Modular intercalary prosthetic reconstruction for malignant and metastatic tumours of the proximal femur

To illustrate the surgical technique and explore clinical outcomes of the reconstruction for the malignant and metastatic bone tumour of proximal femur with metallic modular intercalary prosthesis. Sixteen patients who underwent modular intercalary prosthetic reconstruction after tumour resection were included from April 2012 and October 2020. Prosthesis and screws parameters, resected bone length and residual bone length, clinical outcomes and survivorship were analyzed. All patients were followed up for an average of 19 months (range 1-74). In our series, 12 patients died of the progression of the primary disease at the final follow-up. The cumulative survivorship since the treatment of proximal femoral metastasis was 78.6% (11 patients) at 6 months and 38.5% (5 patients) at 1 year. The mean MSTS score was 22.25 ± 4.55 among all patients. There were no cases of loosening or breakage of the prostheses, plates or screws, despite the various measurements of prostheses and residual bones. Modular intercalary prosthetic reconstruction was an effective method for malignant tumour of the proximal femur, including the advantages of providing early pain relief, quickly restoring postoperative function, required a short operation time, and preserving the adjacent joints.

Comparison of demineralized bone matrix with different cycling crushing times in posterolateral fusion model of athymic rats

Decalcified bone matrix (DBM) is a widely used alternative material for bone transplantation. In the DBM production process, an effective particle size and the highest utilization rate of raw materials can be achieved only through multiple high-speed circulating comminution. The rat posterolateral lumbar fusion model (PLF) is the most mature small animal model for the initial evaluation of the efficacy of graft materials for bone regeneration and spinal fusion. To evaluate the differences in the in vivo osteogenic effects of DBM pulverization through 1, 5, 9, and 14 high-speed cycles, sixty athymic rats were divided into six groups: single cycling crushing (CC1), 5 cycles of crushing (CC5), 9 cycles of crushing (CC9), 13 cycles of crushing (CC13), autogenous bone graft (ABG) and negative control (NC). Posterolateral lumbar fusion was performed. Six weeks after surgery, the bilateral lumbar fusion of athymic rats was evaluated through manual palpation, X-ray, micro-CT and histological sections. Rank data were tested by the rank-sum test, and nonparametric data were tested by the Kruskal‒Wallis H test. The manual palpation and X-ray results showed that the fusion rate did not significantly differ between the CC1, CC5, CC9, CC13 and ABG groups. However, cavities appeared in CC9 and CC13 on the micro-CT image. The bone mass (BV/TV) of CC1, CC5, CC9 and CC13 was better than that of the ABG group, while almost no osteogenesis was observed in the NC group. Histologically, there was no obvious difference between the four groups except that the CC9 group and CC13 group had more fibrous tissues in the new bone. In conclusion, DMB with different cycling crushing times has no obvious difference in fusion rate of PLF, but it is slightly better than the ABG group.

[Incidence and prognosis of olfactory and gustatory dysfunctions related to infection of SARS-CoV-2 Omicron strain: a national multi-center survey of 35 566 population]

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.

Effects of demineralization mode and particle size of allogeneic bone powder on its physical and chemical properties

At present, the commonly used allogeneic bone powder in the clinic can be divided into nondemineralized bone matrix and demineralized bone matrix (DBM). Commonly used demineralizers include acids and ethylene diamine tetraacetic acid (EDTA). There may be some diversities between them. Also, the size of the bone particle can affects its cell compatibility and osteogenic ability. We produced different particle sizes i.e., < 75, 75-100, 100-315, 315-450, 450-650, and 650-1000 μm, and treated in three ways (nondemineralized, demineralized by EDTA, and demineralized by HCl). Scanning electron microscopy showed that the surface of the samples in each group was relatively smooth without obvious differences. The results of specific surface area and porosity analysis showed that they were significantly higher in demineralized bone powder than in nondemineralized bone powder, however, there was no significant difference between the two decalcification methods. The content of hydroxyproline in nondemineralized bone powder and EDTA-demineralized bone powder had no statistical difference, while HCl-demineralization had statistical significance compared with the former two, and the content increased with the decrease of particle size. The protein and BMP-2 extracted from HCl demineralized bone powder were significantly higher than that from nondemineralized bone powder and EDTA demineralized bone powder, and there were differences among different particle sizes. These results suggested the importance of demineralization mode and particle size of the allogenic bone powder and provided guidance for the choice of the most appropriate particle size and demineralization mode to be used in tissue bioengineering.

