Objective To investigate the relationship between Clq/tumor necrosis factor (TNF)-related protein 9 (CTRP9)and coronary heart disease.Methods A total of 232 patients diagnosed with coronary heart disease(CHD)by coronary angiography at our hospital were selected as the CHD group,and 90 cases with normal coronary angiography served as the control group.The double antibody sandwich enzyme-linked immunosorbent assay(ELISA)was used to determine serum CTRP9 levels.Results Serum CTRP9 levels were lower in the CHD patients than in the controls [(116.9±19.5)ng/ml vs.(142.3±17.9)ng/ml,t＝-5.404,P＝0.000].SerumCTRP91evelswere negatively correlated with body mass index,fasting plasma insulin,fasting blood glucose,insulin resistanceindex(IRI),triglyceride and TNF-α(r＝-0.230,-0.225,-0.267,-0.235,-0.230and-0.222,P＝0.017,0.011,0.002,0.010,0.011 and 0.022).Multiple logistic regression analysis revealed that uric acid,IRI,CTRP9,and TNF-α were independent influencing factors for CHD,of which CTRP9 was a protective factor for CHD occurrence(OR ＝ 0.907,95％C1:0.854～0.963,P＝ 0.001).Conclusions Decreased serum levels of CTRP9 are associated with coronary heart disease,indicating that CTRP9 may play a protective role in coronary heart disease occurrence.

Objective To analyze the results of sputum culture from smear-positive pulmonary tuberculosis cases after treatment for 2 months.Methods Sputum specimens from newly diagnosed 147 smear-positive pulmonary tuberculosis cases after treatment for 2 months were fast cultured by BacT/ALERT 3D.Poeitive cultures were further detected by HAIN test in Zhejiang Provincial Center for Disease Control and prevention and compared with L-J meditun.Results Mycobacteria were found in 45 specimens by Bact/ALERT 3D in contrast to 22 by Lonswtein-Jenson method.The median time was 19.3 days for the whole Bact/ALERT 3D test while the whole procedure would cost 3 months for traditional L-J test.Conclusion Results from sputum smear could not reflect tuberculosis progress properly while BacT/ALERT 3D fast culture would help to find drug resistant patients promptly and accurately.

[Objective]To investigate the advantages, risks and kye points of minimally invasive total knee arthroplasty with subvastus approach. [Method] From April 2005 to December 2006, 204 primary total knee arthroplasties were performed, among them 146 cases with convention incision (CI), 58 cases with minimally invasive subvastus approach(MIS). All knees were implanted with the same prosthesis (NEXGEN-LPS, Zimmer).The anesthesia time,operation time, hospitalization time were recorded.The first walking time, walking distance, active knee range of motion, preoperative and postoperative HSS Score and the complications were compared. [Result] Totally 204 cases were followed up and the mean follow-up time was 22 months (range, 13-36 months). The difference of anesthesia time, length of incision, operation time, hospitalization time, walking time had significance between the CI and MIS groups ( u test, P0.05). The difference of active range of motion in 24 hours, 1 week, 2 weeks postoperation had significance between the two groups ( u test, P0.05).The difference of HSS score in 24 hours, 1 week, 2 weeks after operation had significance between the two groups ( u test, P0.05). [Conclusion] The minimally invasive total knee arthroplasty with subvastus approach reduces the quadriceps injury, offers early active knee motion and quickly recovery of knee function. However there is no significant difference in long-term walking distance, range of motion and HSS score.

Objective To investigate the anatomy of the skull base for minimally invasive keyhole approach to sellar lesions.MethodsSixty-seven samples of adult skull bone(134 sides) were collected and sawed at the levels of the supraorbital arch and anterior skull base.After inspecting the opening of the frontal sinus,we observed the appearance of the orbit roof(cerebral juga),and measured the maximum height of the two cerebral jugas.Afterwards,the operation distances and angles with regard to the anterior and posterior clinoid processes through the trans-upper orbit,trans-lateral front,trans-pterion,and trans-sub-temple keyhole approaches in 15 skull bone samples were measured.And then,we statistically analyzed the variance in these measurements among the four operative approaches.ResultsOf the 67(134 sides) adult skull bone samples,52 sides showed frontal sinus openness(38.8%,52/134).Most of the skull bases were clawed(multicuspidity or oblique ridge multicuspidity).The maximum height of the cerebral juga that was less than 2.50 mm was found in 36 sides(26.9%),and over 2.51 mm in 98 sides(73.1%).Among the four methods,the shortest distances between the keyhole and the anterior and posterior clinoid processes were found in the trans-sub-temple keyhole approach [(4.87?0.47) cm and(4.93?0.45) cm],and the longest were observed in the trans-lateral front keyhole approach[(6.45?0.30) cm and(7.83?0.54) cm],and trans-upper orbit keyhole approach[(6.47?0.28) cm and(8.31?0.34) cm].The angle between the sagittal section and the keyhole in the trans-lateral front keyhole approach [(40.83?1.11) ? and(37.86?1.37)?] was larger than that in the trans-upper orbit one [(10.23?0.90) ? and(12.29?0.86)?],while the angle between the cross section and the keyhole in the trans-sub-temple keyhole approach [(21.21?0.45) ? and(20.10?0.63)?] was larger than that in the trans-pterion one [(5.49?0.30)? and(9.84?0.58)?].ConclusionsThe size of the frontal sinus,shape and height of the cerebral juga,depth of the skull base operation,and angle between the operational and the skull base planes play important roles in the selection of minimally invasive keyhole approach for sellar lesions.

