BACKGROUND: A variety of angiogenic factors are involved in bone healing after osteonecrosis of the femoral head.
OBJECTIVE:To explore the role and mechanism of angiogenic factors in osteonecrosis of the femoral head.
METHODS: A computed-based online search of PubMed, Google and SpringerLink databases was performed using the key words of “angiogenic factors, osteonecrosis of the femoral head, vascular endothelial growth factor, angiopoietin-1, fibroblast growth factor-2, hypoxia inducible factor-1, calcitonin gene related peptide and hypoxia inducible factor-1α” for literatures published from December 1980 to May 2015.
RESULTS AND CONCLUSION:Finaly, 68 articles were included. Bone angiogenesis which is dependent on special signaling factors in the microenvironment is closely linked with bone repair. A variety of cytokines, such as vascular endothelial growth factor, angiopoietin-1, fibroblast growth factor-2, platelet-derived growth factor, calcitonin gene-related peptide, and hypoxia inducible factor-1α, have been identifiedto control angiogenesis in different ways and be involved in the repair of necrotic femoral head.

AIM To establish a quantitative analysis of multi-components by single marker(QAMS) method for the content determination of six catechins in Xinnaojian Capsules (Tablets) (tea extract).METHODS The analysis of 50％ methanol extract of this drug was performed on a 35 ℃ thermostatic Shimadzu Wonda Cract ODS-2 column (4.6 mm ×250 mm,5 μm),with the mobile phase comprising of 0.5％ acetic acid (A)-acetonitrile (B) flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 280 nm.With epigallocatechin gallate as an internal standard,the relative correction factors of epigallocatechin,catechin,epicatechin,gallocatechin gallate and epicatechin gallate were calculated,from which the content determination was made.RESULTS Six constituents showed good linear relationships within their own ranges (r ≥ 0.999 8),whose average recoveries were 96.00％-98.47％ with the RSDs of 2.09％-2.91％.The results obtained by QAMS method approximated those obtained by external standard method.CONCLUSION This simple and reliable method can be used for the quality control of Xinnaojian Capsules (Tablets).

Objective To evaluate the efficacy of dexmedetomidine (DEX) mixed with ropivacaine for transversus abdominis plane block (TAPB) combined with general anesthesia in the patients undergoing laparoscopic colorectal surgery.Methods 58 patients scheduled for laparoscopic colorectal surgery under general anesthesia were randomly divided into 3 groups using a random number table:general anesthesia group (group A n =19),ropivacaine for TAPB group (group B n =20),and Dex mixed ropivacaine for TAPB group(group C n =19).After the end of anesthesia induction,ultrasound-guided bilateral TAPB was performed in B and C groups.20 ml of 0.25％ ropivacaine and 0.5 μg/kg DEX mixed with 0.25％ ropivacaine were injected into each side in groups B and C respectively.Patient controlled intravenous analgesia (PCIA) with sufentanil 100 μg and tropisetron 5 mg in 100 ml of normal saline was provided to all patients after surgery.When the visual analogue scale (VAS) score ≥ 4,tramadol 50-100 mg was intravenously injected as remedial analgesic.VAS scores were measured respectively after extubation and 6,12,24 h after surgery.The consumption of remifentanil during the operation and sufentanil during PCIA,and the number of successfully delivered doses and patients requiring rescue analgesic were recorded within 24 hrs after surgery.The occurrence of TAPB-related adverse events were also recorded.Results Compared with group A,the consumption of reminfentanil during the operation and sufentanil during PCIA,and the amount of successfully delivered doses and patients requiring rescue analgsia within 24hrs after surgery,were decreased in B and C groups (P ＜ 0.05).Furthermore,those numbers in group C are more less than group B in 12-24 hrs after the surgery.There were no significant difference among the three groups in the incidence of adverse reactions (P ＞0.05).TAPB-related complication were not found in B and C groups.Conclusions 0.5 μg/kg DEX mixed with 0.25％ ropivacaine for TAPB combined with general anesthesia can play a better analgesic effect in the patiens urdergoing laparoscopic colorectal surgery.

