OBJECTIVETo compare the clinical effects between hip anterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery and posterior K-L approach combined with quadratus femoris bone flap transplantation for the treatment of femoral neck fracture of Garden III-IV in young and middle-aged patients.

METHODSFrom January 2004 to January 2011,46 patients with femoral neck fractures were treated by two kinds of operation. Among them, 20 cases were treated with anterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery, included 12 males and 8 females with an average age of (32.1 ± 7.3) years old, involved 12 cases of Garden III and 8 cases of Garden IV. The other 26 cases were treated with posterior K-L approach combined with quadratus femoris bone flap transplantation, included 20 males and 6 females with an average age of (37.8 ± 6.9) years old, involved 16 cases of Garden III and 10 cases of Garden IV. The index of hospitalization (hospitalization time, total cost, operative time, intraoperative blood loss, postoperative complications), the quality index of operation (fracture reduction, position of internal fixation, fracture healing time, nonunion and femoral head necrosis) of two groups were observed and compared. Hip joint function were evaluated by Harris score.

RESULTSAll patients were followed up from 28 to 41 months with an average of 36 months. The intraoperative blood loss of group S-P (92.3 ± 10.4) ml was less than that of group K-L (132.4 ± 11.2) ml, there was significant difference between two groups (P < 0.05). The operation time of group S-P (81.4 ± 9.2) min was more than that of group K-L (67.1 ± 4.5) min, the difference was statistically significant (P < 0.05). One case in group S-P and 9 cases in group K-L appeared postoperative complications, there was significant difference between two groups (P < 0.05). The fracture healing time of S-P group (83.5 ± 7.3) d was shorter than that of group K-L (103.2 ± 12.6) d, there was significant difference between two groups (P < 0.05). At 30 months after operation, there were significant difference in Harris scoring between two groups (P < 0.05).

CONCLUSIONAnterior S-P approach combined with iliac bone flap transplantation with deep circumflex iliac artery for treatment of femoral neck fracture of Garden III-IV of young and middle-aged patients, it has characteristics in clear anatomic and easy to operate. As compared with K-L approach, S-P approach can better reserve residual blood supply of femoral neck. While combining with the iliac bone flap transplantation with deep circumflex iliac artery, it could better reconstruct the blood supply of femoral neck to promote fracture healing.

Adult ; Case-Control Studies ; Female ; Femoral Neck Fractures ; physiopathology ; surgery ; Fracture Healing ; Humans ; Iliac Artery ; Male ; Middle Aged ; Surgical Flaps ; transplantation

Objective To observe adhesion and growth of Sehwann cells(SCs) on small intestinal submueosa(SIS) and study the bioeompatibility of SIS with SCs.Methods The SCs of SD neonate rat were isolated and cultured in vitro,then were seeded on prepared SIS.At different times,the adhesion,growth and proliferation of SCs on SIS were observed by phase contrast microscope,histological examination,scanning e- lectron microscope and transmission electron microscope.Results By phase contrast microscope,SCs grew well on the edge of SIS after 3 and 5 days.SCs adhered tightly on the surface of SIS after 5 days through histo- logical examination.By scanning electron microscope,on the surface of SIS,SCs grew and adhered actively, prominence of cells body were obvious.They connected end-to-end with each other or arranged in clusters. Protein granules were secreted on cells surface.By transmission electron microscope,SCs grew in good condi- tion and adhered tightly on the surface of SIS.At the interface of SCs and SIS,prominence was seen to contact with SIS in the bottom of cell body.Conclusion SCs are able to adhere and grow well on the surface of SIS.As a scaffold,SIS has good biocompatibility with SCs.

Objective: To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients. Methods: A total of 19 cases with comminuted femoral intertrochanteric fracture, aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification, 13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach, the lesser trochanter was fully exposed, reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP). The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score. Results: All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment, the Sanders hip function score were excellent in 7 patients(36.8%), fine in 12 cases(63.2%). And curative efficacy was good in all cases(100%). There was no significant difference in the curative effect between patients with different classification and gender. Conclusions Through the posterior-lateral approach, the surrounding structures of the lesser trochanter can be fully exposed, and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.

