[Objective]To refine operative indications of rotating hinge prostheses and report the medium term results of these implants,and to analyze the reasons for postoperative complications.[Method]From 1999 to 2007,42 Endo-Model(Link) rotating hinge prostheses were used in 34 patients.The cases were all gonarthrosis with severe genu varus,genu valgus or flexion contracture.Bone defect or instability was found in these cases before operation.The mean follow-up was 6.4 years(2.3-10.4 years).[Result]One case of deep infection,and one periprosthetic fracture were noted.And 3 cases of patella subluxation or tilt were detected by postoperative X-ray.All patients had excellent pain relief and restoration of walking capability.The average HSS score improved from 40.5 points to 89 points after surgery.[Conclusion]Besides being used in revision surgery,rotating hinge prostheses are indicated in primary arthroplasties for patients with severe ligament laxity,substantial deformity or bone losses.With appropriate indication selection and accurate operative skill,satisfactory medium term result can be obtained.

Objective To explore clinical effect of ureteroscope atmospheric pressure trajectory lithotriptor in treatment of the ureterolithiasis.Methods Application of atmospheric pressure trajectory lithotriptor to treat the 108 cases of ureterolithiasis through ureteroscope peeper.Results 103 cases(95.3%) got success in orthotopic lithotriptics,success rate of upper segment calculi in ureter was 83.3%,middle segment was 96.3%,lower segment was 98.4%,mean lithotriptic time was (45?2.5)min,100% stone was excreted 1～3 months after operation.Conclusion Ureteroscope at mospheric pressure trajectory lithotriptor in treatment of ureterolithiasis has merits of safe,effective,manipulation easiness,so it is perfect method for therapy of ureterolithiasis.

Objective To establish a new method for detecting pemphigus antibody (PAb). Methods PI 1 anti idiotype monoclonal antibodies against pemphigus and purified PAb from the serum of a patient with active pemphigus were used to establish an ELISA system for detecting the PAb. Results The result showed the purified PAb was IgG4 subclass, the sensitivity and specificity for the detection of PAb were high in the ELISA system, the sensitivity and specificity were not significantly different among the IIF, indirect ELISA and ABC ELISA. The standard curve for detecting the concentration of the purified PAb was primarily obtained in the study. Conclusion The ELISA system for the detection of PAb in the sera of patients is a good qualitative method, it might be of value in the clinical diagnosis of pemphigus. It is expected to quantitatively detect PAb of pemphigus patients in the future with the ELISA system established, which is directed to the IgG4 subclass of PAb, so it may be of value in the study of IgG4 subclass in the pathogenesis of pemphigus.

Objective To investigate the application of stroke volume variation (SVV) in directing management of elderly septic shock patients. Methods Patients who were diagnosed with elderly septic shock and supported with mechanical ventilation were in?cluded (n=28). They were divided into control group (n=13) and SVV group (n=15). Volume recovery was directed by CVP (central ve?nous pressure ) in control group and by SVV and CO (cardiac output) in SVV guoup respectively. Blood lactate, oxidation index, CVP , MVP, NT-proBNP, time of recovery, the length relying on mechanical ventilation and Vigileo parameters were compared after volume resuscition. During the period of treatment, the incidence of acute left ventricle dysfunction within 24 hours, MODS within 28 days and mortality rates of all causes were compared between these two groups. Changes in SVV, cardiac output (CO) and systemic vascular re?sistance (SVR) in SVV group before and after resustation were recorded. Results Blood lactate acid and NT-proBNP were significant?ly lower in SVV group compared with those in control group whereas oxidation index in SVV group were significantly higher than that of control group. The time of resuscitation and the duration relying on mechanical ventilation were shorter in SVV group than those in control group. On the contrary, the incidence of acute left ventricle dysfunction,MODS and all mortality rates were not significantly different between these two groups. There were significant differences between hemodynamic variables such as SVV, CO in SVV group before and after resuscitation. Conclusion SVV may direct volume resuscitation more effective in elderly septic shock than CVP does.

