BACKGROUND: Bone marrow necrosis has unspecific clinical features, which is often misdiagnosed or missed due to a lack of the knowledge of the disease. OBJECTIVE: To improve the awareness and vigilance to bone marrow necrosis, and to further explore the clinical manifestations, hematological characteristics, pathogenesis and treatment of bone marrow necrosis. METHODS: The bone marrow necrosis, hematologic neoplasms, solid tumor, bone marrow puncture, bone marrow pathology in Chinese and English served as the search terms to search articles related to bone marrow necrosis in PubMed and Wanfang databases, published from 1941 to 2016. Totally 43 articles were selected for review. RESULTS AND CONCLUSION: Bone marrow necrosis is a rare complication caused by various diseases, clinically characterized by bone pain, fever, anemia, and nucleated red cells and immature neutrophilic leukocytes in the blood smear. Bone marrow aspiration and/or bone marrow biopsy show(s) necrotic features. Its pathogenesis is complex, and it is still poorly understood and needs further research. There is no good treatment for bone marrow necrosis, and the prognosis is poor. Early correct diagnosis and etiological treatment are crucial for the prognosis of bone marrow necrosis.With the improvement of disease awareness, bone marrow cytology, genetics, MRI and hematopoietic stem cell transplantation, bone marrow necrosis is expected to get a better prognosis.

Based on status and trends of international medical education,the authors probe the teaching theory,training objectives and curriculum system in military medical university. The purpose is to research and practice creative training model to train creative medical professionals for the army.

Biometry ; Clinical Protocols ; Cryoultramicrotomy ; methods ; Diagnostic Techniques and Procedures ; Frozen Sections ; utilization ; Humans ; Orthopedics ; methods

0.9). Conclusions CT perfusion imaging could quantify the hepatic blood flow.The accuracy is similar to electromagnetic flowmeter,and it could effectively reflect physiological or pathological hemodynamies of liver.CT perfusion is noninvasive,high reproducible and convenient,which could be widely used in clinical practice.

Objective The comparison of the clinical role of stress-redistribution/reinjection with dual isotopes of 99Tcm-methoxyisobutylisonitrile (MIBI) and 201TI in the detection of myocardial viability.Methods One hundred and sixty patients with clinically suspicious coronary artery disease (CAD) were included.All had intravenous injection with 740 MBq of 99Tcm-MIBI.Pharmacological challenge with dobu-macological challenge with dobutamin,111 MBq of 201Tl Was injected to all.Myocardial SPECT images were performed in all at 10-min (stress) and 3-h (redistribution/rest) after injection.The 201Tl(37 MBq)would be given to those patients with myocardial perfusion defect at stress images by 201Tl and were demon-strated by both 201Tl(redistribution) and 99Tcm-MIBI (rest).Coronary angiography (CAG) Was performed within two weeks.X2-test was used with SAS 6.12.Results Coronary artery abnormalities were found in all with 76 patients had one vessel disease,51 had two and 33 had three.Of the 152 patients who had myo- cardial perfusion defect during stress images,63 had redistribution by both 201TI and 99Tcm-MIBI.5 had re-distribution by 201Tl only.9 had redistribution by 99Tcm-MIBI only,and 75 had no redistribution in 201Tl or 99Tcm-MIBI images.The sensitivity of detection myocardial viability with myocardial SPECT images between 201Tl at redistribution (66.0%,68/103) and 99Tcm-MIBI at rest (69.9%,72/103) were insignificant (x2=O.36.P>0.05).Of the 75 patients who did not have redistribution in 201Tl or 99Tcm-MIBI images.34.7% (26/75)had myocardial perfusion when reinjection of 201Tl.In all,there were eight false negative myocardial perfusion SEPCT images.Three were triple vessel disease,one Was two, three were one, and the other was patent collateral circulation.Conclusions Stress.redistributed/reinjection 201TI myocardial perfusion SPECT imaging is superior to stress 201Tl/rest 99Tcm-MIBI simultaneous dual-isotopic myocardial imaging in the detec-tion of myocanrdial viability.

