2012年 · 第125卷第22期

In the past decades,orthopedic sports medicine has witnessed a dramatic growth in China,mainly attributed to the rapid development of molecular biology,biomechanics,transplantation biology,medical imaging,rehabilitation and minimally invasive surgery,including the introduction of advanced techniques and instruments.Development in diagnosis,treatment and rehabilitation of sports injuries has greatly improved the clinical outcomes and patients'life quality,and made incomparable contribution to the development of Chinese Olympians and promotion of nationwide sports。

With the advancement of China's social progress and economic growth,and consequent development of international academic exchanges in orthopaedic traumatology,along with many other related professions,the discipline in China has made considerable progress over the past few decades and continues to develop rapidly。

INTRODUCTION Ever since there was human life,the frequency and impact of injuries are real challenges to survival and well-being.Attempts to heal injuries,whether severe or mild,have been major concerns and over time we have accumulated considerable experiences.All traditional medicines,whether European or Oriental,have extensive records of injury treatment and bone-setting.Such records are available in China,from as early as 1000 BC.The earliest Chinese Medicine Classic,Neijing,contains important principles related to injuries and their management.Different bones are given appropriate names,and functions of different tissues in the skeletal system,e.g.muscles,tendons,marrow etc.are described.1-3 Physiological functions,e.g.circulation and kidney activities,have also been discussed.Interestingly,kidney function has been linked to the activities of bones and joints.2

Abstract：Background Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration.Whether accelerated adjacent segment degeneration is prevented in the long term is unclear.This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery.Methods We studied patients with single level degenerative cervical disc disease.The extent of adjacent segment degeneration was estimated from lateral X-rays.Results Twenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion.All patients were followed up for an average of sixty months.In the Bryan arthroplasty group,nine(17.6％)segments developed adjacent segment degeneration,which was significantly lower than that(60.4％)in the anterior cervical decompression and fusion group.Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee's classification and two segments had range of motion less than 2°.In the heterotopic ossification group,four(19.5％)segments developed adjacent segment degeneration,similar to the number in the non-heterotopic ossification group(16.7％).Adjacent segment degeneration rate was 50％ in gradeⅣ?group but 11.8％ in gradeⅡ?to Ⅲ.Conclusions Adjacent segment degeneration was accelerated after anterior cervical decompression and fusion.However,Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion.Patients with gradeⅣ?heterotopic ossification lost motion,and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification。

Abstract：Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration.There are few reports on Topping-off surgery and its rationality and indications remains highly controversial.Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery.Methods The 25 cases that underwent L5-S1 posterior lumbar interbody fusion(PLIF)+L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group.The 42 cases undergoing L5-S1 PLIF surgery formed PLIF group.Both groups matched in gender,age,body mass index and Pfirrmann grading(4 to 6).The patients were evaluated with visual analogue scale(VAS)and Japanese orthopaedic association(JOA)scores before surgery and in the last follow-up.Modic changes of endplates were recorded.Results The follow-up averaged 24.8 and 23.7 months.No symptomatic or radiological adjacent segment degeneration was observed.There was no significant difference in intraoperative blood loss or postoperative drainage.VAS and lumbar JOA scores improved significantly in both groups(t=12.1 and 13.5,P＜0.05).Neither anterior nor posterior disc height was significantly changed.Segmental lordosis of L4-L5 and total lordosis were all increased significantly(Topping-off group:t=-2.30 and-2.24,P＜0.05;PLIF group:t=-2.76 and-1.83,P＜0.01).In the hyperextension and hyperflexion view,Topping-off group's range of motion(ROM)and olisthesis in the L4-L5 segment did not significantly change in flexion,but decreased in extension.In PLIF group,ROM(t=-7.82 and-4.90,P＜0.01)and olisthesis(t=-15.67and-18.58,P＜0.01)both significantly increased in extension and flexion.Conclusions Compared with single segment PLIF surgery,Topping-off surgery can achieve similar symptomatic improvement in cases with pre-existing mild or moderate adjacent segment degeneration,restrict the adjacent segment's ROM in extension and prevent excessive olisthesis of adjacent segment in both extension and flexion。

