[Objective]To investigate the operation indications and techniques of the ISOLA spinal system in reconstruction of the lumber-pelvis continuity after resection of high-level sacral tumors. [Method]A retrospective study was performed in 43 patients with high-level sacral tumor (HLST) between July 2001 to January 2007. Symptoms, signs, histological findings of the tumors and their outcomes were analyzed. All patients underwent resection of HLST and spinopelvic reconstruction with ISOLA spinal system,11 unilateral and 32 bilateral.[Result]Among the 43 patients, 33(77.1%)had chordoma, giant cell tumor of bone and neurogenic tumors. Thirty-four patients alive were followed-up for an average of 35 months(12~62 months), 5 patients had a recurrence of chordoma and 29 patients with HLST were under control. The pain originated from the lumbosacral joint and the spinal nerve root was obviously relieved.The patients could stand and ambulate normally. No loose screw or broken rod were found.X-rays showed no signs of the enlarged screw canal or lowered lumbar spine.The effect was 76.5%(26/34) excellent judged by the ISOLS system.[Conclusion]Spinopelvic reconstruction by ISOLA system after resection of HLST is characterized by easy manipulation, less complications and instant stable fixation. It may be widely used in the clinical practice.

Objective: To approach the effects of glutamine supplementation on plasma and muscle levels of glutamine, and the activities of tissue glutamine synthetase and glutaminase after high intensity exercise. Methods: BAL/C mice were randomly divided into high intensity exercise(2% body weight load) and control groups to swim 2 hours per day for 8 weeks. Results: To compare with control group, high intensity exercise reduced glutamine levels in plasma and muscle by 74% (P

Objective To analyze the cases of anaphylactic death cases and explore the standards of judi-cial expertise of anaphylactic death for providing evidence for judicial expertise. Methods Fifty-nine cas-es death due to allergic reaction in Shanghai were collected. And details of medical history, clinical manifestation of anaphylactic reaction and postm ortem exam ination findings were review ed for all cases. Results In the 59 cases, there were 58 cases died from drug allergy, including 77.6% of them were an-tibiotics. The rates of treating in standard hospital and illegal clinic were 37.3% and 61.0%, respectively. The allergic sym ptom s were dyspnea and facial cyanosis. The time from contacting allergens to death ranged from 1 m in to 3 d. The concentration of total serum IgE ranged from 50 to 576.92 IU/m L . The results of clinical manifestation and pathological anatomy had obviously changes. Conclusion B ased on the exclusion of all other cause of death and synthetically analysis of details of cases, medical history, clinical manifestation and anatomy, the conclusion of anaphylactic death can reached. The details of cas-es including clinical history, exposure to allergens, and clinical manifestation play an im portant role in diagnosis of anaphylactic death.

Finite element method (FEM) is an effective mathematical method for stress analysis, and has been gradually applied in the study of biomechanics of human body structures. This paper reviews the construction, development, materials assignment and verification of FEM model of cervical vertebra, and it also states the research results of injury mechanism of whiplash injury and biomechanical re-sponse analysis of the cervical vertebra using FEM by researchers at home and abroad.

In drowning cases, it is difficult to judge whether the deceased died from drowning or throw-ing into the water after killed or identificate the cause of death of the decom posed corps in forensic practices. The diatom test is still considered as the im portant assistant evidence in drowning cases. This paper reviews research progress on technologies in recent years of forensic diatom test, and the applica-tion value of the newdeveloping approach in the field of forensic m edicine.

Objective To investigate microvascular injury-related factors post-percutaneous coronary intervention (PCI). Methods Seventy-two elderly patients with stable angina , who underwent PCI from February 2009 to February 2014, were enrolled in this study. The index of microvascular resistance (IMR) was assessed and the clinical data were collected. The correlation between general clinical data and the IMR value before and after PCI were analyzed, and regression analysis was conducted on the relevant factors with postoperative microcirculation after PCI. Results After PCI, FFR, CFR, CK-MB, troponin were higher than those before PCI, with significant differences (P < 0.05). Linear regression analysis result showed that glycated hemoglobin, the degree of stenosis after PCI were positively correlated with IMR, but ejection fraction and CFR before PCI were negatively correlated with IMR. Conclusion Clinically, diabetes, severe vascular stenosis, low ejection fraction, low CFR before PCI in patients with unstable angina may likely occur microcirculation after PCI.

Objective To explore the related risk factors for bypass graft occlusion in patients within 1 year after coronary artery bypass grafting,in order to provide the basis for the prevention of postoperative bypass graft occlusion.Methods Clinical data of 197 cases treated with coronary artery bypass grafting were collected,and the incidence rate of bypass graft occlusion and its related risk factors were analyzed.Results Graft occlusion occurred in 28 (14.2％) of 197 patients.The incidence rate of bypass graft occlusion were much higher in patients with BMI ≥24 kg/m2,smoking,hypertension,hyperlipemia,diabetes,peripheral vascular diseases and cerebrovascular disease than in patients with BMI ＜24 kg/m2,non-smoking,patients without hypertension,hyperlipemia,diabetes,peripheral vascular diseases or cerebrovascular disease (20.0％ vs.9.8％,22.4％ vs.10.8％,21.2％ vs.3.8％,31.1％ vs.9.2％,23.4％ vs.9.8％,25.5％ vs.10.7％,26.3％ vs.11.3％,x2 =4.106,4.534,11.735,13.658,6.615,6.486,5.656,respectively,P=0.043,0.033,0.001,＜0.001,0.010,0.011,0.017).Smoking,diabetes,hyperlipidemia,peripheral vascular diseases and cerebrovascular disease were the independent risk factors for bypass graft occlusion.Conclusions Many risk factors are related with short-term postoperative bypass graft occlusion in patients with coronary artery bypass grafting.The corresponding control measures should be conducted to decrease the risk of postoperative bypass graft occlusion,aiming directly at the risk factors,especially the independent risk factors.

