BACKGROUND: There are many criteria used to evaluate the curative effects of hip-preserving treatment for osteonecrosis of the femoral head (ONFH), and there have been no consistent criteria, so the curative effects of hip-preserving treatment lack comparability to some extent. OBJECTIVE: To review and analyze a variety of criteria for evaluating the curative effects of hip-preserving treatment and to develop a specific quality of life scale of hip-preserving treatment. METHODS: A computer-based retrieval of Pubmed database using key words "osteonecrosis, femoral head, quality of life", or "osteonecrosis, femoral head, curative effect" for manuscripts published from August 2000 to August 2010 and of CNKI database for manuscripts published from January 1994 to December 2009 using key words "femoral head necrosis, curative effect" or "femoral head necrosis, quality of life". Manuscripts that address hip-preserving treatment of ONFH and related quality of life or manuscripts that were recently published or in the high-impact journals were included in this paper. Finally, 31 manuscripts were reviewed.RESULTS AND CONCLUSION: The current criteria for evaluating the curative effects of hip-preserving treatment focus on pain, function, and range of motion of hip joints, but do not lay emphasis on the local changes of hip joints or lower limbs, which can not sufficiently reflect the overall quality of life of patients. The SF-36 scale lack specificity to some extents and cannot be used to evaluate the curative effects of hip-preserving treatment systemically and specifically. Therefore, it is necessary to develop a specific quality of life scale for evaluating the curative effects of hip-preserving treatment of ONFH.

Objective To study deletion mutations and polymorphism of PINK1 gene exons in patients with Parkinson' s disease (PD) in the littoral of Zhejiang Province,and analyze the association between these changes and the etiology of PD.MethodsAll exons of PINK1 gene in 200 PD patients( 112early-onset PD and 88 late-onset PD) and 220 controls (68 young controls and 152 old controls ) were amplified by polymerase chain reaction (PCR). All the positive PCR products were sequenced,and genotypes were detected by dot blot allele and genotype frequencies of PINK1 were compared by the Chisquare test.ResultsNo deletion mutations of the exons were found in all patients and controls.However,a known heterozygote point mutation G12169A in exon 5 was identified in 2 patients with early-onset PD.And G12164A polymorphism and G12101A polymorphism were located on PINK1 gene of exon 5. There were G/G and G/A genotypes in G12164A polymorphism,no A/A genotype.There were G/A and A/A genotypes in G12101A polymorphism,no G/G genotype. The chain relation polymorphism A/A genotype frequency was significantly higher in the PD group 84/200 (42.0％ ) than the control group (52/220,23.6％,x2 =4.034,P =0.045 ).The frequency was also significantly higher in the late-onset PD (40/88,45.5％ ) than the old control (32/152,21.1％,x2 =3.951,P =0.047 ).There were no significant differences in alleles frequencies of other groups.ConclusionThe deletion mutation and point mutation are rare in PD patients in littoral of Zhejiang Province.Chain relation polymorphism at G12164A and G12101A in PINK1 gene might be a susceptible factor for PD patients.

Objective: To compare the advantages and disadvantages of three staining methods of HBV. Methods: Normal Liver tissue and HBV-infected, HCV-infected ,or dually infected (HBV and HCV) liver tissues were selected for this study. Formalin- fixed, paraffin-embedded sections(4 ?m) were prepared. Each of the liver tissue specimens was detected by three staining methods, including immunohistochemical methods ,Shikata’s orcein stain and Victoria blue stain,respectively. Results: In the three methods , all of six HBV -infected cases showed intense staining, and three cases with dual infection (HBV and HCV) were weakly positive. However, both normal and HCV-infected liver tissues showed no staining. HBsAg stained dark brown with Immunohistochemical stain; HBsAg containing ground-glass hepatocytes stained magenta with Shikata’s orcein stain; HBsAg stained blue with Victoria blue. Conclusion: Each of three methods has its own advantages and disadvantages: high specificity and sensitivity, but high cost for immunohistochemical methods;complicated and overelabrate procedure for preparation of solutions, lower specificity and sensitivity,but low cost, for special staining methods.

