[Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty].

OBJECTIVE: To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty. METHODS: A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact. EXCLUSION CRITERIA: combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes < 3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed. RESULTS: Gender(P=0.346), operative side (P=0.619), age (P=0.746), BMI (P=0.142), preoperative ROM (P=0.102), preoperative knee pain score (P=0.131) and functional score (P=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA < 84 ° (P= 0.018, OR= 3.712, 95%CI: 1.250-11.027), preoperative Noyes > 5°(P=0.000, OR= 3.105, 95%CI: 1.835-5.254), preoperative FD > 5° (P= 0.001, OR=1.976, 95%CI: 1.326-3.234). Pre-operative LDFA (P=0.146) and preoperative JLCA (P= 0.709) had no significant effect on postoperative kinematic line. CONCLUSION: Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

[Effect of preoperative Nutritional Risk Screening-2002 combined with hematologic inflammatory markers on prognosis of thoracic esophageal squamous cell carcinoma].

Objective: To evaluate preoperative nutritional status and inflammatory status by Nutritional Risk Screening-2002 (NRS-2002) and hematologic inflammatory markers in patients with thoracic esophageal squamous cell carcinoma (ESCC), and to explore their effects on long-term survival prognosis. Methods: A total of 113 patients with thoracic ESCC treated by radical resection were grouped for further analysis according to preoperative NRS-2002 score, systemic inflammation score (SIS) and the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (CNP) score. The progression free survival (PFS) and overall survival (OS) between groups were compared. Multivariate Cox regression analysis was used to determine the independent prognostic factors of patients with thoracic esophageal squamous cell carcinoma, and the interaction analysis of statistically significant factors was carried out. Results: The median PFS was 21 months for all the patients. The 1-year, 3-year and 5-year PFS rates were 69.0%, 25.7% and 23.1%, respectively. Correspondingly, the median OS was 36 months, and the 1-year, 3-year and 5-year OS rates were 95.6%, 46.2% and 29.2%, respectively. Cox univariate analysis showed that T stage, N stage, TNM stage, SIS, CNP score and NRS-2002 score were significantly associated with PFS and OS (all P<0.05), and sex was associated with PFS (P=0.032) in patients with thoracic ESCC. Furthermore, cox multivariate analysis showed that TNM stage (HR=1.570, P=0.039), NRS-2002 score (HR=2.706, P<0.001) and CNP score (HR=1.463, P=0.011) were independent prognosis factors of PFS in patients with thoracic ESCC. In cox model interaction analysis, there was a positive interaction between NRS-2002 score and CNP score (RR=2.789, P<0.001). Conclusion: Preoperative NRS-2002 score combined with CNP score are risk factors for prognosis of patients with thoracic ESCC, which can be used as prognostic indicators.

[Prognostic analysis of colon and rectal neuroendocrine neoplasm in different stages].

Objective: To explore the survival difference of patients with colon and rectal neuroendocrine neoplasm (NEN) at different stages. Methods: We identified 8 679 patients with colorectal NEN diagnosed between 1988 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) registry, including 5 437 rectal NEN and 3 242 colon NEN ( 1 681 cecum NEN ). Survival curve was drawn by Kaplan-Meier method. Prognostic factors were analyzed by univariate analysis and multivariate Cox regression model. Results: The ratio of male patients with colon and rectal NEN was similar to female (P=0.095). Rectal NEN patients were younger (P<0.001), more highly differentiated (P<0.001), and with earlier stage (P<0.001). Survival analysis showed that the survival of rectal NEN was superior to that of colon NEN, with 10-year tumor-specific survival rates of 86.8% and 44.8% respectively (P<0.001). Multivariate Cox analysis showed that age, gender, marital status, primary tumor site, grade, stage and surgery were independent prognostic factors of colorectal NEN (all P<0.01). The most important factor was stage (HR=3.531), followed by differentiation grade (HR=1.856). Stratified analysis displayed that the survival of rectal NEN in stage Ⅰ, Ⅱ and Ⅳ were better than those of corresponding stage of colon NEN (all P<0.05), but worse in stage Ⅲ (P=0.012). While the survival of rectal NEN were significantly better than those of colon NEN within all stages after excluding 1681 cases of cecal NEN (all P<0.05). Among the patients with well-differentiated NEN, the survival of rectal NEN in stage Ⅰ, Ⅲ and Ⅳ were better than those of corresponding stage of colon NEN (all P<0.05) while there was no significant difference in stage Ⅱ(P=0.169). For poor-differentiated NEN, only the survival of rectal NEN patients in stage Ⅳ (P=0.001) was significant longer than those of colon NEN, while there was no significant difference in stage Ⅰ, Ⅱ and Ⅲ (stage Ⅰ: P=0.760; stage Ⅱ: P=0.181; stage Ⅲ: P=0.313). Conclusions: The survival of NEN patients in colon and rectum is different. Cecum NEN should be considered as a separated tumor for prognostic analysis due to its special clinicopathologic characteristics.

