Objective To investigate the natural history of mild adolescent idiopathic scoliosis in a period of 15 years and search for the risk factors of progress as well as to recommend the modification program of school screening for scoliosis. Methods From a group of 204 patients with adolescent idiopathic scoliosis who were detected from school screening for scoliosis among 20 418 school children in Beijing from May 1985 to January 1986, 90 of the patients were reevaluated 15 years later. The follow-up items of the therapeutic history, physical examination and standing spinal X-ray films were carried out. The late data were compared statistically with the original data at the time of school screening. The final results were divided into four groups: 1)Resolved group with a current curve less than 10 degrees; 2)Reduced group with a current curve more than 10 degrees but reducing less than 5 degrees regarding to the original status; 3)Unchanged group with a current curve more than 10 degrees while progressing less than 5 degrees compared to the original data; 4)Progressed group with a current curve was more than 10 degrees and aggravating more than 5 degrees than the original curve. Results Of 204 patients, 111 patients were followed up, and X-ray films were taken in 90. The follow-up results suggested that 29 cases showed resolved(32.2%), 21 cases reduced (23.3%), 30 cases unchanged (33.3%) and 10 cases progressed (11.1%). In 10 cases of progressed group, there were 8 females and 2 males, furthermore, 6 patients were found with the cobbs angle of curve between 10 and 19 degrees and 4 patient with the cobbs angle of curve more than 20 degrees when school screening. The curve pattern of the 10 progressed patients consisted of double thoracic curves in 2, double thoracic and lumbar curves in 2, right thoracic curve in 3, thoraco-lumbar curve in 2 and lumbar curve in 1. Conclusion Most of cases with less than 20 degrees curve are of no progress. The high risks of progress are as followed: curve more than 20 degrees, female, double thoracic curve, double thoracolumbar curve, right thoracic scoliosis and top vertebral rotation more than grade Ⅱ. The school screening for scoliosis should be carried out by school medical team who were trained by orthopaedists. The specialists should reexamine the suspected children and monitor the patients with high risk of progress.

BACKGROUND:Studies have shown that the reason of the slower liver regeneration in individuals of cirrhotic liver after partial hepatectomy compared with healthy liver may be related to the delayed synthesis and secretion of hepatocyte growth factor during liver regeneration, but the cause of this phenomenon is not clear. The hepatocyte growth factor activator inhibitor found in recent years can indirectly inhibit the activation of hepatocyte growth factor, but there is little research to explore the expression of hepatocyte growth factor activator inhibitor in the regeneration process after partial hepatectomy in cirrhotic liver and its relationship with the liver regeneration. OBJECTIVE:To investigate the expression of hepatocyte growth factor activator inhibitors (HAI-1, HAI-2) during cirrhotic and normal liver regeneration after partial hepatectomy through establishing the cirrhotic rat model, and to explore the biological effects of HAI-1, HAI-2 in cirrhotic liver during the liver regeneration after partial hepatectomy. METHODS:We used 40%CCl4 subcutaneous injection to establish the cirrhotic rat model, then we performed 70%liver resection for the experimental group. The rats in the control group only received ordinary water feeding and 70%liver resection. Rats in each group were randomly sacrificed before surgery and at 3 hours, 6 hours, 12 hours, 24 hours and 48 hours after surgery, and samples were col ected. We used RT-PCR technology to detect the expression of HAI-1 mRNA, HAI-2 mRNA in splenic tissue. RESULTS AND CONCLUSION:The expression levels of HAI-1 mRNA of two groups after partial hepatectomy were increased firstly and then decreased. The expression of HAI-1 mRNA in cirrhotic rats was sustained higher than that of the control group (P<0.05), there was no significant difference between the two groups of the expression of HAI-2 mRNA (P>0.05). The expression of HAI-1 mRNA in liver cirrhosis rats after resection was consistently higher than that in healthy rats, which may lead to the insufficient synthesis and secretion of hepatocyte growth factor activator in cirrhotic rats, then hepatocyte growth factor precursor may not be activated enough, eventual y leading to slow liver regeneration. HAI-2 may not be involved in the wound repair process of liver.

Objective To investigate the role of interferon regulatory factor-1 (IRF-1) in liver ischemia/reperfusion (IR) injury and its underlying mechanism,and identify effective managements in alleviating liver IR injury.Methods Three groups of mice models with liver IR injury were well established,including control group (S),warm liver IR injury group (IR) and recombinant IRF-1 group (IRF-1).The levels of mRNA and protein,liver function and pathological changes of liver tissue were detected in group S and group IR.Additionally,the marker of IRF-1,p-Stat1,p-P38,PARP1 and Caspase-3 were measured and PCNA expression was determined in group IR and group IRF-1 mice with 6-hour liver IR injury.Results IRF-1 mRNA and protein and the levels expression of proteins were significantly elevated with peak occurred after 6-hour IR injury,which was statistic difference compare to the group S (t2h =-3.512,t6h =-4.247,t12h =-4.088,t24h =-3.851;P ＜ 0.05).Serum ALT and AST of mice detected in group IR were higher than group S at all endpoints (tALT =4.931,4.592,4.277,4.809;tAST =4.980,4.617,4.336,4.915;P ＜ 0.05).Furthermore,pathological damage change was more distinct compared with group S.The elevated levels of IRF-1,p-Statl,p-P38,PARP1 and Caspase-3 and decreased PCNA expression were determined in mice models with recombinant IRF-1 intervention.Conclusion IRF-1 expression could be closely correlated with liver IR injury,and its underlying mechanism may be attributed to activation of JNK MAPK protein and inhibition of PCNA expression.

