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.

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.

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.

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.

AIM: To investigate the effect of endogenous and exogenous carbon monoxide on the proliferation of pulmonary artery smooth muscle cells under anoxic condition. METHODS: Primary culture of rat PASMCs were passed every 3 days, the 3-5 passages were used. PASMCs were divided into 5 groups, cultured under normoxia and hypoxia and treated with HO inducer hemin, CO scavenger bovine hemoglobin (Hb) and exogenous carbon monoxide (CO), respectively. After 48 hours incubation under the conditions mentioned above, the following assay were carried out: 1) the MTT colorimetric assay and immunocytochemical staining were used to study the energy metabolism and the expression of proliferating cell nuclear antigen (PCNA) in PASMCs. 2) flow cytometry was used to analyze the cell cycle of PASMCs. RESULTS: In comparison with the control group, the value of MTT colorimetric assay was higher, the immunocytochemical staining of PCNA was stronger and the percentages of PASMCs in S and G 2M phases in the anoxia group were higher ( P

AIM To investigate the effect of Hemin on the expression of inducible heme oxygenase (HO 1) in hypoxic rat lung tissue. METHODS The rat model of hypoxic pulmonary hypertension was recreated by intermittent normal pressure hypoxia (10% O 2). The following assays were carried out: reverse transcriptase polymerase chain reaction (RT PCR) were performed to determine the level of HO 1 mRNA in rat lung tissue, double wave length spectrophotometry was used to evaluate the quantity of COHb in arterial blood, cardiac catheterization was used to measure the right ventricular systolic pressure (RVSP). RESULTS After exposure to hypoxic enviorenment for 15 days, the level of HO 1 mRNA and COHb were higher than those of the control group ( P

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.

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.

Objective To discuss the clinical characteristics of Hashimoto's thyroiditis accompanying with thyroid cancer. Methods Clinical data of 98 cases Hashimoto's thyroiditis accompanying with thyroid cancer were retrospectively reviewed. Results 2 cases underwent lateral thyroid lobectomy and isthmus resection. 58 cases underwent bilateral thyroid lobectomy. 35 cases underwent central lymph node dissection, with 15 cases of lymph node positive. 3 cases underwent modified radical dissection of cervical lymph nodes and all of them were proved to be lymph node positive. Metastasis rate is 25.0% and 52. 2% respectively for tumors whose diameter was less than 1 cm and greater than 1 cm. The difference has no statistic significance. Conclusions Hashimoto's thyroiditis usually accompany with thyroid papillary carcinoma and cervical lymph node metastasis can occur even if it's microcarcinoma. Lymph node metastasis rate increases with increasement of the tumor's diameter. Total thyroidectomy should be performed for Hashimoto's thyroiditis concomitant with thyroid cancer. And if necessary,lymph node dissection should be extended to the central region and lateral neck area.