[Prognostic influence of preoperative Nutritional Risk Screening -2002 (NRS-2002) score for patients with thoracic esophageal squamous cell carcinoma receiving surgery].

Objective: To apply Nutritional Risk Screening-2002(NRS-2002) to perform nutritional status score for the patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving surgery, and to explore the prognostic impact of long-term survival. Methods: A total of 117 patients who were diagnosed with ESCC from 2010 to 2012 were retrospectively analyzed. They recieved standard curative esophagectomy in the Yangzhou University Affiliated Taixing People's Hospital. The nutritional status and risk score for recruited patients were assessed according to the standard of NRS-2002 tool prior to surgery, and these patients were grouped for further analysis according to the median values of NRS-2002 score. Finally, the relationship between NRS-2002 score and prognosis was analyzed. Results: Patients were classified into two groups, with 45 in the NRS-2002<2.0 group, and 72 cases in the NRS-2002≥2.0, respectively. In the NRS-2002<2.0 group, the 1-, 3-, and 5-year progression-free survival (PFS) rates were 75.6%, 44.4% and 40.0% separately, while in the NRS-2002≥2.0 group, the PFS rates were 61.1%, 6.9% and 4.2% respectively, and the differences were statistically significant (P<0.001). Correspondingly, in the NRS-2002< 2.0 group, the 1-, 3-, and 5-year overall survival (OS) rates were 97.8%, 66.7% and 57.8% separately, while in the NRS-2002≥2.0 group, the OS rates were 91.7%, 33.3% and 16.7% respectively, and the differences were also statistically significant (P<0.001). Univariate analysis showed that N stage, TNM stage and NRS-2002 score were closely related to PFS and OS (P<0.05), and T stage was only associated with OS in patients with thoracic esophageal squamous cell carcinoma (P<0.05). Furthermore, multivariate Cox regression analysis showed that N stage (RR=1.640, 95% CI 1.049-2.565, P=0.030) and NRS-2002 (RR=3.154, 95% CI 1.946-5.113, P<0.001) were independent prognostic factors for PFS in patients with ESCC after surgery. Additionally, pathological differentiation (RR=1.556, 95% CI 1.004-2.440, P=0.041), N stage (RR=1.624, 95% CI 1.017-2.593, P=0.042) and NRS-2002 (RR=3.906, 95% CI2.245-6.795, P<0.001) were independent prognostic factors for OS in ESCC patients following surgery. Conclusion: Preoperative nutritional risk screening NRS-2002 score is an independent prognostic factor in patients with ESCC receiving surgery and could be used as a tool for primary screening for nutritional risk.

[Simultaneous Quantitative Analysis of Koumine, Gelsemine and Gelsenicine in Biological Samples by LC-MS/MS].

OBJECTIVES: To establish a LC-MS/MS method which is accurate and sensitive for determination of koumine, gelsemine, and gelsenicine in biological samples and to verify the method. METHODS: Strychnine was used as internal standard. Analytes in blood, urine and liver with 1% sodium hydroxide solution were extracted by ethyl acetate. Chromatographic separation was achieved on a ZORBAX SB-C18 column （150 mm×2.1 mm, 5 µm）, and gradient elution was performed with the buffer solution of methanol-20 mmol/L ammonium acetate （including 0.1% formic acid and 5% acetonitrile） as mobile phase. Qualitative and quantitative analysis was performed in the multiple reaction monitoring mode coupled with an electrospray ionization source under positive ion mode（ESI⁺）. RESULTS: The linearity of koumine, gelsemine and gelsenicine in blood, urine and liver was good within corresponding linear limitation and the correlation coefficients （r）>0.995 0. The limits of detection were 0.1 ng/mL （0.1 ng/g）, 0.1 ng/mL （0.1 ng/g） and 0.01 ng/mL （0.01 ng/g）, respectively. The extraction recovery and accuracy of the alkaloids ranged from 61.9% to 114.6% and 92.4% to 114.3%, respectively. The relative standard deviations of the intra-day and inter-day precisions were not more than 11.0%. CONCLUSIONS: The method is selective, sensitive and suitable for simultaneous determination of koumine, gelsemine and gelsenicine in body fluids and tissues, which offering technical support for clinical diagnosis and treatment and forensic toxicological analysis of Gelsemium elegans poisoning.

