OBJECTIVETo study effects of autogenous femoral head bone grafting combined with total hip replacement for the treatment of old center dislocation of hip joint, and to evaluate the superiority of acetabular defect reconstruction with autogenous bone.

METHODSFrom March 2008 to December 2013, 16 patients (16 hips) with old center dislocation of hip joint were treated with autologous bone graft combined with total hip replacement. There were 11 males and 5 females, ranging in age from 41 to 72 years old, with an average of 56.3 years old. The duration of the disease ranged from 3.6 to 37.2 years. Twelve patients had injuries caused by traffic accidents and 4 patients were caused by falling down. The hip joint pain at the first month after operation, Harris score and hip joint movement of all patients were observed by using electronic case follow-up system.

RESULTSAll the patients were followed up, and the duration ranged from 11 to 78 months, with an average of 27.3 months. The postoperative hip joint movement of (56.2±23.4)° VAS 86.3±7.2 and Harris score 32.6±12.6 were all better than preoperative (181.8±17.6)°, 11.1±2.6 and 86.3±7.2. The joint pain was reduced and the function limitation was improved after operation, and the prosthesis position was good.

CONCLUSIONWhen the autologous femoral head bone grafting combined with total hip arthroplasty is used to treat old hip central dislocation, the initial and long-term stability of acetabular bone grafting is good, and the technique can avoid allogeneic bone complications, bone source rationally and reduce the economic burden of patients.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Femur Head ; transplantation ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Transplantation, Autologous

BACKGROUND: In recent years, ultrasound microbubble gene transfer system has been applied for gene transfection in many parts of the body, but it has been seldom reported to be used for gene transfection in bone parts. OBJECTIVE: To investigate the efficiency and feasibility of ultrasound-targeted microbubble destruction applied for transfection of enhanced green fluorescent protein plasmid into the femoral head of rabbits.METHODS: Japanese big-ear rabbits were randomly divided into five groups: bare transfection, pre-irradiation + bare transfection, ultrasound transfection, pre-irradiation+ultrasound transfection, and repeatable transfection. In the first two groups, ultrasound-targeted gene transfection and irradiation was not used, but in the latter three groups, ultrasound-targeted microbubble destruction was used to transfect enhanced green fluorescent protein (EGFP) plasmid into the femoral head of rabbits. At 1 week after transfection, EGFP expression in femoral head was observed under the fluorescence microscope. RESULTS AND CONCLUSION: EGFP expression appeared in the ultrasound transfection, pre-irradiation + ultrasound transfection and repeatable transfection. The transfection efficiency of EGFP plasmid was significantly higher in the repeatable transfection group than in the other groups (P < 0.01). Obvious injury loci were not observed in the soft tissue and bone tissue slices of ultrasonic irradiation parts in the ultrasound transfection, pre-irradiation + ultrasound transfection and repeatable transfection groups. These results confirm that ultrasound-targeted microbubble destruction is a safe and effective method to transfect EGFP plasmid into the femoral head of rabbits.

Objective Investigate the prognosis of patients undergoing liver transplantation (LT) for end-stage autoirnmune liver disease (ALD).Method The clinical data of 45 patients with endstage ALD undergoing LT from April 2001 to March 2015 in the first affiliated hospital of Zhejiang University were analyzed retrospectively.The postoperative cumulative survival rate of the recipients was calculated,and the causes of death were analyzed.The postoperative rejections,new onset viral hepatitis and ALD recurrence were also analyzed.Result In 45 ALD recipients,33 cases survived and the postoperative 5-year cumulative survival rate was 78.8％.Causes for 12 dead cases were mnultiple organ failure,liver graft failure,respiratory complications,hemorrhage and hepatic artery embolization.In 45 ALD recipients,6 cases suffered rejection after operation with the incidence bing 13.3％.One case suffered new onset hepatitis B infection 8 years after opcration.One recipient suffered primary disease (primary biliary cirrhosis) recurrence 2 years after operation,and 1 recipient with primary disease (primary sclerosing cholangitis) developed into overlap syndrome.They all survived for a long term after active treatments.Conclusion Most LT recipients with endstage ALD can obtain a long term survival.Attentions should be paid to the immunosuppressive regimens in early period after LT,prevention of infection,rejection and postoperative new onset viral hepatitis,and timely diagnosis of primary disease recurrence.