Abstract：Background In recent years,the number of patients undergoing primary total knee arthroplasty in China has rapidly increased.However,the incidence of primary total knee arthroplasty is unknown.The purpose of this study was to investigate the sex,age and,annual incidence of primary total knee arthroplasty based on 3118 Chinese patients who underwent the procedure during the period of 2000-2011.Methods Total knee arthroplasties were performed on 511 males and 2607 females in our hospital during the period of 2000-2011.The sex,age,and annual incidence of primary total knee arthroplasty were evaluated.Results The annual incidence of primary total knee arthroplasty increased from 35 knees in 2000 to 681 knees in 2011.The average annual percentage increase in incidence was 33.2％.Females accounted for 83.2％ of the patients who underwent primary total knee arthroplasty.In both males and females,the highest incidence was observed in the group aged 65-74 years.Conclusions This study demonstrated a rapid increase in the incidence of primary total knee arthroplasty in our Chinese study population.The sex and age incidence of primary total knee arthroplasty in our study population differed from those reported in Western populations。

Abstract：Background Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients,and plantar fasciitis is the main reason for pain.When systematic conservative treatments fail to alleviate these conditions,it requires surgical intervention,mainly plantar fascia release surgery,which used to be an open heel release surgery.This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis.Methods From May 2009 to May 2012,a total of nine patients,three males and six females with plantar fasciitis,were treated in the Peking University People's Hospital with minimally invasive instruments,the KobyGard system,for the release of plantar fascia.Three patients,experiencing bilateral calcaneodynia,underwent bilateral surgery.One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon,and underwent Achilles tendon surgery.Preoperative and postoperative Visual Analogue Scale(VAS),American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot scores,Roles and Maudsley scores and SF-36 questionnaires were evaluated.Results The nine patients were successfully followed up.The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months.Pre-and postoperative average scores of VAS was 9.3 and 1.9(P＜0.001),respectively.Pre-and postoperative average scores of AOFAS hind foot was 36.0 and 82.0(P＜0.001),respectively.There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores.Eight patients were satisfied with the surgery outcome.Conclusion Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time,ease of operation,and similar satisfaction rates with open surgery,but with smaller surgical incision。

Abstract：Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly,but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration(MLAC)of lidocaine is not known.We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions:lidocaine,or lidocaine plus fentanyl 1 μg/ml,2 μg/ml,or 3 μg/ml.The first patient in each group was administered 1％ lidocaine weight by volume;subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1％ increments.Efficacy was assessed using a visual analog pain scale,and accepted if this was ≤10 mm on a 100 mm scale within 30 minutes.The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery,respectively.Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785％(95％C/0.738-0.864).A significant dose-dependent reduction was observed with the addition of fentanyl:the MLAC of lidocaine with fentanyl at 2 μg/ml was 0.596％(95％Cl 0.537-0.660)and 0.387％ with fentanyl at 3 μg/ml(95％Cl 0.329-0.446,P＜0.001).Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects。

Abstract：Background Repair of large bone defects remains a challenge for clinicians.The present study investigated the ability of mesenchymal stem cells(MSCs)and/or periosteum-loaded poly(lactic-co-glycolic acid)(PLGA)to promote new bone formation within rabbit ulnar segmental bone defects.Methods Rabbit bone marrow-derived MSCs(passage 3)were seeded onto porous PLGA scaffolds.Forty segmental bone defects,each 15 mm in length,were created in the rabbit ulna,from which periosteum was obtained.Bone defects were treated with either PLGA alone(group A),PLGA+MSCs(group B),periosteum-wrapped PLGA(group C)or periosteum-wrapped PLGA/MSCs(group D).At 6 and 12 weeks post-surgery,samples were detected by gross observation,radiological examination(X-ray and micro-CT)and histological analyses.Results Group D,comprising both periosteum and MSCs,showed better bone quality,higher X-ray scores and a greater amount of bone volume compared with the other three groups at each time point(P＜0.05).No significant differences in radiological scores and amount of bone volume were found between groups B and C(P＞0.05),both of which were significantly higher than group A(P＜0.05).Conclusions Implanted MSCs combined with periosteum have a synergistic effect on segmental bone regeneration and that periosteum plays a critical role in the process.Fabrication of angiogenic and osteogenic cellular constructs or tissue-engineered periosteum will have broad applications in bone tissue engineering。

