0.05).Conclusion:The method of insulin directly added into TNA can efficiently manage the blood glucose level during parenteral nutrition support.

BACKGROUND:The traditional treatment for thoracolumbar vertebral fractures is posterior short-segment pedicle screw fixation. This method uses vertebral soft tissue stretch through distraction reduction mechanism, makes shift bone reset, and restores shape and height of vertebral body. Long-term folow-up found that part of cases experience complications such as vertebral height loss, loss of spinal correction of Cobb angle, the pedicle screw breakage and loosening. OBJECTIVE:To explore clinical effects of pedicle screw fixation combined with the implantation of artificial bone composite for the treatment of thoracolumbar fractures, and to compare with conventional pedicle screw. METHODS: A total of 80 patients with thoracolumbar fractures, who were treated in the Yantaishan Hospital from March 2011 to May 2014, were randomly divided into two groups. In the experimental group, patients received pedicle screw fixation combined with the implantation of artificial bone composite. In the control group, patients received routine pedicle fixation. Pain visual analog scale score was evaluated before treatment and at 6 months after treatment in patients of both groups, and easement of pain was evaluated after treatment. Vertebral body height (normal anterior flange height and up and down the front cone height and the ratio of the average multiplied by 100%) and sagittal Cobb angle (sagittal measurements of X-ray film) were measured in patients of both groups before treatment and at 1 and 12 months after treatment. According to conventional hierarchical evaluation criteria used al over the world, prognosis was assessed at 6 months after treatment, including basic cure, powerfuly, effectively, and invalid. RESULTS AND CONCLUSION: At 6 months after treatment, significant differences in pain visual analog scale scores were detected in the experimental group (2.4 points) and control group (3.7 points) (P < 0.05). No significant difference in height of the injured vertebra and Cobb angle was detected between the two groups before treatment (P> 0.05). The height of the injured vertebra and Cobb angle were better in the experimental group compared with the control group at 1 and 12 months after treatment (P < 0.05). Significant differences in treatment efficiency were detectable between the experimental group (90%) and the control group (73%) at 6 months after treatment (P < 0.05). These data indicate that pedicle screw fixation combined with the implantation of artificial bone composite in the treatment of thoracolumbar fractures can be used to fix fracture reduction, effectively restore height of injured vertebral body, prevent postoperative Cobb angle loss, and improve the treatment efficiency.

Therapeutic efficiency of advanced stage liver cancer is insufficiency,which has become the hot spot of research.Clinical observation found that prognosis of liver cancer with integrity amicula was better.It is generally accepted that silicon dioxiode(SiO2) can induce pulmonary fibrosis,resulting in the formation of pneumosilicosis.Use of SiO2 as embolism material induces hepatic fibrosis and forms the fibrosis amicula around the liver carcinoma,and then restrains the recurrence and metabasis of liver cancer,which has been turned into one of the aspect of liver carcinoma therapy.The possible mechanisms of inducing hepatic fibrosis by SiO2 are peroxidative damage by free radical,releasing of active cytokines,or inducing cell apoptosis and the activation of HSC etc.

Objective: To investigate alveolar bone remodeling on both labial and lingual aspects of lower anterior teeth during treatment and retention stage. Methods: Forty-three cases with lower first premolars extracted (34 girls and 9 boys) and full records at three time points (pretreatment, posttreatment, follow-up) were collected as study sample. Displacement of lower incisor and bone thickness around its labial and lingual aspect were measured. Results:For the level of center of resistance(LC), there was statistically significant decrease of alveolar bone on lingual aspect (0.78?0.77) mm and no change on labial aspect, as the center of resistance(CR) was retracted lingually by (-3.02?1.13) mm during treatment. Analogous changes were found at the level of 3 mm apical to the center of resistance (L3C). In retention stage, with stable positioned lower incisor, no statistically significant change of alveolar bone was found on labial aspect at LC while a little amount of decrease of labial bone (0.20?0.58) mm was found at L3C. On the contrary, subsequential bone apposition could be detected with increase of lingual bone at both levels by (0.31?0.76) mm and (0.38?0.94)mm respectively. Conclusion:Speed of labial bone resorption is faster than that of lingual bone apposition during orthodontic treatment. In retention stage, sequential bone apposition on lingual aspect is presented with lower incisor in stable position.

