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

ObjectiveTo explore the clinical significance of arterial portography in the diagnosis an d management of prehepatic type portal hypertension(PHPHT). Met hodsBetween 2000 to 2002, all the 11 patients with PHPHT were dia gnosed by angiography and B type ultrasounography. Different operations were par formed including mesocaval shunt in 5 patients,portal-vena cava shunt in 1, splenorenal shunt in 2,and portoazygos venous disconection in 1. Two patien ts were not operated. Results Nine cases undergoing surgical operations had satisfactory outcome. Conclusions PHPHT can be correctly diagnosed by indirect portal venography which is important for the choice of operation.

In order to obtain higher L-lactic acid yield industrial strain, the original strain Rhizopus oryzae PW352 was mutated by means of N+ ions implantation and a mutant strain Rhizopus oryzae RE3303 was obtained. Its lactic acid yield was increased by 75% than that of the original one. The acid producing condition was optimized by orthogonal design. The concentration of L-lactic acid reached to 131～136g/L and the conversion rate of glucose was as high as 86%～90% under the optimum condition.

OBJECTIVETo investigate the technique and clinical effect of interlocked intramedullary nailing through a single incision on the treatment of floating knee injuries.

METHODSThirty-eight patients of floating knee injuries included 25 male and 13 female with an average age of 35.6 years ranging from 17 to 52 years. All patients were treated by interlocked intramedullary nailing through a single incision. The clinical effect was evaluated postoperatively.

RESULTSThirty-eight cases were followed-up for 8.6 to 15.4 months with an average of 12.0 months. Thirty-seven cases gained bone healing and the time of fracture healing was from 2.7 to 6.9 months, with an average of 4.8 months. The nonunion of the distal femoral fracture was observed in 1 case with retrograde nailing, the revision operation was performed by plate and bone graft, and bony union was obtained. The results were excellent in 22 cases, good in 13 cases, fair in 2 cases, and poor in 1 case.

CONCLUSIONThe treatment of floating knee injuries with interlocked intramedullary nailing through a single incision brings less damage, low infection rate, good fracture healing. It is an effective method for treating floating knee injuries.

Adolescent ; Adult ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; methods ; Humans ; Knee Injuries ; surgery ; Male ; Middle Aged

OBJECTIVETo study the result of less invasive fixation in treating comminuted fracture of distal tibia.

METHODSFrom 2002 to 2008, 48 patients with comminuted fracture of distal tibia were treated with surgery. The closed reduction and less invasive fixation were done to stable broken fibula, and the reduction by Kirschner wire to pick was used for relatively larger debris of tibia. The Kirschner wire or screw were used to fix fracture after the restore of the ankle cavity position and the alignment of the tibia. Partial weight loading and functional exercise of ankle joint were done at 6th week after operation.

RESULTSForty-eight patients were followed up for 1-24 months with an average of 12 months. All the fractures were united. According to Johner-Wruhs standard to value the result by factors of pain, deformity, motion range of joint,with or without injury of nerve and blood vessel. Thirty-eight cases obtained excellent result, 8 good, fair 2. The rate of excellent and good were 95.8%.

CONCLUSIONLess invasive fixation has ascendancy such as easy operation, less injury of soft tissue, reliable fixation, which can maximally protect periosteum. It is a choice for treating comminuted fracture of distal tibia.

Adult ; Aged ; Bone Wires ; Female ; Fracture Fixation, Internal ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery ; Young Adult

OBJECTIVETo compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures.

METHODSTwenty-five patients with severe osteoporotic vertebral compression fractures were observed, whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%. The patients were divided into 3 groups for 3 different fracture types according to Rao's classification of osteoporotic vertebral structure and deformity, namely wedge type (group A, n= 12), biconcave type (group B, n= 7) and crush type (group C, n=6). Unipedicular approach was adopted in group A, far lateral bipedicular approach in group B, and posterior wall vertebroplasty and pedicle screw fixation in group C. The average follow-up time was 1 year. Visual analog scale (VAS), analgesic use and the mobility were measured in the patients preoperatively and 3 days (7 days in group C) and 6 months after the operation, respectively, and the success rates and complications were observed.

RESULTSAll the surgical procedures were successful. The average operation time was 35 min in group A, 50 min in group B, and 2 h in group C. The average volume of cement injected into each vertebral body was 2.0 ml. The average blood loss was 30 ml in groups A and B, and 600 ml in group C. The procedure increased mobility and decreased analgesic use. VAS was decreased by a mean of 4.8 in Group A, 6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively, and remained stable till 6 months after the operation (P<0.01). Cement extravasation occurred in 9 cases, cement in the vertebral canal in 2 cases with transient neurological symptoms, and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases, respectively. No neurological complications were observed.

CONCLUSIONDifferent types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body, which provides significant pain relief with wider indications.

Aged ; Female ; Fractures, Compression ; etiology ; surgery ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Osteoporosis ; complications ; Spinal Fractures ; etiology ; surgery ; Thoracic Vertebrae ; injuries ; Treatment Outcome ; Vertebroplasty ; methods

OBJECTIVETo study the relationship between gene p53 codon 72 polymorphism and pathological scar formation occurrence after caesarean section.

