Objective: To explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress. Methods: A total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures. Results: After impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density ( P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle ( P>0.05). Conclusion: The micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.

Objective To compare the surgical outcome of Lichtenstein,open preperitoneal technique and double-laver mesh technique in tension free repair of incarcerated inguinal hernia.Methods Totally 438 cases of indirect inguinal hernia in our hospital were retrospectively analyzed from January 2008 to January 2012,io which 154 patients received Lichtenstein,186 patients received open preperitoneal technique and 98 patients received double-layer mesh technique.Results The recurrence rates of these three groups were low,0.65％,0.54％,0,respectively,and there was no significant difference in the recurrence rate between these 3 groups (P ＞0.05),but significant difference in the foreign body sensation and postoperative pain between the open preperitoneal technique group and the other two groups(P ＜ 0.05),and the cost of the double-layer mesh technique group was ahout 2000 yuan higher than the other two groups.Conclusion The open preperitoneal technique can reduce the postoperative pain and foreign body sensation after surgery with low cost,and it is a good choice for inguinal hernia repair.

[Abstract ] Forkhead box(Fox) M1, as a member of the Fox transcription factor family, overexpresses in many kinds of canc-ers and is related to a variety of oncogenic signaling pathways.It plays an important role in the occurrence, progression and metastasis of cancer.FoxM1 has been a new target for cancer therapy research.

Objective To analyze the epidemiological and clinical characteristics of an outbreak of tsutsugamushi disease in Taizhou region of Jiangsu Province,and to clarify new changes of endemic focus of tsutsugamushi disease in Jiangsu Province.Methods The definition of tsutsugamushi infected cases was determined,field epidemiological investigation with analysis of clinical features and polymerase chain reaction (PCR) results to diagnose tsutsugamushi disease were combined.Some of the positive samples were conducted genotyping by amplification and sequencing.Results The outbreak occurred from October to November,2011.The endemic focus located on the plain with humid climate and abundant rainfall.Fifteen cases of tsutsugamushi disease were found,including 6 PCR confirmed cases,5 clinically diagnosed cases,and 4 suspected cases.The main clinical symptoms were fever in 15 cases,skin rash in 14 cases,lymphadenectasis in 3 cases,skin eschar or ulcer in 12 cases,and liver dysfunction in 3 cases.None of the patients developed severe complications,and all recovered rapidly after the treatment.Comparing the sequencing results of positive samples with standard strains,the homology of base sequences was 99.00％ with that of Kawasaki.Conclusions The outbreak of tsutsugamushi disease in Jiangsu Province in 2011 is of autumn type in transitional endemic focus,and the pathogen is Kawasaki Orientia tsutsugamushi.

Background Deficiency of neurotrophic factor is associated with the damage of optic nerve in glaucoma.Reaserches showed that ectopically applied neurotrophic factor has a transient neuroprotective effect in glaucoma model,and the viral expression of adeno-associated neurotrophie factor may provide long-term supplementation of neurotrophic factor and neuroprotection in tissues.Objective The present study Was to investigate the neuroproteetive effect of adeno-associated viral(AAV)-mediated brain-derived neurotrophic factor (BDNF)on retinal ganglion cells(RGCs)in DBA/2J mice with experimental glaucoma. Methods 10 clean DBA/2J mice were administered intravitreal injection with 1 microliter of AAV-BDNF-GFP in the left eyes at the age of 6 months,and the right eyes were injected with the same volume of saline solution as control.Intraocular pressure (IOP)was measured with Tonolab in the mice every month.Retinas were obtained after 3 months for the investigation of GFP expression in RGCs using fluorescence microscopy.Immunohistochemistry Was performed by applying TUJ1 and Cy3 antibodies to identify surviving RGCs. Results The IOP of DBA/2J mice were 11.90 mmHg and 11.40 mmHg in the right eyes and left eyes,respectively,at 4 months.The IOP of DBA/2J mice began to rise at 5 months and reached its peak in 8 month-old mice.There was no statistically significant difference in IOPs between the right eyes and the left eyes from 4 month-through 9 month-old mice(t=-1.78-0.61,P=0.11-0.90).Three months after intrlavitreal injection of AAV-BDNF-GFP,GFP was positively expressed in RGCs of retinas with the expression rate of 46.33%±8.08%.The over-expression of BDNF led to more RGCs survival than the control eyes (3168.13±1319.33/mm2 vs 2024.81±796.38/mm2,t=2.75,P=0.02). Conclusion These data suggest that BDNF can exert a protective effect in DBA/2J glaucoma mice.

