OBJECTIVETo investigate and clarify the key surgical techniques and evaluate clinical effectiveness of modular cementless femoral stems(LINK MP modular stem) in complex revision hip arthroplasty.

METHODSFrom January 2002 to December 2013, 470 patients in Chinese PLA General Hospital received revision hip arthroplasties using MP stems. Among them, 246 patients were followed for an average of 5.7 years (ranged, 0.5 to 11 years). There were 148 males and 98 females, with an average age of 62.5 years old (ranged from 26 to 83 years old). The most common reason for revision was aseptic loosening of femoral stems (107 cases, 43.5%), followed by prosthetic joint infection (104 cases, 42.3%). Other reasons included unexplained hip or thigh pain, periprosthetic femoral fracture, prosthesis wear and dislocation. According to Paprosky classification of femoral deficiency, there were 171 cases of type IIIA (69.5%), 14 cases of type I, 39 cases of type II, and 22 cases of type IIIB. The average preoperative Harris hip score (HHS) was 37.4 ± 7.5. In addition, radiographic presentation, degree of patients' subjective satisfaction, and clinical effectiveness were assessed as well.

RESULTSThe average Harris score was im- proved to 87.8 ± 4.2 after operation,with significant statistical difference when compared to preoperative score (t = 92.13,P = 0.00). Analysis of patients' subjective satisfaction for leg length discrepancy, stability and overall degree of satisfaction showed that the number of patients with great satisfaction were 27, 60, 61 respectively. The most common complication was the periprosthetic fracture (intraoperatively 21 cases and postoperatively 8 cases). Other complications included infection (7 cases), dislocation (5 cases), numbness possibly caused by incomplete sciatic nerve injury (6 cases) and thigh swelling (3 cases). The X-ray taken at the final follow-up revealed that prosthesis subsidence occurred in 4 cases, 2 of which needed a second revision.

CONCLUSIONThe application of modular cementless femoral stems (LINK MP modular stem) in complex revision hip arthroplasty (especially in cases with the serious defect of proximal femoral bone) shows good results at both the short-term and long-term follow-up, especially in the revision for prosthetic infection with the high success rate. In order to avoid complications and improve clinical outcomes,the surgeons should carefully select proper surgery candidates,perform the procedure with care, and master the key surgical techniques.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Postoperative Complications ; therapy

OBJECTIVETo observe mainfestations of syndrome and biochemical indices of hypertensive model rats with excessive accumulation of phlegm-dampness syndrome (EAPDS), and to explore its possible pathological mechanism.

METHODSEAPDS rat model was prepared in 50 Wistar rats by feeding with high fat forage. Meanwhile, a normal control group consisting of 10 Wistar rats was set up by feeding with normal forage. After 25-week continuous feeding, 22 rats with body weight (BW) and blood pressure (BP) exceeding 25% those of the control group were selected as a model group. BW, BP, blood lipids, and related serological indicators were detected in all rats. Morphological changes of target organs were observed. mRNA expression levels of leptin receptor (LepR), Janus kinase2 (Jak2), signal transducer and activator of transcription 3 (Stat3), suppressor of cytokine signaling-3 (Socs3), angiotensin II receptor type 1 (AT1), angiotensin II receptor type 2 (AT2), phosphatidylinositol 3 kinase (P13K), serine threonine kinase (Akt), nuclear factor of kappa B (NF-κBp65), inhibitor of nuclear factor kappa-B kinase α (IKKα), NF-kappa-B inhibitor β (lKKβ), NF-kappa-B inhibitor α (IKBα), and AMP-activated protein kinase (AMPK) were detected by quantitative real-time PCR (qPCR). Expression levels of AT1 and LepR in aorta were detected by immunohistochemical assay and Western blot respectively.

RESULTSCompared with the control group, BW, BP, and blood lipids increased; serum levels of leptin (Lep) , Ang II, Hcy, ET-1, TNF-α, IL-6, and p2-MG increased, but NO decreased in the model group (P < 0.05, P < 0.01). Aortal endothelial injury and smooth muscle cell proliferation occurred in the model group, accompanied with heart and renal injury. Compared with the control group, mRNA expression levels of LepR, Jak2, Stat3, Socs3, AT1 , PI3K, Akt, NF-κB p65, IKKβ, IKBα, and AMPK in aorta were up-regulated significantly (P < 0.05), while the expression of IKKa decreased (P < 0.05). Immunohistochem- ical staining showed, brownish yellow deposit of AT1 and LepR was obviously increased, with more extensively positive distribution. Western blot results showed, as compared with the control group, protein expression levels of AT1 and LepR obviously increased in the model group (P < 0.05).