METHODSThe method of molecular beacon with real-time PCR was applied to detect gene polymorphism of p53 codon 72 in blood samples taken from 303 pregnant women (within a week after caesarea section). The clinical visits were taken 3 times for 12th to 18th months to ascertain clinical formation of pathological scar and its relationship to genotype of p53. The chi-square method was used to analyze the relationship of p53 gene polymorphism and abnormal scar formation occurrence by statistical software SPSS 13.0.

RESULTSTotal of 303 pregnant women were assayed. 30 patients were found with pathological scar by clinical visit in the total 303 pregnant women. The genotype frequencies of total three types (C/C, C/G and G/G) of p53 gene codon 72 in patients with pathological scar are significantly different from that of normal pregnant woman. The frequency of C/C genotype in patients are higher than that of normal pregnant women (P < 0.01). The frequency of C/C genotype in these patients with pathological scar is higher (46.7%, 14/30) than C/G (33.0%, 10/30, P < 0.01) or G/G (20%, 6/30) genotype (P < 0.01). The C allele frequency in the patients is 63.7%. It is also higher than G allele (36.7%, P < 0.01). The OR value is 2.30. Therefore the C allele of p53 gene codon 72 is a risk factor for pathological scar.

CONCLUSIONSThere was a certain relationship between p53 gene codon 72 C allele and pathological scar formation after caesarean section.

Alleles ; Cesarean Section ; Cicatrix ; genetics ; Codon ; Female ; Gene Frequency ; Genes, p53 ; Genotype ; Humans ; Polymorphism, Genetic ; Pregnancy ; Risk Factors

Objective To measure the expression of CC chemokine ligand 18(CCL18)in cutaneous malignant melanoma (CMM) tissues, and to explore its clinical significance, as well as relationship with vascular endothelial growth factor (VEGF) and Ki67 antigen expressions. Methods Immunohistochemistry was performed to measure CCL18, VEGF and Ki67 expressions in 58 paraffin?embedded CMM tissue specimens, as well as CCL18 expression in 20 paraffin?embedded pigmented nevus specimens, and immunofluorescence assay to confirm the expression of CCL18 in fresh CMM tissue specimens. Correlations of CCL18 expression with CMM clinicopathologic features, VEGF and Ki67 expressions were analyzed. Results CCL18 was detected in 49 (84.48%) of 58 paraffin?embedded CMM specimens, but in none of the 20 paraffin?embedded pigmented nevus specimens, with a significant difference in the positive rate of CCL18 between the CMM group and pigmented nevus group(χ2=45.46, P<0.01). The expression of CCL18 in paraffin?embedded CMM tissues was positively correlated with Clark′s level and Breslow thickness of CMM (rs = 0.609, 0.644 respectively, both P < 0.01), and was significantly different between ulcerated and non?ulcerated CMM(P<0.05), as well as between patients with and without lymphatic metastasis(P<0.05). However, there were no significant differences in the expression of CCL18 among patients of different age, gender, or between acral and non?acral CMM(all P>0.05). In addition, the expression of CCL18 in CMM tissues was positively correlated with that of VEGF(rs = 0.727, P < 0.05), but unrelated to that of Ki67(P > 0.05). Immunofluorescence assay showed CCL18 expression in the cytoplasm of tumor cells in CMM tissues. Conclusion CCL18 is highly expressed in CMM tissues, and may be involved in tumor invasion and metastasis.

Objective To explore the expression and significance of CD34, CD117 on bone marrow mononuclear cells of myelodysplastic syndromes (MDS). Methods Direct immunofluorescence staining was used by means of flow cytometry. 37 patients with MDS were divided into RA/RARS/RCMD subgroup, RAEB Ⅰ/RAEB Ⅱ subgroup; favorable chromosomal subgroup, poor chromosomal subgroup; intermediate-risk Ⅰ subgroup, intermediate-risk Ⅱ subgroup, high-risk subgroup respectively according to WHO classification,cytogenetic abnormalities and international prognostic scoring system (IPSS). Results CD34 and CD117 were positive respectively in 11 of 19 patients with RMRARS/RCMD, all cases in RAEB Ⅰ/RAEB Ⅱ expressed CD34 and CD117; increased expression of CD34 and CD117 was MDS grade-related. Favorable chromosomal subgroup, 14 of 22 patients were positive for CD34, CD117, all cases in poor chromosomes expressed CD34 and CD117; there was a direct relationship between phenotytic density and poor cytogenetic risk factor. CD34 and CD117 expression was present respectively in intermediate-risk Ⅰ (9/17), intermediate-risk Ⅱ (11/11) and highrisk subgroup (9/9); the phenotypic intensity also was correlated with IPSS scores. Conclusion Detection of CD34, CD117 may be a useful tool for subtyping and predicting the prognosis of MDS.

Acquired Immunodeficiency Syndrome ; complications ; pathology ; Antigens, CD34 ; metabolism ; Gastrectomy ; methods ; Humans ; Male ; Middle Aged ; Sarcoma, Kaposi ; metabolism ; pathology ; surgery ; virology ; Stomach ; pathology ; Stomach Neoplasms ; metabolism ; pathology ; surgery ; virology ; Vimentin ; metabolism