The paper introduced to the integration and synergy of knowledge bases upon workflow management technology.With existing medical knowledge bases as starting point,this method first developed knowledge services for each knowledge base,then orchestrated these services using workflow management technology,and finally achieved coordinated decision support applications.Such support system has found clinical uses in tertiary hospitals in China with proven outcomes.

BACKGROUND:Currently, cosmetic liposuction has developed rapidly, but the liposuction for the isolation of adipose-derived stem cells has not been reported.
OBJECTIVE:By evaluating the quantity and viability of stromal vascular fraction, adipocytes and adipose-derived stem cells obtained from different types of liposuctions, to find the advanced liposuction procedures that are most suitable for use in preparation, preservation and clinical application of adipose-derived stem cells.
METHODS:Authors retrieved PubMed database, NIH clinical trial databaseand CNKI ful text database for relevant articles using the key words of“adipose-derived stem cells, ADSCs, liposuction, SAL, UAL, PAL, WAL”in English and Chinese, respectively. After eliminating the objective-independent articles and repeating reviews, 50 papers were included for further analysis.
RESULTS AND CONCLUSION:Suction-assisted liposuction (SAL), ultrasound-assisted liposuction (UAL), power-assisted liposuction (PAL) and water-assisted liposuction (WAL) are four major types of fat-harvesting technologies that can possibly be applied for adipose-derived stem cells isolation. Accumulative evidence suggests that these advanced liposuctions can obtain high quality of adipose tissue/cells, which are good enough for autologous fat grafting. Adipose-derived stem cells that are isolated from lipoaspirate by WAL, SAL and UAL, can be used as autologous cel-assisted lipotransfer and regenerative therapy. In summary, although each of these four types of liposuction technologies has its own advantages and is feasible to be used as autologous fat grafting, systematic comparative studies for viability, chromosome stability and differentiation potentials of adipose-derived stem cells isolated using each col ecting method are necessary in order to confirm the future perspectives in adipose-derived stem cells isolation, banking and regenerative repair.

ObjectiveTo observe the level of transforming growth factor-β1 ( TGF-31 ) in lung tissue of mice with acute lung injury induced by bleomycin. MethodsSixty Kunming male mice were randomly (random number) divided into sham operation group, model group, curcumin high dose group,medium dose group and low dose group (n =12 in each group). The models of acute lung injury were made by intratracheal instillation of bleomycin for once in the mice of model group and curcumin treated groups,and equal volume of saline was used in mice of sham operation group instead of bleomycin. Curcumin was given in doses of 200 mg· kg-1 · d-1 , 100 mg· kg-1 · d-1and 50 mg · kg-1 · d-1 to the mice of high dose group, medium dose group and low dose group, respectively 24 hours after modeling until the day before sacrifice, and the mice of sham operation group and model group were fed with equal volume of saline instead. Six mice of each group were sacrificed on the 3rd and 7th day separately for detecting lung wet to dry ratio (W/D), pathological changes of lung tissue stained with HE, and level of the transforming growth factor-β1 in the lung tissues stained with immunohistochemistry in mice of each group. Data were analyzed to express as mean ± standard deviation. -PSS11.5 statistical package was used for analysis. The comparison of the mean diversity carried out by using single factor analysis of variance. Results Morphological changes in lung tissue observed under light microscope showed that obvious morphological abnormalities,alveolar edema fluid and inflammatory cells were not found in mice of sham operation group, and lung capillaries dilated, widened alveolar septum, edema fluid and inflammatory cells infiltration in the alveolar in lung tissue were seen in mice of model group, and different degrees of pathological changes were found in mice of three curcumin treated groups, but those changes were less severe than those in mice of model group. Lung wet to dry ratio (W/D) was significantly higher in mice of model group than that in mice of sham group ( P ＜ 0. 01 ), but that in mice of three curcumin treated groups was significantly lower than that in mice of model group ( P ＜ 0. 01 ). Immunohistochemistry showed low level of TGF-β1 in lung tissue of mice in sham operation group, and the level of TGF-β1 in lung tissue of mice in model group was significantly higher than that in sham operation group ( P ＜ 0. 01 ). The level of TGF-β1 in lung tissue of mice in three curcumin treated groups was significantly lower than that in mice of model group ( P ＜ 0. 01 ),but that was still higher than that in sham group ( P ＜ 0. 01 ). ConclusionsCurcumin can inhibit the TGF-β1 in lung tissue and play a protective effect on acute lung injury induced by bleomycin, reducing the degree of lung injury. The protective mechanism may be associated with the inhibition of TGF-β1 in lung tissue.

