The outcome of patients with malignant middle cerebral artery infarction (mMCAI) is very poor.The mortality of conservative medical treatment is as high as 80％.Several randomized controlled trials published in recent years have shown that hemicraniectomy can significantly reduce the mortality of mMCAI.It is a life-saving therapeutic measure for patients,even if so in patients older than 60 years of age.

BACKGROUND:Tissue-engineered bone has been considered to be a promising candidate for the repair and reconstruction of load-bearing large segmental bone defects. Currently, the studies on the application of tissue-engineered bone mainly focus on cel-scaffold or cytokine-scaffold constructs, which haveshed light upon the repair of large segmental bone defects. OBJECTIVE:Toestablish simple and convenient tissue engineering of anatomicaly shaped tibial bone defect models using three-dimensional rapid prototyping technology to manufacture rabbit tibia biomimetic artificial bone scaffolds. METHODS:Three-dimensional electronic models were constructed using Mimic software. Hydroxyapatite/polycaprolactonescaffolds were manufactured by fused deposition modeling equipment. Fifty rabbits aged 6 months were randomly divided into three groups: blank control(n=3), control(n=6) and experimental groups(n=6), respectively. Tibial defects ranged 1.2 cmweremade in al groups. No treatment was given in blank control group. The bone defects in control and experimental groups were repaired with autogenous osteotomized bone and anatomicaltissue-engineered bone, respectively, and fixed with plates and screws. RESULTS AND CONCLUSION:(1) Rabbit tibial bone measurements:tibiallengthwas (93.77±0.59)mm, tibiofibular transverse diameter(8.36±0.13)mm, sagittal diameter(5.97±0.12)mm, average thickness of bone cortex(1.20±0.10)mm, average diameter of the medulary cavity(4.30±0.06)mm. Anglebetween the connection line of the midpoints of superior and inferior articular surfaces at the side of tibial bone models and the connection lineof the midpoints of superior and inferior intersecting surfaces at the side of osteotomized bone modelswasα=(5.97±0.13)°.(2) X-ray in bone defects: at postoperative 4 and 12 weeks, no obvious displacement and angulated deformity were found in bone grafts, suggesting the good bone defect repair.(3) Histological examination: at postoperative 4 weeks, bone scaffolds were filed with new bone in the experimental group. Furthermore, considerably increased new bone formation and mineralization were observed at postoperative 12 weeks.(4) General observation: no obvious displacement and angulated deformity occurredin bone defect grafts at postoperative 4 and 12 weeks. These findings suggest that rabbit anatomical models of large segmental tibial bone defects with good stability were constructed using three-dimensional prototyping technology, which may simulate the structure and function of bone tissue and be used for guiding the new bone regeneration.

Objective To characterize the medial femoral circumflex artery based on three-dimensional computed tomographic angiography (3DCTA) so as to provide anatomical aids for diagnosis and treatment of hip injuries.Methods To do this research the 3DCTA data of 103 patients (206 hips) were collected who underwent 3DCTA from March 2012 to June 2014 for examination of the pelvis and lower extremities.They were 55 men (mean age,54.7 ± 15.9 years) and 48 women (50.0 ± 16.1 years).① The origin and course of the medial femoral circumflex artery was observed.② The length of the artery trunk was measured.The distances between the origin(A) of the artery to the main anatomical marks [the peak of greater trochanter (B),the inward peak of lesser trochanter (C),and the crosspoint (D) of the femoral artery and the pubic edge or the acetabulum inlet edge] were measured.Comparisons of the measurements were conducted between genders.③ The distance between point A and point E,the starting point of the femoral profound artery,was measured.Comparisons of the measurements were conducted between genders.Results 2.9％ (3/103) of the subjects had their bilateral medial femoral circumflex arteries originate from the femoral artery,94.2％ (97/103) had their bilateral medial femoral circumflex arteries originate from the femoral profound artery,and 2.9％ (3/103) had one medial femoral circumflex artery originate from the femoral artery and the other from the femoral profound artery.1.9％ (4/206),76.7％ (158/206) and 21.3％ (44/206) of the subjects had the artery of screw type,of circuitous type and of straight type,respectively.The artery trunk goes posteriorly and medially after it is issued,divides into branches along the course,continues to go around the back of the femoral neck,and finally goes to the outward and upper direction.There were no statistical differences between males and females regarding length of the artery trunk,or distances between points AB,AC,AD or AE (P ＞ 0.05).Conclusion Since 3DCTA can clearly demonstrate the origin,course and anatomical morphology of the medial femoral circumflex artery,it can be used to provide anatomical aids for clinical evaluation and treatment of hip injury.