Purpose To analyze the differences of CT manifestations, and to explore the disparity of drainage volume in early drainage between Klebsiella pneumoniae induced liver abscess and non-Klebsiella pneumoniae induced liver abscess. Materials and Methods 337 cases of patients whose blood culture or drainage fluid culture results were positive were divided into Klebsiella pneumoniae group (219 cases) and non-Klebsiella pneumoniae group (118 cases). CT characteristics of the two groups were analyzed, including lesion distribution, quantity, structure, texture, abscess wall thickness, enhancement character around the lesion, whether or not concurrent with thrombophlebitis or migratory infection and so on. Early drainage volume in interventional puncture drainage was observed in both groups. Results Chest CT showed that solitary, multi-room, solid, thin-walled abscesses with concurrent thrombophlebitis, migratory infection and no enhancement around tend to occur in Klebsiella pneumoniae group (χ2=4.065, 3.834, 4.682, 5.689, 5.215, 8.362, 8.407, P<0.01). Early drainage volume of Klebsiella pneumoniae group was significantly lower than that of non-Klebsiella pneumoniae group (χ2=5.863, P<0.01). Conclusion CT manifestations of Klebsiella pneumoniae induced liver abscess are solitary, multi-room, solid, thin-walled abscesses without enhancement around them, thrombophlebitis and migratory infection are common seen and drainage volume is less in early stage after interventional operation.

Objective To investigate the modulating effects and explore their mechanism of 9-nitrocamptothecin and its liposomes to induce apoptosis and inhibit cell cycle in HepG2 and L02 cell lines. Methods Cells were incubated with 9-nitrocamptothecin(9NC) or with 9-nitrocamptothecin liposomes for 24 h, 48 h and 72 h, then, the cell viability was measured via MTT assay; cell cycle and apoptosis was evaluated by flow cytometry after stained by PI and Annexin V-PE/7AAD. Additional, Western Blot was used to evaluate the expression of cell cycle and apoptosis related protein. Results Both cells viability were apparently inhibited by the 9-nitrocamptothecin and 9-nitrocamptothecin liposomes, the inhibitory effect showed a time-dependent and dose-dependent manner. Both S and G2/M phases arrest were observed after incubated with drugs. HepG2 cell was completely arrested in S phase when 9NC concentration over than 0. 1 μmol/L after incubation for 24 h, while more than 95% cells arrested in G2/M phase when 9NC concentration is 0. 1 μmol/L after incubation for 72 h. Apoptosis induction effect also showed a time-dependent and dose-dependent manner. Western Blot results showed the expression of Bax and Caspase-3 were upregulated while Cyclin A, Cdk2, Cyclin E and Bcl-2 were downregulated. More importantly, the compounds were more cytotoxic to the cancer cell lines than to the normal liver cell. Conclusions 9-nitrocamptothecin and 9-nitrocamptothecin liposomes can potently inhibit cell growth via regulation of cell cycle and induction of apoptosis, and this effect was preferentially in cancer cell. Inhibitory of 9-nitrocamptothecin liposomes was slightly better than the 9-nitrocamptothecin.

Objective To observe the inhibitory effect and mechanism of 9-nitrocamptothecin liposomes on HepG2 liver carcinoma cells. Methods HepG2 cells were incubated with 9-nitrocampto-thecin(9NC) or with 9-nitrocamptothecin liposomes(9NC-LP) for 24 h, 48 h and 72 h. Cell viability was then measured by the MTT assay. Cell cycle and apoptosis were evaluated by flow cytometry.Western Blot was used to determine the expression of cell cycle and apoptosis related proteins. HepG2tumor-bearing mouse models were then established. The HepG2 tumor-bearing mice were randomly divided into control group, free liposomes group, DMSO group, 9NC low dose group, 9NC high dose group, 9NC-LP low dose group and 9NC-LP high dose group. There were 10 mice in each group.Drugs were administered by tail vein and tumor volume and body weight were observed 28 days after administration. Then animals were sacrificed and the expression of proteins from tumor homogenates was analyzed by Western blotting. Results In vitro, HepG2 cell viability was apparently inhibited by 9NC and 9NC-LP, and the inhibitory effect increased in a time-dependent and dose-dependent manner.Both S and G2/M phase arrests were observed after incubation with drugs. HepG2 cells were completely arrested in S phase with 9NC concentration over than 0.1 μmol/L after incubation for 24 h,while more than 95% of cells arrested in G2/M phase when 9NC concentration was 0.1 μmol/L after incubation for 72 h. In vivo, compared with the control group, the average tumor volume was reduced in both the 9NC and 9NC-LP group (P<0.05) , and the average animal body weight also decreased in both the 9NC and 9NC-LP group (P<0.05). There was no significant difference among the control group, free liposomes group, and DMSO group. The lights inhibition rates of tumor growth in the 9NC-LP(2.5 mg/kg),9NC-LP(1.5 mg/kg),and 9NC(1.5 mg/kg)groups were 87.02%, 51.57%and 35.47%, respectively. In the 9NC-LP(2.5 mg/kg)group, >50% of animals died 14 days after drug administration. Conclusion 9NC and 9NC-LP can inhibit HepG2 cell growth via cell cycle arrest and apoptosis induction. 9NC-LP has a more potent anti-tumor effect and fewer side effects in vivo,which means 9NC-LP is a promising compound for cancer therapy via intravenous administration.

