Objective To investigate the limitation of quantitative measurement of cerebral blood flow (CBF) of normal white matter by using a single subtraction with thin-slice TI1 periodic saturation (Q2TIPS Ⅱ ) pulsed arterial spin labeling (PASL)technique. Methods Thirty-one patients with brain tumors were examined at 3.0 T MRI system . A second version of quantitative imaging of perfusion using a single subtraction with additional thin-section periodic saturation after inversion and a time delay (Q2TIPS) technique of pulsed arterial spin labeling in the multisection mode and T2* dynamic susceptibility-weighted contrast-enhanced (T2* DSC)MR imaging were both implemented. Cerebral blood flow map obtained from PASL and DSC were reviewed. The regions of interest( ROI )were placed in the region of normal white matter contralateral to the lesion in the proximal and distal slices. In regions of interest, the signal intensity (SI)was measured from the maps of cerebral blood flow map obtained from PASL and DSC. Pair-t test was performed to determine if there were significant signal differences between proximal and distal slices. Pearson linear correlation analysis of signal intensity was performed for values from the same slices of PASL-CBF and DSC-CBF maps. Results In the deep white matter of distal slice, PASL-CBF map showed perfusion deficit while DSC-CBF map showed low CBF in the corresponding brain area. With the increased inversion time,the PASL-CBF map showed obviously improved perfusion signal in deep white matter (but still some perfusion deficit)and slightly decreased perfusion signal in grey matter. The mean signal of normal white matter measured from distal slices of PASL-CBF maps was( -22.1 ±55.5) ml· 100 g-1 · min-1 while it was (89.5 ±45.5) ml. 100 g-1 · min-1 in proximal slices. There was a significant difference of signal intensity from PASL-CBF maps between distal and proximal slices ( t = - 9. 512, P ＜ 0. 01 ＝, while no difference of signal intensity between distal[ (62. 8 ± 29.9) ml · 100 g-1 · min-1] and proximal slices [(57. 1 ±29.6) ml · 100 g-1 · min-1 ]was obtained from DSC-CBF maps(t= -1.607,P＞0.05). There was no significant correlation between PASL-CBF and DSC-CBF in both distal ( r = 0. 093, P ＞ 0. 05 ) and proximal slices ( r = - 0. 234, P ＞ 0. 05). ConclusionsPASL has limitation in the accurate quantification of cerebral blood flow of normal white matter. The quantification of CBF was affected by the limitations of the technique itself and the different parameters chosen..

Objective To evaluate the curative effect of CT-guided stereotactic and neuroendoscope-assisted operation on cerebral hemorrhage caused by hypertension. Methods Twenty-five cases of cerebral hemorrhage caused by hypertension treated in our department in 2005-2006 were selected. ASA602A type position finder was installed under local anesthesia, and operation planning system was imported after CT scanning. The target point was selected at 1-1.5 cm posterior the central point of the largest hematoma, then the coordinate of the target point was calculated, and incisal opening and operation approach were programmed. Brain operation with trephine was performed under general anesthesia. After hematoma evacuating cannula were placed in the skull hole of 3 cm in diameter to remove partial hematoma, neuroendoscope was inserted to get rid of hematoma and stop bleeding.Results Of 25 patients with cerebral hemorrhage, 24 h after operation, 10 received evacuation of 60%-70% of hematomas, 11 did 80%-90%, 4 did more than 90%; 72 h after operation, all patients received evacuation of more than 90%. During the follow-up for 3 months after the operation, activities of daily living (ADL) scoring showed excellent improvement in 14 cases and amelioration in 9; 2 patients died from lung infection 10, 14 d after operation, respectively. Conclusions CT-guided stereotactic and neuroendoscope-assisted surgery is a safe, effective and minimally invasive method to treat hypertensive cerebral hemorrhage.

