Objective To evaluate the efficacy of percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy for the treatment of renal calculi. Methods From January 2005 to December 2006, 132 cases of renal calculi were treated by percutaneous pneumatic nephrolithotripsy and ultrasonic lithotripsy. Percutaneous nephrolithotripsy was performed under the guidance of B-ultrasonography, and then the calculi were removed by pneumatic nephrolithotripsy combined with ultrasonic lithotripsy.Results Single-tract procedure was performed on 122 cases, while two-tract in the other 10. One-stage lithotripsy was performed on 127 cases, and two-stage operation was carried out in 5. The operation time ranged from 30 to 150 minutes with a mean of (60?12) minutes. The stone clearance rate was 90.2% (119/132) one week after the operation. Five patients had 200-to 500-ml hemorrhage 1 to 4 days after the operation, and were cured by blood transfusion and anti-infection treatments. No serious complications were found in the other patients. The nephrostomy tube was withdrawn 4 to 7 days (mean 6 days) after the operation. The hospital stay was 6 to 22 days with a mean of 15 days. Among the patients, 98 were followed up for 3 to 20 months (mean 13 months). No hemorrhage, infection, or recurrence of renal calculi was found during this period. Conclusion Percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy is safe, effective, with mild surgical trauma and a few complications for patients with renal calculi.

Objective To evaluate the efficiency of interventional treatment for primary liver cancer with spontaneous rupture. Methods Three cases of spontaneous rupture of primary liver cancer were undertaken hepatic arterial chemoembolization with prior chemo-infusion and followed by gelfoam partical and stripes for embolization Results 3 cases of massive type of primary liver carcinoma with spontaneous rupture were all successfully once embolized, including one with additional super liquefied lipiodal as embolic agent who has been survived for more than 20 months. Conclusions Hepatic arterial chemo-embolization shows prominent hemostasis during emergency for spontaneous rupture of primary hepatic carcinoma providing double effectiveness of hemostasis and treatment.

Objective:To establish a synthetic cyclic citrullinated peptide induced arthritis model in mice, explore immunogenicity and arthritogenicity of this peptide. Methods: 36 DBA/1 mice were randomly divided into three groups, which were injected the type Ⅱ collagen ( CⅡ, CIA ) emulsion, cyclic citrullinated vimentin peptide ( CCit-Vim, CCV-IA ) emulsion, cyclic citrullinated vimentin peptide conjugated KLH ( CCit-Vim+KLH,CCV+K-IA) emulsion on day 0 and 21,respectively. Using arthritis index( AI) ,paw swelling to evaluate the incidence of arthritis;ELISA tested serum anti-CCit-Vim antibody,anti-CⅡantibody,anti-CCP antibody and TNF-α, IIF detected AKA;Histopathology of the ankle joint was obsearved. Results: There were three mice appeared arthritis in CCV+K-IA,the incidence rate of 25%,but arthritis occurs later time,short duration,and the incidence and extent of arthritis were lower than the CIA. CCV-IA no arthritis performance. CCV+K-IA produce anti-CCit-Vim antibody were significantly higher than those in CIA (1. 32±0. 59 vs 0. 78±0. 27,P=0. 031). While Anti-CCP antibody of CCV+K-IA were significantly lower than CIA (54. 73±7. 33 vs 64. 37±9. 91,P=0. 007). The anti-CⅡ antibody in CCV+K-IA and CCV-IA were lower than the CIA(15. 73±2. 10, 16. 71±3. 03 vs 19. 50±2. 36,P<0. 05). The TNF-α produced by CCV+K-IA and CIA were both significantly higher than the CCV-IA (645. 61±35. 26,618. 98±53. 32 vs 533. 63±79. 49,P<0. 05). The AKA positive rate of CCV+K-IA is 50% (6/12),significantly higher than CCV-IA 25% ( 3/12 ) and CIA 16. 67% ( 2/12 ) . Histopathology of the ankle showed that the CCV-IA and CCV+K-IA have a mild synovial hyperplasia,no obvious synovial pannus formation and inflammatory cell infiltration. Conclusion:The cyclic citrul-linated peptide conjugated KLH not only has stronger immunogenicity but also has arthritogenicity. It induced a higher positive rate of AKA than CⅡ.

Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.

OBJECTIVETo make an animal periodontitis and atherosclerosis compound model, and to study the effects of periodontitis on atherosclerosis.