Objective To investigate the differential expression of hepatocyte growth factor activator (HGFA) and its inhibitors (HAI-1,HAI-2) during cirrhotic and normal liver regeneration after partial hepatectomy,and to explore the causes of the delayed liver regeneration after partial hepatectomy in cirrhotic rat model.Methods We used 40％ CCl4 subcutaneous injection to establish the cirrhotic rat model,and then performed 70％ liver resection for the experimental group together with no operation for the healthy rats as control group.Rats in each group after 3 hours,6 hours,12 hours,24 hours and 48 hours were randomly sacrificed and specimens were collected.The serum HGFA was detected by enzyme-linked immunosorbent assay (ELISA),and we used RT-PCR to detect the mRNA expressions of HAI-1 and HAI-2 in splenic tissue.Results The serum HGFA level in cirrhotic rats at each time point was all significantly lower than that in the control group (P ＜0.05).The expression of HAI-1 mRNA in cirrhotic rats was sustained at a higher level than that in the control group (P ＜ 0.05),but there was no significant difference on the HAI-2 mRNA expression between the two groups (P ＞ 0.05).Conclusions The synthesis of HGFA during the liver regeneration after partial hepatectomy in cirrhosis rats is lower compared with healthy rats,which may lead to the insufficient activation of HGF precursor,eventually causing the slow liver regeneration.HAI-2 may not be involved in the healing process of liver.

Objective To evaluate the results of acromioclavicukr crook plate in treatment of acromioclavicular joint dislocation and distal clavicular fracture and discuss causes for complications and preventive measures.Methods From September 2003 to April 2007,open reduction and acromiocla vicular crook plate fixation was done on 38 patients with acromioclavicular joint dislocation and distal clavicular fracture including 17 with acromioclavicular dislocation and 12 with distal clavicle fractures.Postoperative rehabilitation began early.Results Of all,27 patients were followed up for mean 21 months (3-37 months) and obtained bone healing.The internal fixation was removed at 6-8 months postoperatively and the outcome was evaluated with Karlsson rating system,which showed 22 patients at grade A,four at grade B and one at grade C.There was no dislocation or fracture after the internal fixation was removed ranging.Three patients with limited abduct motion <90° during certain movements got better after plate removal.One patient had acromio clavicular erosion.Conclusions The application of acromioclavicular crook plate provides accurate anatomical reduction and early rehabilitation and enables fast functional recovery.Technically,the implant needs to be used precisely.It is better to get appropriate early exercise and remove plate as early as possible.

Objective To evaluate the early and middle-term results of in-situ single-screw fixation and subtrochanteric osteotomy of femur with external fixator for slipped capital femoral epiphysis(SCFE).Methods From June 1998 to July 2008, eleven patients (12 hips) with SCFE were treated, including 7males (8 hips) and 4 females (4 hips) with an average age of 14.3 years (range, 9-18). The average BMI was 31.1 g/m2. According to the Southwick measurement, mild (＜30°) in 6 cases (7 hips), moderate (30°-50°) in 2 cases (2 hips), and severe (＞50°) in 3 cases (3 hips). All the mild and moderate cases were undergone insitu single screw fixation, and three severe cases were performed subtrochanteric osteotomy of femur with external fixator. All the cases were evaluated at 3 months, 6 months and every year postoperatively. Results All the cases were followed up for average 5.6 years (range, 2-12). The Harris hip score increased from mean 74.8 points preoperatively to 90.6 points postoperatively, with 10 hips excellent, 1 hip good, 1 hip fair and 0 hip poor. The excellent and good rate was 91.7% (11/12). The X-ray showed the epiphyseal closure in in-situ single screw fixation cases, and no further increase in epiphyseal-shaft angle. Partial reduction of slipped epiphysis with normal joint spaces was observed in subtrochanteric osteotomy of femur with external fixator cases. Conclusion In-situ single screw fixation provides a surgical treatment option to treat mild and moderate SCFE with satisfactory clinical outcome, and profit to the prevention further slip. Subtrochanteric osteotomy of femur with external fixator is suitable for severe SCFE with late deformity. The realignment procedure can correct deformity and postpone or avoid the occurrence of osteoarthritis.

Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.

Objective To investigate the effects of different hepatic perfusion procedures for small-for-size liver transplantation in rats. Methods A total of 156 rats were randomly divided into two groups: portal vein perfusion group (groupⅠ, n=78) and abdominal aorta perfusion group (groupⅡ, n=78). After harvesting graft, the left lobe of the liver and the middle lobe were resected and the remaining approximately 30%volumes of the liver were transplanted in groupⅠand groupⅡ. The body weights of donor and acceptor, the weight of graft, the time of operating in donor, the cold ischemia time, anhepatic phase, the blocking time of inferior hepatic vena cava and the time of operating in receptor were recorded in two groups. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), pathological HE staining and 7-day survival rate in 6 h, 1 d, 3 d and 7 d after operation were compared between two groups. Results The serum levels of ALT and AST were decreased gradually in two groups, but the levels decreased slowly in groupⅠ. The serum levels of ALT and AST were significantly higher in groupⅠthan those of groupⅡ(P<0.05). HE staining showed greater damage of mi-crostructure of liver tissue at early stage in group Ⅰthan that in groupⅡ. The 7-day survival rate was lower in group Ⅰthan that of groupⅡ(χ2=4.050,P=0.044). Conclusion There is a higher survival rate and mild liver damage in small-for-size liver transplantation in rats using perfusion by abdominal aorta.