Objective To explore the clinical value of helical CT surface shaded display (SSD) and multiplanar reconstruction (MPR) images in diagnosing the acetabular fractures. Methods According to the anatomical basis of "Y" type cartilage in children acetabulum, adult acetabulum was divided into "two columns" the anterior and posterior column and "four walls"the anterior, posterior, medial and roof walls, so as to define the localization, type, interface and union of fractures accurately. Results From 1999 to 2001, 68 cases of acetabluar fractures were reviewed. Of 68 cases, 28 cases were diagnosed as complex double columns and three walls (anterior, posterior and interior wall respectively) fracture, 7 cases as complex single column (anterior column) and three walls (anterior, posterior and interior wall) fracture, 5 as complex single column (anterior column) and two walls (anterior and interior wall) fracture, 21 as simple posterior wall fracture, 7 as simple anterior wall. In this group, 21 complex double columns and three walls fractures, 7 complex single column and three walls fractures, 5 complex single column and two walls fractures, 15 simple posterior wall fractures, 3 simple anterior wall fractures had reduction and internal fixed with plates or absorbable screws; another 7 complex double columns and three walls fractures, 6 simple posterior wall fractures, 4 simple anterior wall fractures were treated with traction reduction because the separation and displacement of their fragments were not significant. Using ?2 statistical analysis,there was a significant difference between the X-ray film and SSD and MPR in demonstrating the numbers and types. Conclusion SSD and MPR reconstruction imagines are of instructive importance in sufficient evaluation, operative preparation and appropriate instrumentation of internal fixation. In the management of acbtabular fracture, plates are needed to stabilize the fracture involved the anterior or posterior column, while the fragments of anterior or posterior wall are only fixed with screws, small fragments could be removed in order to avoid forming loose body. Therefore, SSD and MPR are the regular and important method in preoperative examination of complex acetabular fracture and dislocation.

Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.

Objective To investigate the expression of Toll like receptor 2 (TLR2) in glioma and its relationship with the malignant biological behavior of glioma, so as to provide a new therapeutic target for glioma immunotherapy. Methods The tumor tissues of 90 glioma patients undergoing surgical excision were collected, of which WHO gradingⅠ-Ⅱgrade 39 cases,Ⅲgrade 24 cases,Ⅳgrade 24 cases. In addition, the normal brain tissues of 12 patients undergoing routine intracranial decompression were selected. The human glioma cell lines U87-MG, U251-MG and human astrocyte cell line HA were cultured. The expression levels of TLR2 mRNA and protein were detected by reverse transcriptase polymerase chain reaction (RT-PCR) and Western Blot test. The correlation between TLR2 protein and different clinical pathological parameters was analyzed. Results The expression levels of TLR2 mRNA and protein in the glioma tissuesⅠ-Ⅱgrade,Ⅲgrade andⅣgrade were significantly higher than those in normal brain tissues (0.27 ± 0.09, 0.57 ± 0.12 and 0.96 ± 0.18 vs. 0.11 ± 0.05; 0.31 ± 0.05, 0.44 ± 0.05 and 0.71 ± 0.09 vs. 0.02 ± 0.01), there were statistical differences (P<0.05). In different grades of glioma tissues, there were statistical differences in the expression levels of TLR2 mRNA and protein (F = 205.9 and 194.9, P<0.05). The expression levels of TLR2 mRNA and protein in human malignant glioma cell lines U87-MG and U251-MG were significantly higher than those in human astrocyte cell line HA (1.000 ± 0.100 and 0.356 ± 0.060 vs. 0.245 ± 0.030, 0.720 ± 0.100 and 1.800 ± 0.150 vs. 0.004 ± 0.000), there were statistical differences (P<0.05). The expression of TLR2 protein was independent of age, sex and location(P>0.05), but was related to tumor diameter and WHO grading (P < 0.01). Conclusions TLR2 in different grade glioma tissues and glioma cell lines are expressed, and its expression level is associated with the malignant degree of glioma; TLR2 protein not only can be used as a biomarker of gliomas and prognosis, but also provide a new target for the treatment of glioma.

