Volume 87  ·   Issue 41  ·  2007

Surgical repair of osteonecrosis of the femoral head (ONFH) is an effective method for the treatment of avascular necrosis of the femoral head in young and middle-aged people. the methods include core decompression, various osteotomies, bone grafting without vascular pedicle and bone flap grafting with vascular pedicle, etc. Mont et al. reported that core decompression and bone grafting with blood supply have good long-term clinical efficacy.

Objective to study the clinicopathological characteristics of perivascular epithelioid cell differentiated tumors (PEComas). Methods Retrospective analysis, screening and external examination of morphological characteristics of PEComas and immunohistochemistry were performed to determine the cases belonging to PEComas. Clinical data (especially the presence or absence of tuberous sclerosis), pathological morphological observation, immunohistochemical staining and follow-up of some cases were performed. Results A total of 39 cases of PEComas family were observed. 30 cases occurred in kidney, 4 cases in liver, 1 case in lung, 1 case in uterus and broad ligament, 1 case in nasal cavity, 1 case in abdominal wall and 1 case in retroperitoneum. No cases with TSC-related symptoms were found. Immunohistochemistry showed that Melan-A was the most sensitive antibody, with an expression rate of 95% (37/39), HMB45 and MiTF were 82% (32/39) and 46% (18/39), respectively. SMA was expressed in 82% (32/39) cases. Desmin expression rate was 26% (10/39), S100 expression rate was 15% (6/39). CD117 was expressed focally in only 10% cases, and the intensity was weak. It needs to be differentiated from many kinds of tumors, and its strict malignant criteria need more cases and follow-up data to confirm.

Objective to observe the morphological changes of mucosa and the expression of neural nitric oxide synthase (nNOS) in mucosa after sigmoid colon replacement vaginoplasty. Methods the morphological examination of 14 cases of sigmoid colon mucosa and 14 cases of normal sigmoid colon mucosa was performed by light microscope and electron microscope, and the expression of nNOS in mucosa was studied semi-quantitatively by immunohistochemistry. Results After sigmoid colon replacement vaginoplasty, the muscular layer of the upper mucosa of artificial vagina was hypertrophied and the density of submucosal plexus increased (3.6±1.5 vs 1.7±0.8, P<0.05); Squamous epithelial metaplasia was observed in part of the lower mucosa.The expression of nNOS in mucosal epithelium and mucosal glands of vaginal sigmoid colon was weaker than that of normal sigmoid mucosa.Conclusion the morphological changes of the mucosa occurred after vaginoplasty of sigmoid colon, with obvious changes in the lower segment.

Objective to retrospectively analyze the operative effect and related factors of open talus fractures treated by open reduction and internal fixation. Methods 16 cases of talus neck and talus body fractures treated by surgery with complete follow-up data were retrospectively analyzed. All fractures were classified according to Gustilo-Anderson classification: 3 cases of type 1, 8 cases of type Ⅱ, 2 cases of type Ⅲ A, 2 cases of type Ⅲ B and 1 case of type Ⅲ C; All patients underwent open fracture debridement, first-stage open reduction and internal fixation in emergency department according to Hawkins classification: 5 cases of type 2, 3 cases of type 3 and 1 case of type 4. All 16 patients with open talus fracture were followed up after operation, and the clinical efficacy was analyzed according to the postoperative complaints, X-ray films, CT films, AOFAS scores, combined with the preoperative open wound, talus fracture classification, intraoperative reduction and other clinical signs. Results The follow-up time of the patients was 3~6 years, with an average of 4.7 years. The fracture healing rate was 81%, 13 patients had fracture healing, and 3 patients had osteomyelitis, which did not heal. The average fracture healing time was 4.5 months. 5 of 16 cases had postoperative infection, and the incidence of infection was 31%; 2 cases were superficial soft tissue infection, 3 cases developed osteomyelitis, 2 cases were successfully treated with anti-infection, 2 cases underwent Blair arthrodesis in the second stage, 1 case underwent horizontal amputation in the middle and lower 1/3 of the lower leg. The wound healing situation showed that 9 cases underwent primary healing, 7 cases underwent wound dressing change, 4 cases underwent delayed healing, 2 cases underwent secondary free skin grafting, 1 case underwent local skin flap transfer to cover the wound successfully, 13 cases underwent secondary traumatic arthritis, and 11 cases showed signs of talar osteonecrosis. The AOFAS hindfoot score was 45~78, with an average score of 53.7. Conclusion Combining with the injury characteristics of talar fracture, primary debridement, open reduction and internal fixation are the key to the treatment.

