Objective To evaluate the short-term clinical results of total hip arthroplasty(THA) through a direct anterior minimally invasive approach aided by lower extremity tractor for hip diseases.Methods Between August 2013 and August 2015,115 patients (138 hips) were admitted for hip diseases.They were 71 men and 44 women,aged from 28 to 77 years (average,59.4 years).Their body mass indexes ranged from 19.7 kg/m2 to 28.9 kg/m2,averaging 24.7 kg/m2.Their hip diseases included avascular necrosis of the femoral head in 56 cases (with an average disease course of 15.7 months),hip osteoarthritis in 35 cases (with an average disease course of 12.6 months),hip dysplasia in 14 cases (with an average disease course of 2.8 years) and inflammatory arthritis in 10 cases (with an average disease course of 6.8 years).All the patients were treated by primary THA through a direct anterior minimally invasive approach and assistance of lower extremity tractor.Results All the 115 patients (138 hips) were followed up for an average of 31.6 months (from 12 to 40 months).Their average length of incision was 9.4 cm,average operative time 115.9 min,average blood loss 210.2 mL,and average hospital stay 7.5 days.Their postoperative imaging results were as follows:the angles of acetabular abduction averaged 41.6° (from 37° to 56°) and the angles of acetabular anteversion 18.1° (from 11° to 23°).Their average Harris hip score one year postoperatively was 91.4 points (from 80 to 96 points).Split fracture of the proximal femur happened in one patient (one hip) (0.7％) intraoperatively;injury to lateral femoral cutaneous never was observed in 6 patients (7 hips) (5.1％).Complications like deep infection,hip dislocation,deep vein thrombosis or prosthetic loosening were not observed during follow-ups.Conclusions THA with assistance of lower extremity tractor through a direct anterior minimally invasive approach can lead to fine short-term clinical results,including quick recovery of hip function and decreased intraoperative and postoperative complications.

Objective To study the protective effect of glutamine on the intestinal mucosal antioxidation in endotoxemic rats. Methods　Twenty-eight male Wistar rats were randomly divided into three groups, group A:parenteral nutrition supplemented with glutamine, group B:TPN without glutamine,and group C:normal control. Endotoxemia was induced by continous intravenous infusion of lipopolysaccharide(LPS) at a dose of 2 mg/kg per day throughout the 5-day study period. The mucosal protein、DNA、ATP、SOD、MDA、GSH、sIgA were determined. Results The mucosal protein、DNA、ATP、SOD、GSH and sIgA content in endotoxic rats were markedly decreased, MDA was increased as compared with normal control(P＜0.05). The former indices in group A were improved and MDA content was decreased as compared with group B(P＜0.05). Conclusion　Glutamine can improve gut energy metabolism, decrease the extent of mucosal injury of free radicals, and give an protective effect on the mucosal probably by increasing GSH.

BACKGROUND:Recent studies have shown that icari n is a good bone-inducing factor that can promote the osteogenic differentiation of mesenchymal stem cel s, providing a new hope for the treatment of bone defects. OBJECTIVE:To review research achievements in pharmacological effects of icari n effects on bone tissue metabolism as wel as its effect to promote osteogenic differentiation of mesenchymal stem cel s. METHODS:The first author retrieved CNKI and PubMed databases for relevant Chinese and English literatures using keywords of“icariin, stem cell, osteogenesis”, respectively. Articles regarding icariin, stem cells, osteogenesis were included, and repetitive studies were excluded. Totally 754 articles were retrieved initially. In accordance with inclusion and exclusion criteria, 41 articles were included in result analysis. RESULTS AND CONCLUSION:As the main ingredient of Herba epimedi , icari n functions as a good osteogenetic growth factor to promote the osteogenic differentiation of bone marrow mesenchymal stem cel s. In recent years, icari n has been shown to promote adipose-, umbilical cord-, and periodontal ligament tissue-derived mesenchymal stem cel s to differentiate into osteoblasts. But such studies are less reported. Until now, mesenchymal stem cel s stil exhibit unsatisfactory osteogenic ability in in vivo experiments. Given this, osteogenetic growth factors contribute to the osteogenic differentiation of mesenchymal stem cel s. Therefore, the use of icari n is expected to provide a good strategy for bone defect repair.

Objective To explore the effect of two different position fixing methods on position deviation of different directions and lesions in patients with lung cancer receiving radiotherapy .Methods 100 cases were randomly selected and divided into the two groups .Group A included 50 cases using thermoplastic membrane and group B included 50 cases using vacuum cushion .Position deviations of different directions and lesions of the two groups were observed and compared .Results The forward and backward directions′position deviation of group A was significantly lower than that of group B(t=3.67,P=0.00).The total position deviation of group A was significantly lower than that of group B(t=2.83,P=0.00).The position deviation in the middle of lung field of group A was significantly lower than group B(t =4.26,P=0.00).The repositioning cases of group A accounted for 30.00%(15/50)and group B accounted for 56.00%(28/50).The difference was significant (χ2 =6.90,P=0.00).Conclusion Using thermoplastic membrane as position fixing method in patients with lung cancer receiving radiotherapy can reduce position deviation .

