Objective To study the X-ray findings of post-traumatic osteolysis and to improve the knowledge of that disease.Methods X-ray features of 7 cases of post-traumatic osteolysis confirmed by clinical findings and pathology were reviewed retrospectively.There were 5 females and 2 males.from 9-56 years(mean 34 years)of age.Three patients had traffic accidents and 4 had trauma unrelated to traffic accidents.Osteolysis occurred from 3 to 18 months after trauma(1 case at 18 months,2 cases at 10 months,2 cases at 6 months and 2 cases at 3 months).Results There were 2 pubis fractures,1 distal tibiofibular shaft fracture,1 femoral neck fracture,1 humeral upper end commiuuted fracture,1 shoulder joint dislocation.and 1 soft tissue swelling around the wrist.The X-ray findings are:3 massive osteolysis,3 plaque flake osteolysis and 1 cystic osteolysis.There were no hardening of bony edge at the site of osteolysis in all 7 cases,clear margin in 5 cases and ill-defined margin in 2 cases,no residual bone in osteolytic area in 4 cases and residual bone in octeolytic area in 3 cases,no periosteal reaction and thickerning of bony cortex in osteolytic area in all 7 Cascs,bone repair in 2 cases and no bone repair in 5 cases.Histopathological findings showed:extensive capillary hyperplasia and fibrous tissue hyperplasia;hyperemia and swelling of synvium,proliferation of granulation tissue,osteonecrosis,increased osteoclast activity,some inflammatory cells,no evidence of neoplastic cells in the involved area.Conclusions Posttraumatic osteolysis is closely related to trauma.X-ray findings include massive osteolysis,plaque-like osteolysis,and irregular cystic changes.Early dignosis may be a challenging task.

Objective To investigate whether and how CD4 + CD25 + regulatory T cells(Tr) affect oxidized low density lipoprotein(oxLDL) induced proinflammatory response in macrophages.Methods Tr were isolated from lymphocyte suspensions by magnetic cell sorting-column and analyzed by flow cytometry.Macrophages were cultured alone,with CD4 + CD25 + Tr or CD4 + CD25 - Tr in the presence of oxLDL for 48 h.The phenotype of macrophages was determined by flow cytometry.NO production was assessed by Griess reaction an iNOS mRNA was isolated by RT-PCR.ELISA were used to measure the production of cytokine/chemokine like MCP-1,MMP-9,TNF-ct,TGF-β and IL-10 in macrophages response to oxLDL.Results Our data showed that with oxLDL challenge,the Tr modulated macrophages have decreased NO production and iNOS expression,decreased HLA-DR and CD86 expression,and down-regulated proinflammatory cytokine/chemokine production.Conclusion Tr can inhibit the proinflammatory properties of macrophages and steer macrophage differentiation toward an anti-inflammatory cytokine producing phenotype.

Objective To investigate the clinical effect of blocking nail in treatment of hypertrophic nonunion after interlocking intramedullary nailing of femoral shaft fractures.Methods A retrospective case series study was made on 11 patients with hypertrophic nonunion following interlocking intramedullary nailing of femoral shaft fractures from January 2006 to February 2016.There were 8 males and 3 females,aged (32.4 ± 6.8) years (range,19-48 years).Comminuted fractures were noted in three patients,long oblique or spiral fractures in two,multi-segment fractures in two,and transverse fractures in four.Time interval between this surgery and intramedullary nailing of femoral shaft fractures was (11.5 ±3.1) months (range,6-18 months).All blocking nails were inserted into pulp cavity of distal ends of the site of the bone nonunion.Fracture healing time,wound healing and postoperative complications were detected.Outcome was evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).Results All patients were followed up for (27.2 ± 4.6) months (range,24-36 months).Bone union was observed within (9.8 ± 3.4) months except that bone nonunion occurred in two cases requiring locking plate fixation and autologous bone grafting to provide union,with the healing rate of 91％.No wound infection,nail breakage and nail loosening occurred after operation.At postoperative 3 months,4 months,5 months,6 months,12 months and 24 months,VAS and ODI differed significant from the preoperative detections (P ＜ 0.05).Conclusion Blocking nail technique is associated with increased stability of intramedullary nails and fracture ends,low incidence of complications and high bone healing rate in treatment of hypertrophic nonunion after femoral interlocking intramedullary nailing.

