Propensity score-matched study of uni-condylar arthroplasty in elderly patients with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis in patients over 75 years old.@*METHODS@#The clinical efficacy of primary fixed platform UKA in patients with osteoarthritis, was retrospectively analyzed from October 2014 to November 2020. Age, body mass index (BMI), range of motion (ROM), preoperative joint function score, the quality of life score and other preoperative indicators were measured by propensity score matching (PSM). The patients were divided into elderly group (≥75 years old) and control group (<75 years old). Oxford knee score(OKS), Western Ontario McMaster Universities osteoarthritis index(WOMAC), Short Form-12 including physical component summary (PCS), mental component summary(MCS), minimal clinically important difference(MCID ) and clinical complications were evaluated preoperatively and postoperatively.@*RESULTS@#A total of 514 patients were analyzed, 428 patients fulfilled the inclusion criteria. A propensity-score matching study was conducted to eliminate confounding factors. After 1∶2 propensity match, there were 84 patients in elderly group (≥75 years), age ranged from 75 to 88 years old, with an average of (78.79±3.08) years old, and 168 patients in control group (<75 years), age ranged from 47 to 74 years old, with an average of (64.10±5.96)years old. The follow-up duration of two groups ranged from 12 to 84 months with an average of (29.35±16.52) months in elderly group, and 12 to 85 months with an average of (31.83±17.34) months in control group. There was only significant difference in age between the elderly and control groups preoperatively (P<0.01). Postoperatively, the elderly group showed significantly higher WOMAC (P<0.01) and lower SF-12 PCS scores (P<0.01) as compared to the control group. There was no significant difference between the elderly group and the control group in knee range of motion, OKS and the proportion of each scoring system reaching the minimum clinical difference value (P>0.05). In the aspect of preperative complications, the elderly group exhibited more surgical site complications and postoperative delirium compared to control group(P<0.05). The differences in other indicators including deep vein thrombosis, acute urinary retention, cardiovascular events, cerebrovascular events and radiolucent lines around prothesis were not statistically significant(P>0.05).@*CONCLUSION@#UKA in the treatment of elderly patients over 75 years old with knee osteoarthritis was safe and feasible, and could obtain satisfactory short-term efficacy.

Efficacy and safety comparison between pro-urokinase and reteplase in the treatment of patients with acute ST elevation myocardial infarction / 中华心血管病杂志

Objective: To compare the efficacy and safety of pro-urokinase and reteplase in the treatment of patients with acute ST elevation myocardial infarction (STEMI). Methods: STEMI patients, who received intravenous thrombolytic therapy in Henan STEMI registry between September 2016 and August 2018, were eligible for this study. A total of 5479 patients from 66 hospitals were screened and patients were divided into pro-urokinase group (n=638) and reteplase group (n=702) according to thrombolytic drugs. Data including patient demographics, risk factors, medical histories, patient information at admission, in-hospital treatment, time delays, and clinical events were collected. The clinical recanalization rate, in-hospital mortality, in-hospital death or treatment withdrawal, in-hospital main adverse cardiovascular and cerebrovascular events (MACCE, death or treatment withdrawal, congestive heart failure, reinfarction and ischemic stroke) and post-thrombolysis bleeding were compared between the two groups. Bleeding events were evaluated with Bleeding Academic Research Consortium (BARC) criteria. Results: The median age [61.8 (53.2, 69.0) vs. 62.6 (52.1, 69.8), P=0.833] or the proportion of women [23.0% (147/638) vs. 25.1% (176/702), P=0.385] were similar between the pro-urokinase and reteplase groups. Clinical recanalization rates were similar between the pro-urokinase and reteplase groups [82.1% (524/638) vs. 84.9% (596/702), P=0.172], and there was no difference in the median time from onset to thrombolysis [194.5 (135.0,290.0) min vs. 190 (126.0,292.0) min, P=0.431] and the median recanalization time [95 (67.5,120.0) min vs. 95 (71.0,119.0) min, P=0.561] between the two groups. There was no significant difference in in-hospital mortality [5.5% (35/638) vs. 5.1% (36/702), P =0.770], in-hospital all-cause mortality, treatment withdrawal [8.9% (57/638) vs.7.7% (54/702), P=0.410], and in-hospital MACCE [13.0% (83/638) vs. 10.4% (73/702), P=0.137] between pro-urokinase and reteplase groups. However, the incidence of post-thrombolysis bleeding was significantly higher in reteplase group than in pro-urokinase group [7.8% (55/702) vs. 3.8% (24/638), P=0.002]. Further analysis found that the incidence of oral bleeding and the BARC grades 1-2 bleeding were significantly higher in reteplase group than in pro-urokinase group, whereas the incidence of cerebral hemorrhage was similar between the two groups [0.6% (4/638) vs. 0.4% (3/702), P=0.715]. The comparison of efficacy and safety outcomes between the two groups after adjusting for baseline characteristics using general linear mixed models was consistent with those before the adjustment. There was no significant difference in in-hospital mortality, in-hospital death or treatment withdrawal, in-hospital MACCE after adjusting for baseline characteristics and post-thrombolysis bleeding between the two groups. Conclusions: Pro-urokinase and reteplase have similar clinical efficacy in the treatment of STEMI. In terms of safety, the incidence of cerebral hemorrhage is similar, while the incidence of BARC grades 1-2 bleeding and oral bleeding is higher in reteplase group than in pro-urokinase group, which has no impact on in-hospital outcomes.

