CR-lipped bearing is an adequate functional solution to patients with perioperative excessive laxity in cruciate retaining total knee arthroplasty

BackgroundThe cruciate retaining lipped (CR-lipped) bearing is designed to provide more anterior-posterior (AP) stability and could be employed to resolve excessive intraoperative laxity during the cruciate retaining TKA (CR-TKA). The aim of the study was to determine whether the CR-lipped bearing in CR-TKAs with a perioperative excessive laxity allows equivalent functional results as compared to the standard CR articulation.MethodsA cohort of 111 TKAs with CR-lipped bearings was matched to a cohort of conventional CR bearings regarding age and sex. The CR-lipped bearing was used in patients with excessive knee AP laxity and the regular CR bearing was used in patients without excessive AP laxity during TKA. Various PROMs (WOMAC, KSS, SF-36) were assessed preoperatively and at 5-years postoperative in combination with revision rate and Range of Motion (ROM).ResultsPROMs did not differ significantly between both groups 5-years postoperatively. Mean ROM (flexion) 5-years postoperatively was not significantly different. The implant survivorship was 100% for both cohorts with revision for any reason as end point.ConclusionBased on these results, the CR-lipped bearing is a safe and effective solution for mild interoperatively assessed PCL laxity during CR-TKA without loss of function or decreased survivorship at 5 years. Peroperative conversion to a PS-TKA in order to obtain satisfactory functional scores might therefore not be necessary when mild PCL laxity is observed during surgery. Further research should focus on verifying this approach and longer follow-up is needed to generate data on long term survivorship.Level of evidenceLevel IV therapeutic, retrospective, cohort study.     

On the role of additive hormone monotherapy with tamoxifen,medroxyprogesterone acetate and aminoglutethimide,in advanced breast cancer

Summary We analyzed the results of clinical studies on the therapeutic efficacy of hormone monotherapy with tamoxifen, medroxyprogesterone acetate, and aminoglutethimide in metastatic breast cancer, which were published between 1971 and 1986 and involved altogether 7000 patients. The overall response rates in patients treated with these hormonal single agents at various dose levels ranged from 31%–42%. When only estrogen receptor-positive patients were considered, the response rates lay between 41% and 54% in groups which were treated with the antiestrogenic agents tamoxifen or aminoglutethimide. The duration of remission was 12 months for tamoxifen- and aminoglutethimide-treated women, whereas medroxy-progesterone acetate effected remissions lasting from 6–16 months. The overall mean survival from start of therapy in tamoxifen- and aminoglutethimide-treated groups was 20 months, whereas information concerning this therapeutic parameter was available only in a minority of medroxyprogesterone acetate-treated groups. With respect to the response by site of metastatic lesions, all three agents caused a significantly higher degree of remissions in the soft tissue as compared to visceral disease.Abbreviations AG Aminoglutethimide - MPA Medroxyprogesterone acetate - TAM Tamoxifen     

Does Low FEV1 in Addition to Fixed Ratio and/or Lower Limit of Normal of FEV1/FVC Improve Prediction of Mortality in COPD? The NHANES-III-linked-mortality Cohort

Purpose

There is presently an ongoing debate on the relative merits of suggested criteria for spirometric airway obstruction. This study tests the null hypothesis that no superiority exists with the use of fixed ratio (FR) of forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) < 0.7 versus less than lower limit predicted (LLN) criteria with or without FEV1 <80% predicted in regards to future mortality.

胃癌的细胞增殖、DNA增殖分数和倍性与患者生存的关系

目的：探讨胃癌细胞增殖、DNA增殖分数(S+G2/M期)和倍性与胃癌患者生存和生物学特性的关系。 方法： 应用流式细胞术，分别分析胃癌细胞群体的增殖、DNA增殖分数和倍性。 结果： 胃癌细胞群体的增殖和增殖分数之间无明显相关关系(P>0.05)；它们与胃癌患者的生存亦无明显相关关系(P>0.05)。胃癌细胞群体的增殖和DNA倍性与胃癌临床病理参数之间无明显相关关系(P>0.05)。胃癌患者DNA二倍体组和异倍体组Kaplan-Meier生存曲线经Log-rank检验有统计学差异（P<0.05）。 结论： 胃癌细胞的增殖和增殖分数与胃癌患者的生存无明显关系； DNA倍性分析对胃癌预后的判断具有重要参考价值。     

嗅成鞘细胞条件培养基对PC12细胞促分化作用及对分化后细胞损伤的保护作用

目的研究嗅成鞘细胞条件培养基(OECCM)对PC12细胞促分化作用及其对-OH自由基损伤分化后细胞的保护作用。方法采用原代分离培养的方法培养和纯化嗅成鞘细胞,收集其培养上清作为OECCM,然后用其培养PC12细胞,培养3 d后,进行细胞形态学观察及-βtubulin免疫细胞化学染色,同时在同一批细胞中加入100μmol/L FeSO4和50μmol/L H2O2作用20 min,再用OECCM继续培养48 h,然后进行MTT对细胞活性进行检测和存活细胞计数。结果用OECCM培养的PC12细胞长有突起,形态酷似神经元,并且-βtubulin免疫细胞化学染色呈阳性,而对照组细胞在同样培养时间里,没有明显的形态变化,-βtubulin染色呈阴性。用FeSO4和H2O2产生的-OH自由基对分化后的PC12细胞进行损伤,发现继续用OECCM培养后,反映细胞活性的A值为0.346 5±0.032,对照组0.201 8±0.034(P<0.01);同时两组细胞存活数目的百分比分别为:实验组为(56.7±5.9)%,对照组为(23.8±7.4)%(P<0.01)。结论嗅成鞘细胞可以分泌有促PC12细胞分化作用的分子和对分化后的细胞在损伤时有保护作用的分子。     

Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction

Adenocarcinoma of the esophagus, or GEJ, has a poor prognosis. Early lesions [i.e. high grade dysplasia (HGD) or T1-carcinoma] are potentially curable. Local endoscopic therapies are promising treatment options for superficial lesions; however, for deeper lesions, surgical resection is considered to be the treatment of choice. To contribute to therapeutic decision-making, we retrospectively analysed the outcome of transhiatal esophagectomy in 120 patients with pathologically proven HGD (n=13) or T1-adenocarcinoma (n=107) of the distal esophagus or gastro-esophageal junction (GEJ). Tumors were subdivided into six different depths of invasion (T1-mucosal m1-m3, T1-submucosal sm1-sm3), and the frequency of lymphatic dissemination and time to locoregional and/or distant recurrence were analysed. Only one of the 79 T1m1-3/sm1 tumors (1%) showed lymph node metastases as compared with 18 out of 41 T1sm2-3 tumors (44%). There was a significant difference in recurrence-free period between T1m1-m3/sm1 versus T1sm2-sm3 tumor patients (P log rank <0.0001), with 5-year recurrence-free percentages of 97% and 57%, respectively. In multivariate analysis including age, gender, tumor differentiation grade, N-stage and depth of invasion, only N-stage was an independent prognostic factor for recurrence-free period (hazard rate=5.9, 95% CI 1.7–20.7). However, if N-stage was excluded from analysis, only depth of invasion (T1sm2-3 versus T1m1-m3/sm1) was an independent prognostic factor for recurrence-free period (hazard rate=7.5, 95% CI 2.0–27.7). These data indicate that T1m1-m3/sm1 adenocarcinomas of esophagus or GEJ show a very low risk of lymphatic dissemination and are therefore eligible for local endoscopic therapy. After transhiatal surgical resection, almost half of the patients with T1sm2-sm3 lesions develop recurrent disease within 5 years, and therefore need additional therapy to improve survival.     

Older age and female gender are independent predictors of early conversion to total knee arthroplasty after high tibial osteotomy

Background

The primary aim was to assess survival of opening wedge high tibial osteotomy (HTO) for medial compartment osteoarthritis. The secondary aim was to identify independent predictors of early conversion to total knee arthroplasty (TKA).

终末期肾病血液透析患者生存期与相关因素分析

目的 调查分析终末期肾病血液透析患者生存期与相关因素。方法 选择2015年1月至2015年11月于我院行维持性血液透析的116例终末期肾病患者,统计其生存期。根据5年随访结果将患者分为生存组和死亡组,建立Logistic回归模型分析影响患者生存的危险因素。结果 随访结果显示,患者1年、 3年、 5年生存率分别为93.97%、 75.00%、 50.86%。单因素分析结果显示,两组患者的年龄、血压及Hb、 Glu、 Alb、 HDL水平比较有统计学差异(P<0.05)。多因素Logistic分析结果显示,年龄、血压、 Glu、 Alb是影响终末期肾病血液透析患者生存的独立因素(P<0.05)。结论 随着终末期肾病血液透析患者维持性血液透析时间的延长,患者的生存率逐年降低,且患者年龄、血压、 Glu及Alb水平与患者生存期密切相关。     

原发女性乳腺癌术后生存率的改善

目的：女性原发乳腺癌术后生存率是否随时间进展有所改善,学术界曾有争论。一些学者认为有而另些则认为无。本文通过对天津肿瘤医院收治的乳腺癌进行回顾性研究。比较不同时期的生存率,并与欧美国家同期比较,企图说明天津肿瘤医院治疗乳腺癌技术不断提高,以及在国际所处的位置。方法：1954年至1984年间,天津肿瘤医院收治原发女性乳腺癌4491例,重新复习病历,按UIEC标准（1987）重新分期,全部病人随访5－15a,将病历资料输入计算机统计分析。结果：50年代,5a,10a和15a的生存率分别为48．4％,37．3％和30．8％;60年代为62．5％,50．9％和43．9％,70年代为69．9％、59．8％和50．7％,80年代仅有5a生存率为79．0％。结论：说明从50年代至80年代乳腺癌术后生存率明显提高。这一结果与美国白人及欧洲生存率最高的国家相同。     

通州市五乡镇恶性肿瘤不同疗法的生存分析

目的：为了解恶性肿瘤不同疗法的治疗效果。方法：对通州市5乡镇1990－1999年诊断的所有恶性肿瘤不同疗法患者进行了生存分析。结果：539例手术治疗的恶性肿瘤生存率高于2289例未手术治疗的生存率;176例放射治疗的恶性肿瘤生存率高于2652例未放射治疗的生存率;596例化学治疗的恶性肿瘤生存率高于2232例未化学治疗的生存率,差异均有非常显著性。114例中药治疗的恶性肿瘤生存率与2714例未用中药治疗的生存率比较差异无显著性。结论：对恶性肿瘤实施正规治疗是提高恶性肿瘤患者生存率的重要措施。