Objective To discuss the common causes for postoperative complications after treatment of spinal fractures and their preventive measures.Methods To analyze the 32 failed eases who received internal fixation for their thoracolumbar fractures between July 1998 and April 2005 in our department.Their preoperative and postoperative results of X-ray,CT and MIR examinations were reviewed to find out the causes for failure.Three of them were treated through anterior approach and 29 through posterior approach.Eighteen screws broke in eight eases, the rods got loosened in eight cases and broken in four cases,15 pedicte screws were mis-located in eight cases and the implants got loosened in three cases.Results Thirty patients had to get a reoperation.Two were cured through non-surgical treatment.The causes for failure were found to be as follows:1,incorrect operation approach;2,in- stability of the front-middle colunm;3,unskillful operation;4,ignorance or the lesion to the adjacent vertebral discs; 5,flaws in pedicle screw design.Conclusion To prevent postoperative complications after internal fixation for spinal fractures,surgeons should strictly stick to the indications before operation,choose a proper approach and method for internal fixation,try to stabilize the front-middle column by the first intention,and have a good command of anatomy and operation skills.

Objective To establish a high performance liquid chromatography(HPLC) method for the simultaneous determination of eight components in Gynostemma pentaphyllum(Thunb.) Makino (ginsenosides Rb1, Rb3, Rd, Re, F2, and gypenosides A, XLIX and XVII). Methods HPLC was performed on Agilent Eclipse XDB-C18(4.6 mm × 250 mm, 5 μm) chromatographic column with 0.3％ formic acid solution (A)- acetonitrile (B) as the mobile phase by gradient elution, flow rate was 1.5 mL·min-1, detection wavelength was 203 nm, and column temperature was set at 50 ℃. Results There was a good linear relationship between peak area and concentration of eight components (r ≥ 0.999) , the recovery was in the range of 97％ to 100％. Conclusion The established method is simple, rapid, accurate, reliable, and reproducible, and can be used for the quality control of Gynostemma pentaphyllum(Thunb.) Makino.

HLA-A* 2402 is one of the most frequently encountered HLA-A alleles in East Asian populations. In order to study the CD8+ T cell responses in Chinese populations, we have described the generation and functional test of HLA-A* 2402 tetramer loaded with HCMV pp65(341-349) peptide (QYDPVAALF, QYD). The cDNA of HLA-A* 2402 heavy chain was cloned by RT-PCR from one of the donors. DNA fragment encoding the ectodomain of HLA-A* 2402 heavy chain fused at its carboxyl-terminal a BirA substrate peptide (BSP) was amplified by PCR with the cloned heavy chain cDNA as a template. The wild-type gene of HLA-A* 2402-BSP was not expressed in Escherichia coli (E. coli), while mutant HLA-A* 2402-BSP gene with optimized codons was overexpressed as inclusion bodies in E. coli. Furthermore, the soluble HLA-A* 2402-QYD monomers were generated by in vitro refolding of washed inclusion bodies in the presence of beta2-microglobulin and QYD peptide. The tetramer was subsequently formed by mixing HLA-A* 2402-QYD monomers with streptavidin-PE at a molar ratio of 4:1. Flow cytometry analysis indicated that this tetramer possessed binding activity with specific CTL from HLA-A24+ donors and the frequencies of tetramer-binding CTL were 0.09% - 0.37% within total CD8+ T cells. This tetrameric agent provides a powerful tool to explore the secrets of CTL responses against HCMV antigens in HLA-A* 2402 individuals.
Amino Acid Sequence ; CD8-Positive T-Lymphocytes ; cytology ; metabolism ; Carbon-Nitrogen Ligases ; metabolism ; Electrophoresis, Polyacrylamide Gel ; Escherichia coli ; genetics ; Escherichia coli Proteins ; metabolism ; Flow Cytometry ; Gene Expression ; HLA-A Antigens ; chemistry ; genetics ; metabolism ; HLA-A24 Antigen ; Humans ; Oligopeptides ; genetics ; metabolism ; Phosphoproteins ; chemistry ; genetics ; metabolism ; Protein Multimerization ; Recombinant Fusion Proteins ; chemistry ; genetics ; metabolism ; Repressor Proteins ; metabolism ; Substrate Specificity ; T-Lymphocytes, Cytotoxic ; cytology ; metabolism ; Viral Matrix Proteins ; chemistry ; genetics ; metabolism

