Objective To induce regeneration of dog's tracheal cartilage by implanting the recombinant human bone morphogenetic protein-2 (rhBMP-2) into the tracheal graft in order to prevent the trachea from collapse. Methods RhBMP-2 with the atelopeptide type-1 collagen carrier was implanted around the cartilage ring of the autograft. New cartilage formed was detected with the histological analysis and immunohistochemical stain after 4 weeks. Six different concentrations of rhBMP-2 with collagen carrier were implanted around the cartilage ring in 6 auto transplantation groups respectively. The area of new cartilage regeneration was calculated in choosing the optimal dosage of rhBMP-2. Auto and allo tracheal transplantation were performed with rhBMP-2 implanted around the cartilage ring, the diameter of the grafts, histological analysis, and the area of the new cartilage regeneration were calculated. Results The addition of rhBMP-2 resulted in significantly greater amount of the new cartilage area (P

Purpose To evaluate the feasibility of magnetic resonance T2 values in diagnosing hepatic fibrosis (HF).Materials and M1etdheds The models of HF were induced in rats by repetitive dosing of carbon tetrachloride.The stage of hepatic fibrosis (S),grade of inflammation (G) and degree of fatty liver (F) for the HF model animals and their normal controls were evaluated by pathology.The relationship between T2 values and liver fibrosis was analyzed by using multiple echo gradient spin echo sequences.Results According to the stage of hepatic fibrosis,the HF model rats were staged into S1-S4.The grade of inflammation of the HF model rats was G0 or G1,and the degree of fatty liver was F3 or F4,both of which had no statistical differences among the HF model rats at different fibrosis stages (P＞0.05).The T2 values for all rats including normal control rats in the stage of liver fibrosis from S0 to S4 were (38.27±1.45) ms,(42.08±2.63) ms,(45.93±3.61) ms,(50.23 ± 2.23) ms and (57.79± 5.40) ms,respectively,with a significant difference (F=31.903,P＜0.01).Except the T2 values had no significant difference between the S0 and S 1 stages (P＞0.05),the pairwise comparisons of the T2 values between the rest stages were statistically significant (P＜0.01).The T2 values were positively correlated with the stages of hepatic fibrosis (rs=0.921,P＜0.01).Conclusion The T2 value can quantitatively reflect the degree of hepatic fibrosis.

Objective To evaluate the changes of cerebrospinal fluid dynamics of Chiari malformation type I associated syringomyelia patients with phase-contrast MRI (PC-MRI).Methods Thirty cases diagnosed with Chiari malformation type Ⅰ associated with syringomyelia clinically underwent cisterna plasty treatment.Cerebrospinal fluid dynamics changes were measured before 24 h and 6 months after operation with PC-MRI.The stroke volume (SV),mean flow (MF),regurgitation fractions (RF) and the maximum peak flow velocity (Vmax) were analyzed.Results After operation,PC-MRI showed SV and MF increased,the bidirectional Vmax decreased,which had statistical difference compared with those of preoperation (all P＜0.05),and the C2-3 level was the most obvious.Conclusion PC-MRI can quantitative analysis of preoperative and postoperative changes of cerebrospinal fluid flow and peak velocity.

Objective To explore the curative effect of headless compression screws in treatment of avulsion fractures of the fifth metatarsal .Methods 37 cases of patients with avulsion fractures of the fifth metatarsal base were treated by internal fixation with headless compression screws from January 2008 to January 2011 .X-ray films after operation were taken to evaluate the bone healing time and the foot function was evaluated according to AOFAS .Results The 37 cases were followed up from 10 to 24 months (mean 13 months) .The X-ray films showed that all fractures healed at 6 to 12 weeks(mean 8 .1 weeks) .Wound infection occurred in one case with open fracture ,which was healed by therapy .According to AOFAS ,the scores after operation ranged from 86 to 100 (mean 94 .5) .Conclusion Headless compression screws in treatment of avulsion fractures of the fifth metatarsal has the advantages of easy manipulation ,stable fixation and few complications .

