Objective Evaluate the outcome of aortic root reconstruction on the analysis of the risk factors influencing surgical results. Methods Between August 1996 and November 2009, 92 patients(56 men, 36 women) aged from 14 to 77years [mean (44.8 ±1.4) years] with aortic root aneurysm underwent aortic root reconstruction. 72 patients had over moderate aortic valve insufficiency. 47 patients suffered from Marfan syndrome. The aortic pathology was aortic dissection in 45. Bentall technique was used in 59 patients, the button technique in 13, the David I with the Valsalva graft in 6 patients and the aortic valve resuspension in 14 patients. Results The hospital mortality rate was 8.7%. The major complications 31. 7%. 18patients died during the period of follow-up. Late complications among 55 survivors were 12. Univariate predictors of the morbidity were the presence of male, non-Marfan, concomitant procedure, deep hypothermia cardiac arrest, aortic cross clamp time and blood infusion. Risk facts for mortality were emergent or urgent operation, aortic dissection, concomitant procedure, aortic cross clamp time and blood infusion. Multivariate analysis revealed risk factors of concomitant procedure and blood infusion were responsible for both morbidity and mortality. The overall long-term survival rate is (97.1 ±2.0)% at 1-year, (88.1 ±4.7)% at 5-year, (54.0 ±9.2)% at 10-year. The mean for survival time is (9.9 ±0.59) years, 95% confidence interval 8.70 -11.01. Conclusion The aortic root restitution procedures are safe and effective in general. The short and long-term outcome is satisfactory. The button technique is the first choice for reimplantation coronary patch. Valve-sparring aortic root reconstructions show promise in safety and applicability.

Objective: To Study the effects and feasibility of life quality list for idiopathic pulmonary fibrosis(IPF) patients.Methods: Applying the self-made life quality evaluating list,life qualities of 36 cases of IPF patients were analyzed and compared before and after the intervention of traditional Chinese medicine.Results: The evaluating list of life quality is available for IPF patients.Conclusion: The evaluation of life quality is an available method for the observations of clinical therapeutic effect and health status on IPF patients and it is worth further investigation.

By co-culturing humm mesenchymal stem cells (hMSCs) and human umbilical rein endothelial cells (HUVECs) under hypoxia and creating a microenvironment similar to that of transplanted hMSCs for the treatment of avascular ni ANFH, the effect of hMSCs on survival, apoptosis, migration and angiogenesis of human umbilical vein endothelial cells (HUVECs) under the hypoxic condition were investigated in vitro. hMSCs and HUVECs were cultured and identified in vitro. Three kinds of conditioned media, CdM-CdM(NOR), CdM-CdM(HYP) and HUVEC-CdM(HYP) were prepared. HUVECs were cultured with these conditioned media under hypoxia. The survival rate, apoptosis rate, migration and angiogenesis of HUVECs were respectively detected by CCK-8, flow cytometry, Transwell and tube formation assay. The content of SDF-1α, VEGF and IL-6 in CdM was determined by ELISA. Our results showed that hMSCs and HUVECs were cultured and identified successfully. Compared with MSC-CdM(NOR) and HUVEC-CdM(HYP) groups, the survival rate, migration and angiogenesis of HUVECs in MSC-CdM(HYP) group were significantly increased while the apoptosis rate was declined (P<0.05). Moreover, the expression of SDF-1α, VEGF and IL-6 in MSC-CdM(HYP) group was up-regulated. Under hypoxia, the apoptosis of HUVECs was inhibited while survival, migration and angiogenesis were improved by co-culture of hMSCs and HUVECs. The underlying mechanism may be that hMSCs could secrete a number of cytokines and improve niche, which might be helpful in the treatment of femoral head necrosis.

Objective To investigate the value of KIM-1 and NGAL in predicting the early diabetes nephropathy(DN).Meth-ods 132 cases of type 1 and type 2 diabetic patients were recruited in this study,patients were divided into four groups based on the urine albumin/creatinine and serum creatinine levels,as follows:normal albuminuria group (45 cases),mi-croalbuminuria group (36 cases),clinical albuminuria group (30 cases),renal failure group (21 cases),65 healthy subjects were recruited as control group.Urinary KIM-1 and NGAL levels were measured by enzyme linked immunosorbent assay (ELISA).Results With the progress of DN,urinary KIM-1 and NGAL levels gradually increased (P<0.05),the urinary KIM-1/Ucr level was positively correlated with ACR (r=0.822,P<0.01),and the urinary NGAL/Ucr was positively cor-related with ACR (r=0.842,P<0.01).Conclusion The urinary KIM-1 and NGAL level can predict the occurrence of ear-ly DN,and also monitor the progression of DN.

