Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

Journal of Thrombosis and Thrombolysis - Whether the clinical outcomes of stent thrombosis (ST) are different when stratified by time of occurrence remains unclear. The objective of this study was...     

Bcl?2与Bax基因在结直肠癌合并血吸虫病患者体内表达及临床病理意义

目的　探讨Bcl?2和Bax基因在结直肠癌（CRC）合并血吸虫病患者体内的表达水平及其临床病理意义。方法　以2016年6月—2020年6月在大理大学第一附属医院接受手术治疗的CRC患者作为研究对象,采用随机数字表法从单纯CRC患者和CRC合并血吸虫病患者中各随机抽取30例作为CRC组和CRC?S组。收集两组患者癌组织和CRC组患者癌旁组织,采用实时荧光定量PCR法和免疫组织化学法检测样本中Bcl?2和Bax mRNA和蛋白表达水平,应用HE染色法观察并比较两组患者癌组织细胞凋亡率。结果　共纳入研究对象60例,其中CRC组和CRC?S组均30例,两组患者性别构成（[χ2] = 0.271,P＞0.05）、平均年龄（t = -0.596,P＞0.05）、结直肠肿瘤生长方式（[χ2] = 0.275,P＞0.05）、肿瘤部位（[χ2] = 4.008,P＞0.05）、肿瘤浸润深度（[χ2] = 0.608,P＞0.05）、肿瘤分化程度（[χ2] = 0.364,P＞0.05）及肿瘤是否脉管转移（[χ2] = 1.111,P＞0.05）差异均无统计学意义,但肿瘤组织学类型、肿瘤是否淋巴结转移和TMN分期差异均有统计学意义（[χ2] = 5.963、8.297、5.711,P均＜0.05）。与CRC组患者癌旁组织相比,CRC组和CRC?S组患者癌组织中Bcl?2、Bax mRNA和蛋白表达水平均升高（P均＜0.05）;与CRC组相比,CRC?S组患者癌组织中Bcl?2 mRNA和蛋白表达水平均升高（P均＜0.05）,Bax mRNA和蛋白水平均降低（P均＜0.05）。CRC组和CRC?S组患者肿瘤组织细胞凋亡率分别为42.00%和25.35%,差异有统计学意义（[χ2] = 41.500,P = 0.000）。结论　血吸虫病可能通过影响细胞凋亡信号通路中Bcl?2和Bax基因表达而参与CRC发生与进展。     

Computer-navigated minimally invasive total knee arthroplasty for patients with retained implants in the femur

Total knee arthroplasty (TKA) in patients with knee arthritis and retained implants in the ipsilateral femur is a challenge for knee surgeons. Use of a conventional intramedullary femoral cutting guide is not practical because of the obstruction of the medullary canal by implants. Previous studies have shown that computer-assisted surgery (CAS) can help restore alignment in conventional TKA for patients with knee arthritis with retained femoral implants or extra-articular deformity, without the need for implant removal or osteotomy. However, little has been published regarding outcomes with the use of navigation in minimally invasive surgery (MIS)-TKA for patients with this complex knee arthritis. MIS has been proven to provide less postoperative pain and faster recovery than conventional TKA, but MIS-TKA in patients with retained femoral implants poses a greater risk in limb malalignment. The purpose of this study is to report the outcome of CAS-MIS-TKA in patients with knee arthritis and retained femoral implants. Between April 2006 and March 2008, eight patients with knee arthritis and retained femoral implants who underwent the CAS-MIS-TKA were retrospectively reviewed. Three of the eight patients had extra-articular deformity, including two femur bones and one tibia bone, in the preoperative examination. The anteroposterior, lateral, and long-leg weight-bearing radiographs carried out at 3-month follow-up was used to determine the mechanical axis of lower limb and the position of components. The mean preoperative femorotibial angle in patients without extra-articular deformity was 3.8° of varus and was corrected to 4.6° of valgus. With the use of navigation in MIS-TKA, the two patients in this study with extra-articular femoral deformity also obtained an ideal postoperative mechanical axis within 2° of normal alignment. Overall, there was a good restoration of postoperative mechanical alignment in all cases, with a mean angle of 0.4° of varus. No limb malalignment or component malposition was found. In clinical assessments, there were also significant improvements in knee specific scores, functional scores, and motion arc. The results of this study suggest that navigation can help achieve accurate alignment and proper prosthesis positioning in MIS-TKA for patients with retained femoral implants and for whom intramedullary rod guidance is impractical.     

TGF-β1对RPE细胞bcl-2/Fas mRNA和Caspase-3表达的影响

目的观察转化生长因子-β1（transforming grawthfactor-β1，TGF-β1）诱导人视网膜色素上皮细胞（retinal pigment epithelium，RPE）凋亡的作用机制。方法使用逆转录多聚酶链反应检测不同浓度TGF-β1作用下的人RPE细胞中凋亡相关基因bel-2和Fas mRNA的表达。使用Western-Blot蛋白印迹法检测不同浓度TGF-β1处理过的PRE细胞中Caspase-3蛋白的表达。结果逆转录多聚酶链反应正示，随着TGF-β1岛浓度的增高，人RPE细胞中bcl-2mRNA表达降低，Fas mRNA的表达逐渐增高；Western-Blot结果显示。随着TGF-β1浓度的增高，Caspase-3蛋白表达逐渐增高。结论TGF-β1可上调RPE细胞表面Fas基因的表达，从而激活Caspase-3的活性而诱导RPE细胞凋亡，Caspase-3在RPE细胞凋亡过程中起着非常重要的作用。[眼科新进展2006；26（3）：194-197]     

