BACKGROUND:The effect of proximal femoral anti-rotation nail fixation in repair of intertrochanteric fracture is better than the other fixation materials. Unarmed inserting guided needle plays an important role for the quality of intertrochanteric fracture fixation. At present, there have been short of fast and accurate methods for inserting femoral canal guided needle from trochanter. OBJECTIVE:To investigate the operating skil s and application value of unarmed inserting guided needle in the process of proximal femoral anti-rotation nail Ⅱ fixation in repair of intertrochanteric fracture. METHODS:Standard operating procedures of guided needle inserting were established. The location of the guided needle was correct or was not judged through discriminating the feeling of inserting into the tip of femoral canal guided needle from trochanter. Slight resistance prompted that guided needle was in correct position. The guided needle closed to the medial femoral cortex and moved downward in the medul ary cavity. The guided needle was confirmed in the correct position by the perspective of C-arm in positive side position. This process was just one lateral perspective. Smoothly without resistance prompted that if the guided needle was out of the medul ary cavity, the direction of the inserting needle needed to be changed, without perspective. The resistance would be large if the needle tip piercing the medial femoral cortical bone, at this moment, the direction of the needle needed to be adjusted;or was blocked by malreduction of fracture or the free fracture block off the medul ary cavity;at this moment, fracture ends needed to be further restored. The surgery time, the time required to complete the guided needle inserting, the amount of bleeding, weight-bearing ambulation time and complications of 19 patients with intertrochanteric fracture treated by proximal femoral anti-rotation nail Ⅱ fixation were statistical y analyzed. RESULTS AND CONCLUSION:The average completed time for internal fixation was 45 minutes, the average desired time for guided needle inserting was 80 seconds, the average blood loss was 100 mL. There was no wound infection, or pressure sore formation. The shimoji time was an average of six weeks after treatment. Al patients were fol owed up for 4-9 months. Three patients needed crutches to walk before treatment, and after three months of treatment, they returned to the pre-exercise levels of injury. These results suggest that the procedure of unarmed inserting the guided needle provides guidance for the quick and correct completion of needle inserting, so as to enhance the internal fixation quality of proximal femoral anti-rotation nail Ⅱ in repair of intertrochanteric fracture, with a high reliability. It can significantly reduce the number of perspective, shorten surgery time, reduce the amount of bleeding and reduce complications.

Objective To investigate the stress characteristics of atlanto-axial bony structure under conditions of anteflexion,posterior extension,lateral flexion,and rotation after artificial atlanto-odontoid joint arthroplasty using three-dimensional finite element method and to improve the orientation of artificial atlantoodontoid joint from perspective of stress.Methods A three-dimensional finite element model of prosthetic atlanto-odontoid joint arthroplasty was created from CT images of the artificial atlantoodontoid joint and cervical vertebrae using software Mimics,Freeform,and Ansys.Stress characteristics of the model dealt with proneness,posterior extension,lateral flexion,or rotation loads were observed.Biomechanical performance of the bony structure of the model was analyzed and the orientation in improving the prosthesis was discussed.Results Anteflexion loading produced a maximum stress of 0.138 ×l08 N/m2 at the junction of lateral mass and posterior arch of the atlas,and 0.201 × 108 N/m2 at axial nail hole,contact point of plates with the axis,and posterior arch of the axis.Posterior extension loading produced a maximum stress of 0.666 × 107 N/m2 at junction of lateral mass and posterior arch of the atlas and 0.254 × 108 N/m2 at arch of the axis.Besides,stress concentration occurred at atlantoaxis nail hole.Right bending produced a maximum stress of 0.124 × 108 N/m2 at nail hole of right mass of atlas and 0.178 × 108 N/m2 at right contact point of the axis with plates.Right rotation produced a maximum stress of 0.847 × 107 N/m2 at junction of lateral mass and posterior arch of the atlas and 0.170 × 109 N/m2 at contact point of the axis with plates.The finite element model comprised 28 620 nodes and 107 441 units and provided good defining of the structural properties of artificial atlanto-odontoid joint arthroplasty.Under different loading conditions,the stress was mainly distributed in contact point of the vertebral body with plates,nail holes,junction of lateral mass and posterior arch of the atlas,and axial pedicle.Conclusions Prosthetic atlanto-odontoid joint scatters a part of the stress and alters the stress distribution of the atlas and axis from the intact condition.Finite element method can obtain complete analysis of the stress distribution of the artificial atlanto-odontoid joint arthroplasty.

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.

Ventricular myocytes from hearts of the neonatal SD rats were treated with 10-7,10-6,and 10-5 mol/L simvastatin for 72 hours under high glucose condition. Compared with control group,the viability of cadiomyocyte was significantly lower in high glucose group (P＜0.01 ).The activity of lactate dehydrogenase,the relative expressions of NADPH oxidase subunits p22phox,p47phox mRNA,and reactive oxygen species level in the high glucose group were higher than those of control group ( all P＜0.05).lndexes mentioned above were significantly improved by simvastatin treatment in a dose-dependent manner.These results suggest that simvastatin ameliorates high glucose-induced injury of cardiomyocytes via increasing the expression of NADPH oxidase mRNA.