Objective To determine the effects of intrauterine growth retardation(IUGR) caused by malnutrition during pregnancy on the lung structure and expression of Clara cell protein (CCSP) and interferon (IFN)-γ in the fetal lungs,and to explore their relation ship with pulmonary disease.Methods Fetal rats from maternal protein-malnutrition dams were studied on day 20(term 21.5 day).The lung pathology was examined by means of Hematoxylin and eosin(HE) stain.Plasma was collected to determine the CCSP and IFN-γ concentration.Lungs were harvested to measure the expression of CCSP and IFN-γ mRNA by using fluorescent quantization reverse transcription (RT)-PCR and the levels of CCSP and IFN-γ protein were assessed by using enzyme-linked immunosorbent assay.Results Malnutrition fetus body weight significantly less compared to control group,so did the lung weight.However,lung weight,expressed as a percentage of body weight between the 2 groups was not different.The IUGR group had significantly decreased alveolar number manifested by lower radial alveolar count,and significantly increased mean linear intercept of alveoli.Both the CCSP mRNA expression and protein level in lung of IUGR rats were decreased compared with control rats (all P ＜ 0.05).A decline in plasma CCSP protein concentration was also noted compared with control group (P ＜0.05).Furthermore,IUGR group fetus showed lower IFN-γ levels both in circulation and in the lung tissue (all P ＜ 0.05).Conclusions Intrauterine malnutrition significantly alters lung structure and cytokine IFN-γ level,and the latter may further inhibit the transcription of CCSP gene.These alterations may contribute to both early and late postnatal respiratory morbidity.

Background:Inflammation plays an important role in intestinal ischemia-reperfusion injury(IRI),and erythropoietin (EPO)has been reported to have anti-inflammatory activity. Aims:To explore the protective effect of EPO on intestinal IRI and its potential mechanism. Methods:Thirty-two healthy male Sprague-Dawley rats were randomly divided into four groups:sham operation group(sham group),IRI group,EPO group and 740Y-P group. Rats in IRI,EPO and 740Y-P groups were injected intraperitoneally with 0. 9% NaCl,EPO and EPO + 740Y-P,respectively,one hour before the establishment of intestinal IRI model by superior mesenteric artery clamping(45 min)-reperfusion. All rats were sacrificed one hour after reperfusion. Histopathological changes of small intestine were observed;expression of proteins in PI3K/ Akt and NF-κB signaling pathways was measured by Western blotting;expression and secretion of inflammatory cytokines, including interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein-1(MCP-1)were examined by real-time PCR and ELISA. Results:Compared with sham group,the damage score of small intestine,protein expressions of PI3K,p-Akt and p-NF-κB p65,as well as mRNA expressions and serum levels of IL-8,TNF-α and MCP-1 in IRI group were significantly increased(P < 0. 05). EPO pretreatment could ameliorate the histopathological changes of small intestine in IRI model rats,inhibit PI3K/ Akt and NF-κB signaling activation and down-regulate expression and secretion of inflammatory cytokines. When 740Y-P,a PI3K agonist,was used combinedly,the effect exerted by EPO was diminished. Conclusions:EPO pretreatment can protect against intestinal IRI by inhibiting the activation of PI3K/ Akt/NF-κB signaling and the subsequent inflammatory response.

Objective To evaluate the reliability and reproducibility of the thoracolumbar osteoporotic vertebral compression fracture (OVCF) severity score system (TLOFS),so as to provide basis for clinical decision-making.Methods A total of 320 cases of thoracolumbar OVCF hospitalized between January 2014 and June 2015 were scored by TLOFS.There were 107 male and 213 female patients,aged 52-90 years (mean,63.78 years).All cases presented with a chief complaint of low back pain.Thirty-nine cases (TLOFS ≤3 in 21 cases,TLOFS =4 in 17 cases) were treated non-operatively,while 259 cases (TLOFS =4 in 23 cases,TLOFS ≥ 5 in 259 cases) were treated surgically.Pain was evaluated by the visual analogue scale (VAS).Reliability,reproducibility and content validity of the TLOFS were analyzed.Results Cronbach' sα coefficients of all TLOFS subgroups including evaluation of morphological changes,MRI,bone mineral density,clinical situation and therapy recommendation and total score evaluation were within the range of higher to high reliability (0.76-0.94).Kappa coefficients of all TLOFS subgroups were within the range of higher to high reproducibility (0.84-0.95).Mean content validity of all TLOFS subgroups was 0.916.VAS improved from preoperative(7.8 ± 2.1) to (1.3 ±0.7) at the final follow-up.Rates of correct diagnosis,sensitivity and specificity were 95.7％,87.6％ and 96.5％ respectively.Conclusion TLOFS exhibits good reliability and reproducibility,easy operation,and accurate and comprehensive evaluation,which is effective in guiding the clinical decision making in treatment of thoracolumbar OVCF.

