Volume 86  ·   Issue 07  ·  2006

Avascular necrosis of femoral head is one of the unsolved difficult diseases in the field of orthopedics. Without timely and effective treatment, the disease of most patients will progress progressively, and eventually lead to severe hip osteoarthritis, which makes patients lose the ability to work or even can't take care of themselves. As a mature and classic orthopedic treatment technique, artificial total hip replacement has achieved great success in the treatment of hip joint diseases [1]. However, for young and middle-aged patients with avascular necrosis of femoral head, the complication rate of artificial joint replacement is high, and the long-term effect is not ideal. Many patients have to undergo joint revision surgery once or even several times in their lives. However, there are still many problems in joint revision surgery from surgical difficulty, intraoperative trauma to long-term effect [2]. Therefore, the main purpose of the treatment of avascular necrosis of femoral head in young and middle-aged adults should be to improve the symptoms and function, preserve the femoral head as much as possible, delay the time of joint replacement and finally avoid artificial joint replacement [3,4].

osteonecrosis of the femoral head (ONFH) is a common disease in orthopedics. It is caused by trauma and non-trauma. the former is mainly caused by femoral neck fracture and hip dislocation, while the latter is mainly caused by corticosteroid use and alcoholism in China. According to reliable evidence, the number of ONFH patients in China to be treated is between 5 and 7.5 million, and the number of new cases every year is between 100,000 and 150,000. Non-traumatic ONFH mainly affects young and middle-aged people (38 years old abroad, 33.5 years old in our center), and about 80% affects both hips [1]. According to the natural history study of the disease, about 80% of ONFH will progress to femoral head collapse within 1 to 4 years without effective treatment. Once the femoral head collapses (positive crescent sign), 87% of hip joints will progress to the degree of artificial joint replacement within 24 months. the long-term efficacy of artificial joint replacement in young and middle-aged people is still difficult to predict. Therefore, it is very important to preserve patients' own joints as much as possible. Early diagnosis and scientific treatment are the keys to improve the efficacy of preserving joints. Many experts who have studied in this field have mentioned the above tendencies. Besides the attraction of commercial interests, the lack of popularization of professional knowledge is also the main reason [2].

Objective to observe the effects of puerarin on the proliferation of vascular smooth muscle cells (VSMC) induced by thrombin, and the expression of proto-oncogene c-fos and bcl-2 proteins and thrombin receptor (TR) mRNA. Methods the DNA content of thrombin and puerarin on the proliferation and DNA synthesis of VSMC was determined by cytometry and flow cytometry, and the effects of thrombin and puerarin on the proliferation and DNA synthesis of VSMC were observed by cell cycle analysis. The expression of c-fos and bcl-2 proteins was detected by Western blot and the expression of TR mRNA was detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) after 24 hours of thrombin and puerarin. Results Thrombin had obvious promoting effect on VSMC, and the promoting effect reached its peak at the end of 24 hours (cell count: 8.64×104/ml ± 0.12×104/ml in thrombin group and 4.20×104/ml ± 0.11×104/ml in control group, P<0.05), and the thrombin concentration was dose-dependent between 0.1 and 1.0 U/L; Puerarin inhibited thrombin-induced cell proliferation, DNA synthesis and VSMC c-fos and bcl-2 protein expression in a dose-dependent manner (the inhibition rates were 42.6%±5.2%, 58.2%±7.9%, 44.5%±7.5% and 39.6%±6.4% at puerarin concentration of 1.5×10-3 mol/L, respectively<0.05); High concentration (1.5×10-3 mol/L) of puerarin significantly inhibited the upregulation of TR mRNA induced by thrombin (the inhibition rate was 17.6%±1.7%, P<Conclusion Puerarin can inhibit the proliferation of VSMC induced by thrombin, which may be related to its inhibition of c-fos and bcl-2 protein, and partly to its inhibition of TR mRNA expression.

