Objective To seek an effective method for the treatment of grade ⅢB tibial fractures.Method From Oct. 1985 to Oct.1999, 26 cases of grade ⅢB tibial fractures were treated by early soft tissue coverage(including 12 cases of free muscle flaps and 14 cases of local muscle flaps), early fracture fixation(including 21 cases of external fixation and 5 cases of non-reamed intramedullary nail) and early bone grafting(15 cases).Results The follow up duration were from 10 to 32 months with an average of 15.5 months. The success rates of free and local muscle flaps were respectively 91.7 %(11/12) and 92.9 %(13/14)?Infection occurred in 5 cases (3 cases of local superficial infection and 2 cases of osteomyelitis). The time for bone union were from 17 to 66 weeks with an average of 42 weeks. Conclusion "San-Zao"therapy,especially early soft tissue coverage and early fracture fixation is on effective management for grade ⅢB tibial fractures with the advantages of promoting wound healing and bone union and decreasing the possibility of infection.

Objective: To present a modified option to surgical crown lengthening for repair of biologic width loss. Methods: The alternative to the traditional method involves reshaping the fractured root surface in combination with conservative removal of the supporting alveolar bone to rebuild the biological width. Although these teeth were considered as not suitable for the traditional methods, 7 teeth from 7 patients with fracture surface located lower than alveolar bone crest were treated by this modified method of surgical crown lengthening. Restoration was accomplished on these teeth two month later. Periodontal index such as tooth mobility, plaque index, probing depth and bleeding index were recorded and followed up. Results: The mean follow-up period was 17 months (ranged from 10 to 31 months). Result of surgery and restoration of these 7 teeth was satisfactory. The gingival tissue remained healthy and esthetic with good function. Conclusion: This modified surgical crown lengthening can be used as an alternative to the traditional method to save more fractured teeth.

Objective To evaluate the value of endoscopic ultrasound (EUS) in differentiatied diagnosis for stromal tumour and lipoma in duodenal tract.MethodsThe EUS images of 44 cases of stromal tumour(30 cases) and lipoma( 14 cases) which were confirmed by pathological results were analyzed retrospectively.The location,size,layer of origin,margin,internal echo pattern and homogeniety of the lesion were recorded and compared.Results Compared with lipoma,stromal tumour showed a significant difference in the layer of origin,margin,internal echo and homogeniety ( P ＜ 0.05 ),but there was no statistical difference in the lesion location and size( P ＞0.05).ConclusionsEUS is greatly helpful to the differential diagnosis of stromal tumour and lipoma in duodenal tract.

Objective To investigation the hydrogen ion excretion of renal tubule in 26 renal transplantation patients for 10 weeks after operation.Methods The medistream urine pH,HCO_3~-,NH_4~+ and titration acid(TA) in 26 cases of renal transplant recipients were detected before and consecutively 10 weeks after renal transplantation,and the net acid content(NAC) was calculated.Results The function of renal tubule was recovered soon but unsteadily in the early stage after transplantation, and tended to be stable after 6 weeks.The levels of TA,NH_4~+ and NAC were significantly lower in 15 cases of acute rejections episodes.The levels were increased quickly in recipients with mild rejection and good therapeutic efficacy to steroids,but slowly in those with severe rejection,requirement of anti-thymic lymphocyte globulin(ATG) or resistant to steroids.Conclusion The function of hydrogen ion excretion of renal tubule may be a better parameter than serum creatinine in reflecting the renal tubule function.It will be useful in the diagnosis of acute rejection during the consecutive observation,especially in the judgement of antirejection therapy and evaluation of prognosis.

