Objective To investigate the treatment of perinail refracture after surgery of proximal femoral fracture.Methods From January 2010 to January 2015,we treated perinail fractures in 31 patients who had undergone surgery for proximal femoral fracture.They were 11 men and 20 women,with an average age of 75.6 years (range,from 24 to 87 years).On average,their refracture occurred 9.4 months after primary fixation (range,from 3 to 60 months).With reference to the Vancouver classification of peri-prosthestic refractures in the proximal femur and the position and bone quality of perinail refractures,we tried to classify the perinail fractures and chose different treatment protocols accordingly.In our cohort,6 were type A,5 type B,15 type C,and 5 type D.Type A cases were treated conservatively,and types B and C cases with locking compression plate or less invasive stabilization system.In one case of type D,dynamic hip screws were implanted to fixate the femoral neck fracture after removal of the original intramedullary nail,and hip replacement was conducted in the other 4 after removal of the original intramedullary nail.Results The operation time averaged 2.1 hours (range,from 1.6 to 3.0 hours) and intraoperative bleeding 600 mL (range,from 150 to 800 mL) in this cohort.Of them,27 were followed up for an average of 15 months (range,from 12 to 24 months),giving a follow-up rate of 87.1％ (27/31).Six type A fractures obtained bone union after protected weight-bearing walking for 12 weeks.All the 16 fractures of types B and C healed after an average period of 4.2 months (range,from 3 to 6 months).Of the 5 type D fractures,one obtained bone union 12 weeks after change into dynamic hip screwing and 4 had fine functional recovery after hip replacement.No infection,nonunion,or implants failure occurred.Conclusions We have set an exploratory classification system for the perinail refractures at the proximal femur with reference to the Vancouver classification of peri-prosthestic refractures.Our classification can provide effective guidance for the treatment of perinail refracture after surgery of proximal femoral fracture.

ObjectiveThe possibility of the hyperplasi a of prostatic outer gland was studied with transrectal ultrasound (TRUS) guided biopsies. MethodsTwenty-seven prostatic outer glands in patients suspicious for prostatic cancer (PCA) were biopsied by TRUS guided, the total sites were 47. The same site was biopsied in sagittal and longitudinal section respectively. The hypoechoic lesion was biopsied 2 times if it was discovered in the outer gland. The histological results were diagnosed in double blind. Results Twenty prostatic inner glands looked symmetrical hyperplasia; 9 outer glands became thin because of the compression, there was no compressive sign in 18 patients; there was a hypoechoic lesion in outer gland of 3 patients. Benign prostatic hyperplasia was diagnosed in the specimens of 47 sites. ConclusionsThe hyperplasia of prostatic outer gland can occur like inner gland because it is glandular tissue.

Objective To evaluate the clinical value of repeat transrectal ultrasound (TRUS) guided biopsy in prostatic cancer (PCA). Methods Repeat TRUS guided biopsy was conducted on 54 patients of the previous benign TRUS guided biopsy at high risk of PCA. Postatic specific antigen ranged in 0.5- 90.0 ?g/L(mean 16.3 ?g/L). Twenty-nine patients were abnormal in digital rectal examination, 21 patients were abnormal in TRUS. Results Forty-seven patients had 2 consecutive times of the biopsy, 6 patients had 3 consecutive times, 1 patient had 4 consecutive times in 54 patients of repeat TRUS guided biopsy. The pathological finding was confirmed in 14 PCA ( 25.9%), and 31 benign prostatic hyperplasia, 5 prostatic intra-epithelial neoplasmia, 4 chronic prostatitis. Conclusions The detection of PCA will be increased by repeat TRUS guided biopsy at high risk of PCA after the previous benign TRUS guided biopsy.

