Objective To compare open reduction and internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the operative treatment of complicated proximal humeral fractures.Methods From January 2014 to October 2015,55 complicated proximal humeral fractures were treated at our department.They were 32 men and 23 women,from 21 to 81 years of age (average,51 years).According to Neer classification,34 cases belonged to three-part fractures and 21 ones to four-part fractures,14 of which were complicated with dislocation.Of them,35 received ORIF and 20 underwent MIPPO.The 2 groups were compared in terms of operation time,intraoperative blood loss,incision length and Neer scoring of the shoulder function at the final follow-ups.The 2 groups were compatible without significant differences in preoperative demographic data (P ＞ 0.05).Results The 55 patients were followed up for 6 to 12 months(mean,9 months).The operation time (100.5 ± 10.2 min),intraoperative blood loss (80.0 ± 10.5 mL),and incision length (7.5 ± 3.2 cm) in the MIPPO group were significantly better than those in the ORIF group (120.0±10.1 min,200.5±10.2mL,and10.5±5.3cm,respectively) (P ＜0.05).According to the Neer scoring of the shoulder function at the final follow-ups,the good to excellent rate was 71.4％ (25/35) in the ORIF group and 85.0％ (17/20) in the MIPPO group,showing a significant difference (P ＜ O.05).The incidence of humeral head necrosis was 15 in the ORIF group,significantly higher than that (3) in the MIPPO group (P ＜ 0.05).Conclusion In treatment of complex proximal humeral fractures,compared with ORIF,MIPPO may lead to less damage to local blood supply,less trauma,and quicker functional recovery due to early functional exercise.

Syndrome of cachexia,which is a common feature of many types of cancer,characterized by loss of adipose tissue and skeletal muscle,is responsible not only for a poor quality of life and poor response to chemotherapy,but also a decreased survival time.It can not be fully explained by the accompanying anorexia,because increasing nutrient support is unable to reverse the wasting syndrome.Although patients with cachexia frequently show an elevated resting energy expenditure,cachexia can occur with a normal energy expenditure.Lipid mobilizing factor and proteolysis inducing factor,two tumor-derived factors,can directly mobilize fatty acids and amino acids from adipose tissue and skeletal muscle respectively.It is important of the knowledge about the roles and mechanism of LMF and PIF in the development of cancer cachexia,which should lead to the development of new therapeutic methods.

OBJECTIVE: To optimize the purification technique for the extract of Acanthopanax senticosus Harms. METHODS: The techniques of D- 101 macroporous resin adsorption, polyamide adsorption and n- butanol extraction were separately applied to purify the aqueous extract of Acanthopanax senticosus Harms. Syringin was detected by HPLC and total flavone was detected by UV. The anti- cerebral ischemia effects of three purified samples were compared using rat MCAO model and mouse decapitation gape model. RESULTS: The three purified samples all showed anti- cerebral ischemia effects, with the sample purified via D- 101 macroporous resin adsorption having stronger effects than the other two. The content of Syringin was correlated with anti- cerebral ischemia effects. CONCLUSIONS: D- 101 macroporous resin adsorption is a be-tter technique for purifying the aqueous extract of Acanthopanax senticosus Harms.

Objective To investigate the effect on differentiation of denervated skeletal muscle-derived stem cells (MDSCs) induced by TGF-β1 in vitro.Methods MDSCs were obtained from the rat denervated skeletal muscle by preplate technique,with TGF-β1 adding on medium.Cultured cells were divided into two groups.A,control group; B,10 ng/ml TGF-β1 group.Cell growth was observed with phase contrast microscope.lmmunocytochemistry,quantitative RT-PCR and Western blot was used to detect the expression of Sca-1,COL-Ⅰ,COL-Ⅲ,α-SMA and vimentin in denervated MDSCs.Results The synthesis of COL-Ⅰ,COL-Ⅲ,α-SMA and vimentin by denervated MDSCs was extremely low at protein level in vitro,while Sca-1 level was really high.Belong to the treatment with TGF-β1,COL-Ⅰ,COL-Ⅲ,oα-SMA and vimentin in the denervated MDSCs had strong expression,but Sca-1 in which had a weak expression.Under the stimulation of TGF-β1,COL-Ⅰ expression reached peak at the 2nd day (12.5591 ± 0.3389),which was about 3 times as control group.COL-Ⅲ reached highest value at the 5th day (0.8956 ± 0.0438),which was about 23 times as control group.α-SMA topped out to 18 times at the 5th day (1.1090 ± 0.0018).Vimentin expression rose by 8.5 times and peaked at the 5th day (0.1794 ± 0.0019).The expression of Sca-1 began to decline at the 2nd day,with a remarkable reduction at the 5th day (0.0636 ± 0.0015).Conclusion TGF-β1 could induce differentiation of the denervated MDSCs to myofibroblasts in vitro,and promote the synthesis and excretion of extracellular matrix.