OBJECTIVEVasoconstriction and vascular hypersensitivity to serotonin were previously shown in animal models of adventitia injury. We investigated the contribution of angiotensin II (AngII)/AngII receptors and oxidative stress to vascular contractility and reactivity in this model.

METHODSWistar Kyoto rats were divided into 3 groups: normal (n = 6, no any intervention, only for measuring the serum AngII concentration), vehicle (n = 12, collared), and valsartan (n = 12, collared + valsartan 30 mg×kg(-1)×d(-1)). After one week of treatment, adventitia injury was induced by positioning a silicone collar around the right carotid artery for one week. Blood flow and vascular reactivity to serotonin were determined one week after injury, the blood from left ventricle was taken to measure the serum AngII concentration by ELISA, and carotids were harvested for morphometry and Western blot analysis.

RESULTSAdventitia injury induced lumen cross-sectional area reduction (-44% vs. -5%), media diameter increase (62% vs. 10%), blood flow reduction [(2.79 ± 0.22) vs. (4.33 ± 0.84) ml/min] were significantly attenuated by valsartan. The increased vascular reactivity sensitivity to serotonin in vehicle group was also significantly reduced in valsartan group. Serum AngII concentration was significantly increased in vehicle group [(45.21 ± 4.52) pg/ml vs. (19.83 ± 0.5) pg/ml in normal rats, P = 0.0148] and the expression of AngII type 1 (AT(1)) receptor, AngII type 2 (AT(2)) receptor, as well as p22(phox) in collared arteries were significantly upregulated. Valsartan did not affect the AT(1) receptor expression but further increased serum AngII concentration [(89.73 ± 20.44) pg/ml vs. (45.21 ± 4.52) pg/ml, P = 0.001], and AT(2) receptor expression, while downregulated p22(phox) expressions.

CONCLUSIONSCollar-induced adventitia injury resulted in chronic vasoconstriction and vascular hypersensitivity to serotonin via increased serum AngII level, upregulated AngII receptors expression in the vascular well, and activated local oxidative stress. These changes could be blocked by valsartan suggesting a crucial role of AngII/AngII receptors on vascular contractility and reactivity changes in this model.

Angiotensin II ; metabolism ; Animals ; Carotid Arteries ; drug effects ; metabolism ; pathology ; Connective Tissue ; pathology ; Male ; Oxidative Stress ; Rats ; Rats, Inbred WKY ; Receptors, Angiotensin ; metabolism ; Tetrazoles ; pharmacology ; Valine ; analogs & derivatives ; pharmacology ; Valsartan ; Vasoconstriction ; drug effects

OBJECTIVETo evaluate the relationship between epithelial mesenchymal transition (EMT) and lung metastasis in hepatocellular carcinoma.

METHODSThere were 100 patients who underwent surgical resection of hepatocellular carcinoma between January 2000 and March 2004. They were classified with non-distance metastasis and lung metastasis depend on the close following up till March 2007. Their hepatocellular carcinoma specimens were retrospectively examined for EMT markers (E-cadherin, Vimentin, Fibronectin) with immunochemistry staining in tissue microarray. Univariate and multivariate analysis were used for study the relationship between EMT and lung metastasis.

RESULTSUnivariate analysis showed that down regulation of E-cadherin, overexpression of fibronectin, cytosolic expression of vimentin, AFP >or= 400 ng/ml, tumor size more than 10 cm, portal vein involvement, poorly differentiated of tumor had close correlation with lung metastasis. Multivariate analysis indicated that overexpression of fibronectin was independent factor for lung metastasis apart from tumor size more than 10 cm, portal vein involvement and poorly differentiated of tumor.

