BACKGROUND:It is a clinical difficult in the treatment of osteonecrosis with joint preservation, and to solve this problem, a variety of bone graft substitutes are at the exploration stage. OBJECTIVE:To evaluate the clinical outcome of lightbulb operation with porous bioceramic β-tricalcium phosphate in a consecutive series of patients with osteonecrosis of the femoral head. METHODS:From January to December 2008, 58 patients (88 hips) who had undergone lightbulb operation with porous bioceramic β-tricalcium phosphate were involved in this study. Al patients were evaluated both clinicaly and radiographicaly at postoperative 3, 6, 12 months and annualy. Functional improvement was assessed with the Harris hip score. RESULTS AND CONCLUSION: Among these patients, 56 patients (85 hips) were folowed up for 2-5 years. According to the ARCO staging system, there were 27 hips of stage II, 40 hips of stage IIIa, 18 hips of IIIb. According to the hospital’s classification, type C was in 4 hips, L1 in 15 hips, L2 in 28 hips, and L3 in 38 hips. According to the Harris hip score system, excelent outcome was in 55 hips, good in 12 hips, fair in 5 hips and poor in 13 hips. Nine of 11 patients who failed to preserve their own joints were subjected to hip replacement. The  mean preoperative and postoperative Harris scores were 61.2 and 85.3, respectively, with a mean improvement of 24.1 points (P < 0.001). All hips were radiologically stable, with no progress of osteonecrosis, and bone density in the bone graft area increased obviously. The replacement time of porous bioceramic β-tricalcium phosphate was 1-1.5 years. These findings suggest that the porous bioceramic β-tricalcium phosphate provides an option to treat osteonecrosis of the femoral head with satisfactory clinical outcomes, and profits the repair and reconstruction of femoral head osteonecrosis. When in the lateral column of femoral head, the porous bioceramic β-tricalcium phosphate can play a supporting role in the lateral column of the necrotic area, and further prevent collapse, which is suitable for patients with osteonecrosis of the femoral head, especially for those with joint preservation.

ObjectiveTo study the clinical value of ultrasound elastography in evaluating the ablated zone and morphology of uterine leiomyoma and adenomyosis treated with percutaneous microwave ablation treatment(PMAT) under ultrasound guidance.MethodsEighteen patients were randomly chosen from 150 patients with symptoms uterine leiomyomas or adenomyosis who were treated with PMAT.Contrastenhanced Ultrasound(CEUS) and ultrasound elastography were performed before and immediately after PMAT.Compared with contrast enhanced MR were performed at 1 - 2 d after PMAT,the accuracy of ultrasound elastography and CEUS in evaluating the ablated range of PMA were analysed.Results Ultrasound elastography showed that the ablated zone was blue and the boundary with the surrounding tissues was clear.The ablated zone showed no enhancement with CEUS and enhanced MR.The mean diameter of the ablated zone in ultrasound elastography,CEUS,and contrast enhanced MR was (4.90 ±1.12)cm,(4.64 ± 0.93) cm,and (4.89 ± 1.02) cm,respectively.The diameter in ultrasound elastography was slightly larger than that in CEUS ( P =0.02) and had no statistical difference with that in contrast enhanced MR ( P =0.44).ConclusionsUltrasound elastography can accurately show the coagulation range immediately after PMAT and is supposed to be a method to evaluate the ablated zone noninvasively immediately after PMAT.

Objective To explore the variation and clinical value of the degradation of endothelial glycocalyx in the patients with septic shock. Methods A prospective case control study was conducted. Patients of 18 years or older diagnosed with septic shock and admitted to Department of Critical Care Medicine of Affiliated Hospital of Binzhou Medical University from June 2014 to May 2015 were enrolled. The levels of degradation products, including hyaluronic acid (HA) and heparin sulfate (HS), at 0, 6, 12, 24, 48 hours were determined, while 20 healthy people were enrolled and served as controls. The changes of HA and HS were analyzed in the patients with septic shock. The differences of HA and HS between survival group and death group after 28 days were also analyzed. The relationships between HA, HS and tumor necrosis factor-α (TNF-α), sequential organ failure assessment (SOFA) score, arterial blood lactate (Lac), platelet, albumin were analyzed by Pearson correlation analysis. The receiver-operating characteristic (ROC) curve was plotted to assess the prognostic value of HA and HS for patients with septic shock. Results Thirty-one patients diagnosed as septic shock were enrolled, among whom 17 patients died after 28 days, with a mortality of 54.8%. The levels of HA and HS in patients with septic shock were increased significantly as compared with those of health control group, peaked at 48 hours, and the levels of HA and HS at 48 hours were significantly higher than those at 0 hour [HA (μg/L): 119.47±32.44 vs. 94.84±23.63, HS (μg/L): 72.83±19.03 vs. 58.83±16.63, both P < 0.05]. The levels of HA and HS at 0 hour and 48 hours in death group were significantly higher than those of the survival group [HA (μg/L): 130.42±27.67 vs. 93.29±29.80, 105.14±19.18 vs. 70.82±13.24; HS (μg/L): 67.23±25.01 vs. 39.23±14.58, 79.74±19.84 vs. 56.17±14.53, all P < 0.05]. The levels of HA and HS in patients with septic shock were remarkably positively correlated with the levels of TNF-α, SOFA score, Lac, and platelet, but were remarkably negatively correlated with albumin levels (r value of HA was 0.595, 0.462, 0.545, 0.466, -0.534, respectively; r value of HS was 0.607, 0.468, 0.563, 0.547, -0.455, respectively; all P < 0.05). It was demonstrated by ROC curves that the areas under ROC curve (AUC) of HA and HS at 0 hour and 48 hours for predicting the prognosis of patients with septic shock were 0.881, 0.940 and 0.833, 0.821, respectively, the sensitivities of HA and HS were 87.5%, 100.0% and 83.3%, 81.3%, respectively, and the specificities of HA and HS were 82.6%, 78.3% and 91.3%, 78.3%, respectively. Conclusions The concentrations of degradation products generated by endothelial glycocalyx in the blood of the patients with septic shock are remarkably increased. The elevated levels of the degradation products are closely associated with the severity of septic shock, microcirculation disturbance, and the levels of inflammatory factors.

