Objective To observe the effects of acute normovolemic hemodilution(ANH)on target-controlled infusion(TCI)of etomidate blood drug concentration and adrenal cortical function.Methods Sixty patients who undergo elective multisegmental spine surgery,35 males and 25 females,aged 30-60 years,BMI 20-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were divided into two groups using random number table method:ANH group and control group,30 patients in each group.Both groups used a target-controlled infusion of etomidate for anesthesia induction and anesthesia maintenance.In the ANH group,ANH was performed after steady anesthesia induction,ideal Hct 28％to 30％,and transfused within 1 hour after surgery;the control group was routinely treated.The dosage of etomidate was recorded.Liquid chroma-tography-tandem mass spectrometry(LC-MS/MS)was used to detect etomidate blood concentrations at the immediate postoperative,10,20,and 30 minutes postoperative periods in the two groups,and the immedi-ate moment autologous blood collected into the storage bag,preserved in the storage bag for 1 hour,and the immediate moment transfused back in the ANH group.Plasma concentrations of cortisol(Cor),adrenocorti-cotropic hormone(ACTH),and aldosterone(ALD)were measured by chemiluminescence immunoassay(CLIA)before the induction of anesthesia,immediately after the operation,and at 1 day and 2 days postop-eratively.Results There was no significant difference in the total dosage of etomidate between the two groups.Compared with the immediate postoperative period,the plasma etomidate concentration was signifi-cantly decreased 10,20,and 30 minutes after surgery(P<0.05).Compared with the control group,the concentration increased significantly 10 minutes after surgery in the ANH group(P<0.05).The plasma concentrations of etomidate were(547.8±119.4)ng/ml at the immediate moment autologous blood collected into the storage bag,(536.7±107.8)ng/ml at the preserved in the storage bag for 1 hour,and(522.8±91.7)ng/ml at theimmediatemoment transfusedbackinthe ANHgroup.Comparedwithbeforein-duction of anesthesia,the concentration of Cor and ALD immediately after the operation decreased signifi-cantly(P<0.05)and the concentration of ACTH was significantly higher(P<0.05).There were no sta-tistically significant differences in the concentrations of Cor,ALD,and ACTH between the two groups before induction of anesthesia 1 day and 2 days postoperatively.Conclusion In the orthopedic surgery of TCI eto-midate,return transfusion of collected autologous blood transiently(about 10 minutes)increases etomidate blood concentrations,the function of adrenal cortical will recover to the preoperative level within 24 hours after the operation.

Objective To assess the value of shear-wave elastic modulus for differential diagnosis of benign and malignant breast lesions using Meta-analysis.Methods Relevant Chinese and foreign articles about shear-wave elastography for differentiating benign and malignant breast lesions were collected from the literatures published before Apr.2016.Meta-analysis was conducted to assess the overall ability of the shear wave elastic modulus including Emax,Emea,Eratio and Esd.Results Totally 31 studies were brought into the Meta-analysis.The summarized sensitivity (SSEN) and summarized specificity (SSPE) of Emax were 0.87(95％CI [0.83,0.91]) and 0.91 (95％CI [0.87,0.93]).The SSEN and SSPE of Emea were 0.84 (95％CI [0.77,0.89]) and 0.88 (95％CI [0.84,0.91]),The SSEN and SSPE of Eratio were 0.88(95％CI [0.83,0.91]) and 0.87 (95％CI [0.80,0.91],the SSEN and SSPE of gsd were 0.85 (95％CI [0.80,0.89]) and 0.90 (95％CI [0.85,0.94]).The summarized receiver operator characteristic analysis showed that the area under the curve of E E Eratio and Esd were 0.95,0.93,0.93 and 0.93.Conclusion The shear wave elastic modulus contribute to differentiate benign and malignant breast lesions.Among these indices,Emax is the best one.