Objective to investigate the effect of tissue inhibitors of matrix metalloproteinases-4 (TIMP-4) on the activity of matrix metalloproteinases (MMP) and to observe its effect on the collagen content of vascular tissues. Methods The experimental animals were divided into three groups: simple injury group, post-injury AdGFP group and post-injury AdGFP-4 group. TIMP-4 was transferred into cultured rat vascular smooth muscle cells with replication defective adenovirus as vector, and the effects of TIMP-4 on MMP activity were detected by gel electrophoresis zymogram and reverse zymogram analysis. The effects of TIMP-4 on MMP activity and collagen content in vascular tissues were detected. Results the activity of MMP-2 in cultured vascular smooth muscle cells was reduced by AdTIMP-4 transfection to 26% of that in the control group (non-transgenic group and AdGFP transfection group). Compared with AdGFP transfected group, the area of neovascular intima and cells decreased in AdTIMP-4 transfected group after injury, and the absorbance of Sirius red content in intima was significantly lower (55 030 ± 5899) than that in AdGFP transfected group (91 530 ± 7729, P<0.05), and did not promote collagen deposition in vascular tissue (collagen content per cell was 135 ± 11 vs 118 ± 13, P>0.05). Conclusion TIMP-4 regulates collagen metabolism in vascular tissue by changing the balance of MMP/TIMP, and plays an important role in vascular repair after injury.

Objective to investigate the correlation between the thickness of reticular basement membrane and the changes of airway wall structure in different asthmatic states.Methods The lung tissues of 5 fatal cases of asthma, 5 cases of asthma who died of unrelated diseases and 5 cases of non-asthmatic death.The thickness of reticular basement membrane of cartilaginous airway (large airway) was measured, and the wall structure of large and small airways (membranous airway) in cross section, including smooth muscle area, submucosal gland area, inner and outer airway wall area and tracheal lumen area, were measured to test the correlation.Results The thickness of reticular basement membrane of large airway and the area of smooth muscle layer (12.3 μ m ± 2.8 μ m, 12.3 μ m ± 1.8 μ m vs 3.5 μ m ± 1.2 μ m; 12.7 μ m ± 1.9 μ m, 12.3 μ m ± 2.9 μ m vs 4.2 μ m ± 0.4 μ m; r =0.721, P<0.05), submucosal gland area (r =0.644, P<0.05), airway inner wall area (0.11 mm±0.03 mm, 0.10 mm±0.02 mm vs 0.05 mm±0.02 mm; 0.27 mm±0.07 mm, 0.14 mm±0.07 mm vs 0.08 mm±0.03 mm r =0.799, P<0.01) correlation; and the smooth muscle area of the small airway (r =0.729, P<0.05), airway inner wall area (r =0.865, P<0.01) correlation; Conclusion the change of basement membrane thickness of large airway can reflect the remodeling of large airway, the changes of smooth muscle layer and tracheal inner wall of small airway. Monitoring the change of reticular basement membrane thickness can be used to evaluate the pathological changes of airway in asthma and to follow up the long-term study of asthma.

Objective to investigate the role of MBL in the pathogenesis of systemic lupus erythematosus (SLE) by detecting the serum levels of mannose-binding lectin (MBL) and its gene variation in patients with systemic lupus erythematosus (SLE). Methods The serum levels of MBL were detected by solid phase ELISA in 30 healthy blood donors and 40 SLE patients. The primers and fluorescent labeled oligonucleotide hybridization probes of exon 1 and promoter region of MBL were designed according to the haploid sequence of MBL2 · LXPA (gene bank X15422). The gene variation of the two groups was detected by Light Cycler real-time PCR. Results (1) The serum levels of MBL in SLE patients were significantly lower than those in healthy blood donors (107.2 μ g/L vs 290.2 μ g/L, P<(2) The main mutation in exon 1 of MBL gene was codon 54, and the mutation rate was 37.1% (15/40) in SLE patients and 13.3% (5/30) in control group, χ 2=3.914, P<0.05. (3) Polymorphism in H/L locus was observed in both healthy blood donors and SLE patients, and the L frequency in both groups was equivalent. (3) Serum MBL levels in SLE patients with codon 54 mutation were significantly decreased, 141.7 μ g/L and 49.8 μ g/L in those with mutation and those without mutation, respectively, P<0.01; the SLE activity index (DAI) scores of the two were 12.87 and 7.44, respectively, P<0.01, and SLEDAI score was negatively correlated with MBL serum level (r = -0.48). H/L polymorphism in promoter region was not related to SLEDAI. Conclusion MBL gene codon 54 mutation may be a susceptible factor to SLE pathogenesis; Serum levels of MBL may be a potential biomarker for disease activity in SLE.