Objective To establish a practical,stable and high purity endothelial progenitor cells culture meth- od in vitro.Methods Human umbilical cord blood mononuclear cells were isolated by Ficoll density-gradient cen- trifugation,then plated on dishes coated with human fibronectin.After 48 hours,the nonaderent cells were collect- ed and replated onto fibronectin-coated dishes.After 7 days of culture,the cells were identified with the techniques of immunohistochemistry,immunofluorescence and flow cytometer.Results The cultured cells were small and spindle or polygonal in shape.Large numbers of typical endothelial progenitor cell colony-forming units were found,vWF and Flk-1 proteins expression were identified in more than 95% of the attached cells with 98% of them showing positive Dil-ac-LDL and FITC-UEA-1.According to the results from fluorescence-activated cell sorting (FACS),7.0%?1.8% of cells were recognized as CD_(133)~+.Conclusion Differential attachment technique is a practical and stable method for obtaining highly purified endothelial progenitor cells.

The clinical features and lung CT findings of 174 heart failure patients,including 85 cases with normal left ventricular ejection fraction (LVEF) and 89 cases with reduced LVEF were reviewed.Patients with normal LVEF had a higher proportion of hypertension,diabetes and obesity than patients with normal LVEF; and cough and dyspnea were more common.The lung CT findings in patients with normal LVEF were frequently presented as interstitial lung edema,increased pulmonary texture,subpleural line,Kerley lines and diffuse ground-glass opacity.Patients with reduced LVEF had a higher proportion of coronary heart disease and clinical manifestations of acute left heart failure,and central alveolar edema presented in lung CT images.Results suggest that heart failure patients with normal LVEF usually have longer clinical history and occult symptoms,and have a different lung CT imaging features from those in heart failure patients with reduced LVEF.

[ ABSTRACT] AIM: To observe the effects of TNF-α/nuclear factor-κB( NF-κB) /matrix metalloproteinase-2 (MMP-2) pathway on the expression of MMP-2 in the mice with viral myocarditis.METHODS: Six-week-old inbred male mice were randomly assigned to control and myocarditis group.The mice in myocarditis group and control group were intra-peritoneally inoculated with 0.1 mL 10-5.69 TCID50 /mL coxsackievirus B3 and vehicle (PBS), respectively.Ten mice were sacrificed at the 4th and 10th days after injection.The blood and heart specimens were harvested.The serum content of TNF-αwas measured by ELISA.The myocardial levels of MMP-2, NF-κB p65 and IκBαwere determined by Western blot.RESULTS: Compared with control group, the protein expression of MMP-2 and NF-κB p65 in the myocardium and the serum content of TNF-αwere significantly increased in myocarditis group (P <0.05).The protein expression of IκBαwas lower in myocarditis group than that in control group (P <0.05).CONCLUSION: TNF-α, NF-κB p65 and MMP-2 were higher in the mice with acute viral myocarditis.The increased expression of them might be involved in the pathogene-sis of viral myocarditis.

OBJECTIVETo investigate the clinical application of the vacuum-sealing drainage (VSD) in the prevention of lymph leakage after inguinal lymphadenectomy.

METHODSFrom September 2003 to September 2013, 60 cases who underwent inguinal lymph nodes dissection received VSD (n = 30), or traditional pressure dressing and drainage( control group, n = 30) after operation. The flap blood supply, healing process and incidence rate of lymph leakage were observed.

RESULTSTwenty-eight cases in VSD group were effective. Eleven cases were cured, ten cases were effective, and nine cases were invalid in control group. The cure rate, effective rate and healing period were significantly different between the two groups (P < 0.01).

CONCLUSIONSThe incidence of lymph leakage after inguinal lymphadenectomy can markedly decrease with VSD application. VSD could be an ideal preventive method for post-operative lymph leakage.

Adult ; Aged ; Female ; Groin ; surgery ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Postoperative Complications ; prevention & control ; Surgical Flaps ; Young Adult