CONCLUSIONThe results proposed that EMT has close relation with lung metastasis in hepatocellular carcinoma.

Adult ; Aged ; Cadherins ; metabolism ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Cell Differentiation ; Epithelial Cells ; pathology ; Female ; Fibronectins ; metabolism ; Follow-Up Studies ; Humans ; Liver Neoplasms ; metabolism ; pathology ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Metastasis ; Stromal Cells ; pathology ; Vimentin ; metabolism

OBJECTIVETo study the clinicopathologic features, diagnosis and differential diagnosis of sinonasal teratocarcinosarcoma (SNTCS) and olfactory neuroblastoma (ONB), and to discuss the histogenesis and possible relationship between SNTCS and ONB.

METHODSSeven cases of SNTCS and 34 cases of ONB were retrieved from the pathological archives together with one case each of malignant teratoma and immature embryonic tissue at 8 weeks were collected from Beijing Tongren Hospital. The clinicopathologic features were analyzed and immunohistochemical staining was performed on paraffin sections.

RESULTSSix of the SNTCS patients were male and one was female. The patients age range was 25 to 69 years (mean age 46). Four cases were initial presentation and three were recurrences. Histologically, the tumor shows multiple tissue components derived from three germ layers. There were mixture of teratoma-like tissue and carcinosarcoma. The components include fetal clear cell squamous epithelium derived from ectoderm. Glandular and tubular structures and ciliated columnar epithelium derived from endoderm. Fibroblasts, striated muscle, smooth muscle, cartilage and osteoid matrix derived from mesoderm. The carcinoma component exhibited mostly adenocarcinoma and squamous cell carcinoma, whereas the sarcoma component mostly exhibited rhabdomyosarcoma, leiomyosarcoma, and fibrosarcoma. In addition, carcinoid, and primitive mesenchymal tissue and the ONB component were also seen. The morphological characteristics of SNTCS comprised fetal clear cell squamous epithelium, carcinosarcoma and the ONB component. By immunohistochemistry, the epithelial component and cells with epithelium differentiation were positive for cytokeratin (pan) and EMA. The ONB component was positive for Syn, NSE, CD99, NF and CgA to different degrees. Neurofibril bundles were positive for S-100, and Flexner-Wintersteiner rosettes expressed cytokeratin (pan) and EMA. The spindle cells expressed vimentin, SMA, desmin, myosin and myoglobin. The primitive mesenchymal tissue expressed vimentin, and the mucoid materials and glycogen were positive for PAS. GFAP was negative in all cases. The 34 cases of ONB, included 18 men and 16 women, the age ranged from 12 to 72 years (mean 42.8 years). Microscopically, the tumor shows epithelial nests, net of angioma-like fibrous connective tissues, small round and spindle cells, glandular, squamous-like cells, and cells of rhabdomyoblastic differentiation, Homer-Wright and Flexner rosette, bundles of neurofibrils, etc. NSE and CgA were expressed in small cells. S-100 protein was positive in the areas of bunches of neurofibril. Cytokeratin (pan) was positive in epithelial cells. Myoglobin was positive in the cells of rhabdomyoblastic differentiation. The single case of immature malignant teratoma exhibited primitive nerve tissue, but fetal clear cell squamous epithelium was not found. In the immature embryonic tissue, rudimentary organs were formed, with fetal clear cell squamous epithelium lining present on the nasal and oral cavities surface.

CONCLUSIONSSNTCS is a rare and aggressive malignant neoplasm. Most of ONB are low-grade malignant tumors. Morphological differences are the most important basis to make differentiate SNTCS from ONB. As SNTCS may demonstrate a multiplicity of structures and pleomorphism, inadequate sampling at biopsy, therefore, may lead to errors in diagnosis. No evidence show that SNTCS are derived from germ cells and sinonasal teratoid carcinosarcoma may be a more proper name. SNTCS probably arises from primitive totipotential cells of olfactory/sinonasal membrane, and the relationship between SNTCS and ONB needs further study.

