BACKGROUND:Current clinical studies seldom concern biomechanical properties of lateral plate combined with medial percutaneous lag screw. Moreover, effects of clinical application to distal tibial fractures are not investigated. OBJECTIVE:To explore biomechanical properties of lateral plate combined with medial percutaneous lag screw, and to analyze the repair effect on distal tibial fractures. METHODS:Six adult antiseptic tibia specimens were studied. Bone saw was used to make a bone defect in 1 cm length, which was fixed with lateral plate and lateral plate combined with medial percutaneous lag screw. Three point bending test, axial compression test and rotation test were performed. Clinical data of twenty cases of distal tibial fracture patients from the Department of Orthopedics of Hebei Medical University were analyzed and randomly divided into lateral plate groupand lateral plate combined with medial percutaneous lag screw group (n=10). Clinical repair effects were compared between the two groups. RESULTS AND CONCLUSION:(1) Biomechanical indexes of cadaver specimens: no significant difference in torsional strength was determined between the two groups (P> 0.05). Bending stress and axial displacement were significantly lower in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group (P< 0.05). (2) Repair surgery related indicators: operation time, intraoperative blood loss, length of stay and fracture healing time were significantly less in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group (P< 0.05). (3) Repair effects: There were nine cases of fracture healing in the lateral plate combined with medial percutaneous lag screw group 3 months after treatment. The total effective rate was significantly higher in the lateral plate combined with medial percutaneous lag screwgroup (90%) than in the lateral plate group (70%) (P<0.05). (4) These findings indicate that lateral plate combined with medial percutaneous lag screw has a unique advantage in resisting axial compression, torsion and bending. Its application to distal tibial fractures obtains ideal effects, can improve the clinical efficacy and stability.

AIM: Granulocyte colony-stimulating factor and stem cell factor are the important cell factor in the hematopoiesis. According to changes in the cell information conduction and obstruction of the expression of the stem cell adhesion molecule, they can increase the quantities of stem cells, restrain the apoptosis and alter the function of bone marrow mesenchymal stem cells. The experiment was to discover how to isolate and culture the granulocyte colony-stimulating factor and stem cell factor mobilized peripheral blood derived mesenchymal stem cells, and to explore the induction to the cartilage cells in the monolayer culture. METHODS: Experiments were performed at the Hebei Provincical Key Laboratory, Research Center, Fourth Hospital of Hebei Medical University from January 2005 to March 2006. ①The 4-6 weeks male BALB/c mice weighting 15-20 g were provided by Animal Experimental Center of Hebei Medical University. The lab procedure met the animal ethical standard. ②The density gradient centrifugation combined with the adherence method were adopted to isolate the mesenchymal stem cells from peripheral blood of BALB/C mice after granulocyte colony-stimulating factor and stem cell factor mobilization. Detections of colony forming unit-forming ability were preformed on grow well cells. Mesenchymal stem cells were identified by flow cytometry and immunohistochemical method. The 3rd passage mesenchymal stem cells were induced to differentiate into chondrocytes in high glucose DMEM medium containing transforming growth factor beta 1. The expression of type Ⅱ collagen was detected by immunohistochemical method. RESULTS: ①The peripheral blood derived mesenchymal stem cells possessed the similar phenotypes with bone marrow derived mesenchymal stem cells and could differentiate into chondrocytes. Flow cytometry showed that CD29 and CD44 were positive, while CD34 and CD45 of them were negative. ②The passage 3 mesenchymal stem cells did not express type Ⅱ collagen and laminin, expressed vimentin in immunohistochemical method. The differentiated mesenchymal stem cells expressed type Ⅱcollagen ③The passage 1,3,5 mesenchymal stem cells showed different ratios of colony forming unit. Pairwise comparison showed that with the passage increasing, the ratio of colony forming unit degraded gradually (21.32%,16.13%,9.63%,P