Persistent baculovirus infection is observed frequently in insect populations. Persistent infection can be transformed to a replicative and infective state caused by stress factors and plays an important role in regulating the size of insect population and in epizoology of baculoviruses. The aim of this study is to establish a persistently baculovirus-infected cell system to explore the molecular mechanisms of baculoviral persistence. Spodoptera exigua nucleopolyhedrovirus (SeMNPV) was serially undiluted passaged in Se301 cells to reduce virulence. Upon infection of Se301 cells with the SeMNPV up to passage 8, a few cells survived even if most of cells died due to virus infection. The surviving cells were passaged and designated as P8-Se301 cell strain. P8-Se301 cells had a population doubling time of 58-65 hours and grew slower than Se301 cells. Light microscopy and electron microscopy observation showed symptom of baculovirus infection, such as virogenic stroma, viral particles and occlusion bodies, in some of P8-Se301 cells. End-point dilution assay and infectious center assay showed that 4.14% +/- 0.99% cells continually released infectious progeny virus which replicated slower than SeMNPV in Se301 cells. The result indicated that P8-Se301 cells show a typical character trait of baculovirus persistent infection.
Animals ; Cells, Cultured ; Nucleopolyhedrovirus ; growth & development ; physiology ; Spodoptera ; virology ; Virus Cultivation ; methods

OBJECTIVETo compare the preliminary effectiveness of mobile-bearing prosthesis and fixed-bearing prosthesis by literature review and observation of cases.

METHODSNinety-eight knees of 94 patients undergoing total knee arthroplasty (TKA) by using cemented and PCL-substitute prosthesis were reviewed from February 2003 to October 2004. The diagnosis of all patients were osteoarthritis. All cases were followed up at least one year. Group A (fixed-bearing prosthesis): 30 knees of 29 patients, 4 males, 25 females, 20 DePuy Prosthesis, 10 Centerpulse Prosthesis. Group B (mobile-bearing prosthesis): 68 knees of 65 patients, 11 males, 54 females, 68 Centerpulse Prosthesis. Make sure statistical comparability between 2 groups by HSS, age and gender, respectively. Postoperation 6 weeks, 3 months, 6 months, 1 year, all cases were evaluated according to Hss and self-satisfaction.

RESULTSThe grades of Hss in different stage were performed statistical analysis. P value in different stage was 0.414 (6 weeks), 0.108 (3 months), 0.235 (6 months), 0.452 (1 year). There were no significant difference between group A and B in different stage by statistical analysis. In one year after operation, the range of motion in 2 groups, group A: 108 degrees (95 degrees - 118 degrees), group B: 107 degrees (90 degrees - 120 degrees), there were no significant difference by ROM (P > 0.05). At the latest follow-up examination, group A: 13.7% of the patients (4 knee joint) complained mild pain, the percent of the patients' self-satisfaction was 90%; group B: 13.1% of the patients (9 knee joint) complained mild pain, the percent of the patients' self-satisfaction was 88%.

CONCLUSIONSAlthough it is certain about the effectiveness of preliminary clinical outcomes with mobile-bearing prosthesis, it is still uncertain about the advantage of mobile-bearing prosthesis over fixed-bearing prosthesis. The reason for preferring to the former still need being demonstrated.

Aged ; Arthroplasty, Replacement, Knee ; instrumentation ; Female ; Follow-Up Studies ; Humans ; Knee Prosthesis ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo compare the rates of perioperative complications in matched patients undergoing simultaneous bilateral total knee arthroplasty, or staged bilateral total knee arthroplasty.

METHODSA total of 219 cases of bilateral total knee arthroplasty were performed from October 1996 to October 2006. It consisted 171 simultaneous and 48 staged (group B) bilateral total knee arthroplasty. Forty-eight patients were matched with group B for age and sex from simultaneous group (group A). A retrospective review of each group was conducted to compare the rates of perioperative complications.

RESULTSNo significant differences between the two matched groups were found with regard to preoperative co-morbidities (P > 0.05). The percentage of patients who had cardiovascular and cerebrovascular complications was significantly higher in the simultaneous group than in the staged group (P < 0.05).

CONCLUSIONSPreoperative health status must be assessed carefully. Patients must be fully informed of the risks of simultaneous bilateral total knee arthroplasty before surgery. Active prevention of perioperative complications must be applied after surgery.

Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Adjustment ; Treatment Outcome

OBJECTIVETo discuss the characteristics and reconstruction strategies of acetabular bone deficiency in total hip arthroplasty in order to find the optimal resolution for this clinical puzzle.

