BACKGROUND:Anterior decompression, bone graft fusion, plate and screw fixation are commonly used in clinic for the treatment of thoracolumbar burst or comminuted fractures. The posterior surgery including decompression laminectomy and pedicle screw internal fixation.
OBJECTIVE:To explore the biomechanical changes of spine after thoracolumbar fracture and dislocation treated with pedicle screw internal fixation.
METHODS:Forty-six patients with thoracolumbar fracture and dislocation were treated with pedicle screw internal fixation, and then the recovery of spinal cord injury and fracture reduction were observed after internal fixation, immediately after internal fixation and 1-year fol ow-up.
RESULTS AND CONCLUSION:Al the 46 cases were fol owed-up. Frankel function classification assessment was used to evaluate the spinal cord injury grade. There was no significant difference in the percentage of A grade between periods (P>0.05), and there were significant differences in the percentage of B-E grades when compared between immediately postoperative period, 1-year fol ow-up period and preoperative period (P<0.05), but there was no significant difference when compared between immediately postoperative period and 1-year-fol ow period (P>0.05). The anterior height percentage, posterior height percentage and Cobb angle indicators were used to assess the fracture reduction, and the results showed there was no significant difference in posterior height between periods (P>0.05), and there was significant difference in Cobb angle when compared between immediately postoperative period, 1-year fol ow-up period and preoperative period (P<0.05), but there was no significant difference between immediately postoperative period and 1-year fol ow-up period (P>0.05). The results indicate that pedicle screw internal fixation system for the treatment of thoracolumbar spinal fracture and dislocation is conducive to the fracture reduction and functional recovery.

Objective To study the clinical nurses and nursing students' cognition of clinical nurse specialist (CNS) and provide the basis for promoting the development of CNS.Methods Quantitative and qualitative research were adopted in this study.One hundred and ninety clinical nurses and nursing students were investigated with a questionnaire about the cognition of CNS,and the qualitative research was conducted on 9 clinical nurses selected by purposive sampling method.Results Most participants realized the importance of CNS and 78.4％ of them wished to be an excellent CNS.The cognition was different between the two groups,especially in terms of ability,working performance and status.Conclusions We should improve the clinical nurses and nursing students' cognition of CNS,and cultivate them with the core competence of CNS.Meanwhile,improving the status and confirming the role must be done to promote the development of CNS in China.

Objective To probe into the present family bed workloads at community health centers in Shanghai,for bettering the service mode.Methods 41 community health centers in 17 districts or counties in Shanghai were randomly sampled with questionnaires,to learn the profile of the family beds and analyze the workloads provided by the institutions from 2010 to 2012.Results For the 41 institutions surveyed,patients aged 60 or above accounted for 95.07％ of the total patients,of whom the seniors over age 80 accounted for 51.00％; 3-year family bed setup rate is 4.45‰,5.09‰ and 5.51‰ respectively;the family bed checkup interval is 6.26 days,6.08 days and 5.84 days respectively.The average monthly payment from medical insurance per person is 441.86 yuan in 2010,433.41 in 2011,and 401.26 in 2012.Diseases makeup:Cardiovascular diseases accounting for 51.16 ％of the total,stroke patients for 31.02 ％,chronic bronchitis for 4.81％,and cancer patients for 1.10％.Among those patients withdrawn from family beds,86.54％ were cured,steady plus improvements.Conclusion Further improvement of the family bed service for better elderly chronic care management; preferential policies to further enhance the family bed service capabilities; emphasis of internal management to continuously improve the social benefits.

Objective To observe the effects of intensive insulin treatment on islet β cell apoptosis associated protein bcl-2 and bax in type 2 diabetic rats.Methods 36 Wistar rats were randomly divided into two groups : normal control group and high fat diet group.Rats in normal control group fed by basical feedstuff.Rats in high fat diet group fed by high fat and basical feedstuff.After 10 days,rats in high fat group were injected with STZ.After 3 days,rats in high fat group were randomly divided into two groups:diabetes control group and insulin treatment group.The course of treatment was 4 weeks.After 10 days by fat milk intragastfic administration, after 3 days of STZ injection and after 4 weeks treatment, each index was measured.After experiment, pancreatic tissue bel-2 and bax were detected through immunohistocbemical method.Results After 4 weeks intensive insulin treatment,the bcl-2 was significantly increased at(6.20 ± 2.05 )% in insulin treatment group than diabetes control group.The bax was significantly decreased at ( 2.68 ± 1.04 ) % in insulin treatment group than diabetes control group ( P < 0.05 ).Conclusion The method of insulin intensive treatment could increase islet βcell bcl-2 and decrease bax in type2 diabetic rots, Insulin intensive treatment could decrease islet β cell apoptosis.

