Objective To investigate the causes of non-union and delayed union of fractures and to report the surgical techniques and outcomes of the treatments. Methods 107 cases of non-union, 54 cases of delayed union and 2 cases of congenital non-union of tibia were treated between July 1990 and December 2004 in our hospital. The treatments were evaluated retrospectively to analyze the causes of the disorder and the treatment outcomes at the follow-up. 18 cases of delayed union were treated conservatively while the other 145 cases in this series underwent surgery. Results Except in the 2 cases of congenital non-union of tibia, iatrogenic factors were found to be responsible for nonunion or delayed union in all the other 161 cases. 153 cases were followed up for an average of 17 (6 to 28) months only to reveal bone union in all the cases with a mean healing time of 10 (6 to 14) months. All the limbs regained good function. Conclusion Since development of non-union and delayed union of fractures chiefly result from iatrogenic technical defects, satisfactory results can be achieved as long as appropriate treatments are performed according to different etiological factors.

Objective To observe the effects of different concertrations of calcifying nanoparticles (CNP) on growth and proliferation of human renal tubular epithelial cells (HK-2),and to explore the effects of autophagy of human renal tubular epithelial cells induced by CNP. MethodsNormal growth HK-2 cells were cultured in vitro and the culture medium was changed to serum-free medium after cell growth to confluence,CNP with different concentrations were then added and the cell proliferation inhibition was measured by MTT assay after 12,24,48 and 72 h co-incubation.EGFP-LC3 express plasmid was transfected into HK-2 cells,CNP with certain concentration was then added after 24h incubation.The formation of autophagosomes and their adherence to cells were observed by electron microscopy,and EGFP-LC3 staining was used to detect the formation of autophagosome by flourescence microscopy after 3,6,24 and 48 h co-incubation. ResultsCNP presented a concentration-dependent cell proliferation inhibition on HK-2 cells,the inhibitory ratio in cell proliferation was 14.5 ％ after 48 h co-incubation when CNP density was 0.05 mg/ml,and the inhibitory ratio was 21.5％ after 72 h co-incubation when CNP density was 0.1 mg/ml.Autophagosome formation and CNP adherence to cell surface could be observed by electron microscopy 6 h after CNP was added to the DMEM medium.The LC3-positive dots were observed in HK-2 cells incubated with CNP.Conclusions Autophagy of HK-2 could be activated by co-incubation with CNP,which may play an important role in the formation of nephrolithiasis.

Objective: To study the role of IL-6 in the dental pulp indirect injury by gunshot. Methods: The mandible was wounded by gunshot at (961.18?8.94) m/s in 17 dogs.2 h,6 h,1 d,3 d,7 d after injury molars,caspids,and lateral incisors were sampled respectively for IL-6 detection by immunohistochemical method in dental pulp. Results: The results showed that positive staining of IL-6 was observed predominantly in infiltrating inflammatory cells, vascular endothelial cells and some fibroblasts,IL-6 expression was consistent with the recruitment and activation of inflammatory cells, and with the severity duration of pulpal tissue injury and response. IL-6 level was increased in the dental pulp 6 h～3 d after injury.Conclusion: IL-6 is involved in regulating physiologic responses of dental pulp injuries in maxillofacial trauma by a projectile.

Objective To evaluate the efficacy and safety of application of F 16 single-tract minimally invasive percutaneous nephrolithotomy ( MPCNL) combined with flexible ureteroscopy for the treatment of complex renal staghorn calculi . Methods From May 2009 to September 2012, 35 patients with complex renal staghorn calculi were treated by F 16 single-tract MPCNL combined with flexible ureteroscopy in this hospital .All the patients underwent MPCNL at the first-stage, and 5-7 days afterwards a second-stage operation was performed by using flexible ureteroscopy .The fragments of stones were removed from the MPCNL tract .For patients diagnosed as having residual stones , a third-stage reoperation of MPCNL combined with flexible ureteroscopy was given . Results Twenty-one patients were stone-free after the second-stage operation , 12 patients were stone-free after the third-stage operation , and the remaining 2 patients with residual stones were given drug administration for stone removal and were clarified as stone -free within 1 month of follow-up.No serious intraoperative or postoperative complications such as hemorrhage or infectious shock occurred .Follow-up reviews for 3 -6 months in the 35 patients found no residual stones or recurrence . Conclusion F16 single-tract MPCNL combined with flexible ureteroscopy is an effect and safe procedure for complex renal staghorn calculi .

