BACKGROUND:There is controversy on the treatment of old femoral neck fracture with hemiarthroplasty.
OBJECTIVE:To observe the clinical effect of cementless hemiarthroplasty in the treatment of old femoral neck fracture, and to compare with total hip arthroplasty.
METHODS:A retrospective analysis was performed on the clinical data of 23 old femoral neck fracture patients treated by artificial joint replacement from January 2009 to June 2010. Among the 23 patients, 11 cases were treated with cementless hemiarthroplasty, and 12 cases were treated with total hip arthroplasty. The time for off-bed activity, Harris score and the incidence of perioperative complications were compared between cementless total hip arthroplasty and hemiarthroplasty.
RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-18 months. The active straight leg raising angle, time for off-bed activity, incidence of early postoperative complications and Harris score at 1 week after treatment of the cementless hemiarthroplasty group were better than those of the total hip arthroplasty group;there were no significant differences in Harris score at 6 weeks, 3 and 6 months between two groups;the incidence of forward hip pain of the cementless hemiarthroplasty group was higher than that of the total hip arthroplasty group. So, we general y think that cementless hemiarthroplasty has better short-term effect in the treatment of old femoral neck fracture, but the long-term integrated efficacy needs to be further identified.

Objective To study the feasibility,safety,indications and possible advantages of minimally invasive surgery over traditional open surgery in treating pancreatic body or tail lesions.Methods From December 2009 to December 2014,the clinical data of 71 patients with lesions in pancreatic body or tail who underwent minimally invasive distal pancreatectomy (MIDP) or open distal pancreatectomy (ODP) at the General Surgery of Huadong Hospital were retrospectively analyzed.There were 22 patients in the MIDP group and 49 patients in the ODP group.The operations in 15 patients in the MIDP group were performed by the Da Vinci robot-assisted surgical system and 7 patients by laparoscopic distal pancreatectomy.Results The MIDP group had a shorter time to pass first flatus [(MIDP (2.5 ± 1.0) d vs ODP (3.5 ±1.0)d,P ＜ 0.05],and shorter postoperative hospital stay [(MIDP (15.2 ± 7.9) d vs ODP (23.4 ±21.2) d,P ＜ 0.05] than the ODP group.There were no significant differences on total pancreatic fistula rate [MIDP 45.5％ (10/22) vs ODP 55.1％ (27/49),P ＞ 0.05] and symptomatic postoperative pancreatic fistula rate [MIDP 18.2％ (4/22) vs ODP 18.4％ (9/49),P ＞ 0.05] between the two groups.The MIDP group had a significant longer operative time [MIDP (246.3 ±75.3)min vs ODP (168.1 ±33.7)min,P＜0.05] than the ODP group.Conclusions Minimally invasive surgery is safe and feasible in treatment of lesions in pancreatic body or tail with less trauma and faster recovery.The application of robotic surgery has expanded the treatment options for lesions in pancreatic body or tail.

Objective To establish reference intervals of nine laboratory projects for hepatorenal function and verify its reliability by indirect method . Methods ALL test results were extracted from physical examinations that were stored in the laboratory information system of Zhongshan Hospital during 2012 to 2014.Using Skewness-Kurtosis test to detect the normality of data , if not the original data were transformed through BOX-COX transformation to obtain an approximatenormal distribution .Outliers were identified and omitted by Turkey method .The indirect reference intervals were taken by applying Hoffmann method.The reference change value ( RCV) was selected to inspect the statistical significance between the calculated and published reference intervals .Results Among those nine laboratory projects ,thedifferences betweenthereference intervalsfor ALT , AST, AKP, GGT, TP, BUNwerelessthan their RCV ( <60.12%, 38.12%, 19.9%, 41.53%, 8.53%, 37.5%) , there were no significant differences between the direct method.There were slight differences between the calculated reference intervals and published reference intervals for the lower limit of the LDH and the upper limit of the ALB (>26.65%,9.92%) ,and there was a significant difference between the calculated reference intervals and the current reference interval in the laboratory for the lower limit of the UA of male (>26.65%).Conclusion This research further proved the reliability of indirect reference intervals and this technique deserved to be promoted and applied by other clinical laboratories.