Objective To investigate the effect of different concentrations of sevoflurane inhalation combined with pro?pofol anesthesia on rocuronium pharmacodynamics. Methods Sixty-seven patients, who underwent elective abdominal op?eration in Tianjin Medical University General Hospital from Nov. 2014 to Feb. 2015, were randomly allocated to three groups:propofol combined 0.5 minimum alveolar concentration (MAC) end-tidal concentration of sevoflurane (group Ⅰ, 24 cases), propofol combined 0.75 MAC end-tidal concentration of sevoflurane (group Ⅱ, 20 cases) and propofol combined 1 MAC end-tidal concentration of sevoflurane (groupⅢ, 23 cases). All those patients were given midazolam 0.05 mg/kg, sufen? tanil 0.3μg/kg, etomidate 0.3 mg/kg for anesthesia induction. Rocuronium was given through the T1 mode of Closed-loop muscle relaxant infusion system and infused by 2ED95(0.6 mg/kg). The following variables were recorded:average consump?tion dosage of rocuronium, recovery index, averaged consumption dosage of propofol and remifentanil. Results The aver?aged consumption dosage of rocuronium was decreased in the three groups in turn[(9.71 ± 2.38 vs 7.50 ± 0.98 vs 6.90 ± 1.14)μg·kg-1·min-1,F=18.562,P<0.05]. There was no significant difference in recovery index between the three groups [(8.92± 2.62 vs 8.95 ± 2.58 vs 10.30 ± 3.65)min,F=1.577, P>0.05]. The average consumption dosage of propofol and remifentanil were lower in groupⅢthan those of groupⅠand groupⅡ(P<0.05). Conclusion High concentration of sevoflurane can enhance neuromuscular blockage effect of rocuronium, and decrease the consumption dosage of propofol and remifentanil.

Objective: To investigate effective matching between computerized physician order entry and charging items in the hospital. Methods: Standard data of computerized physician order has been established, in which physician order items and charging items have been matched. It has effectively solved the problems in the process of computerized physician order entry. Results and Conclusion: The implementation of matching computerized physician and costs has effectively controlled the errors and missing of costs, which released the complaint of patients and received the good reputation and welcome, the compliance of doctors using computerized physician order entry has been obviously improved, meanwhile, it has provided new application experiences for implementing the following charging of national medical services prices in hospitals.

Objective To apply cervical pedicle screw system (CPSS) to treat cervical disorders and discuss its surgical indications, techniques and clinical effectiveness. Methods A total of 52 patients with middle and lower cervical spine lesions who underwent cervical transpedicular fixation were analyzed retrospectively. There were 41 males and 11 females aging from 16 to 62 years. The diagnosis of the patients were fractures and dislocations of cervical spine accompanied by complete paralysis (28 cases) or incomplete paralysis (19 cases) in 47 cases, and metastatic bone tumor in 5 cases. Prior to surgery, anteroposterior and lateral radiographs, CT scan through bone windows, and/or magnetic resonance images were carried out in all patients. During surgery, all screws were inserted into the pedicle under the guidance of lateral or oblique image intensifier to confirm the direction and insertion depth of screws. In 7 to 14 days after surgery, physical examination and roentgenograms evaluations were performed in all patients, and CT scans were obtained in 31 patients, the location of screws were evaluated with the radiographic examinations and CT scan. The follow-up period averaged 13 months (range, 1 to 36 months) in 38 patients. The authors experiences in achieving accurate pedicle screw insertion was introduced, the clinical value of using cervical pedicle screw system to manage cervical lesions was summarized, the possible complications of CPSS were analyzed, the candidates of using CPSS were discussed as well. Results Pedicle screws were inserted successfully in all cases, 9 cases were found to have nerve irritating symptoms by 10 pedicle screws when which were introduced into pedicles, however, by changing the direction of the screws, all symptoms disappeared and screws were successfully inserted. Postoperative radiographic evaluation confirmed proper insertion of screws except 2 screws perforating the lateral pedicle wall but without injury of the vertebral artery demonstrated on CT scans. In the followed-up, no screw breakage and loosening was observed. By applying distractive force between the screws placed into pedicles, the space between the affected vertebrae and discs could be increased, displaced anterior fragments of bone or disc could also be indirectly reduced from the spinal canal, and additional anterior decompression interventions might be avoided. Conclusion CPSS can be considered as one of alternative in posterior cervical internal fixation systems. However, specific caution must be taken. The candidates of utilizing CPSS should be properly selected.