Repair of tendons treated with peracetic acid-ethanol and gamma irradiation by EDC combined with NHS: a morphological, biochemical and biomechanical study in vitro

The purpose of this study was to investigate whether 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) combined with n-hydroxysuccinimide (NHS) can repair tendon damage caused by peracetic acid-ethanol and gamma irradiation sterilization. The semitendinosus tendons of 15 New Zealand white rabbits were selected as experimental materials, and the tendons were sterilized in a solution containing 1% (v/w) peracetic acid and 24% (v/w) ethanol. After 15 kGy gamma irradiation sterilization, the tendons were randomly divided into three groups (n = 10). The tendons were repaired with EDCs of 0, 2.5 and 5 mM combined with 5 mM NHS for 6 h, the tendons were temporarily stored at - 80 ± °C. The arrangement and spatial structure of collagen fibers were observed by light microscopy and scanning electron microscopy, the collagen type and collagen crimp period were observed under a polarizing microscope, and the collagen fibril diameter and its distribution were measured by transmission electron microscopy, from which the collagen fibril index and mass average diameter were calculated. The resistance of collagen to enzymolysis was detected by the free hydroxyproline test, and tensile fracture and cyclic loading tests of each group of tendons were carried out, from which the elastic modulus, maximum stress, maximum strain, strain energy density and cyclic creep strain were calculated. The obtained results showed that the gap between loose collagen fibers in the 0 mM control group was wider, the parallel arrangement of tendons in the 2.5 and 5 mM groups was more uniform and regular and the fiber space decreased, the crimp period in the 5 mM group was lower than that in the 0 mM group (P < 0.05), and the concentration of hydroxyproline in the 5 mM group (711.64 ± 77.95 μg/g) was better than that in the control group (1150.57 ± 158.75 μg/g). The elastic modulus of the 5 mM group (424.73 ± 150.96 MPa) was better than that of the 0 mM group (179.09 ± 37.14 MPa). Our results show that EDC combined with NHS can repair damaged tendons after peracetic acid-ethanol and gamma radiation treatment, and 5 mM EDC has better morphological performance, anti-enzymolysis ability and biomechanical properties than 2.5 mM EDC.

Prognostic Factors for Bone Survival and Functional Outcomes in Patients With Breast Cancer Spine Metastases

According to the Global Cancer Statistics 2020 report, breast cancer is the most commonly diagnosed cancer worldwide. Patients with mammary cancer live longer due to the continuous optimization of chemotherapy, targeted drugs, and hormone therapy, which will inevitably lead to an increase in the prevalence of metastatic bone tumors. Bone metastasis affects approximately 8% of patients with mammary cancer, with the spine being the most common site. Metastatic neoplasms can invade the centrum and its attachments, leading to local pain, spinal instability, vertebral pathological fractures, spinal cord compression, impaired neurological function, and paralysis, ultimately reducing the quality of life. Multidisciplinary and personalized management using analgesic drugs, endocrine therapy, corticosteroid therapy, chemotherapy, bisphosphonates, immunotherapy, targeted drugs, radiotherapy, and surgery has been advocated for the treatment of spinal metastases. Multiple paradigms and systems have been proposed to determine suitable treatments. In the early stages, the occurrence of metastasis indicates a terminal stage of the tumor process in patients with malignant tumors, implying that their lifespan is limited. As a result, the choice of treatment is heavily influenced by longevity. However, with the development of treatment methods, the lifespan of patients with tumors has considerably increased in recent years. This leads to the choice of patient's treatment, which depends not only on the patient's survival, but also on the radiotherapy or postoperative functional outcomes. Nevertheless, they fall short of determining the variables that affect survival and functional outcomes in histology-specific subgroups of breast cancer. To accurately predict the bone survival and functional outcomes of patients with breast cancer spine metastases a review of prognostic factors was performed.