Objective To study the characteristic of the hyperplasia hypoechoic nodules in outer gland of prostate with transrectal ultrasound (TRUS) guided biopsies. Methods 42 patients were suspected of prostatic cancer (PCa) for the existence of hypoechoic nodules in their outer glands of prostate. Each nodule was TRUS guided biopsied in sagittal and longitudinal section, respectively. The histological examinations were performed in double blind. Results Among the 42 patients, there were 22 cases of benign prostate hyperplasia (52.4%) and 20 cases of prostate cancer (47.6%). Conclusions The sonographic findings of the hypoechoic nodules in outer glands included not only PCa, but also benign hyperplasia nodules. Therefore, the definitive diagnosis must dependent on pathologic examinations.

BackgroundBoth accommodative abnormality and higher order wavefront aberrations associated with near work are interrelated with blurry retinal image.It is very important to investigate the higher order wavefront aberrations in stable and progressive myopic eyes before and after near work. ObjectiveThe present study wasto observe the high order aberration change of myopic eyes before and after computer work upon near work stimulation as well as the relationship of high order aberration changes to types of myopia. MethodsThe case-controlled design was used in this clinical study.Sixty right eyes of 60 subjects were enrolled,including 30 progressive myopias and 30 stable myopias with matched age and gender.Refractive errors of the subjects were completely corrected by the wearing of spectacles.The subjects remained the work for 1 hour in front of a computer monitor with 40 cm distance under the dark environment and nature pupil size,and the height of the eye and monitor center kept the same level.The changes of wavefront aberration in test eyes were measured with Complete Ophthalmic Analysis System before and after 1 hour of continuous computer work.The influences of computer-work and myopia types on wavefront aberration were analyzed in 3,4,5 mm pupil size.Root-mean-square (RMS) of aberrations was calculated as the index of higher order wavefront aberrations.ResultsThere were no significant differences in the higher order wavefront aberrations before and after computer work for the two types of myopic eyes under the 3,4,5 mm pupil.The RMS of higher order wavefront aberrations were similar between progressive myopia and stable myopia under the 3 mm pupil condition.Total higher order RMS,6th-order,5th-order and 3rd-order RMS were significantly higher in progressive myopic group compared with stable myopic group under the 4 mm pupil size ( RMS3:F =5.985,P =0.016 ; RMS5:F =3.975,p=0.049;RMS6:F=8.130,P=0.005:RMST:F=6.493,P=0.012) and 5mm pupil size(RMS3:F=13.132,P=0.000;RMS5:F =4.032,P=0.047 ; RMS6:F =4.393,P=0.038:RMST:F=10.508,P=0.002 ).The spherical aberrations were higher in progressive myopic group under the 3,4,5 mm pupil conditions in comparison with stable myopic group,but these alterations were insignificant between two types of myopias ( P＞0.05 ).Conclusions Higher order wavefront aberrations of progressive myopic eyes is comparable higher than the stable myopic eyes.Computer reading task dose not significantly impact the higher order wavefront aberrations on myopic eyes.