Objective CD8 +T cells increased in the airway of patients with chronic obstructive pulmonary disease and exis -ted constantly .The aim was to investigate the role of CD 8 +T-cells in rats with chronic bronchitis ( CB) which was induced by cigarette smoking and intratracheal injection with lipopolysaccharide ( LPS) . Methods 18 health Wistar rats were radomly divided into sham smoking group(group A), CB group(group B) and N-acetylcysteine prevention group (group C).The rats in group B and group C re-ceived intratracheal injection with LPS twice and exposed to cigarette smoking for 4 weeks to induce CB model .The rats in Group C re-ceiving intragastric administration with N-acetylcysteine (NAC)(200mg/kg) before received LPS and smoking.Group A was the sham smoking group.The lung tissue of all rats were stained by HE then evaluated about pathological scores .The expression of nuclear fac-tor-κB (NF-κB), major histocompatibility complex class I (MHCI), CD8 +T cell and Vascular endothelial growth factor (VEGF) in airway were detected by immunohistochemisty which was stained by labeled streptavidin biotin method . Results The pathological scores of airway ( 10 .83 ±3 .31 ) in group B were higher than (1.17 ±2.40) in group A(P <0.05).The pathological scores of airway(4.66 ±2.25) in group C were less than (10.83 ±3.31) in group B(P <0.05).The expression of NF-κB(4.84), MHC I (2.48),CD8 +T cell(5.35)and VEGF(5.02) in airway increased in group B when compared with (1.18, 1.25, 1.33) and (1.18) in group A respectively(P <0.05).The expression of NF-κB (2.18), MHC I(1.46),CD8 +(2.35)and VEGF(2.02) in airway decreased in group C when compared with (4.84), MHC I(2.48),CD8 +T cell(5.35)and VEGF(5.02) in group B respectively (P<0.05 ). There were positive correlations between the expression of NF-κB, MHC I and CD8 +T cells in airways(r=0.670, r=0.701, respec-tively, all P<0.01).There were positive correlations between the expression of CD 8 +T cells and VEGF the pathological scores of air-ways(r=0.689, r=0.782, respectively, all P<0.01). Conclusion NAC can inhibit airway inflammation which is regulated by CD8 +T-cells and VEGF through suppressing the expression of NF -κB and MHC I.

BACKGROUND:Intertrochanteric fracture is one of the most common fractures in older adults. The surgical treatment methods include artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw), but there is no clear evidence to evaluate the effect of them. OBJECTIVE: To compare the effect difference of arthroplasty and internal fixation in the treatment of intertrochanteric fracture in the elderly people. METHODS:We retrieved randomized controled studies on artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw) in the treatment of intertrochanteric fracture from 1990 to 2015. Meta-analysis was used to compare operation time, intraoperative bleeding volume, one-year postoperative Harris hip scores, and one-year postoperative complication between the arthroplasty and internal fixation. RESULTS AND CONCLUSION:(1) Twenty-one studies were included. (2) Intraoperative bleeding volume and one-year postoperative Harris hip scores were higher in the arthroplasty group than in the internal fixation group. (3) Operation time was similar between the arthroplasty and internal fixation groups. (4) Complication rate was lower in the arthroplasty group than in the internal fixation group. Incidence of complications was closed between the arthroplasty and internal fixation groups. (5) Results suggested that the effect of arthroplasty was better than internal fixation for treating intertrochanteric fracture in the elderly. However, prospective large-sample long-term randomized controled trials are needed for verification.