Objective To investigate the risk factors for clopidogrel resistance (CR) in patients with ischemic stroke.Methods Turbidimatry was used to measure the platelet aggregation rate changes after the patients with acute ischemic stroke taking 75 mg of clopidogrel per day for 10-14 days.The patients were divided into either a CR or a clopidogrel sensitivity (CS) group according to the platelet aggregation rate changes.The demographic and clinical data of both groups were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for CR.Results A total of 147 patients with acute ischemic stroke were included,42 of them (28.57％ ) were in the RC group and 105 (71.43％) were in the CS group.The proportion of patients in diabetes (54.76％ vs.11.43％ ;x2 =31.054,P =0.000),the history of transient ischemic attack (TIA) (80.95％ vs.26.67％ ;x2 =36.251,P=0.000) or percutaneous coronary intervention (PCI) (26.19％ vs.3.81％;x2 =16.400,P=0.000),taking calcium channel blocker (CCB) (83.33％ vs.54.29％ ;x2 =10.810,P =0.001 ),angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) (66.67％ vs.42.86％;x2 =6.803,P=0.009),and proton pump inhibitor (47.62％ vs. 14.29％;x2 =18.375,P =0.000) in the CR group,as well as the levels of plasma total cholesterol (TC),glucose,and glycated hemoglobin were significantly higher than those in the CS group.Multivariate logistic regression analysis showed that diabetes (odds ratio [ OR] 13.711,95％ confidence interval [ CI] 1.667 - 112.784; P =0.015),increased TC level (OR 2.828,95％CI 1.574 - 5.080; P =0.001),previous history of TIA (OR16.627,95％ CI 4.691 - 58.934; P =0.000),and long-term taking CCB (OR 4.147,95％ CI 1.053 - 16.332;P =0.042),and ACEI/ARB (OR 4.841,95％ CI 1.539 - 15.231; P =0.007) were the independent risk factors for CR.Conclusions CR in patients with ischemic stroke is associated with a variety of factors,in which diabetes,increased TC,as well as long-term taking CCB and ACEI/ARB are the independent risk factors for CR.

Objective To discuss the MSCT diagnosis and differential diagnosis of primary ureteral carcinoma and non-specific u-reteritis.Methods The pre-contrast and three-phase post-contrast MSCT scans were performed in a group of 12 patients with prima-ry ureteral carcinoma and 5 patients with non-specific ureteritis confirmed by pathology.The MPR,CPR,CTU images were genera-ted from raw data.The MSCT image feature of the primary ureteral carcinoma and non-specific ureteritis were observed respective-ly.Results ①1 2 cases of primary ureteral carcinoma pathologically diagnosed as transitional cell carcinoma,The manifestations of MSCT:9 cases (9/12)showed irregular thickened wall and eccentricity lumen stenosis,5 cases had soft tissue mass in lumen,3 ca-ses (3/12)showed irregular thickened wall and central lumen stenosis.The lesions lumen was significant stenosis,edges and broken ends were irregular.②The non-specific ureteritis manifestations of MSCT:1 case (1/5)showed irregular thickened wall and eccen-trical lumen stenosis;3 cases (3/5)showed irregular thickened wall and central lumen stenosis,and the edge of obstruction was rel-atively smooth.1 case (1/5)prompted hydronephrosis and hydroureter.The lesions lumen was still relatively smooth,had no sig-nificant thickening.③On non-enhanced CT,primary ureteral carcinoma attenuation was equal to the non-specific ureteritis (P>0.05).The degree of enhancement was higher than non-specific ureteritis during all enhanced phases (All P<0.05).Conclusion Main performance characteristics of primary ureteral carcinoma and non-specific ureteritis can both cause the ureteral wall thickening in different appearances and degrees.The MSCT enhanced scan with varies images processing techniques such as MPR,CPR and CTU showed some clinical application potentiality in both diseases diagnosis and discrimination.

Objective To discuss the surgery procedure and treatment effect of reconstruction of the soft tissue of the thumb/finger defects by the second toe tibial toe pulp skin flap. Methods Ten patients with the soft tissue of pulp of the thumb/finger defects were treat by the same side of the second toe tibial toe pulp skin flap, all the patients have the soft tissue defect of finger pulp with exposed phalanx. Crush them in 4 cases, the machine cut wound in 6 cases. A fixed 2 cases, delayed operation 3-7d after injury to repair in 8 patients. The side of skin flap varied from 2.0 cm × 2.2 cm to 2.0 cm × 3.5 cm. Results Ten fingers in 10 cases all survived. Necrosis in edge part of the shin graft occurred in 2 cases, which was healed through changing of dressing. All cases were followed form 4 months to 16 months. The blood-supply, texture and elasticity of transferred flaps and the shape of fingers pulp were excellent. Good function recovery of the fingers was achieved. Pain and temperature sence were regained. Two point discrimination of the finger pulp was 5-9 mm.Primary healing occurred in all cases. It did not disturb dressing shoes and walking. Conclusion It is a reliable approach for soft-tissue coverage of the thumb/finger using the second toe tibial toe pulp skin flap based on distal perforators of digital artery or ulnar artery. The advantages include simply procedures, reliable blood supply without sacrificing main aneries and possibilities of sensoly recovery.