CONCLUSIONSModel rats exhibited typical syndromes of EAPDS. They put up weight with fat abdomen, gloomy hair, poor appetite, hypersomnia, lowered activities , reduced food intake, loose stool, dark red tongue, white tongue with white, thick, greasy fur. Lep could be taken as one of objective indicators for evaluating hypertension rat model with EAPDS.

Animals ; Aorta ; Cell Proliferation ; Disease Models, Animal ; Hypertension ; physiopathology ; I-kappa B Proteins ; Interleukin-6 ; Leptin ; blood ; NF-KappaB Inhibitor alpha ; NF-kappa B ; Phosphatidylinositol 3-Kinases ; Rats ; Rats, Wistar ; Suppressor of Cytokine Signaling Proteins ; Transcription Factor RelA ; Tumor Necrosis Factor-alpha

Objective To evaluate the ultrasonographic (US) features and evolution of breast fat necrosis after cosmetic augmentation with autologous fat obtained by liposuction, to help distinguish fat necrosis from more ominous breast masses. Methods Breast sonography was performed on 38 patients underwent bilateral breast augmentation by autologous fat injection to evaluate the grafted fat tissues in interval of 3-6 month after the operation. Observations in follow up sonography included the sizes,positions, shape,echogenicity,margin features, calcifications and evolutions of the suspicious nodules in the breasts. Results Seventy-six nodules occurred in 25 of the 38 patients were detected after the fat graft. Among the 76 nodules,52 were cystic(68. 4%) ,8 were complex(10. 5%) and 16 were solid(21.1%). The analysis of the predominant features of the nodules sonographic appearances were as follows: all the nodules had no flow signal, 66 (86. 8%) had clear margins,54(71. 1%) had regular shapes,52 were cystic(68. 4%) ,63(82. 9% ) had no calcifications, 10(13. 2%) had egg-like calcifications,74(97. 4% ) had no halo,and the positions of the solid components in 8 complex nodules move following the change of the detected body position. There were 7 nodules with fat necrosis removed surgically and confirmed by pathology. Conclusions Breast ultrasound is an accurate and simple method to follow up the temporal changes of the fat nodules after autologous fat injection. It may help to avoid unnecessary biopsies.

Objective To summarize the sonographic features and differential diagnosis points of mass-type cornual pregnancy. Methods The sonographic ifndings of 23 pathological proven mass-type cornual pregnancy cases enrolled in PUMCH from 2011 January to 2013 January were retrospectively analyzed. Results All pathological proven mass-type cornual pregnancy were located at one corner of the uterus presenting as a heterogenous outward mass. Well-deifned margins were found in 20 cases, and interstitial-line signs were found in 15 cases. The surrounding muscle thickness is 0.1-0.3 cm. Typical hyperechoic villi were found on sonography in cases with bloodβ-hCG>20 000 IU/L. On Doppler, the lesion showed abundant peripheral vascularity with low resistance in 22 cases, 9 lesions also showed abundant internal vascularity. Among 23 mass-type cornual pregnancy cases, 7 cases were misdiagnosed as gestational trophoblastic neoplasia (GTN) due to the similar sonographic characteristics including mixed-echo and abundant vascularity with low resistance. Sixteen cases were diagnosed by ultrasound preoperatively, with featured sonographic signs including mass located in the endometrial extension line;clear margin;peripheral vascularity;or detection of interstitial-line sign and typical villus. Conclusions Mass-type cornual pregnancy may be correctly diagnosed according to the location, boundary of the mass and the distribution of blood flow combining with clinical manifestation and bloodβ-hCG level. Transvaginal sonography could play an important role in diagnosis of cornual pregnancy.