Adult ; Aged ; Biomarkers, Tumor ; metabolism ; Carcinosarcoma ; pathology ; Diagnosis, Differential ; Esthesioneuroblastoma, Olfactory ; pathology ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Nose Neoplasms ; pathology ; Paranasal Sinus Neoplasms ; pathology ; Phosphopyruvate Hydratase ; Rhabdomyosarcoma ; pathology

OBJECTIVETo investigate the clinical safety and effectiveness of percutaneous embolization in treating the late failed renal allograft in patients with graft intolerance syndrome (GIS).

METHODSTranscatheter embolization of renal graft artery was performed in 18 patients with late graft dysfunction and GIS. The subsequent complications, postoperative symptom remission rate, and prognosis were assessed.

RESULTSGIS was relieved in 15 patients (83.3%), of which 6 patients (33.3%) had severer fever and pain in the area of renal graft after embolization, which lasted for a mean of 3.5 days (range: 2-5 days). GIS persisted for more than 2 weeks in 3 patients (16.7%), who ultimately underwent surgical removal of grafts. No severe embolism-associated complications were noted.

CONCLUSIONPercutaneous embolization can effectively avoid surgical graft removal in patients with late renal allograft failure, and therefore can be used as a safe and effective treatment for the late failed renal allograft combined with GIS.

Adult ; Aged ; Embolization, Therapeutic ; Female ; Graft Rejection ; complications ; therapy ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Renal Insufficiency ; complications ; therapy ; Transplantation, Homologous ; Treatment Outcome ; Young Adult

AIM: To explore the relationship between serum uric acid(SUA)and cystatin C(CysC)levels with diabetic retinopathy(DR).METHODS: A prospective study.A total of 53 non-DR patients with type 2 diabetes mellitus(T2DM; T2DM group)and 83 patients with DR admitted to the hospital between May 2019 and May 2021 were enrolled. In DR patients, there were 47 cases with non-proliferative diabetic retinopathy(NPDR)in NPDR group and 36 cases with proliferative diabetic retinopathy(PDR)in PDR group. A total of 48 healthy people in physical examination center during the same period were enrolled as control group. The serological indexes of all subjects were compared. SUA level was detected by urate oxidase method. The level of serum CysC was detected by immunoturbidimetry. The correlation between serum SUA, CysC and the other serological indexes was analyzed by Spearman. The influencing factors of serum SUA and CysC were analyzed by multivariate linear stepwise regression method. The predictive efficiency of serum SUA and CysC for DR was analyzed by receiver operating characteristic(ROC)curves.RESULTS: The body mass index(BMI)and systolic blood pressure(SBP)in T2DM, NPDR and PDR group were significantly higher than those in control group(all P<0.05). SBP in PDR group was significantly higher than that in T2DM and NPDR group(all P<0.05). The course of diabetes mellitus in NPDR and PDR group was significantly longer than that in T2DM group(all P<0.05), and it was significantly higher in PDR group than in NPDR group(P<0.05). The levels of fasting plasma glucose(FPG), hemoglobin Alc(HbA1c), SUA and CysC in control group, T2DM group, NPDR group and PDR group were gradually increased(all P<0.001). The levels of low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG)in PDR group were significantly higher than those in control group(all P<0.05), while level of high-density lipoprotein cholesterol(HDL-C)was significantly lower than that in control group(P<0.05). The levels of serum SUA were positively correlated with FPG, HbA1c, total cholesterol(TC)and TG levels(rs=0.564, 0.631, 0.513, 0.408, P<0.001), but they were not correlated with HDL-C or LDL-C(rs=-0.061, 0.035, P>0.05). The levels of serum CysC were positively correlated with FPG, HbA1c, TC and TG levels(rs=0.524, 0.692, 0.395, 0.435, P<0.001), but they were not correlated with HDL-C or LDL-C(rs=-0.012, 0.049, P>0.05). FPG, HbA1c, TC and TG were influencing factors of serum SUA and CysC levels(P<0.001). The area under the curve(AUC)in the combined detection of SUA and CysC(0.892, 95%CI: 0.840-0.944, sensitivity:71.1%, specificity: 94.3%), was significantly greater than that of AUC [SUA(0.807, 95%CI: 0.735-0.879, sensitivity: 69.9%, specificity: 75.5%)and CysC(0.763, 95%CI: 0.684-0.841, sensitivity: 69.9%, specificity: 75.5%)] alone(all P<0.05).CONCLUSION: The levels of serum SUA and CysC gradually increase with the aggravation of DR. The combined detection of serum SUA and CysC can improve the diagnostic and predictive efficiency for DR.

