BACKGROUND:Now, domestic total knee arthroplasty surgeries mainly use medial parapatel ar approach, with the disadvantages of large trauma and slower recovery. The quadriceps sparing approach is more accorded with normal anatomy, which can keep the knee extension system intact. The clinical comparison between quadriceps sparing approach and medial parapatel ar approach is rare.
OBJECTIVE:To compare the early effect of total knee arthroplasty through quadriceps sparing approach and medial parapatel ar approach.
METHODS:From January 2009 to January 2010, 55 patients (70 knees) were randomly divided into quadriceps sparing approach group (n=26, 35 knees) and medial parapatel ar approach group (n=29, 35 knees). Patients in two groups received total knee arthroplasty through quadriceps sparing approach and medial parapatel ar
approach respectively. The incision length, operative time, postoperative drainage volume, additional amount of etoricoxib tablets, pain degree, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint, Hospital for Special Surgery Knee Score, radiographic alignment of al components and complications were compared between two groups. Al the prostheses used in this study were the Sigma type prostheses
provided by the rotation platform of Johnson&Johnson Company.
RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months without infections, deep vein thrombosis, neurovascular injury, prosthesis instability, prosthesis loosening or displacement. Position of al the
prostheses was normal in patients. The operative time in the quadriceps sparing approach group was longer than that in the medial parapatel ar approach group (P=0.00), while the incision length, postoperative drainage volume, additional
amount of etoricoxib tablets, visual analog scale, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score in the quadriceps
sparing approach group were better than those in the medial parapatel ar approach group (P<0.05). There were no
significant differences in range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score between two groups. The early effect of total knee arthroplasty through quadriceps sparing approach is better than the medial parapatel ar approach, and there is no significant difference in prosthesis alignment between two methods.

Objective To evaluate the clinical efficacy of intracavitary holmium laser for ureter calculi combined with distal ureteral stricture.Methods Sixty-nine patients with ureteral calculi combined with distal ureteral stricture were selected.Nineteen patients with ureteral calculi above third lumbar vertebra inferior margin combined with distal ureteral stricture were given microchannel percutaneous nephroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision,and 50 patients with ureteral calculi below third lumbar vertebra inferior margin combined with distal ureteral stricture were given ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision.The type-B ultrasonic,kidney-ureter-bladder plain film (KUB) + intravenous urography (IVU) were performed before operative and 3 months after removal of double J tube,and the degree of hydronephrosis and calculi removal condition were observed.Results The operations of all the patients were successful,and operation time was 42-85 (58 ± 13) min.Intraoperative hemorrhoea,ureteral rupture,ureteral avulsion,false passage formation did not occur.All patients had varying degrees of gross hematuria after operation,and 68 cases disappeared after 2-3 d.Thirteen cases had postoperative fever,and these patients were alleviated after the anti-infection and symptomatic treatment.The success rate of gravel was 95.7％ (66/69),and the success rate of ureteral stricture was 97.1％ (67/69).Three months after removal of double J tube,calculi had been discharged,with no residual calculi.The patients' hydronephrosis was obviously alleviated.The extension of renal collecting system was (22.0 ± 8.2) mm before operation,and was (12.0 ± 6.1) mm 3 months after extraction double J tube,and there was statistical difference (t =8.52,P ＜ 0.01).Conclusions The nicrochannel percutaneous nephroscope holmium laser lithotripsy or ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision for ureteral calculi combined with distal ureteral stricture patients has no serious intraoperative and postoperative complications,shorter operation time,low cost,operation safety,and satisfactory effect.It is a good method for ureteral calculi combined with distal ureteral stricture.

Objective To investigate the clinical efficiency of Huayu Xiaozhong Decoction (HXD) on preventing peri-operative deep venous thrombosis (DVT) in lower limbs following artificial total hip replacement. Methods Ninety cases following artificial total hip replacement were randomized into blank control group, Rivaroxaban group and HXD group, 30 cases in each group, and were treated with brown sugar water, Rivaroxaban, HXD respectively. Before operation, and one, 3 and 14 days after operation, we monitored the changes of bleeding volume, DVT incidence, hemoglobin, prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , international normalized ratio (INR), and D-dimer (DD) in the three groups. Results (1) Fifteen cases had DVT, with a total incidence rate of 16.67%. Of the 15 cases, 10 were from blank control group, 2 from Rivaroxaban group, and 3 from HXD group. ( 2) The amount of bleeding volume of Rivaroxaban group was larger than that of the blank control group and HXD group (P<0.05), but the bleeding was mild. (3) One, 3 and 14 days after operation, PT and APTT were shortened in blank control group (P<0.01 compared with those before operation). PT, APTT and INR were prolonged, and coagulation function was improved in Rivaroxaban group and HXD group, the differences being significant as compared with the blank control group ( P<0.05). HXD group had better effect on improving INR than Rivaroxaban group ( P<0.05). ( 4) In the three groups, hemoglobin level began to decrease on postoperative day one, arrived to the bottom on postoperative day 3 (P<0.05), and rose up near to the normal level on postoperative day 14; HXD group had higher hemoglobin level than blank control group and Rivaroxaban group on postoperative day 3 and 14 ( P<0.05). The 3 groups had higher plasma DD level than the normal level before the operation, arrived to the highest level on postoperative day one and 3 ( P<0.05) , and fell down near to the normal level on postoperative day 14. The inter-group comparison results showed that Rivaroxaban group and HXD group had lower DD level than the blank control group on postoperative day 3 and 14 ( P<0.05). Conclusion HXD is effective on preventing DVT in the peri-operation period through reducing bleeding, increasing hemoglobin level and improving postoperative anemia. The efficiency and safety of HXD are similar to Rivaroxaban.

