BACKGROUND:Posttraumatic osteomyelitis is bone infection after surgery of open fractures or other joint, which leads to more secretions in antrum or bone exposed wounds, long treatment cycle, delayed healing of fracture, even disunion. The key link in the treatment is complete debridement, adequate drainage, and the use of external fixators with low interference and far away from lesions. ＜br> OBJECTIVE:To observe the clinical efficacy of external fixator combined vacuum sealing drainage (VSD) in the treatment of post-traumatic osteomyelitis, and compared with conventional catheter drainage. ＜br> METHODS:Since June 2010 to June 2013, 21 patients of post-traumatic chronic osteomyelitis were included in this study and divided into VSD group (n=11) and conventional catheter drainage group (n=10). Al patients in VSD groups underwent debridement and VSD was used to fil dead space, then the wounds were sutured. Cases appeared nonhealing fractures underwent external fixation, 10 cases using external fixators and 1 case retained original external fixator. Al patients achieved the closed wounds at the second phase, 9 cases were directly sutured, and 2 cases received skin flap transplantation. Among them, 1 case received autologous bone graft at the third phase because of bone defects. In the conventional catheter drainage group, al patients underwent debridement and conventional catheter drainage to rinse the wounds after surgery, 3 cases failing to close the wounds changed to receive ordinary dressing and skin flap transplantation at the second phase. Cases appeared nonhealing fractures underwent external fixation. Local swel ing, pain and fever were observed after treatment. The time of total hospitalization stay and fracture healing was recorded. ＜br> RESULTS AND CONCLUSION:The VSD group quickly control ed preoperative symptoms such as swel ing and pain and fever than the conventional catheter group (P＜0.05). The length of hospital stay showed no significant difference between the two groups (P>0.05). Al patients were obtained through clinic service and fol owed up for 24-36 months. The healing time in the VSD group was shorter than that in conventional catheter group (P＜0.05). Until the end of fol ow-up, no patients in the VSD group appeared infection recurrence, and two cases in the conventional catheter group had recurrent infection. The results suggest that VSD combined with external fixator can repair post-traumatic chronic osteomyelitis due to rapid control of infection, easy care, shortened treatment time, and reduced rate of postoperative recurrence. In addition, external fixator can be used as the final fixation for post-traumatic chronic osteomyelitis.

Objective To investigate the antitumor and immunologic activities of Laurencia extract(LET) in Sarcoma 180(S 180).Methods The content of total terpenoids in LET was detected by RP-HPLC and its toxicity(LD 50) was estimated by Horn assay. Tumor inhibition rates, index of thymus and spleen, proliferation of spleen lymph cells, IgA,IgG,IgM were detected. The data were analyzed by SPSS software. Results The content of total terpenoids in LET was proved to be 63.29%. LET showed low toxicity with its LD 50 more than 3160mg?kg -1. Tumor inhibition rates of test groups were significantly higher than those of the control group. LET could obviously increase the levels of index of thymus and spleen. LET increase the multiplication of spleen lymph cell.Concentrations of IgA、IgG and IgM in plasma of the test groups were higher than those of the control group. Conclusion LET rich in terpenoids is safety to be taken orally. The alga extract showed obvious antitumor activities and immunologic functions.

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Objective To conduct a systematic review on the safety and efficacy of enhanced recov -ery after surgery ( ERAS) in perioperative management of hepatectomy .Methods A literature search was conducted on databases which included the PubMed , Embase, Cochrane Library, Sinomed, Wangfang, VIP and CNKI for randomized controlled trials ( RCTs) on application of ERAS in patients after hepatectomy . The data collection ended in August 2015.A meta-analysis was performed using RevMan 5.3 software.Re-sults Eleven RCTs which included 1074 patients were selected into this study .There were 530 patients in the ERAS group and 544 patients in the control group .On Meta-analysis, when compared with the control group, the ERAS group had significantly shorter length of hospital day (WMD=-2.36, 95%CI: -3.19~-1.54 , P<0.05 ) , shorter time for functional recovery ( WMD=-2.30 , 95%CI: -3.77 ~-0.83 , P<0.05), lower total complication rate (RR=0.65, 95%CI:0.52~0.80, P<0.05), and significantly decreased rates of postoperative pulmonary infection (RR=0.36, 95%CI:0.14~0.91, P<0.05) and nausea and vomiting (RR=0.48, 95%CI:0.26~0.89, P<0.05).There were no significant differences between the two groups on the rates of postoperative bleeding , biliary fistula, abdominal infection, delayed incisional healing, wound infection and urinary tract infection (P>0.05).The ERAS group had significant-ly lower hospitalization cost (SMD=-1.61, 95%CI:-2.42~-0.80, P<0.05), but the differences between the two groups on mortality and re-admission rates were not significant (P>0.05).When compared with the control group , the drainage tube removal time ( WMD=-2.83 , 95% CI:-3.92~-1.76 , P<0.05), time to first mobilization (SMD=-2.34, 95%CI:-2.98~-1.70, P<0.05), time to first feeding ( SMD=-5.08 , 95%CI: -9.33~-0.83 , P<0.05) , time to passage of first flatus ( SMD=-3.60, 95%CI:-4.85~-2.34, P<0.05) in the ERAS group were significantly shorter , but there was no significant difference on the time to the first bowel motion ( P>0.05 ) .Conclusions ERAS in the peri-operative management of hepatectomy was safe and beneficial .