Objective to investigate the resistance mechanism of Pseudomonas aeruginosa (PA) surgical intensive unit (SICU) isolates to carbapenem. Methods the expression levels of outer membrane proteins OprD and OprN and the mRNA level of mexA gene were determined by Western blot and reverse transcription PCR. Results Among 49 strains of PA isolated from SICU, 42 strains were resistant to carbapenem, and their OprD expression was decreased or deleted to varying degrees except PA42, while 7 strains that normally expressed OprD were all sensitive to 2 kinds of carbapenem. 27 strains were highly expressing the active efflux system MexAB-OprM, and the resistance rate of imipenem in the high expression group was 81.5% (22/27) and that in the low expression group was 86.4% (19/22). There was a significant difference between the resistance rate of 44.4% (12/27) in the high expression group and 13.6% (3/22) in the low expression group (χ 2=5.417, P =0.020). 14 strains expressed MexEF-OprN, but there was no significant difference between the resistance rate of imipenem and meropenem in the expression group and the unexpressed group (χ 2=0.000, P =1.000). The regulatory gene mexR of the active efflux system of MexAB-OprM was mutated in 8 strains, among which 7 strains showed amino acid substitution and 1 strain showed stop codon early. No strains producing IMP and VIM metalloenzymes were found. Conclusion The resistance of PA isolated from SICU in our hospital to carbapenem was mainly caused by the decrease or deletion of the expression of OprD in the outer membrane protein, and had nothing to do with IMP and VIM metalloenzymes; High expression of the active efflux system MexAB-OprM plays an important role in the resistance of meropenem; Its high expression is associated with the variation of the regulatory gene mexR.

Objective to explore the effective methods for the treatment of primary intraspinal hemangiopericytoma. Methods the clinical manifestations, imaging characteristics, treatment methods and prognosis of 23 cases of primary intraspinal hemangiopericytoma were retrospectively analyzed. Results 11 cases were subtotal resection, 4 cases were subtotal resection plus radiotherapy, 5 cases were total resection, and 3 cases were total resection plus radiotherapy. Two patients with total resection were treated with internal fixation at the same time. 19 cases were followed up. The recurrence rate of tumor was 68% (13/19), and the metastasis rate was 21% (4/19). Conclusion Block resection of tumor and involved dura mater can reduce intraoperative hemorrhage and postoperative recurrence. If the lesions are large and need block resection, embolization should be done before operation. Patients who fail to totally resection need adjuvant radiotherapy. Patients with obvious vertebral body or pedicle destruction should be treated with internal fixation as much as possible. Patients with tumor originating from dura mater have better prognosis. Long-term follow-up is necessary.

Objective to investigate the relationship between umbilical foramen and retroperitoneal large vessels. Methods 89 patients with non-pelvic diseases who underwent arteriography were randomly selected. According to the Chinese obesity standard set by the China Obesity Working Group, the patients were divided into three groups: standard weight, overweight and obesity. 32 cases in standard weight group, 35 cases in super-weight group and 22 cases in obesity group. All patients were positioned with a round lead block with a diameter of 1 cm in supine position, and the right femoral artery was punctured by Seldinger method. Digital subtraction abdominal aortomography (DSA) was performed. The vertical projection relationship between the umbilical foramen and the retroperitoneal large artery was measured with the bifurcation of the abdominal aorta as the reference point (0 point). Results (1) The distance between the umbilical foramen and the bifurcation of the abdominal aorta was (14.8±19.7) mm, (0.04±2.5) mm and (-12.6±15.4) mm in the standard weight group, super-weight group and obesity group, respectively. (2) Among 89 patients, 50 (63.9%) of the patients had the umbilical foramen corresponding to the retroperitoneal large artery, 47 (94%) of the patients had the vertical projection of the umbilical foramen on the abdominal aorta or the right iliac artery, and 3 ( The vertical projection of the umbilical foramen was on the right side of the abdominal aorta or right common iliac artery in 32 patients (82.1%), and on the left side of the right common iliac artery in 7 patients (17.9%). Conclusion With the increase of body weight, the vertical projection of the umbilical foramen gradually moved down to the lower side of the bifurcation of the abdominal aorta.