Objective To investigate feasibility and safety of anterior pedicle screw fixation tunnel in the axis so as to provide theoretic evidence for further clinical application.Methods Thirty-two dry axis specimens were used for anterior pedicle screw placement,and the length of pedicle crews tunnel was measured by a digital caliper.The extraversion angle and the downslope angle were determined by CT cross-sectional scanning and reconstruction.Results All the anterior pedicle screws were positioned well,with no perforation of the pedicle.The anchoring point was at the vertex between the vertebral body and the superior articular process,with axis pedicle length of(28.4 ± 2.5)mm,the extraversion angle of (28.5 ±2.3)°and the downslope angle of(15.5 ±2.0)°.Conclusions Anterior pedicle screw fixation tunnel is feasible in the axis and can keep away from some important anatomy structures including transverse foramen,vertebral artery groove and vertebral canal to provide large safety space.

Objective To investigate the effect of the high mobility group protein 1 (HMGB1), cancer embryonic antigen (CEA) and squamous cell carcinoma antigen ( SCC-Ag) by paclitaxel combined with cisplatin chemotherapy in the treatment of advanced esophageal cancer patients .Methods 43 cases advanced esophageal cancer patients from our hospital were selected and randomly divided into the control group and the experiment group.19 cases in the control group were treated by surgery combined with postoperative chemotherapy , 24 cases in the experimental group were treated with surgery and chemotherapy.The clinical efficacy and high mobility group protein 1 ( HMGB1 ) , cancer embryonic antigen ( CEA ) and squamous cell carcinoma antigen ( SCC-Ag ) levels were compared between the two groups before and after treatment.Results The total effective rate of the experimental group was (91.7%) higher than that of the control group (57.9%), the difference was statistically significant (P <0.05).After treatment, the serum levels of SCC-Ag, CEA and HMGB1 were decreased in the two groups, compared with the control group, the experimental group SCC-Ag, CEA and HMGB1 levels were lower, the difference was statistically significant ( P <0.05 ) .There was no significant difference in adverse reactions between the two groups.Conclusion Paclitaxel combined with cisplatin in the treatment of advanced esophageal cancer patients with good results, presumably with the decrease of serum SCC-Ag, CEA and HMGB1 levels in patients with.

BACKGROUND:Myocardial fibrosis following myocardial infarction is an important mechanism of ventricle reconstitution. However, there are few reports concerning effects of myocardial transplantation related to stern cells on this process. OBJECTIVE: To investigate the effects of auto-skeletal muscle satellite cells implanted into ischemic myocardium on myocardial fibrosis in rats with myocardial infarction and their mechanisms.DESIGN, TIME AND SETTING: The randomized controlled animal study was performed at the Third Research Room, Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from July to September 2007. MATERIALS: A total of 45 Wistar rats, of both genders, weighing 150-200 g, were used in this study. Of them, 30 rats were used to establish models of myocardial infarction.METHODS: A total of 45 rats were assigned to 3 groups (n=15). Rats in the myocardial infarction group received ligation of the left anterior descending coronary artery to induce myocardial infarction. 2 weeks later, 0.2 mL serum-free M199 medium was infused into the juncture between infarct region and normal myocardium through multiple points. In the transplantation group, following model induction, 0.2 mL auto-skeletal muscle satellite cells in rats after 2-weeks in vitro culture were transplanted into the surrounding of infarct region. Rats in the sham operation group were not induced to create models, only injected with 0.2 mL saline in the heart anterior wall surrounding the left anterior descending branch through multiple points. MAIN OUTCOME MEASURES: Four weeks after injection, vascular endothelial growth factor mRNA and vascular endothelial growth factor protein expression in the ischemic myocardium was demonstrated. Capillary density changes in the ischemic myocardium were detected. Growth and proliferation of myocardial cells in the infarct region were observed using hematoxylin-eosin staining.RESULTS: Vascular endothelial growth factor mRNA and vascular endothelial growth factor protein expression was significantly decreased in the sham operation and myocardial infarction groups compared with the transplantation group at 4 weeks following satellite cell transplantation (P<0.01). Capillary density was greater in the myocardial infarction group compared with the sham operation group (P<0.05). Capillary density was significantly higher in the rat ischemic myocardium in the transplantation group compared with the sham operation and myocardial infarction groups (P<0.01). Hematoxylin-eosin staining demonstrated that myocardial morphology was normal in rats of the sham operation group, with clear structure, orderly myocardial fibrosis. There were no fibroblastaggregation and hyperplasia among myocardial fibrosis. Fibroblast hyperplasia and collagent formation were found in the rat myocardium in the myocardial infarction group, with disorderly myocardial structure. Myocardial cells with transverse striation and many nuclei were observed in the rat infarct region of the transplantation group, with orderly arrangement. Fibrous tissue was significantly less in the transplantation group compared with the myocardial infarction group.CONCLUSION: Satellite cells can proliferate and differentiate into striated muscle-like cells with flexible and systolic functions in the infarct region. Satellite cells secrete vascular endothelial growth factor and promote blood capillary hyperplasia in ischemic myocardium by autocrine and paracrine, which finally effectively inhibits fibrosis progress in the ischomic myocardium.

