Objective To analyze the characteristics of adrenal metastasis from renal cell carcinoma (RCC),and explore the principles to deal with the ipsilateral adrenal gland during radical nepbrectomy.Methods The data of adrenal metastasis in 19 patients with RCC from January 2003 to December 2012 was retrospectively analyzed,including 8 cases with ipsilateral adrenal metastasis,5 with contralateral adrenal metastasis,and 6 with bilateral adrenal metastasis,respectively.The relationship between RCC location,diameter,TNM stage and adrenal metastases was evaluated,and the clinical features of adrenal metastasis were summarized.Results Diameters of RCC ranged from 1.6 cm to 12.6 cm in the 19 cases,and the average diameter was 6.3 cm.The mean diameter of primary RCC,metastasized to the ipsilateral,contralateral and bilateral adrenal gland,was 5.6,6.5 and 7.1 cm,respectively.Among the 9 patients whose primary RCC located in the upper pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,3,3,respectively.Of the 7 patients with RCC located in the middle and lower pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,2,2,respectively.Three patients with diffused RCC in the whole kidney occurred ipsilateral adrenal metastases.RCC and adrenal metastasis were simultaneously found in 9 patients,with the average diameter of the primary RCC of 7.4 cm and the clinical stage of T2b-4N0-1 M1.Adrenal metastasis were found in 10 patients during the postoperative follow-up,with the average diameter of the primary RCC of 5.3 cm and the clinical stage of T1a-4N0M0.Nine patients underwent surgery,8 received non-surgical treatment,and 2 had no treatment.Fourteen patients had an average follow-up of 31.9 months,with 1,3 and 5-year survival rates of 84.2％,26.3％ and 15.8％,respectively.Conclusions Adrenal metastasis from RCC may be associated with the diameter and TNM of the primary tumor,regardless of the location.For the patients with normal adrenal gland observed in pre-operative imaging,ipsilateral adrenalectomy is not recommended.

Objective To investigate the clinical characteristics of tuberous sclerosis-associated huge renal angiomyolipoma,and to summarize the experiences of diagnosis and treatment.Methods The clinical data of 9 patients with tuberous sclerosis-associated huge renal angiomyolipoma treated in Peking Union Medical College Hospital from January 2009 to June 2014 was analyzed retrospectively,including 4 males and 5 females.The age at onset and diagnosis of tuberous sclerosis was 0 to 7 years (mean 2.3 years) and 2 to 30 years (mean 19.6 years),respectively,and the diagnosis age of renal angiomyolipoma was 14 to 35 years (mean 25.2 years).In the 9 patients,8 cases had facial angiofibromas,7 cases had hypomelanotic macules,6 cases had ungual fibromas and epilepsy,and 5 cases had family history.All the patients underwent abdominal ultrasound examination,CT scan and serum creatinine testing,and 3 cases received renal dynamic imaging to assess renal lesions and functional status.Results Imaging examinations showed typical renal angiomyolipomas,which were bilateral and multiple lesions with the maximum diameter greater than 10 cm in every patient,and with 2 patients had a history of acute retroperitoneal hemorrhage.The levels of serum creatinine were normal in all patients,and 3 patients had unilateral glomerular filtration rate of 44.4-99.1 ml/min (mean 62.9 ml/min).One patient underwent unilateral partial nephrectomy,2 patients underwent selective renal artery embolization,1 received blood transfusion due to acute bleeding,1 received rapamycin treatment,and 4 patients underwent close follow-up.Conclusions Tuberous sclerosis-associated renal angiomyolipomas are often bilateral and multiple.Increase of the lesion diameter may only enhance the risk of bleeding with small effect on renal function.Therapeutically,close follow-up and mTOR inhibitor are the preferred treatment options,surgery or selective renal arterial embolization is used only for the possible malignancy,acute bleeding or patients with high risk of bleeding.

Objective To observe the curative effect of treating CHD angina pectoris with the therapy of clearing away heat and detoxification. Methods Sixty patients with angina pectoris were randomly recurited into two groups, a trial group and a control group. The trial group was treated by Chinese medicine which has the efficacy of clearing away heat and detoxification (Qingre-Jiedu decoction) and conventional therapy of Isosorbide Mononitrate tablets as same as the control group. The period of treatment was 4 weeks. Compare the curative effect and the change of ECG between the two groups after the treatment. Results After the treatment,the curative effect and the change of ECG of the trial group were both better than the control group with significant difference (P< 0.05). Conclusion It was better to treat coronary heart disease with the management of clearing away heat and detoxification and western medicine than that with western medicine only.

