BACKGROUND: Measuring the slope of proximal tibiofibular joint may elucidate the anatomical structure and type of proximal tibiofibular joint, and evaluate the stability of proximal tibiofibular joint. OBJECTIVE: To investigate the measurement methods and clinical significance of the joint slope by comparing the slope measurement of bilateral proximal tibiofibular joint surface on X-ray and 64-row spiral CT reconstruction.METHODS: One hundred normal adult volunteers, including 50 males and 50 females, aged 18-90 years, were photographed in double knees via internal rotation to 30°, 45° and 60°, respectively and scanned with 64-row spiral CT, tibiofibular bone (including knee joints) was reconstructed. The included angle between proximal tibiofibular articular surface and the longitudinal axis of the fibula shaft, between the proximal tibiofibular articular surface and the horizontal line, were measured using an angle square.RESULTS AND CONCLUSION: There were great variations of the data in the same proximal tibiofibular joint measured by X-ray and spiral CT. X-ray results are affected by the site of photograph position, and the slope of articular surface is estimated, so the 64-row spiral CT is an accurate and convenient method to reconstitute the slope of proximal tibiofibular joints. Spiral CT could be used to distinguish the dislocation and instability of the proximal tibiofibular joint, accordingly reduce the clinical misdiagnosis.

Objective To explore operative indications,methods and effect of one stage total hip arthroplasty(THA)in treatment of acetabular fractures.Methods One stage total hip arthroplasty (THA)was carried out in 11 patients with acetabular fractures including 10 males and one female(at mean age of 42.4 years)8-37 days(mean24 days)after injury.There were anterior column fractures in three patients,posterior wall fracture in one,posterior column fracture in two,posterior column fracture combined with posterior wall fracture in two,transverse fracture in one,transverse fracture combined with posterior wall fracture in one and two-column fracture in one.Fresh acetabular fractures were first fixed with reconstruction plate or screws to restore shape of acestbular wall;then,granule or bulk of resected femoral head were implanted into acetabulum posterior to placement of acetabular cup prosthesis.While for old acetabular fractures,the resected femoral head was first implanted on acetabular superior wall and posterior wall and then acetabular cup prosthesis was placed.Results Follow-up for 6-45 months (mean 28 months)showed obdous improvement of hip joint function,with average Harris score of 78 points and average active degree of 95°.X-ray film presented loosening of acetabulum and osteolysis in one patient.All patients began weight bearing three months after operation,with no dislocation of joint prosthesis.Conclusions Under strict control of indications,one stage THA can be done for patients who miss operative reduction due to obvious acetabular fracture dislocation and severe articular cartilage injury.Stable aeetabular cup may beget satisfactory short-term clinical results.

Objective: To explore the relationship between intra-operative blood product transfusion and post-operative prognosis in children with pediatric open heart surgery by cardiopulmonary bypass (CPB).
Methods: A total of 1028 consecutive pediatric patients received the open heart surgery by CPB in our hospital were retrospectively studied. Uni- and multivariate Logistic regression analysis were conducted to analyze the relationship between intra-operative blood product transfusion and post-operative in-hospital death and complication rates.
Results: There were 45/1028 (4.4%) of patients died, 143 (13.9%) with low cardiac output syndrome, 43 (4.2%) received dialysis, 26 (2.5%) with sustained pulmonary failure, 17 (1.7%) with infection, and 28 (2.7%) developed neurologic complications. Multivariate Logistic regression analysis indicated that duration and the lowest temperature of CPB, 24-hour post-operative pediatric risk of mortality (PRISM-III) score and intra-operative transfusion amount of RBC > median (20.3 ml/kg) were the independent risk factors for post-operative in-hospital death. Congenital heart disease (CHD) with pre-operative cyanosis, duration of CPB, 24-hour post-operative PRISM-III score, 6-hour post-operative mediastinal drain loss and intra-operative transfusion amount of RBC > 20.3 ml/kg were the independent risk factors for post-operative complication occurrence.
Conclusion: Large volume of RBC transfusion in the open heart pediatric surgery with CPB may increase the risk of post-operative in-hospital death and complication occurrence, reducing RBC transfusion might be improving the post-operative prognosis in CHD patients.

