In the univariate survival analysis,a statistically significant prognostic impact on survival from the change of CYFRA21-1 and SCC-Ag was observed.Conclusion CYFRA21-1 and SCC-Ag are useful for diagnosis,predicting chemotherapy objective efficacy and prognosis in advanced ESCC.

BACKGROUND:The main factors that influence revision of acetabular bone defects include evaluation of acetabular bone defects,reconstruction of acetabulum and appropriate acetabular cups used in revision.OBJECTIVE:The review from the three aspects will help to choose an appropriate cup in revision and to formulate the best revision protocols.METHODS:A computer-based online search of PubMed was performed for English articles published from January 1900 to June 2009 with the key words of acetabulum,revision,bone defect,in English and Chinese.Clinical studies published in core periodicals of the latest twenty years were reviewed.Articles regarding primary joint replacement,femoral prosthesis revision and animal experiments were excluded.RESULTS AND CONCLUSION:A total of 61 articles were analyzed,31 were excluded,and 30 mainly published in 5 years,were included.Reconstruction of acetabular bone structure,restoration of original rotation center of hip joint are key factors for repair.Moreover,appropriate prosthesis further benefits the repair effect.Bone transplantation for bone defect and cementedless prosthesis have become favorable methods for revision of acetabular bone defects.

AIM:To explore the surgical effect of total hip joint replacement on the severe degenerative arthritis secondary to congenital hip dysplasia.METHODS:The experiment was carried out in the Department of pedics,General Hospital of Chinese PLA between June 1998 and December 2005.①116 adult patients(128 hips) with arthritis secondary to dysplastic hip received total hip replacement,including 13 males(15 hips) and 113 females(106 hips),aged from 16 to 66 years(average of 42.6 years).According to Crowe classification system,there were 57 cases(60 hips) of typeⅠ,20(23 hips) of typeⅡ,16(20 hips) of type Ⅲ and 23(25 hips) of type Ⅳ.②The acetabula were reconstructed at the true acetabular location.Except one case,all patients were given biological fixation of cementless acetabular cups including 83 hips with routine total hip replacement,and 27 hips with smaller cup;11 hips with routine total hip replacement after granular bone grafting,and 7 hips with a smaller cup after autologous femoral grafting on the superior margin of acetabula.119 biological prostheses were used to reconstruct the femoral cups including 4 common cemented shafts,6 long cemented shafts,and 4 S-ROM prostheses.③Harris hip score was adopted to evaluate the hip function,and X-ray photographs were used to observe the location of prostheses.RESULTS:①The Harris hip scores increased from 38.5 preoperatively to 88.5 postoperatively.②No prosthesis displacement,dislocation of hip joint or repair was found in patients,and the length of treated limbs meanly prolonged by 2.3 cm.Additionally,the incision healed primarily.③Radiographically,the positions of the prostheses were normal,and the bone grafts fused with the host bone successfully.The average bone coverage was 95%(90%-100%);radiolucentline was observed at between the acetabular cup and host acetabula in 2 cases,and 1 at femur.④Adverse effects:Sciatic nerve tension injury was found in 1 case and recovered in 4 months,the femoral nerve tension injury in 1 case and recovered in 3 months,and hip rest pain remained in 4 cases.CONCLUSION:In the treatment of arthritis secondary to dysplastic hip with total hip replacement,it is better to reconstruct the acetabulum at the true acetabular location.Moreover,the individualized appropriate selection of femoral prostheses is a key factor to obtain good curative effects.