Objective to investigate the clinical characteristics and treatment strategies of spinal fractures in ankylosing spondylitis (AS). Methods 15 cases of AS spinal fractures were included in this study, including 13 males and 2 females, aged 29-73 years (mean 49.8 years), and the course of AS was 10-45 years (mean 24.6 years). 6 cases of cervical fractures were treated conservatively; There were 2 cases of anterior bone graft fusion and internal fixation, 1 case of posterior internal fixation and bone graft fusion, 1 case of posterior laminectomy and decompression, internal fixation and bone graft fusion, 9 cases of thoracolumbar fracture, 7 cases with thoracolumbar kyphosis, Cobb angle 46~106°, mean 64°. Three kinds of surgical procedures were used for thoracolumbar fracture: (1) Posterior transpedicular osteotomy and internal fixation and bone graft fusion in 3 cases; (2) 2 cases of anterior lesion debridement, internal fixation and bone grafting fusion; (3) Four cases underwent combined anterior and posterior surgery (one stage posterior transpedicular vertebral body osteotomy/multi-segment V-shaped osteotomy, internal fixation and bone grafting fusion, and two stages anterior lesion debridement and bone grafting fusion/internal fixation). Results 6 cases of cervical fractures, 3 cases of fractures through intervertebral space, 3 cases of horizontal fractures of vertebral body adjacent to endplate, 2 cases of conservative treatment, all died of pulmonary infection, 1 case of incomplete paralysis was treated with posterior laminectomy and decompression, internal fixation and bone grafting fusion, and was able to walk independently with the help of walking device at the last follow-up, 4 cases of anterior/posterior internal fixation surgery, fixed segmental bone fusion at the last follow-up, 9 cases of thoracolumbar fractures, 3 cases of horizontal fractures of vertebral body adjacent to endplate; The Cobb angle was 22~42° (mean 26°) in 7 cases of thoracolumbar kyphosis, and the mean correction was 38°; The Cobb angle at the last follow-up was 24~44° (mean 28°), with a loss of 2°. The X-ray at the last follow-up showed that the adjacent vertebral bodies had bone fusion. Conclusion For unstable AS cervical fractures, the conservative treatment effect is poor, and active surgical treatment should be done. Anterior/posterior surgery can effectively reestablish the stability and achieve fracture healing. For AS thoracolumbar fractures/pseudoarthrosis without thoracolumbar kyphosis, anterior lesion debridement, bone grafting, fusion and internal fixation can be used. AS fracture/pseudoarthrosis with thoracolumbar kyphosis, posterior osteotomy can correct the deformity and promote the fusion of fracture/pseudoarthrosis; If the intervertebral space is opened after posterior osteotomy, resulting in significant anterior column defect, complementary anterior bone grafting fusion should be performed to support the anterior column and avoid orthopedic failure.

Objective to use the three-dimensional gait analysis system to quantitatively analyze the three-dimensional kinematic characteristics of lower limbs of hemiplegic patients, and to determine the quantitative indexes that objectively reflect the kinematic characteristics of hemiplegic gait of lower limbs after stroke.Methods The kinematic parameters of 27 normal subjects and 39 stroke patients were detected and analyzed by the three-dimensional gait analysis system.Results the range of motion (ROM) of hemiplegic side hip and knee in the experimental group; Hip extension and ankle dorsal extension angles; The W/S ratio of hip extension and ankle dorsal extension angle were significantly different from those of normal people (P<0.01). The ROM, hip extension and ankle dorsal extension of hemiplegic side of stroke patients were significantly different from those of healthy side (P<0.01). The difference of knee flexion between the affected side and the healthy side was also statistically significant (P<0.05). Conclusion the kinematic characteristics of lower limb in stroke hemiplegic gait were as follows: ROM of lower limb joint was limited on hemiplegic side; Lower extremity movement asymmetry on affected/healthy side; It indicates that the three-dimensional kinematic parameters of hemiplegic lower limbs are important indexes to describe hemiplegic patterns.