Objective To analyze the relationship between the clinical features and the dysfunction and derangement of knee osteoarthritis(OA),in order to improve the understanding of knee OA.Methods Clinical data including symptoms,physical signs,X-ray,arthroscopical findings,pathologic changes,preopera-tive and postoperative diagnosis,treatment and curative effects from206post-arthroscopy patients with OA were analyzed retrospectively.Results The common physical signs were tenderness in knee,positive grinding test of patella,McMurray sign,fricative,muscular atrophy of quadriceps femoris,and stretch or flexion limita-tion.X-ray abnormalities were found as follows in decreasing freguency:bony hyperplasia,articular facet sclero-sis,osteoporosis,uneven articular surface,narrowing of joint space and loose bodies.Arthroscopical findings were as follows:synovial congestion and proliferation,hypertrophy or entrapment of fat pad,osteophyte,syn-ovial fold entrapment,stripping of cartilage,meniscal lesions,subchondral bone exposure,anterior cruciate lig-ament friction or obstruction,and loose bodies.The common diseases that liable to misdiagnosis preoperatively were synovial chondroma,anterior cruciate ligament impingement syndrome and meniscal lesions.The rate of excellent and good results after arthroscopic treatment was86.6%.Conclusion Hypertrophy and entrapment of fat pad,thickening and entrapment of synovial fold,stripping of cartilage,meniscal lesions,anterior cruciate ligament friction or obstruction,and loose bodies are the key factors that cause knee dysfunction in OA.The arthroscopic treatment is an effective supplement in treating knee OA.

Objective To investigate the value of hepatic T2 value in evaluation of chronic HBV-related acute-on-chronic liver failure (HBV-ACLF).Methods The HBV-ACLF group,chronic hepatitis B group and control group who underwent liver MRI (M-GRASE sequence) were enrolled.The T2 map was produced from the post-processing software,and the mean T2 and R2 value of liver was calculated.The blood biochemical indexes from HBV-ACLF and chronic hepatitis B group were collected in 2 days pre-MR scaning.The differences of T2 and R2 values among 3 groups and the correlation between biochemical indexes and T2 value were analyzed.ROC curve was conducted to evaluate diagnostic efficiency of T2 value for HBV-ACLF.Results There were significant differences of T2value (x2 =19.074,P＜0.001) or R2 value (F=10.411,P＜0.001) among the 3 groups.The AUC of T2 value for diagnosing HBV-ACLF was 0.86 (P＜0.001),with the cut-off value 57.73 ms (R2=0.017).Moderate positive correlation was shown between T2 values and international normalized ratio (INR),prothrombin time (PT),haluronicacid (HA) values (rs =0.65,0.67,0.39,all P＜0.05),and moderate negative correlation was shown between T2 values and prothrombin activity (PTA),albumin (ALB),prealbumin (PA) values (rs =-0.67,-0.48,-0.37,all P＜0.05).Conclusion T2 or R2 value could reflect the liver function,and were correlated with some biochemical indexes,which illustrated a good diagnostic efficiency for diagnostic of HBV-ACLF.

Objective The aim of this study was to evaluate the efficacy and safety of the approach of the Nuss procedure for the correction of pectus excavatum in children without thoracoscopy.Methods From Oct 2007 and May 2009,48 patients with pectus excavatum underwent Nuss procedure.Among them 22 were done under the thoracoscopic guidance,and the other 26 in a non-thoracoscopic way,in which,a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection via a bilateral thoracic skin incision.Without introducing the thoracoscopy into the thoracic cavity,a steel bar was inserted in the entirely extrapleural tunnel and turned as the standard Nuss procedure.Results All 48 patients recovered uneventfully.There were no postoperative deaths and serious complications.A single alloy steel bar(23-40 cm)was used in all patients.In the non-video-assisted extrapleural group(n=26),no pneumothorax occurred,the operating time(after anesthesia)ranged from 24～38 minutes[mean(25.4±2.6)mins],blood loss was minimal(range,5-10 ml),and the hospital stay was ranged from 3-6 days[mean(4.5±1.1)days].In the thoracoscopic group(n=22),the corresponding figures were 40 to 60 minutes[mean(53.5±3.4)mins)],10 to 15ml,5-8days[mean(7.0±2.2)days],respectively.No recurrent of the funnel chest occurred during the 3-18 months(median 10.4 monthes)of follow-up.The bar displacement occurred in 1 case 2 months after operation,which was replaced with satisfied result.Conclusion The non-thoracoscopic approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum.