Objective to investigate the perinatal outcome of intrahepatic cholestasis of pregnancy (ICP). Methods the data of 1210 cases of ICP who were examined prenatally and delivered in hospital in recent 10 years were retrospectively analyzed. Results the threatened preterm delivery rate of ICP was 19.0% (230/1210), and 88.7% (204/230) occurred after 32 weeks. The stillbirth in hospitalized cases of threatened preterm delivery accounted for 46.7% (7/15) of all stillbirths of ICP; The preterm delivery rate of ICP was 24.0% (290/1210), 96.2% (279/290) were distributed after 34 weeks, 89.7% (260/290) were abnormal fetal cesarean section; Amniotic fluid meconium contamination rate was 23.2% (281/1210), 41.3% (116/281) occurred before labor, and the predictive rate of amniotic fluid meconium contamination on neonatal asphyxia (neonatal 1 min Apgar score ≤7) was 25% (70/281); The incidence of neonatal asphyxia was 7.1% (86/1210); The perinatal mortality rate was 22.5‰ (27/1210), of which stillbirth accounted for 56% (15/27), the average gestational age of stillbirth was 36.5 weeks ± 1.2 weeks, 80% (12/15) occurred after 35 weeks of pregnancy, and there was no abnormal finding in fetal heart monitoring. 95% (19/20) of stillbirths and stillbirths occurred suddenly in threatened premature labor, occasional uterine contractions or early labor; The rate of cesarean section was 85.9% (1039/1210), the incidence of fetal growth restriction (FGR) was 0.9% (11/1210), the rate of postpartum hemorrhage was 1.4% (17/1210), and 8.1% (101/1210) of ICP patients with preeclampsia. It is difficult to predict stillbirth in ICP by routine fetal monitoring; Actively preventing and treating threatened premature birth, attaching importance to threatened premature birth, occasional uterine contractions, prenatal amniotic fluid and meconium contamination or fetal monitoring at the early stage of labor, and grasping the opportunity of terminating pregnancy (34~37 weeks) are important means to reduce the perinatal mortality rate of ICP.

Objective to investigate the etiology of osteonecrosis after severe acute respiratory syndrome (SARS), so as to be used for the early diagnosis of non-traumatic osteonecrosis and the screening of susceptible groups. Methods Fasting elbow vein blood was collected from 61 patients with osteonecrosis after SARS and 52 healthy people as controls. The coagulation and fibrinolysis indexes were determined by enzyme-linked immunosorbent assay, and the mutation of factor V G1691A (FV Leiden) and prothrombin G20210A mutation was determined by real-time polymerase chain reaction (PCR). Results The hematological factors of patients with osteonecrosis after SARS were significantly changed, including protein C (PC), activated protein C resistance (APC-R), antithrombin Ⅲ (AT-Ⅲ), plasminogen activation inhibitor (PAI) and plasminogen (PLG). (109% ± 20% vs 85% ± 34%, 8.0 U/ml ± 4.3 U/ml, 16 U/ml ± 14 U/ml, 197 s ± 46 s vs 192 s ± 63 s, 104% ± 14% vs 84% ± 29%, 94% ± 15% vs 69 μ/ml ± 23 μ/ml, P<0.01). Conclusion Patients with osteonecrosis after SARS have a tendency to be hypercoagulable and hypofibrinolytic, and patients susceptible to osteonecrosis can be screened for hypercoagulable and hypofibrinolytic indexes. PC, AT-Ⅲ, PAI, APC-R and PLG can be used as screening indexes for osteonecrosis susceptible factors.