Application of Controlled Hypotension During Surgery for Spinal Metastasis

With advances in tumor treatment, metastasis to bone is increasing, and surgery has become the only choice for most terminal patients. However, spinal surgery has a high risk and is prone to heavy bleeding. Controlled hypotension during surgery has outstanding advantages in reducing intraoperative bleeding and ensuring a clear field of vision, thus avoiding damage to important nerves and vessels. Antihypertensive drugs should be carefully selected after considering the patient's age, different diseases, etc, and a single or combined regimen can be used. Hypotension also inevitably leads to a decrease in perfusion of important organs, so the threshold of hypotension and the maintenance time of hypotension should be strictly limited, and the monitoring of important organs during the operation is particularly important. Information such as blood perfusion, blood oxygen saturation, cardiac output, and neurophysiological conduction potential changes should be obtained in a timely fashion, which will help to reduce the risk of hypotension. In short, when applying controlled hypotension, it is necessary to choose an appropriate threshold and duration, and appropriate monitoring should be conducted during the operation to ensure the safety of the patient.

Separation Surgery in the Treatment of Spinal Metastasis

The life expectancy of patients with advanced cancer has been prolonged with the development of systemic treatment technology. Spinal metastasis is one of the common ways of metastasis of advanced tumors, leading to spinal cord compression and compression fractures, which often lead to a significant reduction in patients’ quality of life and physical function. Therefore, surgical treatment is still needed for functional recovery and local control. Separation surgery has been known since 2014 when it was purposed. Combined with radiotherapy, it can achieve an ideal goal of local control. This paper gives a brief introduction to separation surgery, hoping to increase the reader's understanding and consider this method in the course of treatment.

[Relationship between podocyte injury and macrophage infiltration in renal tissues of patients with lupus nephritis]

OBJECTIVE

To investigate the relationship between the expression of nephrin and the infiltration of macrophages in renal tissues in patients with lupus nephritis (LN), and to provide the evidence of potential mechanism of podocyte injury in LN.

METHODS

In the study, 60 patients who were first diagnosed with LN by pathology were selected including 38 active LN patients with r-SLEDAI≥4, and another 10 patients of normal renal tissue were excised as a normal control group. The renal tissue and podocyte injury were observed through light and transmission electron microscope. The expression of nephrin and the infiltration of macrophages (CD68+cells) in the renal tissue of the 60 LN patients and 10 normal cases were detected by immunohistochemical and immunofluorescence method. Different statistical analysis methods were used to analyze the correlation between the variables. Variance analysis was used for comparison among the groups, while LSD test was used for comparison between every two groups. Pearson correlation analysis was used to analyze the correlation between the variables.

RESULTS

(1)Of all the LN patients, 24 h urinary protein [(3.94±1.76) vs. (1.56±0.68), P<0.05], erythrocyte sedimentation rate (ESR) [(79.83±6.3) vs. (40.1±10.5), P<0.05] and serum creatinine [(106.58±14.9) vs. (79.1±9.89), P<0.05] were significantly increased in active group than those in inactive group, while C3 [(0.34±0.12) vs. (0.78±0.11), P<0.05], C4 [(0.07±0.04) vs. (0.17±0.10), P<0.05 ] and eGFR [(62.42±5.16) vs. (81.33±4.53), P<0.05] were significantly decreased in active group. (2)Compared with the normal control group, the expression of nephrin in renal tissue of the LN patients was significantly decreased, and the expression of nephrin in the active patients was significantly lower than that in inactive group (P<0.05). (3)Compared with the normal control group, the number of infiltrated macrophages in the LN patients was significantly increased, especially in the active patients (P<0.05). Macrophages were mainly found in glomeruli. (4)There was a significant negative correlation between the expression of nephrin and macrophage infiltration in renal tissues of the LN patients (r=0.761, P<0.001).

CONCLUSION

Macrophage infiltration in renal tissues may be one of the potential mechanisms of podocyte injury in lupus nephritis.