Combined treatment of minimally invasive 23-G vitrectomy and chandelier for superior bullous rhegmatogenous retinal detachment.

OBJECTIVE: To investigate the clinical efficacy of minimally invasive 23G vitrectomy combined with chandelier for the treatment of superior bullous rhegmatogenous retinal detachment (SBRRD). PATIENTS AND METHODS: A retrospective case series study of 50 patients with SBRRD was conducted. Each of these patients received minimally invasive 23G vitrectomy in one of their eye. A trocar was indwelled with two-step 23-G incision, and the chandelier was inserted in the inferior 6 o'clock pars plana. The tear was closed with 23-G vitrectomy combined with endolaser photocoagulation and infused with perfluoropropane (C3F8) under non-contact wide-angle lens. Postoperative follow-up ranged from 5-49 months (mean 23.9±1.3 months). Intraoperative and postoperative complications, postoperative conjunctival hyperemia, eye irritation signs and inflammation reactions, retinal anatomic reduction rate, best corrected visual acuity (BCVA) and intraocular pressure (IOP) changes were analyzed. RESULTS: The intraoperative scleral incision leakage required 17 sutures (34%). No complications, such as iatrogenic retinal breaks and hemorrhage occurred. The postoperative conjunctival hyperemia, eye irritation signs and inflammation reactions were mild. Transient low IOP occurred in one eye (2%) on the first day postoperatively and recovered on the next day. Transient low IOP occurred in eyes of 16 subjects (32%) and recovered after lowering IOP therapy within an average of 4 days. No complications, such as hemorrhage, effusion, choroidal detachment and endophthalmitis were observed. Forty-nine subjects (98%) had retinal reattachment in their eyes after a single surgery, and 100% eyes showed final retinal reattachment. The preoperative and postoperative BCVAs were 4.61±0.19 and 4.70±0.19, respectively, in 8 patients without detached macula, and the difference was not statistically significant (t = 2.20, p >0.05). CONCLUSIONS: Minimally invasive 23G vitrectomy combined with chandelier is a safe and effective surgical approach for the treatment of SBRRD.

Application of minimally invasive 23G vitrectomy via corneal approach for the treatment of pediatric cataract.

OBJECTIVES: To determine the curative effect and complications of 23G vitrectomy via corneal approach for the treatment of pediatric cataract. MATERIALS AND METHODS: We performed anterior circular capsulotomy, lentectomy and aspiration, posterior circular capsulotomy, and anterior vitrectomy via corneal approach in 40 eyes from 25 children with congenital cataract. In patients aged > 2 years, foldable intraocular lens (IOL) was implanted and frame glasses were prescribed at younger age. The intraoperative/postoperative complications, comfort level, and inflammatory reaction after surgery were observed. RESULTS: No intraoperative complications occurred and 9 eyes were simultaneously implanted IOL. All patients could blink normally except one child who suffered from corneal epithelial abrasion for one day. All corneas were clear and only mild postoperative inflammation was observed. There was no hyphema, effusion, hypotony, and hypertension. A week later, the mild congestion also disappeared. All parents reported good vision of their babies allowing them free play during 3-50 months follow-up. This surgical technique provided a clear 4-6 mm diameter visual axis and circular pupil in all cases. The IOL positions were centered at the pupil area. No secondary cataract developed. CONCLUSIONS: The 23-gauge vitrectomy via corneal approach for the treatment of pediatric cataract involves only mild discomfort and fewer complications.

The normal centre-edge angle of Wiberg in the Chinese population: a population-based cross-sectional study.

This study was designed to provide normal reference values for the centre-edge angle of Wiberg in the Chinese population by measuring 1494 radiographs according to the criteria of Tönnis. The mean angle was 23.1 degrees (4.7 degrees to 46.4 degrees) in childhood (four to nine years), increasing to 28.9 degrees (6 degrees to 48 degrees) in adolescence (10 to 18 years) and reaching 32.8 degrees (13.7 degrees to 58.8 degrees) in adults. The angle was positively correlated with age, increasing by a mean of 0.78 degrees annually before adulthood and by 0.070 degrees annually in adults. A relative upward tendency after middle age might contribute to degenerative changes. No gender difference was discovered. The change in the angle with age was similar to that observed in other ethnic groups, showing moderate differences in the average of individual age groups, but the ethnic differences are not sufficient to explain the variation of incidence of developmental dysplasia of the hip in different races.