Objective To find out more extrema simultaneously including global optimum and multiple local optima existed in multi-modal functions. Methods Germinal center is the generator and selector of high-affinity B cells, a multicellular group's artificial immune algorithm was proposed based on the germinal center reaction mechanism of natural immune systems. Main steps of the algorithm were given, including hyper-mutation, selection, memory, similarity suppression and recruitment of B cells and the convergence of it was proved. Results The algorithm has been tested to optimize various multi-modal functions, and the simulation results show that the artificial immune algorithm proposed here can find multiple extremum of these functions with lower computational cost. Conclusion The algorithm is valid and can converge on the satisfactory solution set D with probability 1 and approach to global solution and many local optimal solutions existed.

Objective To investigate the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal stones in patients with a solitary kidney.Methods Between May 2014 and June 2016,Clinical records of 17 cases of stones in a solitary kidney who underwent flexible ureteroscopy and holmium laser lithotripsy were reviewed.10 of these cases were male and the others female;mean age of these cases was 45.8 (32-67) years.9 were on the left side while 8 were on the right.6 cases were with functional solitary kidney (with the GFR of the contralateral kidney less than 10ml/min),while 11 others were with anatomical solitary kidney (6 due to tumor,2 due to tuberculosis,3 being congenital).All cases underwent BUS,KUB as well as CTU to confirm diagnosis before surgery,with 8 diagnosed with renal pelvis calculi,5 were with upper or middle calyx calculi,and 4 were with subrenal calyx calculi.The mean ± SD size of the stones was 1.2 ± 0.3 cm.Clinical m anifestations were asymptomatic in 10cases,backache in 5 cases and fever in 2 cases.All patients underwent exams of CBC,urinalysis,liver and kidney function,coagulation function,ECG,chest X-ray as well as cleaning midstream urine cultivation after admission.Results Mean ± SD operation time among all cases was (74.2 ± 23.6) min,the amount of bleeding during surgery was 5-15 (mean:8) ml,duration of hospitalization was 3-12 (mean:4.5)days,ureteral stents are kept for an average time of 4 weeks after surgery.3 patients developed fever after operation,1 developed urosepsis;all these patients recovered after active anti-infection treatment.No post-operative complications such as fever,renal colic,hematuresis,ureteral perforation,active bleeding as well as sepsis were found among the other patients.The preoperative and postoperative serum creatinine had statistical difference (P ＜0.05).14 patients were proved to be stone-free by KUB or CTU.The stone-free rate after a single operation was 82.3％ (14/17).Residual stone were found in the 3 patients,who subsequently underwent a second flexible ureteroscopy and holmium laser lithotripsy.The stone-free rate after a second operation was 94.1％.Conclusions Flexible ureteroscopy and holmium laser lithotripsy is a safe and effective method for the treatment of nephrolithiasis in patients with a solitary kidney with a lower procedure-related injury rate,smaller amount of bleeding,a lower complication rate and a shorter time required to recover after surgery.

Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.

BACKGROUND: Acellular vascular matrix as vascular scaffold has following advantages: acellular vascular matrix possesses complicated three-dimensional structure of natural blood vessels. Growth factor and structural domain on the surface of acellular matrix helps for cell adhesion and infiltration.OBJECTIVE: To prepare acellular vascular matrix material and to evaluate its biocompatibility in vivo and in vitro.METHODS: Trypsin and Triton X-100 were used to gradually dispose pig carotid artery and to prepare acellular vascular matrix. The biocompstibility of the material was evaluated by implantation in muscle, acute toxicity experiment and cytotoxicity test in vitro.RESULTS AND CONCLUSION: The acallular vascular matrix material possessed good chemical stability and did not release harmful factors that produced destruction and dissolution in erythrocytes, without acute hemolytic reaction or toxic effects on cell growth. The acellular vascular matrix material showed lots of inflammatory cell infiltration in eady stage of implantation, and no significant inflammatory cell infiltration in late stage of observation. Fibroblasts were visible in the acellular matrix. In addition, the acellular matrix material did not exhibit toxic effects on surrounding tissues, showing wound stage I healing. Simultaneously,histological sections demonstrated that there were good compatibility of scaffold material and surrounding tissues, without rejection. These indicated that acellular matrix material presented good biocompatibility in animals.

