Objective To discuss the surgical indications,relative merits and clinical outcomes of anterior reconstruction plate fixation for treating unstable posterior pelvic ring injuries.MethodsA retrospective study was done on clinical data of 36 patients with unstable posterior pelvic ring injuries treated with anterior reconstruction plate fixation from August 2004 to July 2010 and followed up for minimum one year.There were 25 males and 11 females,at mean age of 35.8 years ( range,13-62 years).There were two patients with anterior dislocation of the sacroiliac joint and 34 with posterior dislocation.According to Tile classification,there were four patients with type B fractures ( B1:3,B2:1 ) and 32 with type C fractures (C1-1:17,C1-2:12,C2:2,C3:1 ).Results All patients were followed up for average 2.3 years ( range,1-6 years).Fat liquefaction and superficial infection were founded in two patients who were cured by dressing change and frequent but low-dose blood transfusion.Eight patients were subjected to iatrogenic lateral femoral cutaneous nerve injury.Meanwhile,five of them was recovered after treatment with neurotrophic drugs,but there were still three patients leaving lateral thigh numbness.One patient had L5 nerve root injury due to pull force,and was recovered after three months of neurotrophic drug therapy.According to Matta and Tometta criteria,the reduction results were excellent in 23 patients,good in 11 and fair in four,with excellence rate of 94％.No reduction loss or implant failure occurred.According to Majeed scoring system,the clinical outcomes were excellent in 17 patients,good in 14,fair in four and poor in one,with excellence rate of 86％.Of the seven patients pre-operatively associated with sacral plexusinjury,three obtained full recovery,two got partial recovery and two were free from recovery.Conclusion The anterior reconstruction plate fixation takes advantages of wide surgical indications,simple exposure,low infection rate,satisfactory reduction and solid fixation and may be a main treatment method for unstable posterior pelvic ring injuries.

OBJECTIVETo compare the early clinical effects of Activ C cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) in treating single-level cervical spondylosis.

METHODSThe clinical data of 76 patients with single-level cervical spondylosis underwent surgery from July 2009 to September 2012 were retrospectively analyzed. Among them, 28 patients were treated with ACDR (ACDR group), including 18 males and 10 females, aged from 32 to 62 years old with an average of (45.2±6.2) years; and 48 patients were treated with ACDF (ACDF group), including 28 males and 20 females, aged from 33 to 60 years old with an average of (45.8±6.4) years. Visual analogue scale (VAS), Japanese Orthopedics Association (JOA) score, Short Form-36 (SF-36), imaging data were used to assess the clinical effects after operation.

RESULTSA total of 76 patients were followed up from 6 to 24 months with an average of 13.2 months. VAS of neck pain and brachialgia were improved in all patients after operation (P<0.05), there was no significant difference between two group (P>0.05). Somato-score and psycho-score of SF-36 of two groups were obviously increased (P<0.05), ACDR group was better than that of ACDF group (P<0.05). In ACDR group, there was no significant difference in the range of motion of surgical segments and adjacent segments between preoperative and postoperative (P>0.05); heterotopic ossification around the edge of vertebral body occurred in 1 case on the 6th month after operation, no fusion was found on the 1st year after operation. In ACDF group, the adjacent vertebral disease occurred in 1 case and the patient underwent the reoperation.

CONCLUSIONActiv C cervical disc replacement can reduce the degeneration of adjacent segments and its early outcomes for the treatment of single-level cervical spondylosis are satisfactory, but the long-term effects still need study.

Adult ; Cervical Vertebrae ; surgery ; Diskectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; methods ; Spondylosis ; surgery ; Total Disc Replacement ; methods

ObjectiveTo evaluate the clinical application of endovascular treatment for severe Takayasu's arteritis (TA).MethodsIn this study,35 target lesions in 32 patients [28 women,mean age (30 ±8) years] with severe Takayasu's arteritis were treated with endovascular merthod.The average length of lesion was 3.1 cm( range 2.7 -5.3).The overall average degree of diameter stenosis was 90％ ± 11％ (range 70- 100)in which 15 lesions were completely occlusive.There were 10 patients whose ESR were higher than 20 mm/h( range 25 -37).Follow-up included physical examination and patency evaluated by color duplex souography/computed tomography angiography/angiography at 6 months and then annually.ResultsRecanalization was unsuccessful in 3 completely occlusive lesions,with a successful rate of 80％(12/15).There was one case in which embolization leading to acute thrombogenesis developed during interventional procedure and resulting in severe stroke.The technical successful rate ( residual stenosis ＜ 50％ ) was 88.6％ ( 31/35 ).The transient cerebral ischemia attack ( TIA ) symptoms disappeared in 31 cases.26 cases were followed up for an average of (19 ± 10) months (range 13 -40).Occipital infarction following severe in-stent restenosis developed 13 months later in one case.Symptomatic in-stent restenosis18monthslaterwasfoundin2cases. Patencyratewas88.5％( 23/26 ).ConclusionsEndovascular treatment is safe and effective for severe TA.Strict indication and accurate targeting the lesions help ensure the success of management.

