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 investigated the clinicopathological findings and prognosis of 60 patients with pleomorphic carcinoma.Methods 60 cases of pleomorphic pulmonary carcinoma were collected and studied clinicopathologically between 1999 and 2011.All patients underwent pulmonary resections.Results There was no in-hospital death.1 had haemothorax that required reoperation,1 patient had a late cicatricial bronchial stenosis after sleeve lobectomy of the upper right lobe,and treated successfully by the resection of the right two lobes.The 3,5-year survival rates of all patients were 47.2％ and 25.6％ respectively.For N0 and N1-N2 patients,3-,5-year survival rates were 57.3％,32.5 ％ and 25.4％,17.1％,respectively.Overall survivals were of significant difference between radical resection and uncomplete resection.Multivariate Cox regression analyses of overall survival of all 60 patients indicated that radical resection (P =0.041) and nodal status (P =0.029) were significant independent prognostic factors.Conclusion Pleomorphic carcinoma is a rare type of lung cancer.Pleomorphic carcinoma of the lung was often found as a large mass peripherally located and was associated with poor prognosis.Radical resection and nodal status were significant independent prognostic factors.

Objective To investigate the relationship between diameter and drainage territory of tributaries of the hepatic vein and the clinical value of hepatic venous drainage territory evaluation before LDLT.Methods MSCT covering abdomen was performed on 68 donors.The images were transported and reconstructed in GE Advantage Windows 4.2 workplace and IQQA-liver CT images readout and analytical system.The tributaries of hepatic vein were marked,and the diameter and drainage territory were measured.Functional hepatic volume (FHV),and effective hepatic volume (EfHV) of donors and recipients according to the hepatic venous reconstruction results during the operation were calculated.The corresponding graft-to-recipient body weight ratio of recipients was calculated.Results In the tributaries of 220 hepatic veins studied,the coefficient correlation of diameter and drainage territory was 0.752 (P≤0.01),but there was significant difference in the drainage territory of the veins with same diameter.By using Chi-square analysis,venous diameter and drainage territory are classified and statistical frequency by 5 mm and 50 cm3 respectively,and there was statistically significant difference between them (X2 =61.97,P＜0.01).The mean value of drainage territory of RHV (RHVV) was 510.80 ± 168.33 cm3,and that of RFHV (drainage territory with reconstructed IRHV added) was 577.26± 156.72 cm3 respectively.The mean value of drainage territory of LHV (LHVV) was 292.70 ± 76.61 cm3,and that of LFHV (drainage territory with Ⅳ segment tributaries of MHV added) was 551.26 ± 111.82 cm3 respectively.In 25 grafts without MHV,the mean value of drainage territory of EfHV was 405.52-1038.43 cm3.In 43 donors donating grafts with MHV,the mean value of drainage territory of EfHV was 175.35-575.35 cm3.Conclusion There is significant difference in drainage territory of same diameter veins.Bigger diameter doesn't always mean bigger drainage territory.Hepatic vein drainage territory evaluation before LDLT has important clinical significance to formulate surgery scheme.

BACKGROUND: Halofuginone has been proved to ameliorate the pathogenesis of osteoarthritis.OBJECTIVE: To further verify the protective effect of halofuginone on early osteoarthritis.METHODS: Forty-five healthy male C57BL6J mice were randomly divided into three groups (n=15 per group): the mice in sham operation group were only subjected to right knee capsulotomy; in the other two groups, animal models of osteoarthritis were established by cutting off the right anterior cruciate ligament, followed by treated with distilled water (placebo group) or 0.5 mg/kg halofuginone (halofuginone group) via gavage, once daily beginning at 3 days after modeling. Twenty-eight days after treatment, all mice were sacrificed and the right knee was removed. The morphology and structure of the joint tissue were observed by hematoxylin-eosin staining and safranin fast green staining; the expression of transforming growth factor-β1 (TGF-β1) was detected by immunohistochemistry.RESULTS AND CONCLUSION: The structure of articular cartilage in the sham operation group was normal, the cells arranged in neat rows, and the articular surface was not worn. In the placebo group, the articular cartilage layer became thinner, the cartilage surface was worn and even fragmented, and cells arranged in disorder. In the halofuginone group,the cartilage cell layer was clear and tidy, with regular cell morphology. The hyaline cartilage thickness and hyaline cartilage thickness/calcified cartilage thickness were ranked as follows: sham operation group > halofuginone group >placebo group. The calcified cartilage thickness was the highest in the placebo group, followed by halofuginone group,and lowest in the sham operation group. Osteoarthritis Research Society International scores and TGF-β1 positive cells/chondrocytes in the halofuginone group were significantly lower than those in the placebo group, and all above indices showed significant differences among groups (P < 0.05). These results suggest that halofuginone via gavage can partially prevent articular cartilage degeneration in early osteoarthritis mice probably by downregulating the expression of TGF-β1, thus delaying the progression of osteoarthritis.

Objectives Postoperative atrial fibrillation (AF) has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery (CABG) and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials (RCTs) and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies (observational studies), involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence of AF.

