BACKGROUND: The core of bone tissue engineering is to construct a scaffold that is similar to human bone tissue structure and features.OBJECTIVE: To compare pathochemical and mechanical characteristics between pig and human bone scaffold materials.DESIGN, TIME AND SETTING: Contrast study was performed at Clinical Anatomy Institute, South Medical University; Guangdong Province Key Laboratory of Tissue Construction and Detection from March to December 2006.MATERIALS: Four fresh health adult human cadavers were provided by South Medical University, Guangzhou Red Cross Society, and the relatives knew the fact. Ultra low temperature freezing 6-month iliac bones of 6 adult swines were also used in this study.METHODS: Pig iliac and healthy adults iliac bones were obtained to remove soft tissue, curettage periosteum and bone marrow. Bone sawing machine was used to cut cancellous bone into smaller bone sections around 5 mm×5 mm×40 mm, which underwent ultrasonic cleaning, H2O2 and alcohol soaking, freeze drying and radiation treatment; finally, xenogeneic bone scaffold and allogeneic bone scaffold were obtained.MAIN OUTCOME MEASURES: Xenogeneic bone scaffold material and human allograft bone scaffold were observed with scanning electron microscopy to compare porosity, contents of protein content, calcium and phosphorus, and mechanical properties.RESULTS: Xenogeneic bone scaffold and allogeneic bone scaffold both had intrinsical bone trabecula, trabecular spaces and bone cavity system. Both of them had unabridged natural three dimensional network structure. The 3D supporting frames of them were complete. The xenogeneic bone scaffold had more spaces than allogeneic bone scaffold. The size of both scaffolds was approximation, about 400 μm. The interval porosity of xenogeneic bone scaffold was higher than the allogeneic bone scaffold (P<0.05). And the protein of xenogeneic bone scaffold was not as many as it of allogeneic bone scaffold (P<0.05). The contents of Ca and P were similar (P>0.05), and there was no significant difference in Young's modulus of xenogeneic bone scaffold and allogeneic bone scaffold (P>0.05).CONCLUSION: Xenogeneic bone scaffold may completely meet the clinical demands for bone grafting or be the scaffold of bone tissue engineering in mechanical chemical properties.

ObjectiveTo investigate the effects of partial hepatic ischemia/reperfusion (I/R) on choline acetyltransferase(ChAT) expression in hippocampal neuron in mice.MethodsOne hundred adult male mice,aged 2 months,weighing 20-25 g,were randomly divided into 5 groups (n =20 each): normal control group(group C),sham operation group(group S),groups I/R1,I/R2,I/R3.Partial hepatic ischemia was produced by clamping left hepatic artery and portal vein for 20,30,40 min respectively followed by reperfusion in groups I/R1,I/R2,I/R3.Passive avoidance task was performed with 10 mice in each group at 4-9 and 18-23 d after operation respectively.The animals were sacrificed and their brains were removed for determination of the expression of ChAT in CA3 of hippocampal neuron.ResultsCompared with group C,the latency was significantly shortened and number of errors increased in groups I/R1 and I/R2 at 4-7 d after operation and in group I/R3 at 4-9 d after operation,the expression of ChAT in hippocampal neuron down-regulated in groups I/R1,I/R2 and I/R3 at 9 d after operation( P ＜0.05 or 0.01).There was no significant difference in the latency and number of errors at 18-23 d after operation and the expression of ChAT in hippocampal neuron at 23 d after operation among groups C,I/R1,I/R2 and I/R3 ( P ＞ 0.05).Compared with group I/R1,the number of errors was significantly increased at 4 and 5 d after operation in group I/R2,the latency shortened at 4-6 d after operation and number of errors increased at 4-9 d after operation in group I/R3,and the expression of ChAT in hippocampal neuron down-regulated at 9 d after operation in groups I/R2 and I/R3 ( P ＜ 0.05 or 0.01 ).There was no significant difference in the latency and number of errors at 18-23 d after operation and the expresson of ChAT in hippocampal neuron at 23 d after operation among groups I/R1,I/R2 and I/R3 ( P ＞ 0.05).ConclusionPartial hepatic I/R can result in transient cognitive impairment in mice by down-regulating the expression of ChAT in hippocampal neuron.

