Objective To investigate the treatment of local recurrence after sphincter preserving surgery for low rectal cancer. Methods Fifty-six patients with local recurrence after sphincter preserving surgery for low rectal cancer were divided into three groups, 20 cases underwent radical resection (group A), 21 cases underwent palliative resection combined with 3 dimensional conformal radiation therapy (group B), and 15 cases only received 3 dimensional conformal radiation therapy (group C). Results All the patients were followed up from 6 months to 3 years. The 1-year,2-year and 3-year survival rates were 100.0%(20/20),80.0% (16/20),65.0% (13/20) in group A,90.5% (19/21),52.4% (11/21),33.3% (7/21) in group B and 80.0%(12/15),40.0%(6/15),20.0%(3/15) in group C respectively. Both 2-year and 3-year survival rates in group A were significantly higher than those in group B and group C (P <0.05). Conclusions The first choice of patients with local recurrence after sphincter preserving surgery for low rectal cancer is radical resection. Palliative resection combined with 3 dimensional conformal radiation therapy is the second choice.

Objective To study the dynamic imaging changes of the uterine leiomyomas before and after uterine arterial embolization (UAE) treatment and to discuss its therapeutic mechanism. Methods Color Doppler senography and both plain and enhanced MR[scanning were performed in 45 patients with uterine leiomyomas before and after UAE. Plain CT scan was performed in all patients after UAE. All the patients were followed up for 3-16 months (average 10±3.5 months). Results In 41 of the total 45 cases, the color Doppler senography showed rich blood flow signals in leiomyomas and myometrium before UAE and no or less blood flow signals in both leiomyomas and myometrium on the first day after UAE. On the seventh day, the blood flow signal was still absent in leiomyomas while it was restored in myometrium, and the same phenomena remained in the first, the third and the twelfth month after UAE. In the other four eases, color Doppler sonography demonstrated blood flow signals inside leiomyomas on the seventh day after UAE and it remained till twelve months after embolization. The embolic agent (Lipiodol) was found in both leiomyomas and myometrium on CT scan for 45 cases on the first day of UAE. CT scan also showed the deposit of the Lipiodol in myometrium, but Lipiodol gradually vanished in leiomyomas at one, three and the twelve months after UAE. The enhancement was apparent in leiomyomas and myometrium on MRI scan in all 45 cases before UAE. The enhancement was found in the myometrium, but not in leiomyomas, on MRI scan in 39 cases 3 months after UAE. The other six cases demonstrated different degrees of enhancement in leinmyomas after embolization. In two cases the detachment of the leiomyomas were observed after embolization and the desquamating materials were pathologicallyproved to be necrotic tissue. The difference in the measuring data about leiomyoma volume between MPI and color Doppler sonography was of no statistical significance (P > 0.05). Conclusion The therapeutic mechanism of UAE for uterine leiomyomas is selectively embolizing the vascular bed of uterus, leading to subsequent necrosis of leiomyomas. The color Doppler sonography should be the fast choice for the dynamic imaging follow-up after UAE.

Objective To investigatc thc short-term clinical and radiographic outcomes of tantalum trabecular metal (TM) components associated with TM augments for Paprosky type Ⅱ and type Ⅲ acetabular defects in revision hip arthroplasty.Methods From June 2014 to April 2016,seventeen patients with aseptic loosening underwent revision total hip arthroplasty for Paprosky type Ⅱ or type Ⅲ acetabular defects with TM revision acetabular cups and TM augments.The subjects consisted of 5 males and 12 females with mean age of 56.6 years (range 30-75).Acetabular bony defects were Paprosky type Ⅱ A in 4 hips,Ⅱ B in 3 hips,Ⅲ A in 8 and Ⅲ B in 2 hips.The whole hip revision was performed in 13 hips and acetabular reconstruction in 4 hips.Preand post-operative functional outcomes were accessed by the Harris Hip Score.The vertical and horizontal position of the rotation center from the intertear drop line were measured and analyzed.Complications were recorded during the follow-up.Radiographic examination was performed after operation immediately by X-ray.The recent X-ray was conducted to assess bone ingrowths at the cup-bone or augments-bone interface,radiolucent lines and implant migration.Results All of the patients were followed-up for an average of 23 months (range 11-33 months).There was no infection,dislocation or periprosthetic fracture complications at the last followed-up.The Harris Hip Score was improved from 45.8±3.4 pre-operatively to 79.2±7.5 post-operatively (t=-16.8,P=0.00).The mean vertical distance of the center of rotation was 32.1±4.3 mm preoperatively and 14.5±2.3 mm postoperatively (t=14.8,P=0.00).The mean horizontal distance of the center of rotation was 33.6±6.1 mm preoperatively and 27.8±3.2 mm postoperatively (t=3.5,P=0.00).More than 3 radiographic signs of osseointegration were observed in 11 hips.No progressive radiolucent lines or component migration was observed.All the TM components were well-fixed at last follow-up.Conclusion Using tantalum TM cups with TM augments in revision hip arthroplasty could be regarded as an effective management for Paprosky type Ⅱ and type Ⅲ acetabular defects.This technology can avoid using over-large cup,provide reliable primary stability,restore the center of rotation with almost normal hip biomechanics and improve the functional outcome.