Objective To evaluate the clinical effects and experiences of short stem ceramic-on-ceramic total hip arthroplasty in the treatment of young and middle-aged patients with femoral head necrosis.Methods From December 2009 to March 2011,40 patients with femoral head necrosis were treated primarily with short stem ceramic-on-ceramic hip arthroplasty (43 hips) through posterior-lateral or anterior-lateral approach.There were 23 males,17 females； with the mean age of 40.5 years (range,27-55 years).All cases were stage Ⅳ or more according Steinberg stage.The patients were followed up at the 3,6,12 months after operation,and then once each year.Standard X-ray films were taken at the follow-ups.Femoral prosthesis subsidence was assessed through X-ray films.Harris scores system and WOMAC Osteoarthritis Index were recorded before and after operation to evaluate clinical effects of surgery.Results Thirty-eight patients (41 hips) were followed up for 21-36 months,with an average of 31.3 months.The femoral stem subsided 0.68±2.90 mm at the last follow-up.After operation,hip pain of patients was relieved obviously.The Harris score improved from 38.7±12.1 (15-66) preoperatively to 95.2±4.49 (83-100) postoperatively,WOMAC Index from 66.7±12.0 (49-94) to 12.8±5.6 (0-24).During follow-up period,there was no serious complication such as femoral neck fracture,infection of wound,pulmonary embolism,et al.No dislocation,implant prosthesis failure and infection were observed.Conclusion The short stem hip arthroplasty preserves bone stock to a great extent.The short stem implant showed a good stability and osseous integration.The wear rate of ceramic-on-ceramic bearing surface is extremely low.Short stem hip arthroplasty plus ceramic-on-ceramic bearing surface might be a good option for the young and middle-aged patients with femoral head necrosis.

Objective To evaluate the clinical indications and outcomes of dynesys neutralization system in the treatment of degenerative lumbar diseases.Methods From January 2007 to December 2011,102 consecutive patients with degenerative lumbar spine diseases underwent posterior decompression and internal fixation with the Dynesys dynamic neutralization system.Among them,69 patients were followed up,including 39 males and 30 females,aged from 30 to 62 years (average,44 years).The series of cases were composed of 24 cases of lumber disc herniation,35 cases of degenerative spinal stenosis,10 cases of degenerative changes of lumbar discs.Results The mean follow-up period was 35 months (range,6-44 months).The visual analogue scale (VAS) score decreased from preoperative 8.6 (range,6-9) to postoperative 2.8 (range,0-5),and the Oswestry disability index (ODI) improved from preoperative 73％ (range,30％-91％) to postoperative 30％ (range,0-61％).There were no implant failure or infection.According to the evaluation criteria of surgical treatment for low back pain,which was established by the Chinese Orthopaedic Association,the result was excellent in 53 patients,good in 12 patients,fair in 4 patients and poor in 1 patient.Conclusion The Dynesys dynamic neutralization system is effective in the treatment of degenerative lumbar spine disease,which can reserve the range of motion of stabilized segments,prevent degeneration of adjacent segments and improve clinical outcomes.

Objective To retrospectively analyze the methods and clinical outcome to treat Crowe type Ⅳ developmental dysplasia of the hip (DDH) in young adults with total hip arthroplasty (THA) after limb-lengthing with external fixator.Methods From October 2007 to January 2012,12 patients with unilateral Crowe type Ⅳ DDH were treated with two-staged surgical method in our department.There were 2 males and 10 females with an average age of 25.7 years (range,18-35 years).In the first stage,the patients underwent soft tissue relaxation and iliofemoral distraction with use of an external fixator for 10-17 days.There were 1-2 cm distraction at the first time and 3-5 mm daily distraction.When the femoral head was distracted to the level of anatomical position,the second stage-THA was performed.All patients underwent uncemented prosthesis with bulk femoral head autograft for acetabular reconstruction.The acetabular cup was placed in the anatomical position in every patient.Shortening femoral osteotomies were not required.Results The mean time of first operation was 35.2±3.6 min,and hospital stay was 13.3±1.6 days.The mean time of second operation was 77.3±12.4 min,and hospital stay was 9.2±2.5 days.The average follow-up was 13.6±3.2 months,limb-length discrepancy was 5.6±1.5 cm on average preoperatively and 0.5±0.2 cm on average postoperatively.The Harris hip score was increased from 45.7±2.6 preoperatively to 92.3±3.3 postoperatively.All of the cases had acquired good hip and knee function.No patient suffered pin-site infection,hip joint infection,prosthesis loosening or deep vein thrombosis in our research.Transient nerve palsy occurred during the leg limb lengthening in 3 cases; calf skin numbness after THA occurred in 5 cases.Conclusion For the Crowe type Ⅳ DDH in young adults,normal limb length can be restored nearly and avoid nerve injury via continuously limb-lengthing with external fixator before THA.This method can get precise results,improve limb function significantly and have fewer complications.

Objective To enhance the test efficiency and management level of medical record quality by designing and using med-ical record quality management system based on new electronic medical record .Methods System design and development were based on JAVA ,consisting of data exchange platform and medical record quality management system .The platform used C/S archi-tecture and the main program used B/S architecture .Achieved the integration with new electronic medical record and clinical infor-mation system through data exchange with business database .Results The supervision model and business workflow of medical re-cord quality were changed ,and the process and terminal medical record quality were promoted .Conclusion Design and application of the system can provides strong support for medical record quality management ,supplys effective supports for supervision of med-ical record quality ,and plays positive role in promoting medical record quality ,clinical work efficiency ,and medical quality .