Objective To observe the ultrastructure and absorption function of colon mucosa in rat with ultra-short bowel syndrome. Methods Totally 30 SD rats were randomly divided into three groups: ultra-short bowel group (90%-95% of the intestine was surgically resected, n = 10), sham group (n = 10), and normal control group (n = 10). All animals were given with enteral nutrition. Scanning electron microscopy was performed 21 days later to observe the morphology of mucosal surface, and transmission electron microscopy was performed to observe the ultrastructural changes of intestinal epithelial cells. The absorption of colon to water, carbohydrates, and amino acid determined after 3 hours of closed perfusion of the colon with D-xylose solution and 15N-glycine on the continuous cycle of colon. Results As shown by the transmission electron microscopy, compared with the normal control group, rats in the ultra-short bowel group showed significantly decreased goblet cells on colonic mucosl surface, increased epithelial cells, longer and denser microvillus, increased area of membrane surface, increased number of cell-cell junctions, increased number of desmosome, tight junction, and gap junctions, higher development of endoplasmic reticulum and dictyosome, and increased number of mitochondria. As shown in the screening electron microscopy, compared with the normal rats, rats in the ultra-short bowl group had significantly deeper colon folds, thicker mucous membrane, increased number of bay openings, and longer and denser microvillus-like structures inside bays. The capability of water absorption was signicatnly higher in the ultra-short bowl group than in the sham group and normal control group (P = 0. 000) . The absorption rates of xylose and 15 N-glycine were also significantly higher in the ultra-short bowl group than in the control group (P ＜ 0. 01). Conclusions The absorption capability can be compensatively increased in rats with ultra-short bowel syndrome. Decreased apoptosis of colon mucosa cells, increased absorption cells, hyperplasia of microvilli, increased area of the membrane surface,and increased number of mitochondria may constitute its material and energy bases.

Objective To investigate the expressions of claudin-5 and claudin-10 in colorectal carcinoma(CRC) and its significance.Methods Pathological verified 50 colorectal tissue (CRT),25 colorectal adenoma (CRA),25 non lymph node metastasis CRC (non-LNM CRC) and 25 lymph node metastasis CRC (LNM CRC) were detected for the expression of claudin-5 and claudin-10 by immunohistochemical SP(streptavidin perdcidase) method.Results The positive expression rate of Claudin-5 was 82%,76%,68% in CRT,CRA,CRC,respectively.The positive expression rate of claudin-5 in different groups was not significantly different(X~2 =2.638,P＞0.05).claudin-5 expression was correlated with LNM (P＜0.05),but was not correlated with gender,age,tumor,location,differentiation,tumor diameter and serous membrane invasion(P＞0.05).The positive expression rate of claudin-10 was 54%,56%,72% in CRT,CRA,CRC,respectively.The positive expression rate of claudin-10 in different groups was not significantly different(X~2 = 3.839,P＞0.05).claudin-10 expression was correlated with tumor diameter,serous membrane invasion and LNM (P＜0.05),but was not correlated with gender,age,location and differentiation (P＞0.05).There was no significant correlation between claudin-5 expression and claudin-10 expression in CRC (r = 0.050,P = 0.732).Conclusions claudin-5 and clandin-10 are expressed in CRT,CRA,and CRC.They are not involved in CRC occurrence,claudin-5 and clandin-10 abnormally expressions are significantly associated with the incidence of LNM.Meanwhile,claudin-10 expression is correlated with tumor diameter and serous membrane invasion.There was no significant correlation between claudin-5 expression and claudin-10 expression in CRC.

Objective To evaluate the clinical significance of plasma ionized calcium (ICa) and total calcium (TCa) measurement in diagnosis of tumor-associated hypercalcemia. Methods The heparin lithium anticoagulated plasma were collected and measured with ion selective electrode (ISE) and orthocresolphthalein complexone (OCPC) method for ICa and TCa in 77 patients with malignant tumor (tumor group) and 44 healthy controls (control group). Meanwhile,plasma albumin and pH value were measured to correct TCa (cTCa) and ICa(nICa). The results were analyzed. Results The levels of cTCa,ICa and nICa in tumor group were significantly higher than those in control group(P＜ 0.01 ) ,but there was no significant difference of TCa between two groups (P ＞ 0.05 ). cTCa ＞ 2.70 mmol/L, nICa ＞ 1.35 mmol/L as the hypercalcemia eritical value, the positive rate of nICa and cTCa were 18.18% (14/77) and 6.49% (5/77)respectively,the difference was significant (P = 0.023). Conclusion Determination of ICa may be more clinical meaningful than TCa for tumor-associated hypercalcemia.

