Objective To develop an all-in-one multifunctional thoracolumbar fixation rescue vest for land and water rescue of thoracolumbar injury and investigate its application effect.Methods According to the thoracolumbar physiological curve,type Ⅰ thoracolumbar fixation rescue vest with keel and inflatable airbag and type Ⅱ thoracolumbar fixation rescue vest with additional lifesaving balloon and inflatable cylinder were developed using thermoplastic polyurethane (TPU)-nylon composites and polycarbonate (PC) as the main materials.Clinical application of type Ⅰ thoracolumbar fixation rescue vest in 532 cases of thoracolumbar injury was discussed.Type Ⅱ thoracolumbar fixation rescue vest were tested at marine rescue and related parameters measured were automatic inflation time,buoyancy force,floating time,floating condition and victims' face orientation.Clinical outcome was quantified by the MacNab standard,and VAS for pain was recorded.Results According to the MacNab standard,excellent outcome was achieved for all cases.VAS improved from 8.2 points to 2 points after the bracing was applied,showing 100％ improvements.The brace into the water showed automatic inflation time of 3-5 seconds and maximum buoyancy force of 100 kg,and ensured a 90 kg dummy of floating over 96 hours.At marine rescue,the wounded in braced condition showed face upward with 24-hour buoyancy loss ≤5％ and freedom of movement.Conclusions The multifunctional thoracolumbar fixation rescue vest provides dual immobilization and ensures marine rescue for its automatic inflation device.This invention provides the feasibility to remove,transport and evacuate the thoracolumbar fracture patients in cabin.

BACKGROUND:The diagnosis of osteoporosis depends upon the bone mineral density T-score of ≤ -2.5 standard deviation or brittle fractures. Bone mineral density measurement combined with vertebral fracture assessment might prevent the missed diagnosis of osteoporosis due to bone mineral density evaluation alone, and improve the diagnosis rate of osteoporosis.
OBJECTIVE:To evaluate the effect of bone mineral density measurements combined with vertebral fracture assessment for the diagnosis of osteoporosis.
METHODS:Bone mineral density measurements of proximal femur and vertebral fracture assessment for lateral thoraco-lumbar images were consecutively done for 217 postmenopausal women who aged ≥ 50 years. The rate of osteoporosis diagnosed with bone mineral density T score was compared with that diagnosed with bone mineral density combined with vertebral fracture assessment. The effects of bone mineral density on the vertebral fracture were analyzed.
RESULTS AND CONCLUSION:92 (42.4%) patients had bone mineral density T score ≤ -2.5, which met the threshold for diagnosis of osteoporosis. 102 (47.0%) patients had osteopanic (-1>T>-2.5) and 23 (10.6%) had normal range of bone mineral density. 158 patients had no vertebral fractures and 59 (27.2%) patients had 101 vertebral fractures. The vertebral fracture rate was 21.6%in the patients with bone mineral density T> -2.5 and 34.8%in the patients with bone mineral density T ≤ -2.5, with significant differences (P<0.05). Bone mineral density in combination with vertebral fracture assessment for the diagnosis rate of osteoporosis was up to 54.8%, which was significantly higher than the rate diagnosed with only bone mineral density (12.4%;P=0.01). Bone mineral density measurement combined with vertebral fracture assessment improves the diagnosis of osteoporosis for postmenopausal women.

Objective: To study the relationship between bone morphogenetic proteins(BMPs),BMP receptor type IA (BMPR IA) and the oncogenesis of squamous cell carcinoma in oral epithelia. Methods: Expression of BMP 2/4,BMPR IA was immunohistochemistry analyzed in the specimens obtained from buccal mucosa, including 18 cases of normal mucosa(NB), 24 cases of chronic inflammation(NCI) and 58 cases of oral squamous cell carcinoma(SCC). Result: Weak staining of BMP 2/4 and BMPR IA was observed in normal and chronic inflammation samples,while stroug staining was found in 52 out of 58 cases of oral SCC. No significant difference was found among the heighly,intermediately and poorly differentiated SCC groups.Conclusion: BMP 2/4,BMP IA might be involved in oncogenesis and development of squamous cell carcinoma of oral epithelium.