Objective To construct p66shc gene interfering lentivirus vectors recombination and transfect it to 293T cells ,RNA interfering was carried out to induce p66shc gene silence ,so as to provide basis for further study of the p66shc function .Methods Screening of three RNA targets which were named after p66shc‐shc1 ,p66shc‐shc2 ,p66shc‐shc3 ,cloned into the pLenR‐GPH vec‐tor ,which contained green fluorescent protein(GFP) and transformed into DH5αcells .The positive clone were picked out for right sequencing and transfected to 293T cells with pRsv‐REV ,pMDlg‐pRRE ,pMD2G .The expression of GFP in inverted fluorescence microscope confirmed the virus packaging success .Fluorescence quantitative PCR and Western blot technology were used to investi‐gate the expression of p66shc at the molecular and protein levels ,p66shc‐shc1 target of effective silencing p66shc gene was selected to prepare for subsequent tests .Results The shRNA lentivirus vector was constructed which could express p66shc and was trans‐fected into 293T cells successfully .Fluorescence quantitative PCR and Western blot technology were used to investigate p66shc gene silence by RNA interference .Conclusion The lentivirus RNAi vector of targeted expression p66shc could induce p66shc gene si‐lence at the molecular and protein levels after transfected into 293T cells by RNA interference .

Objective To investigate the safety and efficacy of intravenous thrombolysis (IVT) in elderly patients (aged≥80 years) with acute ischemic stroke.Methods From July 2014 to February 2016,157 consecutive patients with acute cerebral infarction treated with alteplase for intravenous thrombolysis within 4.5 h after onset at the Department of Neurology,the Third People's Hospital of Chengdu were collected retrospectively.They were confirmed by head CT or MRI.They were divided into a ≥80-year old group (n=47) and a <80-year old group (n=110) according to the age of onset.The baseline data were documented,including the risk factors for cardiocerebrovascular diseases,National Institute of Health stroke scale (NIHSS) score,onset to thrombolytic time (3.0-4.5 h),and application of anticoagulant drugs,etc.The adverse reactions of the patients were observed and the safety and efficacy of thrombolysis were evaluated,that is 7 d and 3 months mortality,symptomatic intracranial hemorrhage rate,and good recovery rates of intravenous thrombolysis at 24 h,1 week,and 3 months.Results (1) Compared with the <80-year old group,the ratio of atrial fibrillation and median age in the ≥80-year old group were higher.There were significant differences between the two groups (59.6% [n=28] vs.32.7% [n=36],83 [81,85] vs.67 [59,75] years old,all P<0.01).There were no significant differences in the remaining baseline data between the two groups (all P>0.05).(2) In the subtypes of cerebral infarction etiology,the proportion of cardiogenic embolism in the ≥80-year old group was higher than that in the <80-year old group.There was significant difference between the two groups (59.6% [n=28] vs.32.7% [n=36],P<0.01).There was no significant difference in the other etiological types between the two groups (all P>0.05).(3) There were no significant differences at one week (6.4% [n=3] vs.6.4% [n=7] respectively) and 3 months (12.8% [n=6] vs.9.1% [n=10]) in the mortality rates between the ≥80-year old group and the <80-year old group (all P>0.05).There were no significant differences in the proportions of intracranial hemorrhage (10.6% [n=5] vs.8.2% [n=9]) and symptomatic intracranial hemorrhage (4.3% [n=2] vs.6.4% [n=7]) between the two groups (all P>0.05).There was no significant difference between the good recovery rate at 24 h (38.3% [n=18] vs.45.5% [n=50]) and that at one week (53.2% [n=25] vs.62.7% [n=69];all P>0.05).The long-term (3 months) favorable prognosis rate in the ≥80-year old group was lower than that in the <80-year old group.There was significant difference between the two groups (51.1% [n=24] vs.71.8% [n=79], P<0.05).Conclusion For the onset within 4.5 h (aged≥80 years) in elderly patients with acute ischemic stroke,selecting the appropriate cases for intravenous thrombolysis is help to increase safety and early benefit.

BACKGROUND: Thoracolumbar segments (T11-L2) prone to damage due to its special anatomical and biomechanical characteristics. Therefore, fully understanding the shape of pedicle of vertebral arch and finding the visible, constant, and the point of insertion of the pedicle axis is very important to the safety of pedicle screw placement.OBJECTIVE: To measure the surgically relevant parameters of thoracolumbar pedicles between Han and Uygur males using computed tomography (CT) scan to provide some anatomic reference data for pedicle screw fixation.METHODS: The vertebral bodies and pedicles of adult males were scanned (60 cases of Han people and 60 cases of Uygur people) from T10-L3 with CT. The parameters were processed by three-dimensional reconstruction. Transverse pedicle width, pedicle axis length, transverse pedicle angle, and sagittal pedicle angle were measured by using length and angle measurement tool of browser in bone-window CT images. The age and stature information were recorded. All the data above were processed by SPSS 13.0 software.RESULTS AND CONCLUSION: (1) The mean transverse pedicle width of T12 and L1 in Han was bigger than that in the Uygur. (2) The mean transverse pedicle angle of T12 and L2 in Han was bigger than that in the Uygur. (3) The mean pedicle axis length and sagittal pedicle angle of T11 and L1 in Han were bigger than that in the Uygur (P < 0.05). (4) There were some differences among some parameters of the thoracolumbar pedicles between the Han and Uygur people.Data from any study only can be used as a guide for pedicle screw fixation. Preoperative CT evaluation may provide an individualized strategy to reduce the incidence of postoperative complications caused by misplacement.