Objective To evaluate the efficacy of post-operative radiotherapy and prognosis of renal cell carcinoma(RCC). Methods Between 1981 and 1998 , 90 s uch patients with disease limited to the kidney underwent nephrectomy at our ins titution. According to TNM classification(UICC,1997) the pathological stage was: Ⅰin 27 patients(30%),Ⅱ in 18 (20%), Ⅲ in 35(38.9%), and Ⅳ in 10(11.1%).Post - operative irradiation, with a median dose of 50?Gy in 25 fractions over 5 weeks w as given to 52 patients in 3～5weeks after surgery, using AP-PA opposing portal s or oblique portals. Results The 5- and 10-year survival rates in the irradiate d patients(S+Rt) were 75% and 60%,respectively, but in the non-irradiated patien t s(S) 50% and 40%, respectively.This difference is statistically significant. 5- y ear survival rates by TNM stage in the two groups were as follows: stageⅠ:S 67 %,S+Rt 100%;stageⅡ: S 55%,S+Rt 71%;stageⅢ: S 47%,S+Rt 65% (P=0 .010);stageⅣ: S 0%, S+Rt 43%.Diseases recurred locally in a total of 12 patients: 3 had tumo r b ed recurrence and 6 had regional lymph node recurrence and 3 had both. Local rec urrence in S was 29% and that of S+R was 2% (P=0.001). and local recurrence by T NM stage:Ⅲ were 33% and 5%, respectively. One patient developed radiation-indu c ed small bowel obstruction which necessitated surgical intervention, but no pat i ent died from radiotherapy-induced complications. By multivariate analysis: per f ormance status, symptomatic presentation, lymph node involvement, post-operativ e radiation and post-operative residual were all independent predictors of overa l l survival in the RCC patients. Conclusions In renal cell carcinoma, radiothera py is beneficial in reducing the locoregional recurrence. Radiotherapy has a sup prisingly positive effect on both local control and survival in TNM stage Ⅲ pat ients. Performance status, symptomatic presentation, lymph node involvement, pos t-operative radiation and post-operative residual are prognostic indicators of RCC. TNM staging is superior to Robson staging in predictive values .

Objective To evaluate the pathological,histochemical and clinical features of primary clear cell carcinoma of the epididymis,and to investigate its diagnosis,treatment and prognosis.Methods The clinical data of one case of primary clear cell carcinoma of the epididymis were reported and the relevant literature was reviewed.Results The patient was a 43-year-old man presenting with a painless mass in the left epididymis.On physical examination,a 1.0 cm-sized smooth solid nodule on the head of left epididymis could be palpated without tenderness.Then the patient underwent left epididymectomy.On postoperative histopathological study,the tumor was characterized by diffuse sheets of clear cells and adenoid structures.Immunohistochemical assay showed AE(++),AE3(+/-),NSE(-) and interstitialoma(-) in the tumor tissues.Postoperatively,MRI showed no space-occupying lesion in both kidneys,and B-ultrasound indicated no abnormality of the bladder.Fifteen days after operation,left orchiectomy was performed on the patient.Pathology showed no clear cell carcinoma tissue of the testis.Follow-up was 15 months.The patient was reported to be alive and tumor-free.Conclusions The histogenesis of primary clear cell carcinoma of epididymis is unclear yet.The diagnosis depends on pathologic studies,and should be differentiated from nephrogenic adenoma and metastatic carcinoma.Radical surgery is the main treatment choice.

The changes in excitability and autorhthmicity of bladder detrusor in experimental non-insulin dependent diabetes mellitus (NIDDM) rats were observed. Sixty-nine NIDDM rats as NIDDM group and 69 normal rats as control group were enrolled into this experimental study. At 6th, 10th, 14th, 18th, 22nd and 26th week after the rats were injected last time, the changes in the excitability and autorhthmicity of detrusor strips in vitro were observed. The results showed that the threshold of the tension which made the detrusor strips contract was significantly higher in NIDDM group (0.716 +/- 0.325 g) than in control group (0.323 +/- 0.177 g) (F = 59.63, P < 0.001). At different stages, the threshold of the tension resulting the contract of the detrusor strips in NIDDM group was also higher than in control group. At 18th week after STZ injection, the frequency of spontaneous contract of the detrusor strips in NIDDM was significantly higher than in control group (P < 0.05), whereas at 22nd week, that in NIDDM group was significantly lower than in control group (P < 0.05). It was concluded that the decreased excitability of the bladder detrusor was the earliest and most obvious changes in bladder function in diabetes rats and the autorhthmicity had also changed at the early stage of diabetic bladder.
Diabetes Mellitus, Experimental/*physiopathology ; Diabetes Mellitus, Type 2/physiopathology ; Muscle Contraction/physiology ; Muscle Relaxation/physiology ; Rats, Wistar ; Urinary Bladder/*physiopathology ; Urinary Bladder Diseases/etiology ; Urinary Bladder Diseases/*physiopathology