Objective To investigate the relationship between EphA2, EphrinAl and E-cadherin expressions and tumor stage and prognosis in pancreatic cancer. Method EphA2, EphrinAl and Ecadherin expressions were detected by immunohistochemistry in the tumor tissue and normal tissue specimens from 48 patients with primary pancreatic cancer. Results The expressions of EphA2 and EphrinAl were higher in the pancreatic carcinoma tissues than in the normal pancreatic tissues (P<0. 05). The E-cadherin expression was lower in the pancreatic cancer tissues than in the normal pancreatic tissues (P<0. 05). With decreasing histological differentiation, the expressions of EphA2 and EphrinAl in carcinoma tissues increased significantly (P<0. 05), while the E-cadherin expression decreased significantly (P<0. 05). The positive expressions of EphA2 and EphrinAl in the primary tumor significantly increased in stageⅢ and Ⅳ than in stage Ⅰ and Ⅱ (47. 9%vs 6. 25% , P<0. 05;47. 9% vs 8. 3%, P<0. 05), while the negative expression of E-cadherin was reversely correlated with these tumor stages (14. 6% vs 64. 6%, P<0. 05). Cox multivariate analysis showed that the clinical stage, EphA2 positive expression and E-cadherin negative expression were significantly associated with survival. Conclusion Abnormal expressions of EphA2, EphrinAl and E-cadherin were involved in the progression of pancreatic cancer and they were useful in predicting prognosis.

Objective To investigate the prognostic value of vascular endothelial growth factor C (VEGF-C) and clinicopathologic indexes in predicting recurrence following curative resection of pancreatic cancer. Methods The expressions of VEGF-C of 47 patients who underwent curative resection for curative pancreatic cancer resection were detected by Envision immunohistochemical methods. The effects of VEGF-C and clinicopathologic indexes on recurrence were assessed by the Kaplan-Meier and Cox proportional hazards model. Results The positive rates of VEGF-C were 61. 7% in = 29) and 14. 9%(n = 7), respectively, in pancreatic cancer and normal pancreatic tissues. The positive expression of VEGF-C in pancreatic carcinoma was obviously higher than the normal pancreatic tissues (P = 0. 018). The median disease-free survival time was 11. 9 months, the average disease-free survival time was 18. 4 + 2. 4 months, and the cumulative 1-year, 2-year and 3-year actuarial recurrence free survival rates were 46. 8%, 23. 4%, 14. 4%, respectively. There was a significant correlation between the VEGF-C expression and lymph node metastasis in pancreatic cancer (P = 0. 036). On Kaplan-Meier analysis, VEGF-C (P = 0. 020), tumor diameter (P = 0. 013), age (P = 0. 057) and adjuvant chemotherapy (P=0. 017) were associated with disease-free survival time. Multivariate analysis showed VEGF-C (P = 0. 009), tumor diameter (P = 0. 010) and adjuvant chemotherapy (P = 0. 017)were independent prognostic factors of disease-free survival after surgery for pancreatic cancer.Conclusion The expression of VEGF-C was higher in pancreatic cancer, and VEGF-C was correlated with lymph node metastasis. VEGF-C was the biomarker that independently predicted disease-free survival after surgery for pancreatic cancer.

ObjectiveTo investigate the change of gene polymorphorism of surfactant protein-B (SP-B) intron 4 in infants with bronchopulmonary dysplasia (BPD).MethodsForty-five infants with BPD (BPD group) and ninety-nine infants without lung diseases (control group) who admitted into Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from July 2008 to July 2011 were selected into this study.Genotyping for fragment length polymorphism of SP-B intron 4 was performed by polymerase chain reaction (PCR),agarose gel electrophoresis,cloning and sequencing methods in both groups.Differences of allele frequencies (invariant allele and variant allele) and genotype frequencies (invariant genotype and variant genotype) between BPD group and control group were analyzed.The differences of gestational age and birth weight between the two groups were compared with Independent-Samples t test.The gender composition and differences of allele or genotype frequencies between the two groups were compared with Chi-square test.Results Invariant allele frequencies in BPD group and control group were 83.3％ (75/90) and 92.0％ (182/198),and variant allele frequencies were 16.7％ (15/90,including eight insertion alleles and seven deletion alleles) and 8.1％ (16/198,including eight insertion alleles and eight deletion alleles).There were significant differences between the two groups (x2 =4.75,P =0.029).In BPD group,there were 32 cases (71.1 ％,32/45) invariant genotypes and 13 cases (28.9 ％,13/45,including seven cases insertions and six cases deletions) variant genotypes; in the control group,there were 85 cases invariant genotypes (85.8％,85/99) and 14 cases (14.1％,14/99,six insertions and eight deletions) variant genotypes.Significant difference was found between the two groups (x2=4.42,P＜0.036). ConclusionsVariations of SP-B intron 4 were more in BPD infants,and the variation of SP-B intron 4 might be associated with BPD.