BACKGROUND: It was reported that the reason why the fracture healing become more and more difficult with the increasing age may be associated with the varied gene regulation of bone marrow mesenchymal stem cells differentiation into osteoblast and lipoblast. However, the exact mechanism under it remains poorly understood.OBJECTIVE: To explore the association of the age-related changes on expression of peroxisome proliferator-activated receptor γ (PPARγ) and core binding α1 (Cbfα1) with the age-relatad fracture healing impairment, we studied the expression changes of PPARγ and Cbfα1 during aging fracture healing.DESIGN, TIME AND SETTING: A randomized control animal trial was performed in the Third Xiangya Hospital of Central South University between October 2007 and Febuary 2008. MATERIALS: Six male SD rats of 3 months and the other six of 23 months, randomly-selected, were divided into two groups: the old experiment group (23 months) and the young control group (3 months). METHODS: Transverse osteotomies on the middle-upper parts of left tibiae were performed to the rats, with the self-made extemal mini-fixator implanted there simultaneously. Tractions were taken twice a day (0.2 mm/d) for 14 days from day 2 till day 15 post operation. On day 15 post operation, rats were sacrificed to harvest left tibea samples. MAIN OUTCOME MEASURES: Both imaging examination and histological observation were performed to the fractures of rats. The PPARγ and Cbfα1 expression were detected with reverse transcription-polymerase chain reaction (RT-PCR) technique. RESULTS: All samples were involved in the results analyses. The imaging examination showed that many osteotylus generated between the broken ends of fractures in the young control group; that the bone formation of the young control group was much better than that of the old experiment group. The histological observation showed that large amounts of osteotylus growth occurred to every animal in the young control group and their membrane bone formation was remarkable; comparatively, the osteotylus growth in the old group was weakened dramatically, and only fibrous joints were seen. The RT-PCR detection showed that differences of significance existed in both PPARγ and Cbfα1 mRNA expressions between the two groups, with the much higher Cbfol mRNA expression in the bone marrow of rats in the young group and the much higher PPARy mRNA expression in the bone marrow of rats in the old group.CONCLUSION: Rats of different ages show different fracture healing abilities, i.e. the higher ages, the lower fracture healing abilities. In addition, expressions of PPARγ and Cbfα1 in the bone marrow of rats alter with the increasing age, which indicates that there are certain associations between the changed expression level of the two factors and the fracture healing impartment.

Objective To investigate whether determination of CEA and CA19-9 levels in EUS-FNA pancreatic samples can be useful in detecting pancreatic adenocarcinoma and differentiating pancreatic adenocarcinoma from chronic pancreatitis.Methods Levels of CEA,CA19-9 were examined by chemiluminescence immunoassay analysis in EUS-FNA specimens obtained from 25 patients with chronic pancreatitis and 65 patients with pancreatic adenocarcinoma,and compared with those of their peripheral serum.Twelve patients with suspected pancreatic adenocarcinoma while with negative EUS-FNA pathological findings were followed up.Results First,the levels of CEA,CA19-9 in EUS-FNA specimens were higher than those in serum obtained from same patient with pancreatic adenoearcinoma(P＜0.01),but there was no difference in these variables of EUS-FNA specimens and serum obtained from patients with chronic pancreatitis.Second,in the EUS-FNA samples,the levels of CEA,CA19-9 in pancreatic adenocarcinoma were higher than those in chronic pancreatitis(P＜0.01).On the contrary,in serum samples,there was no significant difference in CEA level between pancreatic adenocarcinoma and chronic pancreatitis(P=0.079).CA19-9 level in serum of Dancreatic adenocarcinoma was higher than that of chronic pancreatitis(P＜0.01). Finally,during the follow-up,of all the 12 patients with suspected pancreatic adenocarcinoma,10 patients were diagnosed as having pancreatic adenocarcinoma and 2 patients as having chronic pancreatitis.Diagnostic accuracy of serum CEA and CA19-9were 30%and 70%respectively,while sensitivity of CEA and CA10-9 determined by EUS-FNA was both above 90%.Conclusion The method of measuring CEA and CA19-9 levels in samples obtained by EUS-FNAcan be useful in detection of pancreatic adenocarcinoma and differentiation of malignant pancreatic tissue from chronic pancreatitis.