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture.Methods 203 patients with stage Ⅰ of unstable femoral intertrochanteric fracture were selected as the research object,and they were taken artificial lengthening femoral head replacement,among which 65caese were male,female in 138 cases.The Harris scoring,SF-36,VAS pain scores on admission,2 weeks after operation,postoperative follow-up limb were counted,and the pain of the affected limb and the hip scores were compared amond 3 time periods.Results All 203 cases of senile patients with follow-up,average operation time was 83.64 minutes,the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score,SF-36 and VAS pain scoring criteria,and the Harris scores of the affected limbs at admission,at 2 weeks after the operation and after the follow-up were (28.26 ± 5.50) points,(68.26 ±5.50) points,(93.13 ± 5.31) points,respectively,the differences were statistically significant (t =-71.27,-1 397.55,-46.07,all P ＜ 0.01);The VAS pain scores were (8.19 ± 0.48) points,(3.53 ± 0.71) points,(0.23 ± 0.42) points,respectively,the differences were statistically significant (t =88.06,324.17,60.84,all P ＜ 0.01).The sf-36 scores:physiological [(8.35 ± 1.24) points,(15.23 ± 2.17) points,(19.21 ± 2.12) points],social/family [(7.01 ±1.13) points,(14.12 ± 2.12) points,(19.85 ± 2.24) points],emotional [(4.83 ± 1.01) points,(10.12 ±1.22)points,(14.87 ± 1.32) points],function [(6.35 ± 1.21) points,(13.67 ± 1.87) points,(16.81 ±2.12) points],additional focus [(8.85 ± 1.45) points,(16.38 ± 2.12) points,(20.21 ± 2.42) points],total quality of life [(47.35 ± 4.76) points,(74.69 ± 5.87) points,(89.21 ± 6.12) points],the differences were statistically significant(-39.77,-62.92,-20.21,-44.87,-71.89,-26.79,-45.04,-89.01,-38.25,-45.79,-63.41,-15.29,-45.20,-60.39,-17.54,-52.12,-76.49,-22.58,all P＜0.O1).Conclusion Artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture has good clinical effect,intraoperative high safety,less postoperative complications,postoperative limb functional recovery is good,and it is worthy of clinical promotion and application.

Objective The inhibitor of differentiation 3 (Id3) is an important transcriptional regulation factor, which participates in tumorigenesis, cell proliferation, and cell apoptosis.β-catenin, as a central molecule of the Wnt signaling pathway, is critical for tumor development.This study aimed to evaluate the expressions of these two molecules and the regulatory effect of Id3 on β-catenin in different tumor cells.Methods Total RNA was extracted using the Trizol Reagent.The relative mRNA expression levels of Id3 and β-catenin in tumor cells were detected by quantitative real-timePCR(qRT-PCR).The recombinant eukaryotic expression vector pEGFP/Id3 with the human Id3 gene was transfected into A549, A549/ DDP and SW-480 cells using the non-liposome-mediated method.The protein expressions of Id3 and β-catenin were determined by Western blot.Results The expression of Id3 was significantly lower in the colorectal cancer cell lines SW-480 and HT-29 than in A549 and other tumor cells (P<0.05), but remarkably higher in nasopharyngeal carcinoma CNE and 5-8F cells than in other tumor cells (P<0.05).The expression of β-catenin was the highest in SW-480in comparison withother malignant tumor cells(P<0.05), and the second highest was in gastric cancer AGS and colorectal cancer HT-29 cell lines, but low in H446, A549, SPC-A-1, A549/DDP, and SK-MES-1 cell lines and extremely low or almost absent in CNE and 5-8F cells (P<0.05).After transfected with pEGFP/Id3, the cells showed a decreased volume, wrinkled membrane and absent refraction under the fluorescence microscope, which, however, were not observed in most of the cells transfected with the empty vector pEGFP.Compared with the control, the Id3/pEGFP group showed remarkably increased expressions of Id3 mRNA in the A549, A549/DDI, and SW-480 cells (1.24±0.12 vs 193.12±2.80, 1.09±0.11 vs 188.30±2.60, and 0.92±0.29 vs 19.08±0.59, P<0.01), and the expression of β-catenin was significantly down-regulated in the transfected SW-480 cells with an overexpression of Id3 (0.98±0.05 vs 0.32±0.03, P<0.01), but exhibited no statistically significant differences from those in the transfected A549 and A549/DDP cells (0.98±0.07 vs 1.04±0.08 and 0.98±0.05 vs 0.32±0.03, P>0.05).Western blot showed the same results.Conclusion The expression levels of Id3 and β-catenin vary in different tumor cell lines.Anabnormally high level of β-catenin is an important risk factor for colorectal cancer, and the down-regulatedexpression of β-catenin after eogenous transfection of Id3 may provide some new ideas for target gene therapies of colorectal cancer.