Abstract：Background Features of necrotic lesions and various interventions could affect the biomechanics of the femoral head.A three-dimensional finite-element analysis was designed to demonstrate necrotic femoral head stress changes with various sizes of necrotic lesions,and evaluate the effect of tantalum rods on preventing femoral head cracking.Methods Femoral computed tomography scans were used to build a normal three-dimensional finite-element femoral head model in a computer.Based on the normal model,necrotic models of different lesion diameters(15 mm,20 mm and 30 mm)were created,as were the repaired models with tantalum rods for each diameter.After a series of meshing and force loading,the von Mises stress distributions,simulating single-legged stance,and stresses on specific points under loaded conditions were determfned for each model.Results Deep exploration into the burdened area of the femoral head indicated that higher stresses to the femoral head were observed with a larger necrotic lesion;the largest stress concentration,91.3 MPa,was found on the femoral head with a lesion diameter of 30 mm.By contrast,topical stress on the surface of the necrotic regions was lowered following implantation of a tantalum rod,and the changesin stress were significant in models with lesions of 15 mm and 30 mm in diameter,with the best biomechanical benefit from the tantalum rod found with a lesion diameter of 15 mm.Conclusions Femoral heads with larger necrotic lesions usually have a higher stress concentration and a higher risk of collapse.Various sized lesions on the femoral head can benefit from the mechanical support offered by the implantation of a tantalum rod;however,femoral heads with smaller sized lesions may benefit more.A thorough evaluation of the lesion size should be conducted prior to the use of tantalum rod implants in the treatment of femoral head necrosis。

Abstract：Background Parkinson's disease(PD)is a common neurodegenerative disease,which occurs mainly in the elderly.Recent studies have demonstrated that apoptosis plays an important role in the occurrence and development of PD.Subthalamic nucleus deep brain stimulation(STN-DBS)has been recognized as an effective treatment for PD.Recent clinical observations have shown that STN-DBS was able to delay early PD progression,and experiments in animal models have also demonstrated a protective effect of STN-DBS on neurons.However,the correlation between the neuron-protective effect of STN-DBS and the progression of substantia nigra pars compacta(SNc)neuronal apoptosis is still unknown.The aim of this study was to investigate the protective effect and potential mechanism of STN-DBS on SNc neurons in PD rats.Methods After the establishment of a PD rat model by unilateral/2-point injection of 6-hydroxydopamine in the medial forebrain bundle of the brain,DBS by implanting electrodes in the STN was administered.Behavioral changes were observed,and morphological changes of SNc neurons were analyzed by Nissl staining and DNA in situ end-labeling.Through extracellular recording of single neuron discharges and microelectrophoresis,the causes of and changes in SNc excitability during STN-DBS were analyzed,and the protective effect and potential mechanism of action of STN-DBS on SNc neurons in PD rats was investigated.Results SNc neuron apoptosis was significantly decreased(P＜0.05)in the stimulation group,compared with the sham stimulation PD group.Spontaneous discharges of SNc neurons were observed in normal rats and PD model rats,and the mean frequency of spontaneous discharges of SNc neurons in normal rats((40.65±11.08)Hz)was higher than that of residual SNc neurons in PD rats((36.71±9.23)Hz).Electrical stimulation of the STN in rats was associated with elevated excitation in unilateral SNc neurons.However,administering the gamma-aminobutyric acid receptor blocker,bicuculline significantly reduced SNc neuron excitation,but the change in SNc neuron excitation was not present when MK801,a glutamate receptor blocker,was administered.Conclusions High-frequency stimulation of the STN has a protective effect on SNc neurons in PD rats.The possible molecular mechanism may be related to changes in the distribution and metabolism of neurotransmitters in the SNc region。