Objective To investigate the effect of dexmedetomidine on excitatory aminoacid (EAA)and inhibition of amino acid(IAA)in cerebro-spinal fluid(CSF)of patients undergoing in-tracranial tumor surgery,and to explore the cerebral protective mechanism of dexmedetomidine in neurosurgery.Methods Sixty patients aged 18-64 years old,ASA Ⅰ or Ⅱ,weighing 50-90 kg un-dergoing elective intracranial tumor surgery were randomly divided into dexmedetomidine group (group D)and control group(group C).Dexmedetomidine 1 μg/kg was infused before anesthesia in-duction for more than 10 minutes and pumped continously with 0.2-0.7 μg·kg-1·h-1 in group D, while in group C midazolam 0.03-0.05 mg/kg was injected followed by intermittent administration of 0.03-0.05 mg/kg.BIS value was maintained between 40-50.MAP and HR was recorded at the time points before induction(T0 ),dura mater incision(T1 ),tumor resection(T2 ),at the end of the surgery (T3 ).And we collected CSF at T0 ,T3 ,6 hours after the surgery(T4 ),12 hours after the surgery (T5 ),24 hours after the surgery(T6 ),then the concentrations of EAA and IAA were determined with high-performance liquid chromatography (HPLC)at T0 ,T3 ,T4 ,T5 and T6 .Results The MAP and HR in group D at T1-T3 were much lower than that in T0 and in group C(P <0.05).Compared with T0 ,the Glu and Asp in CSF significantly increased in group C at T3-T6 and were much higher than those in group D (P < 0.05 ),GABA was significantly decreased and much lower than group D(P <0.05).Compared with T0 ,the Glu and Asp in group D at T3-T5 were increased and GABA was decreased, but without statistic significance. At T6 , the values recovered to the level at T0 . Conclusion Dexmedetomidine can be used to maintain hemodynamic stability in intracranial tumor surgery,and may play a role in cerebral protection through inhibiting expression of Glu and Asp (EAA).

AIM To investigate the role of serotonergic projection from dorsal raphe nuclei (DRN) to basolateral amygadaloid (BLA) in the regulation of sleep and waking state. METHODS stereotaxic microinjection and polysomnography were employed. RESULTS Microinjection of L Glu into the DRN caused an enhancement of wake (W) and a decrease of slow wave sleep (SWS) and paradoxical sleep (PS). However, microinjection of L Glu into the DRN plus bilateral microinjection of methysergide (MS) into the BLA reversed the effects of L Glu. Microinjection of PCPA into the DRN caused an enhancement of SWS and a decrease of W. Microinjection of PCPA into the DRN plus bilateral microinjection of 5 HTP into the BLA reversed the effects of PCPA. CONCLUSION These results suggest that the role of the DRN in the regulation of sleep and waking state is partly mediated by serotonergic projection from the DRN to the BLA.

Parkinson′s disease is a neurodegenerative disease characterized by bradykinesia, resting tremor, and hypermyotonia. Its pathological features are the loss of nigra dopamine neurons and the abnormal aggregation of α-synuclein, and there is currently no treatment that blocks the progression of the disease. Gene therapy, by increasing the expression of neurotrophic factors and increasing levels of neurotransmitters, may slow, terminate, or even reverse the progression of the disease, so it gets more attention. This article reviews the progress of registered clinical research on gene therapy for Parkinson′s disease.