Objective:To compare the quantitative measurements of the retinal capillary nonperfusion areas in a cohort of proliferative diabetic retinopathy (PDR) patients with fluorescein fundus angiography (FFA) and swept source optical coherence tomography angiography (SS-OCTA), and to determine the intrapersonal variability between examiners.Methods:A cross-sectional study. Eighteen eyes of eleven PDR patients diagnosed in Department of ophthalmology of Henan Provincial People's Hospital from September 2019 to January 2020 were included in this study. FFA was performed using Spectralis HRA+OCT (Germany Heidelberg Company) from and SS-OCTA was performed using VG200D (China Vision Micro Image Corporation). SS-OCTA was used to collect images of retinal layer, superficial capillary plexus (SCP) and deep capillary plexus (DCP). The same observation area was 80°×60° for SS-OCTA and 55° for FFA with both setting centered on the fovea. The forty-nine retinal capillary nonperfusion areas were observed. The area measurement was completed independently by three examiners. Paired sample t test or paired sample Wilcoxon test were used to compare the measured values of retinal capillary nonperfusion areas between the two examination methods and among the three examiners. Results:There was no significant difference in the retinal layer, SCP and DCP nonperfusion area measured by FFA and SS-OCTA among the three examiners ( P>0.05), and the consistency is good (consistency correlation coefficient> 0.9, P<0.05). The nonperfusion area measured by FFA was 0.786 mm 2. The median nonperfusion area of retinal layer and SCP measured by SS-OCTA were 0.787 mm 2 and 0.791 mm 2, respectively, and the average nonperfusion area of DCP was 0.878±0.366 mm 2. The nonperfusion area of retinal layer and SCP measured by FFA and SS-OCTA showed no statistically significant difference ( P=0.054, 0.198). The nonperfusion area of DCP measured by SS-OCTA was significantly larger than that of FFA, and the difference was statistically significant ( P<0.001). The results of repeatability analysis showed that 93.88% (46/49) of the DCP nonperfusion area data measured by SS-OCTA were greater than those measured by FFA. Conclusion:The retinal nonperfusion area of DCP in PDR patients measured by SS-OCTA is larger than that of FFA.

Objective To construct expression vectors of calmodulin(CaM)mutants N2 and C2,and to express,purify,and identify the mutant proteins,in order to study the interactions between CaM and calcium channels. Methods The cDNA of N?lobe and C?lobe of CaM were used to prepare the cDNA of N2 and C2. Next,the recombinant cDNAs were cloned into a pGEX?6p?3 plasmid,and the recombinant plasmids were trans?ferred into E.coli BL21 cells. The transfected BL21 cells were stimulated with IPTG. The fusion proteins were extracted by ultrasonication and puri?fied by using GS?4B beads. Finally,protein activity was identified by the pull?down assay. Results Both the restriction digestion map and the DNA sequence identification results confirmed that the recombinant plasmids were successfully constructed. SDS?PAGE results showed high purity and concentration of N2 and C2 proteins. Their activities and binding abilities with the calcium channel fragment were confirmed by the pull?down assay.Conclusion In this study,expression vectors of N2 and C2 are successfully constructed,and physiologically active N2 and C2 CaM mutant proteins are obtained.

OBJECTIVETo realize quadratic formula optimization of Renshen Jianxin Capsule (RJC) by screening Chinese herbs with major anti-myocardial ischemia effect in RJC and optimize their optimal dosages.

METHODSBy following "uniform design-pharmacodynamic experiment-mathematical modeling-formula optimization", authors employed U10(10(8)) uniform design in the experiment. Eight Chinese herbs contained in RJC were taken as observatory factors. Electrocardiograph (ECG) changes of myocardial ischemia induced by isoproterenol were taken as pharmacodynamic indices. The mathematical model between herbal factors and pharmacodynamic indices was established using stepwise regression analysis to screen Chinese herbs with major anti-myocardial ischemia effect. Their optimal dosages were optimized using the grid algorithm.

RESULTSThe regression equation was y =1. 7889 -0. 3247 Ginseng xSalvia Miltiorrhiza -0. 0663 Astragalus membranaceus xOriental Waterplantain tuber. Forecasting factors included were Ginseng, Salvia Miltiorrhiza, Astragalus membranaceus, and Oriental Waterplantain tuber. The optimal formula dosage calculated by the grid algorithm was Ginseng 1. 62 g, Astragalus membranaceus 4. 62 g, Salvia Miltiorrhiza 2. 43 g, and Oriental Waterplantain tuber 1. 66 g.