Objective to evaluate the effect of changes of blood supply in the femoral head before and after the treatment of vascular pedicled bone flap for avascular necrosis of femoral head (ONFH). Methods 54 patients with unilateral avascular necrosis of femoral head treated with preserving femoral head were examined by digital subtraction angiography (DSA) before and 6 weeks after operation. According to the ARCO staging criteria, 33 hips in stage Ⅱ and 21 hips in stage Ⅲ were examined. The treatment methods were 23 sides of iliac bone flap with ascending branch of external circumflex femoral artery, 13 sides of greater trochanter flap with ascending branch of lateral circumflex femoral artery, 9 cases of greater trochanter flap with transverse branch of external circumflex femoral artery, and 9 cases of greater trochanter flap with double vascular pedicle of lateral circumflex femoral artery, and 9 cases of greater trochanter flap with double pedicle of lateral circumflex femoral artery. Postoperative DSA in 6 cases showed poor filling of vascular pedicle or no filling of contrast medium in femoral head, among which 1 case showed satisfactory filling of vascular pedicle and good blood supply in femoral head after 8 months postoperative.The clinical success rate of this group was 91%, and the imaging success rate was 85%. Conclusion Ensuring the patency of vascular pedicle of metastatic bone flap is the key to the success of ONFH head preservation treatment.

postantibiotic effect (PAE) is an important parameter to evaluate the pharmacodynamics of antibacterial drugs in recent years [1]. However, the mechanism of its occurrence has not been elucidated. The morphological changes of bacteria during PAE can reflect the function of bacterial enzymes and suggest the mechanism of PAE production [2]. The effects of combined gatifloxacin and cefmetazole on PAE of Escherichia coli have not been reported at home and abroad. In this experiment, the morphological changes of Escherichia coli during PAE of gatifloxacin and cefmetazole alone and combined in vitro were studied by atomic force microscopy, so as to explore the different mechanisms of PAE formation of two different antibacterial drugs.

Mesenchymal stem cells (MSCs) are a kind of pluripotent stem cells belonging to mesoderm, which have the ability to differentiate into osteoblasts, chondrocytes, adipocytes, muscle (tendon) cells, bone marrow stromal cells, liver cells and nerve cells [1]. In recent years, MSCs have high expansion and multidirectional differentiation potential in vitro, and support the properties of hematopoiesis and immune regulation, and their immunomodulatory and immunotherapeutic effects have become a hot spot.

Epidemiological studies have shown that drug addiction is a highly hereditary disease [1, 2]. About 40% ~60% of the risk of alcohol, cocaine and opioid addiction is hereditary. However, no clear progress has been made in identifying the genetic genes of drug addiction so far [1, 3]. Proteomics has analyzed thousands of gene expression products-proteins "in parallel", and studied the changes and interactions of proteins at the "group" level, which provides unprecedented opportunities for elucidating the mechanism of drug abuse [4]. It can be expected that the application of this kind of technology will bring a qualitative leap to the research of drug abuse. This paper reviews the progress of proteomics related to drug abuse.

When the avascular necrosis of the femoral head reaches the irreversible stage, that is, the femoral head has collapsed and secondary to osteoarthritis, in order to relieve pain and improve joint function, joint replacement surgery is the only effective treatment.

European Paediatric Hepatitis C Virus Network (EPHN) published on 1 December 2005<Hepatitis C virus (HCV) transmission from mother to child occurs significantly more frequently in girls than in boys in a multicenter prospective study published in J Infect Dis, 2005, 192: 1872 1879. The study involved 1787 women infected with hepatitis C and their children from 33 EPHN centers in 7 European countries (Italy, Spain, Germany, Ireland, UK, Norway, Sweden). The results of the study disapprove of selective cesarean section and breastfeeding abandonment in infected pregnant women in order to prevent vertical transmission of HCV.

Researchers at Columbia University Medical Center found genetic markers on stem and progenitor cells that can stimulate and promote the growth of malignant tumors. The findings were published in December 2005<In the journal Cancer Cell (2005, 8: 479-484), it was found that stem cells and progenitor cells are very sensitive to a specific error in the process of Cell division, and this specific error can lead to chromosomal abnormalities.This susceptibility can be used to explain how the tumor initial cells, i.e. Cancer stem cells, evolve from a normal Cell, and how Cancer stem cells mutate to promote malignant growth of tumors.

mastocytosis (MT) is a disease caused by abnormal proliferation and aggregation of mast cells (MC). Generally, MC accumulates in the skin, and skin pigmented plaques, papules or nodular lesions appear; It can also be aggregated in multiple systems throughout the body; However, the mechanism of abnormal aggregation of MC in MT and the pathogenesis of MT are still in the research and exploration stage.