Objective to investigate whether adults with developmental stuttering have abnormal brain structural changes and to explore the related neural mechanisms.Methods 10 adults with developmental stuttering and 12 non-stuttering adults were scanned with GE Haifa 2T high field intensity MR imaging system.Three-dimensional structural images were obtained by fast gradient echo imaging sequence.The VBM software package based on SPM99 software was used to process the data automatically by computer, and the differences of local gray matter between the two groups were compared.Results The gray matter in the bilateral cerebral hemispheres of superior temporal gyrus, middle temporal gyrus, posterior central gyrus, inferior parietal lobule and anterior motor gyrus in the stuttering group was significantly higher than that in the control group (P<0.001), and the number of voxels increased in the left and right hemispheres was 48 782 and 60 247, respectively; The decrease of bilateral cerebellar posterior lobe and medulla oblongata was significantly less than that of the control group (P<0.001), and the total number of voxels decreased was 32 394. Conclusion the brain tissue structure of developmental stuttering adults is different from that of non-stuttering adults, among which the decrease of bilateral cerebellar and medulla oblongata gray matter volume may be the main neuroanatomical basis of speech motor coordination disorder in stuttering patients; The increased volume of gray matter in the bilateral hemisphere may be the structural changes caused by long-term compensation for insufficient speech coordination.

Objective to investigate the effects of adenovirus-mediated p53 gene (Ad-p53) on the drug resistance and multidrug resistance gene 1 (MDR1) of human breast cancer cell line MCF-7/ADM. Methods MCF-7/ADM cell line was transfected with Ad-p53, and the changes of p53 protein were detected by flow cytometry. Cell growth was observed by trypanosome blue viable cell rejection method; The resistance of MCF-7/ADM cells to doxorubicin was observed by MTT assay, and the changes of MDR1 mRNA were detected by real-time fluorescence RT-PCR. Results The expression rate of p53 protein increased from 10.24% to 36.20% in MCF-7/ADM cells after 48 h treatment with Ad-p53 by MOI50. The cytostatic rate was 7.4% (P =0.003); The resistance of MCF-7/ADM to ADM was reversed by 11.6 times (P =0.001); Real-time fluorescence RT-PCR results showed that the relative expression of MDR1 mRNA decreased from 1.25±0.01 to 0.91±0.01 (P =0.011). Conclusion Adenovirus-mediated p53 gene can inhibit the expression of MDR1 gene in MCF-7/ADM cells, partially reverse the drug resistance of MCF-7/ADM, and increase the chemosensitivity of doxorubicin.

Objective to investigate the relationship between the abnormal methylation of Ras-related domain family gene 1A (RASSF1A) promoter region and the development of esophageal carcinoma. Methods Methylation-specific PCR was used to detect the abnormal methylation of RASSF1A promoter region in 66 esophageal carcinoma tissues and the corresponding normal tissues adjacent to cancer. Results The incidence of abnormal methylation of RASSF1A promoter region in esophageal carcinoma tissues and normal tissues adjacent to cancer tissues was 48.5% (32/66) and 6.1% (4/66), respectively. The incidence of abnormal methylation of RASSF1A promoter region in esophageal carcinoma tissues with lymph node metastasis was significantly higher (61.1%) than that in patients without lymph node metastasis (33.3%) (χ 2=5.055,P =0.025); The incidence of abnormal methylation in the promoter region of RASSF1A gene in advanced stage (Ⅲ ~ Ⅳ) esophageal carcinoma was significantly higher (69.2%) than that in early stage (Ⅰ ~ Ⅱ) (35.0%) (χ 2=7.392, P =0.007); There is no correlation between the abnormal methylation of RASSF1A gene promoter and the degree of tumor differentiation in esophageal cancer tissues (P>0.05). Conclusion Abnormal methylation of RASSF1A gene promoter region exists in esophageal cancer tissues, and the methylation is related to the pathological stage of esophageal cancer and lymph node metastasis.