Objective To develop a computer-aided diagnosis(CAD)system with automatic contouring and morphologic and tex-tural analysis to aid on the classification of breast nodules on ultrasound images .Methods A modified Level Set method was pro-posed to automatically segment the breast nodules(46 malignant and 60 benign nodules) .Following ,16 morphologic features and 17 texture features from the extracted contour were calculated and principal component analysis(PCA)was applied to find the optimal feature vector dimensions .Fuzzy C-means classifier was utilized to identify the breast nodule as benign or malignant with selected principal vectors .Results The performance of morphologic features was 78 .30% for accuracy ,67 .39% for sensitivity and 86 .67%for specificity ,while the latter was 72 .64% ,58 .70% and 83 .33% ,respectively .After the combination of the two features ,the re-sult was exactly the same with the morphologic performance .Conclusion This system performs well in classifying the malignant breast nodule from the benign breast nodule .

We investigated the Toxop lasma infection prevalence among planned pregnant women in Chongqing ,and to pro‐vide reference for the first level intervention of birth defects in the region .A total of 11 953 planned pregnant women were se‐lected by proportionally stratified multi‐stage random sampling method .Questionnaire survey was given to the women ,and blood samples were collected .Specific IgM and IgG antibodies against Toxoplasma were detected with ELISA .Results showed that among the 11 953 cases surveyed ,Toxoplasma IgM was positive in 71 cases ,with the positive rate of 0 .59% ;IgG was positive in 771 cases ,with the positive rate of 6 .54% .The positive rate of IgM and IgG antibodies in the metropolitan core re‐gion of the city was higher than that in the suburb areas (χ2 =35 .28 ,P<0 .000 1 ;χ2 =82 .65 ,P<0 .000 1) .The positive rate of IgM antibody increased with the educational level (χ2trend=3 .25 ,P=0 .001 1) .The positive rates of IgM and IgG varied in occupations among women (χ2 =13 .93 , P= 0 .016 0;χ2 = 15 .58 ,χ2 =0 .008 1) ,with the highest rate of public officials . Planned pregnant women with the history of abnormal pregnancy outcomes had higher positive rate of T .gondii IgM and IgG antibodies than those in the control (χ2 =6 .85 ,P=0 .008 9;χ2 =59 .25 ,P<0 .000 1) .There was no significant difference of IgM positive rate between the planned pregnancy women who had closed contact to cats and the control group (χ2 =0 .23 ,P=0 .628 6) ,while the positive rate of IgG was higher than that of the control group (χ2 =9 .95 ,P=0 .001 6) .T .gondii infec‐tion rate was on the low level of planned pregnant women in Chongqing .Adverse pregnancy outcomes are related to Toxoplas‐ma infection .

Diagnostic Errors ; Humans ; Inflammation ; diagnosis ; etiology ; Laryngeal Neoplasms ; surgery ; Male ; Middle Aged ; Papilloma ; surgery ; Pneumonia ; diagnosis ; Postoperative Complications ; diagnosis

Objective To evaluate the effectiveness and safety of one stage posterior vertebral osteotomy for correction of severe and rigid congenital scoliosis associated with Ⅰ, Ⅱ type of diastematomyelia.Methods According to the diastematomyelia packet,52 patients were divided into type Ⅰ group performed with mediastinum resection combined with spinal osteotomy, group Ⅱ without treatment of diastematomyelia direct spinal osteotomy.Group Ⅲ spinal osteotomy directly without diastematomyelia.Results The mean operation time was (548.6±113.2) min,the average amount of bleeding was (3 728.6±1 436.5) ml.In group Ⅰ,the mean operation time was (608.6± 123.2) min, significantly longer than those of group Ⅱ ((521.3 ±102.4) min,t=2.787,P＜0.01).In group Ⅰ the average amount of bleeding was (5 018.3 ±2 174.2) ml, significant more than that of group Ⅱ((2 615.3± 1 132.8) ml,t=5.182,P＜0.01).Patients with preoperative Cobb angle measurement for (95.2± 14.3) degrees, postoperative for (35.2± 14.8) degrees, follow-up of 2 years for (37.6± 16.1) degrees, group Ⅰ included preoperative (92.3 ± 12.8) degrees, postoperative (32.6 ± 15.8)degrees, 2 years later (35.8 ± 17.2) degrees;group Ⅱ before operation (99.2 ± 17.3) degrees, postoperative (37.3±14.3)degrees, 2 years later (40.2± 15.3) degrees.The postoperative Cobb angle correction rate and correction loss rate showed no significant difference between two groups (P ＞0.05), a posterior spinal osteotomy for the treatment of type Ⅰ and type Ⅱ with diastematomyelia severe rigid congenital scoliosis has good correction effect.This group of patients, the complication rate was 21.2％ (11/52);where in Ⅰ group the incidence rate of 36.4％ (8/22) was significantly higher than that of Ⅱ group 10.0％ (3/30) (P =0.021).Conclusion One stage posterior vertebral osteotomy for severe rigid with diastematomyelia of congenital scoliosis with the feasibility, effectiveness and safety, patients with type Ⅰ diastematomyelia should first bony mediastinum resection, Ⅱ type of diastematomyelia there is no need for treatment of diastematomyelia.