[Efficacy analysis of psychological intervention on the basis of medication for the treatment of moderate-severe persistent allergic rhinitis]

Objective:To observe the effect of psychological intervention on the basis of drug therapy for moderate-severe persistent allergic rhinitis.Method:Sixty patients with moderate-severe persistent allergic rhinitis were randomly divided into two groups: control group and study group. The control group was only given pure drug therapy. The study group was given drug treatment and psychological intervention. Both groups were treated for 12 weeks. Before and after the treatment, the patients were graded by SAS, SDS and RQLQ to assess their anxiety and depression, as well as changes in the quality of life. Finally, a statistical analysis was performed.Result:After the treatment, the SAS and SDS scores of the control group and the study group were lower than those scores before treatment, and the difference was statistically significant (P<0.05). The SAS and SDS scores were lower in the study group than in the control group after treatment, and the difference was statistically significant (P<0.05).After the treatment, the scores of RQLQ in the control group and the study group were lower than those scores before treatment. and the difference was statistically significant (P<0.05). After treatment with two regimens, the scores of the sleep, the non-nose/eye symptoms, and the emotion were lower in the study group than those scores in the control group, and the difference was statistically significant (P<0.05).Conclusion:To improve the mental disorder and the quality of life of the moderate-severe persistent allergic rhinitis patients, on the basis of drug treatment along with psychological intervention is more effective than using medical treatment.

[Effects of nasal cavity ventilational function at low temperature plasma ablation and lateral fracture in treatment for nasal spetum deviation with chronic hypertrophic rhinitis]

Objective:To observe the outward flow of low temperature plasma ablation combined inferior turbinate fracture treatment for chronic hypertrophic rhinitis nasal ventilation function. Method:NR6 nasal resistance meter and A1 nasal sound reflection instrument were used to test 40 patients of Hypertrophic rhinitis nasal septum deviation merger before and after operation for one year, recording the nasal airway resistance,0 to 5 cm nasal cavity volume and the nasal minimum cross-sectional area, combine visual analog scale to analyze the changing parameter value, and to analyze the test values between the correlation. Result:Postoperative patients of NCV, NMCA, NS value was higher than that of preoperative, VAS, NAR value compared with preoperative lower (P<0.05); Postoperative VAS was negatively correlated with NCV, NMCA, NS (r=0.472, 0.698, 0.586, P<0.05); VAS was positively related with NAR (r=0.877, P<0.05); Postoperative NAR was negatively correlated with NCV, NMCA and NS (r=-0.464, -0.870, -0.707, P<0.05); there was a positive correlation between postoperative NS and NCV, NMCA (r=0.442, 0.741, P<0.05). Conclusion:On the deflection of nasal septum (lighter, smaller scale, the part of the deflection of a back with no obvious compressive deformation and lateral deflection of inferior turbinate) in patients with chronic hypertrophic rhinitis, low temperature plasma ablation combined offshoring inferior turbinate fracture surgery can effectively improve the nasal ventilation function, there is a good correlation between postoperative test values.

[Curative observation on allergic rhinitis treated by intranasal corticosteroids combined with nasal irrigation]

Objective: To observe the effect of normal saline with intranasal corticosteroids in the treatment of allergic rhinitis(AR).Method:Two hundred and seventy-three outpatients with severe persistent allergic rhinitis were participated in this study.All patients were randomly divided into three groups, and were treated for 12 weeks using three different therapies, respectively. Symptom assessment of each patient were performed before treatment, 4 weeks, 8 weeks, and 12 weeks after treatment, respectively. The content of symptom assessment includes visual analogue scale, rhinoconjunctivitis quality of life questionnaire, symptoms scores and endoscopy examination scores.Result:Efficacy of intranasal corticosteroids combined with normal saline nasal irrigation in the treatment of AR is better than that of intranasal corticosteroids only, and is almost equivalent to intranasal corticosteroids combined with antihistamines.Conclusion:Long-term application of intranasal corticosteroids in combination with normal saline irrigation can effectively control and mitigate symptoms of severe persistent AR patients, and improve the patient's quality of life. This combination therapy is a better choice for the patient who is not satisfied with the single use of intranasal corticosteroids.