Objective To investigate the curative effect of damage control theory in treating severe polytrauma patients combined with bone and joint injury. Methods A retrospective study was done on data including complication, death rate, fracture healing and joint function recovery of 63 patients with severe polytrauma combined with bone and joint injury( average ISS ≥27 points) admitted to our hospital from January 2006 to June 2009. Results Of all the patients, 57 shock patients were cured,three died of hemorrhagic shock within two hours after admission and one patient died of severe traumatic brain injury 11 hours after admission. One patient died of ARDS at 24 hours postoperatively and one died of multiple organ failure at day 6 after injury. Fracture healing was achieved in 52 patients, with satisfactory recovery of the limb function. Amputation was performed in two patients and three patients had mild claudication and pain walking. Conclusion Damage control strategy has great clinical significance in guidance of treatment of severe polytrauma combined with bone and joint injury.

Objective To investigate the clinical characteristics of cervical spine injury associated with chest injury by contrast with simple cervical spine injury.Methods A retrospective analysis was performed on records of 116 patients with cervical spine injury hospitalized from March 2009 to September 2014.There were 65 patients with simple cervical spine injury (simple injury group) and 51 patients with associated chest injury (associated injury group).Data recorded were the causes of injury, injury segment, treatment choices (tracheotomy rate, mechanical ventilation use and non-operative treatment), treatment time (operation rate at different time, time from injury to operation and length of hospital stay) , complications (electrolyte disorder, respiratory infection, respiratory dysfunction or failure, urinary tract infection, gastrointestinal bleeding and multiple organ dysfunction syndrome), and treatment outcome.Results The main cause of injury for the two groups was high falling.Lower cervical segment was the most likely to be affected.Significant differences were detected between the simple injury group and associated injury group with regard to tracheotomy rate (63％ vs.42％), rate of mechanical ventilation (41％ vs.25％), rate of early surgery (29％ vs.58％), rate of delayed surgery (69％ vs.30％), time from injury to operation [(7.2 ± 3.7) d vs.(3.1 ± 1.3) d], length of hospital stay [(22.6-± 5.5) d vs.(17.3 ± 3.7)d], electrolyte disorder rate (35％ vs.17％), incidence of respiratory system infection (55％ vs.35％), and respiratory dysfunction (43％ vs.25％) (P ＜0.05).After treatment, American Spinal Injury Association (ASIA) scale for grade D was significantly lower in associated injury group than in simple injury group (25％ vs.39％ P ＜ 0.05).Conclusion Cervical spine injury associated with chest injury is severe injury, often requiring tracheotomy and mechanical ventilation, and demonstrates difficulties to be effectively treated in the early phase, long hospitalization, various complications and high morbidity.

Objective To explore the role of chemokines and ehemokine receptors in the etiopathog-enesis of diffuse proliferative lupus nephritis (LN). Methods ① Total RNA from the kidney tissues and peripheral blood cells of 12 patients with diffuse proliferative LN and 10 normal controls were prepared simultaneously and reverse transcribed into complementary DNA. Sybr green dye based real-time quantitative PCR method was used to compare the expression levels (indicated as-AACt value) of MCP-1, CCL19,CXCLg, CXCL10 and CCR2, CCR7, CXCR3. ② Immunofluoresceee labeling and immunohistochemical staining technique were used to observe the distribution of chemokines MCP-1, CCL19, CXCL9 and CXCL10 in normal and patients kidney tissues. Results The 4 chemokines genes (MCP-1, CCL19, CXCL9 and CXCL10) were consistently highly expressed in kidney tissues and peripheral blood ceils of diffuse proliferative LN patients compared with normal controls. The 2 chemokine receptors, CCR2 and CXCR3 were also overexpressed in peripheral blood cells of diffuse proliferative LN patients. There was nearly no expression of these 4 chemokine proteins in normal kidneys. But they were found in glomeruli of diffuse proliferative LN patients. Conclusion The expression of chemokines in the peripheral blood cells may be used as biomarkers for LN. Further study maybe lead to the development of specific drugs targeting at them for the treatment of systemic lupus erythematosus (SLE).

