To study the expression of bone morphogetic protein(BMP) and transforming growth factor β１（TGF-β１) in regenerative gap during lengthening period. Method: The right tibia of 14 mature rabbits were lengthened using metaphyseal osteotomy. Distraction was started on the 4th day postoperatively, 1mm per day and conducted twice each day. The expression of endogenesis BMP and TGF-β１ in regeneraive gap were observed during ten weeks after distraction by histology and immunohistochemisty. Results: The result showed that bone morphogetic protein(BMP) and transfoming growth factor β１(TGF-β１) were expressed in chondrocytes, osteoblasts, and fibroblasts. The expression of BMP was at a high level in initial two weeks after distraction while the expression of TGF-β１ was increased step by step. Then both of them decreased alonged with lengthening proceeding. Two weeks after distracting stopped, the expression of BMP could not being observed. But the expression of TGF-β１ could being observed all stage after distraction stopped. Conclusion: BMP and TGF-β１ were expressed persistently in regenerative gap during bone lengthening.

Budd-Chiari syndrome (BCS) is a rare disease. Because of lack of clear characteristic symptoms in the early stage, many patients are misdiagnosed or never diagnosed. Early diagnosis and prompt treatment play a key role in improving survival rates and quality of life for BCS patients. With the progress in imaging techniques, the radiological examination is playing more and more important role in the diagnosis and assessment of BCS. Ultrasound, computed tomography, magnetic resonance imaging and digital subtraction angiography are all helpful in evaluating the obstruction of hepatic vein and inferior vena cava. Thus, these imaging tests should be used rationally according to their features. On the other hand, the interventional therapy is the preferred method for the treatment of BCS. This paper intends to get a deeper understanding of BCS for clinicians, which is essential for patients to be diagnosed in time.

BACKGROUND: As reported in some literatures, articular dysfunction following limb lengthening is one of the commonest complications, but some scholars believe that the articular dysfunction after lower limb lengthening is avoidable providing appropriate technical operation and effective function prevention.OBJECTIVE: To investigate the changes of articular function of knee during limb lengthening in rabbits so as to provide a experimental basis for clinical tasks.DESIGN: A randomized controlled trial SETTING: Department of Orthopeadics, Affiliated Hospital of Some Military Medical University.PARTICIPANTS: Study was conducted in the Experimental Animal Center of the Third Military Medical University of Chinese PLA from February 2001 to June 2002. Totally 30 healthy adult New Zealand rabbits obtained from the Experimental Animal Center of the Third Military Medical University of Chinese PLA were randomly divided into lengthening group and delayed observation group(observed at 3 months after the stop of lengthening).METHODS: Every group was further divided into three sub-groups according to distraction range: 10%, 20% and 40%. Upper-tibia metaphysis distraction was adopted at the rate of 1 mm per day . Distraction and iconography changes of knee joint were observed with X-ray. The motive range of knee was investigated at the end of distraction and three months later.MAIN OUTCOME MEASURES: Articular motive range of the knee before the distraction, at the end of distraction and three months later, X-ray resutls RESULTS: ① There was no obvious radiographic change in knee at every time point in each group. ② Significant flexion disorder in knee was found in 20% distraction subgroup( P ＜ 0. 05), which was only 44. 7% of normal motive range in 40% distraction subgroup( P ＜ 0. 01) . Motive functions of knee in delayed observation group were significantly improved; thereinto,20% distraction subgroup returned to preoperative level, while 40% distraction subgroup also had significant improvement compared with that of 3 months earlier but still lower than normal level, which was only about 88.5% of normal level( P ＜ 0.05).CONCLUSION: Temporary articular dysfunction might occur during limb lengthening process, and mostly during big range of distraction. Although the dysfunction could be gradually recovered after the stop of lengthening, active prevention is still necessary.

Objective To study the clinical significance of the caudate lobe vein in patients with Budd-Chiari syndrome (BCS) by contrast-enhanced magnetic resonance imaging(MRI).Methods Contrast-enhanced MRI data of 46 patients with BCS, 30 patients with cirrhosis due to hepatitis B virus (HBV) and 49 healthy people in our institution were analyzed retrospectively.The presence and diameter of the caudate lobe vein among the three groups were measured.Among the BCS group, in which the caudate lobe vein could be seen, andpatients were divided into two groups according to disease duration and patency of inferior vena cava (IVC), respectively.And comparative study of diameter between two groups was performed.Results ①The caudate lobe vein was noted in 76.1% of patients with BCS, in 30.0% of patients with cirrhosis due to HBV,and in 36.7% of healthy subjects.The diameter of caudate lobe vein in BCS group was larger than that in both cirrhosis group and healthy group(P<0.01).There was no statistically difference between cirrhosis group and healthy group(P>0.05).②Among BCS group,the caudate vein was shown in 35 patients, with mean diameter of(4.21±1.66)mm.For 35 BCS,the diameter of caudate lobe vein in chronic group was larger than that in acute group(P<0.05).The diameter of caudate lobe vein in IVC obstruction group was larger than that in IVC open group(P<0.05).Conclusion The demonstration of the caudate lobe vein on contrast-enhanced MRI is of great significance in the diagnosis and treatment of BCS.