Objective To investigate the pathogenesis of diseases with antineutrophil cytoplasmic antibody (ANCA)and its diagnostic value in primary small vessel vasculitis.Methods 57 patients with serum ANCA positive were involved in this study,and ELISA was employed to assay anti-MPO.Patients with ANCA positive,anti-MPO positive and/or anti-PR3 positive were involved in group A.Patients with ANCA positive,anti-MPO negative and anti-PR3 negative were involved in group B.X2 was used to analyze the differences between the two groups.Results The etiology of 57 ANCA positive patients included primary small vessel vasculitis (20 cases,35.1%),non inflam-matory connective tissue disease(19 cases,33.3%),non connective tissue disease(18 cases,31.6%).A group of primary small vessel vasculitis accounted for 58.6%,which was significantly higher than 10.7% of the B group (χ2 =14.354,P<0.01);while the B group of non inflammatory connective tissue disease accounted for 50%,which was significantly higher than 17.2%of the A group (χ2 =6.879,P<0.01).Conclusion ANCA should be found in many kinds of diseases,so combined detection of anti-MPO and anti-PR3 should be employed to improve the diag-nosis specificity in primary small vessel vasculitis.Furthermore,non vessel vasculitis connective tissue disease should be excluded in patients with ANCA positive,anti-MPO and anti-PR3 negative.

Objective To study the clinical features of traumatic mitral regurgitation and its surgical treatment methods and outcomes. Methods Clinical data of 16 patients with traumatic mitral regurgitation surgically treated from December 2000 to November 2008 were retrospectively analyzed. The cardiac thoracic ratio was 0.55 ±0.07 and the left ventricular ejection fraction (LVEF) was (51.2% ±23.2)%. According to the New York Heart Association (NYHA) functional classification, 10 patients were at grade Ⅰ - Ⅱ before operation. The surgical procedures consisted of mitral valvuloplasty in 14 patients and mitral replacement in two, when correction of other cardiac injuries was made at the same time.Of all, 14 patients obtained follow-up for (35.2 ± 25.7 ) months. Results The interval between trauma and appearance of mitral regurgitation was (23.3 ±50.90) months. Of 13 patients with echocardiography during follow-up, there were four patients with normal tricuspid hemodynamics, seven with trace tricuspid regurgitation and two with mild regurgitation. The value of LVEF was (66.8 ± 9.0)% at followup, significantly higher than preoperation (P ＜ 0. 05 ). There were 13 patients at grade Ⅰ - Ⅱ of NYHA,with a significant increase compared with preoperation ( P ＜ 0. 01 ). Conclusions Mitral regurgitation may emerge either immediately or several years after trauma. Traumatic mitral regurgitation patients can get satisfactory outcomes when comprehensive mitral valvuloplasty or mitral replacement is performed promptly.

Objective To study the effects of costimulatory blockade with anti-inducible costim- ulator antibody(ICOS mAb)in combination with CTLA4Ig on prevention of islet allograft rejection. Methods Experimental animals were randomly divided into 4 groups(10 rats in each group).CT- LA4Ig + ICOS mAb group(group A):intraperitoneal injection of CTLA4Ig on day 0,2,4 and ICOS mAb on day 1,3,5 after islet transplantation;ICOSmAb group(group B):intraperitoneal injection of ICOS mAb on day 1,3,5 after islet transplantation;CTLA4Ig group(group C):intraperitoneal injection of CTLA4Ig on day 0,2,4 after islet transplantation;control group(group D):simple islet transplantation.The islet allograft survival and pathological changes in the transplanted islets after transplantation were observed.By using RT-PCR,the expression of IL-2 and IL-10 mRNA in the transplanted islets was detected.The expression of CD4~+ and CD8~+ T cell was detected by flow cy- tometry.Results In group A,the survival time was obviously prolonged as compared with other three groups and the transplanted islets were near normal under a light microscope.As compared with other three groups,the expression of IL-2 mRNA was significantly decreased in group A(P0.05).The expression of CD4~+ and CD8~+ T cell was not obviously up-regulated on the day 21 after transplantation.Conclusion The blockade of costimulatory signals with ICOS mAb in combination with CTLA4Ig has a favorable effects to restrain the rejection of islet transplantation.

Craniocervical unstability may cause severe motor and respiratory compromise due to recurrent upper spinal cord and/or brain stem impingement.In recent years,by improving internal fixation materials and surgical techniques,the methods of surgical treatment of craniocervical unstability has made great progress.With the appearance of these new surgery and internal fixation methods,the successful rate and safety of the operation obviously increased and the complications was reduced greatly.We reviewed the surgery methods for craniocervical unstability in this article.