Objective To observe the effect of electroacupuncture of Siguan on contents of hippocampal monoamine neurotransmitter NE, DA and 5-HT in post-stroke depression rats, and throught it to probe the possible mechanism of anti-depressive.Methods 60 rats were divided into five groups randomly, as the normal group, MCAO group, PSD group, Siguan group, and fluoxetine group. Except the normal group, the rats of other groups were used to establish left side of the MCAO models by modified Longa filament method. PSD model was prepared by living alone in combination with mild stimulation by chronic unpredictable after stroke model success 7 days. The Siguan group was received electroacupuncture at Siguan point, and the fluoxetine group was gastrically perfused with fluoxetine, and all rats were received sugar consumption experiment in different period of treatment. After continuous treatment for 21 days, contents of NE, DA and 5-HT in hippocampal tissue were measured with RP-HPLC-fluorescent method. Results At the seventh day, compared with PSD group, the ratio of sugar water consumption(51.09%± 3.68%vs. 38.97%± 4.07%)has a significant increase in the Siguan group(P<0.01), while no significant changes in the fluoxetine group. At the fourteenth day, the ratio of sugar water consumption(68.25%± 4.69%vs. 39.64%± 4.49%)continued to rise in the Siguan group, the fluoxetine group also had significantly increased compared with the PSD group, the two groups were significantly higher than those in the PSD group (P<0.01), but the Siguan group was higher than that of the fluoxetine group(P<0.01).At the twenty-first day, the ratio of sugar water consumption (41.56%± 2.12%vs. 41.56%± 2.12%)increased further in the Siguan group and the fluoxetine group, which was significantly higher than those in the PSD group (P<0.01), but the Siguan group and fluoxetine group had no obvious difference(P>0.05). Compared with the PSD group,the contents of NE(244.93 ± 44.57 ng/g vs. 129.27 ± 11.68 ng/g), DA(86.80 ± 14.64 ng/g vs.44.22 ± 7.60 ng/g), 5-HT(526.31 ± 54.41 ng/g vs.221.56 ± 39.57 ng/g) in the hippocampus tissues were significantly higher than many in the Siguan group and fluoxetine group(P<0.01), but the difference between the two groups was not obvious(P>0.05). Conclusion The symptoms of PSD rats pleasure disappeared can be improved by electroacupuncture atSiguan. Its mechanism may be related with the increased contents of monoamine neurotransmitters in the hippocampus of rats.

Objective To investigate the effect of pregnancy and spontaneous delivery on the morphologic characteristics of the levator ani muscle and innervation of the vaginal mucosa. Methods Eight nullipara without pelvic floor dysfunction (PFD) and 64 normal primipara undergoing spontaneous delivery were enrolled in this study during July to December 2006 in Peking Union Medical College Hospital. Biopsy specimens of levator ani muscle (LAM) and anterior and posterior vaginal walls were obtained from the puerpera as well as from the 8 nullipara undergoing vaginal operation. The structures of LAM were examined with histological techniques. Vaginal mucosa specimens were examined using immunohistochemistry staining for protein gene product 9. 5 ( PGP 9. 5), vasoactive intestinal poptide (VIP) and ne uropeptide Y ( NPY),and the positive stained nerve fibers were calculated respectively. Results The LAMs of the puerpera undergoing spontaneous delivery presented myogenetic and neurogenetic changes, both acute and chronic.Type Ⅰ muscular fibers were predominant(79% )with both types increasing in diameters [ (86±9)μm and (79±15) μm]. Significantly different ( P < 0. 05 ) innervation of PGP 9. 5, VIP, and NPY nerve fiberswas observed between epithelial lamina of anterior vaginal wall(5.9±3. 3, 7. 6±3. 1 and 8. 2±3. 2, respectively) and that of posterior vaginal wall (3. 8±2. 9, 5.9±3. 1 and 6. 0±3.0, respectively), with the nerve fibers being more in epithelial lamina of anterior vaginal wall, while no difference in the innervation of nerve fibers was observed in the lamina propria. Significantly different( P <0. 05 ) innervation of PGP 9. 5 and VIP nerve fibers was observed in the lamina propria of the anterior vaginal wall in puerperal undergoing vaginal delivery (6.9±3.2 and 4.9±2. 1) compared with those in nullipara (3.9±3.6 and 3. 1±1.2). Conclusions Pathologic changes occur in LAMs and pelvic floor nerves during labor and delivery. LAM fibers become hypertrophy to adapt to the physiological changes during pregnancy. Richer innervation of PGP 9. 5 and VIP nerve fibers in the lamina propria of the anterior vaginal wall in puerpera undergoing spontaneous delivery is beneficial for dilation of the blood vessels and smooth muscles and makes preparation for delivery.