Background Aberrant proliferation of residual lens epithelial cells (LECs) is one of main causes of posterior capsular opacification (PCO).Researches indicated that Wnt3a signaling pathway promote proliferation of epithelial cells,but its effect on LECs is still unclear. Objective The present study was to investigate the effects of Wnt3a on proliferation of human LECs and its mechanism and to provide a new gene target in the prevention and treatment of PCO. Methods Human LECs line (SRA01/04 cells ) was cultured and then incubated to 6-well plate at the density of 4×105/well.A human Wnt3a cDNA expressing vector targeted human LECs was constructed to increase the Wnt3a expression in SRA01/04 cells,and pcDNA3-HA expression vector was used as the control group.The expression of Wnt3a was identified by Western blot assay after transfected.The growth and proliferation of SRA01/04 cells were detected by MTT and flow cytometry (FCM).The expressions of β-catenin,cyclin D1 and c-myc in the cells were detected by Western blot assay.β-Catenin expression was localized using immunofluorescence assay,and the expression and localization of proliferating cell nuclear antigen ( PCNA ) were analyzed by immunocytochemistry for the exploration of the active mechanism of Wnt3a to proliferation of LECs.Results Human Wnt3a cDNA expression vector was designed successfully and transiently transfected to SRA01/04 cells,and Wnt3a/SRA01/04 cells and pcDNA3-HA/SRA01/04 cells were obtained.The expression of Wnt3a was verified in the Wnt3a transfected group compared with the control group.MTT indicated that the cell proliferating rate was significantly different between the Wnt3a transfected group and the control group ( Fgroup =15.235,P =0.005 ;Ftime =369.677,P =0.000),and that in various time points after transfected was significantly different (t =20.843,P=0.001 ;t =26.214,P＜0.001 ;t=25.177,P=0.001 ;t =35.516,P＜0.001 ;t =615.056,P＜0.001 ).The proportion of SRA01/04 cells in G1 phase was 51.74％ in the Wnt3a cDNA transfected group,with a significantly decrease in comparison with 79.44％ of the control group.However,the proportion of SRA01/04 cells in S phase in the Wnt3a cDNA transfected group was higher than that of the control group (36.23％ versus 12.34％ ).The positive expression rate of PCNA protein in SRA01/04 was (47.00％ ±7.58％ ) in the Wnt3a cDNA transfected group and ( 16.00％ ±3.61％ ) in the control group with a significant difference between them (t =8.256,P＜0.01 ).After 48 hours of transfection of the Wnt3a cDNA,the expression amount of β-catenin proteins was higher and the immunofluorescence was stronger in cell nucleus,and the expressions of cyclin D1 and c-myc proteins were elevated in Wnt3a/SRA01/04 cells. Conclusions The overexpression of Wnt3a activates the Wnt/β-catenin signaling pathway and downregulates the expression of a subset of target genes,including cyclin D1 and c-myc,which plays an important role in promoting the proliferation of human LECs.

OBJECTIVETo evaluate digital rectal examination (DRE) , transrectal ultrasonography (TRUS) , free/total (f-PSA/ t-PSA) prostate-specific antigen (PSA), and PSA density (PSAD) in the diagnosis of prostate cancer (PCa) in patients with PSA < or = 4.0 microg/L.

METHODSBetween April 1996 and December 2012, a total of 343 subjects, aged 30 -91 years, with PSA < or =4.0 microg/L and abnormal findings on DRE or TRUS underwent prostatic biopsy. Based on the levels of PSA, the subjects were divided into four groups: 0 -1.0, 1.1 -2. 0, 2.1 -3. 0, and 3.1 -4.0 microg/L. The diagnostic values of DRE, TRUS, f-PSA/t-PSA, and PSAD were assessed in those with different PSA levels. According to the age, the subjects were again divided into five groups: C49 yr, 50 -59 yr, 60 -69 yr, 70 -79 yr, and > 80 yr. The rates of PCa detection in relation to PSA levels were estimated in different age groups.

RESULTSOf the 343 subjects, 65 (19.0% ) were diagnosed with PCa, with detection rates of 16.28% (21/129) , 17. 17% (17/99), 21.82% (12/55), and 25.00% (15/60) in those with the PSA levels of 0 -1.0, 1.1 -2.0, 2.1 -3.0, and 3.1 -4.0 microg/L, respectively. There were statistically significant differences in f-PSA/t-PSA between the PCa patients and non-PCa subjects with the PSA level > 2.0 microg/L (P <0.05) , but not with the PSA level < or =2.0 microg/L (P > 0.05) , nor did PSAD show any significant difference between the PCa and non-PCa groups ([0.09+/-0. 16] versus [0. 06 +/- 0. 07] micro/L/ml, P > 0. 05). The rate of cancer detection rose -with the elevation of the PSA level, but had no statistically significant difference among different age groups (P >0.05).

