BACKGROUND: The bone marrow stem cell (MSC) transplant treatment have the obvious superiority to tradition graft treatment for bone nonunion, but how to obtain the concentrated and highly effective bone marrow mesenchymal stem cell, as well as the dose-effect relations to fracture healing need further discussions. OBJECTIVE: To observe the curative effect of bone nonunion by using autologous MSC transplant treatment, and to compare with autologous iliac bone graft.DESIGN, TIME AND SETTING: Randomized controlled analysis was performed from January 1999 to June 2005 in the Affiliated Second Hospital of Hebei Northern College.PARTICIPANTS: The admitting 140 patients with humerus and tibia fracture were divided into 2 groups at random, autologous iliac bone graft group and autologous MSC transplant group, with 70 patients in each group. METHODS: Under aseptic condition, autologous MSC transplant group received puncture through posterior superior iliac spine, extracting bone marrow 10-20 mL from different spots, separating MSC using the density gradient centrifugation method, and counting as 4×10~9 nucleated cells/mL under the microscope for later use. In the autologous iliac bone graft group, bone fracture end was implanted with the suitable amount of iliac bone, while autologous MSC transplant group with the mixture of decalcified bone matrix and MSC, followed by suture. After the transplantation, external fixation may assist for 4-6 weeks according to the fixed degree of internal fixation.MAIN OUTCOME MEASURES: ① Bone callus formation and pain conditions in 2 groups at different time points after transplantation. ② Comparison of bone healing time between 2 groups. ③ Adverse events and side effects.RESULTS: According to intention-treatment analysis, experimental adopted 140 patients of humerus and tibia fractures, who all entered the final analysis. ① Bone callus formation and pain at different time points post-surgery: At 1 month after transplantation, bone callus formation in the fracture end was not obvious in autogenous iliac bone graft group, and could be seen in autologous MSC transplant group, both groups of fractures exhibited tenderness. At 2 months after transplantation, bone callus formation was observed in autogenous iliac bone graft group, fracture tenderness was relieved compared with the previous condition; in autologous MSC transplant group, a large number of bone callus formed, fracture tenderness was not obvious. At 3 months after transplantation, there were a large number of bone callus formations in autogenous iliac bone graft group, with slight fracture tenderness; in the autologous MSC transplant group, continuous bone callus formation appeared, without fracture tenderness. ② Bone healing time: The average healing time of autologous MSC transplant group was significantly shorter than autogenous iliac bone graft group [(5.5±1.5), (8.0±2.0) months, P < 0.05]. ③ Adverse events and side effects: Except 4 patients had iliac bone pain, all patients during the treatment had no infection and other complications, there were no re-fracture occurred at the follow-up of 8 months.CONCLUSION: The autologous MSC transplant treatment of exhibits a short duration and good effect for bone non-union, has obvious advantages over traditional bone graft.

Objective:To study the effect of anti CD3 monoclonal antibody on preventing acute rejection episodes after renal transplantation.Methods:42 patients undergoing renal transplantation were treated with anti CD3 monoclonal antibody (5 mg) daily for a mean of 10 days (treated group).122 patients who were not treated with anti CD3 monoclonal antibody (control group).Acute rejection episodes,graft loss,death and rate of CMV infection in patients were observed.Results:The treated group had a significantly reduced risk of acute rejection (18 6%),as compared with the control group (28 7%).The rate of graft loss were significantly reduced in the treated group 1 year,2 years,or 3 years after renal transplantation.There were no significant differences in mortality between treated group and control group 1 year,2 years,or 3 years after renal transplantation.The incidence rate of CMV infection were significantly increased in the treated group (33 3%),as compared with the control group (13 9%).The first acute rejection episode was postponed significantly in the treated group.There were more acute rejection episodes that could be reversed by MP in the treated group.Conclusion:Anti CD3 monoclonal antibody significantly reduced the risk of acute rejection and significantly reduced the rate of graft loss.Anti CD3 monoclonal antibody significantly increased the incidence rate of CMV infection,which should be paid attention. [

Objective To study the method and effectiveness of interventional therapy for the stenotic or obstructive inferior vena cava(IVC) caused by hepatic cancer. Methods All together 6 patients were enroled, 4 males and 2 females, with age of 45 to 58 years, average 53 years. The main symptoms including abdominal distention, varices on abdominal walls and edema in lower extremities were caused by compression or involvement of IVC with right hepatic lobe lesion. We performed thrombolysis first and follower by balloon dilation and stent placement. Results IVC were recanalized in all 6 patients with free patent blood flow. The postal venous pressure dropped from 4.4 kPa to 2.1 kPa without major complications. Conclusions Treating the IVC stenosis and obstruction caused by primary liver cancer with interventional method is safe and effective together with improvement of life quality and prolongation of survival time. (J Intervent Radiol, 2006, 15: 537-538)