We investigated the expression of heme oxygenase-1 (HO-1) gene and production of endogenous carbon monoxide (CO) in the rat lung tissue at different time points of chronic hypoxic pulmonary hypertension and the effect of hemin on the expression of HO-1 gene and pulmonary hypertension. A rat model of hypoxic pulmonary hypertension was recreated by exposure to intermittent normobaric hypoxic environment (10% O2). Reverse transcriptase polymerase chain reaction (RT-PCR) was performed to determine the level of HO-1 mRNA in the rat lung tissue and double wave length spectrophotometry was used to evaluate the quantity of COHb in arterial blood. Cardiac catheterization was employed to measure the right ventricular systolic pressure (RVSP) and HE staining was performed in dissected lung tissue to observe the pathological changes of the intra-acinar pulmonary arteries (IAPA). It was found that (1) There was a low level of HO-1 mRNA in normal rat lung tissue, but the level of HO-1 mRNA increased by 2-4 times in the lung tissue of hypoxic rats (P<0.01). The quantity of COHb was 2-3 times those of control group (P<0.01 or P<0.05). These were accompanied by the increased of RVSP and the thickened IAPA; (2) Hemin could keep the HO-1 mRNA and COHb in the hypoxic rat lung tissue at a high level, and partially suppressed the increase of rat RVSP, thereby ameliorating the pathological changes of IAPA. In conclusion, the upregulation of the expression of HO-1 gene and production of CO in the rat lung of hypoxic pulmonary hypertension plays a role of inhibition in the development of hypoxic pulmonary hypertension. Hemin has a therapeutic effect on hypoxic pulmonary hypertension.
Anoxia/complications ; Carbon Monoxide/*metabolism ; Carbon Monoxide/physiology ; Heme Oxygenase (Decyclizing)/*biosynthesis ; Heme Oxygenase (Decyclizing)/genetics ; Heme Oxygenase-1 ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/*metabolism ; Lung/metabolism ; Myocytes, Smooth Muscle/drug effects ; Myocytes, Smooth Muscle/pathology ; Pulmonary Artery/metabolism ; Pulmonary Artery/*pathology ; RNA, Messenger/biosynthesis ; RNA, Messenger/genetics

Objective To analyze the radiologic characteristics of focal organizing pneumonia (FOP) and discuss its values in diagnosis of FOP.Methods 57 lesions of FOP proved by histological examination were studied retrospectively.All of the lesions could be classified into types of nodule(diameter≤30 mm, n=40) and mass(diameter>30 mm, n=17),which were analyzed to explore the imaging characteristics such as location, margin, internal state, and enhancement features.Results 39 lesions were located in the right lung and 18 lesions in the left lung, and 51 lesions in the peripheral and 6 lesions in the inner or middle of the lung.The differences between the location of lobe and lung field were statistically significant.The radiographic common features included air bronchogram were seen in 28 cases, while loose composition sign in 18 cases and vessel convergence in 21 cases.49 lesions occurred in subpleural region, including 34 lesions broad contract with pleura.In 54 lesions with contrast-enhanced CT scan, the difference between arterial phase and plain scan in CT value was 35 HU and difference of venous phase and plain scan was 45 HU, presenting gradual enhancement.14 lesions were inhomogeneous enhancement in mass type and 25 lesions were homogeneous enhancement in nodule type.There were statistic differences in margin, shape, round-glass opacity, necrosis, cave and the relationship with pleura between the nodule type and mass type.Conclusion FOP has specific radiographic features.Enhanced CT scan combining multi planar reformation images is helpful in differential diagnosis.

Objective To investigate the ABO blood type and sepsis complicated with acute kidney injury,to provide the basis for prevention and treatment.Methods A total of 130 patients with sepsis from renmin hospital of Wuhan University intensive care unit from january 2015 to december 2015 were enrolled in this study,divided into complicated AKI group (64 patients in the observation group) and non-complicated AKI group (66 patients in the control group),analyzed two groups of general data,laboratory indicators,multivariate logistic regression analysis was used to screen out the risk factors for AKI in patients with sepsis.Results A total of 64 patients with AKI were collected from the observation group and 66 patients with non-AKI in the control group,the age of the observation group was higher than that of the control group (65.7 ± 13.1 years old vs 58.5 ± 15.4 years old,P =0.005),male proportion was higher than control group (76.6％ vs 56.1％,P =0.014),drop calcium pigment original quantitative was higher than control group (28.1 ± 21.0pg/L vs 21.1 ± 13.61μg/L,P =0.026),positive blood culture rate was higher than in the control group (30.2％ vs 15.3％,P =0.006).There was no significant difference in ABO blood group distribution between the two groups (P =0.825).The levels of white blood cell count,C-reactive protein and partially activated thrombin were higher in the observation group than in the control group,the platelet count and albumin level were lower than those in the control group,the difference was not statistically significant.The risk factors associated with the incidence of sepsis with AKI were analyzed by multivariate analysis of the logistic regression model:age(P =0.021,OR =0.965),gender (P =0.003,OR =5.321),calcitonin-original(P =0.047,OR =0.975),positive blood culture (P =0.002,OR =1.009),comparison of type A blood and type O blood (P =0.037,OR =5.409) were associated with sepsis complicated with AKI.Conlusion Type A blood and sepsis with AKI associated with the existence of independent correlation,type A blood may increase the risk of sepsis with AKI.