CONCLUSIONPSA 2.1 -4.0 microg/L with abnormal DRE and TRUS findings should be considered as a warning signal, which requires regular follow-up and PSA detection. With f-PSA/t-PSA <0. 15 with or without abnormal DRE and TRUS findings, routine prostate biopsy should be performed. PCa diagnosis cannot be effectively established by DRE, TRUS, f-PSA/t-PSA, and PSAD in those with PSA < or = 2.0 microg/L.

Adult ; Aged ; Aged, 80 and over ; Biopsy ; Humans ; Male ; Middle Aged ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; pathology

Adult ; Altitude ; Asian Continental Ancestry Group ; genetics ; Female ; Humans ; Janus Kinase 2 ; genetics ; Male ; Middle Aged ; Mutation ; Polycythemia ; diagnosis ; ethnology ; genetics

Objective To evaluate anesthesia efficacy of sevoflurane combined midazolam and remifentanil and propofol in patients undergoing short surgery. Methods Fifty ASA Ⅰ or Ⅱ patients who scheduled for elective surgery under general anesthesia were enrolled in study. The anesthesia was induced with intravenous injection of midazolam 0.03 mg/kg and sevoflurane inhalation. Induction of anesthesia was started with 6% sevoflurane and fresh gas flow rate of 6 L/min. The inspired concentration of sevoflurane was reduced to 2% as soon as eyelash reflexes of these patients were abolished. At the same time, remifentanil 2 μg/kg was injected slowly over 1 min,and 30 s later,patients were mechanically ventilated after tracheal intubation. 2% sevoflurane was kept inhaling, and remifentanil and propofol were kept pumping for anesthesia maintenance. The mean arterial pressure (MAP), heart rate, pulse oxygen saturation (SpO_2) and bispectral index (BIS)were recorded before administration,at the time of the disappearance of eyelash reflex, immediately before tracheal intubation,and immediately after tracheal intubation. The time period from sevoflurane inhalation to the disappearance of eyelash reflex was also recorded. And conscious recovery, spontaneous breathing recovery,the endotracheal extubafion time and OAAS score were recorded. Results All patients were successfully intubated at the first attempt. The satisfactory intubation conditions were found in 82% (41/50) of cases. The time period from sevoflurane inhalation to the disappearance of eyelash reflex was (73 ± 12) s. MAP,heart rate and SpO_2 remained stable and BIS was maintained at 45-55 before and after tracheal intubation, and all patients were quick recovery. Conclusion The anesthesia efficacy of sevoflurane combined midazolam and remifentanil and propofol without muscle relaxant in patients undergoing short surgery is smooth, safe and reliable.

Objective To investigate the effects of metal particles produced by metal prosthesis on oxidative stress levels in human mononuclear cells . Methods Mononuclear cells obtained from peripheral blood of 15 healthy volunteers .Coculture mononu-clear cells with iron particles , cobalt particles , chromium particles , titanium particles and physiological saline , respectively .Levels of reactive oxygen species ( ROS) , malondialdehyde ( MDA) , superoxide dismutase ( SOD) and glutathione peroxidase ( GSH) were as-sessed in mononuclear cells at 6 h, 12 h, 24 h, 36 h, 48 h, respectively . Results Levels of ROS and MDA were higher in the parti-cle groups than that in the control group at 6 h, 12 h, 24 h, 36 h, 48 h, respectively (P<0.05).Levels of ROS and MDA were higher in cobalt particle, chromium particle and iron particle groups than that in the titanium particle group (P<0.05).Levels of SOD and GSH were lower in particle groups than that in the control group (P<0.05).Levels of SOD and GSH were lower in cobalt particle , chromium particle and iron particle groups than that in the titanium particle group (P<0.05). Conclusion Oxidative stress levels increased and anti-oxidant levels decreased in mononuclear cells when cocultured with metal debris .Cobalt particles , chromium parti-cles and iron particles induced higher changes than that in titanium particles .Oxidative stress may play an important role in metal deb-ris-mediated osteolysis .