This study was aimed to discuss the influence of specific acupoint acupuncture therapy to the serum angiogenesis factor of high fat diet obese mouse models. Mice were randomly divided into the blank control group , acupuncture control group , model control group , and acupuncture treatment group . There were 6 mice in each group . Obese mouse models were induced after 15-week high fat diet . The specific acupoint acupunc-ture therapy was used as an intervention treatment method for 10 days . The enzyme-linked immunosorbent as-say (ELISA) was used in the detection of serum insulin, vascular endothelial growth factor (VEGF), soluble vascular endothelial growth factor receptor , leptin and the level of nitric oxide in mice . The results showed that the serum insulin , nitric oxide and leptin level in the obese mouse models were increased . However , there were no obvious changes on the vascular endothelial growth factor and soluble vascular endothelial growth fac-tor receptor level . The specific acupoint acupuncture therapy can obviously reduce the level of serum nitric ox-ide and leptin, and improve the content of vascular endothelial growth factor in obese mouse models. However, there were no influence on the level of blood glucose and soluble vascular endothelial growth factor receptor . It was concluded that the specific acupoint acupuncture therapy method had preferable antiobesity action . Its mechanism of action may be related to the regulation of angiogenesis .

The pathogenesis of gouty arthritis contains internal cause and external cause. The deficiency of Zang Fu organs is the internal cause and the invasion of external pathogens is the external cause, which is related to the liver, spleen and kidney. In clinical treatment, we should grasp the pathological factors such as dampness, heat and blood stasis, and treat this diseaseaccording to different stages and types, anddeal with both symptoms and the root cause. Clinically, orally taken Traditional Chinese Medicine (TCM), acupuncture, collateral pricking and bleeding, and external application of TCM are the common methods to treat this disease and combining various methods together has better curative effect, which could significantly relieve the pain and alleviate inflammation with safetiness. However, the operation methods and standards of the existing studies are not unified, which needs long-term follow-up, large samples and high-quality studies.

Objective To investigate the effects of predictive nursing intervention on acute myocardial infarction ( AMI ) patients undergoing temporary preventive cardiac pace maker .Methods A total of 130 patients with AMI undergoing emergency percutaneous coronary intervention ( PCI) were enrolled by convenience sampling method and divided into control group (n=65) and observation group(n=65) according to the time of admittion.All patients were received temporary preventive cardiac pace maker before PCI .Routine nursing was applied in patients of the control group , and predictive nursing was applied in patients of the observation group . Malignant arrhythmia , hypotension and serious complications were recorded and analyzed .Results In both groups, the right coronary artery was the main artery of the infarction , accounting for 80.00%(control group, 52/65), 76.92%(observation group, 50/65) respectively, the difference was not statistically significant (P>0.05).Malignant arrhythmia rate in the observation group tended to decrease compared with that of the control group (7.69% vs 18.46%), but there′s no statistically significant difference ( P =0.069 ).Malignant arrhythmia rate of right coronary artery infarction in the observation group was lower than that of the control group (6.00%vs 21.15%) ( P =0.026 ).12.31% of observation group patients developed hypotension versus 26.15% in the control group ( P =0.045 ).Predictive nursing intervention had a tendency to reduce complications occurrence compared with routine nursing intervention (10.77%vs 20.00%), but no statistical significance was achieved(P=0.145).Conclusions Implementation of predictive nursing intervention among AMI patients undergoing temporary preventive cardiac pace maker plays an important role in reducing the risks of malignant arrhythmia and hypotension , which has certain meaning for the clinical nursing .

Objective:To prepare a nano-carrier based on combining bacterial outer membrane vesicles (OMV) with three block polymer pluronic F127 (PEO100-PPOss-PEO100) (OMV-F127) and to investigate its immunological activity.Methods:Attenuated salmonella (sal) was cultivated.OMV were separated by centrifugal ultrafiltration or ultrasonication,and OMV-F127 was prepared by mechanical extrudation method.The protein contents and compositions were tested with BCA and SDS-PAGE;the morphology of OMV,F127 and OMV-F127 were observed with FM and TEM;the particle sizes and their zeta potential were determined with DLS.Mouse macrophage RAW246.7 cells were treated with OMV-F127 (50 μg/mL,100 μg/mL) In vitro,and the concentrations of IL-12,TNF-α and IFN-γin culture supernatant were measured with ELISA kits.Results:The contents of protein in separated OMV by centrifugal ultrafiltration and ultrasonication were 2.8 mg/mL and 2.7 mg/mL,respectively.SDS-PAGE showed the marker protein OmpF/C in OMV.Under the FM and TEM,ball-like structure of F127 and OMV-F127 was observed.Size analysis revealed that the diameters of OMV,F127 and OMV-F127 were (72 ±2)nm,(90 ± 3)nm and (92 ± 2)nm,respectively.ELISA tests revealed that OMV-F127 significantly stimulated the secretion of IL-12,TNF-α and IFN-γ in RAW246.7 cells.Conclusion:A nano-carrier based on bacterial OMV has been prepared,which can stimulate the secretion of cytokines and may have immunomodulatory effects.