Objective To investigate the effect of auto-skeletal muscle satellite cell implantation into ischemic myocardium on cardiac function and the mechanisms.Methods Approximately 10 7 to 10 9 muscle satellite cells(SCs)were cultivated in vitro.The left anterior descending(LAD)artery was ligated in Wistar rats to create myocardial infarction(MI).Some rats only underwent sham operation served as control.Two weeks after MI,autologous SCs,serum-free culture medium and sodium chloride injection were injected into ischemic myocardium of implantation rats(n=15),control rats(n=15)and myocardium around LAD of sham operation rats(SO,n=15),respectively.Four weeks after injection,hemodynamic parameters and cardiac function in all groups were evaluated by polygraph system,capillary density in the ischemic myocardium was demonstrated by immunohistochemical method,serum VEGF concentration was examined by ELISA,and the differentiated myofibers from SCs in the infarcted site were observed by pathologic examination and immunohistochemical method.Results Four weeks after injection,the SCs had progressively differentiated into striated muscle fibers in the myocardial infarction site,and immunohistochemical analysis confirmed their skeletal muscle origin.Compared with the SO rats,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean ar-tery pressure(MAP),left ventricular systolic pressure(LVSP)and dp/dtmaxwere markedly decreased(P

Objective:To investigate the serum thyroglobulin (Tg) levels of women in early pregnancy in Dali City, Yunnan Province, and provide a scientific basis for evaluation of individual iodine nutrition of early pregnant women in this area.Methods:Dali City, Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early pregnancy were selected from each township (town) as survey subjects. General condition and medical history of all subjects were collected, and random urine samples and fasting venous blood samples were collected for determination of urinary iodine and thyroid function indexes, and a portable ultrasound machine was used for thyroid ultrasonography. After excluding the patients with a history of thyroid disease and abnormal thyroid function, the level of Tg in the included early pregnant women was analyzed.Results:A total of 120 women in early pregnancy were investigated, aged from 19 to 40 years. Among them, 61 cases came from urban areas and 59 were from rural areas. The median urinary iodine was 156.54 μg/L, which was at the appropriate level of iodine nutrition. A total of 102 women with normal thyroid function in early pregnancy were included, and the Tg level was 11.56 (6.67, 15.27) ng/ml. Among them, 58 cases were in urban areas and 44 cases were in rural areas. There was no significant difference in serum Tg levels between rural and urban women in early pregnancy ( U = 1 362.50, P = 0.559). Conclusion:The serum Tg level of women in early pregnancy in Dali City can provide a reference for evaluation of individual iodine nutrition of relevant populations in this area.

Objective:To investigate and analyze the prevalence of thyroid disease during pregnancy in Dali, Yunnan Province, and to provide scientific basis for prevention and treatment of benign thyroid disease during pregnancy in the region.Methods:From July to December 2014, Dali in Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early, middle and late pregnancy, respectively, were selected from each township (town). To conduct this investigation, medical history data was collected, thyroid ultrasound examination and serological indexes of thyroid function test were performed based on the normal reference value of specific thyroid function serological indexes during pregnancy in this region.Results:A total of 370 cases of pregnant women were investigated, including 120 cases in early pregnancy (61 cases in urban areas and 59 cases in rural areas), aged 19 - 40 years; 126 cases in middle pregnancy (60 cases in urban areas and 66 cases in rural areas), aged 19 - 45 years; and 124 cases in late pregnancy (57 cases in urban areas and 67 cases in rural areas), aged 19 - 44 years. The detection rate of thyroid disease in pregnant women was 27.57% (102/370). The detection rate of thyroid dysfunction was 7.57% (28/370), the positive detection rate of thyroid antibody was 11.62% (43/370), and the detection rate of thyroid nodule was 13.51% (50/370). The detection rates of thyroid diseases in early, middle and late pregnancy were 33.33% (40/120), 23.02% (29/126), 26.61% (33/124), respectively, and the difference was not statistically significant(χ 2 = 3.362, P > 0.05). Conclusions:In Daliy, Yunnan Province, there is a high detection rate of thyroid diseases during pregnancy, especially in early pregnancy. Therefore, it is necessary to carry out further large-scale investigation and study to provide a more reliable scientific basis for prevention and treatment of thyroid disease during pregnancy in this region.