Objective to investigate the possible effects of potassium channels TASK-1 and TASK-3 on the occurrence of sleep apnea in rats. Methods Sleep breathing was monitored in free-moving SD rats. The expression levels of TASK-1 and TASK-3 in brainstem of different rats were detected by Western blot method, and their correlation with sleep apnea index was analyzed. Rat models of persistent and intermittent hypoxia were established, and the effects of hypoxia on the expression of TASK-1 and TASK-3 were analyzed. Results Total spontaneous apnea (SP) index and NREM spontaneous apnea index were positively correlated with the expression of TASK-1 protein in brainstem of normal SD rats (r values were 0.547, 0.601, respectively, all P<0.01), while post-sigh apnea (PS) index was not correlated with the expression of TASK-1. There was no correlation between spontaneous apnea index and post-sigh apnea index and the expression of TASK-3 (P>0.05). Intermittent hypoxia associated with hypercapnia can increase the expression of TASK-1 and TASK-3 in brainstem

Objective to analyze the effects of siRNA on the synthesis of prostaglandin E2 (PGE2), interleukin-1 β (IL-1 β), IL-6, tumor necrosis factor (TNF-α) and vascular endothelial growth factor (VEGF). Methods Four small molecule interfering RNAs (siRNAs) of cyclooxygenase-2 (hCOX-2) mRNA (1# ~4#) were designed, and blank negative (CTL) and one random sequence (NC) were set up as controls. The siRNAs were transfected into synovial fibroblasts (RASF) with LipofectAMINE 2000. After 4 h, 100 nmol/L phorbol ester was added. The mRNA and protein expression levels of hCOX-2 were detected by RT-PCR and Western blot, respectively. The levels of proinflammatory factors in the supernatants of each group were detected by ELISA. Results After 48 h of transfection, the absorbance ratios of mRNA bands in NC, 1# ~4#siRNA group and CTL group were 0.72, 0.3, 0.25, 0.4, 0.04, respectively. After 36 and 48 h of transfection, the absorbance ratios of hCOX-2 protein in each group and CTL group were 1.04, 0.52,

Objective to construct a recombinant adenoviral vector of active caspase-3 (AdHT-rev-casp3) regulated by human telomerase reverse transcriptase promoter (hTERTp) and to detect its therapeutic effect on human ovarian carcinoma. Methods to construct a recombinant adenoviral vector expressing active caspase-3 (AdHT-rev-casp3) regulated by hTERTp, and to detect the expression levels of active caspae-3 protein p17 and polyadenosine diphosphate-ribose polymerase (PARP) fragment p85 in ovarian cancer cell line AO and normal human umbilical vein endothelial cells HUVEC after AdHT-rev-casp3 treatment by Western blot, cell counting kit (CCK-8) method, flow cytometry and TUNEL. The expression of active caspase-3 in tumor and liver tissues of nude mice after AdHT-rev-casp3 was detected by Western blot. The survival rate and tumor volume of nude mice before and after AdHT-rev-casp3 were observed, and the levels of liver enzymes ALT and AST in nude mice were observed. Results After AdHT-rev-casp3 infection (MOI =70), AO cells clearly expressed active caspase-3 protein p17 and PARP cleaved fragment p85 protein, with cell survival rate of 55% and apoptosis rate of 26%. However, after AdHT-rev-casp3 infection, HUVEC had no significant expression of p17 and p85, and the cell survival rate and apoptosis rate were not significantly different from those of negative control group. Active caspase-3 was obviously expressed in tumor tissues of nude mice after AdHT-rev-casp3 treatment, but not in liver tissues; AdHT-rev-casp3 can significantly prolong the survival time of tumor-bearing nude mice [(177±12) d vs (106±11) d], the tumor inhibition rate is 60%, and the liver enzyme level in nude mice does not increase significantly after its effect. Conclusion AdHT-rev-casp3, the recombinant adenovirus of rev-caspase-3 regulated by hTERTp system, has strong apoptotic ability and tumor targeting, can significantly inhibit the growth of ovarian cancer transplanted tumors, prolong the survival time of tumor-bearing nude mice, and significantly reduce the toxicity of rev-caspase-3 to liver.