Objective To analyse gene mutation in members of a Chinese family with Hailey-Hailey disease(HHD)and study the relationship between the genotype and clinical features of the disease.Meth-ods Genomic DNA of leucocytes were obtained from members of the Chinese family with HHD including4patients and6normal persons.Ten exons of ATP2C1gene were amplified by polymerase chain reaction(PCR)and the products were analysed by single-strand conformation polymorphism(SSCP)and direct DNA sequencing.Results A novel mutation was identified in this family.The sequence of"TGTAGCCAT"(2068→2076)was substituded by"AGATGGAACA",which caused a frame shift of open reading frame and premature termination codon(PTC)in gene ATP2C1.There was no relationship between the genotypes and the phenotypes.Conclusion Gene mutation of ATP2C1gene at exon21is the cause for HHD in this fami-ly.

Objective To develop neural stem cells(NSCs) which can stably express exogenous brain-derived neurotrophic factor(BDNF) in vitro. Methods NSCs from the subependymal zone of embry-onic day 14.5(E14.5) rat brain were purified by limiting dilution assay and then infected with supernatant of recombinant retrovirus pLXSN-BDNF and retrovirus pLXSN. The original copy numbers of exogenous gene templates from three groups NSCs(pLXSN-BDNF viral infection group, pLXSN viral infection group, control group) were detected by fluorescent quantitative PCR(FQ-PCR). ELISA assay was used for determining the protein contents of BDNF of supernatant from three groups NSCs for six days continually after seeded in 24-well plates in the same cell density. Results NSCs were purified successfully by limiting dilution assay.The original copy numbers of exogenous BDNF gene templates from pLXSN-BDNF viral infection group by FQ-PCR were (19.57±0.65) × 10~3 copies/μl, higher than those of another two groups(P < 0.05). The protein contents of BDNF of supernatant from NSCs of pLXSN-BDNF viral infection group was highest among three groups and compared with another two groups had statistical significance (P <0.05) . Conclusion The purified NSCs can be transduced exogenous BDNF successfully with supematant of recombinant retrovir-us pLXSN-BDNF which provide experimental evidences and laying foundations for further research of retinal transplantation and quantization investigation of gene therapy for optic nerve injury.

BACKGROUND:Articular cartilage injuries can result from a variety of causes. Conventional therapy cannot obtain the optimal clinical results. Low-intensity pulsed ultrasound has been shown to promote the repair of injured articular cartilage. OBJECTIVE:To investigate the effects of low-intensity pulsed ultrasound on the repair of injured articular cartilage. METHODS:Twenty New Zealand white rabbits were used to establish knee arthritis models and equal y randomized into study and control groups, respectively. Rabbits in the study group received low-intensity pulsed ultrasound treatment, and sham low-intensity pulsed ultrasound treatment was given in the control group. At 8 weeks after treatment, pathological change and histological scores in articular cartilage tissue col ected from both groups were determined. Moreover, the ultrastructure and type II col agen expression of chondrocytes were determined. Matrix metal oproteinase-13 mRNA expression was detected by quantitative real-time PCR. RESULTS AND CONCLUSION:At 8 weeks after treatment, toluidine blue staining showed a disordered arrangement of cel s, decreased number of cartilage cel s in each layer and cluster in the control group. Light disordered arrangement of cel s, decreased appearance of the superficial layer cel s and the cluster phenomenon were observed in the study group. Articular cartilage tissue scores were significantly decreased in the study group compared with the control group (P<0.05). The chondrocytes were smal , enlarged intracel ular mitochondria and rough endoplasmic reticulum, cytoplasmic swel ing, col agen fibrils coarse, wel developed Golgi apparatus, and nuclear fragmentation were observed in the control group. In addition, the normal structure of organel es disappeared and cel degeneration was observed in the control group. In the study group, the size of chondrocytes and the Golgi complex and other organel es were normal, and the protein polysaccharide granules were observed in the cytoplasm and membrane. The mRNA expression of matrix metal oproteinase-13 in the study group was significantly lower than that in the control group (P<0.05). Type II col agen immunoreactivity in the study group was stronger than that in the control group. No incision infection, suppuration, red swel ing appeared in al rabbits. Our results suggest that low-intensity pulsed ultrasound can be used for the treatment of articular cartilage injury by al eviating the degradation of col agen type II and inhibiting the expression of matrix metal oproteinase-13.