Objective To compare the safety and efficiency of nasogastric ( NG ) feeding with nasojejunal (NJ) feeding in treating severe acute pancreatitis ( SAP).Methods The terms NG tube,NJ tube,SAPand enteral nutritionwere used for literature search in PubMed , Embase, Cochrane Library, WanFang and CNKI databases and the publication deadline was June 1, 2016.Random effect model was used for Meta analysis .Results A total of 5 random clinical trials involving 264 patients ( 136 in NG group and 128 in NJ group ) were included .There was no statistical difference on the incidence of adverse events (mortality:RR=0.77, 95%CI 0.42~1.41, P=0.39; infection complications: RR=0.77, 95%CI 0.45~1.30, P=0.39; digestive complications: RR=1.26, 95%CI 0.73~2.16, P=0.41; stopping nasogastric proportion:RR=0.66, 95%CI 0.10~4.10, P=0.65;MODS rate:RR=0.98, 95%CI 0.71~1.35, P=0.90; the percentage of energy balance: RR=1.00, 95%CI 0.97~1.03, P=0.39 and the average length of hospital stay:RR=0.98, 95%CI 0.71~1.35, P=0.90).Conclusions NG feeding was safe and effective , which was comparable with NJ feeding .NG feeding was more convenient with a higher clinical value .

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.

Objective To evaluate the safety of enhanced recovery after surgery (ERAS) programs in pancreas surgery.Methods A computer search was performed on databases which included the Wanfang,CNKI,VIP,PubMed,Cochrane Library,Embase and Sciencedirect for randomized controlled trials or case-control studies on ERAS programs in pancreatic surgery published between January 1995 and August 2017.Two researchers independently evaluated the quality of the studies which met the inclusion criteria and performed a meta-analysis using the RevMan5.3.5 software.Results Four randomized controlled trials and twenty one case-control studies which included 4 063 patients entered into the meta-analysis.These patients included the ERAS group (n =2 052) and the control group (n =2 011 who underwent traditional perioperative management).Compared with the control group,the ERAS group had a lower postoperative complication rate (OR =0.57,95％ CI:0.45 ～0.71,P ＜0.05),a lower delayed gastric emptying rate (OR =0.46,95％ CI:0.37 ～ 0.59,P ＜ 0.05),a lower abdominal infection rate (OR =0.68,95％ CI:0.53 ～ 0.88,P ＜ 0.05),a shorter hospital stay (WMD =-4.86,95％ CI:-6.10 ～-3.62,P ＜ 0.05)and intensive care stay (WMD =-1.04,95％ CI:-2.01 ～-0.08,P ＜ 0.05).No significant differences existed in the mortality,readmission and postoperative pancreatic fistula rates between the two groups.Conclusion Perioperative implementation of ERAS programs was safe and effective in pancreatic surgery,and decreased postoperative complication rates and promoted recovery.

Objective To explore the application and clinical effect of blood bridge venous flap in finger wound with proper palmar digital artery defect. Methods From February,2007 to September,2016,11 cases of fin-ger wound with artery defect were repaired with forearm vein free flap by the way of bridging blood vessels. The time from injury to surgery was 1.5 to 6 hours(average 2.5 hours).Vascular defect length was 1.4 to 3.4 cm(average 2.3 cm). 8 cases were bridged the unilateral digital artery and 3 cases were bridged the both side. The area of skin flap was 1.5 cm × 2.0 cm to 2.2 cm × 3.5 cm and the donor site was sutured directly. Results One case appeared necrosis in marginal part and healed after dressing change. The other flaps and finger survived and the incisions healed well.All the 11 cases were followed up after operation. The follow-up time ranged from 6 to 20 months, aver-aged 10 months. The color and texture were well,the sensation of temperature, pain and tactile were recovered, and the flap had good contour. According to TAM system evaluation method: 6 cases got excellent results,4 cases were good,1 case was poor. The donor site only had a linear scar and the flexion and extension of wrist were not limited. Conclusion Flow bridging venous flap can reconstruct the finger blood and repair the wound simultaneously. To the finger with nerve or tendon defect,bridged with the cutaneous nerve or palmaris longus tendon can also get satisfactory result.

Objective: To observe the outcomes of total hip arthroplasty in patients with stiff hip and moderate or severe leg length discrepancy and to explore the strategy for balance recovery. Methods: A retrospective review was conducted on the clinical data of 30 patients who had stiff hip and moderate or severe leg length discrepancy treated with unilateral primary total hip arthroplasty at Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2017.There were 18 male and 12 female patients aging of (43.5±9.7)years (range, 30-68 years). All patients had different degrees of pelvic tilt and scoliosis. In operation, contractured soft tissues were released, periarticular osteophytes were removed thoroughly and the center of ratation was restablished without femoral shortening osteotomy.Patient satisfaction, Harris hip score, perceived leg length discrepancy (LLD), true LLD and functional LLD were collected.Data were analyzed by paired-samples t-test. Results: The mean follow-up duration was (17.6±7.6)months (range, 12-30 months). The Harris hip score was improved from 37.6±5.7 preoperatively to 84.3±5.2 at last follow-up (t=-57.54, P=0.000). The preoperative and last follow-up data of true LLD((3.19±0.82)cm vs.(0.70±0.71)cm), functional LLD((4.36±1.72)cm vs.(0.46±0.53)cm) and perceived LLD((7.74±2.01)cm vs.(0.98±0.79)cm) was significantly difference(t=26.47, t=15.05, t=26.9, P<0.01). Twenty-seven patients were restored to normal level (LLD≤10 mm ) and there was no sciatic nerve injury observed after surgery. 90.0% (27/30) patients were satisfied by the outcome. Conclusions Total hip arthroplasty have satisfactory effect in correcting leg-length discrepancy of stiff hip patients. Preoperative assessment, individualized surgical methods and soft tissue releasing are important for balance recovery of affected limbs.