OBJECTIVE: To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones. METHODS: The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function. RESULTS: In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%. CONCLUSION This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.
Adult ; Humans ; Kidney Calculi ; Middle Aged ; Nephrolithotomy, Percutaneous ; Retrospective Studies ; Solitary Kidney/surgery* ; Treatment Outcome

Objective To explore the treatment efficacy and safty of donepezil hydrochloride combined with comprehensive rehabilitation in memory impairment of patients after traumatic brain injury(TBI).Methods Seventy-six patients with TBI,admitted to our hospital from May 2008 to October 2010,were randomly divided into control group(n=38)and treatment group(n=38)using a case-control study method; patients from control group were given memory training,cognitive training and other comprehensive rehabilitation therapy while those from treatment group were given donepezil hydrochloride combined with comprehensive rehabilitation therapy for 3 months.Wechsler memory scale (WMS)was used to evaluate the efficacy and the drug adverse reactions were observed.Results As compared with those before treatment,the scores of forward counting in the long-term memory,scores of recall and recognition in short-term memory,scores of counting without looking in immediate memory and total scores of WMS were significantly higher in the cnntrol group after treatment(P＜0.05); as compared with those before treatment,the scores of long term memory(forvard counting,backward counting and adding),and scores of recall,recognition and logic memory in short-term memory,scores of counting without looking in immediate memory,and total scores of W-MS were significantly higher in the treatment group after treatment(P＜0.05); as compared with those in the control group after treatment,the scores of adding in long term memory,scores of logic memory in short-term memory and total scores of WMS were significantly higher in the treatment group after treatment(P＜0.05); oral administration of donepezil hydrochloride showed no significant adverse reactions.Conclusion Donepezil hydrochloride therapy combined with memory training,cognitive training and other comprehensive rehabilitation program is more effective than comprehensive rehabilitation therapy alone for memory impairment of patients after TBI.

OBJECTIVETo study the chemical constituents from rhizome of Pulsatilla dahurica.

METHODThe constituents were isolated and purified by various chromatographic methods. AR compounds were identified on the basis of spectral analysis and physico-chemical characters.

RESULTSix compounds were isolated from the 70% alcohol extract of the rhizome identified as hederagenin ( I ), hederagenin 3-O-alpha-L-arabinopyranoside (II), hederagenin 3-O-beta-D-glucopyranosyl(1-->2)-alpha-L-arabinopyranoside (III), hederagenin 3-O-beta-D-glucopyranosyl(1 -->2) [beta-D-glucopyranosyl(1-->4)]-alpha-L-arabinopyranoside (IV), beta-sitosterol (V) and daucosterol (VI), respectively.

CONCLUSIONCompounds I approximately VI were isolated from this plant for the first time.

Oleanolic Acid ; analogs & derivatives ; chemistry ; isolation & purification ; Plants, Medicinal ; chemistry ; Pulsatilla ; chemistry ; Rhizome ; chemistry ; Saponins ; chemistry ; isolation & purification ; Sitosterols ; chemistry ; isolation & purification

OBJECTIVETo investigate the feasibility of computer simulation in maxillofacial firearm injury.

METHODSThe three-dimensional finite element models and simulations of 7.62 mm, 5.56 mm standard bullets projectile injuries to pig mandibular angle were established by using MIMICS, ANSA, LS-DYNA and LS-POST software. Based on the simulation results, the bullet hole diameters, energy loss values, energy loss rates, von Mises stress, effective strain, effective strain rate dynamic contours at different time points were used for biomechanical analysis.

RESULTSThe damage processe of 7.62 mm, 5.56 mm standard bullets projectile injury to pig mandibular angle were simulated successfully. The injury rate of 7.62 mm standard bullet and injury severity of the mandible were higher than that of 5.56 mm standard bullet.

CONCLUSIONSComputer simulation can simulate maxillofacial firearm injuries effectively and may become an important method for oral and maxillofacial firearm injuries analysis.