METHODSClinical and radiological materials of 37 patients (37 hips) with acetabular deficiency who underwent primary or revision total hip arthroplasty were analyzed retrospectively from May 1998 to August 2008. According to the common classification system for acetabular bone deficiency-the AAOS classification system, the acetabular bone defect was reconstructed using morselized or structural bone grafting, accessory acetabular hardware (ring, cup or cage) together with cemented or cementless acetabular component respectively. All patients were followed up regularly to assess their hip function improvement by measuring the Harris hip score and to find out the grafting bone healing, absorption and position of the prosthesis by plain radiographic examination.

RESULTSThere were 11 primary and 26 revision total hip arthroplasty. There were 9 hips of AAOS-type I defect, 13 of type II and 15 of type III. Morselized bone grafting was used in 24 cases, bulk structural bone grafting in 6 cases and mixed bone grafting in 7 cases. Twenty-one patients used cementless prosthesis and 16 used cemented prosthesis. The average follow-up period was 53.7 months (6.5 to 130.5 months), the average preoperative Harris hip score was 42 +/- 8 with contrast to 87 +/- 5 of post-operation. Statistically significant difference was found according to t-test with P value less than 0.05. Major or complete healing of grafting bone was obtained at the latest follow-up.

CONCLUSIONSAcetabular bone defect during primary or revision total hip arthroplasty should be reconstructed according to its characteristics and severity. For relatively simple AAOS type I and type II cases, morselized or bulk structural bone grafting together with cementless prosthesis could achieve favorable initial stability, but for more severe AAOS type III cases, bulk structural bone grafting with accessory reinforcement hardware would be necessary. Though the early and mid-term results of the above strategies are satisfied, the long term outcome still require further study.

Acetabulum ; surgery ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Bioprosthesis ; Bone Transplantation ; Female ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgical Mesh

Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Osteochondrodysplasias ; diagnosis ; diagnostic imaging ; surgery ; Radiography ; Young Adult

OBJECTIVETo investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty (TKA).

METHODSWe prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008. The age and body mass index of male and female patients were matched. The surgical and rehabilitation clinical factors were compared between two groups.

RESULTSThere was no significant difference in postoperative hospitalization time, surgical tourniquet time, and wound drainage volume between two groups (P>0.05). The extension/flexion degrees of knee joint before operation, 1-week, 2-week and 1-year after operation for male patients were 6.0 +/- 3.3 degrees/114.0 +/- 10.0 degrees, 2.0 +/- 1.6 degrees/93.0 +/- 7.4 degrees, 0.6 +/- 0.6 degrees/104.0 +/- 9.9 degrees and 0.3 +/- 0.5 degrees/125.0 +/- 8.8 degrees, for female patients were 7.0 +/- 3.4 degrees/112.0 +/- 14.0 degrees, 2.0 +/- 1.3 degrees/89.0 +/- 10.9 degrees, 0.9 +/- 0.8 degrees/101.0 +/- 11.8 degrees, 0.4 +/- 0.5 degrees/124.0 +/- 7.1 degrees. The range of motion before operation, 1-week, 2-week, and 1-year after operation for male patients was 108.0 +/- 9.5 degrees, 91.0 +/- 7.1 degrees, 103.0 +/- 9.9 degrees, and 125.0 +/- 8.9 degrees, for female patients was 105.0 +/- 14.1 degrees, 87.0 +/- 11.4 degrees, 100.0 +/- 11.9 degrees, and 124.0 +/- 7.0 degrees. The preoperative and 1-year postoperative HSS scores were 55.8 +/- 13.3 and 89.6 +/- 6.7 for males and 54.5 +/- 13.8 and 89.2 +/- 4.1 for females. No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion, range of motion and HSS score (P>0.05).

CONCLUSIONSGender does not influence postoperative knee function of osteoarthritis patients. TKA significantly improves knee joint function and relieve osteoarthritis-related pain.

Aged ; Arthroplasty, Replacement, Knee ; rehabilitation ; Body Mass Index ; Female ; Humans ; Knee Prosthesis ; Male ; Osteoarthritis, Knee ; rehabilitation ; surgery ; Postoperative Period ; Prospective Studies ; Sex Factors ; Treatment Outcome