Abstract：Background Bone morphogenetic protein(BMP)-2,alkaline phosphatase(ALP),and collagen typeⅠ?are known to play a critical role in the process of bone remodeling.However,the relationship between mechanical strain and the expression of BMP-2,ALP,and COL-Ⅰ?in osteoblasts was still unknown.The purpose of this study was to investigate the effects of different magnitudes of mechanical strain on osteoblast morphology and on the expression of BMP-2,ALP,and COL-Ⅰ.Methods Osteoblast-like cells were flexed at four deformation rates(0,6％,12％,and 18％ elongation).The expression of BMP-2 mRNA,ALP,and COL-Ⅰ?in osteoblast-like cells were determined by real-time quantitative reverse transcription polymerase chain reaction,respectively.The results were subjected to analysis of variance(ANOVA)using SPSS 13.0 statistical software.Results The cells changed to fusiform and grew in the direction of the applied strain after the mechanical strain was loaded.Expression level of the BMP-2,ALP,and COL-Ⅰ?increased magnitude-dependently with mechanical loading in the experimental groups,and the 12％ elongation group had the highest expression(P＜0.05).Conclusion Mechanical strain can induce morphological change and a magnitude-dependent increase in the expression of BMP-2,ALP,and COL-Ⅰ?mRNA in osteoblast-like cells,which might influence bone remodeling in orthodontic treatment。

Abstract：Background Measurement of human epidermal growth factor receptor 2(HER2)protein in the serum of metastatic breast cancer patients has previously been reported,but there are no consistent data to support the clinical utility of serum HER2 extracellufar domain for patients with early stage breast cancer.We aimed to evaluate the correlation between serum extracellular domain levels and tissue HER2 expression,and analyzed their relationship with clinico-pathological parameters in patients with early stage disease.Methods A prospective study was conducted on 232 breast cancer patients with stage Ⅰ-Ⅲ?prior to treatment.Preoperative serum samples were measured by enzyme-linked immunosorbent assay.Tissue HER2 status was analyzed by immunohistochemistry and fluorescence in situ hybridization assays.Results The median serum extracellular domain concentration was 6.8 ng/ml.The best diagnostic cut-off value was 7.4 ng/ml,with 62.9％ sensitivity and 85.3％ specificity.High serum extracellular domain levels were reported in 89 patients(38.3％),and HER2-positive expression was observed in 77 patients(33.2％).Multivariate analysis showed that elevated serum extracellular domain correlated with postmenopausal status(P＜0.001),high histological grade(P＜0.001),negativity of both estrogen(P=0.012)and progesterone receptors(P＜0.001),and high levels of carcinoembryonic antigen 153(P=0.048).Conclusions We recommend that 7.4 ng/ml should be used as the cut-off value when evaluating serum extracellular domain levels in early stage of breast cancer.Patients with high serum extracellular domain levels have a certain clinicopathological characteristics,may provide a basis for clinical practice。

Abstract：Background Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery,because they may have advantage over conventional open surgery in approach-related morbidity.This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring.Methods Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion.A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement.The operative duration,blood loss,complications,and fluoroscopic time were recorded.Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index.Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates.Results The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively.A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan.Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring.The average fluoroscopy time in each patient was 31.8 seconds,which equals to 7.9 seconds per pedicle screw.No patients had instrument related neurological complications,infection,implant failure or revision.Successful fusion was found in all patients.Conclusions The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement。

Abstract：Background Treating developmental dysplasia of the hip is often challenging.The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity However,there have been very few studies on such deformity in patients with developmental hip dysplasia.In this study,we investigated the prevalence and severity of lower-limb valgus deformity,along with the relationship between the severity ef valgus deformity and mechanical alterations of the hip or the ipsilateral knee.Methods Two hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study,grouped according to the severity of hip dysplasia.Each study participant's radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb,and further to evaluate the prevalence and severity of the lower-limb valgus deformity.Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs.Results Of the affected lower limbs,14.1％ had valgus deformities.Study participants with Crowe typeⅢ?hip dysplasiahad the most severe deformity and the highest prevalence of deformity.Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration.A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity,and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity.Conclusions Hip dysplasia is commonly associated with lower-limb valgus deformity,and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head.The valgus deformity may originate mainly in the distal femur,in addition to the hip joint itself.These findings can be taken into account when planning to treat the patients with hip dysplasia。

Abstract：Background There are different materials used for anterior cruciate ligament(ACL)reconstruction.It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement.This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System(LARS)artificial ligament.Methods Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years.X-ray and CT examinations were performed at 1,3,6,12,24,and 36 months after surgery,to measure the width of tibial and femoral tunnels.Knee function was evaluated according to the Lysholm scoring system.The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer.Results According to the Peyrache grading method,grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery.No grade 2 or grade 3 bone tunnel enlargement was found.The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of(2.5±0.3)mm.Forty cases were evaluated as grade 0.The average tibial and femoral tunnel enlargements at the last follow-up were(0.8±0.3)and(1.1±0.3)mm,respectively.There was no statistically significant difference in bone tunnel width changes at different time points(P＞0.05).X-ray and CT measurements were consistent.Conclusions There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament.Such enlargement may,however,result from varying grafting factors involving the LARS artificial ligament or from different fixation methods。