BACKGROUND: The intelligence retardation in children refers to hypo-intelligence structure of full intelligence quotient(FIQ) composed of performance intelligence quotient(PIQ) and verbal intelligence quotient (VIQ) . It is verified in some researches that some of compound formulas provide better intervention on it.OBJECTIVE: To observe the effect of yizhi koufuye on intelligence structure in children with intelligence retardation.DESIGN: Homochronous controlled study based on children.SETTING: Pediatric department in a provincial college of traditional Chinese medicine and one provincial rehabilitation center.PARTICIPANTS: The cases were selected in Rehabilitative Central Hospital in Gansu Province and Clinic of the Hospital Affiliated to Gansu College of Traditional Chinese Medicine from January to July 2002. They were 74 students in Fudu Schools in Chenguan District, Lanzhou City, aged varied from 6 to 16 years, diagnosed as intelligence retardation according to CCMD-Ⅱ-R proposed Intelligence Retardation Diagnostic Standards, and they were able to accept medical and training treatment and were absent of congenital hereditary chromosome disorders. Of those, 47 cases were males and 27 cases females. They were divided into treatment group of 33 cases,the control of 20 cases and simple educational training group of 21 cases.METHODS: In treatment group of 33 cases, yizhi koufuye was administrated and was taken 15 mL each time for children younger than 10 years old, 20 mL for those between 10 to 14 years old and 25 mL for those over 14years old. In addition, the special educational training was applied. In the control of 20 cases, oral application of piracetam was prescribed, 0.4 g per time, 3 times a day and the special educational training was applied additionally. In simple educational training group of 21 cases, the children only received special education same as those in treatment group and the control. Three months made one session. Chinese-Wechsler Intelligence Scale for Children (C-WISC) and specific devices were used to assess FIQ and PIQ and VIQ in classified IQ in 3 groups before and after treatments, and the control comparisons were carried on among groups.MAIN OUTCOME MEASURES: Improvement of FIQ and improved values of VIQ and PIQ in 3 groups.RESULTS: Totally 74 cases were selected and no one lost. Improvement of FIQ: In treatment group, there were 44.7±9.8 and 51.8 ± 11.5 before and after treatment respectively, t = 2. 701, P ＜ 0.01; In the control, there were 43.8 ± 14.0 and 51.0 ± 13.6 before and after treatment respectively, t = 1. 680, P ＞ 0. 05; In simple educational training group, there were 41.6 ± 7.8 and 45.2 ± 10.6 before and after treatment respectively, t = 1. 561 and P ＞ 0.05. Improved values of VIQ: It was 8.1 ± 5.5 in treatment group, 5.3 ± 3.9 in the control and 4. 8 ± 4. 8 in simple educational training group. P ＜ 0.05 compared with the results in treatment group. Improved values of PIQ: It was 4.0 ± 3.6 in treatment group and P ＜ 0. 05 compared with 1.7± 2. 2 in the control and simple educational training group. Improving extent of VIQ was 8. 1 ± 5. 5 and of PIQ was 4.0 ± 3.6 in treatment group, P ＜ 0. 01.CONCLUSION: Yizhi koufuye improves markedly FIQ of children with intelligence retardation and for the classified IQ, the improving extent of VIQ is superior to that of PIQ.

Objective: To clone hGLP-1 cDNA in the pBS SK(+/-)vector and construct the expression vector of pGEX-4T-3/hGLP-1cDNA to express GST-hGLP-1 fusion protein. Methods: The hGLP-1 cDNA was constructed by 6 synthetic oligonucleotides fragments, followed by the procedure of annealing and ligation with oligonucleotides fragments. The hGLP-1 cDNA was cloned into the pBS SK(+/-) vector, and was selected by α-complementation. It was confirmed by DNA sequening, then inserted into the MCS of the fusion expression vector pGEX-4T-3. The recombinant vector was transformed into E. coli TG1. Results: The recombinant plasmid DNA was digested with restrictive endonuclease BamHⅠand XhoⅠ. The result demonstrated that the hGLP-1 cDNA was successfully inserted into the pGEX-4T-3 vector and fusion protein GST-hGLP-1 had been expressed in SDS-PAGE. Conclusion： Expression of GST-hGLP-1 fusion protein can provide foundation for obtaining a larger quantity of recombinant hGLP-1 for experimental and clinic studies.

Eight-year-system medical education is a kind of elite education. The object of this education model is to train medical personnel with medical doctorate. Forensic science is a highly practical medical discipline, closely related with the clinical medicine. This paper performs some explorations of the role of forensic science in 8-year-program medical education. Eight-year-program medical education should be combined with the high practicality of forensic science. For the Eight-year-program students, we should focus on cultivating their creative ability, practical ability, and sense of self-protection.