Objective To evaluate the effects of femoral offset (FO) on the stress level of bone cement total hip arthroplasty (THA) in the elder patients by the three-dimensional finite element analysis. Methods The normal bilateral hip joints in two cases was determined with CT imaging,with parameters including FO,neck shaft angle and neck length.The three-dimensional finite element model of THA was built so as to make Von Mises stress analysis of the changes of different neck lengths,neck shaft angles and FO. Results Stress levels in the prosthesis and bone cement reduced monotonically with the increase of neck shaft angles.In the meantime,the stress levels were lowered when neck length was in a range of 35-44 mm,but beyond the range they showed monotonous increase. Conclusions The reduction of stress levels of prosthesis and bone cement,promotion of femur stress and extension of range of motion of hip joints are closely related to FO.FO reconstruction benefits the restoration of abductor force arm and biomechanical function of normal hip joints.

Objective To evaluate the function of MRE11 in inflammasome activation.Methods Different stimuli,in-cluding Poly(I∶C), Poly(dA∶dT),E.coli gDNA,293T gDNA,CPPD and HSV,were used to identify the effective inflamma-some activator using ELISA.Then, MRE11 siRNA oligos were sythesized and transfected into THP-1 cells while Western blotting was used to analyze the efficacy of MRE 11 knockdown .Finally ELISA and Western blotting were used to analyze the involvement of MRE11 in inflammasome activation induced by Poly (I∶C), Poly(dA∶dT), E.coli gDNA and 293T gDNA. Results The IL-1βsecretion and pro-caspase-1 activation which induced by Poly ( I∶C) , Poly( dA∶dT) , E.coli gDNA and 293T gDNA were reduced with different degrees in MRE 11-knockdown THP-1 cells.Conclusion These results indicate that MRE11 is required for inflammasome activation induced by genetic materials .

Objective To assess the clinical relevance of polymorphisms at position-251 in the promoter region of IL-8 gene and the incidence of sepsis in patients with severe trauma.Methods A total of 296 patients with severe trauma were included in the prospective cohort study.Incidence of sepsis was decided on the basis of the clinical manifestations and blood culture results.Muhiple organ dysfunction score (MODS) was performed using Marshall' s standard.IL-8/-251 gene polymorphisms were genotyped using restriction fragment length polymorphism polymerase chain reaction (PCR-RFLP).IL-8 plasma level was determined using ELISA method.Results Genotype frequency at IL-8/-251 locus in trauma patients was in accord with Hardy-Weinberg equilibrium (P ＞ 0.05).Sepsis incidence in trauma patients with TT,TA,and AA genotypes at IL-8/-251 locus was 58.1％,49.6％,and 25.0％ respectively.Multiple regression analysis showed inverse correlation between sepsis incidence and quantity of A alleles [OR =0.637,95％ CI (0.421,0.963),P ＜ 0.05].Carriers of AA genotype presented lower MODS score than those of other two genotypes (P ＜ 0.05).IL-8 plasma level presented significant difference among carriers of the three genotypes (P ＜ 0.01) and A alleles were associated with the down-regulation of IL-8 (P ＜ 0.01).Conclusion IL-8/-251T/A polymorphisms are implicated in the development of posttraumatic sepsis and AA genotype is protective against posttraumatic sepsis.