Objective To study clinical efficacy of porcine-derived small intestinal submucosa (Surgisis) in treatment of pelvic organ prolapse (POP).Methods From Mar.2012 to Mar.2013,15 patients with POP at more than Ⅲ of POP quantitation (POP-Q) staging system undergoing pelvic reconstructive surgery with Surgisis in Peking University People's Hospital.The mean age was 59 years old (39-82).The variable site of POP-Q staging systemn was compared between preoperative and postoperative status among those patients.Quality of life questionnaire of pelvic floor impact questionnaire (PFIQ-7),pelvic floor distress inventory short form (PFDI-20) and PISQ-31 were studied to evaluate subjective satisfaction,recurrence and the quality of life's improvement.Results All patients were followed up at mean of 9.9 months (3-15 months),the mean time of surgery was 96 mins (65-120 mins),the mean blood loss was 159 ml (50-500 ml).No infection and erosion was observed on those patients.The rate of subjective satisfaction was 14/15,the recurrence rate of prolapse was 2/15.Scoring system of PFDI-20 was from 87 (56-124) at operative status to 30 (22-48) at postoperative status.PFIQ-20 was from 129 (85-158) at preoperative status to 24 (18-48) at postoperative status.PISQ-31 was from 48 (32-55) at preoperative status to 79 (66-89) at postoperative status,which all reached statistical difference (all P ＜0.05).Total 9 patients obtained satisfactory sexual life.Conclusions The short-term clinical effect of pelvic reconstructive surgery with Surgisis was satisfied,quality of life and sexual life was improved,and less complication were observed.However,long-term clinical effect on patients should be warranted to follow up.

Objectiye To study the mechanism by which transcranial magnetic stimulation (rTMS) affects cognitive dysfunction in vascular dementia (VD). Methods Thirty-six male Wistar rats were randomly divided into a control group, a VD group, a low frequency rTMS group and a high frequency rTMS group. Two-vessel occlusion was employed to induce VD models. Low frequency rTMS group rats were given 0.5 Hz rTMS for six weeks. High frequency rTMS group rats were given 5 Hz rTMS for six weeks. Morris' water maze test was used to measure their spatial learning ability and memory. The ultrastructures of the synapses in the four groups were detected with transmission electron microscopy. The expression of synaptophysin (SYN), brain derived neurotrophic factor (BDNF) and Nmethyl-D-aspartate receptor 1 ( NMDAR1 ) mRNA and protein in the hippocampus were determined by real-time PCR and Western blotting. Results The behavior and morphology of the rats treated with rTMS improved. The average expression of SYN, BDNF and NMDAR1 mRNA and protein in the low frequency rTMS group and the high frequency rTMS group were significantly higher than in the VD group. Conclusion rTMS can provide a rehabilitative effect for VD. The mechanism might be associated with enhancing the expression of SYN, BDNF and NMDAR1 in the hippocampus.

Colon cancer is one of the common malignant tumors of digestive system.In our previous study, it has been demonstrated that colon cancer specific antigen thioredoxin like-2b (Txl-2b) can interact with Ras-related nuclear protein (Ran).However, there are few reports about the role and mechanism of Ran in tumorigenesis of colon cancer.Aims: To investigate the effect of Ran-targeting RNA interference on apoptosis and expressions of caspase-3 and poly(ADP-ribose) polymerase (PARP) in colon cancer cell lines.Methods: 20, 40 and 60 nmol/L siRNA-1 (si-1 group), siRNA-2 (si-2 group), siRNA-3 (si-3 group) targeting to Ran gene and normal control siRNA (NC group) were transfected into colon cancer cell line HCT116 and DLD-1, respectively.The interference efficiency of siRNAs and expressions of caspase-3 and PARP were detected by Western blotting.Cell apoptosis was determined by flow cytometry.Results: 20 nmol/L siRNA-1 and siRNA-2 had the best effect on inhibiting expression of Ran.Early apoptosis rates of HCT116 and DLD-1 cells in si-1 group were significantly higher than those in NC group (19.37%±7.57% vs.4.83%±1.72%;16.53%±3.38% vs.6.27%±3.13%;P all <0.05).Late apoptosis rates of HCT116 and DLD-1 cells in si-1 and si-2 groups were significantly higher than those in NC group (15.97%±3.31%, 16.33%±5.40% vs.6.40%±1.05%;22.93%±1.57%, 11.50%±0.70% vs.6.20%±0.98%;P all <0.05).Compared with NC group, expressions of cleaved caspase-3 (active form) and cleaved PARP (inactive form) were significantly increased in DLD-1 cells of si-1 and si-2 groups.Conclusions: Silencing Ran gene can significantly promote the apoptosis of colon cancer cells, and its mechanism is related to the regulation of caspase-3 and PARP expression.

Objective To study the current situation of human brucellosis infection in a population at high risk in Qian'an,and to provide a scientific basis for prevention and control of the disease.Methods Towns with centralized residents working in sheep breeding,transporting,slaughtering and processing in Jianchangying,Muchangkou and Xiaguanying of Qian'an were selected.In each selected town,2-3 villages with relatively centralized households working in sheep farming,transportation and slaughtering were chosen.All of the people who contacted the sheep or their excrement were chosen as monitoring objects,and serological antibody was tested with rose Bengal plate test(RBPT) and serum agglutination test(SAT).Regional,gender,age and occupational distribution of brucellosis were analyzed.Results A total of 367 blood samples were tested,46 of them were positive in both RBPT and SAT with a ratio of 12.53％ (46/367).Male positive rate [13.51％ (30/222)] was slightly higher than that of females [11.03％(16/145)].The rate in Jianchangying was higher than that of other two towns with a ratio of 13.38％(40/299).The veterinary population had the highest ratio of 33.33％(1/3).Conclusions It is necessary to carry out the surveillance on brucellosis and to further strengthen communication with the animal husbandry department,and strengthen protection on key population.At the same time,in order to control the spread of the disease,extensive health education and intervention measures should be carried out.