Objective To explore the effect of spinal 360°circumferential resection decompression combined with bone cement fill-separation and pedicle screw fixation instrumentationb for patients suffering from spinal metastases.Methods Retrospectively analyzed the clinical data of 42 patients suffering from spinal metastases and underwent spinal 360°circumferential resection decompression combine with bone cement fill-separation and pedicle screw fixation instrumentation in our hospital from April 2012 to October 2016.The pain level were assessed by visual analogue scale(VAS),the functional impairment was classified by Karnofsky score(KPS) and the neurologic deficit was evaluated by Frankel grade before preoperation,1 week after operation and 3 months after operation.Results Through the following-up of 3 months,there was no neural symptoms relapse in primary segment.The VAS score was (0.57 ±0.79) points,and the KPS was (72.61 ± 19.12) points 3 months after operation,which were significantly improved compared with the data before operation (P ＜ 0.05).The VAS score improvement rate was (91.09％ ±13.73％),and the Frankel grade improvement rate was 80％.Conclusion Circumferential resection decompression combined with bone cement fill-separation and pedicle screw fixation instrumentationb for patients suffering from spinal metastases can effectively improve the neural symptoms and life-quality of patients and prevent neural symptoms relapsing in primary segment after operation.

To study the chemical constituents of the 95% ethanol extract of Psidium guajava. Compounds were separated by using a combination of various chromatographic methods including silica gel, D101 macroporous resin, ODS, Sephadex LH-20 and preparative HPLC. Their structures were elucidated by physicochemical properties and spectral data Eighteen compounds were isolated and identified as (+) -globulol (1), clovane-2beta, 9alpha-diol (2), 2beta-acetoxyclovan-9alpha-ol (3), (+) -caryolane-1 ,9beta-diol (4), ent-T-muurolol (5), clov-2-ene-9alpha-ol (6), isophytol (7), tamarixetin (8), gossypetin (9), quercetin (10), kaempferol (11), guajaverin (12), avicularin (13), chrysin 6-C-glucoside (14), 3'-O-methyl-3, 4-methylenedioxyellagic acid 4'-O-beta-D-glucopyranoside (15), p-hydroxy-benzoic acid (16), guavinoside A (17) and guavinoside B (18). Compounds 2-9 and 14-16 were isolated from this plant for the first time. The ethanol extract showed 61.3% inhibition against the proliferation of colon cancer cell line SW480.
Drugs, Chinese Herbal ; chemistry ; Organic Chemicals ; analysis ; Plant Leaves ; chemistry ; Psidium ; chemistry

OBJECTIVE: To demonstrate the spatial organization of neurons, astrocytes and vessels in rat brain. METHODS: Cerebral vascular was shown by vivi-perfusion with ink. Glial fibrillary acidic protein (GFAP) immunohistochemistry and nissl's staining were performed on the serial sections of frozen brain tissues. RESULTS: Astracytes distributed along the branches of blood vessels, and neurons in the region of the relatively rich blood vessels. Neurons and astrocytes presented regional distribution. CONCLUSION This method can well indicate the spatial organization of neurovascular unit, the regional differences in the distribution may be related to physical activities and the corresponding adjustment function.
Animals ; Astrocytes ; cytology ; physiology ; Brain ; cytology ; physiology ; Cerebrovascular Circulation ; physiology ; Female ; Glial Fibrillary Acidic Protein ; biosynthesis ; Male ; Neurons ; cytology ; physiology ; Rats ; Rats, Sprague-Dawley