Purpose To explore the expression of CBX8 in gastric adenocarcinoma tissue and its clinical significance.Methods 119 cases of primary gastric adenocarcinoma treated by surgery and corresponding adjacent normal tissues were collected. The protein expression levels of CBX8 in gastric adenocarcinoma and their corresponding adjacent normal tissue was determined using tissue microarray and immunohistochemistry PV 6000 method staining. The relationship between CBX8 expression and clinicopathologic characters and survival prognosis was analyzed. Results The positive expression rate of CBX8 in gastric cancer and their corresponding adjacent normal tissue was 46.2％ (55/119) and 13.4％ (16/119) respectively. There was statistically significant difference between two groups (χ2=30.53, P < 0.01). The expression of CBX8 in gastric adenocarcinoma tissue was obviously correlated with the differentiation, clinical staging, and lymph node metastasis (P < 0.05). The high expression rate of CBX8 in the poorly differentiated gastric adenocarcinoma was lower than moderately differentiated and well differentiated group. The high expression rate of CBX8 in stage Ⅰ + Ⅱ gastric adenocarcinoma was higher than that in stage Ⅲ + Ⅳ. The gastric adenocarcinoma patients with high expression of CBX8 had low metastasis rate. Cox multivariate analysis showed CBX8, clinical staging, and lymphatic metastasis were independent predictors of overall survival and disease-free survival (P < 0.05). Kaplan-Meier analysis showed that the patients with higher expression of CBX8 had both longer overall survival time (P = 0.004) and disease-free survival time (P =0.004). Conclusion The expression of CBX8 may be involved in the tumorigenesis and progression of gastric adenocarcinoma. CBX8 is one of the independent predictor of prognosis, and the detecting of CBX8 expression may have important clinical value for the evaluation of gastric adenocarcinoma. CBX8 may became a new target for target therapy of gastric adenocarcinoma.

OBJECTIVETo summarize lessons learned from an outbreak of severe acute respiratory syndrome (SARS) in China during the spring of 2004.

METHODSData of SARS cases were officially reported by Beijing Municipal Center for Disease Control and Prevention (BCDC) and Anhui Provincial Center for Disease Control and Prevention (APCDC) and results of epidemiological investigations were collected and analyzed.

RESULTSThree generations of 11 cases of SARS were identified during the outbreak. Initial two cases were most likely to be infected in Diarrhea Virus Laboratory of National Institute of Virology, China Centers for Disease Control and Prevention and main mode of transmission was direct contact with SARS patients. Delay in detecting initial case resulted in spread of the illness at hospitals and communities with two generations of secondary cases.

CONCLUSIONSSARS outbreak in 2004 has yielded following lessons for public health globally. (1) Lab bio-safety programs should be made and should be strictly abided by. Studies in highly pathogenic viruses such as SARS coronavirus should be utmost cautious. (2) Management systems of occupational exposure to virus and disease surveillance need to be strengthened to take all risk factors into account so as to detect potential patients with infectious disease as early as possible.

China ; epidemiology ; Disease Outbreaks ; Female ; Humans ; Male ; Occupational Exposure ; prevention & control ; Occupational Health ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; epidemiology ; prevention & control ; transmission