Objective To systematically assess the diagnostic performance of CTA for lower extremity peripheral arterial disease (PAD) using a Meta analysis method. Methods Studies were located through electronic searching of the PubMed, EBSCO, Springer, Ovid, CNKI, Cochrane library (from the date of establishment of the databases to October 2009 ). Bibliographies of the retrieved articles were also checked. All the studies concerning the diagnosis of PAD using CTA had been searched and reviewed, and the studies with the DSA as the gold standard were adopted as eligible. Subsequently, the characteristics of the included articles were appraised and extracted. Data on accuracy of included studies were extracted for further heterogeneity exploring, statistical pooling and SROC ( summary receiver operating characteristics)analyzing using the Meta Disc 1.4 software. Results Totally 24 studies met the inclusion criteria with a total of 1096 patients. The heterogeneity was found in these studies. The pooled accuracy indicators like sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.95 ( 95% CI:0.94-0.95 ), 0.96 ( 95% CI:0.95-0.96), and 471.13 (95% CI:242. 92-913.71 ), respectively. The area under of SROC curve was 0.9888 and the Q index was 0.9555. Subgroup analysis demonstrated significant difference on diagnostic performance for various CT slices (P ＜ 0.05 ). Conclusion CTA can be regarded as an effective and feasible method for PAD diagnosis and screening, based on the results of this systematic review. However,more rigorous evaluations of CTA in patients with critical limb ischemia are needed.

BACKGROUND: Tranexamic acid has been shown to effectively reduce dominant and hidden blood loss in patients undergoing proximal femoral nail antirotation fixation, and it is safe and effective. At present, the use of tranexamic acid in this operation is mainly divided into intravenous infusion and local intramedullary perfusion; intravenous infusion can be divided into single use or multiple uses, and most of the local use is single use. For the combined local use with intravenous infusion is rarely reported. However, the combined use of tranexamic acid in hip and knee arthroplasties has been proven to be safe and effective. OBJECTIVE: To explore the effectiveness and safety of intravenous combined with local application of tranexamic acid on the perioperative blood loss in proximal femoral nail antirotation. METHODS: Ninety patients with intertrochanteric fracture who underwent proximal femoral nail antirotation in Shantou Hospital of Traditional Chinese Medicine from January 2016 to December 2018 were enrolled, and randomly divided into combined, intravenous and local groups (n=30/group). All patients signed the informed consents and the study was approved by the hospital ethical committee. In the combined group, tranexamic acid (20 mg/kg dissolved in 20 mL normal saline) was injected intravenously at 30 minutes before surgery, followed by femoral intracavitary injection of tranexamic acid (1 g, dissolved in 20 mL normal saline) after proximal femoral nail antirotation. Intravenous group only underwent intravenous injection of tranexamic acid. Local group only received femoral intracavitary injection of tranexamic acid. The total blood loss, dominant blood loss, hidden blood loss, International Normalized Ratio, prothrombin time, activated partial thromboplastin time, blood transfusion rate and the incidence of deep venous thrombosis were counted and compared in the three groups. RESULTS AND CONCLUSION: (1) The total blood loss in the combined group was significantly less than that in the intravenous and local groups (P < 0.01), while the difference between intravenous and local groups was insignificant (P > 0.05). (2) The hidden blood loss in the combined group was significantly less than that in the intravenous and local groups (P < 0.001). The difference of hidden blood loss between intravenous and local groups was insignificant (P > 0.05). (3) There was no significant difference in the dominant blood loss among groups (P > 0.05). (4) The International Normalized Ratio, prothrombin time, and activated partial thromboplastin time before and after surgery showed no significant difference among groups (P > 0.05). (5) The blood transfusion rate showed no significant difference among groups (P > 0.05). (6) None presented with deep venous thrombosis. (7) These results suggest that compared with single intravenous and intracavitary injection of tranexamic acid, their combination can obviously reduce total and hidden blood loss of proximal femoral nail antirotation without increasing the risk of deep venous thrombosis. In addition, single intravenous and intramedullary injection of tranexamic acid has no significant difference in total or hidden blood loss.