Objective To evaluate the diagnostic value of dual-source CT angiography (DSCTA) for intracranial aneurysms.Methods The data of DSCTA and digital subtraction angiography (DSA) were collected from 95 patients with subarachnoid hemorrhage (SAH).The efficacies of detection and description of morphologic features of intracranial aneurysms were analyzed retrospectively.Results A total of 117 aneurysms in 88 patients were detected with DSCTA.Two patients were suspected of having aneurysms,and no aneurysrms were detected in 5 patients.These patients were reexamined with DSA,4 were diagnosed as having aneurysm,and the aneurysms were not detected in 3 patients.DSA results were considered as gold standard,the specificity,sensitivity and accuracy of DSCTA for the detection of intracranial aneurysms were 100％,96.7％and 96.8％,respectively.The larger volume of intracranial aneurysm was,the higher the sensitivity of DSCTA diagnosis would be.Even for small aneurysms,the sensitivity of DSCTA diagnose was more than 90％.In addition,tmeasurement results of the maximum diameter and neck width of aneurysms measured by DSCTA were almost consistent with DSA.Condclusions SCTA is a non-invasive,quick,reliable,and effective method,and can provide accurate imaging information for surgery.The specificity and sensitivity of the diagnosis of aneurysms with DSCTA are almost the same with DSA.It has more advantages than DSA in the emergency operation of intracranial aneurysms.

Objective To analyze the effects of 25-hydroxyvitamin D[25(OH)D]on the result of the HCV RNA and the FIB-4 in the patients with hepatitis C.Methods 255 serum samples were random collected from the patients with hepatitis C and 218 serum samples were random collected from the healthy people.The 25(OH)D,HCV RNA,aspartate aminotransferase (AST),alanine aminotransferase (ALT)and blood platelet (PLT)were detected.Then,compared the results of the 25 (OH)D in the patients with hepatitis C and the healthy group.Analyzed the relevance between the concentration of 25(OH) D and HCV RNA.According to the quartile concentration of the 25(OH)D,the patients with hepatitis C were categorized to four groups.The relationship of FIB-4 between HCVRNA and 25(OH)D was analyzed.Results The average concentration of the 25(OH)D in the patients with hepatitis C and healthy people were 48.16±1.41 nmol/L vs 60.42±1.34 nmol/L, with a significant difference (t=4.682,P<0.01).There were 38 patients (14.90%)had severe deficiency of 25(OH)D (<25 nmol/L)in 255 patients with hepatitis C.And there were 8 patients (3.67%)had severe deficiency of 25(OH)D (<25 nmol/L)in 218 healthy people,with a significant difference (t=5.216,P<0.01).Then found no relevance between the log-arithmic of the HCV RNA and the concentration of the 25(OH)D (r2=0.018 8,P=0.412)and there was significant differ-ence between the proportion of FIB-4 in the highest quartile concentration of the 25(OH)D and the lowest quartile concen-tration of the 25(OH)D (χ2=8.190,P=0.042).Conclusion The patients with hepatitis C were easier to have a severe de-ficiency of 25(OH)D than the healthy people.The hepatitis C patients should been suggested to supply the vitamin D.FIB-4 has a significant difference with 25(OH)D and no great effects on the result of the HCV RNA.

Objective To construct two kinds of eukaryotic ccll expression vcctors pIRES2-EGFP-SP-B-C/T 1580 and evaluate their expressions in 293T cells,for the further study of relationship between polymorphism of surfactant protein B (SP-B) gene and bronchopulmonary dysplasia (BPD).Methods The eukaryotic pIRES2-EGFP-SP-B-C/T 1580 expression vectors were constructed by gene recombination,and identified by gene sequencing.The recombinant expression vectors were transfected into 293T cells by lipofectamine2000.The expression of green fluorescence protein in 293T cells was observed by fluorescence microscopy.The mRNAs and proteins of SP-B-C/T 1580 were tested and identified by reverse transcriptionpolymerase chain reaction-restriction fragment length polymorphism(RT-PCR-RFLP) and western blot.Results Two recombinant plasmids contained the complete cDNA of SP-B with the same sequence as in gene bank.The base of SP-B 1580 gene of pIRES2-EGFP-SP-B-C 1580 was C,that of pIRES2-EGFP-SP-B-T 1580 was T.After being transfected into 293T cells,highly efficient expression of SP-B-C/T 1580 gene was detected at mRNA and protein levels.Conclusions The pIRES2-EGFP-SP-B-C/T 1580 eukaryotic cell expression vectors were successfully constructed.

