Thevascularendothelialprogenitorcellsareapopulationoffunctionalendothelialprecur sorsincirculatingblood ,whicharederivedfrombonemarroworcordblood .CD34+,Flk - 1+andACl33+ aretheirmolecularmarkers .Inthisreview ,thefunctionalcharacterizationofvascularendothelialprogenitor cellsisintroducedandtherelationshipbetweenvascularendothelialprogenitorcellsandangiogenesisinis chemiccardiovasculardiseasesisdiscussed .Thesedatamayofferafoundationforthedevelopmentofthera peuticangiogenesisforthepreventionandtreatmentofischemiccardiovasculardiseasesbytransplantationof vascularendothelialprogenitorcells .

Controlling serum phosphorus levels is critical in patients with renal failure. Currently phosphate-binding agents are widely used to reduce phosphate absorption in patients with end-stage renal disease. If possible, serum phosphorus level should be reduced without disturbing calcium homeostasis or increasing accumulation of potentially toxic elements. Aluminum hydroxide and traditional calcium-based phosphate binders are commonly used to control serum phosphorus level. Aluminum hydroxide can effectively lower serum phosphorus level, but aluminum can accumulates in the body and results in toxic effect. Traditional calcium-based phosphate binders tend to promote hypercalcemia and calcium overloading, and accelerate cardiovascular calcification. Therefore aluminum-free and calcium-free phosphate-binding agents have become the focus of study; however, agents like sevelamer hydrochloride and lanthanum carbonate are not widely used due to high price, although they are effective in controlling serum phosphorus level. New generation of phosphate binders, such as colestilan, nicotinic acid and magnesium salt, are cheaper than their previous counterparts, but their long-term effect still needs to be observed. This article summarizes the progress of non-calcium phosphate binders in treatment of end-stage renal diseases, hoping to help clinical drug usage.

Clinical data and radiological findings of 78 patients with distal radial fractures,who underwent plain X-ray film and muhislice CT (MSCT) examinations,were retrospectively analyzed.Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases;while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P ＜ 0.05).The missed diagnosis rate of X-ray was 38％.Results indicate that MSCT can significantly improve the detect rate,which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.

Objective To investigate the changes in plasma concentrations of IL-6 and IL-10, pHi and the difference between tissue and arterial PCO2 [(P(t-a)CO2 ] during pulmonary surgery and the effects of thoracic epidural anesthesia on cytokine production and gut mucosal perfusion. Methods Twenty ASA class Ⅰ - Ⅱ patients undergoing elective pulmonary surgery, were randomly assigned to be operated upon under general anesthesia (group GA , n = 10) or under general anesthesia combined with thoracic epidural anesthesia (group GEA, n - 10) . Premedication in both groups consisted of pethidine 50mg and scopolamine 0.3 mg im 30 min prior to surgery and oral ranitidine 150 mg the night and 1 h before operation. Anesthesia was induced with fentanyl 2 ug?kg-1 , droperidol 1 mg, propofol 1.5-2.5 mg?kg-1 and succinylcholine 1-2 mg?kg-1 and maintained with inhalation of 1%-2.5% isoflurane and 50% N2O in oxygen and intermittent iv boluses of fentanyl and vecuronium. In GEA group epidural catheter was inserted through the needl placed at T7-8 or T8-9 and advanced cephalad for 2.5-3.0 cm. A loading dose of morphine 2 mg was given followed by epidural infusion of 0.4% ropivacaine at a rate of 6 ml?h-1 during maintenance of anesthesia and the concentration of isoflurance inhaled was reduced to 0.6%-1. 5% . Postoperative analgesia was provided by epidural infusion of 0.25% ropivacaine at 6-8 ml/2h until the morning of the 3rd postoperative day. Blood samples were taken before induction, at incision and 2 h, 4 h and 6 h after the incision and on the 1st and the morning of the 3rd postoperative day for determination of IL-6 ( by radioimmunoassay) and IL-10 (ELISA) . P(t-a)CO2 and pHi were assessed by tonometry before induction, at incision and 1 h, 2 h, 4 h and 6 h after the incision. Results (1) IL-6 and IL-10 increased significantly during operation as compared with the baseline value before induction in both groups and there was no significant difference between the two groups. (2) pHi decreased significantly during operation in both groups and there was no significant difference between the two groups. pHi was negatively correlated with IL-6. (3) P(t-a)CO2 increased significantly during operation in both groups and was negatively correlated with pHi. P(t-a)CO2 was significantly higher in GA group than that in GEA group at 4h after skin incision. Conclusion Pulmonary surgery elicits both pro- and and-inflammatory cytokine response which is not affected by thoracic epidural analgesia. Thoracic surgery leads to gut mucosal hypoperfusion of which P(t-a)CO2 is an indicator. Thoracic epidural anesthesia can improve gut mucosal perfusion. There may be some correlation between cytokine production and gut mucosal hypoperfusion.