Objective To analyze the risk factors,clinical characteristics,and missed factors of acute pulmonary embolism (APE) after surgery,so as to advise clinicians to improve understanding of the early postoperative APE and enhance prevention concepts.Methods Retrospectively analyzed the general information of 43 cases of surgical patients with APE after surgery categories,risk factors,clinical manifestations and prognosis.Results APE after surgery had obvious risk factors; often occurred within 2 weeks after surgery; commonly seen in malignant tumors (53.5％,23/43),orthopedics (27.9％,12/43) and other major surgery; clinical manifestations wasn't typical,of which chest distress and dyspnea was the most common symptom (93.0％,40/43),and other pestoperative symptoms were similar,easy to misdiagnosis.Conclusions Surgery is one of the important risk factors of APE.Preoperatively evaluating underlying diseases,postoperative strengthening preventional methods,early detection,early treatment,have great significance in reducing the occurrence of postoperative APE and improve the prognosis.

Objective To investigate the clinical manifestations, pathologic features, treatment and prognosis of oncogenic osteomalacia (OO). Methods A 17-year-old male patient was admitted.The patient presented with a 4-year history of progressive lower limb weakness, muscle atrophy and joint pain. Lab tests demonstrated hypophosphatemia. Lumbar and pelvic X-ray showed wedging of the lumbar spine and decreased pelvic bone density. Ultrasonography revealed a low-echo and bloodrich mass measuring 15.1 cm× 14.5 cm× 13.2 cm located at the lower pole of left kidney. Computed tomography showed a voluminous enhanced tumor, supplied by the left renal artery, vice renal artery and a branch of the inferior mesenteric artery. A tortuous vein at the lower part of the tumor drained into the left renal vein. A radioactive octreotide scan was used to study an increased radionuclide-uptake lesion which was initially suspected on the CT scan. The patient was preoperatively diagnosed with left malignant kidney tumor and oncogenic osteomalacia. During a left radical nephrectomy performed through a transperitoneal anterior subcostal incision, a round diameter 15 cm tumor covered by twisted veins was found. The patient recovered well postoperatively. Results The histological diagnosis was renal clear cell carcinoma. Immunohistochemical staining detected Vimentin and RCC were positive and Ki-67antigen index was about 2 %. After lesion removal, the paraneoplastic syndrome resolved. At the 11-month follow-up, no recurrence of the disease was observed. Conclusions Oncogenic osteomalacia is rare and OO with renal cell carcinoma has not been reported so far. OO or rickets should be suspected in those patients who presented with metabolic bone disease associated with hypophosphatemia and inappropriate phosphaturia. If OO syndrome was suspected, in addition to past medical history and imaging, a standard meticulous examination should be initiated promptly. Surgical treatment is still necessary once confirmed. And all of them achieved a good prognosis.

Objective To explore the mechanism of the formation of glioma cells derived vessels (GCDV).Methods The tubular formation assay was performed on 3D cell cultures of U87,U251,U373,SF295,T98G,SKMG-4 and C6 glioma cell lines.The expression of Notch1 、Dll4 were examined by western blot analysis.Result The mean number of vasculogenic channels of cell lines C6,U373,U87,T98G,SF295,U251 and SKMG-4 per area (100×) were 25.2±5.0,36.4±3.2,19.0±2.2,12.6±2.4,4±2.2,0.2±0.4 and 0,respectively.The relative protein densities of Notchl in U87,U251,T98G,SF295,SKMG-4,C6 and U373 were 0.34,0.21,0.79,0.04,0.28,1.75 and 1.19,which were significantly related with the tubular formation ability (P＜0.05).However,the expression of Dll4 was not associated with tubular formation ability (P＞0.05).Conclusion Notch1 may play a key role in tubular formation of glioma cells while the role of Dll4 in the process needs further study.