Abstract：Background Several techniques have been described for posterior cruciate ligament(PCL)reconstruction.However,double-bundle PCL reconstruction using the quadruple bone-tunnel technique has been seldom reported.The current study investigated this technique,focusing on the anatomy of the femoral and tibial insertions of the anterolateral(AL)and posteromedial(PM)bundles of the PCL.Methods Twenty-two fresh,healthy adult cadaveric knees were dissected and measured.The PCL was divided into the AL bundle and PM bundle at the insertion footprint.The insertion footprints of the AL and PM bundles,their location,size,and the clock positions were measured and described.Results On the femur,the clock position of the footprint of the AL bundle was 11:21±0:23(left)or 0:39±0:23(right),and the PM bundle was 9:50±0:18(left)or 2:10±0:18(right),with the knee flexed at 90 degrees.The distances from the center of the femoral insertions of the AL and PM bundles to the anterior cartilage margins of the medial femoral condyle were(7.79±1.22)mm and(8.36±1.63)mm,respectively.On the tibia,the vertical distances from the center of the tibial insertions of the AL and PM bundles to the tibial articular surface were(3.25±1.20)mm and(6.91±1.57)mm,respectively.Conclusions These results have led to a better definition of the anatomy of the AL and PM bundle footprint of the PCL.The technique of double-bundle PCL reconstruction using quadruple bone-tunnel is feasible.Application of these data during PCL reconstruction using the quadruple bone-tunnel technique may help optimize knee stability。

Abstract：Background Gastroesophageal junction adenocarcinomas include adenocarcinomas of the distal esophagus(DE)and gastric cardia(GC).It is controversial whether these tumors are the same entity and whether they have the same survival rates.Patients with DE and GC adenocarcinomas have a similar survival rate in the US;however,data are lacking in Asian countries.Therefore,we conducted a retrospective study to understand the implications of the tumor location in the survival of Asian patients.Methods A total of 209 patients with pathologically confirmed DE and GC adenocarcinomas,from 2005 to 2007,were included in the study.We identified patients with adenocarcinomas of the DE(DE group,n=91)and GC(GC group)(n=118).We performed an unadjusted survival analysis using the Kaplan-Meier method,and used a Cox proportional hazards regression model to adjust for potential confounding covariates.Results We found no significant difference between the overall survival of the DE and GC groups.The 3-year survival rates were 44.8％ and 53.0％,respectively,and the 5-year survival rates were 27.9％ and 30.2％,respectively(P=0.162).We found no significant difference in early staging,advanced staging,different T staging,and different N staging,between the groups.Both advanced post-operative N staging and advanced AJCC staging had a significant adverse effect on survival.Conclusions Patients with DE and GC adenocarcinomas have similar survival rates in the Asian population.Both post-operative N staging and AJCC staging are prognostic factors。

Abstract：Background The mechanisms of endometriosis with infertility have not been fully studied.The present study aimed to assess the follicular fluid(FF)levels of prostaglandin E2(PGE2),which plays a critical role within the ovary,and to investigate the effect of PGE2 on steroidogenesis in granulosa-lutein cells(GLCs)from women with and without endometriosis.Methods Thirty-three women with laparoscopically documented endometriosis and 40 controls undergoing in vitro fertilization(IVF)were studied.We assayed the concentrations of PGE2 in FF,the production of E2 and progesterone in FF and in culture medium,and the expression of steroidogenic acute regulatory protein(StAR)and CYP19A1 in GLCs with the intervention of PGE2.Results PGE2 and progesterone concentrations were increased and displayed positive correlation in endometriotic FF.PGE2 induced the expression of StAR and the production of progesterone in GLCs from women with endometriosis,and the expression of StAR and the production of progesterone were increased in GLCs from women with endometriosis.However,there were no significant effects of PGE2 on promoting the production of E2 or the expression of CYP19A1 in GLCs.Moreover,the production of E2 and the expression of CYP19A1 in GLCs from women with endometriosis were significantly decreased compared to the controls.Conclusions PGE2 concentrations are increased in endometriotic FF,along with concomitant increases in progesterone and StAR.In contrast,the E2 and CYP19A1 are decreased in GLCs,which may delay the development of the follicles and cause an imbalance in the follicular steroid hormone levels.These changes may have close relationship with endometriosis-associated infertility。