BACKGROUND:The pathogenesis of steroid-induced osteonecrosis of the femoral head remains unclear. Femoral head reconstruction after colapse is related to the bone remodeling due to disorder of the bone formation-absorption coupling. “Removing Blood Stasis” Method has been shown to have a positive effect on the disease in clinics. However, the mechanisms by which the “Removing Blood Stasis” Method confers bone repair after osteonecrosis remain poorly understood.
OBJECTIVE:To explore the effect of “Removing Blood Stasis” Method on bone repair in rabbits with steroid-induced femoral head osteonecrosis.
METHODS: Fifty New Zealand rabbits were randomly assigned into three groups: normal control (n=10),
model (n=20) andTaohong Siwu Decoction (n=20) groups, respectively. The steroid-induced osteonecrosis of the femoral head animal models were established by intramuscular injection of endotoxin combined with methylprednisolone (MPS). Rabbits inTaohong Siwu Decoction group were intragastricaly administered with 0.3 g/kg ofTaohong Siwu Decoction suspension after the last injection of methylprednisolone. The control and model groups were administrated by equal volume of ultrapure water for 8 consecutive weeks. High-resolution MRI and pathological determinations were used to assess the successful models. Protein expression levels of ABCB1, RUNX2, OPN, RANK, RANKL, PPAR, osteoprotegerin (OPG), vascular endothelial growth factor (VEGF) in rabbit femoral heads were detected by western blot assay.
RESULTS AND CONCLUSION:(1) Hematoxylin-eosin staining showed that trabecular bone fracture, karyopyknosis, empty lacunae, necrotic bone marrow cels were seen in the model group. Empty lacunae rate in the model group was significantly different from that in the normal control group (P < 0.05). Bone formation was active and kept better trabecular morphology in theTaohong Siwu Decoction group. It suggested that “Removing Blood Stasis” Method can improve repair of necrotic area. (2) In the model group, femoral head with a wide range of low-density areas in high-resolution MRI;Taohong Siwu Decoction group showed the relatively normal shape of the femoral head with smal areas of low density. It suggested that “Removing Blood Stasis” Method can improve image changes in the necrotic area. (3) Protein expression levels of RUNX2, RANK, RANKL were significantly up-regulated but protein expression levels of ABCB1, OPG, VEGF were significantly down-regulated in the model group compared with the normal control group; whereas, they were al significantly up-regulated in theTaohong Siwu Decoction group compared with the model group, except for RANK and RANKL (P < 0.05). These results suggest that the “Removing Blood Stasis” Method can promote bone repair in steroid-induced femoral head osteonecrosis rabbits by regulating protein expressions of ABCB1, RUNX2, RANK, RANKL, OPG, and VEGF.

Objective To evaluate the feasibility and advantages of robot-assisted laparoscopic radical prostatectomy (RALRP) in treating high-risk prostate cancer.Methods From Mar.2010 to Dec.2014,69 men with high-risk prostate cancer (clinical stage ≥ T3a,serum PSA ≥ 20 μg/L or biopsy Gleason score ≥8) underwent surgical treatment at our center.RALRP was performed in 44 cases,with a mean age of (66.7 ± 8.6) yrs (range:50 ～ 82) and a mean baseline PSA of (23.1 ± 11.2) μg/L (range:3.6-48.8).Transperitoneal approach was adopted in all cases.Twenty-five patients were treated with ORP.The mean age was (64.3 ± 5.9) yrs (range:52-75) and baseline PSA was (21.7 ± 10.2) μg/L (range:5.7-41.3).Baseline clinical features,including age,initial PSA,biopsy Gleason score and clinical staging,were comparable between two cohorts.Surgical outcomes after RALRP were analyzed and compared between groups.Results All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.Mean operation duration were similarly (158 ± 47)min for RALRP group and (152± 42)min for ORP group,respectively.The mean estimated blood loss and postoperative length of hospital stay in RALRP group were (328 ± 254) ml and (8.4 ± 3.1) days,both of which were significant lower than those in ORP group,(674 ± 302) ml and (14.4 ± 3.7) days.Two cases of urine leak and two of lymphatic leak occurred after RALRP,and a statistically insignificantly higher complication rate was observed for the ORP group,in which four of urine leak and three of lymphatic leak happened.The positive surgical margin rates of two groups were 20.5％ and 24％,respectively.After the mean follow-up of 25 (RALRP) and 27 months (ORP),continence rate was significantly higher in the RARLP group (93.2％ vs.72.0％).PSA failure was observed in seven RALRP cases (15.9％) and four ORP cases (16.0％).Conclusion Compared with traditional ORP,RALRP shows significant advantages,including less blood loss,fewer complications,shorter length of stay,better postoperative continence and equivalent oncologic outcome when dealing with high-risk prostate cancer cases.Robot-assisted surgery is a safe and efficacious surgical modality in this setting.