Objective To compare the clinical value of three-dimensional dynamic contrast enhanced magnetic resonance angiography (3D DCE MRA) and digital subtraction angiography (DSA) in diagnosing inferior vena cava diseases in suspected case of Budd-Chiari syndrome (BCS).Methods Radiological findings of 91 suspected BCS cases obtained from 3D DCE MRA and DSA in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.DSA test was considered as golden standard,which assess the capacity of 3D DCE MRA in diagnosing inferior vena cava diseases,including sensitivity,specificity and accuracy.Kappa test was utilized to compare the coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases.Results Among 91 suspected BCS cases with 3D DCE MRA,a total of 17 cases without inferior vena cava diseases were misdiagnosed as inferior vena cava stenosis,two patients with inferior vena caval obstruction was misdiagnosed as falsely negative.Seventy-two patients with 3D DCE MRA were confirmed via DSA in diagnosing inferior vena cava diseases,sensitivity was up to 97.7％ (58/60),false positivity 54.8％ (17/31),specificity 45.2％ (14/31),respectively.Fair coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases (Kappa =0.474,P ＜ 0.05).Conclusions There could be clinical value of 3D DCE MRA for its high sensitivity and low specificity in diagnosing inferior vena cava diseases,and favorable coincidence ratio was discovered between 3D DCE MRA and DSA.Comprehensive consideration is needed for suspected cases of inferior vena cava stenosis detected by 3D DCE MRA,and further analysis may figure out potential causes of misdiagnosis and decline false positive events.

Objective To investigate the relationship between smoking and insulin resistance in non-obese male patients with CAD. Methods 414 consecutive non-obese male patients with angiographically-documented CAD(luminal diameter narrowing>50%)were recruited,including 113 nonsmokers and 301 smokers.With 99 miht smokers(<400 packs/year),95 medium smokers(400-799 packs/year)and 107 heavy smokers(≥800 packs/year).Insulin resistance index(IRI)was expressed by homeostasis model assessment for insulin resistance(HOMA-IR)calculated by the formula of[fasting serum glucose(mmol/L)×fasting plasma insulin(mU/L)]/22.5.IRI≥2.69 was defined as insulin resistance,while IRI<2.69 was insulin sensitive.Fasting glucose,fasting insulin and IRI were recorded and odds ratio for the incidence of insulin resistance was calculated.Results Fasting glucose was higher in heavy smokers (5.86 mmol/L)than that in nonsmokers(5.51 mmol/L,P=0.037)and mild smokers(5.33 mmol/L,P=0.014).Fasting insulin and IRI were also significantly higher in heavy smokers(10.25 mU/L)than those in non-smokers(8.72 mU/L,P=0.0231,respectively)and mild smokers(8.67 mU/L,P=0.023 1).Compared with nonsmokers,the odds ratio for the incidence of insulin resistance was 1.53(95%CI 0.55-2.94;P=0.027)in medium smokers and 1.89(95%CI 0.49-3.14;P=0.018)in heavy smokers.Conclusions The relationship between smoking and insulin resistance is highly dose dependent in non-obese male patients with CAD.

Objective To evaluate the value of serum uric acid(UA)levels with reference to the age,waist circumference,and body mass index(BMI)in predicting the metabolic syndrome(MS)in obese children.Methods A total of 300 obese children,including 180 boys and 120 girls,were enrolled in this study.The height,BMI,waist and hip circumference,blood pressure,serum glucose,insulin and lipid profile in all participants were measured.Oral glucose tolerance test and insulin releasing test were performed.The boys or girls were divided into 4 groups according to the 4 quantile of UA level,respectively.The clinical characteristics and correlation of UA with the clinical indexes and MS components were compared.The binary Logistic regression analysis was applied in the risk of MS and its components for the 4 groups of obese children.The area under the receiver operating characteristic curve(ROC curve)of UA level,age,waist circumference and BMI were used to predict the MS.Results UA level was increased with the increase of age,waist circumference and BMI,and the UA level was significantly correlated with triacylglycerol,postprandial 2 h glucose(2 h PG)(r=0.196,0.174 in boys;r=0.291,0.179 in girls).In boys,the adjusted odds ratio and 95％CI of the highest quartile of UA for triglyceridemia was 2.71(95％CI:0.77-9.58);which in girls,the adjusted odds ratio and 95％CI of the highest quartile of UA for hyperglycemia,hypertension were 8.45(95％CI:1.76-40.52)and 3.93(95％CI:0.66-23.33),respectively,with significant differences.In boys,the area under the ROC curve of UA level,age,waist circumference and BMI which predict the MS were 0.652 0.626,0.621,0.62,respectively,and the differences were significant(all P<0.05).Conclusions The UA level is significantly correlated with the composition of MS,UA detection combining with reference to the age,waist circumference,and BMI is helpful for the identification of high risk groups of metabolic syndrome.

