Volume 87  ·   Issue 45  ·  2007

Objective to study the clinical and radiological effects of complete hydroxyapatite precoated femoral stem prosthesis.Methods A total of 35 cases of hip arthroplasty were performed with complete hydroxyapatite precoated femoral prosthesis.Among them, 32 cases were followed up completely. The average follow-up time was 10.2 years, and the average age was 59.7 (32-79) years. Results the average Harris score was (39.2±8.9) before operation and (87.7±7.7) after 10.2 years of follow-up. One patient underwent simple acetabular revision operation 7 years after operation because of acetabular abrasion. Two patients had mild claudication gait. All prostheses were stable on X-ray film, no osteolysis and radiological translucent band were observed. Three patients had prosthesis sinking but less than 2 mm, and no case of aseptic loosening occurred. The survival rate of the prosthesis at 10 years was 100%. Conclusion The long-term follow-up results showed that the clinical and radiological effects of the hydroxyapatite completely pre-coated femoral stem prosthesis were good.

Objective to investigate the clinical effect of autologous bone-patellar tendon-bone reconstruction of damaged anterior cruciate ligament (ACL), simultaneous semitendinosus tendon transposition combined with upward movement of femoral insertion of medial collateral ligament in the treatment of medial collateral ligament relaxation.Methods 20 cases of medial collateral ligament relaxation were treated by autologous bone-patellar tendon-bone reconstruction of damaged ACL, simultaneous semitendinosus tendon transposition combined with upward movement of femoral insertion of medial collateral ligament, including 14 males and 6 females, aged 16-64 years, with an average age of 32.6 years. The follow-up time was 6~59 months, with an average of 19.2 months. The postoperative Lysholm score was 50~96, with an average of 83.9 points, and the excellent and good rate was 90%. One case had joint flexion of 90°, one case had joint pain aggravated, and the other knee functions were normal. Conclusion Autologous bone-patellar tendon-bone reconstruction and semitendinosus tendon transposition combined with MCL femoral insertion is a reliable surgical method for the treatment of medial collateral ligament relaxation and ACL injury.

Objective to investigate the changes of alveolar-arterial oxygen partial pressure difference (P (A-a) O2) in patients with chronic obstructive pulmonary disease (COPD) under static and maximum exercise, and its relationship with static pulmonary function. Methods 47 male patients with COPD in stable stage were exercised by power bicycle to the maximum exercise volume, and the oxygen uptake and carbon dioxide emission were measured simultaneously in real time. Arterial blood was drawn before and at the peak of exercise, respectively, and P (A-a) O2 was calculated according to the formula. Results PaO2 at the peak of exercise was (89 ± 14) mm Hg (1 mm Hg =0.133 kPa), which was slightly lower than PaO2 before exercise (92 ± 9) mm Hg, but the difference was not statistically significant; PaCO2 (43±3) mm Hg at peak exercise was higher than that before exercise (41±4) mm Hg (t =3.398, P =0.003). If the patients were divided into two groups according to whether the lung diffusion function was normal or not, the P (A-a) O2 at static and peak exercise in the diffusion dysfunction group were (16±8) mm Hg and (42±9) mm Hg, respectively, and the difference between the two groups was statistically significant (P =0.005); There was no significant difference in P (A-a) O2 between static and exercise peak in the normal diffusion function group (P =0.106); The P (A-a) O2 in the diffusion dysfunction group was significantly higher than that in the normal diffusion group (26±7) mm Hg (P =0.007). The correlation analysis between P (A-a) O2 and static lung function at the peak of exercise showed that P (A-a) O2 was negatively correlated with forced vital capacity (r = -0.581, P =0.037) and lung diffusion of carbon monoxide (r = -0.671, P =0.012). Conclusion The main reason for the significant increase of P (A-a) O2 during exercise in COPD patients was the decrease of lung diffusion function.