[The relationship between IL-4 and trace elements in patients with allergic rhinitis of hui and han populations in Ningxia]

Objective: To examine the relationship between trace elements and IL-4 in patients with allergic rhinitis(AR).Method:According to the inclusion and exclusion criteria, a total of 260 cases in AR group(130 hui cases, 130 han cases),and 260 cases in normal control group(130 hui cases, 130 han cases) were recruited in this study. The concentrations of IL-4 were detected by enzyme linked immunosorbent assay(ELISA), the contents of Zn, Mn, Ni, Se and Fe were determined by inductively coupled plasma atomic emission spectrometry(ICP-AES), and the correlation between the trace elements and IL-4 were also analyzed.Result:IL-4 levels in serum of both hui and han AR patients were higher than those in control group(P <0.05). Contents of serum Zn and Se in hui AR patients were lower than those in control group(P <0.05), Ni content was higher than that in control group(P <0.05);Zn level in serum of han AR cases was lower than that in control group,Ni content was higher than that in control group (P <0.05).The serum IL-4 level in AR group was positively correlated with Ni(P <0.01,r=0.671), and negatively correlated with Zn(P <0.01, r=-0.819).Conclusion:We demonstrated that there are significant correlations between IL-4 and Zn,Ni in the serum of patients with AR in Ningxia hui and han population. It indicates that trace elements are involved in the occurrence and development of AR, and may as a therauptic target of AR.

[Minimally invasive small incision direct anterior total hip arthroplasty in the lateral decubitus position: complications and early outcome]

Objective: To analyze the feasibility, perioperative complications and early outcomes of minimally invasive small incision in direct anterior approach total hip arthroplasty in lateral decubitus position. Methods: From January 2015 to January 2017, 212 patients (228 hips) received minimally invasive small incision (approximately 8 cm in length) direct anterior approach total hip arthroplasty in modified lateral decubitus position and approach. Sixteen cases underwent bilateral hip arthroplasty separately. All procedures were performed by the same surgeon in the Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital. Twenty-eight patients (28 hips) were set as the complicated case group. The rest 184 patients (200 hips) had no previous hip surgeries, severe deformity and limited motion of the hip, were set as the standard group, and were divided into the first 100 cases group and the second 100 cases group in sequence. The difference between the standard group and complicated case group were analyzed. Also we compared the difference between the first 100 cases and the second 100 cases. Perioperative complications, postoperative function and radiological evaluation were recorded and statistically analyzed. The t test was applied to compare the data between groups. Results: All the patients were followed-up for 13 to 25 months[(18±5) months]. Intraoperative complications and postoperative complications happened in 9 and 34 patients respectively. The anterior dislocation occurred in 2 cases. The standard group showed significant superior outcomes when compared with complicated case group in the surgical time[(42±19) vs (67±16) min, t=-2.628, P=0.027], blood loss[(222±94) vs (579±120) ml, t=-8.371, P=0.000], postoperative Harris hip score[90±5 vs 83±7, t=2.390, P=0.024]and the rate of surgical complication (15.0% vs 46.4%, χ(2)=15.854, P=0.000). The complication rate tended to decrease in the second 100 cases when compared with that in the first 100 cases (11.0% vs 19.0%, χ(2)=3.922, P=0.037). Meanwhile, the second 100 cases showed significant excellent outcomes when compared with the first 100 cases in the mean surgical time[(34±15) vs (48±10) min, t=4.217, P=0.002]and blood loss[(182±52) vs (254±40) ml, t=2.889, P=0.018]. Conclusions: It suggests that there is a learning curve with the minimally invasive small incision direct anterior approach total hip arthroplasty in lateral decubitus position. The risk of intraoperative femoral fractures is slightly high, especially for cases with osteoporosis, stiffness and limited range of movement. Surgeons in early learning curve period should grasp the surgical indications and master the technical points.

[The differences of myringoplasty performed in active and inactive nflammatory stage]

Objective:Through comparing of simple underlay myringoplasty performed in active and inactive inflammatory stage of the chronic otitis media, to explore how the tympanic cavity inflammation affect the outcome of the myringoplasty.Method：Forty-six ears were enrolled in active inflammation group (group A,n=46), and 52 ears were enrolled in inactive inflammation group (group B,n=52). All the patients had received the simple underlay technique myringoplasty. The following-up with otoscope and auditory test had been done in post-operative 12 months.Result:There was no statistic difference of gender and age between two groups. The graft taken-up rate of the group A was 87,0%, that of group B was 90,4%, and there was no statistic difference between two groups(P>0.05).There was no statistic difference of auditory threshold in pre-operative period(P>0.05) and the ABG closure in post-operative period(P>0.05)between two groups. The re-perforation rate of the tympanic membrane also has no difference between two groups(P>0.05).Conclusion：There is no difference of the underlay technique myringoplasty between the active inflammatory stage and inactive inflammatory stage. The active inflammatory condition of the tympanic cavity is not the contraindication of the myringoplasty.