Objective To evaluate the relationship between the extravascular lung water (EVLW) and other markers of lung injury and determine whether or not EVLW predicts survival in patients with acute respiratory distress syndrome (ARDS) and examine if indexing EVLW with predicted body weight (EVLWp) strengthens its discriminative power.Methods EVLW and other markers of lung injury [including:PaO2/FiO2(P/F),oxygenation index (OI) =mean pressure (Pm) × FiO2 × 100/PaO2,static compliance (Cst) and lung injury score (LIS)] were measured prospectively for 3 days in 27 patients with early ARDS between January 2011 and December 2011 at intensive care units (ICU) of Subei People's Hospital.The relationship between indexing EVLW with actual body weight (EVLWa),EVLWp and other markers of lung injury,the 28-day mortality were evaluated.Results Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),fluid balance in first 3 days,days of mechanical ventilation and ICU stay were significantly higher on admission in nonsurvivors compared with survivors (P ＜ 0.05).Nonsurvivors had higher OI,LIS,EVLWa and EVLWp than survivors at Days 1 and 3 (P ＜ 0.05).EVLWa and EVLWp were correlated positively with LIS (r =0.471,0.528 P ＜ 0.05) and OI (r =0.527,0.627,P ＜ 0.05) and negatively with P/F (r =-0.467,-0.646,P ＜ 0.05).EVLWp had a stronger correlation to LIS,OI and P/F than did EVLWa.No obvious correlation existed between EVLWa,EVLWp and Cst (r =-0.260,0.226,P ＞ 0.05).ROC curve analysis indicated that EVLWp (0.759,P ＜ 0.05) but not EVLWa (0.661,P＞0.05) discriminated between survivors and nonsurvivors.Three-dav average EVLWp ≥12.5ml/kg predicted the 28-day mortality with 62.5％ specificity and 80％ sensitivity.Conclusion Increased extravascular lung water is a feature of early ARDS and predicts survival.EVLWp,instead of EVLWa,improves the predictive value of extravascular lung water for survival and it is correlated with markers of disease severity.

AIM: To observe the anti-inflammatory effect of CQMUH-011 and to explore its mechanism.METHODS: Three kinds of animal models, mouse ear swelling induced by xylene, rat granuloma induced by cotton ball and rat rheumatoid arthritis induced by Freund's complete adjuvant, were established to study the anti-inflammatory effect of CQMUH-011.The ear swelling degree, dry weight of cotton ball granuloma, arthritis index, paw swelling and ankle joint pathological changes were measured to reflect the severity of inflammation.The anti-inflammatory mechanisms of CQMUH-011 were investigated by detecting the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by ELISA.Malondialdehyde (MDA), myeloperoxidase (MPO) and nitric oxide (NO) were determined by corresponding kits.RESULTS: Treatment with CQMUH-011 significantly decreased TNF-α, IL-6 and NO concentrations, MDA contents and MPO activity in the serum.Meanwhile, Ear swelling degree, dry weight of cotton ball granuloma, arthritis index, paw swelling and ankle joint pathological damage were attenuated.CONCLUSION: CQMUH-011 has an anti-inflammatory effect, which may be related to inhibiting the production of inflammatory factors and attenuating lipid peroxidation.

Objective To evaluate the effects of prone position ventilation (PPV) combined with inhalation of NO on oxygenation of acute respiratory distress syndrome (ARDS) patients.Methods A total of 21 patients with ARDS composed of 15 male and 6 female aged ranging from 2 to 74 years with mean age of 39 ± 17.4 years were hospitalized from September 2008 through January 2011.After application of mechanical ventilation with optimal PEEP,patients still needed the high concentration oxygen inhalation (FiO2 ≥ 60％).They were randomly (random number) divided into three groups for controlled study.Patients of group A were given NO in addition to oxygen inhalation for 4 hours,patients of group B were put in prone position ventilation with oxygen inhalation for 2 hours,then they were returned to the supine position ventilation,and patients of group C were put into prone position ventilation with inhalation of oxygen plus NO for 2 hours,and then they were returned to the supine position ventilation,but they were continued to inhaled NO.The oxygenation indexes of three groups of patients were measured before the intervention,2 hours and 4 hours after the procedure of experiment.Results The oxygenation indexes of three groups of patients were improved in terms of comparison between pre-intervention and 2 hours after intervention,but there was no statistically significant difference found in group A (P ＞ 0.05),the differences in group B and group C were statistically significant (P ＜ 0.05).Compared the oxygen index between pre-intervention and 4 hours after intervention,the differences in group A and group B were not statistically significant (P ＞0.05),but the difference in group C was statistically significant (P ＜ 0.05).Conclusions PPV could improve oxygenation in acute respiratory distress syndrome (ARDS) patients.PPV with NO inhalation could improve oxygenation in acute respiratory distress syndrome (ARDS) patients as well as effectively maintain the oxygenation after patients were returned to the supine position ventilation.Therefore prone position ventilation combined with inhalation of NO improved oxygenation and at the same time reduced the prone position time.