OBJECTIVE: To investigate the effect of total hip arthroplasty(THA) with the prosthesis of 127° small neck stem angle and 135° large neck stem angle. METHODS: From January 2014 to June 2016, 84 patients with THA were selected, including 44 males and 40 females, aged 45 to 72(53.4±8.1) years old, 68 patients with necrosis of the femoral head(32 on the left and 36 on the right), 16 patients with serious osteoarthritis of the hip caused by other reasons, and the course of disease was 9 to 36 (24.0±5.5) months. Forty-two patients in each group were evaluated by Harris score, visual analog score(VAS), length measurement of lower limbs, biomechanical evaluation of different angles of the neck stem. The complications and quality of life 24 months after operation were compared. RESULTS: Two patients in each group were lost, the rest were followed up for 30 to 36 (33.0±1.6)months. The Harris score and the length of both lower limbs were measured before and 1, 6, 12, 24 months after operation. The difference of Harris score and the length of both lower limbs in the two groups was significantly improved compared with that before operation( CONCLUSION THA with large and small neck stem angle prosthesis can better recover the function of hip joint, but large neck stem angle can reduce the degree of postoperative pain and improve the quality of life of patients.
Aged ; Arthroplasty, Replacement, Hip ; Female ; Hip Joint/surgery* ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; Treatment Outcome

Background:Clinical outcomes of undifferentiated arthritis (UA) are diverse,and only 40 ％ of patients with UA develop rheumatoid arthritis (RA) after 3 years.Discovering predictive markers at disease onset for further intervention is critical.Therefore,our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.Methods:We performed a prospective,multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals.Clinical and serological parameters were obtained at recruitment.Follow-up was undertaken in all patients every 12 weeks for 2 years.Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.Results:A total of 234 patients were recruited in this study,and 17 (7.3％) patients failed to follow up during the study.Among the 217 patients who completed the study,83 (38.2％) patients went into remission.UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9％ vs.16.8％,x2=8.228,P=0.008),anti-cyclic citrullinated peptide (CCP) antibodypositivity (66.7％ vs.10.7％,x2 =43.897,P ＜ 0.001),and double-positivity rate of RF and anti-CCP antibody (38.1％ vs.4.1％,x2 =32.131,P ＜ 0.001) than those who did not.Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017,95％ confidence interval:5.803-55.938;P ＜ 0.001).Conclusion:As an independent predictor of RA,anti-CCP antibody should be tested at disease onset in all patients with UA.

Objective To explore the cognitive level and demand of chronic disease prevention and treatment integration in the County hospitals and primary health care institutions. Methods A stratified cluster sampling method was used to investigate the medical staff of five county-level hospitals and 39 community health service centers in Liandu District, Yunhe County and Jingning County, and qualitative interviews and on-site questionnaire survey were carried out among 573 medical staff from August to October in 2016. Results A total of 252 medical personnel at the county level or above, accounting for 43.98％, and 321 medical personnel in primary health care institutions, accounting for 56.04％. And 96.86％ of the medical staff thought it is necessary to integrate medical treatment and prevention. Only 32.98％ think that the local medical and anti-integration were the real ones and only 36.13％ have contacted the"top five prevention and control offices" at the county level. Two-way referral of key chronic patients and promotion of grassroots promotion of appropriate technology were better. And 77.38％ of medical staff at medical institutions above the county level and 75.70％ of medical personnel of primary medical institutions participated in the two-way referral work, with 66.67％ of county level medical staff of above medical institutions and 93.46％ medical staffs of primary medical institutions participated in the promotion of grassroots workplaces for appropriate technologies. And 82.72％ of the medical staff held or participated in appropriate technical training courses for chronic diseases within one year, but the proportion of holding or participating in ≥3 times was only 24.08％. Conclusion The work that county level five platform to promote chronic disease prevention and control of chronic disease prevention and treatment of medical integration still need to be strengthened. We should use the appropriate training mode to improve comprehensive prevention and treatment of chronic diseases among primary medical staff.