Objective: To explore the clinical effect of minimally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixation. Methods: From January 2013 to March 2017, data of 22 patients treated by minimally invasive treatment with single main plate combined with multiple planar screws for supporting fixa-tion were retrospectively analyzed. There were 17 males and 5 females, aged from 23 to 69 years (average, 51.2 years). All cases were closed fractures involving fibula including weight hitting (5 cases), traffic accident (7 cases) and fall injury (10 cases). There were 3 cases of 43-C1 type, 11 cases of 43-C2 type and 8 cases of 43-C3 type according to AO/OTA classification. According to the Rüedi-Allgöwer classification, there were 5 cases of type Ⅱ and 17 cases of type Ⅲ. Complications were recorded postopera-tively and the articular surface reduction was evaluated using the Burwell-Charnley score. At the last follow-up, Tornetta’s pilon fracture clinical treatment outcome criteria was used to evaluate ankle joint function. Results: All the patients were followed up for 13 to 25 months (average, 17.3 months). There were 20 cases of anatomical reduction, 1 case of fair reduction and 1 case of poor reduction according to the Burwell-Charnley score. All the 22 patients were healed with healing time of 3 to 6 months (aver-age, 4.8 months). The efficacy was evaluated according to the evaluation criteria of the clinical treatment results of pilon fracture by Tornetta: excellent in 8 cases, good in 10 cases, fair in 3 cases, and poor in 1 case. The excellent and good rate was 81.8% (18/22) . All patients had no complications such as wound edge blistering, skin necrosis and infection. Among them, 1 case of internal fixa-tion rejection occurred, and the incision was well healed after removal of the internal fixation after 3 months. Conclusion Mini-mally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixa-tion not only provides a better anatomical reduction of the articular surface, but also effectively reduces or even avoids incision complications. The long-term clinical results are satisfactory.

Objective To investigate and compare the median effect-site concentration(Ce50)of sufentanil combined with propofol or ciprofol blunting cardiovascular responses to tracheal intubation in eld-erly patients.Methods Sixty-six elderly patients were selected for extracranial-intracranial cerebral revas-cularization for general anesthesia with tracheal intubation,32 males and 34 females,aged ≥ 65 years,BMI 20-30 kg/m2.Patients were randomly divided into two groups:1.5 mg/kg propofol group(group P)and 0.3 mg/kg ciprofol group(group C),33 patients in each group.Sufentanil was target controlled infused with the initial dose of 0.30 μg/kg,then propofol 1.5 mg/kg or ciprofol 0.30 mg/kg injected slowly after reaching the effect-site concentration.After the lose of consciousness and BIS score less than or equal to six-ty,rocuronium 0.60 mg/kg was administrated,and underwent endotracheal intubation after the TOF value monitored by muscle relaxation drops to zero.Dixon's up and down sequential method was used to determined the target concentration of sufentanil.A positive response was defined as a 20％increase in HR or SBP exceeding the baseline within 2 minutes after tracheal intubation,otherwise,it was considered a neg-ative response.According to the Dixon's sequential method,the ratio of adjacent dosed was 1.2 and if the patient had a positive response,the dose of next patient was moved up one gradient,otherwise,the dose would be reduced.The trail was terminated when the seventh crossover point was observed.When a positive response turned to a negative response,it was called a crossover point.HR,SBP,DBP and BIS were recor-ded before induction of anesthesia(T0),before tracheal intubation(T1),1 minutes after tracheal intubation(T2),3 minutes after tracheal intubation(T3)and 5 minutes after tracheal intubation(T4).Dixon-Mood's half effective quantity sequential calculation formula was used to calculate the Ce50 and 95％confidence interval(CI).Results Compared with group P,SBP was significantly increased at T1,BIS was significantly decreased at T2-T4 in group C(P＜0.05).The Ce50 and 95％CI of sufentanil inhibiting cardiovascular response to tracheal intubation were 0.253 ng/ml(95％CI 0.215-0.297 ng/ml)in group P and 0.241 ng/ml(95％CI 0.209-0.279 ng/ml)in group C.There was no significant difference in Ce50 between the two groups.Conclusion When combined with propofol 1.5 mg/kg during anesthesia induction,the Ce50 of sufentanil inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.253 ng/ml(95％CI 0.215-0.297 ng/ml).While combined with cirprofol 0.30 mg/kg,Ce50 of sufentanil was 0.241 ng/ml(95％CI 0.209-0.279 ng/ml).