BACKGROUND:At present, finite element analysis technology can set up the model, predict diagnosis, treatment design, as wel as surgical plan, and can be used in the treatment of necrosis of femoral head. OBJECTIVE:To sum and discuss recent progress in clinical and experimental research regarding biomechanical study in osteonecrosis of femoral head by using finite element analysis. METHODS:A computer-based retrieval was performed by the authors (Hong Guo-ju and Zhou Guang-quan) in PubMed, Google, SpringerLink, ChinaNational Knowledge Infrastructure databases for literatures published from January 2010 to December 2015. The key words were“(finite element analysis OR finite element) AND (osteonecrosis OR osteonecrosis of femoral head)”. Inclusive criteria:studies with contents closely related to this paper;original papers with reliable topics and evidence;or papers with clear points and al-round analysis and both studies in vitro and in vivo. RESULTS AND CONCLUSION:A total of 27 studies were included. The articles in the latest five years related to femoral head osteonecrosis and finite element analysis application were concentrated on. We summarized the latest research progress and problems, including the applied research carried out in the femoral head osteonecrosis clinical cases, innovational skil s, so as to point out the direction of future research in the finite element analysis.

BACKGROUND: Osteonecrosis of the femoral head (ONFH) following internal fixation of femoral neck fractures is difficult to be cured in clinic.OBJECTIVE: To analyze the literatures concerning ONFH in patients with femoral neck fractures treated with screw internal fixation in recent 15 years, and to summarize the research progress in views of epidemiology, etiology, diagnosis,treatment and rehabilitation.METHODS: Databases of CNKI, WanFang, CqVip, PubMed, Medline, Web of Science were searched with the keywords of femoral neck fracture, osteonecrosis of femoral head, osteonecrosis, internal fixation, internal fixation with screw in English and Chinese, respectively. Afterwards, the reviews and case reports were excluded. RESULTS AND CONCLUSION: (1) A total of 54 eligible articles addressing the ONFH following internal fixation for femoral neck fractures were included, and the incidence of ONFH varied from 8.1% to 37.2%, which was found at an average of 17 months after injury. (2) ONFH was found to be related to age, preoperative fracture displacement, preoperative traction,reduction condition, time from injury to operation, elderly patients companied with other diseases, older patients undergoing removal of the screws, closed or open internal fixation, restored time postoperatively, high body mass index, hyperlipidemia, season, and depression. (3) Early prevention and remedial surgery were used to treat ONFH. (4) The patients without weight-bearing activities at 3-6 months postoperatively could be beneficial for functional recovery. (5) These results suggest that choosing appropriate surgical programs and rehabilitation plan can reduce the incidence of ONFH and achieve good treatment outcomes, such as reasonable preoperative planning, standardized operation skills, correct diagnosis and treatment, proper postoperative rehabilitation and good doctor-patient cooperation.

OBJECTIVE:To establish the method for contents determination of catechins active components in lipid-lowering slimming health products. METHODS:HPLC method was adopted. Using epigallocatechin gallate(EGCG)as a reference,relative correction factor(RCF)of EGCG to gallocatechin(EGC),catechin(C),epicatechin(EC),gallocatechin gallate(GCG)and gal-loylepicatechin(ECG)were calculated. The contents of EGC,C,EC,GCG and ECG in 5 batches of samples were calculated through RCF. The contents of EGC,C,EC,GCG and ECG determined by external standard method were used as measured value. The similarity of the value determined by external standard method with the value calculated by quantitative analysis of multi-com-ponents via single marker method(QAMS)was evaluated with vector included angle cosine method. RESULTS:The linear ranges of EGCG,EGC,C,EC,GCG and ECG were 0.0065-0.1305 mg/mL(r=0.9998)、0.0005-0.0107 mg/mL(r=0.9997)、0.0020-0.0400 mg/mL(r=0.9999)、0.0153-0.3053 mg/mL(r=0.9998)、0.0008-0.0155 mg/mL(r=0.9998)、0.0040-0.0792 mg/mL (r=0.9999);RSDs of precision,stability and reproducibility tests were all lower than 2.0%.The recoveries were 95.07%-100.35%(RSD=1.94%,n=6)、95.24%-101.87%(RSD=2.79%,n=6)、96.08%-103.86%(RSD=3.01%,n=6)、97.51%-101.06%(RSD=1.45%,n=6)、96.01%-101.66%(RSD=2.27%,n=6)、96.20%-102.89%(RSD=2.71%,n=6),respectively. There was no signifi-cant difference between measured value and calculated value. CONCLUSIONS:The method is simple,precise,stable and repro-ducible,and can be used for contents determination of catechins active components in lipid-lowering slimming health products.