Endoscopic combined ultrasound-guided access vs. ultrasound-guided access in endoscopic combined intrarenal surgery / 北京大学学报(医学版)

OBJECTIVE@#To compare the outcomes of endoscopic combined ultrasound-guided access (EUGA) with the conventional ultrasound-guided access (UGA) to achieve percutaneous renal access in endoscopic combined intrarenal surgery (ECIRS).@*METHODS@#A retrospective review of 53 patients undergoing ECIRS to treat upper urinary tract calculi between January 2017 and October 2019 was con-ducted. All of the cases were of complex upper urinary tract stones larger than 2 cm in diameter. The com-plex stone situations, such as multiple renal calyces calculi or staghorn calculi necessitated ECIRS. Under general anesthesia, the patients were placed in the galdakao-modified supine valdivia (GMSV) position, thus allowing both antegrade and retrograde accesss. The patients were divided to UGA and EUGA groups according to the protocol of achieving percutaneous renal access. In 28 cases, endoscopic combined ultrasound-guided accesss were obtained. Puncture and dilation were performed under direct flexible ureteroscopic visualization, while percutaneous renal access of 25 cases were performed with the conventional technique employing ultrasound guidance. Demographic and perioperative information, such as stone burden, presence of hydronephrosis and number of calyces involved was compared. Primary outcomes included total operative time, renal access time, repeat puncture, hemoglobin level, perioperative complications, and stone-free rate.@*RESULTS@#No major intra-operative complication was recorded in all the 53 ECRIS. No significant difference was observed between the groups in age and gender. There was no significant difference in body mass index[BMI (29.21±3.14) kg/m2 vs.(28.53±2.56) kg/m2], stone burden (37.68±6.89) mm vs. (35.53±6.52) mm, number of calyces involved 2.72±0.68 vs. 2.86±0.71, presence of hydronephrosis (56.0% vs. 46.4%), total operative time (93.0±12.2) min vs. (96.8±14.2) min, hemoglobin level reduction (6.56±2.16) g/L vs. 97.54±2.64) g/L, stone-free rate (92.0% vs. 92.8%), hospital stay (5.52±0.59) d vs. (5.64±0.62) d, perioperative complication rate (8.0% vs. 7.2%). Two patients in EUGA group experienced perioperative complications (one urinary tract infection and one hematuria) while two patients in UGA group experienced perioperative urinary tract infection. None in both groups received blood transfusion. The patients undergoing EUGA had shorter renal access time [(4.0±0.7) min vs. (6.8±2.6) min, P < 0.01] and less repeat puncture (0 vs. 4 cases, P < 0.05).@*CONCLUSION@#EUGA is an optimal technique to establish percutaneous renal access in ECIRS, which minimizes access time and repeated procedures.

Clinical outcomes of simultaneous bilateral endoscopic surgery for bilateral upper urinary tract calculi / 北京大学学报(医学版)

OBJECTIVE@#To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience.@*METHODS@#Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications.@*RESULTS@#A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=－2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=－2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=－0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=－0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ).@*CONCLUSION@#The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.