OBJECTIVE: to investigate the origin characters of snore in simple snorers and provide the basis for its treatment. METHOD: Thirty-two simple snorers diagnosed by polysomnography were induced to sleep by propofol and dexmedetomidine, then we observed the vibration sites, pattern and concomitant collapse of soft tissue in pharyngeal cavity by nasendoscopy. RESULT: Thirteen cases showed palatal fluttering only, and 1 case showed vibration of epiglottis only. Six cases showed palatal fluttering with vibration of epiglottis, and 2 cases showed palatal fluttering with vibration of epiglottis and tongue base. Five cases showed palatal fluttering with vibration of pharyngeal lateral wall, and 5 cases showed palatal fluttering with vibration of lateral wall, epiglottis and tongue base together. Palate and pharyngeal lateral wall vibrated strongly and always collapsed with vibrating, but epiglottis and tongue base usually vibrated slightly and seldom collapsed. CONCLUSION The palatal fluttering is the main source of snoring sounds for most simple snorers, then followed by vibration of palatal and pharyngeal lateral wall together. The site of collapse in pharyngeal cavity is consistent with the main site of vibration.
Endoscopy ; Epiglottis ; physiopathology ; Humans ; Palate ; physiopathology ; Pharynx ; physiopathology ; Polysomnography ; Propofol ; Sleep ; Sleep Apnea, Obstructive ; Snoring ; diagnosis ; Tongue ; physiopathology

Objective To investigate the application value of identification of the scalp surface locations of cerebral ischemia lesions before direct revascularization for moyamoya disease and to design surgical approaches according to this by using the fusion of single photon emission computed tomography ( SPECT) cerebral perfusion imaging with CT imaging. Methods The clinical data of 13 adult patients with ischemic-type moyamoya disease underwent superficial temporal artery-middle cerebral artery bypass surgery were analyzed retrospectively. SPECT cerebral perfusion imaging was fused with CT imaging of the same machine before procedure. The lesions of ischemia were located on the cortical surface. The surgical approaches were designed at the center of the ischemic lesions. The patients were followed up for 6 to 12 months after procedure. The improvement of clinical symptoms and cerebral perfusion of the patients were observed after operation. Results One patient had perioperative cerebral hyperperfusion syndrome,and the others did not have any perioperative complications. At one-month follow-up, the improvement of symptoms in 4 patients were excellent,in 5 were good,in 4 were fair,and none was poor. At 6 to 12 month follow-up,the improvement of symptoms in 9 patients were excellent,in 4 were good,and none was poor. The postoperative visual SPECT cerebral perfusion imaging analysis suggested that the cerebral perfusion was improved significantly as compared with before procedure in all patients. Quantitative analysis:There was significant difference in target ischemic lesions between preoperative Fb and postoperative Fb ([2. 13±1. 06]% vs. [4. 13±2. 09]%;P<0. 05). There was significant difference between preoperative Fb and Fe ([2. 46±1. 97]% vs. [2. 13±1. 06]%;P<0. 05). The postoperative BFCR was [67. 57±3. 78]%( >50%) , which indicated that the efficacy of the procedure was remarkable. The superficial temporal arteries fed to brain of the patients were observed after procedure by using the head CT angiography. The postoperative head MRI reexamination showed no new infarcts occurred at 6 months. Conclusion Combine SPECT cerebral perfusion imaging with CT imaging to design surgical approach for superficial temporal artery-middle cerebral artery bypass surgery may improve the efficacy and reduce the risks of operation.

Objective To compare the difference of serum adiponectin levels between polycystic ovary syndrome (PCOS) patients and age, boby mass index (BMI) and insulin-resistance index matched controls, and explore its influence factors.Methods Case-control study, involving 97 women with PCOS and 116 age, BMI, fasting plasma glucose and insulin levels, homeostasis model assessment-insulin resistance index (HOMA-IR) matched controls.Hormone profiles, and serum adiponectin levels were measured and compared.Hormone profiles and serum adiponectin levels were compared among the four PCOS phenotypes.Multiple regression analysis was used to evaluate the factors affecting serum adiponectin levels.Results (1) Serum adiponectin level was significantly lower in PCOS group [(21 ± 16) mg/L] than controls [(25± 13) mg/L, P=0.038], and the same result in stratified analysis on weight height ratio (WHR, ≥0.8 and ＜0.8).(2) There was statistical differences in testosterone among different four PCOS phenotypes (P=0.001), there were no statistical differences in FSH, LH, WHR and serum adiponectin levels among four PCOS phenotypes (P＞0.05).(3) WHR and PCOS status were independent determinants of serum adiponectin levels (P＜0.05).Conclusions Low serum adiponectin levels in the women with PCOS is correlated with PCOS per se, independent of insulin resistance and obese.This fact supports the further study of the effect of adiponection in the pathophysiology of PCOS and its log-term impact.