Objective To detect the MRI manifestations and discrimination of tuberculous spondylitis and pyogenic spondylitis with atypical features in early stage. Methods Six patients with pathologically proved tuberculous spondylitis and 7 patients of pyogenic spondylitis with atypical clinical features and were included. MRI features of the vertebral bodies, intervertebral discs, paraspinal soft tissues and their enhancement patterns were analyzed. Chi-Square test was used to compare the MRI features of two diseases. Results Patients with pyogenic spondylitis had a significantly higher incidence of disk space narrowing (8 intervertebral bodies), abnormal signal in superior/inferior of vertebral body (12 intervertebral bodies) and endplate with high signal (13 intervertebral bodies), which were not seen in the patients with tuberculosis spondylitis (P<0.05).Patients with tuberculous spondylitis had a significantly higher incidence of local abnormal signal in anterior of vertebral body (4 intervertebral bodies) and paraspinal abscess spanning vertebral body (5 intervertebral bodies), while none of them was found in patients with pyogenic spondylitis (P<0.05). Conclusion MRI is accurate for the differentiation of tuberculous spondylitis and pyogenic spondylitis with atypical feature in early stage.

[Objective] To assess the outcomes of lumbar spinal pedicle subtraction osteotomy on single segment for correction of kyphosis in ankylosing spindylitis.[Methods]15 patients were treated with L2 or L3 pedicle subtraction osteotomy and internal fixation by pedicle screw system.All the patients underwent X-ray examinations in standing position before and after the operations.The angles in different part of the sagittal planes were measured and the preoperative and postoperative differences were compared.[Results]All the operations were well complete.The mean time of operations was 3h and the mean bleeding was 840 ml.The lumbar lordosis angle increase from(14.5?15.5)?to(48.4?11.9)?,the total spinal kyphosis angle and the thoracolumbar kyphosis angle improve from(36.1?14.7)?and(30.7?9.3)?to(0.2?14.2)?and(23.7?12.3)? respectively,the sacral slope increase from(12.0?12.7)?to(28.9?8.8)?,whereas thoracic kyphosis angle remained relative stable.[Conclusion]Lumbar spinal pedicle subtraction osteotomy on single segment is a satisfactory and reliable technique for correction of kyphosis in ankylosing spindylitis and the average correction of lumbar lordosis was 33.9?.

Objective: To study the influence of screening dementia with mini-mental state examination (MMSE) combining with delay memory test . Methods: MMSE and delay memory test are used in screening 301 residents. The diagnosis of dementia is according to the DSM-Ⅲ-R criterion. The validity and reliability were studied when the MMSE and delay memory test were used to screen dementia alone or combined. Results: When MMSE was used to screen dementia alone, the specificity, sensitivity, false positive proportion and false negative proportion were 85.40%, 52.43%, 47.56% and 14.60% respectively. When delay memory test was used to screen dementia alone, the specificity, sensitivity, false positive proportion and false negative proportion were 74.45%, 92.07%, 7.93% and 25.55% respectively. If parallel connection of MMSE and delay memory test were used to screen dementia, the specificity, sensitivity, false positive proportion and false negative proportion were 95.62%, 49.39%, 50.61% and 4.38% respectively. If MMSE was in series with delay memory test, the specificity, sensitivity, false positive proportion and false negative proportion of screening dementia were 64.23%, 95.73%, 4.27% and 35.77% respectively. Conclusion: The parallel connection of MMSE and delay memory test can elevate sensitivity of screening dementia and decrease false negative proportion, so it is important in epidemiologic investigation. MMSE in series with delay memory test will raise specificity of screening dementia and decrease false positive proportion, so it is useful for diagnosing early dementia.