Objective To study the increased radiosensitivity of tumor cells by triterpene acids of loquat leaf (TAL) and mechanism.Methods C6 and MG63 cells were pretreated by TAL,and then were exposed to X-rays at 1,2,3,5,7 Gy.Clonogenic assay was used to evaluate those tumor cells survival fraction (SF) to calculate the sensitization enhancement ratios (SER) of TAL.The cellular micronuclei ratios of tumor cells were analyzed by micronuclei assay.Additionally,the changes of Rad51 and XRCC4 levels were observed by RT-PCR and Western blot.Results D0 values were decreased to 1.31 and 2.85 Gy in C6 and MG63 cells by TAL pretreatment respectively.The SER value of the effect of TAL on C6 and MG63 cells was 1.73 and 2.04,respectively.There was a statistical difference in the cellular micronuclei ratios between tumor cells with TAL above 2 Gy and those without TAL (C6:t =-8.372--2.476,P ＜0.05 ; MG63:t =-4.03--2.557,P ＜ 0.05).TAL attenuated the expression of XRCC4 at transcriptional and translational level,but not for Rad51,a key gene in homologous recombination repair (HRR).Conclusions TAL pretreatment could increase the lethal effect of X-rays on tumor cells in vitro.The mechanism might be involved in the inhibition of non-homologous end joining (NHEJ).

Objective By analyzing the urinary calculi ingredient and 24-hour urinary stone risk factors of urolithiasis patients in Hengyang area,to investigate the effects of diet intervention on recurrence rate in urolithiasis patients,and provide the measures for prevention and treatment.Methods Prospectively collected 692 patients that permanent residents in Hengyang area from September 2008 to September 2012,who had implementation of minimally invasive operation and taken stone specimens to analyze composition,and also collected 24 hours urine to analyze the urinary stone risk factors.They were divided into test group and control group by random number table method,346 cases in each,control group without diet intervention,and test group was given diet intervention according to the stone composition and urinary stonerisk factors.All patients were followed up for 1 year,the urinary stone recurrence rate in Hengyang area was observed.Results Among 692 urolithiasis patients,663 patients completed the study (test group of 341 cases and control group of 322 cases),the expulsion rate was 4.19％(29/692).The 24-hour urinary stone risk factors in control group before and after diet intervention had no significant difference(P ＞ 0.05).In test group after diet intervention,the excretion of ingredients in urine such as dietary calcium (t =3.412,P ＜ 0.05),oxalate(t =3.018,P ＜ 0.05) and uric acid(t =1.990,P ＜ 0.05) was obviously decreased,and urinary citrate (t =3.174,P ＜ 0.05) was increased,but the excretion of ingredients such as magnesium and phosphorus had no significant difference (P ＞ 0.05).After 1 year after diet intervention,the recurrence rate in test group was lower than that in control group [0.88％ (3/341) vs.7.76％ (25/322)],there was significant difference (P ＜ 0.01).Conclusion Diet intervention can effectively reduce the risk of urinary stone according to the stone composition and the 24 hours urine stone risk factors,plays an important role on reducing urinary stone recurrence,which is worth clinical promotion.

Objective To summarize the experience of minimally invasive treatment in upper ureteral calculi complicated with urinary tract infection.Methods Retrospectively analyzed the clinical data of 40 cases with upper ureteral calculi complicated with urinary tract infection who were treated from December 2009 to December 2013.Results Twenty-one cases were performed with retrograde catheterization at cystoscopy and 11 cases were performed with percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,the infection were controlled after operation 2-6 d.These patients were successfully cured by extracorporeal shock-wave lithotripsy (ESWL),ureterorenoscope lithotripsy (URL) or percutaneous nephrolithotomy (PCNL) in the stage Ⅱ].The remaining 8 cases were successfully cured by URL with antiinfection therapy in the stage Ⅰ.All patients had no ureteral perforation,laceration,urine derived sepsis and severe bleeding complications.All of ureteral calculi were drained after 2-10 weeks.The average hospital stay was 13.4 d.Patients were followed up for 1-12 months after the stone expulsion,the average was 6 months.There was 3 patients who with preoperative renal dysfunction had been improved after URL,and other patients' renal function returned to normal.Conclusions The therapy of retrograde catheterization at cystoscopy and percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,combined with ESWL,URL or PCNL in the stage Ⅱ in treating upper ureteral calculi complicated with urinary tract infection have more advantage such as less complication,rapid control of infection and complete removal of stones.It is an ideal method.