Objective:To investigate the protective effects and related mechanisms of Astragaloside Ⅳ(ASⅣ)alleviating Angiotensin II-induced cardiomyocyte hypertrophy.Methods:H9c2 cardiomyocytes were divided into six groups: normal control group, ASⅣ group(ASⅣ 100 μmol/L), AngⅡ group(AngⅡ 1 μmol/L), and three ASⅣ dose experiments(AngⅡ 1 μmol/L + ASⅣ 25 μmol/l group, AngⅡ 1 μmol/L+ ASⅣ 50 μmol/l group, AngⅡ1 μmol/L+ ASⅣ 100 μmol/L group), and simultaneously cultured for 24 hours.Cardiomyocyte viability was assessed by CCK8 assay, and surface area of culturedcardiomyocytes in each group was assessed by immunofluorescence assay.Atrial natriuretic peptide(ANP)mRNA expression was assessed by fluorescence real-time quantitative RT-PCR.And LC3 protein expression, an autophagy related protein, was assessed by Western blotting as well as immunofluorescence.Results:(1)AngⅡ decreased cardiomyocyte H9c2 viability in a dose-dependent manner( P<0.05). ASⅣ could inhibit the decrease of cardiomyocyte H9c2 viability in response to AngⅡ in a dose-dependent manner( P<0.05). (2)H9c2 cardiomyocytes induced by AngⅡ showed a significantly larger cell area and significantly higher ANP mRNA and ANP protein expression compared with controls.Different concentrations of ASⅣ intervention could reverse the increase of cardiomyocyte H9c2 area induced by AngⅡ and also decreased the expression of ANP protein induced by AngⅡ in a dose-dependent manner(all P<0.05). (3)Compared with the control group, the autophagy level and the expression of autophagy marker LC3II/I of H9c2 cardiomyocytes induced by AngⅡ were significantly increased(all P<0.05). ASⅣ could inhibit AngⅡ-activated autophagy, and the difference was statistically significant( P<0.05). ASⅣ inhibited the expression of LC3II/I in H9c2 cardiomyocytes stimulated by AngⅡ, and the difference was statistically significant( P<0.05). Conclusions:ASⅣ inhibits AngⅡ-induced cardiac hypertrophy by inhibiting autophagy of cardiomyocytes.

BACKGROUNDThe acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty (THA). Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation. Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method.

METHODSA total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers, cup inclination, and anteversion were measured radiographically. The paired t-test was used to compare left and right hip center heights. Scatter plots and Pearson's correlation coefficients were used to evaluate differences in hip center heights, cup anteversion, inclination angles, and medialized cup center distance compared to the contralateral hip joint.

RESULTSCup center height was significantly greater (P < 0.01) than contralateral hip joint center height (93.4% in the 0-5 mm range, 6.6% >5 mm). There was a weak correlation between hip center height difference and inclination (r = 0.376, P < 0.01) and between difference and anteversion (r = 0.310, P < 0.01) but no correlation between difference and outer cup diameter (r = 0.184, P = 0.058) or difference and medialized cup center distance (r = -0.098, P = 0.318).

CONCLUSIONSAlthough this method did not exactly replicate anatomic hip center height, the clinical significance of cup center height and anatomic hip center height differences is negligible. This acetabular component placement method has high simplicity, reliability, and stability.

Arthroplasty, Replacement, Hip ; methods ; Hip Joint ; surgery ; Humans ; Retrospective Studies