Objective To investigate the clinical effect of minimally invasive single locking plate combined with multiplanar screw internal fixation on pilon fracture of distal tibia. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with pilon fracture involving distal tibial articular surface admitted to 81th Group Military Hospital of the Army from January 2013 to August 2017. Among the patients, 20 patients including 15 males and five females, aged (37. 5 ± 9. 9)years were treated with closed traction reduction or open joint reduction through minimally invasive incision and single main locking plate combined with multiplanar screw placement ( study group) . There were 13 patients with type II and seven patients with type III according to Ru edi-Allgwer classification of fracture. In addition, 31 patients were treated with open reduction and multi-plate internal fixation (control group), including 25 males and six females, aged (43. 4 ± 11. 3) years. There were 20 patients with type II and 11 with type III according to Ru edi-Allgwer classification. The operation time, fracture healing time, postoperative complications were compared between the two groups. Burwell-Charnley imaging evaluation criteria were used to assess the quality of fracture reduction. At the last follow-up, ankle function was assessed by the American Orthopedic Foot and Ankle Society ( AOFAS) ankle-hind foot functional score. Results All 51 patients were followed up for 6-24 months, with an average of 16 months. The operation time was (82. 5 ± 19. 2)minutes in the study group and (127. 7 ± 40. 8)minutes in the control group (P<0. 05). The fracture healing time was (10. 8 ± 1. 6)weeks in the study group and (11.0 ±1.5) weeks in the control group (P>0.05). Local skin necrosis (not above the plate) occurred in two patients in the study group and in three patients in the control group, with the wounds being healed within 3 months after dressing change and vacuum sealing drainage ( VSD) . In the control group, one patient had severe infection and recovered after treatment of steel plate removal, debridement and irrigation, and external fixator fixation. Three patients in the control group had skin necrosis resulting in plate exposure, who received transferred skin flaps to cover the wound. The incidence of postoperative complications were 10％ (2/20) and 23％ in the study group and the control group, respectively (7/31) (P >0. 05), with the incidence of severe complications for 0 and 13％(4/31)(P<0. 05), respectively. According to Burwell-Charnley imaging evaluation criteria, 18 patients obtained anatomical reduction in the study group, one had unsatisfactory reduction and one had poor reduction, with satisfaction rate of 90％. In the control group, 29 patients obtained anatomical reduction and two had unsatisfactory reduction, with satisfaction rate of 94％ (P>0. 05). At the last follow-up, AOFAS ankle-hind foot function scores were excellent in 12 patients, good in five patients, fair in two patients and poor in one patient in the study group with excellence rate of 85％, while the scores were excellent in 20 patients, good in six patients, fair in three patients and poor in two patients in the control group, with excellence rate of 84％ (P>0. 05). Conclusion For pilon fracture of distal tibia, both minimally invasive single locking plate combined with multi-plate screw internal fixation and open reduction combined with multi-plate internal fixation have good reduction effect and satisfactory recovery of ankle function, but the former can significantly shorten the operation time and reduce the incidence of serious complications after operation.

Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures.Methods A retrospective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016.They were 20 males and 8 females,aged from 24 to 68 years (average,42.3 years).The time from injury to surgery ranged from 7 to 21 days(average,14.5 days).According to the Letournel-Judet classification,there were 2 posterior column fractures,4 transverse fractures,5 posterior column plus posterior wall fractures,6 transverse plus posterior wall fractures,2 T-shaped fractures,3 anterior and posterior transverse fractures and 6 double column fractures.The posterior acetabular approach or combined anterior and posterior approach was used.In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the intraarticular fracture.After the open reduction and internal fixation was accomplished,the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed.The reduction quality,complications and outcomes at the final follow-ups were recorded.Results All the 28 patients were followed up for 10 to 36 months (mean,15.6 months).By the Matta criteria,anatomical reduction was achieved in 26 cases,unsatisfactory reduction in one and poor reduction in one,yielding an anatomic reduction rate of 92.9％.By the improved Mere d'Aubigne & Postel criteria,the clinical outcomes at the final follow-up were excellent in 27 cases and good in one,yielding a good to excellent rate of 100％.Postoperatively,heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function;transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery.No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups.Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface,leading to satisfactory short-term clinical outcomes.