Objective To discuss the necessity of closing the peritoneum during the operation of ileal conduit after the radical cystectomy.Methods We retrospectively analyzed the clinical data of 395 patients with bladder cancer who received radical cystectomy from Jan.2014 to Sep.2016.The amount of male was 327,female was 68.The mean age was (65.8 ± 9.7) years old.Patients were divided into four groups according to the surgical method of cystectomy and urinary diversion.In group A,patients,including 78 males and 9 females,were received open radical cysectomy (ORC) with extraperitoneal ileal conduit.The mean age was (67.8 ± 9.2) years old.In the preoperative clinical staging,66 cases were less than T2 and 21 cases were more than T2.Preoperative pathological grade in 83 cases and low grade in 4 cases.In group B,patients,including 31 males and 2 females,were accepted ORC with ileal conduit without peritoneum closure.The mean age was (67.3 ± 8.7) years old.Preoperative clinical staging showed less than T2 in 25 cases,more than T2 in 8 cases,The preoperative pathological grade showed high grade in 33 cases.In group C,patients,including 112 males and 27 females,were accpeted LRC with ileal conduit without peritoneum closure.The mean age was (64.3 ± 10.5)years old.The preoperative clinical staging showed less than T2 in 107 cases and more than T2 in 32 cases.The preoperative pathological grade showed high grade in 135 cases and low grade in 4 cases.In group D,patients,including 106 males and 30 females,were accepted RARC with ileal conduit without peritoneum closure.The mean age was (65.9 ±10.0)years old.Preoperative clinical staging showed less than T2 in 103 cases and more than T2 in 33 cases.The preoperative pathological grade showed high grade in 132 cases and low grade in 4 cases.Ileal conduit without peritoneum closure means completely open the peritoneum after anastomosis of the ureter and intestine in the urinary diversion surgery without shutting down the peritoneum,which is different from the extraperitoneal ileal conduit.The operating time,blood loss,blood transfusion rate,recovery time of intestinal function and perioperative complications and rate of hydronephrosis were analyzed.Results The 395 cases completed operation successfully,no LRC or RARC had been converted to ORC.The operative time was (280.1 ± 92.3) min,(233.6 ± 99.4) min,(304.8 ± 108.9) min,(364.6 ± 86.4) min in four groups,respectively (P ＜ 0.05).The blood loss in four groups were (489.1 ± 285.6) ml,(431.8 ± 233.1) ml,(373.0 ±213.7) ml,(205.6 ± 137.8) ml,respectively (P ＜0.05).The transfusion rate in four groups were 18 (20.7％),16 (48.0％),15 (10.8％),14 (10.3％),respectively (P ＜ 0.05).The mean time to flatus in four groups were (3.7 ±1.8)d,(3.6±1.0)d,(3.5±1.2)d,(2.2±1.7)d,respectively (P ＜ 0.05).While ileal obstruction rate had no statistical difference in four groups [group A 17 cases(19.5％),group B 6 cases(18.2％),group C 27 cases(19.4％),group D 19 cases(14.0％),P =0.678].Urine leakage,intestinal leakage,lymphocyst were only occurred in group A [7 cases (8.0％),2 cases (2.3％),2 cases (2.3％)].Pyelonephritis was noticed in each group,including 14 cases(16.1％)in group A,2 cases(6.1％)in group B,9 cases (6.5％)in group C,6 cases(4.4％)in group D (P ＜ 0.05).Hydronephrosis 6 months after surgery was observed in four groups,including 15 cases(17.2％)in group A,3 cases(9.1％)in group B,7 cases(5.0％)in group C,5 cases(3.7％)in group D (P ＜ 0.05).Conclusions Ileal conduit without peritoneum closure would not increase the incidence of complications,on the contrary,it would relieve the tension of anastomosis,and reduce the occurrence of complications such as urine leakage.