Objective To investigate the prenatal diagnosis and postnatal management of fetal hydronephrosis.Methods One hundred and two cases (87 unilateral and 15 bilateral,with a total of 117 kidneys) of fetal hydronephrosis in singleton pregnancy were diagnosed by prenatal ultrasonography in Jinhua People's Hospital between January 2011 and December 2014.During pregnancy and postpartum,all cases were routinely examined by genitourinary ultrasound for the classification of severity of hydronephrosis.The age of gestation at diagnosis of fetal hydronephrosis,the classification of hydronephrosis and postnatal follow-up outcome were recorded and retrospectively analyzed by descriptive statistical analysis.Results Of the 102 pregnancies,the mean gravida age and gestational age at diagnosis of fetal hydronephrosis was (28.1 ± 3.7) years (20-39 years) and (30.44-4.9) gestational weeks (16-40 gestational weeks),respectively.One hundred and two cases (35 right,52 left and 15 bilateral) of fetal hydronephrosis were diagnosed by antenatal ultrasonography.In the second trimester,59 cases (11 bilateral) of fetal hydronephrosis were diagnosed,including 28 mild (five bilateral),24 moderate (three bilateral),four severe (one bilateral) and three terminated ones.In the third trimester,43 cases (four bilateral) were diagnosed,including 22 mild (two bilateral),17 moderate (one bilateral),two severe and two terminated ones.All these patients were re-examined by ultrasonography at 48 hourspostpartum,and hydronephrosis was still present in 41 cases (five bilateral),including 19 grade 1 (two bilateral),11 grade 2 (two bilateral),seven grade 3 and four grade 4 (one bilateral).From the second and third trimester to postnatal period,there were 18 (two bilateral) and 23 (three bilateral) cases of hydronephrosis,respectively.The regression rate of prenatal hydronephrosis was 53.8％ (63/117),including 64.3％ (45/70) in the second trimester and 38.3％ (18/47) in the third trimester.During postnatal follow-up period,two cases (6.7％,2/30,unilateral) of grade 2,four grade 3 (4/7,unilateral) and four grade 4 (one bilateral) underwent surgery.Eleven cases of grade 3-4 hydronephrosis (one bilateral) were followed up and nine kidneys were treated with surgery due to ureteropelvic junction obstruction (6/9),ureter stricture (1/9),vesicoureteral stricture (1/9) and posterior urethral valves (1/9).Conclusions Although the majority of cases of fetal hydronephrosis spontaneously regress,postnatal hydronephrosis should be monitored timely and continuously by ultrasound.In particular,grade 3-4 hydronephrosis should be followed up to evaluate renal functions.If hydronephrosis presents with symptoms,progressive aggravation,pathological obstruction,or differential renal function ＜ 40％,early surgical intervention should be provided to improve renal functions.

Objective The policy of quota payment for specific diseases has been carried out at the hospital for several years, yet proven a failure. This paper aims at searching for a new way of management.Methods Since 2013,attempts have been made for classification of medical costs and the quota setting for specific diseases, and for development of a real-time supervision software for classification of disease-specific costs.The attempts prove a success with a new model for management of quota management for specific diseases.Results This practice has proved to be effective in 2014,and used in other likewise diseases,which has been embraced by administrators of medical insurance sector. Conclusion This model proves useful for reducing inpatient expenses and regulating medical behaviors. but also shorten the average hospitalization days,improve the satisfaction of patient.The method of management control can be expanded and imitated.