Objective to investigate the clinical and neuroelectrophysiological characteristics of myasthenia gravis with thymoma (MGT). Methods the data of 72 patients with MGT and 63 patients without thymoma MG (NMGT) were analyzed retrospectively. The data were statistically analyzed by SPSS 13.0 software. Results MGT occurred more frequently in patients between 35 and 59 years (72.2%), the mean onset age was older than that of NMGT (39.5 years vs 29.4 years), and the mean course of disease was shorter than that of NMGT (13.1 months vs 29.1 months). There was basically no difference between male and female (50% each). The ratio of whole body type was higher than that of NMGT (72.8% vs 66.7%). The respiratory muscle was more likely to be involved than that of NMGT (20.8% vs 9.5%). The disease progressed rapidly, and the mean time from onset to respiratory muscle and bulbar muscle involvement was significantly shorter than that of NMGT (12 months vs 26.4 months; 7 months vs 11.6 months) The positive rate of RNS detection of MGT was higher than that of NMGT (86.9% vs 75.0%). Thymoma or mediastinal abnormality could be found in 97.2% (70 cases) by thymus CT. The positive rate of acetylcholine receptor antibody (AchRab) was not statistically different from that of NMGT (50.0% vs 52.4%). Conclusion MGT is more common in middle-aged and elderly, both men and women. The disease progresses quickly, and it is easy to have systemic skeletal muscle involvement, and the rate of respiratory muscle involvement is high. Neuroelectrophysiology is a sensitive examination method of MGT. AchRab may not be a specific antibody to detect MGT. Thymus CT is an important auxiliary examination method before MGT.

Objective to investigate the characteristics of cognitive impairment in patients with temporal lobe epilepsy and its relationship with DTI parameters by using neuropsychological methods and magnetic resonance diffusion tensor imaging (DTI). Methods Neuropsychological examinations were performed in 32 adult patients with temporal lobe epilepsy and 42 healthy controls, including speech fluency, Stroop, connection test (A), number breadth and number sign. Diffusion tensor imaging was performed in 19 patients with temporal lobe epilepsy and 21 healthy controls. Results the speech fluency (11±4) in patients with temporal lobe epilepsy was significantly worse than that in the normal control group (16±4), and the number breadth and number sign were significantly lower than that in the normal control group. Compared with the control group, the FA values of left inner capsule hindlimb and bilateral thalamus in patients with temporal lobe epilepsy were significantly reduced, and the differences were statistically significant. The correlation analysis showed that: left caudate nucleus (r = -0.56,P =0.04), bilateral putamen nucleus (right r = -0.58,P =0.04; left r = -0.58,P =0.04), and right thalamus MD value (r = -0.64,P =0.02 The MD values of left putamen and left putamen (r = -0.59, P =0.04) were negatively correlated with the number breadth, and the MD values of bilateral inner capsule hindlimbs were positively correlated with the connection time, and the correlation coefficients were 0.65 (P =0.02) for right inner capsule hindlimbs and 0.59 (P =0.03) for left inner capsule hindlimbs, respectively.

Objective to investigate the manifestations and prenatal diagnosis of fetuses with short and long bones. Methods 57 cases of fetuses in the short and long bone group and 62 cases of normal fetuses in the control group were detected by cord blood chromosome and exon 10 of fibroblast growth factor receptor 3 (FGFR3) gene in fetuses with short and long bone, and 30 cases of fetuses with short and long bone induced labor were examined by skeletal X-ray and pathology. Results 21 cases (37%) of congenital skeletal dysplasia, 8 cases (14%) of chromosome abnormality, 4 cases (7%) of fetal growth restriction and 24 cases (42%) of unknown cause were finally diagnosed in the short and long bone group. The degree of long bone shortening in fetuses with chromosome abnormalities and growth restriction ranged from 2 to 4 SD; The fetus with fatal skeletal dysplasia decreased by more than 8 SD compared with the normal mean; The sensitivity and specificity of femoral length/abdominal circumference<0.16 in predicting fetal thoracic stenosis were 100% and 85.7%, respectively.Conclusion The common causes of fetal short long bone include congenital skeletal dysplasia, chromosome abnormalities and fetal growth restriction.Prenatal ultrasound examination of femoral and humeral length is lower than the mean value of corresponding gestational age by more than 4 SD, and alert for skeletal dysplasia when combined with increased biparietal diameter; When the mean value is 2~4 SD, fetal chromosome detection and dynamic observation are required; Fatal skeletal dysplasia was considered when it was more than 8 SD below the mean and femoral length/abdominal circumference<0.16.