Aim The m_5AChR-G_ 11? fusion protein was expressed by baculovirus-Sf9 cells system, then using it to identify the specific agonists and antagonists for m_5AChR via detecting the affinity of GDP and m_5AChR-G_ 11?. Methods The m_5AChR-G_ 11? fused cDNAs were generated via a two-step PCR protocol and inserted into pBacPAK9 virus vector. We expressed m_5AChR-G_ 11? fusion protein and m_5AChR protein using baculovirus-Sf9 cell system. [ 3H]QNB and [ 35S]GTP?S binding tests were performed to detect the expressional level of receptor proteins and determine the affinity of GDP and m_5AChR-G_ 11? fusion protein. Results The expression level of m_5AChR-G_ 11? was (47.6?3.2) nmol?g -1 protein. The affinity of GDP to G_ 11? partner changed in the presence of different muscarinic ligands. IC_ 50 values of GDP in the presence of ACh, YM796, Oxotremorine, Methixene, Dextimide and atropine were 128.0, 72.1, 68.5, 16.2, 14.9 and 9.7 ?mol?L -1 respectively, and that in the absence of muscarinic ligand was 20.8 ?mol?L -1. Conclusion The m_5AChR-G_ 11? fusion protein has the pharmacological specificity of M_5 receptor and the efficient coupling interaction of the two partner. Affinity of GDP to ligand bound m_5AChR-G_ 11? fusion protein represents the species of muscarinic ligands. ACh is a full agonist for m_5AChR-G_ 11? fusion protein, YM796 and oxotremorine are partial agonists, while methixene, dextimide and atropine are antagonists.

BACKGROUND:For the sacroiliac joint has complex structure and locates deep,its biomechanical properties have not been fully understood,even less about the study of reconstruction.OBJECTIVE:To construct a finite element model of pelvis after subtotal sacrectomy,and validate its effectiveness,which is supposed to be useful for evaluating reconstructions of sacroiliac joint.TIME AND SETTING:The establishment and validation of three-dimensional finite element model was performed in the Orthopaedic Laboratory of Changhai Hospital,Second Military Medical University between January and March 2008.MATERIALS:The CT scan images of adult males who had no pathological changes in lumber and pelvis were downloaded from CT work station in Changhai hospital.The CT scan included low lumber and whole pelvis,and got 132 DICOM images in all.METHODS:Two three-dimensional finite element pelvis models were established:① an intact pelvis model,② a defective pelvis model on which subtotal sacrectomy was performed cephalic to the S1 neural foramina.According to the biomechanical experiment of Hugate RR Jr,axial loads of 3 000 N and 1 000 N were applied on intact and defective pelvis models,respectively.The max axial displacements and stiffness on the L5 of two models were calculated and following comparison with the result in the literature.MAIN OUTCOME MEASURES:The max axial displacements and stiffness on the L5 were observed and considered as the index reflecting sacroiliac joint stability.RESULTS:The max axial displacements of the L5 on intact and defective pelvis models were 7.99 mm and 7.68 mm,respectively.The stiffness of the L5 on intact and defective pelvis models were 375 N/mm and 130 N/mm,respectively.The max axial displacements of the L5 on intact and defective pelvis models in the literature were(10.73?5.10) mm and(11.71?5.74) mm,and the stiffness were(353?231) N/mm and(101?49) N/mm,respectivly .CONCLUSION:In this experiment,we were successful to establish the finite element model of pelvis after subtotal sacrectomy.The calculated result was similar with the reference.The model could be used to evaluate different ways to reconstruct the sacroiliac joint.

Objective To analysis the biomechanical properties of four-rod fixation system for lumbosacral reconstruction after sacrectomy.Methods Two finite element models of lumbosacral area were established according to pelvic CT images:a subtotal saerectomy model and a total sacrectomy model.The range of motion of L3 vertebral body and max yon Mise stress of instruments of a novel four-rod fixation system were evaluated and compared with those of modified Galveston technique(MGT)under conditions of veaebral body and max von Mise stress of instruments of the four-rod fixation system were evaluated and compared with those of MGT under vertical compression.Results In subtotal sacreetomy model,the range of motion of L3 vertebral body in the four-rod fixation system were 4.2 mm,0.49°,0.49°,0.24°and 0.26°compared to 5.5 mm.0.74°,0.74°,0.27°and 0.30°in the MGT.The max von Mise stress of instruments in the four-rod fixation system were 810.7,148.0,148.0,134.6 and 14.4 MPa,compared to 655.0,109.9,109.9,119.1 and 11.4 MPa in the MGT.In total sacrectomy model under veaical compression,the range of motion of L3 vertebral body and max van Mise stress of instruments in the four-rod fixation system were 10.9mm and 2172 MPa compared to 49.1 mm and 4325 MPa in the MGT.Conclnsion Comparing with the MGT.the four-rod fixation system was stiffer and showed a significant increase in the stability of lumbosacral area.When total sacrectomy without bone graft were performed,the max stress of the four-rod fixation system was much lower than that of the MGT,which means smaller risk of instrument failure.When subtotal sacrectomy or bone graft were performed,despite better stability,the higher stress shielding-effect of the four-rod fixation svstem might be unfavorable for bone fusion,which still need to be evaluated by clinical trials.