Objective To analyze the reasons of early complications in anterior cervical spine surgery and its management. Methods Between Jan 1992 and Dec. 2003, 412 patients underwent anterior cervical surgery. There were 308 males and 104 females with an average age of 45.6 years (18-76). The di-agnosis of these patients included 258 of cervical spondylosis, 138 of cervical injury, 8 of cervical spinal tu-mor and 8 of tuberculosis of cervical spine. The medical history was from 4 hours to 20 years with an aver-age duration of 548 days. Among 412 patients, there were 58 cases (14.1%) with complete paraplegia, 192 cases (46.6%) with incomplete paraplegia and 162 cases without neurological deficits. Anesthesia used in this group of patients were local in 35, cervical plexus block in 52, local associated with cervical plexus block in 6, general in 318 and general associated with cervical plexus block in 1. Three surgical procedures were performed: 1) anterior decompression and interbody fusion with autogenous iliac crest in 33 cases; 2) anterior decompression and interbody fusion with threaded fusion cage in 32 cases; 3) anterior decompres-sion, interbody fusion with autogenous iliac crest and plate fixation in 347 cases. Results Fifty-one early complications occurred in 42 patients and the incidence was 12.37%. 28 patients (6.8%) had complications directly related to the procedure which included superior laryngeal nerve injury in 5, recurrent laryngeal nerve injury in 4, migration of bone graft in 2, infection or haematoma in 4, deterioration of neurological function in 5,nerve root injury in 2, loosening of screw or plate fixation in 2 and esophageal fistula in 1. 23 cases (5.08%) had early complications indirectly related to the procedure. Conclusion In order to reduce the incidence of early complications in anterior cervical spine surgery, make familiarization with anatomy, improvement of surgical skill as well as appropriate perioperative management are essential in anterior cer-vical spine surgery.

Objective To discuss the selection of surgical procedures for the treatment of spinal tu-berculosis according to the status of segmental stability of the spine. Methods One hundred adult patients with spinal tuberculosis were treated surgically between January 1998 and December 2003. There were 57 males and 43 females with an average age of 39.4 years and an average history of 16 months. The lesion ranged from T2 to S 2, and involved single vertebral body in 3 cases, double vertebral bodies in 66 cases, and more than two vertebral bodies in 31 cases. Of 100 cases, 32 were with neurological dysfunctions, and 65 were accompanied by kyphotic deformity with an average Cobb angels of 36.4? (20? to 48?). Preoperative chemotherapy of four drugs lasted more than two weeks. Three surgical procedures were performed according to the status of segmental stability of the spine: 12 cases without spine instability underwent single debride-ment, 8 cases of spine instability with debridement and interbody fusion, and 80 cases of significant insta-bility with debridement, fusion and internal fixation. Results All patients' incision healed without chronic infection and sinus formation. 95 patients were followed up with an average of 2.9 years ranged 1 to 77 years except 5 patients lost at follow up. 68 cases with anterior fusion achieved solid fusion in average 3.5 months. 65 cases with kyphotic deformity had an average correction of 20.2? postoperatively, and 2? to 4? loss during follow-up. 32 cases with neurological deficits had an improvement of neurological function postoperatively. One patient of L 4,5 tuberculosis treated with anterior debridement, fusion and instrumentation recurred at 7 months due to an inadequate postoperative chemotherapy of 6 months, and healed with a continuous chemotherapy for 18 months, However, satisfactory clinical results were obtained in other patients without any recurrence. A left external iliac vein was torn and repaired successfully in 1 case. Conclusion The maintenance of segmental stability has significant effect in the surgical treatment of spinal tuberculosis. Sta-tus of segmental stability of each patient should be evaluated preoperatively. Satisfactory clinical results can be achieved by proper selection of the surgical procedure according to the status of segmental stability.

DS ③Combined MMSE with one or more of FOM、RVR 、BD、DS,the validity of diagnosis was improved.Conclusion: Neuropsychological test is useful in diagnosis of AD.The validity is improved when MMSE are combined correctly with other rating scales.