Objective To explore gene polymorphism of the G/C genotype of-173G/C(rs755622)in the promoter of macrophage migration inhibitory factor(MIF)gene in male population,and thus to investigate the relationship between gene polymorphism of MIF and gout.Methods A total of 380 gout patients and 378 healthy controls were enrolled.The possible association between the polymorphism of MIF-173G/C and gout in Chinese were investigated and genotype frequencies and allelic frequencies were analyzed by polymerase chain reaction with sequence-specific primers(PCR-SSP)method.Hardy-Weinberg was used to verify the representativeness of the samples.Comparisons between the groups were performed with x2 test.The gene polymorphism of MIF and gout was performed by t test.Results The frequencies of GG,GC,CC genotypes were 62.1％(236 cases),34.2％(130 cases)and 3.7％(14 cases),respectively among gout patients,while they were 66.5％(252 cases),29.8％(113 cases)and 3.7％(14 cases),respectively among the controls.There was no statistical difference in MIF-173G/C genotype frequencies between gout patients and controls(x2=1.713,P=0.425).The allele frequencies of G and C in gout cases were 79.2％(602 cases)and 20.8％(158cases),while the controls were 81.4％(617 cases)and 18.6％(141 cases),and no significant difference between them could be found(x2=1.148,P=0.302).Combine GG and GC of gout into GG+GC,the association analysis of the two groups showed that,mean age,leves of glucose,TG,TC,BUN,Cr and UA of the GG+GC group and the CC group were(51±13)and(50±15)t=0.369,P=0.712;(7.1±8.8)and(6.1±1.2)mmol/L,t=0.352,P=0.725;(2.3±1.6)and(2.9±3.4)mmol/L,t=-1.207,P=0.228;(5.3±1.2)and(5.7±1.4)mmol/L,t=-1.207,P=0.228;(5.8±2.9)and(6.2±2.2)mmol/L,t=-0.513,P=0.608;(92±52)and(84±17)μmol/L,t=0.537,P=0.592;(472±103)vs(557±154)μmol/L,t=-2.949,P=0.03 respectively;no significant difference was found in the two group.Moreover,no association between MIF-173G/C genotypes and risk factors for gout were detected in gout cases by t-test.Conclusion Results of the present study suggest that the G/C genotype of-173G/C in the promoter of MIF gene is not associated with gout in male population.

Objective To investigate the association between rs1013940 in SLC5A7 and Tourette Syndrome ( TS) in Chinese Han population.Methods Polymorphism was genotyped in 401 TS nuclear fam-ilies trios from china by real-time fluorescent quantitive PCR.Transmission disequilibrium test ( TDT) and Haplotype relative risk ( HRR ) were used to analyze the association between the genetic distrbution of rs1013940 and TS and the results were verified by haplotype-based haplotype relative risk( HHRR) .Results No transmission disequilibrium was found between rs1013940 in SLC5A7 and TS by TDT and HRR( TDT:χ2=0.268, P=0.657, OR=0.728,95%CI=0.366-1.451;HRR:χ2=0.111, P=0.739, OR=0.959,95%CI=0.762-1.466) .HHRR also indicated the same result ( HHRR:χ2=0.276, P=0.599, OR=1.082,95%CI=0.806-1.453) .Conclusion The result reveals that there is no significant association between rs1013940 in SLC5A7 and TS in Chinese Han population.However,the results need to be further validated in different populations.

Objective To study features of the MRI and clinic in a family with pure hereditary spastic paraplegia (PHSPG) type 6.Methods Target loci (SPG3, 4, 6, 8 10 and 12) linkage analysis was performed in a SPG pedigree having 6 affected individuals using microsatellite markers and NIPA1 gene was screened for mutation by PCR-amplification and sequencing. MRI of brain and cervical and thoracic spinal cord were examined in these 6 patients and 6 normal controls matched for age and sex by two independent radiologists blinded to the clinical diagnosis. Cross-sectional areas and anteroposterior and transverse diameters of the spinal cord at the levels of C2～3, C7, T1～4, T9 were measured and data was statistically analyzed using the student's t test. Results A missense mutation of 316g→c in NIPA1 was identified in the affected subjects, presumably resulting in substitution of glutamic acid for arginine in residue 106. Evaluation of the brain MRI images revealed non-specific brain abnormalities. All patients presented thinning of cervical and upper thoracic spine with atrophy in both gray and white matter and enlarged subarachnoid cavity. In severe atrophic segments, a distinct boundary between grey and white matter was observed and the lesions in grey matter presented literal high intensity spots or patches with clear boundary on transaxial T2-weighted images (T2WI) and high signal intensity longitudinal strip on the sagittal T2WI. Cross-sectional areas and anteroposterior and transverse diameters of the spinal cord at C2～3, C7, T1～4 were significantly smaller in patients than in controls, while at the T9 level only transverse diameter showed significant difference (7.22±0.08 vs 8.17±0.41, t=2.870, P=0.046). Conclusions These findings indicate that the disease process in patients with SPG6 might be confined to the cervical and thoracic spinal cord, with atrophy in both white and grey matter having a distinct boundary.