Objective To compare the efficacy of KumaFix posterior spinal screw/rod system (KumaFix system) and posterior U-shape screw/rod system for treatment of thoracolumbar vertebral body fractures.Methods A total of 131 patients with thoracolumbar vertebral body fractures treated from January 2011 to July 2011 were prospectively analyzed.All patients showed thoracolumbar injury classification and severity score (TLICS) more than 5 points and spinal load-sharing classification (LSC) score of 4-6.The patients were assigned to two groups according to the coin toss method:group A (n =72,treated with reduction and fixation with KumaFix system in combination with transpedicular bone grafting of fractured vertebrae) and group B (n =59,submitted to posterior reduction and fixation with U-shaped screw/rod system in combination with transpedicular bone grafting of fractured vertebrae).In group A,there were 41 male and 31 female patients at age of (41.2 ± 4.9) years (range,20-53 years).In group B,there were 33 male and 26 female patients at age of(40.6 ± 4.5)years (range,21-51 years).The two groups were analyzed and compared in aspects of operation time,blood loss,anterior vertebral height ratio,middle vertebral height ratio,posterior vertebral height ratio,kyphosis angle,Oswestry disability index (ODI) and incidence of adjacent segment degeneration.Results All patients were followed up for mean 5.3 years (range,5.1-5.8 years).Operation time and blood loss were (72.5 ±21.8)rain and (320.6 ±90.0)ml in group A,less than (104.3 ±20.7)min and (421.0 ± 84.5) ml in group B (P ＜ 0.05).Both groups achieved obvious improvements in anterior vertebral height ratio,middle vertebral height ratio,posterior vertebral height ratio and kyphosis angle after operation(P ＜ 0.05).At the last follow-up,the middle vertebral height ratio was (92.0 ± 2.8) ％ in group A,better than (84.1 ± 5.1) ％ in group B (P ＜ 0.05).Both groups showed improvement in ODI after operation (P ＜ 0.05).At the last follow-up,ODI and incidence of adjacent segment degeneration were 11.9 ± 7.1 and 0 in group A,decreased compared to 20.9 ± 6.7 and 12％ in group B (P ＜ 0.05).Conclusions For thoracolumbar vertebral body fractures,the KumaFix system has better reduction effect than U-shape screw/rod system.Meanwhile,the KumaFix system can avoid negative effect.

Objective To study the effect of the combined medial and lateral operative approach for the serious intra -articular fractures of calcaneus.Methods The lateral and medial approach for the treatment of the serious intra -articular fractures of calcaneus 22 cases (26 feet),fully exposed in the medial and lateral subtalar joint surface,reduct subtalar joint surface,drill into Kirschner nails for reduction of the calcaneus angle,then graft bones fully in the defect left after reduction,used calcaneus anatomic plate and screws to fix the fracture on the lateral. Results The patients were followed up for 10 -22 months.According to the American Orthopaedic Foot and Ankle association ankle scoring system,the averange score was 87 points.Normal union of 22 feet,4 feet delayed union,skin necrosis no incision,no infections,no cases of neurovascular injury.Conclusion The combined medial and lateral operative approach for the serious intra -articular fractures of calcaneus is an effective method,and can fully expose the lateral and medial fracture,and is conducive to reduction of the lateral and medial articular surface,and restoration of calcaneus shape,reduce malunion and the foot -pain with walking.

Objective To explore the value of MR diffusion tensor imaging ( DTI) in diagnosis of traumatic Axonal injury ( TAI) .Methods Twenty nine patients with traumatic brain injury ( TBI) and matched 22 control subjects were performed with DTI . Fractional anisotropy ( FA) was calculated from semioval center , corpus callosum , internal capsule and pons of controls and TBI pa-tients.According to Glasgow Score (GCS), TBI patients were divided into mild group (GCS≥13) and moderate-severe group (GCS≤12), each group compared with control group in FA value .The correlation between FA values in different regions and GCS score were analyzed in DTI group .Results FA value of semioval center was decreased in mild DTI group ( P <0.01 ) .FA values of semio-val center , corpus callosum , and internal capsule were decreased in moderate-severe DTI group ( P <0.05 ) .The FA values in semio-val center , corpus callosum , and internal capsule were positively correlated with GCS score in TBI group ( P <0.05 ) .Conclusions DTI is sensitive to detect the traumatic axonal injury??Changes of FA value in ROIs can access the severity of axonal injury ?? which ishelpful for diagnosis earlier and improving prognosis.