[To observe the effect of "Fangfenggubenkeli" on IL-4, IL-5, IL-10 and IFN-γ cytokines in PBMC supernatant of allergic rhinitis patients with lung depression and spleen efficiency]

Objective:To observe the effect of "Fangfenggubenkeli" on IL-4, IL-5, IL-10 and IFN-γ cytokines in PBMC supernatant of allergic rhinitis' patients with lung depression and spleen deficiency.Method:One hundred patients were randomly divided into two groups. The treatment group of 50 cases, was given to ancient side of the "Fangfenggubenkeli". The control group of 50 patients, was given to cetirizine hydrochloride, oral treatment. The levels of IL-4, IL-5, IL-10 and IFN-γ in the two groups were measured before and after treatment of 1 month. The changes of the laboratory indexes were compared between the two groups before and after treatment.Result:The levels of IL-4 in the two groups were significantly lower than those before treatment (P < 0.01), and the levels of IFN-γ were significantly higher than those before treatment (P < 0.01), there was a statistically significant difference.Conclusion:The mechanism of "Fangfenggubenkeli" in patients with allergic rhinitis with lung depression may be related to the IFN-γ level, lower IL-4 level. Thereby Fangfenggubenkeli would improved the Th1/Th2 imbalance state as a whole.

[The analysis of the allergic rhinitis and chronic rhinosinusitis with nasal polyps]

Objective:To study the influence of allergen,sIgE,total IgE in allergic rhinitis and chronic rhniosinusitis with nasal polyps.Method:Fifty patients with allergic rhinitis and fifty patients with both allergic rhinitis and nasal polyp were involved in this study.Average dense of sIgE and total IgE in serum were dectected. Result:The kinds of allergens between the two groups were siginificantly diffierent;there was no siginificantly diffierence on sIgE average dense(P>0.05);total IgE dense was higher in allergic rhinitis and chronic rhniosinusitis with nasal polyps patients(P>0.05).Conclusion:AR with nasal polyps in patients was high proportion of food allergies and allergic reactions strength was high than the AR.

[Clinical features of multiple myeloma patients with renal insufficiency as the initial clinical manifestation]

OBJECTIVE

To analyze the clinical features of multiple myeloma (MM) with renal insufficiency as the initial manifestation, and to improve the level of clinical diagnosis of MM, and reducing misdiagnosis of this disease.

METHODS

To retrospectively analyze the clinical data of 140 patients with MM, who were admitted in our Department of Nephrology and Hematology. They were diagnosed as MM by bone marrow aspiration biopsy. The patients were divided into renal insufficiency group and normal renal function group, based on the criterion of serum creatinine >177 μmol/L. The two groups were statistically analyzed byt test, rank sum test,χ(2) test and binary logistic regression analysis.

RESULTS

55.7% of the patients in the renal insufficiency group presented low level of three immunoglobulin classes (IgG, IgA, IgM), while in the normal-renal function group, 54.3% of patients mainly presented IgG subtype, showing statistically significant differences between the two groups (P<0.001). Univariate analysis showed that IgM level (<0.4 g/L), hemoglobin, white blood cells, erythrocyte sedimentation rate (ESR), total protein, globulin, uric acid, corrected serum calcium, proteinuria and hematuria were statistically significantly different between the two groups (P<0.05 for all). Unconditional logistic regression analysis showed that lower level of IgM (OR=19.992, 95%CI: 1.327-301.202), hemoglobin, uric acid, ESR, serum total protein, proteinuria and hematuria are independent risk factors for the development of renal insufficiency in MM patients (P<0.05 for all).