Zero-profile anterior cervical ROI-C cage versus traditional fusion cage combined with titanium plate in treatment of two-level cervical spondylotic myelopathy / 中国组织工程研究

BACKGROUND: Self-locking self-stabilizing zero-profile cage ROI-C is advanced from the traditional titanium plate fusion cage, but the systematic studies on ROI-C internal fixation system applied in the comprehensive evaluation of two-level cervical spondylotic myelopathy are few. OBJECTIVE: To comprehensively evaluate the clinical efficacy of small-incision anterior cervical self-locking self-stabilizing zero-profile cage ROI-C in the treatment of two-level cervical spondylotic myelopathy. METHODS: Fifty-seven patients with two-level cervical spondylotic myelopathy at the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2016 to March 2018 were selected, including 30 males and 27 females, aged 34-77 years old. Of which, 33 patients underwent small-incision anterior cervical self-locking self-stabilizing zero-profile fusion cage ROI-C implantation (observation group), and another 24 patients received small-incision cervical anterior titanium internal fixation (control group). The JOA score, Neck Disability Index, Odom criteria, Visual Analogue Scale score, dysphagia degree, Cobb angle of cervical lordosis, angle of fusion segment, and disc height and cervical fusion rate were assessed at 2 weeks and 1, 3, 6, and 12 months after surgery. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangdong Pharmaceutical University. RESULTS AND CONCLUSION: (1) There was no significant difference in the Odoms criteria between two groups (P > 0.05). All 57 patients were followed up for 12 months after surgery. No internal fixation loosening or vertebral structure changes were found. No complications such as loosen and broken of titanium plate occurred. (2) Postoperative JOA score, Neck Disability Index, and Visual Analogue Scale in the two groups were significantly improved compared with those before surgery (P 0.05). (3) The incidence of dysphagia at 2 weeks and 1 month in the observation group was significantly lower than that in the control group (P 0.05). (4) The Cobb angle of cervical lordosis, angle of fusion segment, and disc height were significantly improved in both groups after surgery (P 0.05). (5) The cervical fusion rate at the last follow-up in both groups was > 95%, and the fusion effect was good. There was no significant difference in the fusion rate at different time points between two groups (P > 0.05). (6) These results indicate that the small-incision anterior cervical self-locking self-stabilizing Zero-profile interbody fusion ROI-C and anterior titanium plate internal fixation exert significant effects in the treatment of two-level cervical spondylotic myelopathy. However, ROI-C can reduce the incidence of postoperative dysphagia.

Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi.</p><p><b>METHODS</b>A retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls.</p><p><b>RESULTS</b>Puncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P> 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P< 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P< 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12/12).</p><p><b>CONCLUSION</b>Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.</p>

Biomechanical comparison between resurfacing hip arthroplasty and normal proximal femur / 医用生物力学

Objective To investigate the variation of stress distributions on proximal femur after hip resurfacing arthroplasty (HRA) by using three-dimensional (3D) finite element method. Methods The 3D finite element model of proximal femur was reconstructed based on 64-slice spiral CT scan image data. Both the stress distributions on proximal femur after metal-on-metal HRA and normal proximal femur were studied, so as to analyze the biomechanical environment changes after HRA. Results After HRA, the superior, anterior, rear and inferior area of the proximal femoral head showed significant stress shielding, with peak stress of 0.60, 0.57, 0.66, 0.79 MPa, respectively, and stress shielding rate of 99.80%, 99.16%, 98.92%, 96.66%, respectively. Increased stress occurred in most regions of the distal femoral head, while stress shielding appeared only in rear area of the distal femoral head, with stress shielding rate of 4.92%. Increased stress occurred in anterior region of the proximal femoral neck, while stress shielding appeared in the superior, inferior and rear area of the proximal femoral neck, with shielding rate of 16.48%, 22.75% and 7.83%, respectively. Increased stress also occurred in inferior area of the distal femoral neck, while the remaining area showed stress shielding. The stress in greater trochanter increased by 9.22%, and the stress shielding rate for lesser trochanter area and basal area of femoral neck were 2.49% and 14.44%, respectively. Conclusions Stress distributions on most regions of proximal femur after HRA were similar to that on normal femur, and the stress transfer was close to physiological status, which could effectively avoid obvious stress shielding in proximal femur and preserve bone mass, which could contribute to normal physiological activity of patients.