ObjectiveTo explore the effects of steroids for hyperthyroidism management during the perioperative period. Methods198 cases were analyzed in terms of the perioperative use of steroids such as dexamethasone for hyperthyroidism. ResultsFT3 and FT4 decreased gradually to the nomal level after use of dexamethasone. 15 cases had hypokalemic limb paralysis, 2 cases had hyperthyroidism crises, 9 cases had transient numbness of mouth, lip and limb, and the rest resumed normal. ConclusionsThe use of steroids such as dexamethasone for hyperthyroidism can shorten the preoperative preparation time, improve the success rate, and reduce postoperative complications.

Objective To study the protective effects of ulinastatin and tumor necrosis factor-?(TNF-?) antibody on ischemia and reperfusion injury of liver in rats. Methods One hundred and twenty male SD rats were randomly divided into four groups: the normal control group, ischemia and reperfusion group, TNF-? antibody group and ulinastatin plus TNF-? antibody group. And the animals were killed after 60 minutes ischemia of liver followed by reperfusion for 1,3,6 and 12 hours. Serum alanine aminotransferase(ALT) and malondialdehyde(MDA) were detected, and liver histopathologic lesions were observed. Results After ischemia and reperfusion, the serum level of ALT and MDA remarkedly increased, and the hepatic congestion was prominent. Treatment of ulinastatin and TNF-? antibody could decrease the serum level of ALT and MDA significantly, and relieve hepatic congestion. Conclusions Ulinastatin and TNF-? antibody can suppress the inflammatory reaction induced by hepatic ischemia and reperfusion, and has protective effects on rat hepatic ischemia and reperfusion injury.

BACKGROUND: During the hip replacement, selection of prosthesis often depends on patients' bone condition. There has been no gold standard for selection of prosthesis. It will be of scientific significance to select femoral prostheses implanted under different bone densities through three-dimensional finite element analysis and simulated contrast mechanical tests.OBJECTIVE: Three-dimensional finite element analysis was employed to select femoral prostheses according to different bone densities, and simultaneously simulated contrast mechanical tests were performed to determine the age criteria regarding the selection of femoral prosthesis during the hip replacement.DESIGN, TIME AND SETTING: An open experiment was performed at the Second Department of Orthopedics, First Clinical Hospital of Jilin University and Institute of Biomechanics, Jilin University between September 2006 and May 2007.MATERIALS: Freshly adult femoral specimens were harvested from cadavers.METHODS: Three-dimensional finite element models of femur were established using Solidworks software. Following the known formula, the bone density and elastic modulus at different age brackets were calculated and input into the computer. The human one-foot standing condition was simulated and pressure was loaded on the reconstructed femoral models.MAIN OUTCOME MEASURES: Some biomechanical characteristics of uncemented and cemented femoral prostheses, such as the distress distribution and initial micromovement at different bone densities, were measured.RESULTS: Relatively well-distributed whole distress and slight initial micromovement of uncemented femoral prostheses were found in male patients at 30-60 years old and in female patients at 40-55 years old. Symptoms of cemented femoral prostheses the same as the uncemented femoral prostheses were present in male patients at 60-70 years and in female patients older than 55 years old.CONCLUSION: Results of three-dimensional finite element analysis and simulated contrast mechanical tests suggest that uncemented femoral prostheses provide better therapeutic effects in male patients younger than 60 years and in female patients younger than 55 years than cemented femoral prosthesis.

BACKGROUND:Standard artificial prosthesis does not well match to patients' skeleton due to absolute individuation,while the difference between them does not keep the stabilization of artificial joint for a long term.OBJECTIVE:To construct three-dimensional models of custom-made femoral prosthesis by using computer-aided design and to verify whether custom-made femoral prosthesis is superior to popular femoral prosthesis via simulating and contrasting mechanical study.DESIGN,TIME AND SETTING:Opening study was performed in the Orthopaedics Institute of the First Clinical Hospital and the Biomechanics Institute,Jilin University between September 2006 and May 2007.MATERIALS:One fresh femur was derived from adult corps.METHODS:Two-dimensional images of the fresh femur was obtained by using total-length CT scanning and processed with computer edge recognition and three-dimensional contour extraction software to identify outer and inner contour of bone cavity,extract contour data of bone cavity and prosthesis,and construct three-dimensional models of femur and custom-rhade femoral prosthesis.SolidWorks software was used to establish three-dimensional prosthetic models in common biological and bone cement types; moreover,bone-cement,biological,and custom-made femoral prosthesis were replaced via simulating clinical surgery.MAIN OUTCOME MEASURES:Standing on single or double feet was simulated to measure stress distribution,interface stress,and primary micromotion of femoral prosthesis in the three types.RESULTS:Edge extracting was replaced by Canny calculator,characterizing by stable running,credible outcome,and consistent with the primary request.Stress,femoral stress,interface stress,and primary micromotion of custom-made femoral prosthesis were significantly lower than biological and'bone-cement femoral prosthesis (P ＜ 0.01).CONCLUSION:The computer-aided design is reliable to perform the assistant design of prosthesis; furthermore,biomechanical properties of the custom-made femoral prosthesis are superior to those of popular femoral prosthesis.