Objective To evaluate the clinical application value of susceptibility weighted imaging (SWI) in neonatal hy-poxic ischemic encephalopathy (HIE). Methods Thirty-six neonates with HIE were collected and scanned by GE 3.0 T supercon-ducting MR scanner. Routine axial T1WI, T2WI, FLAIR scan and axial SWI scan were conducted. SWI sequence was compared with conventional head MRI sequences in detection rate of distribution and quantity of intracranial hemorrhage. Meanwhile, the display condition of the dilated cerebral deep veins and cortical veins was observed on SWI image and the performance of HIE in different clinical classification on SWI was compared. Results A total of 97 intracranial hemorrhages were detected by SWI in 27 cases. Only 41, 27 and 51 hemorrhages were found by TIWI, T2WI and FLAIR sequences, respectively. SWI were significantly superior to T1WI, T2WI and FLAIR in displaying the size, scope and boundary definition of hemorrhage. A total of 50 dilated ce-rebral deep veins and cortical veins were detected by SWI in 22 cases which were not found by conventional head sequences. The detection rates of intracranial hemorrhage and intracranial hemorrhage in addition of dilated cerebral veins on SWI sequence were the lowest in mild HIE group, and highest in severe group. There was significant difference among the mild, medium and severe groups (P<0.05). Conclusions SWI sequence has higher sensitivity than conventional MRI sequence in detecting intracranial hemorrhage and dilated vein in HIE, and is useful for early diagnosis of HIE.

AIM: To observe the effect of small dose ephedrine on hypote ns ion as the lithotomy position in laying down legs after the aged in the operatio ns with epidural anesthesia. METHODS: Twenty-seven ASA Ⅰ-Ⅱma le patients, aged 65-83 (71? 6.5 ) years undergoing transurethral resection of prostate (TURP) with the lithotomy position were randomly assigned to two gro ups by double blind method: ephedrine group (n=13) and contrasti ve group (n=14). The continual epidural anesthesia was administe red in T 12 -L 1 and L 3-4 for all patients used 1.5 % lidocaine. W hen the operation was finished off, before thirty seconds of horizontal position laying down legs, 15 mg ephedrine was iv at ephedrine group and 3 ml saline wat er at control group. After legs were laid down on the lithotomy position, variab les of SBP, MBP and P were recorded in ten minutes. RESULTS: Dur ing ten minutes after double legs were laid down, the variables were lightly ris en about 8.7 % to 76.9 % in ephedrine group and were fallen about 7.8 % to 85.7 % in control group. The difference on variables of two groups was significant (P