AIM: The role of human interleukin-2(IL-2) signal peptide sequence in the effect of human Endostatin (hEndostatin) expression and secretion was investigated in HeG2 cells. METHODS: RT-PCR and Western-blotting were conduct to observe mRNA level difference of hEndostatin gene, its protein expression and secretion level difference between with hIL-2 signal peptide sequence and without it. RESULTS: mRNA level of hEndostatin gene in HepG2 (pBlast-hIL2-hEndo) cells was higher than that in HepG2(pBlast-hEndo)( P

BACKGROUND:At present, there are few reports about the non-human primate models of type 2 diabetes mel itus in domestic and abroad, so it lacks of standardized production methods and evaluation criteria.
OBJECTIVE:To establish a safe and effective type 2 diabetes mel itus model of rhesus monkey and evaluation method.
METHODS:Twelve rhesus monkeys were randomly assigned to experimental group (n=9) and control group (n=3). Rhesus monkeys in the experimental group were fed with high-glucose and high-fat diet for 4 weeks, and intraperitoneal y injected with 30 mg/kg streptozotocin to establish models of type 2 diabetes mel itus. Rhesus monkeys in the control group were fed with an equal volume of physiological saline. At 12 weeks after injection, peripheral blood serum was col ected to measure fasting blood glucose, lipids, insulin, and C-peptide levels. Intravenous glucose tolerance test and C-peptide release test were used to detect pancreatic gland and pancreatic islet function. Histopathological examination was performed in pancreas, kidney and liver.
RESULTS AND CONCLUSION:(1) 12 weeks after injection, fasting blood glucose, triglycerides, and total cholesterol levels were significantly higher in the experimental group than in the control group (P<0.05). Insulin and C-peptide levels were significantly lower in the experimental group than in the control group (P<0.05). (2) The area under the curve for intravenous glucose tolerance test was increased in the experimental group than in the control group (P<0.05). The area under the curve for C-peptide response test was significantly reduced in the experimental group than in the control group (P<0.05). (3) The pathological sections of pancreas, kidney and liver showed typical pathological changes of diabetes in the experimental group. (4) It is confirmed that we got high achievement about rhesus monkey models of type 2 diabetes mel itus made by high-glucose and high-fat diet combined with low-dose streptozotocin. It is a feasible, safe and effective method.

BACKGROUND:Three-dimensional (3D) printing technology has been successful y used in the field of joint replacement, fracture fixation and spinal implant, but the potential of 3D printing technology in the field of surgery for ossification of posterior longitudinal ligament of cervical spine remains to be discussed. OBJECTIVE:To determine the application value of a 3D printing model in the selection of anterior and posterior surgical decompression for cervical ossification of the posterior longitudinal ligament. METHODS:A retrospective analysis was carried out involving 15 patients with ossification of the posterior longitudinal ligament col ected by computed tomography (CT) and printed by a 3D model pre-operatively between October 2014 and October 2015 in Affiliated Hospital of Xuzhou Medical University. There were isolated type (n=2), segmental type (n=6), continuous type (n=4), and combined type (n=3). The application value of a 3D printer model in patients with ossification of the posterior longitudinal ligament was evaluated by Japanese Orthopedic Association scores, Visual Analog Scale scores, symptoms, and imaging data 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up. RESULTS AND CONCLUSION:(1) Al 15 patients underwent successful treatment of cervical spine decompression surgery and were fol owed up for 4-16 months. The post-operative symptoms were relieved more significantly than the pre-operative symptoms. Using the posterior approach for cervical spinal surgery, 1 patient had incision fat necrosis and healed after negative pressure drainage. (2) Japanese Orthopedic Association scores 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up were 9.0±1.6, 11.7±1.8, and 15.5±1.4, respectively;the differences were statistical y significant (P<0.05). Visual Analog Scale scores 1 month pre-operatively, 1 month post-operatively, and at the final fol ow-up were 6.7±2.5, 2.13±1.4, and 1.4±0.5, respectively;the difference was statistical y significant (P<0.05). (3) The imaging results at fol ow-up showed that the anterior interbodies were fused, and the pivot of the posterior operation was healed wel without a re-closing phenomenon. (4) A 3D printer model was shown to be beneficial in observing the characteristics of cervical ossification of the posterior longitudinal ligament, performing the pre-operative evaluation, and simulating the surgical procedure. There was value for the choice of operative approach.