Surgical treatment for ipsilateral fractures of the hip and femoral shaft

Concomitant ipsilateral femoral shaft and neck fractures are difficult to treat. There is still no consensus on the optimal treatment of these complex fractures. Forty-seven patients with these complex fractures were treated in Kaohsiung Medical University Hospital between the periods of 1982 and 1998. Our standard treatment protocol is plate fixation for femoral shaft fracture and lag screw or dynamic hip screw (DHS) fixation for hip fracture. Among 42 cases treated with this protocol, 34 were males and 8 were females with an average age of 36 years and average follow-up period of 55 months. We divided hip fractures into two groups: femoral neck fracture as group I and intertrochanteric fracture as group II. There were no non-union and osteonecrosis of the hip in either group. One diaphyseal non-union was observed in group I and four in group II. There were 92 and 76% good functional results in groups I and II, respectively. The result shows that our standard method can yield a reliable outcome in group I, but not in group II.     

Hindfoot arthrodesis for neuropathic deformity

Acquired neurologic disorders of the foot lead to arthrosis, deformities, instabilities, and functional disabilities. Hindfoot arthrodesis is the current option available for irreducible or nonbraceable deformities of neuropathic feet. However, the role of ankle arthrodesis in these patients has been questioned because of high nonunion and complication rates. From 1990 to 2001, 17 cases of acquired neuropathic foot deformities were treated by four tibiotalocalcaneal (TTC) arthrodeses and 13 ankle arthrodeses. TTC arthrodesis was performed on cases with combined ankle and subtalar arthritis or cases whose deformities or instabilities could not be corrected by ankle fusion alone. There was no nonunion of TTC arthrodesis and seven ununited ankle arthrodeses were salvaged by two TTC-attempted arthrodeses and five revision ankle-attempted arthrodeses. Eventually in these cases, there was one nonunion in TTC arthrodesis and one nonunion in revision ankle arthrodesis. The final fusion rate was 88% (15 of 17 cases) with average union time of 6.9 months (range, 2.5-18 months). The American Orthopaedic Foot and Ankle Society ankle hindfoot functional scores were evaluated: one was excellent (5.8%), seven were good (41%), eight were fair (53.3%), and one was poor (5.8%) in terms of total functional outcome. We conclude that TTC arthrodesis is indicated for cases with ankle and subtalar involvement and ankle arthrodesis is an alternative for cases with intact subtalar joint. We recommend revision ankle arthrodesis if the ankle fails to fuse and the bone stock of the talus is adequate. TTC arthrodesis is reserved for ankles with poor bone stock of the talus with fragmentation.     

Surgical treatment of type II floating knee: comparisons of the results of type IIA and type IIB floating knee

The prognosis of type II floating knee injuries was not as good as that of type I. Our purpose is to clarify the factors affecting the outcome of type II floating knee injuries. Thirty-five patients (36 limbs) with type II floating knee injury were studied with a mean follow-up of 52 months (26–96). Blake and McBryde had classified these injuries into type I for pure diaphyseal (true type) fracture and type II if the intra-articular involvements are one or more including hip, knee and ankle joints (variant type). According to this classification, we divided these patients into two groups depending on whether their knees were involved or not. Those cases with intra-articular knee involvement were classified as type IIA, while those without intra-articular knee involvement were classified as type IIB. Of the 36 cases, 21 were classified as type IIA and 15 were type IIB. The functional outcomes of these injuries were evaluated by using the criteria of Karlström and Olerud and analyzed with multivariate analysis. After multivariate analysis with logistic regression, we show the following results: first, the poor functional outcome of type II floating knee is contributed by type IIA. Second, the type IIA group has severer femoral open fracture grading (P = 0.027) and poorer functional outcome (P = 0.009) than type IIB. Third, the significant contributing factors to final outcome are the group (P = 0.013) and the fixation time after injury in femur (P = 0.015). Intra-articular knee involvement is the most important factor contributing to poor outcome of type II floating knee. The treatment of floating knee injuries with intra-articular knee involvement is still difficult. Further efforts to search better methods of treatment are required for these complex injuries in the future.     

Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients

BACKGROUND: It is difficult to keep the alignment of a distal radius fracture in patients with osteoporosis and prevent malunion. Therefore, we hoped to design better method to maintain alignment. METHODS: Thirty-two patients over 65 years old with a displaced unstable distal radius fracture were treated by the external fixator combined with buttress-maintain pinning method and were compared with a group of 66 patients less than 60 years old treated by the same method. RESULT: The radiologic results demonstrated that postoperative and final radial length and volar tilt were not statistically different between both groups. The functional result (excellent and good) in the elderly group was 87.5% and 89% to that of the control group. There was only one complication of pin tract infection in the elderly group. CONCLUSIONS: External fixation for unstable distal radius fracture combined with buttress-maintain pinning method can be used in the osteoporotic bone of older adults with results similar to those for young adults at 18 months follow-up.