Evaluation of early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures in young patients.</p><p><b>METHODS</b>From June 2008 to June 2010,24 patients with femoral head necrosis caused by failed internal fixation were treated with hip arthroplasty. Among them, 12 patients were male and 12 patients were female, with an average age of 42.9 years old (ranged, 18 to 58). According to Harris score and X-ray examination, the clinical result was evaluated.</p><p><b>RESULTS</b>Twenty-three cases were followed up with an average age of 34.4 months (ranged, 25 to 48). After operation, 1 case complicated with the dislocation of hip joint. No deep infection of hip joint, prosthetic loosing or peripheral fracture was found. The mean Harris score was 90.9 +/- 4.3, and 18 obtained excellent results, 4 good and 1 fair.</p><p><b>CONCLUSION</b>Although treatment of femoral head necrosis with two stage hip replacement after failed internal fixation is difficult during operation, its early result is satisfactory.</p>

A single institution experience using the LigaSure vessel sealing system in laparoscopic nephrectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Vascular control and tissue dissection are crucial steps in successful laparoscopic surgery. Recently, a new commercially available vessel sealing technology, the LigaSure vessel sealing system (Valleylab, Boulder, USA), has been introduced. The aim of the present study was to evaluate the benefits of the LigaSure in laparoscopic nephrectomy.</p><p><b>METHODS</b>From January 2005 to March 2010, 170 laparoscopic nephrectomies were performed with the LigaSure vessel sealing system, including simple and radical nephrectomy and nephroureterectomy. In a retrospective study, the laparoscopic operating time, estimated intraoperative blood loss, duration of postoperative drainage, total amount of postoperative drainage, as well as postoperative hospital stay, were recorded and studied.</p><p><b>RESULTS</b>All 170 laparoscopic nephrectomies using LigaSure were accomplished successfully without conversion to open surgery. There was no severe vascular complication or other serious complications. The mean laparoscopic operating time was 124.2 minutes (range, 14 - 230 minutes); mean blood loss was 148.6 ml (range, 20 - 540 ml); mean time for postoperative drainage was 3.1 days (range, 1 - 7 days); mean amount of postoperative drainage was 206.5 ml (range, 27 - 435 ml) and mean postoperative hospital stay was 6.9 days (range, 3 - 18 days).</p><p><b>CONCLUSIONS</b>Laparoscopic nephrectomy using LigaSure appears technically feasible and easy, and produces satisfactory results. The LigaSure provides a safe and fast way to seal vessels and tissue bundles during nephrectomy.</p>

Using exploratory spatial data analysis(ESDA)on the regional distribution of human brucellosis in six provinces of north China: 2004-2007 / 中华流行病学杂志

Based on data related to human brucellosis which was collected from the national notifiable infectious disease reporting system in the 6 provinces(Inner Mongolia,Shanxi,Heilongjiang,Shaanxi,Jilin and Liaoning)of north China from 2004 to 2007,at the county scale.Data would include age and gender standardized mortality ratios(SMRs)while ESDA was including histograms,box plots and box maps,global and local Moran' s I statistics,etc.The global Moran' s I values from 2004 to 2007 were 0.2581,0.4574,0.4457,0.4841,respectively and all with statistically significant differences.Most of local Moran' s I values were significant positive statistically.High-high counties were mainly in the northeast,most of which were pastoral areas,but the farming-pastoral areas and agricultural areas/town had an increasing trend over time.Low-low counties were mainly in the western and southern areas and most of which were agricultural areas/towns.Low-high counties appeared to be rare,mainly around the counties with high incidence,mainly belonged to agricultural areas/towns.The incidence rates of brucellosis in the six provinces of north China had a trend of increase from 2004 to 2007,namely spreading from east to west,from south to north,and from pastoral areas to farming-pastoral areas and agricultural areas/towns.ESDA could be used to develop effective measures for prevention and control of brucellosis.