Abstract：Background The heme oxygenase/carbon monoxide(HO/CO)system plays an important role in the development of hepatic fibrosis.The level of the HO/CO can be directly obtained by determining the carboxyhemoglobin(COHb)level.The aims of this study were to reveal the significance of COHb in patients with hepatitis B virus-related cirrhosis(HBC)complicated by hepatic encephalopathy(HE),and to further investigate the influence of the HO/CO pathway on the end-stage cirrhosis,hoping to find a reliable indicator to evaluate the course of HBC.Methods According to the diagnostic criteria,63 HBC inpatients with HE were enrolled in group H.Patients regaining awareness with current therapies were categorized into group P-H.Comparisons were made with a control group(group N)consisting of 20 health volunteers.The levels of COHb,partial pressure of oxygen(PaO2)and oxygen saturation(SaO2)were determined by arterial blood gas analysis method.The incidences of hepatorenal syndrome(HRS),upper gastrointestinal bleeding,esophagogastric varices and spontaneous bacterial peritonitis(SBP)in group H were recorded.COHb levels in different groups were compared,and the correlations of COHb levels with HE grades(Ⅰ,Ⅱ,Ⅲ,and Ⅳ),PaO2,SaO2 and hypoxemia were analyzed.Results The COHb level in group P-H((1.672±0.761)％)was significantly higher than that in group N((0.983±0.231)％)(P＜0.01),and the level in group H((2.102±1.021)％)was significantly higher than groups P-H and N(P＜0.01).A positive correlation was observed between the COHb concentration and the grade of HE(rs=0.357,P=0.004).There were no significant differences of COHb levels between HE patients with and without complications such as esophagogastric varices((2.302±1.072)％ vs.(1.802±1.041)％,P＞0.05)or the occurrence of SBP((2.960±0.561)％ vs.(2.030±1.021)％,P＞0.05).Compared with HE patients with HRS,the level of COHb was significantly higher in HE patients without HRS((2.502±1.073)％ vs.(1.981±1.020)％,P=0.029).The COHb level had a negative correlation with PaO2(r=-0.335,P=0.007)while no statistically significant relationship was found with SaO2(r=-0.071,P＞0.05).However,when the above two parameters met the diagnostic criteria of hypoxemia,the COHb concentration increased((2.621±0.880)％ vs.(1.910±0.931)％,P=0.011).Conclusions COHb is a potential candidate to estimate the severity and therapeutic effect of HE.The levels of COHb may be tissue-specific in cirrhotic patients with different complications。

Abstract：Background Increased levels of interleukin-6(IL-6)and C-reactive protein(CRP)have been reported in patients with venous thromboembolisms(VTE).However,prospective studies did not confirm an association between IL-6,CRP and their polymorphism with the risk of V-TE.Methods One hundred and forty patients(including 66 males and 74 females,mean age(55.55±17.11)years)and one hundred and sixty controls(including 74 males and 86 females,mean age(56.58±12.24)years)were involved.An enzyme linked immunosorbent assay(ELISA)method was used for detecting the serum levels of inflammatory factors IL-6 and CRP in both groups.Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)was used for analyzing the distribution of polymorphisms at the-572C/G and-597G/A sites of the promoter of the IL-6 gene and at 1059G/C of the CRP gene.Results Serum levels of IL-6 and CRP were significantly higher in the VTE group than in the control group(P＜0.05).The frequencies of-572C/G promoter polymorphisms CC,CG,and GG in the IL-6 gene were found to be 34％,48％,and 18％,respectively,and the derived allele frequencies for the C and G alleles were 58％ and 42％.There was a significant difference in the-572C/G promoter polymorphisms between the VTE group and control group(P＜0.05).For the-597G/A polymorphism,individuals all carried the GG and GA type;AA genotypes were not detected.The frequency of the GG,GC,and CC genotypes at the CRP1059G/C promoter was 87.57％,7.86％ and 3.57％ in VTE group,while 86.25％,10％,and 3.75％ in control group,respectively.The frequency of G and C alleles at CRP 1059G/C was 91.43％and 8.57％ in VTE group and 91.56％ and 8.44％ in the control group.The results showed that there was no statistically significant difference of 1059G/C genotype and mutation frequency of the allele between the VTE group and control group(P＞0.05).Multiple Logistic regression analysis showed CC homozygotes of the IL-6-572G/C,body mass index(BMI),and CRP,IL-6,and high-density lipoprotein cholesterol(HDL-C)were independent risk factors for VTE(P＜0.05).Conclusions We found that VTE was associated with IL-6 and CRP levels,and there was an association of IL-6 and its promoter polymorphism at-572G/C with the risk of VTE.Thus far,a causal relationship between inflammation and VTE remains to be clarified and more prospective data are required。