Objective TolearnthehealthstatusofemptynesterswithdiabetesinthemountainssouthwestofZhejiangand toexploretheinfluencingfactors.Methods Usingthemethodofstratified-random-clustersampling,78emptynesters with diabetes and 1 56 non -empty nesters with diabetes who come from five streets and 1 0 towns of 30 community (or village)were selected and investigated by questionnaire and physical examination were conducted.Univariate analysis were conducted to compare the differences about lifestyle,biochemical indicators and health status between the two groups and multivariateunconditionallogisticregressionanalysiswereconductedtoanalyzetheinfluencingfactors.Results The prevalence of hypertension of empty nest group was 70.51%,and the prevalence of hypertension of non-empty nest group was 58.97%.Fasting blood glucose level of empty nest group was 9.39 ±5.73 mmol/L,higher than that of the non-empty nest group(P<0.05 ).There was significant difference between the two groups in other indicators,such as drinking rate,high -salt diet rate,obesity rate,triglyceride levels,regular exercise rate,vegetables/fruits ≥4 days/week proportion,fish/meat≥4 days/week,awareness of their own blood pressure and blood sugar awareness (P<0.05).After adjustment for age,the obesity rate,abnormal rate of triglycerides,fish/meat(≥4 days/week)intake,regular exercise rate,blood pressure and blood sugar awareness rate were lower among non-empty nesters with diabetes,and overweight rate,systolic blood pressure abnormal rate,fasting glucose ratio,alcohol and high salt diet were higher in empty nest group patientswithdiabetes.Conclusion Emptynesterswithdiabeteshavearelativelyhighproportionoflackofexercise, inadequate nutrition intake,alcohol consumption,high-salt diet and lack of health knowledge and other unhealthy factors. The community health services and individual guidance for the empty nesters should be strengthened to improve the health status of empty nesters with diabetes.

Objective To analyze serum vitamin D level in patients with type 2 diabetes mellitus(T2DM),and to provide evidence for the intervention.Methods A total of 270 blood samples from patients with T2DM by multi -stage random sampling in 1 0 streets/towns in Lishui City were collected to test 25 -hydroxyvitamin D level by high performance liquid chromatography - tandem mass spectrometry.Results The average level of 270 case of T2DM patients '25 -hydroxyvitamin D was (22.97 ±8.07)ng/mL.Gender,household registration,BMI stage and 25 -hydroxyvitamin D level were statistically significant,respectively (Z =4.1 3,P <0.05),(Z =2.44,P <0.05),(F =3.21 ,P <0.05).By multiple linear regression analysis,we found that gender,household registration and length of outdoor exercise time was related to vitamin D level,the B value were -5.1 78,2.369,and 2.026,respectively(P <0.05).Conclusion T2DM patients had lower level vitamin D in their blood.Vitamin D had negative correlation with gender,household registration, and outdoor exercise time.T2DMpatients’vitamin D monitoring and outdoor activities should be strengthened.

Objective To evaluate the efficacy of chemoradiotherapy alone and prognostic factors for locally advanced rectal cancer. Methods The clinical data of 47 patients with locally advanced rectal cancer who were admitted to our hospital and mostly treated with chemoradiotherapy alone from 2003 to 2010 were retrospectively analyzed. Three of the patients received radiotherapy alone. The Kaplan?Meier method was used to estimate overall survival (OS), progression?free survival (PFS), and distant metastasis?free survival ( DMFS ) rates, and the log?rank test was used for survival difference analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients, the 3?and 5?year OS rates were 53?2% and 33?2%, respectively, while the 3?and 5?year PFS rates were 37% and 31%, respectively. During the follow?up, 15 patients (32%) had local progression with PFS of 1?60 months (median PFS, 14 months);23 patients (49%) had distant metastasis with DMFS of 2?60 months ( median DMFS, 17 months) . Patients treated with high?dose radiotherapy had significantly lower 3?and 5?year local progression rates than patients treated with medium?dose radiotherapy ( 11% vs. 54%;11%vs. 57%;P=0?004). After chemoradiotherapy, 9 patients (19%) had clinical complete response (cCR), and the 3?and 5?year OS and PFS rates in those patients were all 8/9. The univariate analysis indicated that tumor distance from the anus and cCR were influencing factors for prognosis ( P= 0?026;P= 0?000 ) . However, the multivariate analysis showed that cCR was the only influencing factor for survival ( HR=12?24;95% CI, 1?64 ?91?29;P= 0?015 ) . Conclusions Chemoradiotherpay or radiotherapy alone is effective and safe in the treatment of patients with locally advanced rectal cancer who have to give up surgery or have unresectable tumors. High?dose radiotherapy may improve local control rate. Complete response to chemoradiotherapy predicts satisfactory treatment outcomes.