BACKGROUND: Femoral head necrosis can be induced in adult rabbits when a large dose of steroid has been used for a long time. However, the pathogenesis of steroid-induced femoral head necrosis needs further study.OBJECTIVE: To probe into the mechanism of the disease by light microscope and transmission microscope from morphological perspective based on the model of femoral head necrosis in rabbits.DESIGN: A randomized controlled observation.SETTING: Laboratory of Morphology; Teaching and Research Division of Pathology; Laboratory of Surgery, Weifang Medical College.MATERIALS: The experiment was carried out at the Experimental Center of Morphology, Weifang Medical College, between March 2002 and March 2003. Totally 40 adult New Zealand white rabbits were randomly divided into control group (n=10), dexamethasone group (n=10) and horse serum group (n=20).METHODS: Control group was given intravenous injection of normal saline of 10 mL/(kg·d) for 7 consecutive days. Dexamethasone group was given intramuscular injection of dexamethasone of 10 mL/(kg ·d)for 7consecutive days. Horse serum group was given intravenous administration of horse serum of 10 mL/kg; 3 weeks later the same volume of horse serum was injected once again, followed intramuscular injection of dexamethasone of 10 mL/(kg·d)for 7 consecutive days. Inferior sections of cartilage of the femoral head necrosis in the experimental animals were obtained 5 and 10weeks later, and then histological and ultrastructural changes were observed under the light microscope and transmission microscope.MAIN OUTCOME MEASURES: ① Histo-morphological observation of the animals in each group. ② Ultrastructural changes.RESULTS: All the experimental animals survived and entered the result analysis. ① Histo-morphological observation: The cells of inferior sections of cartilage of the femoral head necrosis of the experimental animals in control group were arranged regularly and had a small volume of elliptical bone cells. The cell body was located at bone lacuna, blood vessel arranged well in the medullary cavity of bone. Lesion haracteristics of femoral head in dexamethasone group and horse serum group were similar:Hematopoietic adipose in the medullary cavity of bone was significantly decreased while fat adipose obviously increased; bone trabecula of metaphysis and the inferior sections of cartilage of femoral head were found with ered, and so was the bone nucleus. The number of lacuna of bone was increased. ② Ultrastructural changes: Normal bone cells in control group were elliptical, located at bone lacuna. Nucleus was at one end of the cell with complete karyotheca and many mitochondria in the cytoplasm. In dexamethasone group and horse serum group there were lipid droplets in the osteocytes, narrowed blood capillary in the medullary cavity of bone and injured vascular endothelial cells.CONCLUSION: Corticotropin can induce necrosis of femoral head; the hormone causes accumulated fat adipose in the medullary cavity of bone.The increased internal pressure in the medullary cavity leads to ischemia of femoral head, thus inducing the necrosis of osteocytes.

Objective To investigate the feasibility of diffusion-weighted(DWI) MRI on basis of the intravoxel incoherent motion (IVIM) in nasopharyngeal carcinoma (NPC),and the diagnostic value of pure molecular diffusion coefficient (D),perfusion-related diffusion coefficient (D *) and perfusion fraction (f) in first onset NPC.Methods From December 2011 to January 2013,40 consecutive patients (26 men,14 women; median age,52 years) with suspected NPC were examined on a 3.0 T MR scanner.DW imaging was performed by using a single-shot echo-planar sequence with 13 b-values (0,10,20,30,50,80,100,150,200,300,400,600,800 s/mm2).MR imaging was compared with endoscopy and biopsy for the detection of NPC.Mean interval time between MR imaging examination and subsequent nasopharyngeal biopsy was 3 days (range,0-11 days).The subjects were divided into 2 groups according to the pathological results,group A was subjects with NPC (17 men,9 women; median age,35) and group B was ones with nasopharyngeal chronic hyperplastic inflammation(NPH) (9 men,5 women; median age,35).The D,D * and f were measured and compared in patients with first onset NPC and nasopharyngeal hyperplasia (Mann-Whitney test).Results IVIM DWI was successful in 24/26 with NPC and 12/14 with NPH.D value was significantly lower in A group compared with B group [mean,(0.70 ± 0.13) ×10-3 mm2/s vs (0.78 ± 0.05) × 10-3 mm2/s ; U =2.05,P ＜ 0.05],as was f value [mean,(16.25 ±1.46) ％ vs (26.20 ± 3.90) ％ ; U =11.16,P ＜ 0.01].However,D* value was significantly higher in Agroupas compared with B group[mean,(161.8 ±23.56) × 10-3 mm2/s vs (55.28 ± 17.05) × 10-3 mm2/s; U =13.90,P ＜0.01].Conclusions IVIM DWI is a feasible technique for investigating first onset NPC and D value has a certain value in differentiating NPC and NPH.D* value has an important potential value in distinguishing benign and malignant NPC.

Here we discuss whether N terminal sequencing is appropriate as one of the conventional control methods for monoclonal antibody products. We determined the N terminal sequences of two monoclonal antibody products targeting two antigens separately with both Edman degradation and mass peptide spectrometry. We also identified the characteristic peptide fragments with mass spectrometry. Furthermore, we analyzed their heterogeneity with ion exchange chromatography, capillary zone electrophoresis and Imaged Capillary Isoelectric Focusing. Edman degradation method showed that the N terminal 15 amino acids of heavy and light chains of the two monoclonal antibodies were identical. Peptide mass spectrometry demonstrated that T1 peptide fragments of heavy and light chains of the two antibodies were also the same. But in contrast, peptide mapping and the three analytical methods for heterogeneity analysis could effectively identify and differentiate the two antibodies. The N terminal sequences of two monoclonal antibodies are identical because the number of framework sequences of humanized or human monoclonal antibodies is relatively limited, so whether N terminal sequencing analysis could be regulated as one of the practical control methods should be carefully discussed. Our work also proves that the above analytical methods could combinatorially applied to the identification of monoclonal antibody products, and are more objective compared to N terminal sequencing.
Amino Acid Sequence ; Antibodies, Monoclonal ; isolation & purification ; Chromatography, Ion Exchange ; Humans ; Isoelectric Focusing ; Mass Spectrometry ; Peptide Mapping ; Peptides ; Sequence Analysis, Protein ; methods