PURPOSE: The aim of this study was to determine the relationship of hypoxia-inducible factor-2 (HIF-2α) and vascular endothelial growth factor (VEGF) with radiographic severity in primary osteoarthritis (OA) of the knee. Expression of these two factors in cartilage samples from OA knee joints was examined at mRNA and protein levels. MATERIALS AND METHODS: Knee joints were examined using plain radiographs, and OA severity was assessed using the Kellgren and Lawrence (KL) grading system. Specimens were collected from 29 patients (31 knees) who underwent total knee replacement because of severe medial OA of the knee (KL grades 3 and 4), 16 patients who underwent knee arthroscopy (KL grade 2), and 5 patients with traumatic knees (KL grade 0). HIF-2α and VEGF expression was quantified by real-time polymerase chain reaction and western blotting. RESULTS: Cartilage degeneration correlated with the radiographic severity grade. OA severity, determined using the Mankin scale, correlated positively with the KL grade (r=0.8790, p<0.01), and HIF-2α and VEGF levels with the radiographic severity of knee OA (r=0.7001, p<0.05; r=0.6647, p<0.05). CONCLUSION: In OA cartilage, HIF-2α and VEGF mRNA and protein levels were significantly and positively correlated. The expression of both factors correlated positively with the KL grade. HIF-2α and VEGF, therefore, may serve as biochemical markers as well as potential therapeutic targets in knee OA.
Adult ; Aged ; Arthroplasty, Replacement, Knee ; Arthroscopy ; Basic Helix-Loop-Helix Transcription Factors/*metabolism ; Biomarkers/*blood ; Cartilage/*metabolism ; Female ; Humans ; Knee Joint/*diagnostic imaging ; Male ; Middle Aged ; Osteoarthritis, Knee/*blood/diagnostic imaging/physiopathology ; RNA, Messenger ; Radiography ; Real-Time Polymerase Chain Reaction ; Severity of Illness Index ; Vascular Endothelial Growth Factor A/*metabolism

BACKGROUNDKnee osteoarthritis (KOA) is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling, stiffness, and movement disorders. The therapeutic goal is to alleviate or eliminate pain, correct deformities, improve or restore joint functions, and improve the quality of life. This study aimed to evaluate the efficacy and safety of Zhuanggu joint capsules combined with celecoxib and the benefit of treatment with Zhuanggu alone for KOA.

METHODSThis multi-center, randomized, double-blind, double-dummy, parallel controlled trial, started from December 2011 to May 2014, was carried out in 6 cities, including Beijing, Shanghai, Chongqing, Changchun, Chengdu, and Nanjing. A total of 432 patients with KOA were divided into three groups (144 cases in each group). The groups were treated, respectively, with Zhuanggu joint capsules combined with celecoxib capsule simulants, Zhuanggu joint capsules combined with celecoxib capsules, and celecoxib capsules combined with Zhuanggu joint capsule simulants for 4 weeks consecutively. The improvement of Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the decreased rates in each dimension of WOMAC were evaluated before and after the treatment. Intergroup and intragroup comparisons of quantitative indices were performed. Statistically significant differences were evaluated with pairwise comparisons using Chi-square test (or Fisher's exact test) and an inspection level of α = 0.0167.

RESULTSFour weeks after treatment, the total efficacies of Zhuanggu group, combination group, and celecoxib group were 65%, 80%, and 64%, respectively, with statistically significant differences among the three groups (P = 0.005). Intergroup pairwise comparisons showed that the total efficacy of the combination group was significantly higher than that of the Zhuanggu (P = 0.005) and celecoxib (P = 0.003) groups. The difference between the latter two groups was not statistically significant (P > 0.0167). Four weeks after discontinuation, the efficacies of the three groups were 78%, 95%, and 65%, respectively, with statistically significant differences (P < 0.0001). Intergroup pairwise comparisons revealed that the efficacy of the combination group was significantly better than that of the Zhuanggu and the celecoxib groups (P < 0.0001). The difference between the latter two groups was not statistically significant (P > 0.0167). The incidences of adverse events in Zhuanggu group, combination group, and celecoxib group were 8.5%, 8.5%, and 11.1%, respectively, with insignificant differences (P > 0.05).

CONCLUSIONSZhuanggu joint capsules alone or combined with celecoxib showed clinical efficacy in the treatment of KOA. The safety of Zhuanggu joint capsules alone or combined with celecoxib was acceptable.

TRIAL REGISTRATIONChinese Clinical Trial Registry, ChiCTR-IPR-15007267; http://www.medresman.org/uc/project/projectedit.aspx?proj=1364.

Adult ; Aged ; Celecoxib ; administration & dosage ; adverse effects ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; drug therapy