Objective to investigate the possible protective effects of ascorbate, catalase (CAT) and superoxide dismutase (SOD) on oxidative stress-induced DNA damage in frozen-thawed human sperms.Methods Thirty healthy fertile male semen were added with modified human sperm cryoprotective solution, and divided into 6 groups according to the added antioxidant and final concentration; Results (1) After freezing and thawing, the A + b sperm in 300 μ mol/L ascorbate group and CAT 200 U and 400 U group decreased less than that in the control group (all P<0.05), and the sperm viability recovery rate and ROS level were higher and lower than those in the control group, respectively (67%±14%, 68%±14%, 69%±15% vs 59%±10%, all P<0.05; 30±13, 30±11, 30±11 vs 37±17, all P<0.05). (2) Compared with those before freezing, there were no significant differences in the percentage of comet cell tail DNA and Olive tail moment in 300 μ mol/L ascorbate group and CAT 200 U and 400 U group (P>0.05); But the above indexes were significantly higher than those of the control group (41%±4%, 40%±7%, 40%±6% vs 46%±6%, all P<0.01; 7.7±1.2, 7.5±1.6, 7.8±1.9 vs 10.1±3.1, all P<0.01). The above indexes of the other experimental groups were significantly higher than those before freezing (all P<0.01), but the differences with the control group were not statistically significant (P>0.05). (3) After freezing and thawing, there was a negative correlation between the A + b sperm levels and the ROS levels in each experimental group (P<0.05 or P<0.01). Except for the ascorbate 600 μ mol/L group, the tail DNA% and Olive tail moment of the other experimental groups were significantly positive correlations with the ROS of their corresponding groups (P<0.05, P<0.01). Conclusion Adding ascorbate and CAT to a certain concentration in semen cryoprotectant can reduce the excess ROS produced by freezing, and then reduce the oxidative stress damage of the latter to sperm nuclear DNA, thus improving the quality of frozen and thawed human sperm.

Objective to investigate the efficacy of thoracoscopic thymectomy in the treatment of myasthenia gravis by comparing the efficacy of thoracoscopic thymectomy with sternal split thymectomy in the treatment of myasthenia gravis. Methods 204 patients with myasthenia gravis (non-thymoma) treated by thymectomy from 1991 to 2003 were retrospectively analyzed, including 161 patients with sternal split thymectomy, followed up for 5 years; Results in the thoracoscopic group, the average operation time was (132±32) min, 4 cases had myasthenia crisis after operation, and the complete stable remission (CSR) at 1 and 3 years after operation was 34.9% and 46.5%, respectively; The mean operation time was (96±18) min in the sternal split group, and the CSR was 26.7%, 35.4% and 40.4% in 41 cases of myasthenia crisis at 1, 3 and 5 years after operation, respectively.Conclusion Thoracoscopic thymectomy can achieve the same ideal treatment effect as median sternal split surgery in the middle and long term.

Objective to investigate the expression of tissue factor (TF), urokinase-type plasminogen activator (uPA) and urokinase-type plasminogen activator receptor (uPAR) in non-small cell lung cancer (NSCLC) and their relationship with microvessel density (MVD), lymph node metastasis, vascular invasion and prognosis of NSCLC. Methods Immunohistochemistry was used to detect the expression of TF, uPA and uPAR in 97 cases of NSCLC and 40 cases of adjacent normal lung tissues. The relationship between the expression of TF, uPA and uPAR and MVD, lymph node metastasis, vascular invasion and prognosis was analyzed by t test, χ 2 test and Kaplan-Meier survival curve. Results TF, uPA and uPAR were widely expressed in NSCLC tissues, the positive rates were 61.9%, 58.8% and 61.9%, respectively. Only a few macrophages and fibroblasts were weakly positive in adjacent normal lung tissues. The expression of TF (34/47), uPA (33/47) and uPAR (39/47) were all correlated with lymph node metastasis (χ 2 values, respectively The synergistic expression of TF and uPAR was significantly correlated with lymph node metastasis and vascular infiltration (P<0.01). The median survival time of patients with positive expression of TF, uPAR and TF-uPAR was significantly shorter than that of patients with negative expression of TF, uPAR and TF-uPAR. Conclusion TF promotes tumor microvascular formation, and uPAR expression is correlated with lymph node metastasis and vascular infiltration.