Objective Rheumatoid arthritis (RA) is a typical type Ⅲ hypersensitivity with a large number of immune complexes (IC) and complement deposits in the synovial tissue , but its specific pathogenesis is not yet clear.This article was to explore the expression of the antigenic profile of serum ICs in RA.Methods ICs were isolated from the serum of 55 patients with RA (41 cases of anti-CCP antibody [+] and 14 cases of anti-CCP antibody [-]), 41 with systemic lupus erythematosus (SLE), and another 41 healthy controls by polyethylene glycol (PEG) precipitation, separated by immunoprecipitation, digested with trypsin in gel, and then subjected to mass spectrometry for identification.The levels of total proteins were compared among different groups using Vennny 2.1.0.The protein expression was considered to be up-regulated when the total protein level of the RA group was >2 times and down-regulated when it was <0.5 times that of the control.Further functional analysis was performed on the differential proteins in RA using the STRING software.Results Totally, 277 proteins were identified in the serum ICs of the RA patients, including 162 in the anti-CCP (+) and 248 in the anti-CCP (-) RA group.Compared with the SLE and healthy control groups, only 129 proteins were found in the RA patients, including 38 in the anti-CCP (+), 109 in the anti-CCP (-) RA group, and 18 in both the two groups.Among the proteins identified in the RA patients and healthy controls, 2 and 11 were up-regulated while 17 and 21 down-regulated in the anti-CCP (+) and anti-CCP (-) RA group, respectively.Conclusion More differentially expressed proteins were identified in the anti-CCP (-) than in the anti-CCP (+) RA patients.The identification of differentially expressed proteins provides a new idea and direction for the investigation of the pathogenesis and new biomarkers of RA.

Objective To scan protein expression profile of immune complexes (ICs) derived from the synovial tissue of the patients with rheumatoid arthritis (RA) based on liquid chromatography-tandem mass spectrometry (LC-MS).Methods The samples of synovial fluid were obtained from knee joints of the patients with RA and osteoarthritis (OA) used as control during therapeutic arthrocentesis in knee jiont at the Department of Orthopedics of Jinling Hospital,School of Medicine,Nanjing University.The protein expression profile of ICs was identified by enrichment strategy based on immunoprecipitation and LC-MS analysis.The value of fraction of total (FOT) was used to estimate protein abundance and screen the up-and down-regulated proteins.The function enrichment,interaction network and signal pathway of differential proteins were analyzed using softwares David and String.Results A total of 511 and 526 protein spots in ICs of RA and OA patients were identified respectively.Among them,170 proteins existed only in RA group.45 and 85 proteins in RA group were statistically up-and down-expressed compared with controls.Conclusion HSP90AA1,HSP70,HLAG,Thioredoxin,Annexin A2 and vitronectin may be involved in the pathogenesis of RA through different paths and possible to become promising diagnostic indicators or new therapeutic targets for RA.

BACKGROUND:Three-dimensional finite element simulation has been widely used in biomechanics. However, there is little research in knee joint replacement. The study of femoral prosthesis is less.
OBJECTIVE:To analyze the optimal positioning parameters of knee replacement and femoral prosthesis implantation, and to verify the efficacy of Gemini-PS knee prosthesis in total knee arthroplasty.
METHODS: (1) Knee finite element model in total knee replacement was constructed. Orthogonal experiment was performed in femoral osteotomy positioning parameters. The shift amount A, external rotation degree B, and valgus degree C of femoral prosthesis were selected as the relevant factors for orthogonal experiment. Three values were taken for each parameter to establish orthogonal tables. Nine experimental combined knee replacement finite element models were created and analyzed with finite element. Analysis of variance and range analysis were used by optimization. (2) Totally 42 patients (47 knees) with knee osteoarthritis received total knee arthroplasty with Gemini-PS knee joint prosthesis. Knee joint function was evaluated after replacement with Hospital for Special Surgery knee score and American Knee Society knee score. Knee pain was assessed with Visual Analogue Scale score.
RESULTS AND CONCLUSION:(1) Minimal polyethylene substrate surface compressive stress peak was translation 0 mm, external rotation of 3°, valgus 6°; the peak stress was 15.9 MPa. Among the influential factors, the effects of internal and external translation were larger than that of external rotation angle, and greater than that of valgus angle. The optimal positioning parameter combination was pan 0 mm, external rotation 3°, valgus 6° by range analysis and variance analysis. Orthogonal experiment was valid by simulation. (2) 42 patients were folowed up for 12-36 months. One patient affected subcutaneous fat liquefaction of the lower segment of the incision. Hospital for Special Surgery knee score and American Knee Society knee score were significantly higher after implantation (P < 0.05). Visual Analogue Scale score was significantly lower after replacement (P < 0.05). X-ray films showed that osteolysis, dislocation or loosening was not found. The recovery of knee joint was good after operation. (3) These findings