Short-term result of hip resurfacing arthroplasty in the treatment of patients with femoral head necrosis / 中国骨伤

<p><b>OBJECTIVE</b>To study short-term results of hip resurfacing arthroplasty (HRA) in the treatment of patients with avascular necrosis of femoral head (ANFH), and to explore indication and strategy in this surgery.</p><p><b>METHODS</b>From December 2006 to December 2009, 37 patients (43 hips) with avascular necrosis of femoral head were treated with total hip resurfacing arthroplasty. Among the patients, 25 patients were male and 12 patients were female, with an average age of 44.5 years (ranged, 21 to 67 years). According to ARCO classification, 3 hips were 3A stage, 6 hips were 3B stage, 16 hips were 3C stage and 18 hips were 4 stage. X-ray evaluation of the patients were conducted. The clinical results were evaluated by the Harris hip score system including pain,range of motion, correction of deformity and total function.</p><p><b>RESULTS</b>Thirty-four patients (40 hips) were followed up with an average period of 32.4 months (ranged, 16 to 53 months), and 3 patients were lost. Thirty-seven hips got complete relief of joint pain and 3 patients feel aching pain after walking. There was 1 heterotopic ossification, no femoral neck fracture no dislocation, no infection and no revision in all patients. From pre-operation to present, the average Harris hip score improved significantly from (51.5 +/- 1.7) to (94.3 +/- 1.4). Thirty-seven hips got an excellent result, 3 hips good and no poor.</p><p><b>CONCLUSION</b>The total hip resurfacing arthroplasty is an effective solution for the problems of the younger and active patients with ANFH, and the short-term results are satisfying.</p>

Case-control study on acute colonic pseudo-obstruction after total hip or knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the incidence, predisposing factors and therapeutic modalities of acute colonic pseudo-obstruction (ACPO) in patients after total hip arthroplasties (THA) and total knee arthroplasties (TKA).</p><p><b>METHODS</b>From January 2006 to December 2009, 12 patients with ACPO after THA and TKA operation were investigated retrospectively,who were viewed as the ACPO group. There were 10 males and 2 females with an average age of (78 +/- 12) years in the ACPO group. Other 853 patients without ACPO after THA and TKA operation were viewed as the control group treated at the same period. The incidence of ACPO was calculated. The clinical data were collected and compared between the two groups including patient age, gender, procedure, anesthetic class, clinical presentation, radiographic findings, duration from index surgery to diagnosis of ACPO, treatment, postoperative mobilization time, and length of hospital stay.</p><p><b>RESULTS</b>The incidence of ACPO was 1.4%. The incidence of primary THA (1.3%) was higher than that of primary TKA (0.4%); the incidence of hip and knee revisions (5.0%) was higher than that of primary THA and TKA (1.0%); there was no difference in incidence between hip revisions (5.5%) and knee revisions (4.0%). The mean age was (78 +/- 12) years old in ACPO group and (71 +/- 13) in the control group. The male/female ratio was 5:1 in ACPO group and 2:3 in control group. There were statistical differences in mean age and gender ratio between the two groups. No association was found with respect to anesthetic class. On average, ACPO occurred at 2.5 days after index surgery. The abdominal distention occurred in all 12 cases, nausea or vomiting in 8 cases and abdominal pain in 3 cases. Radiographically cecal dilation occurred in all cases and intestinal dilation in 3 cases. All patients initially were treated conservatively with immediate cessation of oral intake,a nasogastric tube and oral mineral oil. Three patients received a rectal tube. Only 1 patient required endoscopic decompression. There were no deaths after ACPO in the series. Mean mobilization time after surgery averaged (5.0 +/- 2.2) days in ACPO group compared with (2.5 +/- 1.1) days in the control group. Mean hospital stay averaged (16.5 +/- 6.4) days in ACPO group compared with (10.5 +/- 4.5) days in the control group. There were statistical differences in mean mobilization time after surgery and mean hospital stay between two groups.</p><p><b>CONCLUSION</b>ACPO mainly happened in old male patients. The majority cases response to conservative treatment and their prognoses are good. But ACPO will delay mobilization time after surgery and increase hospital stay.</p>

Comparison of humeral head replacement and internal fixation for the treatment of 3 parts and 4 parts fractures of proximal humerus in the elderly / 中国骨伤