Objective To compare safety and feasibility using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft ( CABG) surgery. Methods We retrospectively evaluated 116 consecutive patients who underwent graft intervention via the transradial (TRA group, n = 46) or transfemoral approach (TFA group, n = 70), and observed the baseline clinical characteristics, angiography characteristics and complications between the 2 groups. Results The baseline clinical characteristics between the 2 groups were similar ( all P > 0. 05) . No significant difference was observed in angiography characteristics and procedural parameters including operation time, radiation exposure and puncture time between the 2 groups (all P > 0. 05). There was no significant difference in major adverse cardiac events during hospitalization. PCI to graft vessels were all successful and procedural success rates were similar between the 2 groups (P = 0. 669). Vascular access site complications were significantly lower ( P = 0. 03) in the TRA group. No access site complication was recorded in the TRA group. 7 cases (10. 0% ) with complications were recorded in the TFA group including 1 case of major bleeding (1. 4% ), 3 cases of minor bleeding (4. 3% ), 2 cases of local hematorna (2. 9% ) and 1 case of A-V fistula formation. Conclusions In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach.

Objective To observe the influence of pioglitazone on the expression of adiponectin in the liver of high fat diet-induced obese rats.Methods Forty male SD rats were randomly divided into control group which received regular diet ( n =10),high fat diet group ( n =15 ) and high fat diet goup administened pioglitazone ( n =15 ) on high fat diet.After twelve weeks,fasting blood glucose,fasting serum insulin,triglyceride,total cholesterol,and the histomorphologieal changes in liver were observed;insulin sensitivity test was performed;the fatty experimental group are treated with Pioglitazone(30mg · kg-1 · d-1,oral gavage),treatment was administered daily for 2 weeks.The control group and fatty control group all received an equal volume of vehicle (saline).The protein expression of adiponectin in the liver of rats was determined by immunohistochemistry.Results The insulin sensitive index was significantly decreased in the high-fat-diet rats compared with the control group[(0.021 ±0.010),(0.015 ±0.007),P ＜0.05] ;The protein level of adiponectin in the liver of fatty,control group was significantly decreased compared with the control group[(2929.73 ± 157.45 ),(3814.21 ±211.42),P ＜0.05],adiponectin in the liver of fatty experimental group was significantly increased compared with the fatty control group[(2929.73 ± 157.45),(3657.68 ±217.31 ),P ＜0.05].Conclusion Pioglitazone could improve the expression of adiponectin,and improve the resistance of insulin.

BACKGROUND: Operative correction of hallux valgus is one of the most procedures in foot and ankle department, but postoperative plaster slab immobilization often brings great inconvenience and pain. Off-loading forefoot shoes can theoretically help them to do activities off bed early, and prevent loading on the forefoot during walking. But its advantages and disadvantages compared with plaster slab are still unknown.OBJECTIVE: To compare the clinical effects of over-the-toe plaster slab and off-loading forefoot shoes after hallux valgus correction.METHODS: Patients with hallux valgus undergoing distal Chevron osteotomy or Scarf osteotomy in the Huashan Hospital of Fudan University between May 2012 and October 2013 were retrospectively reviewed. Group A patients had a below-knee and over-the-toe plaster slab while Group B had an off-loading forefoot shoe applied after surgery.Radiological assessment was done at 6 weeks postoperatively. Immobilization was removed once bone union was indicated. Clinical scales and subjective satisfaction investigation were performed at final follow-up, and complications during follow-up were noted. All values between groups were analyzed statistically.RESULTS AND CONCLUSION: Totally 125 patients (157 feet) were completely followed up, including 83 patients (95 feet) in Group A and 42 patients (62 feet) in Group B. There was no significant difference in demographics, pre-and-post operative radiological assessments, clinical scale, union time or general satisfaction rates between two groups. However,Group B patients had less chance to suffer metatarsophalangeal joint or inter-phalangeal joint stiffness, restricted ankle motion and supra-ankle pains of operated side in comparison with Group A (P < 0.05), and were more willing to accept the same treatment if they could choose again (P < 0.05). Compared with the plaster slab, the application of off-loading shoes not only maintains correction level, but also reduces such complications as stiffness or restricted motion of the joint, limb pains and so on, which makes patients more likely to accept, and should be given priority to in the rehabilitation following hallux valgus correction.