Objective To define the variables associated with preterm infants with patent ductus arteriosus (PDA) and identify the optimal timing for PDA closure clinically.Methods Three hundred and fifty-three premature babies with gestational age ＜ 32 weeks in Ba Yi Children's Hospital,Beijing Military General Hospital,from February 2011 to January 2013 were selected.Among them the PDA patients with degree of cardiovascular dysfunction using a scoring system (CVD) ≥3 scores at 48 hour life by using the cardiovascular dysfunction scoring systerm received primary drug treatment with 1-3 cycles Ibuprofen.If drug treatment failed or contraindicated,underwent surgical closure.Gestational age,body weight,presence of symptomatic hypotension,drug treatment or surgical closure were analyzed to see whether these factors were related to clinical outcomes,including hospital mortality,necrotizing enterocolitis (NEC),intraventricular hemorrhage(IVH),retinopathy(ROP) and bronchopulmonary dysplasia(BPD) at 36 weeks.Data were analyzed with Kruskal-Walls test,Wilcoxon signed rank test,Pearson x2 test,Fisher's exact test,Friedman,Halton,Logistic regression model.Results In the PDA patients with CVD≥3 scores persistently,the effectiveness of Ibuprofen was lower as time went on,PDA and BPD(OR =3.163,P =0.002),ROP(OR =2.557,P =0.007) were related markedly,and surgical treatment was possibly required.When CVD scores ≥ 3 after birth,drug treatment for one cycle was effective in 169 cases(47.8％),52 cases (14.7％) for two cycles,and 44 cases(12.5％) required surgical ligation after drug treatment failed.Such patients had younger gestational age [(29.4 ± 2.4) weeks vs (30.7 ± 1.4) weeks,P ＜ 0.000 1],and lower body weight at birth [(1 450 ± 577) g vs (1 750 ± 508) g,P =0.004).Conclusions The prolonged patency of the ductus arteriosus in preterm infants is related to an increase for IVH,BPD and ROP.Surgical ligation of PDA is a safe and effective treatment and should be done soon after two complete cycles of Ibuprofen,especially in selected patients who CVD ≥3 scores,to reduce the possibility of BPD and ROP occurence.

BACKGROUND: Demineralized bone matrix and bone morphogenetic protein have been shown to have good bone induction, but less studies concerned nanometer demineralized bone matrix. Its physical and chemical properties and biological security are not yet clear.
OBJECTIVE:On the basis of preparing the nanometer human demineralized bone matrix in previous experiment, we mixed the recombinant human bone morphogenetic protein-2 together to obtain the new bone graft substitute and to research its physical and chemical properties and biological security.
METHODS:The human demineralized bone matrixes were prepared by the method of modified Urist and nano-processed then mixed with the bone morphogenetic protein-2 in specific proportions in order to be lyophilized to complete the fol owing experiments. (1) Pyrogen experiment:the material extracts were injected in the rabbits by ear intravenous. (2) Toxicity experiments:material extracts and saline were separately injected via the tail vein of mice in vivo. (3) Implantation experiments:experimental materials andβ-tricalcium phosphate were implanted into rabbits on both sides of the hindlimb muscle.
RESULTS AND CONCLUSION:After lyophilized shaping, the nanometer demineralized bone matrix material had dense surface and it’s pore diameter was 100-400μm. The pore distribution was less uniform and the porosity was of less than 30%. The main elements were carbon, oxygen and nitrogen. Nanometer human demineralized bone matrix with recombinant human bone morphogenetic protein-2 did not have pyrogen effect and the rabbits’ body temperature had no significant fluctuations after injection. The acute systemic toxicity test results showed that the nanometer human demineralized bone matrix with recombinant human bone morphogenetic protein-2 complied with the relevant provisions of the State, without obvious toxic reaction. The inflammatory response of nanometer human demineralized bone matrix with recombinant human bone morphogenetic protein-2 was significantly lighter than the reaction ofβ-tricalcium phosphate. The results showed that the nanometer human demineralized bone matrix with recombinant human bone morphogenetic protein-2 is a nanometer al ogeneic bone graft substitutes with nontoxicity, good biocompatibility, high bioavailability, and less inflammatory reaction.