Abstract：Background Yes-associated protein(YAP)plays an important role in signal transduction and gene transcription regulation in normal cells,with elevated and over-expressed YAP levels observed in various malignant tumors.The aim of this study was to investigate the expression of YAP in non-small cell lung cancer(NSCLC),and to study the possible relationship of YAP expression with the occurrence and development of NSCLC.Methods YAP expression was assessed in 40 cases of NSCLC tumor tissues by immunohistochemistry,and their protein and mRNA levels were evaluated through Western blotting and reverse transcription-polymerase chain reaction(PCR),respectively.Normal lung tissues obtained from the same patient were used as control.Statistical analysis was performed to correlate the YAP expression to clinical pathological factors,such as tumor type,stage and grade.Results YAP-positive expression was found in 28(70％)of the 40 cases of NSCLC,which included 10 cases of squamous cell carcinoma(25％),17 cases of adenocarcinoma(42.5％)and 1 case of squamous adenocarcinoma(2.5％).In the 28 YAP-positive cases,19 cases showed lymph node metastasis and were classified in TNM stage Ⅱ+Ⅲ(47.5％);the other nine cases showed no lymph node metastasis(22.5％)and were classified in the TNM stage Ⅰ.There was no relationship between YAP expression and patients'age,gender or tumor histological grades.However,YAP showed significant over expression in late period of T stage(P=0.012),TNM stage(P=0.039),and lymph node metastasis(P=0.013),respectively.Notably,YAP-positive expression was significantly higher in adenocarcinoma than that in squamous cell carcinoma(P=0.041).Conclusions Over-expression of YAP was associated with NSCLC,especially lung adenocarcinoma.The high YAP expression in late period of tumor stage and lymph node metastasis may indicate that YAP expression could be an early marker for NSCLC tumorigenesis。

Abstract：Background Calcium and phosphorus metabolic disturbance are common in dialysis patients and associated with increased morbidity and mortality.Therefore,maintaining the balance of calcium and phosphate metabolism and suitable intact parathyroid hormone(iPTH)level has become the focus of attention.We investigated the effects of different peritoneal dialysate calcium concentrations on calcium phosphate metabolism and iPTH in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods Forty stable CAPD patients with normal serum calcium were followed for six months of treatment with 1.25 mmol/L calcium dialysate(DCa1.25,PD4,22 patients)or a combination of 1.75 mmol/L calcium dialysate(DCa1.75,PD2)and PD4(18 patients)twice a day respectively.Total serum calcium(after albumin correction),serum phosphorus,iPTH,alkaline phosphatase(ALP)and blood pressure were recorded before and 1,3 and 6 months after treatment commenced.Results No significant difference was found in baseline serum calcium,phosphorus between the two patient groups,but the levels of iPTH were significantly different.No significant changes were found in the dosage of calcium carbonate and active vitamin D during 6 months.In the PD4 group,serum calcium level at the 1st,3rd,6th months were significantly lower than the baseline(P＜0.05).There was no significant difference in serum phosphorus after 6 months treatment.iPTH was significantly higher(P＜0.001)at the 1st,3rd,and 6th months compared with the baseline.No differences were seen in ALP and blood pressure.In the PD4+PD2 group,no significant changes in serum calcium,phosphorus,iPTH,ALP and BP during the 6-month follow-up period.Conclusions Treatment with 1.25 mmol/L calcium dialysate for six months can decrease serum calcium,increase iPTH,without change in serum phosphorus,ALP,and BP.The combining of PD4 and PD2 can stabilize the serum calcium and avoid fluctuations in iPTH levels。