CONCLUSIONS

Low level of IgM (<0.4 g/L) is an important clinical characteristics of MM patients with renal insufficiency as the initial clinical manifestation. For middle-aged and elderly patients, who present as low levels of three IgG classes (IgG, IgA, IgM) or low level of IgM, multiple myeloma should be excluded, so as to reduce the misdiagnosis.

[Clinical application of iodine solution staining in the diagnosis of early laryngeal cancer with electronic endoscope]

Objective:To discuss the feasibility and clinical application value of the laryngeal iodine staining under the electronic fiber laryngoscope.Method:Will meet the inclusion criteria of 90 patients, randomly divided into three groups, set to a, b, c group.a ,all patients in the a group were examined by electronic fiber mirror, NBI mode and 0.5% Lugol liquid iodine staining method in three ways. b, all patients in the b group were examined by electronic fiber mirror, NBI mode and 1.0% Lugol liquid iodine staining method in three ways. c,all patients in the c group were examined by electronic fiber mirror, NBI mode and 1.5% Lugol liquid iodine staining method in three ways. The location and range of positive lesions were recorded in each person of the three groups, positive lesions were biopsy, if the positive lesion is repeated, the site can only take a biopsy. As a diagnostic gold standard, the results of the other tests were compared with the results of other tests. And to observe the color of iodine in the throat, all patients were followed up for 24 hours in the presence of dyspnea, severe pain in the throat and other symptoms, and 24 hours after the examination again electronic fiber optic examination. Biopsy was performed in all patients, as gold standard. Using chi square test, inspection standardP <0.05.Result:As the solution of the iodine concentration increased, the rate of the laryngeal was cancer gradually increased. Ninety people take part in the experiment, no one has serious complications. All the patients have no significant inflammation on the mucous membrane of the throat and the subglottic airway afer 24 hours, by the electronic fiber laryngoscope. 1% and the following concentration of Lugol solution for iodine staining, sensitivity to the diagnosis of early laryngeal cancer was higher than that of electronic fiber,the two methods were compared, and the statistical analysis was performed(P >0.05). No statistical significance. There was no significant difference in the diagnosis of early laryngeal cancer. Contrast between iodine stain with 1.5% Lugol solution and electronic fiber sus pension, after statistical calculation(P <0.05);both are statistically significant, and the difference is significant.Comparison of iodine stain with 1.5% Lugol solution and NBI examination, make statistical analysis,P >0.05, there was no significant difference between the both.Conclusion:The 1.5% and below the concentration of the iodine staining under the electronic fiber laryngoscope can be safely applied to inspect the throat, and 1.5% Lugol iodine solution in the diagnosis of laryngeal cancer in the early stage of laryngeal cancer is better than using electronic, and has a certain value in clinical application.

Comparison of calycosin and irbesartan for their impact on renin angiotensin system in human umbilical vein endothelial cell

AIM

The aim of this paper was to compare the efficacy of in vitro calycosin and irbesartan for the treatment of angiotensin II (AngII)-induced renin angiotensin system (RAS) disorder in human umbilical vein endothelial cells (HUVECs).

METHODS

Cultured HUVECs were randomly divided into several groups: control, AngII 1×10-6 mol) alone, Ang II (1×10-6 mol) plus calycosin (0.1, 1, 10 mg/L) and Ang II (1×10-6 mol) plus Irbesartan (10 μmol). Morphology of vascular endothelial cells was studied by using a light microscope with hematoxylin and eosin double staining. Changes in both protein and gene expression of Angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) were detected by immunohistochemistry analysis and reverse transcription polymerase chain reaction (RT-PCR) techniques, respectively.

RESULTS

In comparison to control, AngII significantly promoted both protein and gene expressions of ACE while inhibited those of ACE2 in HUVECs. Interestingly, Calycosin was able to inhibit the effect of AngII in a concentration dependent manner, and its effect at concentration of 35 μmol was equal to that of positive control Irbesartan (10μmol).

CONCLUSION

Calycosin from Radix Astragali from Gansu province could protect HUVECs from AngII induced RAS disorder by downregulation of ACE expression and increased ACE2 expression, which is similar to irbesartan. These results suggest that calycosin may be a promising candidate for treatment of endothelial dysfunction.

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.