Objective to observe the effects of new generation hydroxyethyl starch (130/0.4) on renal ischemia-reperfusion injury and the expression of immune adhesion molecule (ICAM) -1. Methods the rat model of renal ischemia-reperfusion injury was established, and the infusion treatment was started before the end of ischemia. The rats were randomly divided into sham operation group (C group), normal saline group (S group) and hydroxyethyl starch treatment group, with 10 rats in each group. The latter were divided into W1 group (5 ml/kg), W2 group (10 ml/kg) and W3 group (20 ml/kg) according to the dose. Renal function, renal tubular injury (Paller score) and renal tissue ICAM-1 expression were compared 24 h after reperfusion. Results Renal function was impaired after ischemia-reperfusion. The renal tubular injury score was 43.2 ± 15.8 in group S, and the injury was significantly milder in group W2 and group W3 (33.6 ± 16.6 and 29.2 ± 12.3, P<0.05). The absorbance value of ICAM-1 was 213 ± 32 in group S, and the expression of ICAM-1 was less in group W2 and group W3 (182 ± 22 and 161 ± 25, P<0.01). However, there was no significant difference between group W1 and group S. Conclusion

Objective to analyze the expression of osteopontin (OPN) in lung cancer tissues and to explore its role in the development of lung cancer. Methods Immunohistochemistry (SP) and in situ hybridization were used to detect the expression of osteopontin and osteopontin mRNA in 57 lung cancer tissues, 30 lung inflammatory pseudotumor tissues and 20 lung bullae tissues. Results the expression rates of osteopontin in lung cancer tissues and lung inflammatory pseudotumor tissues were 57.9% (33/57) and 16.7% (5/30) (χ 2=13.581, P =0.000), respectively. The expression rates of osteopontin mRNA in lung cancer tissues and lung inflammatory pseudotumor tissues were 71.9% (41/57) and 30.0% (9/30) (χ 2=14.138, P =0.000), respectively. The expression rates of osteopontin and osteopontin mRNA in lung bullae tissues were negative. The expression rates of osteopontin and osteopontin mRNA were 71.1% (27/38) and 86.8% (33/38) in 38 lung cancer tissues with lymph node metastasis, respectively, and 31.6% (6/19) and 42.1% in 19 lung cancer tissues without lymph node metastasis, respectively The expression rates of osteopontin and osteopontin mRNA were 68.1% (32/47) and 78.72% (37/47) respectively in 47 cases of non-small cell lung cancer (χ 2=11.412, P =0.001 and χ 2=6.124, P =0.013). The expression of osteopontin and osteopontin mRNA in lung cancer tissues was positively correlated (r =0.623, P =0.001). 57 cases of lung cancer were followed up for 24 to 40 months, with a median follow-up of 28 months. Among the 15 cases in the all-negative group, only 1 case relapsed (χ 2=14.258, P =0.000); There were 12 deaths in the positive group of osteopontin and osteopontin mRNA, and none in the negative group (χ 2=7.554, P =0.006). Conclusion The increase of the expression of osteopontin and osteopontin mRNA in lung cancer tissues is related to tumor metastasis and prognosis.

Objective to investigate the feasibility of injecting superparamagnetic iron oxide particle (SPIO) -labeled bone marrow mesenchymal stem cells (MSCs) into the joint cavity of rabbit knee femoral condylar cartilage defect by 1.5T MRI in vivo tracer. Methods MSCs were isolated and cultured from rabbit bone marrow, dual-labeled with SPIO and BrdU in vitro, compounded with chitosan scaffold, and then injected into the joint cavity of rabbit knee femoral condylar autologous cartilage defect. MR was used to scan and trace the MSCs injected into the joint cavity of knee joint 1 d, 4, 8, and 12 weeks after operation, and compared with Prussian staining of tissue sections and immunohistochemical BrdU. Results Prussian staining and electron microscopy examination of the labeled MSCs in vitro showed that the cytoplasm of the cells contained dense iron particles, and the labeled cells could differentiate into cartilage normally. MRI GRET2*WI sequence examination after complex injection showed that the magnetically labeled MSCs in the joint cavity produced granular low signal changes for at least 12 weeks, Conclusion MSCs with SPIO label still have the ability to differentiate chondroblasts, and it is feasible to use 1.5T MRI in vivo to trace the distribution and migration of rabbit magnetically labeled MSCs injected into the knee joint cavity of autologous cartilage defect.