ObjectiveTo investigate the changes of hepatitis B sarfaceantigen (HBsAg) titer in hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogs and pegylated interferon alfa-2a (PEG IFNα-2a) sequential therapy.Methods Among 6 HBeAg positive CHB patients,3 patients were treated with nucleos(t)ide analogs followed by PEG IFNα-2a for 48 weeks,3 patients were treated with nucleos(t)ide analog monotherapy.The serum HBsAg,anti-HBs,HBeAg,anti-HBe andanti-HBcweredetectedusingthetime-resolved immunofluorometric assay and serum hepatitis B virus (HBV) DNA levels were determined by Taqman polymerase chain reaction (PCR) every 12 weeks.Results HBsAg loss were achieved in three patients after 48-week nucleos(t)ide analogs and PEG IFNα-2a sequential therapy.However,the HBsAg titers of another 3 patients varied from 100 IU/mL to 320 IU/mL.ConclusionIn HBeAg positive CHB patients who obtain virologic response accompanied with HBsAg titer decreasing dramatically by nucleos(t) ide analog treatment,PEG IFNα-2a sequential treatment can increase HBsAg clearance rate.

Objective To analyze and evaluate a new acetabular revision component with three wings. Methods The finite-element models of a new acetabular component and acetabulum with bone loss were established to calculate the interface stresses during a normal gait cycle with use of the finite-element formulations. Results The finite-element analysis demonstrated that stress and strain at the interfaces of bone-shell and metal-polyethylene liner had the same direction of change but no remarkable difference between them. In the study, the result indicated increased contact stresses with an increased joint load and orientation. The peak stress was tested at the second stage of gait cycle. The stress of wings increased gradually from rim to root. Its peak stress that was significantly lower than yield force of the Co-Cr alloy was at the joint between the wing and the shell. The stress of graft had the same change rule as the joint force. The part of graft near to acetabular component was subjected to higher stress conditions. Conclusion The hip forces can transfer from acetabular component and implant to acetabulum. The result of the finite-element analysis underlined the importance of wings of the new acetabular component. The wing can help to improve the antitorsion ability of acetabular component and to minimize its aseptic loosening rate. Therefore, based on results of this study and clinical application, the acetabular component with wings is known a viable means for acetabular revision in the presence of bone loss. But further research is needed as to this acetabular component.

OBJECTIVE: To evaluate the histocompatibility of poly (lactic-co-glycolic acid)/RNA Ⅲ inhibiting peptide (PLGNRIP) sustained release microspheres.METHODS: The crude peptide comprising N to C-terminals was synthesized using Fmoc method. The crude synthetic RNAⅢ peptide was purified by reverse phase high performance liquid chromatography, followed by component harvesting according to ultraviolet absorption peak, and freeze-drying. PLGNRIP sustained release microspheres with a diameter of 50-70 pm were prepared using liquid-phase multiple emulsion method. The histocompatibility of PLGNRIP sustained release microscopes were preliminarily evaluated through the use of acute general toxicity test, MTT cytotoxicity test, intramuscular implantation test, sensitivity test, and pyrogen test.RESULTS: Acute general toxicity test results showed that all included animals survived and presented with no toxicosis reaction and obviously changed body mass. MTT cytotoxicity test results revealed that the average relative growth rate of cells from two eluents was over 85%, with cytotoxicity grade 1, which indicated no cytotoxicity. Intramuscular implantation tests showed that at 4 weeks after implantation of RiP powder or PLGNRIP microscopes, no obviously congested, degenerated, or necrotic tissue was observed. All RIP powder and a part PLGNRIP microscopes were degraded. Fibroblasts accounted for a large proportion in all cells. NO inflammatory cell infiltration, involving neutrophits and multinucleated giant celts, was observed. Sensitivity test rasults displayed that the average primary irritation index was 0.38, 0.33, arid 0.31 in the eluent stock solution, 2% dinitoflruorobenzene, and physiological saline-administerd groups, respectively. Pyrogen test results showed that fervescence of each rabbit in the experiment was under 0.5 ℃ and the sum of fervescence was under 1.3 ℃ .This is in coincidence with evaluation criteria of pyrogen test.CONCLUSION: PLGNRIP sustained release microspheras exhibit good histocompatibility.