Objective To analyze the causes of misdiagnosis of esophageal leiomyoma.Methods The clinical data of 20 patients who were preoperatively misdiagnosed as esophageal leiomyoma at our hospital in 16 years were retrospectively analyzed.There were 11 males(55%) and 9 females(45%) with a mean age of(45.9 ± 16.4) years(range, 13-71 years).The initial presentations were obstructive symptoms in 12 patients(60%).CT imaging were performed in 9 patients(45%), of which 4 cases were enhanced CT(20%).Results The misdiagnosed patients included 5 cases of extraesophageal lesions(4 cases of paraesophageal lymph node tuberculosis and 1 case of lymph node hyperplasia), 8 cases of begin interstitial diseases(3 cases of neurinoma, 3 cases of inclusion cyst, 2 cases of angioma), 5 cases of malignant interstitial diseases(4 cases of GIST, 1 case of PNET), and 2 cases of esophageal cancer.The 4 cases of esophageal tuberculosis were misdiagnosed due to the absence of CT examination.The patients with esophageal cancer were treated with esophageal resection and reconstruction without clear staging of the tumor.This might be associated with the neglection of the rapid symptom development and the characteristic lumen stenosis under the gastroscope.The characteristic mucosal ulcer in patients with highly malignant GIST was overlooked.The disease relapsed postoperatively because only tumor enucleation was performed.Conclusion Preoperative diagnosis of esophageal leiomyoma is not uncommon.This disease is most often misdiagnosed as paraesophageal lymph node tuberculosis or esophageal GIST.CT examination is useful in distinguishing esophageal leiomyoma and paraesophageal lymph node tuberculosis.The roles of reoperation and adjuvant therapy in the surgical treatment of esophageal leiomyoma need further investigation.

Professional assessment in Chinese Higher Education has made great progress in three stages: the sporadic practice, trial and promotion. The authors present several comments on the characteristics and the professional assessment standards of clinical pharmacy in China, and focus on the scientific system of professional assessment.

[ ABSTRACT] AIM:To investigate the mechanism of L-type calcium channel ( L-Ca2+)/calpain signal transduc-tion pathway in verapamil inversing resistance of papillary thyroid carcinoma to doxorubicin .METHODS:Human papillary thyroid carcinoma TPC-1 cells were cultured for 2 d.For determining the appropriate concentrations and treatment time of verapamil and doxorubicin , a compatibility test was conducted to detect the cell viability by CCK-8 assay.The cells were divided into control group , doxorubicin group , verapamil group and doxorubicin +verapamil group .The techniques of whole-cell patch-clamp was used to record L-Ca2+currents.The protein expression levels of calpain 1 and LC3 were detec-ted by Western blot .RESULTS: Compared with control group , the density of L-Ca2+current decreased in doxorubicin group and verapamil group (P<0.05).Compared with verapamil group , the density of L-Ca2+current decreased in doxo-rubicin+verapamil group (P<0.01).Compared with control group, the expression of calpain 1 decreased in doxorubicin group and verapamil group (P<0.05).Compared with doxorubicin group , the expression of calpain 1 decreased in doxo-rubicin+verapamil group (P<0.05).Compared with control group , the expression of LC3 increased in doxorubicin group and verapamil group (P<0.05).Compared with doxorubicin group , the expression of LC3 increased in doxorubicin +ver-apamil group ( P<0.01) .CONCLUSION:The drug resistance of TPC-1 cells to doxorubicin may be related to the in-crease in autophagic activity .Verapamil further increases autophagic activity of TPC-1 cells, resulting in autophagic death and inversing the resistance of TPC-1 cells to doxorubicin .The mechanism may be involved in L-Ca2+/calpain 1 signal transduction pathway of autophagy .

Objective To explore the neural damage induced by acute exposure to methamphetamine (METH).Methods The mice were administrated with METH,then the stereotyped behavior of mice was evaluated,and spatial recognition memory was analyzed by Y-maze test.In addition,nitric oxide synthase (NOS) activity was detected by kit,and the apoptotic proteins including Bax,Bcl-2,Caspase-3 were assayed by using Western blot.The DNA injury induced by METH was observed by using the comet assay.Moreover,mitochondrial membrane potential was detected to assess the toxic effects of METH on mitochondria by JC-1.With the Western blot assay,the phosphorylation of MAPK signaling pathways were also investigated.Results Acute METH exposure significantly increased the stereotyped behavior in mice,and spatial recognition ability of mice was obviously decreased.On the molecular level,total nitric oxide synthase (TNOS) and induced nitric oxide synthase (iNOS) were increased,and the apoptotic proteins,such as Bax and cleaved caspase-3 were markedly enhanced.With the comet assay,it showed that METH exposure resulted in DNA damage.In parallel,mitochondrial membrane was damaged which manifested as mitochondrial membrane potential decreased.With the western blot,It was further found that METH enhanced the activation of MAPKs.However,p38 MAPK signahng pathway was demonstrated to be the only one factor involved in METH-induced neural damage.Conclusion METH induced neural damage,and MAPK signaling pathways might be involved in this process,since inhibition of p38 MAPK signaling pathway significantly ameliorated METH-induced neural damage.