BACKGROUND: The uterine arterial embolization which is a major method to treat hysteromyoma has bean widely used in clinic and achieved a satisfactory therapeutic efficacy. The study addressing the effect of trisacryl gelatin microspheres on uterine arterial embolization in a hysteromyoma guinea pig model has less bean reported yet. OBJECTIVE: To vedfy the feesibility of trisacryl gelatin microspheres to uterine arterial embolization in hysteromyoma guinea pig models. METHODS: A total of 30 adult female guinea pigs were randomly divided into two groups: pelvic cavity artery moulding group (n=10) was performed pelvic vascular casting mould to demonstrate the anatomical characteristics, such as source, running shape, length, diameter and branches; arterial embolization group (n=20) was induced hysteromyoma model using astrogen-progestogen replacement therapy and performed technical research and pathological analysis by bilateral uterine arterial embolization. RESULTS AND CONCLUSION: The trunks of uterine arteries were erupted from internal iliac arteries. The diameter of the trunks and its arcuate branches were (0.350±0.022) mm and (0.160±0.012) mm, respectively. The 20 guinea pigs of the arterial embolization group were succeeded in operating bilateral arterial embolization. The dosage of 40-120 pm and 100-300 μm trisacryl gelatin microspheras were (0.040t±0.005) mL and (0.017±0.002) mL respectively during the operation. The achievement ratio of establishing model was 75% in the arterial embolization group. On the pathological section, the microspheres could be found in the uterine arterial arcuate branches and second branches within the subsercsa and third branches. The myometrium Was thickening. The cells of the leiomyoma nodules arranged in palisade or weaving shapes. Ischemia and necrosis were evidently present in leiomyomas of guinea pigs after embolization, but the myometria and endometria had no pathological change of ischemia and necrosis. It is feasible to use trisacryl gelatin microspheres to operate uterine arterial embolization for hysteromyoma of guinea pigs and the embolization effects are satisfactory.

Objective To investigate the short-term outcomes after revision hip arthroplasty for severe acetabular bone deficiency by cup-cage.Methods We retrospectively analyzed 16 patients (16 hips) with Paprosky type Ⅲ B acetabular bone deficiency,who received cup-cage from October 2013 to May 2016.There were 6 males and 10 females,with an average age of 62.6 years (range 40-84 years).All but one patient were with pelvic discontinuity.The reason for revision was aseptic loosening for 14 patients and periprosthetic joint infection for 2.Eleven patients underwent surgery via Trabecular Metal Acetabular Revision System (cup+cage),2 via Trabecular Metal cup and AR cage,and 3 via R3 cup and AR cage.During the follow-up,Harris hip score was recorded to evaluate the clinical efficacy,and X-rays were performed to identify the signs of loosening and changes in rotation center position.Results The mean follow-up was 18.7 months (range 6-36 months).The height of rotation center was decreased from 42.00±12.18 mm preoperatively to 22.75±8.44 mm postoperatively,whereas the horizontal distance of the rotation center was 26.81 ±7.61 mm preoperatively and 32.50±6.51 mm postoperatively (t=8.249,P＜0.001;t=-4.786,P＜0.001).The height of the rotation center was slightly higher than that of the contralateral side postoperatively (t=-3.478,P=0.003),whereas the difference in the horizontal distance of the rotation center between the two groups was not statistically significant (t=1.235,P=0.236).The Harris hip score was improved from 45.63± 11.68 preoperatively to 75.78±9.12 postoperatively (t=-12.157,P＜0.001).During the follow-up,one dislocation occurred at 5 days postoperatively and closed reduction was conducted under anesthesia.There was no blood vessel injury,nerve injury,wound complication and periprosthetic joint infection.No recurrence of infection occurred in 2 patients who received revision hip arthroplasty for periprosthetic joint infection.Conclusion Revision hip arthroplasty for Paprosky Ⅲ B acetabular bone deficiency by cup-cage can achieve good primary stability and reconstruct the rotation center,especially for patient with pelvic discontinuity.