Objective To explore the risk factors of type 2 diabetes mellitus(T2DM)in mountainous countryside residents in order to provide relevant intervention measures.Methods 80 new cases of T2DM were selected from pingyuan community in Liandu District of Lishui City as case group,and 1 60 normal people were selected as control group at the same time and places,in which the 1∶2 matched design of case -control study method was used.Conditional Logistic regression analysis was applied in this study.Results The multiple conditional logistic regression analysis suggested that primary family history,history of hypertension,abdominal obesity were the risk factors of T2DM(OR=2.08,1.55 and 2.78 respectively);while education level,exercise and fish intake were the protective factors(OR=0.74,0.59 and 0.32 respectively).Conclusion T2DM is the result of both genetic factors and environmental factors.Moreover,health education,balanced diet and proper physical exercise should be encouraged among residents to prevent T2DM in mountainous countryside.

Objective To investigate the effects of Shenfu injection on blood pressure and heart rate of patients receiving carotid artery stenting.Methods One hundred and twenty patients were randomly divided into the treatment group and the control group , sixty cases in each group.The control group received conventional medication under custodial care , and the treatment group was given Shenfu ( 1 mL · kg -1 ) 10 minutes before surgery.Mean arterial pressure(MAP), heart rate (HR), oxygen satu-ration (SpO2), as well as the frequency of intra -operative hypotension, and the applications of ephedrine and atropine were recorded respectively at the beginning of surgery , the 30 th minute during surgery , the end of surgery and 24 hours after the surgery.Results The operations were all successful , and no adverse reactions occurred.MAP in treatment group at the 30th minute during surgery was higher than in the control group , while it was lower than of the control group at the end of surgery ( P<0.01).HR in the treatment group (68.25 ±7.35) times· min-1 was lower than that of the control group (73.28 ±10.43)times· min-1 at the end of surgery (P<0.05 ).Conclusion Shenfu injection helps stabilize blood pressure and heart rate of patients receiving carotid artery stenting through the two-way adjustment , and it could reduce the occurrence of cerebrovascu-lar accident during the per -operative period.

OBJECTIVEThe purpose of this study was to investigate the value of postoperative chemotherapy for locally advanced rectal cancer patients who reached pathological ypT1-4N0 after neo-adjuvant chemoradiotherapy.

METHODSWe performed a retrospective study of 104 patients treated with preoperative chemoradiotherapy followed by radical resection, who achieved pathological ypT1-4N0, between Mar 2003 and Dec 2010. There were 73 patients who received postoperative adjuvant chemotherapy, and the other 31 patients did not. The distribution of final pathologic stages for these patients was ypT1-2N0 in 39 cases and ypT3-4N0 in 65 cases.