Antioxidative effects of astaxanthin against nitric oxide-induced oxidative stress on cell viability and gene expression in bovine oviduct epithelial cell and the developmental competence of bovine IVM/IVF embryos.

The aim of the present study was to elucidate the fundamental mechanism of bovine oviduct epithelial cell (BOEC) co-culture on developmental capacity of bovine in vitro oocyte maturation/in vitro fertilization (IVM/IVF) embryos. We examined the effects of astaxanthin against nitric oxide-induced oxidative stress on cell viability by MTT assay, lipid peroxidation (LPO) by using thiobarbituric acid (TBA) reaction for malondialdehyde (MDA) and the expression of antioxidant genes (CuZnSOD, MnSOD and Catalase) or apoptosis genes (Bcl-2, Caspase-3 and Bax) by RT-PCR in BOEC. We also evaluated the developmental rates of bovine IVM/IVF embryos co-cultured with BOEC pre-treated with astaxanthin (500 µM) in the presence or absence of sodium nitroprusside (SNP, 1000 µM) for 24 h. Cell viability in BOEC treated with SNP (50-2000 µM) lowered, while astaxanthin addition (50-500 µM) increased it in a dose-dependent manner. Cell viability in astaxanthin plus SNP (1000 µM) gradually recovered according to the increase in astaxanthin additions (100-500 mM). The LPO in astaxanthin group (50-500 µM) gradually decreased in a dose dependent manner and among SNP or astaxanthin plus SNP group, SNP alone and astaxanthin (50 µM) plus SNP shown a significant increase than other groups (p < 0.05). Expression of apoptosis or antioxidant genes was detected by RT-PCR. Bcl-2 and antioxidant genes were detected in astaxanthin or astaxanthin plus SNP group, and Caspase-3 and Bax genes were only found in SNP group. When bovine IVM/IVF embryos were cultured for 6-7 days under co-culture system such as BOEC treated with astaxanthin in the presence or absence of SNP, the developmental ability to blastocysts in 500 µM astaxanthin group was the highest of all groups. These results suggest that astaxanthin has a antioxidative effect on cell viability and LPO of BOEC, and development of bovine IVM/IVF embryos due to the induction of antioxidant genes and suppression of apoptosis genes.

Racial residential segregation and the concentration of low- and high-income households in the 45 largest U.S. metropolitan areas.

"The objectives of this paper are to determine the relationship between racial residential segregation and (1) the spatial concentration of low- and high-income households, and (2) the socioeconomic characteristics of racial minority households. The three largest racial minority groups are compared (blacks, Hispanics, and Asians) in the largest 45 metropolitan areas in the United States. Data were obtained from the U.S. bureau of the Census' Population and Housing Summary Tape files. The results revealed that residential segregation of blacks was distinctly different from Asians and Hispanics. Moreover, for Asians and Hispanics, their socioeconomic characteristics matter in their level of residential segregation. For black households, however, their socioeconomic characteristics matter little."

[Clinical and pathological changes of ischemic necrosis of the femoral head in children].

A total of 54 cases (73 hips) with ischemic necrosis of the femoral head after treatment of CDH have been followed up with an average of 7 years. We found that 89% cases of type I and 70% of type II recovered to normal and 83% cases of type III and IV developed the coxa breva deformity due to injury of longitudinal growth plate of the proximal end of the femur. According to the value of ATD, the coxa breva was divided into three types. The L shape growth disturbance line revealed by X-ray is considered as a marker for determination of early epiphyseal plate injury by the authors.

Intramedullary pressure changes in proximal femur before and after treatment of congenital dislocation of the hip. Evaluation of the development of the femoral head.

Thirty-four hips were observed radiographically to see the development of the femoral head. The intramedullary pressure was measured in the proximal femur before and after treatment of congenital dislocation of the hips. The intramedullary pressure in the avascular femoral head decreased more obviously than that in the normal head after treatment. A term of "IMP subtraction value" was put forward as an objective index for evaluating the development of the femoral head after treatment of congenital dislocation of the hip.

Intramedullary pressure in the proximal femur before and after treatment of congenital dislocation of the hip in children.

Intramedullary pressure in the proximal femur was measured before and after treatment of congenital dislocation of the hip. The intramedullary pressure before treatment was higher than that of the control group, and after treatment it was lower as a whole; in the close reduction group the pressure decreased as compared with the operation group. In 8 hips, stress test yielded negative results. These findings suggested the characteristics of arterial blockage may be that the potential cause of avascular necrosis of the femoral head after treatment of congenital dislocation of the hip.