Objective To design a new type of medical management system based on No 1 military medical project.Methods Data were extracted from the database of No 1 military medical project,and PB6.5 was used to develop the system.Results The medical management system was built which could be applied to information inquiry in such three levels information as hospital,department,doctor.Conclusion This new type of medical management system,with macroscopic and microscopic medical data involved in,provides ample information for the authorities of the hospital in their decision-making.

Objective To investigate the effect of different bone cement volume injected after vertebroplasty on stress distribution of the upper and lower endplates of the injured vertebra in the flexion and extension positions by finite element analysis.Methods Two patients with osteoporotic compression fractures of L2 vertebral body were chosen.Bone cement volumes of 25％ and 50％ were respectively injected into the fractured vertebral body bilaterally.Pre-and post-operative finite element models of fractured and adjacent vertebral bodies were developed after extracting the CT data.Stress changes at L2 superior-and inferior-vertebral endplates were observed in the vertical,flexion,and extension loading.Results Stress at the upper and lower endplates of the fractured vertebra increased after bone cement injection and more increase was observed in 50％ bone cement group than in 25％ bone cement group.In the neutral position,the stress mainly concentrated at posterior vertebral body,with stress of the upper endplate improving from 0.91 × 106 N · mm to 0.93 × 106 N · mm and stress of the lower endplate from 0.98 × 106 N ·mm to 1.03 × 106 N · mm.In the anterior flexion,the stress mainly concentrated at anterior vertebral body,with stress of the upper endplate improving from 4.44 × 106 N · mm to 5.55 × 106 N · mm.In the posterior extension,the stress mainly concentrated at medial vertebral body,with stress of the upper endplate improving from 21.95 × 106 N · mm to 22.10 × 106 N · mm and stress of the lower endplate from 30.60 ×106 N · mm to 30.88 × 106 N · mm.The finite element model revealed stress at the upper and lower endplates was higher in the anterior flexion and posterior extension than in the neutral position,while in the anterior flexion the stress was comparatively higher.Conclusions A small amount of implanted bone cement act no evident effect on stress distribution of the upper and lower vertebral endplates.However,the stress changes are significant as cement volume reached up to 50％,especially in the flexion position,as may suggest an enhanced risk of adjacent intervertebral disc degeneration and adjacent vertebral body fractures.

Objective To investigate the therapeutic effect and safety of the clip with the flossmethod during endoscopic submucosal dissection for early gastric angle cancer. Methods A total of 27 gastric angle lesions diagnosed as early gastric cancer were treated by ESD. They were randomized to two groups, routine ESD group and clip with the flossgroup. The procedure time, complication events, en-block resection rate and complete resection rate were compared between the two groups. Also,the learning time was divided to two stages and the learning curve was studied according to the resected specimen areas per minute. Results The en block rate was 85. 7%(12/14) in the routine ESD group and 100. 0%(13/13) in the clip with the floss group. The procedure time in the clip with the flossgroup was significantly less than that in the routine ESD group (the median time 30 min VS 40 min, P =0. 011) . Perforation and the post operative bleeding did not occur in either group. The ESD learning curving during the first learning period and the mean resected specimen (area/min) in theclip with the floss group were larger than routine ESD group(30±6 mm2/min VS 20±5 mm2/min,P=0. 01). However, no difference presented during the second learning period between the two groups. Conclusion Clip with the flossmethod during endoscopic submucosal dissection for early gastric angle cancer as a novel procedure is safe, efficacious and worthy to recommend to beginning learners.