The expression of inducible co-stimulator (ICOS) in peripheral blood T lymphocytes from the patients with systemic lupus erythematosus (SLE) and the role in the pathogenesis of SLE was investigated. By using two-color immunofluorescent staining and flow cytometric assay, the expression levels of ICOS in peripheal blood T lymphocytes from 33 patients with SLE and 16 healthy volunteers were detected. SLE diseases activity index (SLEDAI) of the patients with SLE was used to evaluate the disease activity. The correlation between the ICOS expression and SLEDAI was analyzed among the groups. The results showed that the expression levels of ICOS in T lymphocytes in active SLE group was markedly higher than those in the control and inactive SLE groups (both P< 0.01). There was no significant difference in the expression levels of ICOS between the inactive SLE and the control groups (P>0.05). In active SLE and inactive SLE groups, positive linear correlation was found between the levels of the ICOS expression in T lymphocytes and SLEDAI (r=0. 711, P=0.001; r=0.561, P=0.03). It was suggested that the expression of ICOS in peripheral blood T lymphocytes from the patients with active SLE was up-regulated and and ICOS might be related to the pathogenesis of SLE.
Antigens, Differentiation, T-Lymphocyte/*biosynthesis ; Antigens, Differentiation, T-Lymphocyte/genetics ; Lupus Erythematosus, Systemic/blood ; Lupus Erythematosus, Systemic/etiology ; Lupus Erythematosus, Systemic/*immunology ; T-Lymphocytes/*immunology

OBJECTIVE:To investigate the effects of target-controlled infusion of etomidate combined with remifentanil on in-dexes of immune and stress response in elderly surgery patients. METHODS:Totally 60 patients undergoing elective surgery were randomly divided into control group(n=30)and observation group(n=30). Control group was given Propofol injection 1.5-2 mg/kg intravenously. Observation group was given Remifentanil hydrochloride for injection with pump volume of 0.5 μg/(kg·min), and then target controlled infusion of Etomidate injection 0.1-0.3 mg/kg;the dose of etomidate increased by 0.05-0.1 mg/kg accord-ing to physical activity during surgery. Postoperative eye opening time,recovery time of orientation and extubation time were com-pared between 2 groups as well as the levels of immune indexes(CD4+,CD8+,CD4+/CD8+),stress response indexes [serum norepi-nephrine(NE),adrenaline(E)and cortisol(Cor)]. The occurrence of ADR was recorded during surgery. RESULTS:Postopera-tive eye opening time,recovery time of orientation and extubation time in observation group were significantly shorter than control group,with statistical significance(P<0.05). Before surgery,there was no statistical significance in CD4+,CD8+ and CD4+/CD8+between 2 groups(P>0.05). After surgery,CD4+ and CD8+ of 2 groups were significantly higher than before surgery,and the ob-servation group was significantly higher than the control group,CD4+/CD8+ of 2 groups was significantly lower than before,and the observation group was significantly lower than control group,with statistical significance(P<0.05). Before surgery,there was no statistical significance in the levels of NE,E and Cor between 2 groups(P>0.05);after surgery,the levels of NE,E and Cor in 2 groups were significantly higher than before surgery,but the observation group was significantly lower than the control group, with statistical significance(P<0.05). There were no obvious adverse reaction occurred in 2 groups during the surgery. CONCLU-SIONS:The target-controlled infusion of etomidate combined with remifentanil is ideal for perioperative anaesthesia in the elderly patients and effectively improves related immune indexes and stress response indexes with good safety.