Objective To compare the clinical effects of ROI-C self-locking fusion cage and common cage+titanium plate fixation on treatment of multi-segment anterior decompression and fusion for cervical spondylotic myelopathy.Methods From March 2010 to September 2013,92 patients with multi-segment cervical spondylotic myelopathy were treated with anterior decompression and fusion.52 patients were treated with common cage plus titanium plate fixation,while 40 patients were treated with ROI-C self-locking fusion cage.Clinic data including clinical preoperative condition,operation time,intraoperative blood loss,intervertebral space height,Cobb angle of cervical spine,bone graft fusion rate,complications,and JOA score and VAS score were compared.Results Follow-up visit was conducted for all cases,with the time of 12-48 months (22 months on the average).The neurologic symptoms of patients in two groups were relieved obviously after postoperative 1 week,including chest and abdomen constriction feeling,finger pain,finger and lower limb activities.Intervertebral space height of cage +titanium plate group and ROI-C fusion cage group increased to 79.06±6.67 mm and 78.80±6.85 mm respectively after postoperative 3 months from preoperative 47.15±6.96 mm and 46.95±7.14 mm;the Cobb angle increased to 9.29°±12.90° and 8.57°±13.00° respectively after postoperative 3 months from preoperative 4.27°±11.15° and 2.80°±10.81°.In ROI-C group,the operation time,intraoperative blood loss and postoperative complications were significantly lower than those in cage+titanium plate group.The differences of two groups have statistical significance.In the last follow-up visit,JOA score of ROI-C group increased to 15.15±0.91 from preoperative 9.32±1.74,with the improvement rate of 75.82％±13.28％;JOA score of cage + titanium plate group increased to 15.29± 1.07 from preoperative 9.11 ± 1.23,with the improvement rate of 77.91％± 14.14％.The differences of two groups in the improvement rate have no statistical significance.Conclusion Curative effects of ROI-C self-locking fusion cage and common cage+titanium plate fixation on treatment of muhi-segment anterior decompression and fusion for cervical spondylotic myelopathy are similar,while ROI-C self-locking fusion cage has such advantages as short operation time,less blood loss,little injury and low complication incidence.

BACKGROUND: Skin defect is commonly repaired by autologous skin graft, but in which, it is required healthy skin provider and it probably results in scarring deformity to various extents. The successful construction and clinical application of tissue-engineered skin (TE skin) mark the major breakthrough in treatment of skin defect.OBJECTIVE: To analyze the relationship between operation method and healing rate, through repair of skin defect with TE skin, to provide experimental evidence on clinical application of TE skin.DESIGN: Randomized controlled observation was designed.SETTING: Department of Oral and Maxillofacial Surgery, Teaching-Research Room of Histology and Pathology and Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University of Chinese PLAMATERIALS: The experiment was performed in Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University, in which 6 healthy York pigs were employed, of clean grade,aged varied from 2.5 to 3 months. 3 groups were randomized, named TE whole-layer group, TE dermal and auto-epidermal group and auto-graft group, 2 pigs in each group. 8 wounds were prepared in each pig, round in shape and 50 mm in diameter, 16 wounds in each group, totally 48wounds.METHODS: ①Preparation of TE whole layer and TE true skin. ② In TE whole-layer group: The whole layer of skin was cut off from fat layeralong the drawn line. When bleeding stopped thoroughly and the wound was covered with wet physiological saline gauze, TE whole-layer skin was collected and windowing was done on the skin for drainage. Physiological saline was used to rinsed away the culture solution on the surface of TE skin, and then, the cuticular layer was upward-covered the wound, avoiding gas vacuole between cuticular layer and wound. Single-layer oleic gauze, physiological saline gauze, aseptic dry gauze and elastic sponge cushion were covered successively, about 3-5 mm in thickness each layer. After routine dressing, elastic bandage was wrapped with compression terminally. ③ TE dermal and auto-epidermal group: The whole- layer skin was cut off with same method. Thin split-thickness skin (TIS) 0.1-0.2 mm was collected with drum dermanuring machine and soaked in physiological saline. The same method was used to collect the managed TE true skin and cover it on the wound, covering immediately on autoTTS. The rest management was same as TE whole-layer group. ④ Autograft group: The whole-layer skin was cut off and the fat tissue was removed, afterwards, it was re-grafted on the auto-wound, covered with various layers of dressing and bandaged with compression. ⑤ The survival case was determined if it was discovered no infection, necrosis and scaling of grafted skin, less than 3 mm in diameter when the wound was opened for changing fresh dressing each time, otherwise, the failed case was recorded. The survival rate in each group was analyzed statistically in 4 weeks after operation.MAIN OUTCOME MEASURES: Survival situation of grafted skin in 4weeks after operation in each group.RESULTS: In 4 weeks after operation, the survival rate of grafted skin was 75% in TE whole-layer group was 87% in TE dermal and auto-epidermal group and was 94% in auto-graft group. The results were similar basically in comparison among 3 groups (x2=-2.34, P ＞ 0.05).CONCLUSION: The effect of TE skin graft on repair of skin defect is near to that of auto-epidermal graft, testifying that the repair of skin defect with TE skin is feasible.