OBJECTIVE: To design and synthesize folate-modified pH-responsive chitosan-based nanomicelles and investigate the anti-tumor activity of the drug-loaded micelles. METHODS: CHI-DMA was obtained by reductive amination reaction of aldehyde-based chitosan and hydrophilic amine compounds, and CHI-DMA-LA was obtained by condensation reaction with lauric acid; FA-CHI-DMA-LA was obtained after modification with folic acid (FA). The drug-loaded nanomicelles FA-CHI-DMA-LA/DOX were assembled by solvent change method. The physicochemical properties of polymers were characterized by hydrogen nuclear magnetic resonance and transmission electron microscope. The particle size and surface potential were determined by dynamic light scattering method. Folic acid access rate, doxorubicin (DOX) loading rate and entrapped efficiency were measured by UV-vis spectrophotometer. The drug release properties of DOX-loaded micelles were monitored by fluorescence spectrophotometer at different pHs (7.4, 6.5, 5.0). The cytotoxicity against human oral cancer KB cells was detected by MTT assay. Fluorescence microscope and flow cytometry were applied to investigate the phagocytosis of DOX-loaded micelles on KB cells. RESULTS: FA-CHI-DMA-LA was synthesized. The particle sizes of FA-CHI-DMA-LA-1 and FA-CHI-DMA-LA-2 micelles which used for the subsequent experiments were (73±14) nm and (106±15) nm, zeta potential were (15.59±1.98) mV and (21.20±2.35) mV, respectively. The drug loading rates of drug-loaded micelles FA-CHI-DMA-LA-1/DOX and FA-CHI-DMA-LA-2/DOX are (4.08±1.12)%and (4.12±0.44)%, respectively. drug release is pH-responsive, with cumulative release of DOX up to 37%and 36%at pH 5.0, which is about 1.5 times higher than that of pH 7.4. For FA-CHI-DMA-LA micelles with 1.25 to 125 μg/mL concentration, the survival rate of KB cells is more than 70%after incubation for 24 hours. The cell uptake of FA-CHI-DMA-LA/DOX micelles was enhanced compared to CHI-DMA-LA/DOX, and the cell uptake was higher in incubation without FA medium than that with FA. Compared with free DOX or CHI-DMA-LA/DOX, FA-CHI-DMA-LA/DOX nanomicelles showed higher cyctoxicity to KB cells, especially the FA-CHI-DMA-LA-2/DOX nanomicelles, the cell survival rate was about 17% after incubation for 24 hours. CONCLUSIONS FA-modified chitosan-based nanomicelle with good biocompatibility was successfully prepared, which exhibits tumor microenvironmental pH responsive drug release and tumor targeting.
Antineoplastic Agents ; Chitosan ; Doxorubicin ; Drug Carriers ; Folic Acid ; Humans ; Micelles ; Nanostructures ; Polymers

Objective To determine the diagnostic value of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for gastrointestinal lesions with inconclusive endoscopic biopsies. Methods A retrospective analysis was performed in 65 patients who were found to have gastrointestinal lesions with inconclusive endoscopic biopsies and underwent EUS-FNA in Drum Tower Hospital. Diagnostic value of EUS-FNA was determined by comparing with surgical histopathology and follow-up results. Results This study included 41 males ( 63％) and 24 females ( 37％) with median age of 60 years. The most common lesion was diffuse infiltrative lesions ( 37, 56. 9％) , followed by submucosal protrusion types ( 17, 26. 2％) . Fifty-four cases ( 83. 1％) were malignant lesions, and 11 cases ( 16. 9％) were benign. The overall sensitivity, specificity, and accuracy of EUS-FNA for gastrointestinal lesions with inconclusive biopsies were 76. 8％ ( 95％CI: 65. 7％-87. 8％) , 100. 0％ ( 95％CI: 66. 4％-100. 0％) , and 80. 0％( 95％CI: 70. 3％-89. 7％) , respectively. Sub-group analysis showed the sensitivity, specificity, and accuracy of EUS-FNA for diffuse infiltrative lesions were 70. 6％ ( 95％CI: 55. 3％-85. 9％, 100. 0％( 95％CI:29. 2％-100. 0％) , and 73. 0％ ( 95％CI: 58. 7％-87. 3％) , respectively. For submucosal protrusions, the sensitivity, specificity, and accuracy of EUS-FNA were 68. 8％ ( 95％CI: 46. 0％ -91. 5％) , 100. 0％ ( 95％CI: 2. 5％-100. 0％) , and 70. 6％ ( 95％CI: 44. 0％-89. 7％) , respectively. Conclusion EUS-FNA has moderate diagnostic value for endoscopic biopsy-inconclusive gastrointestinal lesions. It can be an alternative option when standard methods, such as endoscopic mucosal forceps biopsy, fail to provide a definitive diagnosis.