Objective To compare everolimus (EVR) with calcineurin inhibitor (CNI) minimization or withdrawal on renal function of liver transplant patients with standard CNI therapy.Methods A search was conducted on databases which included the PubMed,Embase and Cochrane library for randomized controlled trials (RCTs) comparing EVR with CNI with minimization or withdrawal (the EVR group) with standard CNI therapy (the standard CNIs group) on renal function of liver transplant patients.A metaanalysis was performed using RevMan 5.3 software.Results Five RCTs which included 1 264 patients were selected into this study.There were 790 patients in the EVR group and 474 patients in the standard CNIs group.On meta-analysis,the EVR group had significantly better renal function (SMD =0.36,95％ CI 0.09 ～ 0.64,P ＜ 0.05),but higher rates of infection (RR =1.37,95％ CI 1.08 ～ 1.74,P ＜ 0.05),dyslipidemia (RR =2.46,95％ CI 1.79 ～ 3.38) and leukopenia (RR =2.37,95％ CI 1.32 ～ 4.26).No significant differences were found on the mortality and the acute rejection rates between the two groups (all P ＜ 0.05).Conclusions EVR with CNI minimization or withdrawal after liver transplantation provided effective immunosuppression and improved patients' renal function.The treatment increased the rates of infection,dyslipidemia and leukopenia.

Objective To investigate the risk factors and clinical manifestations of placental abruption, and to analyze the causes of missed diagnosis and misdiagnosis. Methods A retrospective analysis was conducted in 135584 women who delivered in Women′s Hospital, School of Medicine, Zhejiang University from January 2005 to December 2015. The diagnosis of placental abruption was made in 1212 cases. According to the consistency of prenatal and postnatal diagnosis, they were divided into 3 groups.(1) The diagnosis was consistent prenatally and postnatally in 715 cases(58.99%,715/1212) as the diagnosis group.(2)In 312 cases (25.74%,312/1212), the diagnosis was made after birth as the missed diagnosis group.(3)In 185 cases (15.26%,185/1212), the diagnosis was made prenatally but excluded after birth as the misdiagnosis group. The disease classification was made, and the risk factors, clinical manifestations, lab results, the time of termination and perinatal outcomes were recorded in the 3 groups. The reasons of missed diagnosis and misdiagnosis were analyzed. Results (1) In the 1212 cases, the diagnosis of placental abruption was confirmed in 1027 cases, with the incidence of 0.76%(1027/135584). The rate of missed diagnosis was 30.38%(312/1027), and the rate of misdiagnosis was 0.14%(185/134557). (2) There were significant differences in the degree of placental abruption among the 3 groups (P＜0.05). (3)Significant differences were found among the 3 groups regarding the ratio of hypertensive disorders, trauma, induced labor and advanced maternal age (all P＜0.05). (4) There were statistically significant differences among the 3 groups regarding the incidence of vaginal bleeding, persistent abdominal pain and uterine tenderness, bloody amniotic fluid, increased uterine tension and stillbirth (all P＜0.05). (5) There was no significant difference in the rate of abnormal fetal heart rate mornitoring among the 3 groups (P=0.22). The differences were statistically significant among the 3 groups when regarding the incidence of abnormal ultrasound finding and abnormal blood coagulation (P＜0.01), with the highest incidence of abnormal ultrasound in the diagnosis group (68.1%) and the highest incidence of abnormal coagulation in the misdiagnosis group (24.9%). (6)There was statistically significant difference among the 3 groups when comparing the ratio of termination of pregnancy within 24 hours (P=0.01). (7) There were statistically significant differences among the 3 groups when the ratios of postpartum hemorrhage, DIC, neonatal asphyxia and perinatal death were compared (all P＜0.05). The highest incidence of postpartum hemorrhage was in the diagnosis group (17.9%) and the lowest was in the misdiagnosis group (5.4%). The highest incidence of DIC was in the diagnosis group (3.9%) and the lowest was in the misdiagnosis group (0). The highest incidence of neonatal asphyxia was in the diagnosis group (30.6%) and the lowest was in the misdiagnosis group (7.6%). And for perinatal death, the highest incidence was in the diagnosis group (12.6%), the lowest was in the misdiagnosis group (2.2%). Conclusions Placental abruption could be misdiagnosed when depending on risk factors, such as trauma. And it could be missed diagnosis during the induction of labor. Uterine contraction, abnormal fetal heart rate mornitoring, abnormal ultrasound and abnormal coagulation function are important in the diagnosis of placental abruption.