Objective to explore the feasibility of ectopic transplantation of autologous sinus node cells and constructing ventricular ectopic pacing focus for the treatment of bradyarrhythmia. Methods Sixteen healthy adult dogs were randomly divided into transplantation group and control group (8 dogs in each group). The transplantation group was treated with isoproterenol and atropine via femoral vein to study the changes of heart rate. The survival of transplanted cells and the gap junction structure formed with ventricular myocytes were observed by immunofluorescence staining. Results The cell structure and activity of spontaneous beats obtained by digestion and isolation of adult dogs sinus node were well maintained. After 1 h of establishing the complete atrioventricular block model, the heart rate of transplanted dogs was higher (91 ± 14) beats/min than that of control group (49 ± 11) beats/min (t =6.672, P<0.01). After injection of isoproterenol, the ventricular heart rate increased from (95 ± 11) beats/min to (118 ± 15) beats/min in the transplanted group (t =3.497, P<0.01), but the ventricular heart rhythm did not change significantly after injection of atropine [(95 ± 11) beats/min and (101 ± 17) beats/min, respectively] (t =0.838, P>0.05). Immunofluorescence staining confirmed that the transplanted cells survived at the transplanted site, and gap junction protein was formed between the cells. Conclusion Transplantation of adult canine sinus node cells into autologous right ventricular wall can increase the ventricular rate after complete atrioventricular block, and the reaction to isoproterenol is good, but no obvious reaction to atropine.

Objective to detect the expression of seven important CLOCK genes during the induced differentiation of mouse embryonic stem cells (ES) into neurons in vitro.Methods Mouse embryonic stem cells (ES) were induced to differentiate into neurons in five stages.The total RNA of cells in each stage was reverse transcribed into cDNA, and the specific primers of seven CLOCK genes were used for PCR reaction to determine their expression with differentiation.Results There was no non-specific amplification of each CLOCK gene.BMAL1, CLOCK, CRY1 and CRY2, PER1 and PER3 genes were expressed in each differentiation stage, while PER2 gene was detected only in the terminal stage.Conclusion The transcription of CLOCK genes in the process of ES cell differentiation into neurons is not consistent, which suggests that the CLOCK gene circuit existing in adult animals has not been established in the process of ES cell differentiation.PER2 is transcribed only in the terminal stage of differentiation, when a large number of neurons and glial cells stop dividing, which suggests that it may play some role in the process of cell proliferation.

A 55-year-old male was admitted to Peking Union Medical College Hospital on December 6, 2006 due to "numbness and weakness in both lower limbs for 10 months and hearing loss for 6 months".

A 47-year-old female was admitted to the hospital in August 2006 due to intermittent fever and headache for 5 years, mental retardation and unsteady walking for 1 month. The patient suffered from sudden high fever, above 39℃, headache and slow reaction in July 2001. Local lumbar puncture showed 30 white blood cells/mm3, slightly increased protein, normal sugar and chloride.

antiphospholipid syndrome (APS) is a clinical syndrome caused by antiphospholipid antibody (APL), mainly manifested as arterial/venous thrombosis and/or pathological pregnancy [1].

In recent years, epidemiological reports on white blood cell count and cancer mortality have been observed successively. Several studies suggest that white blood cell count can predict cancer mortality, but some people think that it is mainly the mortality rate of smoking-related cancer. Whether white blood cell count can predict the occurrence of cancer in women is still controversial.

A 59-year-old male was admitted to hospital due to "episodic chest pain for 5 years, aggravated for 2 months". Physical examination showed blood pressure 20.15/10.6 kPa, heart rate 85 beats/min, atrial fibrillation rhythm, serum total cholesterol 3.43 g/L, liver and kidney function was not abnormal. Coronary angiography showed coronary heart disease, left main and three vessel lesions, and venous bridge stenosis after coronary artery bypass grafting (Figure 1,2).

The medical insurance mode and development situation of China's medical insurance system are facing a difficult problem, that is, the excessive growth of medical insurance expenditure has brought great pressure to social economy [1]. An important reason for the rapid growth of medical insurance fund is the original payment system of payment according to items. In order to ensure the sustainable development of medical insurance system, the state takes perfecting the payment system as an important direction of future reform. The payment methods of medical insurance are basically divided into two categories: prepayment system and postpayment system.