Objective to investigate the molecular mechanism of 5-allyl-7-difluoromethylene chrysin (ADFMChR) inducing apoptosis in human ovarian cancer cells by activating peroxisome proliferation factor-activated receptor (PPAR γ). Methods The inhibitory effect of ADFMChR on the proliferation of ovarian cancer (CoC1) cell line was determined by MTT assay. Propidium iodide staining flow cytometry (FCM) was used to detect the degree of apoptosis induced by ADFMChR in CoC1 cells; The effect of ADFMChR on the expression of PPAR γ, NF-κ B, Bcl-2 and Bax protein in CoC1 cells was confirmed by DNA agarose gel electrophoresis. The effect of ADFMChR on the expression of PPAR γ, NF-κ B, Bcl-2 and Bax protein in CoC1 cells was detected by Western blot. FCM analysis showed that ADFMChR induced apoptosis of CoC1 cells in a dose-dependent manner. The apoptosis rates of CoC1 cells treated with ADFMChR (10.0, 30.0 μ mol/L) for 48 h were 33.07% and 73.70%, respectively, which were higher than those induced by chrysin (21.70% and 40.00%). ADFMChR (30 μ mol/L) treated CoC1 cells for 48 h showed typical trapezoidal bands, but the bands disappeared after adding PPAR γ blocker (GW9662); The expression of PPAR γ and Bax and NF-κ B and Bcl-2 in CoC1 cells was upregulated by ADFMChR in a dose-dependent manner by Western blot analysis. Conclusion ADFMChR inhibits the expression of NF-κ B and Bcl-2 by activating PPAR γ, upregulates Bax and induces apoptosis in CoC1 cells.

A 63-year-old female, retired teacher, was admitted to the hospital due to repeated fever, poly-drinking for 15 months, numbness, pain and edema of the limbs for 10 months. The patient developed chest tightness, dry cough and fever without obvious trigger 15 months ago, and her body temperature fluctuated between 37 and 38.5 ℃, without night sweats and chills, etc. The patient went to the local hospital for lung CT examination and found a nodular shadow in the right lung, about 1.2 cm in diameter. After being treated with various anti-inflammatory drugs, CT examination showed that the above nodules were enlarged. Therefore, the patient underwent mass resection in the thoracic surgery department of the Second Affiliated Hospital of Zhejiang University School of Medicine. The postoperative pathological examination was: suppurative necrotizing granuloma lesion, and the diagnosis was "right lung inflammatory pseudotumor".

Muscle tissue has its own precursor cells. When a series of injuries such as trauma, inflammation, degenerative diseases and other wasting diseases occur in the body, muscle can maintain a certain degree of regeneration ability. However, clinical research has found that when the above diseases occur, muscle that has lost muscle strength and muscle volume often cannot recover completely. In addition, there is a lack of specific drugs to improve and promote muscle regeneration at present, so muscle atrophy of different degrees often occurs.

progressive muscular dystrophy (PMD) is a general term for a group of hereditary diseases with progressive aggravation of muscle dystrophy and muscle atrophy as the main clinical manifestations. Molecular biology technology makes the responsible genes, encoding proteins and pathogenesis of this group of diseases gradually recognized. Because of the similar clinical symptoms, laboratory examinations, electromyography and skeletal muscle histochemical staining, it is necessary to use immunohistochemical staining, Western blotting, polymerase chain reaction (PCR) or gene sequencing to further typing and diagnosis at the protein or gene level. The present status of molecular biological diagnosis of various types of PMD is summarized as follows.

Georgetown University Medical Center found that neuropeptide-Y (NPY) can directly act on peripheral adipose tissue to regulate obesity and metabolic syndrome induced by stress stimulation. Long-term stress stimulation combined with high-calorie diet can cause excessive weight gain in mice.

Magnetic resonance imaging (MRI) has had a revolutionary influence on the localization and qualitative diagnosis of neurological diseases since it was applied to clinic in 1980s. It was first reported in 1981 that it was applied to multiple sclerosis (MS). Young et al. [1] compared the head MRI and CT findings of 10 patients with MS. MRI found 131 brain lesions, while CT only found 19.

SAPHO syndrome, namely synovitis-acne-impetigo-osteohypertrophy-osteitis syndrome, is uncommon in clinic. Six cases are reported as follows. There were 4 males and 2 females who attended Peking Union Medical College Hospital from 1990 to 2006. The average age was 33.3 years (18-63 years). The course of the disease ranged from 8 months to 25 years, with an average of 8.11 years. Clinical characteristics: (1) Skin: All the patients had skin changes, including 3 cases with impetus simplex, 2 cases with acneoid rash simplex, and 1 case with impetus and acne.