Objective To study the inhibitory effects of dendritic cells modified by sCD41)gene on T lymphocytes phenotypes and cytokines production and the mechanism of inducing donor-specific immune tolerance in vitro.Methods T lymphocytes prepared with Nylon Fiber Column from Balb/c mice(as reaction cells)and DCs of different groups(as stimulation cells)were subjected to primary mixed lymphocyte culture(MLC).After incubation for 7 days,the responsiveness of the cells was de- tected by MTS method at the indicated time points,and supernatants were assayed for IFN-?,IL-2, IL-4,IL-10 by ELISA kits.On the day 5,the cultured cells were assessed for the expression of CD4, CDS,CD25 and CD69 by using flow cytometry(FCM).After secondary MLC for 5 days,the same indexes were assayed hy using the same methods.Results Dendritic cells modified by sCD40 could in- duce the hyporesponsiveness to alloantigen in primary and secondary MLC.In primary MLC,the ex- pression of CD4~+ and CD8~+ T cells and CD4~+ CD25~+,CD8~+ CD25~+,CD4~+ CD69~+,CD8~+ CD69~+ T cells in IX;modified by sCD40 group were less than those in control group(P

Objective:To investigate the effect of Laurencia terpenoid extract (LET) on tumor inhibition,immune modulation and apoptosis of Sarcoma 180 cell. Method:The LD50 of LET was estimated by Horn assay. The models of S180-bearing mice were established and divided into 4 groups which were given LET 0 (control group), 25 (low-dose group), 50 (mid-dose group), 100 (high-dose group) mg/kg bw respectively for 10 d. Tumor inhibition rates were detected in treatment groups and control group respectively. To weigh exactly the thymus and spleen to calculate their indices. The proliferation effect of LET on spleen lymphocyte was evaluated by MTT assay. The apoptosis of tumor cell was assayed by flow cytometry. Results:The LD50 was more than 3 160 mg/kg bw. LET had low toxicity. The average tumor weights of the supplemented groups were all less than the control group(P

BACKGROUND: By targeting inducing differentiation in vitro,mesenchymal.stem cells(MSCs) transform into osteoblasts,lipocytes,chondrocytes,muscular cells,neuronal cells,etc. Whether Chinese herbs act on induced differentiation of MSCs in rats or not?OBJECTIVE: To study the amplification of MSCs cultured in vitro in SD rats and efficacy of Chinese herbs on targeting inducing differentiation of neuron-like cells.DESIGN: Exploring study with repeated observation and measurement based on cells.SETTING: Department of pathophysiology in a medical college.MATERIALS: Experimental marrow collected from SD male tested-healthy rats.METHODS: By adhesion method,MSCs in rats were isolated for amplifying culture in vitro. Flow-type cell instrument was applied for the determination of its surface antigen expression. Various Chinese herbal components were used for the targeting inducing differentiation of MSCs into neuron-like cells. The cellular morphology was observed under optical microscope. and the specific antigen label of neuronal cells was determined with immunocyto-chemical method.MAIN OUTCOME MEASURES:①Results of MSCs isolation and amplification;②Results of identification of MSCs surface antigen and neuon-like cells.RESULTS: By adhesion method,MSCs in rats were isolated successfully and amplified in a large amount in vitro. It was indicated in the results determined by flow-type cell instrument that CD14,CD1 1α,CD34,CD38,CD45,CD80 and CD86 presented negative,and CD29,CD44,CD90,CD105 and CD166 presented positive. By induced with various kinds of Chinese herbs,like huangqi(Radix Astragali seu Hedysari),tianma(Rhizoma Gastrodiae),renshen (Radix Ginseng),danggui(Radix Angelicae Sinensis),naoxinshu,renshen fengwangjian for 1 to 3 hours,most MSCs transformed into neuron-like cells,presenting soma and neurite. With immunocyto-chemical staining,neuron-specific enolase(NSE) and nestin displayed positive and glial fibrillary acidic protein negative.CONCLUSION: MSCs in SD rats have the potential of multi-targeting differentiation,presenting a strong capacity of amplification and self-replacement. In a suitable inducing condition,MSCs may differentiate into neuron-like cells.