Objective To assess the effect of continuous renal-replacement therapy (CRRT) dose on the outcome of acute renal failure (ARF) patients with meta-analysis of randomized controlled trials (RCTs). Methods Studies were identified by systematic search of peer-reviewed publications in Medline, EMBASE and Cochrane library database through June 2010. All the RCTs that compared the incidence of clinical outcome such as mortality, need for chronic dialysis between standard and low dose CRRT were eligible. The pooled relative risk (RR) for clinical outcome was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup and sensitivity analysis. Results Six eligible studies were identified. By meta-analysis, standard dose CRRT was associated with non-significant 13% mortality risk reduction (RR 0.87, 95%CI 0.70-1.07, P=0.19)and 13% composite outcome risk reduction of chronic dialysis dependence and mortality (RR 0.87, 95%CI 0.69-1.09, P=0.21), but the trend toward increased chronic dialysis dependence risk among survivors (RR 1.43, 95%CI 0.94-2.18, P=0.09). The overall test for heterogeneity among cohort studies was significant (P=0.001, I2=76.2%). The risk of mortality was modality was significantly lower in some studies of which delivered dose was moer than 35 ml·kg-1·min-1,modality was continuous venous-venous hemofiltration (CVVH) and major cause was non-sepsis treated with standard dose CRRT. Conclusions Standard dose CRRT in patients with ARF does not improve survival, renal recovery and composite outcome, but decreases mortality in important subgroups including those with higher delivered dose, CVVH and non-sepsis.

BACKGROUND: Nerve growth factor (NGF) is characterized by poor stability both in vitro and in vivo, and liable to lose its bioactivity.OBJECTIVE: To study the stability of liposome-encapsulated NGF injection preserved under various conditions.DESIGN: A controlled study of liposome-encapsulated NGF.SETTING: Department of Surgery of the First Affiliated Hospital of Nanjing Medical University.MATERIALS: This study was carried out at the Central Laboratory of the First Affiliated Hospital of Nanjing Medical University between July 2002and March 2004. NGF from rat submaxillary gland was purified, encapsulated by liposome, and prepared into lyophilized dosage form before preserved under different conditions (at 4 ℃, room temperature, 40 ℃ or 40 ℃ with saturated humidity, respectively).METHODS: Chicken embryo dorsal root ganglion cultured in serum-free medium was used to evaluation the bioactivity of NGF in vitro. The dorsal root ganglion from 8-day-old chicken embryo was inoculated in a polylysine-coated 24-well culture plate and cultured in Dulbecco modified Ea-gle medium (DMEM) containing different testing samples. Only DMEM was used for culture in the negative control group, while DMEM containing NGF at different concentrations used in the positive control group. The ganglion was cultured at 37 ℃ with 50 mL/L CO2 and saturated humidity for 24 hours, and the growth of the nerve fibers was observed under an inverted microscope. The bioactivity of NGF was also evaluated in simulated condition in vivo by adding lyophilized liposome-encapsulated NGF and positive control NGF specimen into 0.5 mL rat serum, which, along with the blank control serum, was added into 2.5 mL DMEM at 0.5, 1, 2, 3, 4,6 hours and thoroughly mixed. The bioactivity of NGF was assessed accord-ing to the length and density of the dorsal root ganglion and graded the prominences (recorded as "++" or "+++ "), and very long and dense growth of the prominences (++++).MAIN OUTCOME MEASURES: In vitro bioactivity of NGF preserved for 10, 30, 60, and 90 days by testing the growth of cultured chick embryo dorsal root ganglion in serum-free DMEM and in test of rats serum containing NGF added at 0, 0.5, 1, 2, 3, 4, and 6 hours into DMEM.RESULTS: Lyophilized liposome-encapsulated NGF exhibited stable bioactivity (+++) after preservation at 4℃ and room temperature for 10-90days; at 40 ℃ for 10-60 days, the it retained its the bioactivity (+++),which, however, slightly decreased by 90 days (++); its bioactivity was preserved (+++) at 40 ℃ with saturated humidity for 10 days (+++), slightly decreased at 30-60 days (++) and noticeably lowered (+) at 90 days. When preserved for 0, 0.5, 1, 2, and 3 hours in rat seum, the NGF preparation retained stable bioactivity (++++ or +++), which slightly decreased at 4 hours and 6 hours (++).CONCLUSION: Liposome-encapsulated NGF has stable bioactivity but its preservation at relatively high temperature with high humidity is difficult.Lyophilized liposome-encapsulated NGF exhibits better bioactivity than NGF-liposome suspension after preservation under various conditions.