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL)guided by ultrasonography through upper pole access. Methods From October 2007 to October 2009, 42 patients with upper urinary tract calculi underwent PCNL through upper pole access.Among these cases, there were 10 cases of staghorn calculi, 22 cases of renal pelvis calculi, 7 cases of the upper calyx calculi, 3 cases of the lower calyx calculi, 4 cases combined with ureter calculi and 2 cases combined with ureteropelvic junction obstruction. The stone measured from 2.0 to 6.5 cm (average: 3.4 cm) in length. Working tunnels (F16-F26) were established through the 10th or llth intercostals. Pneumatic or holmium laser lithotripsy was used to disintegrate and remove stones by nephroscopy or ureteroscopy. Clinical data including operation time, complications and stone free rate were analyzed retrospectively. Results All the operations were completed in one session, single tract was used in 36 cases(85.7%), double tracts were used in the other 6 cases(14.3%). The stonefree rate after one session was 88.1% (37/42), 3 cases(7.1%) received a second-session PCNL, 2 cases (4.8%)underwent ESWL after operation. The mean operative time was 65 min(30- 140 min).Postoperative surgery-related infection rate was 9. 5% (4/42). One patient (2. 4%)required blood transfusion. Perforation of the pelvis occurred in 1 patient(2.4 %). No pleural or important organ injury occurred. Conclusion The upper pole access for PCNL can be convenient to remove stones,this method is a highly efficient and safe technique.

Objective To review the clinical characteristics of paraganglioma of the urinary bladder with 5 cases reprt.Methods The clinical data of 5 patients (2 males and 3 females,age 23-68 years)with paraganglioma of the urinary bladder were reported.Two cases were diagnosed by ultrasonography during health examination,1 case was found by hematuria,1 had difficulty of voiding,and 1 presented with palpitation,chest discomfort while urination.Two cases were clinical diagnosed as bladder paraganglioma,1case urachal carcinoma,and 2 cases bladder tumor.Cystoscopy showed a protruding tumor within the bladder or bladder had compressed changes.One case of tumor located in the triangle,1 in the posterior wall,1in the top,2 in the anterior wall.Three cases of biopsy were negative.Three cases of preoperative endocrine examinations showed norepinephrine significantly higher.Results Laparoscopic partial cystectomy was performed in 3 cases,open partial cystectomy in 1 case,and transurethral resection of bladder tumor (TURBT) in 1 case.One case had the complication of stress cardiomyopathy during TURBT,3 cases found intraoperative hypertensive crisis.The bleeding volume was 20-800 ml (average 126 ml),and I case received blood transfusion.During the follow-up period for 3-48 months,the blood pressure was normal,and no recurrence was found.Conclusions Bladder paraganglioma is uncommon and easily misdiagnosed.For the patients with bladder tumor,accompanied by changes in blood pressure,palpitations during urination should be highly suspicious of bladder paraganglioma.Partial cystectomy is the main treatment method.

Objective To evaluate the application of percutaneous nephroscopy in the treatment of upper urinary tract transitional cell carcinoma, particularly renal pelvic carcinoma. Methods From June 2006 to June 2010, eight cases (with 10 sides) of renal pelvic carcinoma received percutaneous nephroscopy tumor resection. There were six males (with 7 sides) and two females (with 3 sides) in the study group. There were six cases with solitary kidney and two cases with bilateral renal pelvic tumors. There were four cases with high-grade tumors and six cases with low-grade tumors. The age of patients ranged from 52 to 72 yrs (average 61.2 yrs). Tumor sizes ranged from 0.5 to 3.5 cm (average 2.6 cm). Patients were treated with laser or electrocautery through percutaneous nephroscopy. A ureteral stent was placed in the patients after the procedure. Chemotherapy was administered postoperatively through the nephrostomy tube. Results All the operations were successfully completed uneventfully. The operative time was 45-95 min (average 73 min), estimated blood loss was 20-300 ml (average 50 ml). No remarkable differences were found in serum creatinine levels before and after operation. After 10 to 36 mon. follow-up by CT, MRI, and ureteroscopy, one patient died of tumor metastasis and two patients had local tumor recurrence. The remaining patients had no local recurrence. Conclusions Percutaneous nephroscopy in treating renal pelvic tumor is safe and feasible. This is a better choice for the renal pelvic carcinoma patients who are unsuitable for ureteronephrectomy.