Objective To determine the frequency of depression in patients with Parkinson' s disease(PD) and healthy controls over 50 years of age and to analyze the characteristics and influencing factors of PD with depression(PDD) in Nanjing.Methods One hundred and twenty-six PD patients were diagnosed and assessed using Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD).The frequency,characteristics and influencing factors of depression were statistically analyzed,and the factor analysis of HAMD was carried out.Also,one hundred and twenty-four healthy subjects over the age of 50 were selected as the control group.Ressults The incidence of depression in PD group was 48.4％ ( 61/126):15.1％ (19/126) for mild depression,27.8％ (35/126) for moderate depression,5.6％ (7/126) for severe depression.The incidence of depression in the control group was 9.7％ (12/124):5.7％ (7/124) for mild depression,2.4％ (3/124) for moderate depression,1.6％ (2/124) for severe depression.There was a significant difference between these two groups( x2 =45.36,P ＜ 0.01 ).Univariate and Logistic regression analysis revealed that a high frequency of depression occurred in patients with long PD duration,high H-Y stage and UPDRS Ⅲ.According to each factor analysis of HAMD,the scores of cognitive impairment,tardiness,anxiety and sleep disturbances of the PD patients with depressive syndromes were higher than that of the control group.Conclusion Depression is a relatively common complication of PD in Nanjing which is associated with long PD duration,severity of motor disturbances and increasing H-Y stage.

Objective To investigate the role of hybrid bone grafting using autograft and freezedried allograft bone in restoration of acetabular bone defect,as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency.Methods Between April 1999 to December 2007,18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold.There were 8males and 10 females,aged from 33 to 76 years (average,64.7 years).The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia.There were 5 cases of Paprosky Ⅱ B defect,2 Paprosky Ⅱ C defect,6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect.Results All patients were followed up for 3.6 to 12.3 years (average,6.5 years).Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up.According to X-rays,bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3to 6 months postoperatively,and effective bone incorporation was achieved in all cases one year postoperatively.Polyethylene wear occurred in one case.Acetabular component loosening was not found at final follow up.Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect.Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation.Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.

Objective To screen and analyze genes differentially expressed within dermal papillae cells(DPC)with aggregative behavior.Methods Total RNA was extracted from DPC with and without ag-gregative behavior,and double-stranded cDNA were synthesized by using SMART cDNA synthesis.The cD-NA fragments of differentially expressed genes in dermal papillae cells with aggregative behavior were isolat-ed by suppression subtractive hybridization,sequencing,and then subtracted library was set up.Positive clones were screened by PCR method and verified by cDNA dot blot and then analyzed through homologous retrieving.Results A subtractive cDNA library of DPC with aggregative behavior was successfully construct-ed.The results of screening and cloning of the library showed that DPC with aggregative behavior could ex-press genes related to homologous aggregation,regnlation of growth,differentiation and development,and sig-nal transduction proliferation and cycle control,which included known genes(capping protein,paladin,vas-cular endothelial growth factor),hematopoietic stem/progenitor cells(HSPC)related genes(HSPC011and HSPC016)and a new gene.Conclusions The construction of subtractive library of DPC lays solid founda-tion for screening and cloning new and specific genes related to aggregative behavior of DPC.Several genes may cooperatively involve in homologous aggregation,and regnlation of growth of DPC.Among these genes,capping protein and palladin may be closely related to aggregative behavior of DPC,and VEGF and HSPC re-lated clones may be responsible for the status of higher proliferation of DPC.