Animals ; Biomechanical Phenomena ; Computer Simulation ; Finite Element Analysis ; Imaging, Three-Dimensional ; Mandibular Injuries ; physiopathology ; Models, Biological ; Software ; Stress, Mechanical ; Swine ; Wounds, Gunshot ; physiopathology

Objective To evaluate the safety of 3D printed titanium alloy trabecular reconstruction rod, bone grafts and its clinical efficacy. Methods Sixty patients with osteonecrosis of femoral head (ONFH) stageⅡ(ACROⅡ) were randomly divided into experimental group (titanium rod group) and control group (tantalum rod group). Patients were followed up at 6, 12 and 24 months after the operation. Harris score and visual analogue scale (VAS) were used to evaluate the postoperative function. Changes of X-ray were observed before and after operation. The imaging evaluation was analyzed after 24 months. Results The Harris score was decreased in titanium rod group compared with that of tantalum rod group at six-month. There were no significant differences in Harris scores for other time points between two groups. Repeated measures analysis of variance showed that there was a significant difference in time effect. The X-ray staging results changed gradually before and after operation in two groups, stage Ⅲand stage Ⅳgradually increased with time. There was progress in ONFH after operation in two groups. No infection or rejection was found in the two groups. There were higher improvement rates of stageⅡA and stageⅡB. There were no significant differences in improvement rate and hip preservation rate between two groups. The transparent lines disappeared in the positive and lateral X-ray films 6 months after the operation. No new transparent lines were found. The bone enhancement was not found in two groups of patients during follow-up period. No stress occlusion and bone trabecular bone enhancement were observed in two groups. Conclusion Titanium rods are satisfactory for the treatment of femoral head necrosis in the early stage of ACRO Ⅱ, which is not recommended for the treatment of relatively large ACROⅡC stage of necrotic area.

Objective To investigate the effect of transcatheter arterial chemoembolization(TACE) using As_2O_3 and Lipiodol on the growth and metastasis of the implanted hepatic tumor in rabbits and the correlation of metastasis with angiogenesis of the residual tumor.Methods Forty-eight New Zealand white rabbits were randomly divided into four groups and VX_2 carcinoma was implanted in the left lobes of the livers.Two weeks later,a catheter was inserted into the hepatic artery and infusion was performed via the hepatic artery using physiological saline(group A),Lipiodol(group B),ADM-Lipiodol(group C),and As_2O_3-Lipiodol(group D),respectively.One week after the treatment,the value of microvessel density (MVD)of tumors(samples got by biopsy)was examined by immunohistochemistry.Three weeks after the treatment,the volume and necrotic area of the implanted tumor were measured.The metastases in the liver, lungs and other organs were recorded.Results One week after the treatment,the value of MVD of the tumorswas(21.8?5.3),(23.4?3.9),(22.4?4.5),and(14.3?3.4)/400 power LM(F= 11.246,P=0.000).Three weeks after the treatment,the mean volume of the implanted tumor was (35.5?7.1),(21.2?8.3),(20.7?9.1),and(11.8?3.7)cm~3(F=21.203,P=0.0000)in groups A,B,C and D,respectively.There was significant difference between group D and group B(q= 4.398,P

BACKGROUNDInflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.

METHODSPatients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected. These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study. We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.

RESULTSThere was a significant difference in the serum levels of MMP-9 between the two groups (P < 0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P = 0.034, P = 0.031, and P = 0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95%CI 1.02 - 3.75). Hypertension, diabetes mellitus were negatively related with the occurrence of angina in the non-plaque group with the ORs being 0.50, and 0.36, respectively (95%CI 0.26 - 0.96 and 0.14 - 0.94). The MMP-9 level was negatively related to the occurrence of angina in the non-plaque group with an OR of 0.59 (95%CI 0.47 - 0.81).

CONCLUSIONSThere is a significantly difference in MMP-9 levels between the plaque and non-plaque groups. Current smoking has a significant influence on unstable angina patients without documented plaques. The serum MMP-9 level may be a significant biomarker which can help differentiate patients with unstable angina with plaques from those with unstable angina but without plaques.

Aged ; Angina, Unstable ; blood ; metabolism ; physiopathology ; C-Reactive Protein ; metabolism ; Coronary Angiography ; Coronary Artery Disease ; blood ; metabolism ; physiopathology ; Coronary Vessels ; metabolism ; pathology ; Female ; Humans ; Male ; Matrix Metalloproteinase 9 ; blood ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Smoking ; adverse effects