Osteonecrosis is often caused by ingestion of large doses of steroids or alcohol, which can cause disability of musculoskeletal system.Most patients need total hip replacement surgery within a few years of femoral head necrosis.Osteonecrosis is related to taking steroids.Previous studies have found that corticosteroids can inhibit the proliferation and differentiation of bone marrow stem cells and osteoblasts and increase adipogenesis.This phenomenon is considered to be an important mechanism of osteonecrosis caused by steroids.In addition, it has also been found that the simultaneous use of statins, a hypolipidemic drug, can avoid the effects of steroids in vivo and cell culture of mice and chickens [1]. However, these phenomena have not been confirmed in human bone marrow cells.In this study, the effects of steroids and statins on osteogenesis of human bone marrow cells were determined by detecting the changes of bone morphogenetic protein 2 (BMP-2) gene expression in human bone marrow cells under the action of steroids and/or statins.

With the continuous improvement of prosthesis preparation technology and surgical technique, total hip arthroplasty (THA) has become a mature and standard orthopedic treatment technique for the treatment of advanced avascular necrosis of femoral head. However, due to the anatomical characteristics of hip joint and the specific requirements of prosthesis placement during operation, the original THA technique has shortcomings such as long incision, large trauma and many complications. On the premise of ensuring the safety and effectiveness of surgery, how to reduce surgical trauma and reduce the incidence of complications has been the key issue of people's attention. We improved the incision and intraoperative exposure of traditional THA, and performed small incision THA to treat 48 hips in 43 cases of advanced avascular necrosis of femoral head with satisfactory results.

Metabolic glutamate receptors (mGluR) are a new group of glutamate receptors, which are widely distributed in the nervous system and closely related to pain, especially the type V receptor-mGluR5 is involved in various pain processes. Electrophysiological studies have found that mGluR5 mainly plays a role in the process of chronic nociceptive pain [1]. Recent studies have found that mGluR5 antagonists can alleviate neuropathic pain caused by peripheral nerve injury [2], while 2-methyl-6-phenylethynylpyrimidine (MPEP) is a highly potent non-competitive mGluR5 antagonist [3]. The purpose of this study is to observe the possible preventive effect of MPEP on neuropathic pain in rat sciatic nerve chronic compactness model (CCI).

In recent years, many researchers have isolated fetal mesenchymal stem cells (MSCs) from fetal tissues and fetal accessory tissues [1-3]. Fetal MSCs and MSCs derived from adult tissues have the same cell morphology and antigenic phenotype, and have stronger value-increasing and differentiation ability, as well as the characteristics of efficient transfection and expression of exogenous target genes, which provide an important source of seed cells for fetal tissue engineering and gene therapy research [4, 5]. However, fetal tissues or visible fetal accessory tissues collected during pregnancy inevitably cause harm to the fetus and mother, which limits their clinical application. In 2003, Prusa et al. [6] reported that fetal MSCs were contained in amniotic fluid, because amniotic fluid can be obtained by amniocentesis, it has a slight effect on the fetus and mother, and it is safe. Therefore, in this research, fetal MSCs were isolated and cultured from amniotic fluid in the second trimester of pregnancy, and their biological characteristics were studied.

An 8-year-old 2-month-old male was admitted to hospital on March 10, 2005 with fever and cough for 4 days, headache and vomiting for 1 day. He was diagnosed with upper respiratory tract infection and viral encephalitis. At the time of admission, his body temperature was 36.5℃, blood pressure was 97/58 mm Hg (1 mm Hg =0.133 kPa), his mind was clear, his skin was dark, his voice was coarse, he had no special face, his body weight was 38 kg, his height was 156 cm, his heart and lungs were not abnormal, his vulva developed, and his pubic hair was seen, his sexual maturity was stage IV ~ V, his bilateral testicles were enlarged, with a diameter of 4 cm, and his left testicles palpated with a solid mass of 1 cm ×1 cm.