Objective To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI). Methods An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose>10 mmol/L) and known diagnosis of diabetes mellitus (DM) ,these patients were divided into four groups, Ⅰ :no DM and normal glucose group (control group) ; Ⅱ : DM but normal glucose group; Ⅲ : no DM and hyperglycemia group; and Ⅳ: DM and hyperglycemia group. Results Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group Ⅲ 17. 1% vs group I 8.6%, group Ⅳ 18.6% vs group Ⅰ 8. 6%, P<0.001) and also an increased incidence of MACE (group Ⅲ36. 3% vs group Ⅰ 21.6%, group Ⅳ 38. 8% vs group Ⅰ 21.6%, P<0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group Ⅱ 11.6% vs group Ⅰ 8. 6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group Ⅰ patients, group Ⅲ and group Ⅳ had a risk of death of 1.51 fold(OR 1.51,95% CI 1.22-1.87,P<0.001) and 1.83 fold(OR 1.83,95% CI 1.40-2. 39, P<0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05,95% CI 1.04-1.07,P<0.001), but DM without hyperglycemia was not so (OR 1.11,95% CI 0. 87-1.42, P =0. 412). Conclusions The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia isv not associated with the short-term mortality.

Objective To discuss the influence of anatomical variations of the cystic duct on preoperative diagnosis and operational scheme for cholecystectomy. Methods A 47-year-old woman was admitted to our hospital with diagnosis of cholecystolithiasis. Ultrasonography suggested minimal intra- and extrahepatic ductal dilatation. Laboratory tests showed that serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were 189 IU/L, 366 IU/L and 144 IU/L, respectively. In order to make a certain diagnosis, the patient received both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Results MRCP showed the bile duct slightly dilated with a shuttle shape figure and a lower signal with a strip form in it. MRCP could not confirm the quality of this signal and was doubtful of choledochus diaphragma. Subsequently, ERCP was applied to demonstrate that the cystic duct was collateral with the common hepatic duct when arriving into its left side and converged into the bile duct with a lower position, which was the reason for why MRCP misjudged the formation of choledochus diaphragma in the bile duct. Finally, the patient underwent open cholecystectomy. Conclusion There are some kinds of variations in the cystic duct including course, appearance and location of confluence. Combing MRCP with ERCP can significantly elevate the diagnostic accuracy of the cystic duct before operation, especially in those patients with doubtful diagnosis upon admission. To avoid biliary injury as much as possible, open cholecystectomy is superior to the laparoscopic cholecystectomy (LC)with regard to the patients suffering from cholecystolithiasis complicated with variation of the cystic duct.