Objective To investigate the value of prothrombotic state (PTS) in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.Methods One-hundred and twenty-eight ASA physical status Ⅰ or Ⅱ elderly patients (NYHA class Ⅰ or Ⅱ) of both sexes,aged 6575 yr,undergoing elective abdominal surgery,were enrolled in the study.Total intravenous anesthesia was performed during surgery.Venous blood samples were collected for detection of the levels of D-dimer,thrombus precursor protein and P-selectin (molecular markers of PTS).Detection of PTS was based on the three indexes mentioned above.The patients were divided into 2 groups according to the cardiac events occurred during surgery and within 3 days after surgery:non-cardiac event group and cardiac event group.The general data of patients and each index during surgery were recorded.Logistic regression analysis was used to pick out the potential risk factors for cardiac events.Results Twenty-nine patients developed cardiac events.There was no significant difference in age,obesity,ratio of diabetes,duration of operation,and ratio of PTS between non-cardiac event and cardiac event groups (P ＜ 0.05 or 0.01).Logistic regression analysis showed that old age,diabetes,prolonged duration of operation,and PTS were independent risk factors for cardiac events (P ＜ 0.01).Conclusion PTS produces some value in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.

Objective To evaluate the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing coronary artery bypass grafting (CABG).Methods We searched PubMed,EMBASE,Highwire,CENTREN and its affiliated clinical trial registration data center,Chinese Biomedical Database,and CNKI from 2000 to 2010 for randomized controlled trials involving the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing CABG.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included development of fibrillation,requirement for insulin treatment because of hyperglycosemia,infection,and death (during stay in hospital or within 30 days after discharge from hospital) after operation and mechanical ventilation time.Meta-analysis was conducted using the RevMan 5.1 software.Results Twenty-one randomized controlled trials involving 1737 patients were included in our meta-analysis.Different doses of glucocorticoid decreased the risk of fibrillation,and did not increase the risk of various causes-induced infection and death.Moderate and large doses of glucocorticoid increased the risk of requirement for insulin treatment because of hyperglucosemia.Large dose of glucocorticoid resulted in prolongation of ventilation time.Conclusion Different doses of glucocorticoid can decrease the development of postoperative fibrillation without increasing the risk of infection and death,moderate and large doses of glucocorticoid increase the risk of requirement for insulin treatment because of hyperglucosemia and large dose of glucocorticoid increases the risk of prolonged ventilation time in patients undergoing CABG.

Objective To explore a modified technique of perforator flap anatomical study,in an attempt to understand the vascular territory of the specific perforator vessel in flaps,and determined its application in posterior tibial artery perforator flaps.Methods From October,2013 to October,2014,6 corpse were used in this study.A full-thickness posterior tibial artery perforator flap was excised from the crus of a fresh adult corpse.The anatomical measurements were synchronized with the procedure.The isolated skin flaps were fixed in a frame made of silk screen and batten and subsequently photographed.In vitro skin flaps were divided into 3 groups:full-thickness,without deep fascia,and without subcutaneous adipose layer.The skin flaps were perfused with barium sulfate silicone,and photographed using mammography after coagulation of the silicone.The imaging data were processed by digital software system.Results The mean number of posterior tibial artery perforators in the lower medial leg was 4.17 ± 0.94.The projection points of perforated sites were located in the area 2-3 cm lateral to the A-C line.The proximal border was (4.51 ± 1.84)cm distal to the plane of tibial medial condyle;the distal border reached the medial malleolus plane;and the anterior and posterior borders reaching the anterior and posterior midline of the crus respectively.And according to the comparison of the 3 group processed images,vascular territory change could be obtained.And this could provid clinicians with reliable anatomical information,guiding the acquisition and trimming of perforator flaps.Conclusion The modified strategy intuitively indicated the blood vascular areas of different artery perforator flaps of varying thickness and the vascular branches as well as their courses.The approach is profoundly significant in guiding the acquisition of skin flaps and for the trimming and reconstruction of flaps.The deep fascia of posterior tibial artery perforator flaps plays a negligible role in the blood supply of flaps.Furthermore,the subcutaneous adipose tissues in the distal portion of flaps can be thinned appropriately,with limited vascular consequences.