Objective To determine the risk factors for development of succinylcholine-induced postoperative myalgia.Methods One hundred and fifty-five patients,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index of 20-30 kg/m2,scheduled for elective craniofacial surgery,were included in the study.Total intravenous anesthesia with propofol or combined intravenous-inhalational anesthesia with sevoflurane was performed during surgery.The patients were divided into 2 groups according to whether or not myalgia occurred within 24.h after surgery:myalgia group and non-myalgia group.Factors including gender,age,body weight,duration of surgery,method of anesthesia,dose of succinylcholine,preinjection of lidocaine or nondepolarizing muscular relaxants during induction of anesthesia,use of hormone (dexamethasone or methylprednisolone) and nonsteroidal analgesics (parecoxib sodium) during surgery,and consumption of fentanyl were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for development of succinylcholine-induced postoperative myalgia.Results Forty-one patients developed postoperative myalgia,and the incidence of myalgia was 27.2％.The results of logistic analysis indicated that succinylcholine ＜ 1.5 mg/kg and no preinjection of lidocaine were closely correlated with the development of postoperative myalgia induced by succinylcholine.Conclusion Succinylcholine＜1.5 mg/kg and no preinjection of lidocaine are the risk factors for development of succinylcholine-induced postoperative myalgia in the patients.

Objective To explore the setup errors of two different position fixing techniques in radiotherapy for thoracic canc -er, and analyze and compare the accuracy and repeatability of the two different techniques .Methods Sixty four patients with thoracic cancer were selected in our hospital from December 2011 to June 2013 .All patients received radiotherapy .Patients were divided into two groups by means of random number table .Each group had 32 cases.The low-temperature thermoplastic membrane group used ther-moplastic membrane method to fix position while vacuum bag group with negative pressure fixed position by vacuum bag method .The setup errors in the right/left direction (X-axis), anterior/posterior direction (Z-axis), head/foot direction (Y-axis) and three dimen-sional directions ( I) were compared and analyzed between the two groups .Results The low-temperature thermoplastic membrane group was able to reduce the setup errors significantly in the Z-axis (1.13 ±0.33 /2.33 ±1.24, P <0.05).The differences of setup errors in X-axis, Y-axis and I between the two groups were not significant ( P >0.05).Conclusions Position fixing technique with low-temperature thermoplastic membrane can help to fix position in radiotherapy for thoracic cancer , reduce the setup errors in the Z-axis, and improve the setup accuracy .

Objectives:To evaluate the effect of early enteral nutrition(EEN) on the structure and function of the gut, the bacterial and endotoxin translocation. Methods:SAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and trypsin into the pancreas via pancreatic duct.15 dogs were divided into PN group and EEN group.Systemic plasma endotoxin levels was quantified.Both portal and systemic blood sample were obtained before and 1?4?7 d following SAP,and cultured for aerobic as well as anaerobic bacterial growth.Specimens of tissue from mesentery lymph nodes,lung and pulmonary portal nodes and pancreas were removed,weighed and homogenized at the 7th day. Results:The levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and cycle blood and distant organs were significantly reduced the protein and DNA content of the small intestine and colon increased,and the height of the villi and the thickness of mucosa and whole bowel wall of the intestinel and colon improved in EEN group as compared with those in PN group. Conclusions:We conclude that EEN can improve gut metabolism,decrease the extent of mucosal atrophy,and assist in the maintenance of the mucosal barrier function.It is effective touse EEN in severe acute pancreatitis.

Objective:To evaluate diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for pancreatic cystic lesions.Methods:Endoscopic and clinical follow-up data of patients with pancreatic cystic lesions diagnosed by EUS in Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University with CEH-EUS video from March 2013 to April 2020 was retrospectively analyzed.Results:A total of 36 patients were included. There were 16 cases of serous cystadenomas (SCA), 10 cases of mucinous cystic neoplasm (MCN), 5 cases of intraductal papillary mucinous neoplasms (IPMN, 3 with complex type, 2 with main pancreatic duct type) and 5 cases of pancreatic pseudocyst (PPC). 87.5%(14/16) of SCA and 86.7%(13/15) of MCN+ IPMN had hyperenhanced cystic wall with obvious peak and similar washout as surrounding tissue, whereas only 20%(1/5) PPC had hyperenhanced cystic wall. The hyperenhancing effect of PPC was significantly lower than that of SCA and MCN+ IPMN ( P=0.0035 and P=0.0048, respectively ). Mural nodules were detected in 17 cases of pancreatic cystic lesions by EUS, of which 3 cases had hyperenhanced mural modules and 14 cases had hypoenhanced mural nodules by CEH-EUS. Patients showing hyperenhanced mural modules were all finally diagnosed as pancreatic malignancy (1 IPMN, 2 MCN), and the accuracy was 100%. Conclusions:CEH-EUS can have a obvious advantage of differentiating pseudocyst and other pancreatic cystic lesions, while not very useful for differentiating SCA and MCN. Pancreatic cystic lesions showing hyperenhanced mural nodules under CEH-EUS may imply malignancy potential.