Objective To investigate the clinical effect of percutaneous autogenous bone marrow stem cell transplant on bone nonunion. Methods 140 patient with bones nonunion were divided into the autogenous bone transplants (A) group and the autogenous bone marrow stem cell transplant (B) group, with 70 cases in each group. They were assessed 2 and 5 months after operation. Results A few calluses could be observed at the end of fracture in 42 cases in group A 2 months after operation, and massive callus formation could be observed in 46 cases 5 months after operation. However, massive callus formation could be observed in 60 cases in group B 2 months after operation, and continual callus formation could be observed in 45 cases 5 months after operation. The mean healing time was (8.4±1.8) months in group A, and (6.5±2.0) months in group B (P<0.05). No side-effects have been observed during the treatment. Conclusion The percutaneous autogenous bone marrow stem cell transplant is more effective on bone nonunion compared with the traditional treatment.

Objective Acute massive pulmonary embolism(PE)is a clinical emergency requiring rapid and supportive measures.With the development of interventional technology and devices,percutaneous mechanical thrombectomy(PMT)is considered to be an alternative for the treatment of PE,though there is still relative lack of clinical experience.The purpose of this study is to evaluate the clinical efficacy and safety of PMT in the management of acute massive PE.Methods The clinical data of massive PE patients treated with interventional methods were collected and analyzed in a retrospective way.From Jan.2003 to Jan.2008,6 patients(5 males and one female,with a mean age of 62 years)with acute massive PE,which was initially diagnosed by computed tomography and finally confirmed by pulmonary angiography,were treated with percutaneous catheter fragmentation and/or Straub Rotarex thrombectomy device.Results The improvement of clinical status and restoration of blood flow in the main branches of pulmonary artery were obtained in all patients.Oxygen saturation(SaO2)increased from preoperative(79.5±5.3)%to postoporative (92.8±3.4)%,with P＜0.01.Partial arterial oxygen pressure(PaO2)increased from preoperative(58.0±9.8)mmHg to postoperative(88.7±4.1)mmHg(P＜0.01).After PMT treatment,the mean pulmonary artery pressure(PAP)decreased from preoperative(40.8±7.8)mmHg to postoperative(29.8±8.0)mmHg (P＜0.01).Miller index decreased from preoperative 0.54±0.03 to postoperative 0.18±0.07(P＜0.01).During a clinical follow-up period ranged from 1 to 5 years,four patients showed no recurrence of PE,the other two patients lost touch with the authors.Conclusion The preliminary experience in onr series suggests that PMT is an easy,effective and safe therapy in the clinical management of acute massive PE,especially when thrombolysis is contraindicated.

Objective To study the clinical efficacy of computer-assisted stereotactic brain transplantation of human retinal pigment epithelium (hRPE) cells into the patients with Parkinson disease (PD). Methods Under the guidance of computed X-ray tomography and magnetic resonance imaging image mergence, 4 × 106 hRPE cells were transplanted into the putamen and ventriculus laterlis of 17 cases of PD by stereotactic surgery. The transplantation sites were contralateral to the side of main symptoms and signs. The curative efficacy were observed at the 7th day, 1st month, and 3rd month after the transplantation. Results The contralateral symptoms were ameliorated continuously after the transplantation. Three months after the surgery, the total effective rate of cell transplantation was 88. 2 %, and 82. 4 % of the cases got significant improvement. The cases that got ipsilateral improvement soon after the surgery gave a total effective rate as high as 88. 2 % at the 3rd month during follow-up period, and 64. 7% among these cases improved significantly. Only a minority of cases had transient dizziness and hemiparesis, but the duration was short. Conclusion The therapy, computer-assisted stereotactic transplantation of hRPE ceils in the treatment of PD, is safe and efficient.