[ ABSTRACT] AIM:To investigate the different dose of perindopril on cardiac function in the rabbits with ische-mic cardiac dysfunction .METHODS:Male rabbits weighing 2.5~3.0 kg ( n=30) were randomly divided into 3 groups (n=10):high dose perindopril group (HD group), low dose perindopril group (LD group) and cardiac dysfunction group (CD group).The Left anterior descending coronary artery of the rabbits was ligatured for model preparation .In HD group, the rabbits were treated with perindopril split normal saline solution (1 g/L)2 mL· kg-1 · d-1 .In LD group, the rabbits were treated with perindopril split normal saline solution (0.33 g/L)2 mL· kg -1 · d-1.In CD group, the rabbits were treated with normal saline solution 2 mL· kg-1 · d-1 .Four weeks after treatment , the cardiac function was measured via echocardiography , the mRNA expression of angiotensin-converting enzyme 2 ( ACE2 ) and angiotensin type 2 receptor (AT2R) was analyzed by real-time PCR, serum angiotensin (Ang)-(1-9) and Ang-(1-7) levels were detected by ELISA. RESULTS:Compared with CD group , the cardiac function of the 2 groups treated with perindopril was significantly im-proved (P<0.01), and more improvement in HD group was observed than LD group (P<0.05).The serum angiotensin ( Ang)-(1-9) and Ang-(1-7) level and the mRNA expression of ACE 2 and AT2R in the 2 groups treated with perindopril were significantly improved (P<0.01).Compared with LD group, the mRNA expression of ACE2 and AT2R and the ser-um levels of Ang-(1-9) in HD group were significant improved (P<0.05), while no difference of serum Ang-(1-7) level was observed.Correlation analysis revealed that the improvement of the cardiac function was associated with serum Ang -(1-9) level, mRNA expression of ACE2 and AT2R (P<0.01), but has no significant correlation with serum Ang-(1-7) lev-el.CONCLUSION:High dose of perindopril may improve more cardiac function in ischemic cardiac dysfunction model in rabbits.The mechanism may relate to increasing serum Ang-(1-7) level to activate AT2R.

The inflammatory response is involved in the pathogenesis of the most common types of heart disease.Sanguinarine (SAN) has various pharmacological properties such as anti-inflammatory,antioxidant,antibacterial,antitumor,and immune-enhancing properties.However,few studies have investigated the effects of SAN on lipopolysaccharide (LPS)-induced inflammatory and apoptotic responses in H9c2 cardiomyocytes.Therefore,in this study,H9c2 cells were co-treated with SAN and LPS,and the mRNA levels of pro-inflammation markers and the apoptosis rate were measured to clarify the effect of SAN on cardiac inflammation.The underlying mechanism was further investigated by detecting the activation of Toll-like receptor (TLR)4/nuclear factor-κB (NF-κB) signaling pathways.As a result,increased mRNA expression of interleukin (IL)-1 β,IL-6,and TNFα induced by LPS was attenuated after SAN treatment;LPS-induced apoptosis of H9c2 cardiomyocytes and cleaved-caspase 8,9,3 were all significantly reduced by SAN.Further experiments showed that the beneficial effect of SAN on blocking the inflammation and apoptosis of H9c2 cardiomyocytes induced by LPS was associated with suppression of the TLR4/NF-κB signaling pathway.It was suggested that SAN suppressed the LPS-induced inflammation and apoptosis of H9c2 cardiomyocytes,which may be mediated by inhibition of the TLR4/NF-κB signaling pathway.Thus,SAN may be a feasible therapy to treat sepsis patients with cardiac dysfunction.

Objective To explore the application of 3D printing technology in surgical approach choice for cervical vertebra dumbbell tumor.Methods Retrospectively analyzed the clinical data of 17 patients with cervical vertebra dumbbell tumor who were admitted into our hospital from August 2012 and February 2017 and recieved 3D model printing.Three director surgeons chosen surgical approach for each pa-tient with or without 3D printing models.The surgical approach,combined with 3D printing and chosen by most surgeons,was selected as final surgical approach for patients.All the patients were evaluated by JOA score and Frankel grade before and after operation.Results The tumor of patients who selected surgical approach with 3D printing was completely resected.Without 3D printing models in preoperation,3 surgeons selected the same surgical approach for 8 patients,2 surgeons selected the same surgical approach for 9 patients.Compared with those who se-lected surgical approach with 3D printing models in preoperation,the 3 surgeons changed surgical approach in a total of 13 times.The surgical approach of 5 patients were changed,including 2 cases changed from posterior approach to lateral approach,2 cases changed from lateral ap-proach to posterior approach,and 1 case changed from lateral approach to anterior approach.Eventually,11 cases underwent posterior ap-proach,1 case underwent anterior approach,3 cases underwent lateral approach and 2 cases underwent far lateral approach.Conclusion Ap-plied of 3D printing in treatment of cervical vertebra dumbbell tumor can rebuild and print local anatomy by digitizing method.It can excel-lently show the tumor form,relationship of tumor and vertebrae,tumor and foramen intervertebrale,tumor and vessel.3D printing technology could help surgeon precisely and directly understand the operation area and select advanced surgical approach to reduce surgical risk and in -crease the resection rate of tumor.And it has an excellent display effect especially for complex tumors and abnormal blood vessels.