<p><b>OBJECTIVES</b>To compare the indication, technical keys during surgery and early results of humeral head replacement and internal fixation for the 3 parts and 4 parts fractures of proximal humerus in the elderly.</p><p><b>METHODS</b>From July. 2004 to July. 2006,58 patients with 3 parts and 4 parts fractures of proximal humerus were randomly treated with AO locked compressive plates (LCP) or humeral head replacement. In LCP group, there were 12 males and 16 females with an average age of (66.5 +/- 1.4) years, including 24 cases of 3 parts fractures, 1 case of 3 parts fractures with dislocation, 2 cases of 4 parts fractures and 1 case of 4 parts fractures with dislocation. In the humeral head replacement group,there were 12 males and 18 females with an average age of (68.9 +/- 3.5) years, including 9 cases of 3 parts fractures, 2 cases of 3 parts fractures with dislocation, 12 cases of 4 parts fractures, 4 cases of 4 parts fractures with dislocation and 3 cases of humeral head split fractures. Trauma series X-rays of shoulder were taken after operation, 2-week, 6-week, 10-week, 16-week, 6-month and the latest followed-up. VAS, SST (simple shoulder test) questionnaire, ASES (American shoulder & elbow surgeon)score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest followed-up.</p><p><b>RESULTS</b>The mean followed-up period of LCP group was 29.8 months and that of humeral head replacement group was 28.2 months. VAS of LCP group and humeral head replacement group were (2.2 +/- 1.5) and (2.6 +/- 1.9), respectively. There was a statisticaly difference between the two groups (P = 0.002). The degrees of forward elevation of shoulder in LCP group and humeral head replacement group were 110.2 degrees (81 degrees to 130 degrees) and 120.2 degrees (89 degrees to 140 degrees), respectively. There was a statistical difference between the two groups (P = 0.031). ASES score, Constant-Murley score, UCLA score and response "yes" in SST questionnaire in LCP group were 87.7 +/- 2.2, 83.9 +/- 6.8, 30.3 +/- 2.2, 8.0 +/- 0.9, and in humeral head replacement group were 86.4 +/- 4.5, 85.5 +/- 5.6, 31.2 +/- 2.1, 9.0 +/- 0.7, respectively. There was no significant difference between the two groups in ASES score, Constant-Murley score, UCLA score and SST questionnaire.</p><p><b>CONCLUSION</b>Both humeral head replacement and internal fixation are effective treatment for the 3 parts and 4 parts fracture of proximal humerus in the elderly. Humeral head replacement is more technically demanding and has a strict indications. The satisfactory results of humeral head replacement are based on the suitable placement of prostheses and the correct reconstruction of rotator cuff insertion.</p>

Natural progression of early esophageal squamous cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The survival time of untreated advanced esophageal squamous cell carcinoma is about 8 - 9 months. The objective of this study was to observe the natural progression of untreated early esophageal squamous cell carcinoma for 20 years.</p><p><b>METHODS</b>4800 subjects from a high risk area of esophageal cancer in Lin-zhou city, Henan province, were examined by endoscopy from 1985 to 1990. Among them, 132 cases were diagnosed as early esophageal cancer. Based on the criteria, the lesions were endoscopically diagnosed as superficial mucosal lesions and histopathologically confirmed by biopsy as carcinoma in situ, intramucosal carcinoma or squamous cell carcinoma. 48 of the 132 patients, who refused treatment, were followed up to the end of 2005. There were 43 death and 5 alive. 40 patients were re-examined for 1 - 4 times by endoscopy during the following up.</p><p><b>RESULTS</b>A total of 48 patients have been followed up for 20 years. 38 (79.2%) cases died of esophageal squamous cell carcinoma, 5 (10.4%) died of non-cancer diseases and 5 (10.4%) were surviving. 37 patients had survived for over 5 years. The 5-, 10-, 15- and 20-years survival rates were 77.1%, 39.6%, 25.0% and 10.4%, respectively.</p><p><b>CONCLUSION</b>The natural history of esophageal squamous cell carcinoma takes a long time to progress from early to advanced stage. It is very helpful for early diagnosis and selection of opportunity for treatment. The leading time bias by natural history of this disease should be considered when evaluate therapeutic effect on early stage esophageal cancer.</p>

