Objective:To investigate the influence of chronic periodontitis on the clinic effect of implant restoration.Methods:Fifty-two cases of chronic periodontitis patients with 70 implants and forty-nine cases of periodontally healthy patients with 69 implants admitted into our hospital from July 2013 to June 2016 were named as observation group and control group respectively.The implants survival rates,marginal bone loss (MBL),modified plaque index (mPLI),modified sulcus bleeding index (mSBI),and peri-implant probing pocket depth (PD) as well as IL-1,IL-6 in peri-implant sulcular fluid of the two groups were detected and analyzed after loading of 1,3,6,12 months.Results:After 12 months of loading,no obvious difference was found in the implants survival rate between two groups (P＞0.05).After 1,3 months of loading,no remarkable change was found in mPLI,mSBI,PD,and MBL between two groups(P＞0.05),while mSBI,PD,and MBL in observation group were significantly higher than those of control group except of mPLI after 6 months of loading (P＜0.05).Additionally,after 1,3 months of loading,IL-β in control group was not detected,while IL-β in observation group was conspicuously higher than those of control group after 6 months of loading and IL-6 in observation group was significantly higher than that of control group after 3 months of loading (P＜0.05).Conclusion:Chronic periodontitis could decrease the clinical effect ofim-plant restoration,which was probably due to the occurrence ofperi-implantitis.

Objective:To investigate the curative effect of different restorations for deciduous teeth defect of children.Methods:67 children with teeth defecting seriously and being unable to fill restore were enrolled from January 2011 to January 2015 and randomly divided into three groups,one group of patients accepted metal crown restoration (Group A,n=22),one group adopted ceramic inlay restoration (Group B,n=22),and the last one accepted silver amalgam filling (Group C,n=23),the curative effect and incidence of adverse reactions among three groups in the period follow-up were compared.Results:In the period of 18-month follow-up,6 patients of toothache,5 patients of food impaction and crevices between restorations and teeth,3 cases of gingival congestion,2 cases of secondary caries were observed in group C;3 cases of toothache,1 case of food impaction,gingival congestion,crevices between restorations and teeth and secondary caries were observed in group B;2 cases of toothache and food impaction,1 case of gingival congestion were observed in group A.The incidence of adverse reactions in group A and group B was lower than those in group C (P＜0.05),which was lower in group A than that in group B,but no significant difference was found between group A and group B (P＞0.05).Conclusion:The restoration of metal crown and ceramic inlay deserved popularization had better curative effect and safety for deciduous teeth defect of children than silver amalgam filling.

With the popularization of ureteroscopy, ureteral avulsion has become a common complication of urological surgery in recent years. In the study, we reviewed the clinical management of 2 patients who underwent emergency ureterostomy and selective operation of ileoureteral substitution, emergency repair and selective operation of Boari-flap ureteroneocystostomy respectively. After 22 and 17 months of follow-up, no ureter stricture were found, and hydronephrosis were relieved compared with preoperative in both.

Objective To investigate the effects of combined use of an allograft and vascularized fibular flap for the reconstruction of bone defects after intercalary resection of long bone malignancy.Methods From April 2006 to October 2009,19 patients that had intercalary resection of long bone malignancy (5 in humerus,7 in femur,7 in tibia)underwent reconstruction with an allograft and vascularized fibula construct,including 11 males and 8 females with an average age of 18.5 years.The average length of the defect was 13.2±4.3 cm.Free vascularized fibula flaps were used in 16 patients and ipsilateral pedicle vaseularized fibula grafts in 3.Time to union was recorded through evaluation of plain radiographs.Bone scan was used to evaluate the viability of the vascularized fibula.Patients were examined oncologically and radiographically and were assessed functionally with MSTS-93.Results The mean follow-up time was 27.5 months.The average length of the fibula flap was 17.9±5.2 cm.Viability of the fibular grafts was verified in all cases.The average time for bone union at allograft-host junction was 11.3±2.8 months in femur,14.1±3.3 in tibia,6.8±1.4 in humerus,respectively.The MSTS-93 average score at final follow-up was 95.2% in upper extremity and 91.8% in lower extremity.The oncology result in patients with follow-up more than 2 years was continuous disease free in 11 patients.no evidence of disease after recurrence following resection in 1,alive with tumor in 1,and died of lung metastasis in 1.Conclasion Vascularized fibular flap in combination with massive allograft provide an option for reconstruction of large bony defects after long bone malignancy extirpation.The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing,leading to earlier patient's recovery of function.

Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.

Objective To explore the significance of motor unit number estimation (MUNE) by using multiple point stimulating technique to evaluate patients with Hirayama disease (HD).Methods Multiple point stimulating technique was used to estimate the motor unit number of abductor pollicis brevis and abductor digiti minimi in 35 normal subjects [14-33 years old,mean (20.9 ±4.0) years old,33 men and 2 women]without nerve and muscle disease and 69 patients definitely diagnosed as HD [16-35 years old,mean (21.46 ±6.61 ) years old,67 men and 2 women].The differences between the two groups were examined by Fisher's exact test and t test.Results There were 42 patients with atrophy and 27 patients with normal clinical manifestation of left hand.For right hand there were 54 patients with atrophy and 15 normal.For controls,the MUNE value of left abductor pollicis brevis was 226.97 ± 30.59,while that of right side was 22g.31 ± 25.35.The MUNE value of left abductor digiti minimi was 237.43 ± 30.78,while that of right side was 240.20 ± 37.73.For HD patients,the MUNE of left abductor pollicis brevis and abductor digiti minimi was 145.66 ± 126.10 ( t =5.07,P ＜ 0.01 ) and 102.20 ± 112.67 ( t =9.31,P ＜ 0.01 )respectively,while those of right hand was 149.72 ± 117.80 ( t =5.31,P ＜ 0.01 ) and 64.23 ± 69.27 ( t =16.76,P ＜0.01 ) respectively.MUNE of left abductor digiti minimi in 17 patients that was below 200 among 27 patients with normal clinical manifestation (x2 =9.57,P =0.002).MUNE of right abductor digiti minimi in 12 patients that was below 200 among 15 patients with normal clinical manifestation ( x2 =4.64,P =0.03).Conclusions The differences of MUNE values by multiple point stimulating technique between the normal subjects and the HD patients is significant,which suggests this method is very useful to evaluate HD in the early state.

BACKGROUND:Dexamethasone can improve the cellapoptosis and decrease the number of osteoblasts and bone cells through increasing the time of cellcycle. Protein kinase C is a kind of intraecellular singnal transduction pathways, and there are related reports on the relationship between protein kinase C and cellapoptosis. OBJECTIVE:To investigate the mechanism of dexamethasone-induced osteoblast apoptosis via protein kinase C intracellular signal transduction pathway. METHODS:Fetal rat bone marrow mesenchymal stem cells were col ected for osteogenic induction, and the cells were divided into dexamethasone group, phorbol group and star cytochalasin group. The cells in the dexamethasone group were added with 1×10-6 mol/L dexamethasone, the cells in the phorbol group were added with 1×10-6 mol/L dexamethasone and 1×10-7 mol/L phorbol, while the cells in the star cytochalasin group were added with 1×10-6 mol/L dexamethasone and 1×10-7 RESULTS AND CONCLUSION:Dexamethasone could induce apoptosis significantly, and after added with mol/L star cytochalasin. The proliferation and inhibition of the cells in different intervention groups were observed, and the content of protein kinase C in the cellmembrane and cytoplasm was measured. phorbol, the apoptosis was increased significantly;while after added with star cytochalasin, the apoptosis was decreased significantly. After added with dexamethasone, the content of protein kinase C in the cytoplasm was significantly decreased, while increased in the cellmembrane. At different time points after added with dexamethasone, the change of the content of protein kinase C in the cytoplasm and cellmembrane was most significant at 30 minutes. The results indicated that mechanism of dexamethasone-induced osteoblast apoptosis was correlated with protein kinase C, and dexamethasone was the agonist of protein kinase C. After the cells were stimulated, the protein kinase C in the cytoplasm wil moved to the cellmembrane, and then the content of protein kinase C in the cytoplasm was decreased, while increased in the cellmembrane.