Objective To observe the influence of chitosan on the skin and soft tissue expansion.Methods Twenty-five patients were selected,who were suitable to be embedded soft tissue expanders in the face,a 100-milliliter expander was implanted in one side of the face,and other side was used as control.A 100-milliliter expander was implanted in each group,and a slender silicon duct was embedded between the expander and subcutaneous tissue in the experimental group.About five to seven days after the operation,the negative drainage tube was removed,and then two-milliliter medical chitosan injected with the silicon duct in the experimental group,but not in the control group.Two groups were injected with normal saline in the second day.The center of expanded skin was pressed and skin elasticity and relaxation were compared between the two groups during the injection interval.The time of injection interval,the quantity of normal saline inside the expanders after two weeks and three weeks and the total time of expansion to 100 milliliters were recorded.After injection was completed in the two groups and maintained for two weeks.In the stage Ⅱ operation,the expanders were taken out,1 cm × 1 cm fibropeplos was removed from the center of the expanded skin flap from the two groups,and pathological section was prepared to measure the thickness of fibropeplos,average gray scale of collagen and the quantity of blood capillaries.The fibroblasts,collagen fiber and capillaries were observed and compared under light microscope.A matched-pairs t analysis was used to analyze the data.Results Compared with the control group,the quantity of normal saline inside the expanders in the experimental group was increased at the same time; the water injection period was shorten and tissue expansion was significantly accelerated.The number of fibroblasts in the fibropeplos decreased with the influence of chitosan.The fibroblasts were restrained to mature period and collegan decreased.The fibropeplos became thinner but the capillaries were not affected.Conclusions Chitoson can inhibit fibroblast proliferation and collagen production,and the effect of accelerating tissue expansion is significant and deserves to be recommended.

Objective To cxplore the variation of the range of motion (ROM) of operative level after different heights of artificial cervical disc replacement,and to provide guidance for clinical work in selecting appropriate height of artificial cervical disc prosthesis.Methods The preoperative cervical anteroposterior and lateral Ⅹ-rays of 9 fresh male cadaveric cervical spine specimens were obtained to measure the intervertebral height of C5-6,and 3 screened specimens with the height of about 5 mm were included in the experiment.The experiment was designed to test self-control,and other four groups of cervical specimens including intact group,appropriate height (5 mm) of C5.6 artificial cervical disc replacement group,1mm increased (6 mm) group and 2 mm increased (7 mm) group were made biomechanical test sequentially.The specimens were fixed to the cervical three-dimensional movement machine,with a 75 N follower load and pure moments of 2 Nm for flexion/extension 、left/right bending and left/right axial rotation,to measure the ROM of operative level under the condition of changes in 0.2 Nm/s.Results There were no significant differences in the ROM of flexion/extension,lateral bending and axial rotation between 5 mm group and intact group;the ROM of flexion/extension、lateral bending and axial rotation in 6 mm group increased compared with 5 mm group,but the difference was not statistically significant;the ROM of flexion/extension in 7 mm group was significantly less than that of intact,5mm and 6 mm group (9.5°± 1.0° vs 12.5°±0.9°、11.3°±0.8°、11.6°±0.9°),but significantly greater in axial rotation than 6 mm group (10.4°±1.4°vs 8.6°±0.3°),and there was no significant difference in lateral bending compared with other 3 groups.Conclusion 2 adjacent heights of cervical disc prostheses are implantedsuitably when testing the mold of disc prosthesis,the choice of cervical disc prosthesis with 1 mm increased can improve the ROM of operative level to some extent;while the height with 2 mm increased can lead to the ROM of flexion/extension at the operative level reduced,but the ROM of rotation shows an increasing trend.

AIM:To investigate the effects of resveratrol ( Res) on the proliferation of ARPE-19 cells and to ex-plore the possible mechanisms.METHODS:After ARPE-19 cells were treated with Res at concentrations of 0, 50, 100, 150, 200 and 300 μmol/L for 24 h, 48 h and 72 h, the effects of Res on the proliferation of the cells were tested by CCK-8 assay.The ARPE-19 cells were treated with Res at concentrations of 0, 100, 150 and 200 μmol/L for 48 h.The effects of Res on the cell cycle and apoptosis were detected by flow cytometry with Annexin V-FITC/PI staining.The protein expression of proliferating cell nuclear antigen (PCNA) was detected by immunofluorescent assay.The mRNA expression of PCNA, P21 and P27 was determined by real-time PCR.RESULTS:The results of CCK-8 assay showed that Res inhibited the prolifera-tion of ARPE-19 cells in a time-and dose-dependent manner.The treatment with Res for 48 h resulted in an arrest of cell cycle at S phase without increasing cell apoptosis.Res inhibited the protein expression of PCNA in ARPE-19 cells.The re-sults of real-time PCR showed that Res increased the mRNA expression of P21 and P27, and decreased the mRNA expres-sion of PCNA.CONCLUSION: Res inhibits the proliferation of ARPE-19 cells and induces the cell cycle arrest at S phase.The mechanism may be related to up-regulation of P21 and P27, and down-regulation of PCNA.