Objective To investigate the features of soft tissue myxofibrosarcoma (MFS)on MRI.Methods The MRI data of 15 cases with MFS confirmed by surgery and pathology were analyzed retrospectively.Results Of all the 1 5 cases,7 were located in the thigh,3 were located in the lower leg,2 were located in the forearm,1 was located in the shoulders,1 was located in the back and 1 was located in the buttocks.The average maximum diameter of all lesions was (9.43±3.1)cm.Fifteen cases showed isointensity with slightly hypointensed fiber septa on T1WI.The signal intensity of MFS on T2WI was mixed.Five cases of low-grade MFS with myxoid area showed slightly hyperintensity,with sporadic small nodular and striped fibrous septa which showed hypointensity on T2WI and inhomogeneous enhancement.In 5 cases of high-grade MFS,the solid part and the septa showed hypointensity on T2WI;the myxoid matrix area and the necrotic area showed hyperintensity on T2WI.The myxoid matrix part showed mild inhomogeneous enhancement with peritumoral enhancement of"tail sign".Among the 5 cases,the solid part of 4 cases showed middle to severe annular heterogeneous enhancement,while the solid part of the remaining 1 case showed nodular enhancement.Five cases of intermediate-grade MFS showed slightly hyperintensity or isointensity on T2WI,and nodules and fibrous septa showed hypointensity.The enhanced solid part and myxoid matrix area showed mild to moderate inhomogeneous enhancement,and there were 2 cases with"tail sign".Conclusion MRI features of soft tissue myxofibrosarcoma have some characteristics including isointensity on T1WI,mixed signal intensity on T2WI,heterogeneous enhancement and peritumoral enhancement of"tail sign".

Objective To analyze influencing factors of paclitaxel coated ballon(PCB)on long-term restenosis in patients with severe subpatellar artery lesions in type 2 diabetes mellitus(T2DM),and to construct a prediction model.Methods A total of 268 T2DM patients with severe infra-popliteal artery disease and received PCB treatment were selected.Patients were followed up for 1 year after treatment.Patients with target vessel restenosis were included in the observation group,and the other patients were included in the control group.Clinical data of two groups were analyzed.Multivariable Logistic regression analysis was used to analyze influencing factors of long-term restenosis in T2DM patients with severe infra-knee arterial disease,and a nomogram prediction model was constructed.Results A total of 260 patients(97.00%)completed the follow-up,and the incidence of restenosis was 13.85%(36/260).Both univariate and multivariate Logistic regression analysis showed that age,coexisting coronary heart disease,Trans-Atlantic Inter-Society Consensus(TASC)Ⅱ classification,Fontaine staging,glycosylated hemoglobin(HbA1c)and low density lipoprotein cholesterol(LDL-C)were independent influencing factors for the occurrence of long-term restenosis in T2DM patients with severe infra-popliteal artery disease(P<0.05).The risk factor with the highest score in the constructed nomogram prediction model was HbA1c,followed by age,LDL-C,TASCⅡ classification,Fontaine stage and coronary heart disease.According to the column chart,the total score was 210 points,and the probability of long-term restenosis was 90%.The discrimination of the nomogram model was 0.866,with a Brier score of 0.081 and a calibration slope of 0.733.When the risk threshold was 0.15 to 1.0,the net benefit rate of long-term restenosis in T2DM patients with severe infra-popliteal artery disease was greater than that of individual evaluation.The smaller the risk threshold,the greater the net benefit rate.The benefit was the best when the threshold reached 0.23.Conclusion The influencing factors for long-term restenosis in T2DM patients with severe subknee artery disease treated by PCB include age,combined coronary heart disease,TASCⅡ grade,Fontaine stage,HbA1c and LDL-C.The prediction model based on the above influencing factors has important value in predicting long-term restenosis in patients.