CONCLUSIONUniform design combined with stepwise regression analysis and grid algorithm were able to realize quadratic formula optimization of RJC.

Astragalus membranaceus ; Chemistry, Pharmaceutical ; standards ; Coronary Artery Disease ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; therapeutic use ; Electrocardiography ; Humans ; Isoproterenol ; Myocardial Ischemia ; drug therapy ; Panax ; Salvia miltiorrhiza

Objective: To investigate the long-term outcomes of posterior long segment instrumentation and fusion in adult degenerative scoliosis (ADS), and to explore the correlative factors of sagittal imbalance after long segment instrumentation and fusion, and to summarize the impacts of different lowest instrumented vertebra (LIV) on sagittal complication rates. Methods: ADS patients who underwent long segment instrumentation and fusion between January 2008 and January 2014 were retrospectively reviewed and divided into two groups depended on LIV (L ₅ group and S₁ group). The follow-up time was at least five years. Radiographic parameters, Visual Analogue Score (VAS), Oswestry Disability Indexscore(ODI), the 12-item Short Form Health Survey-Physical Component Summary (SF-12 PCS)and sagittal complications were analyzed. And the correlation between sagittal imbalance and sagittal complications were calculated. Patients were divided into two groups(sagittal imbalance group and sagittal balance group) to explore the correlative factors of sagittal imbalance. Results: All of 56 patients were included and evaluated in this study, and 35 cases stopped at L ₅, 21 cases at S₁. The mean follow-up time was 6.6±1.6 years. No significant difference were found in age, gender, follow-up time and surgery method (P>0.05) between two groups. No significant differences were found in Cobb angle(11.8°±7.3° vs 12.6°±6.4°), coronal balance distance(CBD) (0.7±0.6 cm vs 1.0±0.5 cm), sagittal vertebral axis(SVA)(3.0±3.1 cm vs 2.6±5.6 cm), thoracic kyphosis(TK) (21.4°±9.6° vs 22.5°±6.9°), lumbar lordosis(LL) (-32.7°±7.3° vs-34.8°±9.1°), pelvic tilt (PT) (23.4°±9.8° vs 23.3°±8.1°), VAS score(2.0±1.2 vs. 2.2±0.9), ODI score(18.5%±6.4% vs 19.3%±5.2%) and SF-12 PCSscore(45.5±5.2 vs 42.4±7.0) between two groups at final follow-up time(P>0.05). Radiographic parameters including Cobb angle, CBD, SVA and health related quality of life scores including VAS score, ODI score and SF-12 PCS scores were improved significantly at two weeks postoperatively, two-year follow-up time andfinal follow-up time in two groupscompared with those preoperatively (P<0.05). And no significant difference were found in radiographic parameters and health related quality of life scores between those at two years follow-up time and those at final follow-up time; Sagittal complication rates at final follow-up were higher than these at two years follow-up (82.1% vs 33.9%, P=0.000). Sagittal imbalance was related to internal fixation failure in L ₅ group (r=0.691, P=0.011), internal fixation failure in S₁ group (r=0.691, P=0.001) and pseudoarticulation formation (r=0.499, P=0.021). 10 patients in the sagittal imbalance group were with preoperative sagittal imbalance, 9 with preoperative coronal imbalance, 6 with internal fixation failure, 5 with proximal junctional kyphosis (PJK), 4 with adjacent segment degeneration during the follow-up periods, the incidence rates of which were higher than those in the sagittal balance group. LL in the sagittal imbalance group was lower than that in the sagittal balance group at two years follow-up time and final follow-up time. Compared with the sagittal imbalance group, the sagittal balance group achieved a higher SF-12 PCS (45.4±5.1 vs 41.6±7.4, P<0.05) and lower ODI scores (17.8%±6.1% vs 21.5±4.6%, P<0.05), and no significant difference was found in VAS scores between two groups (1.9±1.2 vs 2.4±0.8, P>0.05). The incidence of adjacent segment degeneration in L ₅ group was higher than that in S₁ group (P<0.05) at final follow-up time, and the incidence of pseudojoint in S₁ group was higher than that in L ₅ group (P=0.002) at final follow-up time. Conclusion Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can obtain satisfying long-term clinical outcomes, and postoperative sagittal imbalance was related to preoperative sagittal/coronal imbalance, postoperativeinternal fixation failure, PJK, pseudoarticulation formation and adjacent segment degeneration. Distal fusion at L ₅ or S₁ may lead to high risk of adjacent segment degeneration or pseudoarticulation formation respectively.