Objective To express the N protein of middle east respiratory syndrome coronavirus ( MERS-CoV) in prokaryotic expression system and evaluate the immunogenicity of the purified recombinant N protein.Methods The gene encoding N protein of MERS-CoV was synthesized and cloned into the vector pET30a to construct the recombinant expression plasmid pET30a-MERS-CoV-N.The transformed E.coli BL21 ( DE3) strains carrying expression plasmid were induced by IPTG to express N protein.The expressed protein was purified by using affinity chromatography.SDS-PAGE and Western blot assays were used to iden-tify the expressed N protein and evaluate its immunogenicity.Results The recombinant N protein was suc-cessfully expressed in soluble form with the size of 46×103 .The results of Western blot assay showed that the recombinant N protein could specifically react with rabbit serum samples positive for antibodies against N protein B-cell epitope peptide and mouse anti-His tag antibodies.No positive band against N protein was found when primary antibody was used with thirty adult serum samples from Beijing in 2008.Conclusion N protein of MERS-CoV was successfully expressed in prokaryotic expression system.The successful expres-sion of N protein laid the foundation for immunological diagnosis of N protein of MERS-CoV and researches on its immunogenicity.

Objective To explore the value of endoscopic ultrasound (EUS) in differential diagnosis of ectopic pancreas and stromal tumor in stomach.Methods The clinical data and endoscopic ultrasound findings of 40 patients with ectopic pancrea and 141 patients with stromal tumor were retrospectively analyzed,including the location,size,growth pattern,layer of origin,internal echo pattern and so on.All patients were diagnosed pathologically.Results Ectopic pancreas were predominantly located in the antrum (92.5％) and stromal tumor were mainly located in the gastric body (45.4％),the antrum (23.4％) and the fundus (22.0％),there was a significant difference in lesion' s location between two diseases (P ＜0.001).There was no statistical difference in the ratio of longest/shortest diameter of the lesion size(P =0.057).But there was statistical difference in lesion size between ectopic pancrease and stromal tumor [(19.98 ± 12.80)mm vs (11.25 ± 3.61)mm].Mural growth pattern was most common in ectopic pancrease (82.5％) and mural growth pattern (37.6％),extraluminal growth pattern (24.8％) and intraluminal growth pattern (22.7％) in stromal tumor (P ＜0.001).The third layer (75.0％) was predominant in ectopic pancrease while the fourth (54.6％) and the second layers (34.0％) in stromal tumor (P ＜0.001).With regard to internal echo pattern,hypoechoic (32.5％),intermediate (27.5％) and heterogeneous (27.5％) was predominant in ectopic pancrease and homogeneous hypoechoic lesion (72.3％) in the stromal tumor (P ＜ 0.001).Conclusions There were statistical differences between ectopic pancrease and stromal tumor in the location,size,layer of origin,growth pattern and internal echo pattern under EUS.EUS plays an important role in identification of ectopic pancrease and stromal tumor.

Objective To explore the clinical characteristics of pleural effusion caused byMycoplasma pneumoniae in children.MethodsThe clinical data from children with pleural effusion caused byMycoplasma pneumoniae were retrospectively analyzed. Differences of clinical characteristics in children with pleural effusion caused byMycoplasma pneumoniae infection and non-Mycoplasma pneumoniae infection were compared. Moreover, multiple logistic regression analysis was performed on the factors that were identified to have statistical differences in single factor analysis. Receiver operating characteristic (ROC) curve was performed and the diagnostic boundary value of each factor and the diagnostic accuracy of the regression model were calculated.ResultsThere were statistical differences between children with pleural effusion caused byMycoplasma pneumoniae infection and by non-Mycoplasma pneumoniae infection in age, white blood cell count, lactic dehydrogenase (LDH), levels of IgA and IgM, and the proportion of multiple nuclei, glucose and lactic acid (LAC) in pleural effusion, pleural thickening, and formation of ifbrous separation (allP??3.92 years, serum IgM?>?1.29 g/L, LDH?>?367 U/L and pleural effusion LAC?