Strategy of prevention and management of intraoperative fractures of acetabulum during primary total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To analyse the causes and resultes of intraoperative occurrence of an acetabular fracture in primary total hip arthroplasty and discuss propriate prevention and treatment of this problem.</p><p><b>METHODS</b>Between July 2004 and December 2006, 326 primary total hip arthroplasties were retrospectively reviewed and found that eleven patients (eleven hips) had sustained an intraoperative acetabular fracture involving 7 male and 4 female,aged from 37 to 71 years (mean 54 years). Analyzed the causes of fractures, the anatomic location, treatment and outcome of the fractures. Acetabular component designs were categorized and each design was analyzed for fracture risk.</p><p><b>RESULTS</b>Among 11 cases, the fractures occurrenced as setting the prosthesis in 6 cases, grinding and drilling in 3 cases, drawning hook in 2 cases. There were 5 cases of central type fracture, 3 of posterior-wall, 2 of anterior, 1 of posterior-upper. Nine of these patients (nine hips) had been followed-up for 12 to 29 months(mean 18 months). There were no heterotopic ossification, no dislocation, no deep venous embolism. All fractures were healing.</p><p><b>CONCLUSION</b>Acetabular fracture during primary total hip arthroplasty is a complication of acetabular fixation without cement, which should be think highly of. In the present series, retention of a stable cup is associated with uneventful osseous in growth and excellent early-term outcomes.</p>

Training model construction and education reform exploration of eight-year medical education / 上海第二医科大学学报

Objective To construct and implement the training model of eight-year medical education with characteristics of Shanghai Jiaotong University. Methods Based on survey,discussion and consultation,the experiences of long schooling medical education in Shanghai Jiaotong University School of Medicine were summarized.Training plan and education reform scheme were established. Results Training objective,guideline and major reform measures had been clarified.The training plan and reform scheme were under process of implementation. Conclusion The training objective of eight-year medical education should be further confirmed.The curriculum should be in accordance with the training objective,and education reform is important and necessary for the eight-year medical education.

Vector-mediated shRNA inhibits HIF-1alpha expression in prostate cancer cells / 中华男科学杂志

<p><b>OBJECTIVE</b>To construct a short hairpin RNA (shRNA) vector of the hypoxia inducible factor-1alpha (HIF-1alpha), determine its inhibitory effect on the expression of the HIF-1alpha gene in PC-3M cells, and investigate its application prospects in the treatment of prostate cancer.</p><p><b>METHODS</b>We designed and synthesized the shRNA template sequence specific against HIF-lalpha, inserted it into the vector psilencer 2.1-U6 to generate the plasmid psilencer-HIF, transfected the recombinant plasmid into prostate cancer cell line PC-3M cells and detected the transfection efficiency by cotransfection with the pEGFP vector as well as the expression of HIF-1alpha by RT-PCR and Western blot.</p><p><b>RESULTS</b>The DNA sequencing analysis showed a complete consistency of the recombinant plasmid psilencer-HIF with the design. Twenty-four hours after the transfection, the rate of transfected plasmid was about (89.26 +/- 4.72)% and the vector-mediated shRNA induced RNA interference (RNAi), while 48 hours transfection reduced the HIF-1alpha mRNA and protein levels by 82.09% and 81.61% respectively (P < 0.01) in PC-3M cells.</p><p><b>CONCLUSION</b>The shRNA vector was successfully constructed, which can effectively suppress the expression of HIF-1alpha in prostate cancer cells.</p>

Diagnosis and long-term results of surgical resection of early cardiac adenocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize therapeutic experience and the long-term results of early cardiac adenocarcinoma with surgical resection.</p><p><b>METHODS</b>Ninety cases were diagnosed with early cardiac adenocarcinoma during endoscopic screening in high incidence rate area of esophageal cancer from 1972 to 1997. All of the patients accepted surgical treatment. Cardiectomy included partial stomach and esophagus was performed through left thoracotomy in all patients. Esophagogastrostomy was carried out in the infra-aortic region and thoracoabdominal lymphatic dissection was performed in all cases.</p><p><b>RESULTS</b>The resection rate was 100%. One patient died in one month after the operation. Postoperative complications occurred in 4 cases (4.4%). Pathological examination of cancer specimens showed that 46 cases (51.1%) were intramucosal carcinoma without lymphatic metastasis and 44 cases (48.9%) were submucous infiltrating carcinoma with lymphatic metastasis in 5 (11.4%). The patients were followed-up to 2002, and the overall 5, 10, 15, 20 and 25 year survival rates were 91.9%, 83.6%, 69.6%, 49.8% and 16.6%, respectively.</p><p><b>CONCLUSIONS</b>Early diagnosis and early treatment may be the best approach for promoting the survival of the cardiac cancer. Surgical resection of early cardiac carcinoma provides excellent long-term survival.</p>