BACKGROUND:Studies have demonstrated that tetrandrine has protection on acute spinal cord injury,but the specific mechanism remains poorly understood.OBJECTIVE:To study the protection of tetrandrine on rat acute spinal cord injury and to study its mechanism from apoptosis pathway.METHODS:A total of 100 rats were randomly divided into 4 groups.All rats were prepared for spinal cord injury models using modified Allen method except that in the sham-surgery group.Methylprednisolone and tetrandrine was injected into rats in the methylprednisolone and tetrandrine groups by tail intravenous injection prior to and at 24,48 hours after model preparation.The same volume of physiological saline was injected in the sham-surgery and model groups.Basso-BeatUe-Bresnahan(BBB score)was recorded at 8 hours,1,3,7 and 14 days after model preparation.The morphological changes of spinal cord injury sites were observed by hematoxylin-eosin staining and the expressions of bcl-2 and bax were determined by immunohistochemistry.RESULTS AND CONCLUSION:The BBB score of methylpradnisolone and tetrandrine groups were significantly higher than that model group at 7 and 14 days(P<0.05),but there were no significant difference between the methylprednisolone group and tetrandrine group(P>0.05).Hematoxylin-eosin staining showed that the spinal cord injured severely at 3-7 days,the injury degree in the methylpradnisolone group and tetrandrine group was slighter than that of the model group,with smaller bax expression and greater bcl-2 expression(P<0.01).The findings demonstrated that,tetrandrine is able to protect neurons from apoptosis and promote the nerve function recovery by inhibiting the expression of Bax and promoting the expression of Bcl-2.Its effect is not inferior to methylprednisolone.

ObjectiveTo explore the clinical outcome of one stage posteroanterior decompression and bone implant in the treatment of severe lower cervical spinal bony canal stenosis. Methods The study involved 29 patients with severe lower cervical spinal bony canal stenosis treated with one stage posteroanterior decompression and bone implant from April 2006 to March 2009. There were 11 patients with old fractures, seven with posterior longitudinal ligament ossification and 11 with cervical disc calcification. The course of disease ranged from 2 months to 3.2 years, average 1.4 years. The nerve function was rated as grade B in two patients, grade C in 19 and grade D in eight according to Frankel scale. The average Japanese Orthopaedic Association (JOA) score was 9.8. ResultsAll patients were followed up for 7-28 months (average 15.2 months), which showed bony fusion five months after operation, with fusion rate of 100％. The Frankel grade was increased for average 1.2 grades and the nervous symptoms alleviated remarkably. Mean postoperative JOA score was 13.8 and increased for mean 4.0, with mean amehoration rate of 55.6％. ConclusionsOne stage posteroanterior decompression and bone implant is a safe and effective method for treatment of lower cervical spinal bony canal stenosis, when the intraoperative electrophysiological monitoring can assure the operative safety.

ObjectiveTo improve the treatment of urethral stricture and evaluate the applicative effects of wire-guided supporting catheterization in clinical urology. MethodsDuring January 2004 and December 2005, the patients with urethral stricture were dwelled with the catheters using the traditional guideless catheterization (group A). If the dwelling failed,it will be replaced by the wire-guided supporting catheterization using the improved catheters. During January 2006 and December 2009, the patients with urethral stricture were dwelled with the improved catheters using wire-guided supporting catheterization ( group B) straightly. Compared the first-time dwelling success incidence,the incidence of catheter associated urinary tract infection and side-effect events. Then after 1 year, compared the urethral stricture recrudescence and the course of treatment. ResultsThe success incidence of first-time catheterization in group A was 48.98％ (24/49) ,and in group B was 97.94％ (95/97) ,there was significant difference between 2 groups;The incidence of catheter associated urinary tract infection in group A was 12.24％, and 8. 25％ in group B, there was significant difference between 2 groups; As for the course of treatment, group A was 46. 2w,group B was 32.7w;The urethral stricture recrudescence in group A and B were 16.33％ and 9.28％ respectively,and there was significant difference between 2 groups. ConclusionThe wire-guided supporting catheterization, which minimize the injury and simplify the operation of internal urethrotomy,could makes the improved catheter easy to induct and replace, improve the success rate of first time-catheterization and prevent the false tunnel damage and new scar expansion. It could make benefit to reduce of incidence of catheter associated urinary tract infection and urethral stricture recrudescence,but also could shorten the course of treatment significantly.