Objective： To study the changes of water molecular diffusion in the ischemic region by using MR dephase technique and discuss the potential mechanism of the diffusion changes at early stage. Methods: Totally 43 cases were studied retrospectively. There were 10 cases whose MRI examinations were performed within 6 hours，12 cases from 7－24 hours，7 cases from 2－7 days, 8 cases from 8－14 days, 6 cases from 15 days to 2 months. The apparent diffusion coefficients in the ischemic region were calculated. Results: The ADCav in the grey matter was 8.61×10－4mm2*s－1. The ADCav decreased to (4.72×10－4±1.51×10－4) mm2*s－1 in ischemic region at superacute stage, ADCav ratio to contralateral corresponding region was 0.55±0.18, and ADCav increased to (5.68×10－4±1.22×10－4) mm2*s－1 during the time range of 2-7 days, （9.22×10－4±2.07×10－4） during the time range of 8－14 days, and approaching （26.42×10－4+9.65×10－4） mm2*s－1 during the time range of 2 months. The pearson product- moment correlation between the changes of diffusion value and time was sighificent (r=0.95, P<0.001). ADCv increased at superacute stage and decreased over time. Conclusion: The diffusion of water molecules in ischemic region decreased at superacute stage, and the ADC increased over time. The anisotropy increased at superacute stage and decreased as the course developed. DWI could detect ischemic lesion much earlier than CT and routine MR examination. DWI has great value in the diagnosis of superacute stroke. The mechanism of the diffusion changes at early stage may be the intracellular toxicity edema.

Objective To analyze MRI features of different cervical flexion positions in Hirayama disease (HD) and discuss the effects on these features by different cervical flexion angles.Methods The cervical MR images of neutral and different flexion positions (20°, 25°, 30°, 35° ,40°) of 20 patients, who were clinically diagnosed as HD,were studied.At flexion positions, the appearance of anterior shifting of the posterior wall of the cervical dural canal and widening of epidural space was recorded.The maximum sagittal diameters (d) of widened cervical epidural space and the cervical canal sagittal diameters (D) on the same level were measured to calculate d/D value for quantitative evaluation of the two signs.Comparisons of appearance of the signs among different flexion positions were made using F/sher's exact test.Repeated measures analysis of variance (rmANOVA) was used to compare mean d/D values among groups with different positions, and paired comparisons were also performed.Results The appearance of anterior shifting of the posterior wall of the cervical dural canal were different between 20° group (70%, 14/20) and other 4 larger angles groups (100%) (χ2 =5.76, P=0.020).The d/D values were 0.51±0.06,0.54±0.08,0.57±0.09,0.61±0.09,0.59±0.07 respectively at abovementioned 5 flexion positions, which were different among groups( F = 3.450 ,P = 0.013 ).The value was greater at 35° than that at 20° and 25°( P <0.05 ), and it was also greater at 40° than that at 20° ( P < 0.05 ).Conclusion Cervical flexion angle has an effect on anterior shifting of the posterior wall of the cervical dural canal and widening of epidural space.

Objective To build a three-dimension finite-element model of patella and to make a preliminary mechanics analysis on the model.Methods According to the model-building principle of Ansys software which started from point to line to area to volume,a three-dimension finite-element patella model was reconstructed on the basis of the images of spiral CT.Then,loading on the model patella were simulated and the stress magnitude and distribution on the patella were analyzed.Results Finite element analysis of the patella showed that stress concentration zone located in the middle and lower patella,indicating that fracturepredilectionsitesinthelower patellar.TheVon misesstresson thetensionsidewas significantly greater than that on pressure side.Conclusion The established finite element model of the patella can reflect the real geometry of patella treated in clinics.