A patient with impaired kidney function after kidney transplantation and received treatment at the First Hospital of Jilin University was retrospective analyzed. The patient was male, 45 years old, and was diagnosed hemolytic uremic syndrome by transplanted kidney biopsy. The patient received cyclosporine A (CsA) as maintenance centered immunosuppression therapy postoperatively. He was admitted because of 1 week acratia followed by 1 day increased serum creatinine level at 1.5 years after transplantation. At 1 day after admission, he was received renal needle biopsy, and underwent 2 days Prednlsolone treatment. After hemolytic-uremic syndrome was diagnosed, CsA was transferred to Tacrolimus (Fk506) with dose of 2 mg/d, and Azathioprine was replaced by mycophenolate, Prednisone was taken orally for 20 mg/d. The function of the transplanted kidney and the change of routine blood tests were observed. After 1 week treatment of the changed Immunosuppression therapy, the function of the transplanted kidney was improved obviously, and the hemoglobin and platelets was decreased during the treatment. The results demonstrated that kidney biopsy is a key method to diagnose hemolytic-uremic syndrome, and adjustment of immunosuppressive agents, replacing CsA with FK506 are effective for postoperative hemolytic-uremic syndrome.

Objective To study the effect of assistive functional rehabilitation exercise on cardiac functioning of patients with chronic heart failure (CHF). Methods Sixty CHF patients were divided randomly into a treatment group (the rehabilitation group) and a control group, with 30 in each group. All the patients were administered routine therapy. In the treatment group, the patients were administered rehabilitation exercises with the assistance of a electric equipment made by the authors, daily for 5 days a week for a total of 3 months. The New York Heart Association (NYHA) cardiac function grading, the left ventricular ejection fraction(LVEF), the left ventricular end diastolic diameter (LVEDD) and the brain natriuretic peptide (BNP) level in plasma as well as the 6 min walking range were observed in both groups before and after treatment. Results After 3-months of treatment, the NYHA grading, LVEF, LVEDD, BNP level in plasma and 6 min walking range were all significantly improved in both groups when compared with those before the treatment, with the treatment group improved to a significantly larger extent than the control group ( p<0.05 ). Conclusion Assistive rehabilitation exercise in addition to the routine therapy can significantly help improve the cardiac function in CHF patients.

Objective To investigate the effects of different depth of anesthesia on ScvO2 and ABL in elderly patients with gastrointestinal cancer. Methods Totally 55 elderly patients undergoing gastrointestinal sur-gery were randomly divided into deep anesthesia group(BIS40-49)(group D,n=27)and light anesthesia group (BIS50-59)(group S,n = 28). While SVV value was fixed,fluid management was conducted while monitoring CVP. HR,MAP,the change of central venous oxygen saturation and lactic acid index were recorded in different time points. Results Propofol dosage in group D and group S indicated statistical significance(P<0.05). ScvO2 in group S in T3~T5 was higher than that in T0 and the difference was statistically significant(P < 0.05). Com-pared with ScvO2 in T3 in group D,that in group S was significantly higher and the difference was statistically sig-nificant(P<0.01),but no significant difference was found in other time point in 2 groups(P>0.05). There was no significant difference between and within ABL groups in each time period(P>0.05). There was no significant difference in terms of other indicators between 2 groups. Conclusions For elderly patients with gastrointestinal surgery,shallow anesthesia can improve tissue oxygenation and reduce the amount of anesthetics.

Objective To explore the influence of duration of untreated psychosis (DUP)on cognition and social function in first-episode drug-na?ve schizophrenia. Methods Ninety-three first-episode drug-na?ve schizophrenic were enrolled as the schizophrenia group and 93 normal people served as the control group. The Positive and Negative Symptoms Scale (PANSS) were used to assess the degree of mental symptoms. The Matrics Consensus Cognitive Battery (MCCB) was used to evaluate the cognitive function. Personal and Social Performance Scale (PSP) and the Global Assessment Function Scale (GAF) were used to evaluate the social function. Result There were significant differences in scores of Trail Marking Test, Symbol Coding test, Category Fluency test, Stroop color word test, Continuous Performance Test, Spatial Span test, Brief-Visuospatial Memory Test-Revised (HVLT-R), Brief-Visuospatial Memory Test-Revised (BVMT-R) and Maze test between the schizophrenia group and the control group (all P<0.05). There were significant differences in scores of GAF and PSP between the schizophrenia group and the control group (all P<0.05). DUP was negatively related to the score of HVLT-R2 (r=-0.265, P=0.010) or BVMT-R3 (r=-0.328, P=0.001). DUP was negatively related to the scores of GAF score(r=-0.292,P=0.005)or PSP score(r=-0.397,P<0.001). Conclusion There are social function impairment and a wide range of cognitive function impairment in the first-episode drug-na?ve schizophrenic. The length of the DUP is associated with the severity of the social functional and cognitive functional impairment.