Background and purpose:Hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare, vascularly original tumor, and would be misdiagnosed easily in the clinical and imaging characteristics. This study aimed to investigate the imaging features of HEHE and our experience in clinical diagnosis and treatment, and to provide important reference for the diagnosis and treatment of HEHE in the future.Methods:This study retrospectively analyzed clinical manifestations, imaging features, pathological characteristics and treatment effects of 5 HEHE cases confirmed by pathology at Department of Integrative Cancer, Fudan University Shanghai Cancer Center.Results:The ratio of male to female patients was 2 to 3. HEHE predominantly occurred in middle-aged female patients whose ages range from 26 to 65 (mean=45.6). Imaging features of HEHE included multifocal hepatic disease (n=2), systemic multi-center multi-tissue occurrence (n=3). The ultrasound images showed isoechoic or hypoechoic lesions with no obvious blood lfow signal in the lesions. CT plain scan showed isointensity or hypointensity, while MR unenhanced with hypointense T1 signal and hyperintense T2 signal. The density or signal was uneven. Contrast-enhanced CT and MR images showed “slow in slow out”, obvious and variable degrees of peripheral rim enhancement. High FDG uptake showed delayed imaging characteristics (PET/CT). DSA angiography showed the tumor blood vessels were slim. After transcatheter arterial chemoembolization (TACE) surgery, lipiodol deposition within the lesion was not ideal. Under the microscope, tumor cells showed epithelial differentiation; angiogenesis was also visible. Immunohistochemistry staining showed CD31 and CD34 positive in all the 5 cases. Two cases treated with TACE combined with high intensity focused ultrasound (HIFU) and/or radiofrequency ablation (RFA) had good result.Conclusion:The clinical and radio-logical characteristics of HEHE are distinctive. Currently, for patients with systemic multi-organizational multi-center lesions, TACE combined with HIFU and/or RFA might be the most effective treatment method.

BACKGROUND:The hidden blood loss, accounted for a fairly large proportion of perioperative blood loss in total hip replacement, can seriously affect the recovery of postoperative joint function, but the specific influential factors and mechanisms remain unknown at present. OBJECTIVE:To evaluate the relative influential factors for hidden blood loss after primary total hip arthroplasty by the blood loss condition, and to analyze the association between hidden blood loss and prognosis. METHODS:Clinical data of 110 patients who underwent primary total hip arthroplasty in the Liuzhou Worker’s Hospital between April 2011 and April 2013 were retrospectively analyzed. The hidden blood loss was calculated according to Ward and Gross formula. The effects of patient’s gender, age, body mass index, type of prosthesis, presence of internal diseases, and different causes of a disease on hidden blood loss after arthroplasty were analyzed. The patients were divided into the high blood loss group (≥ 480 mL) and the low blood loss group (<480 mL) according to the hidden blood loss. Al the patients were fol owed up for 1 year. The Harris hip score system was used to assess the recovery of hip joint function between the two groups. The correlation between hidden blood loss and the recovery of joint function was analyzed using Pearson’s correlation analysis RESULTS AND CONCLUSION:The total blood loss of primary total hip arthroplasty was (1 340±367) mL, and the hidden blood loss was (748±324) mL, and the percentage of hidden blood loss was 53.7%. The type of prosthesis, presence of internal diseases, and different causes of a disease were significantly associated with hidden blood loss after total hip arthroplasty (P<0.05). Gender, age, body mass index, and operation time were not significantly associated with hidden blood loss after total hip arthroplasty (P>0.05). The hidden blood loss was correlated with postoperative functional recovery (P=0.046). Results indicated that type of prosthesis, presence of internal diseases, and different causes of a disease are main influential factors for hidden blood loss after total hip arthroplasty. The hidden blood loss has some influence on the recovery of postoperative joint function.

Objective To evaluate the efficacy and safety of 650 nm,810 nm diode laser on the treatment of moderate to severe acne.Methods A total of 87 patients with moderate to severe acne were divided into diode laser group (group A) and medication group (group B).In group A,the patients were irradiated with 650,810 nm diode laser at the fluence of 400-450 mW distance of 2-3 cm.In group B,the patients were treated with roxithromycin combined with vitamin B6 and gel lincomycini.Clinical follow-up was performed every week for 4 months.All the adverse effects were recorded.Results There was no significantly statistical difference in the cure rate between the two groups (group A versus group B at 2 weeks:65.0 ％ versus 42.6 ％,P＞0.05; at 4 weeks:92.5 ％ versus 76.5 ％,P＞0.05).However,the recurrence rate of group A was much lower than that of group B (30.0 ％ versus 61.7 ％,P＜0.01).There were no severe adverse effects in both groups during the period of the follow-up.Conclusions Compared to the medication,650,810 nm diode laser appears to be associated with lower recurrence rate in the treatment of moderate to severe acne.