BACKGROUND:Acetabular cup orientation is critical for preserving the range of motion and preventing dislocation of the prosthesis. Cup malpositioning may result in an increased polyethylene wear rate,pelvic osteolysis and acetabular migration (aseptic loosening).There are no definite criterion for the orientation of the acetabular cup.OBJECTIVE:To explore the relationship between acetabular cup Position and the load distribution within the acetabulum and to confirm an optimal range of cup position.thereby providing a theoretical criterion from a biomechanical aspect for proper cup implantation in clinical work.DESIGN:Repeated measurements.SETTING:Second Department of Orthopaedics in the First Clinical Hospital of Jilin University.MATERIALS: One healthy male adult fresh Cadaveric pelvis was offered by the Department of Anatomy in Jilin University.METHODS:This experiment was carried out at the Institute of Orthopaedics in the First Clinical Hospital of Jilin University,and the Institute of Biomechanics in Jilin University from September 2005 to May 2006.Cadaveric pelvic was scanned with spiral CT,and then the two-dimensional images were evaluated using GE medical systems software and the outline of the pelvis was identified by the edge detective estimation.Pelvic coordinate data were put into the computer to build up a three-dimensional (3D) finite element model of the pelvic using Solidworks software.A P48 non-cemented cup from Tianjin Huabei Medical Instrument Factory was used,and the 3D measurement of the cup was carried out by CLY single-arm 3D measurement apparatus,which was made in Testing Technology Institute of China.The measurement data were transferred into computer.Through the CAD SliodWorks2003 software,the 3D model of the cup was automatically reconstructed. Afterwards, one-foot standing position was simulated to conduct the loading and constraint of the model,the Mises and shear force distributing of the cup were analyzed,forecasting the mechanical risk of prosthetic failure.MAIN OUTCOME MEASURES:The evaluation of Mises stress and shear force distributions under different cup positions.RESULTS:In the 3D finite element modeI of human pelvis.the number of total nodes was 103043 and the number of total elements was 69271.Abduction angle did not affect the Mises and shear force distributions between the range of 40°-50°(P>0.05).However,significant affects appeared in Mises and shear force once the abduction angle was<35°or>50°.The change of the cup anteversion within 5°-30°would not affect the Mises and shear forces in the acetabulum(P>0.05).CONCLUSION:A uniform load distribution on the cup-bone interface can be obtained when the cup abduction angle is from 40°to 50°.The change of the cup anteversion angle can not affect the load distribution in the acetabulum,therefore the cup abduction range of 40°-50°can be confirmed as the safe range for cup implantation.

Objective To approach the expressions of vascular endothelial growth factor(VEGF) and transforming growth factor-beta(TGF-?) in periosteum in patients with congenital pseudarthrosis of tibia(CPT) and elucidate the pathogenesis possibility.Methods The expressions of VEGF and TGF-? in 19 specimens from patients with CPT were detected by using immunohistochemical method.Ten normal periosteum from the healing site after tibia fracture were taken as negative group;15 fresh periosteum from the close tibia fractures were positive group.Results VEGF and TGF-? expressed in vascular endothelial cytoplasm of periosteum.The expression levels of VEGF and TGF-? of CPT were lower than those in positive group(P0.05).Conclusion The decreasing of expression levels of VEGF and TGF-? in periosteum may be involved in pathogenesis of CPT.

Epithelial architecture is formed in tissues and organs when groups of epithelial cells are organized into polarized structures.The epithelial function as well as signaling across the epithelial layer is organized by polarity proteins.Epithelial polarity complexes form and regulate epithelial integrity.Polarity proteins establish and maintain cell polarity,regulate tight junctions and adherens junctions.Polarity proteins act as neoplasms suppressors in mammals and interact with oncogenes,disrupt cell polarity,induce tumorigenesis.Therefore,polarity mechanisms of epithelial cell could therapeutic targets for clinical therapy.