Objective To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) transplantation on angiogenesis and functional recovery after focal cerebral ischemia in rats.Methods BMSCs were isolated and cultured using the whole bone marrow adherent method,and conducted phenotypic identification using flow cytometry analysis of surface positive antigen of CD29,CD90 and the negative antigen of CD34,CD45.Rats were subjected to middle cerebral artery occlusion (MCAO) for 90 minutes,and divided into three groups randomly,the sham group,model group and BMSCs group.24 hours after cerebral ischemia,rats were injected with 1 ml BMSCs solution (1 × 106 cells/ml) or PBS via the tail vein.The modified neurological severity score(mNSS) test,the corner test and the adhesive tape test were used to evaluate sensorimotor function on the 1,7,14 and 28 days after ischemia.Infarcted volume was detected by toluidine blue staining,and the numbers of vWF positive microvessels and vascular endothelial growth factor (VEGF) positive cells in the ischemic boundary were determined by immunofluorescence.Results By flow cytometric analysis,the cell phenotype of passage 3 BMSCs showed that CD29,CD90,CD34 and CD45 were 98.3％,97.4％,0.2％ and 4.8％,respectively.Compared with the model group,BMSCs significantly reduced the score of mNSS(P＜0.01),the number of right turn of corner test(P＜0.05),latency of removal adhesive tape(P＜0.05) and the infarcted volume (P＜0.01).The numbers of vWF positive vesscls and the VEGF positive cells were (42.97±8.64)/mm2 and (54.83± 10.66)/mm2 at the boundary zone in model group 14 days after ischemia,respectively.BMSCs significantly increased the numbers of vWF positive vessels ((69.43± 7.29)/mm2) and VEGF positive cells ((78.70±6.16)/mm2,P＜0.01).Conclusion BMSCs can improve the functions of cerebral lesions after cerebral ischemia,which may be associated with the enhanced angiogenesis and VEGF expression in the ischemic boundary.

Objective To explore the effect of nucleos(t)ide analog (NA)antiviral treatment on the pathological differentiation of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC)and the prognostic factors of HCC.Methods Totally 127 patients with HBV-related HCC who were hospitalized and received partial hepatectomy in First Affiliated Hospital of Harbin Medical University from March 2007 to November 2013 were included in this study.Sixteen cases received antiviral treatment before operation and the remaining 111 cases had no history of NA treatment.The differences of histopathological grading were compared between the two groups.Twenty-nine patients received antiviral treatment for the first time after surgery,and the rest 82 patients did not.All these patients were followed up for survival and recurrence.Multivariate analysis was used to explore the prognostic factors for HCC.The categorical variables were analyzed byχ2 test or Fisher exact test.Survival rate was compared with Log-rank test. Univariate or multivariate Cox regression analysis was used to explore the related factors of survival. Results The proportions of well-,moderately- or poorly-differentiated HCC in patients with antiviral treatment before surgery were 18.75 %,68.75 % and 12.5 %,respectively.Whereas the proportions in those without treatment were 16.22%,66.67% and 17.11 %,respectively.There was no significant difference in histopathological grading of HCC between the two groups (χ2=0.224,P =0.885 ).The overall median survival time was 39 months.The 6-month,1-and 2-year survival rates were 91 .7%, 77.5 % and 59.3%,respectively.The 6-month,1- and 2-year survival rate of postoperative antiviral treatment were 96.3%,92.4% and 78.5 %,respectively,which were significantly higher than those of no antiviral treatment group (85 .9%,70.0% and 48.5 %,respectively;χ2= 6.967,P = 0.008 ). Univariate analysis showed that tumor number,size,portal vein transfer,AFP level,postoperative antiviral treatment,histopathological grading,TNM staging,BCLC staging,γ-GT and PTA were prognostic factors for postoperative HCC survival.Multivariate analysis showed that AFP level (HR=1 , 95 %CI :1 .0004—1 .002,P =0.004),postoperative antiviral treatment (HR =0.38,95 %CI :0.38—0.15 ,P =0.04)and BCLC stage (B vs A:HR=1 .55 ,95 %CI :0.76—3.18;C vs A:HR=3.63,95 %CI :1 .31 —10.09,P =0.04)were independent prognostic factors.Conclusions Preoperative antiviral treatment has no impact on the histopathological grading of HCC. BCLC stage, AFP level and postoperative antiviral treatment are independent prognostic factors for HBV-related HCC.

Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei (PM) infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results (1) The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture.All the 12 cases (100％) had irregular fever (38-41 ℃) and enlarged lymph nodes, 8 cases (66％) had skin rashes; 8 cases (66％) had hepatomegaly; 9 cases (75％) had splenomegaly while 8 cases (66％) had anemia. (2) Imaging manifestation: Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 zases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung,and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS (CD4T lymphocytes ＜50/μ L) with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver,spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of cakes.