Ossification is a highly complicated physiological process of in vivo osteogenesis and includes intramembranous ossification and endochondral ossification.During intramembranous ossification,the periosteum forms first around the trabeculae in response to differentiating mesenchymal stem cells(MSCs),under which the primary center of ossification appears.Osteogenic cells originate from the periosteum and then promote appositional growth and formation of the bone collar.Eventually,the bone collar is mineralized and lamellar bone is formed。

For interventional cardiologists,it is very challenging to do percutaneous coronary interventions(PCI)in lesions of the left inain,bifurcations or of chronic total occlusion types.However,it is more challenging to demonstrate an evidence based rationale supporting the indications of PCI in these lesions.In this article,new questions are raised on the benefits and the mechanism of benefits for PCI of bifurcations involving large side branches such as the diagonal(DIAG),obtuse marginal(OM)or posterior descending artery(PDA).Besides a positive effect on symptoms,does PCI on these branches improve the left ventricular(LV)function?The preliminary results of new investigations on PCI of bifurcation lesions involving a large DIAG,OM or PDA were presented for the first time at the 3rd Coronary Bifurcation and Left Main Symposium in November 2011 in Nanjing,China and the final results at the China Interventional Therapeutics(CIT)meeting in Beijing,China,March 2012。

Abstract：Background Peripheral T-cell lymphoma(PTCL)is generally characterized by poor prognosis after conventional chemotherapy.The place for high-dose chemotherapy and autologous stem cell transplantation(ASCT)in these patients is still not clear.In this study,we presented the outcomes of PTCL patients followed these treatments in our centre.Methods We retrospectively analyzed the outcomes of 39 patients with PTCL received the two treatments between 1999 and 2010.Results The 3-year overall survival(OS)of 61.9％ and 3-year progression free survival(PFS)of 35.7％ were observed in the 39 patient.Twenty-one patients received Hyper-CVAD chemotherapy with 3-year OS of 46.2％ and 3-year PFS of 27.9％.Eighteen patients received ASCT with 3-year OS of 70.3％ and 3-year PFS of 44.2％.Further analysis revealed that patients with elevated lactate dehydrogenase,at least 2 international prognostic index(IPI)points,and extranodal involvement had a poorer outcome compared with the control group.Conclusion These findings might suggest that Hyper-CVAD chemotherapy and ASCT could offer a durable survival benefit for patients with aggressive PTCL。

Abstract：This case report describes a 44-year-old woman with primary spinal cord malignant melanoma localized in the lumbar region.This is a very rare lesion.The patient presented with back pain and slight weakness in her lower extremities.Magnetic resonance imaging showed hyperintense signals on T1-weighted images and hypointense signals on T2-weighted images.The entire tumor was removed surgically.The patient's postoperative clinical examination revealed mild neurological improvements.Histopathological investigations confirmed the tumor was a malignant melanoma.When treating common lesions of the lumbar spinal cord with a benign appearance,surgeons should be aware of the potential for malignant tumors。

Total knee arthroplasty(TKA)is an effective treatment for severe knee arthritis.However,TKA is more challenging when that arthritis is associated with femoral deformity that has resulted in irregularity of the canal and variation in anatomic landmarks.1 In such cases,it is difficult to restore the mechanical alignment of the lower limb using intramedullary instruments.Shao et al2 have reported that computer-navigated TKA has satisfactory early clinical outcomes in patients with severe osteoarthritis combined with extra-articular femoral deformity.In navigated surgery,the distal femoral osteotomy is performed with respect to the mechanical alignment of the femur instead of that of the femoral canal.Therefore,computer-assisted navigation can be used to accurately reestablish mechanical alignment in patients with deformed femurs who do not require femoral osteotomy。

To the editor:In the recent issue,XU Rong-he et al1 reported one elderly age case with acute chest pain which was finally diagnosed as Takotsubo cardiomyoapthy.Authors provided us with detailed medical profiles;however,I think the diagnosis of this case was controversial based on all available data。