RESULTSThe median follow-up was 41 months. The 3-year overall survival rate (OS) and recurrence-free survival rate (RFS) for the whole group (ypT1-4N0) were 93.4% and 85.3%, respectively. The 3-year OS and RFS in the adjuvant chemotherapy group and non-adjuvant chemotherapy group were 95.5%, 88.6% and 88.6%, 77.2%, respectively. There were no significant differences in 3-year RFS (P = 0.108) and OS (P = 0.106) between the two groups. The 3-year local recurrence and distant metastasis rates in the adjuvant chemotherapy group were 4.1% (3/73) and 5.5% (4/73), while for the non-adjuvant chemotherapy group, the 3-year local recurrence rate and distant metastasis rate were 3.2% (1/31) and 16.1% (5/31), respectively. Significant difference was found in distant metastasis rates (P = 0.030) between the two groups, but not in local recurrence rates (P = 0.676).Further subgroup analysis indicated that for the ypT1-2N0 patients, there were no significant differences in 3-year OS (P = 0.296) and RFS (P = 0.939) between the adjuvant and non-adjuvant chemotherapy groups, while negative results displayed in 3-year local recurrence rates (P = 0.676) and distant metastasis rates (P = 0.414). However, for patients with ypT3-4N0, significant differences were showed in both the 3-year OS (P = 0.034) and RFS (P = 0.025), and further analysis revealed that the 3-year distant metastasis rate was significantly higher in the non-adjuvant chemotherapy group than in the adjuvant chemotherapy group (P = 0.010) , but with non-significant difference in the 3-year local recurrence (P = 0.548).

CONCLUSIONSAdjuvant chemotherapy may not improve survival for ypT1-2N0 patients. However, it may be clinically meaningful for ypT3-4N0 patients by decreasing distant metastasis rate. Further randomized controlled clinical trials are needed to confirm our results.

Adenocarcinoma ; drug therapy ; pathology ; radiotherapy ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Female ; Fluorouracil ; analogs & derivatives ; therapeutic use ; Follow-Up Studies ; Humans ; Leucovorin ; therapeutic use ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Organoplatinum Compounds ; therapeutic use ; Postoperative Period ; Radiotherapy, Conformal ; Rectal Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Retrospective Studies ; Survival Rate ; Young Adult

BACKGROUNDT-cell receptor (TCR) plays an important role in the development of autoimmune diseases. Recently, it was reported that immunization of animals with TCR peptide derived from the pathogenic cells could prevent autoimmune diseases. The aim of this study was to investigate whether vaccination with a synthetic peptide from the hypervariable region of TCR V(beta) 8.3, an experimental autoimmune uveoretinitis (EAU)-associated gene, was able to prevent the disease.

METHODSEAU was induced in Lewis rats by immunization with IRBP R16 peptide emulsified in complete Freund's adjuvant (CFA). The clinical and histological appearances were scored. Delayed type hypersensitivity (DTH) and lymphocyte proliferation were detected. Cytokine levels of aqueous humour, supernatants of cells from spleen and draining lymph nodes were measured by enzyme linked immunosorbent assay (ELISA). Gene expression of TCR V(beta) 8.3 on CD(4)(+) T cells was examined by real time quantitative polymerase chain reaction (PCR).

RESULTSAfter vaccination, the intraocular inflammation was significantly mitigated, antigen specific DTH and lymphocyte proliferation responses were suppressed, interleukin (IL)-2 in aqueous humour, interferon (IFN)-gamma and IL-2 produced by the spleen and draining lymph node cells were significantly decreased, whereas the production of IL-4 and IL-10 were increased. The response of draining lymph node cells to TCR V(beta) 8.3 peptide was enhanced after vaccination. Inoculation with CFA alone did not affect the severity of EAU and the above parameters. The suppression of EAU was much stronger in the group of four fold inoculations than the group of two fold inoculations. The expression of TCR V(beta) 8.3 gene was significantly reduced in the group of fourfold inoculations.

CONCLUSIONVaccination with the synthetic TCR V(beta) 8.3 peptide could remarkably inhibit the development of EAU.

Animals ; Autoimmune Diseases ; prevention & control ; Cytokines ; biosynthesis ; Female ; Genes, T-Cell Receptor beta ; Rats ; Rats, Inbred Lew ; Receptors, Antigen, T-Cell, alpha-beta ; immunology ; Retinitis ; prevention & control ; Retinol-Binding Proteins ; immunology ; Th1 Cells ; immunology ; Th2 Cells ; immunology ; Uveitis ; prevention & control ; Vaccination