METHODS36 Japan rabbits were randomly divided into four groups: Including periodontitis model group, periodontitis and atherosclerosis compound model group, atherosclerosis model group and control group. Periodontitis model was initiated by ligating floss around teeth cervical and oral inoculating with Porphyromonas gingivalis (P. gingivalis). Atherosclerosis was established by single iliac artery of balloon-injured rabbit. Histopathological change of injured iliac artery was observed under optical microscope after hematoxylin-eosion stain. Elastica van Gieson-stained sections were used for the morphometric analysis. We measured intimal and medial lesion areas in iliac artery cross-sections as well as the intimal/medial ratio (I/M). We also analyzed P. gingivalis 16S rDNA amplification with nested-polymerase chain reaction (nested-PCR), and detect systemic proinflammatory mediators with enzyme linked immunosorbent assay (ELISA), including C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-1beta (IL-1beta).

RESULTSThe serum levels of CRP, IL-6 and IL-1beta increased obviously among the compound model group than other groups (P<0.01). Histopathological observation revealed the compound model group in I/M was bigger than other groups (P<0.01). P. gingivalis 16S rDNA was detected among the periodontitis model group and the compound model group by nested-PCR.

CONCLUSIONPeriodontitis may accelerate intimal hyperplasia in balloon-injured iliac arteries by upgrade of systemic inflammation factors and local bacterial infection.

Animal Experimentation ; Animals ; Atherosclerosis ; C-Reactive Protein ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Interleukin-6 ; Periodontitis ; Porphyromonas gingivalis ; Rabbits

Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital.

Objective To investigate the effects of different dialysates on expression of protein kinase C-δ (PKCδ) and apoptosis of U937 cell line. Methods Different dialysates were added into culture fluid with U937 cell line at exponential phase of growth, and groups were divided: fluid A+fluid B group (dialysate A+dialysate B), fluid A+fluid B+rottlerin (PKCδ specific inhibitor)group, fluid A+powder B group (dialysate A+powder B) and fluid A+powder B + rottlerin group. Besides, blank control group and normal control group were established. Cells were harvested 24 h and 48 h after treatment, morphological changes were observed by Hoechst33258 fluorescence staining, cell apoptosis was measured by Annexin-V-FITC/PI double staining, and expression of PKCδ mRNA and protein was detected by RT-PCR and Western blotting, respectively. Results Cell apoptosis significantly increased in fluid A+powder B group, with typical morphology of apoptosis. After treatment for 24 h and 48 h, cell apoptosis rates in fluid A+powder B group were significantly higher than those at corresponding time points in blank control group , normal control group and fluid A+powder B+rottlerin group (P<0.05). Compared with normal control group, blank control group and fluid A+powder B+rottlerin group, the expression of PKCδ mRNA and protein of U937 cells in fluid A+powder B group were significantly increased (P<0.05). There was no significant difference in cell apoptosis rates and expression of PKCδ mRNA and protein between fluid A+fluid B group and blank control group, normal control group and fluid A+fluid B+rottlerin group (P＞0.05). Conclusion Fluid A+powder B can significantly increase apoptosis of U937 cell line, the mechanism of which may be associated with the up-regulation of expression of PKCδ. Compared with fluid A+powder B, fluid A+fluid B is superior in reducing apoptosis of peripheral blood monouclear cells.

BACKGROUND:Autologous micro-skin graft covered with alogeneic skin has become a major means for repair of extremely severe burn wounds. Due to the limitation of the source of alogeneic skin, heterogeneous skin (pigskin) or artificial skin serves as a vector to cover the wound on the clinical use. OBJECTIVE: To observe the curative effect of thin-thickness micro-skin pulping covered with heterogeneous skin for repair of burn wounds in comparison with blade-thickness micro-skin pulping covered with heterogeneous skin. METHODS:A self-control study was performed in 36 patients with severe burns of bilateral limbs. There were 42 pairs of wounds, 32 of which were at joint sites. One or two pairs of III-degree burns treated with escharectomy were selected from each patient for self-control comparison. Covered with heterogeneous skin, thin-thickness micro-skin pulping and blade-thickness micro-skin pulping were used in the trial and control groups, respectively. The expansion ratio was controled at 1:8-1:12 in al patients. Wound healing time, degree of scar hyperplasia within 6 months to 2 years after transplantation, and ratio of reconstruction surgery at joint sites were observed and compared. The removed scars by surgery were analyzed based on the total score of the Vancouver Scar Scale. RESULTS AND CONCLUSION: The average wound healing time was (44.7±1.24) days in the trial group and (49.6±1.41) days in the control group, and there was a significant difference between the two groups (P < 0.05). The trial group exhibited less scar hyperplasia than the control group at 6 months to 2 years after transplantation. Compared with the control group, the ratio of severe scar hyperplasia was significantly less in the trial group (P < 0.05), while the ratio of mild scar hyperplasia was obviously greater in the trial group (P < 0.01). However, there was no difference in the ratio of moderate scar hyperplasia between the two groups (P > 0.05). The reconstructive surgery ratio of the trial group was 38%, significantly lower than that of the control group (59.38%;P < 0.01). The total score on the Vancouver Scar Scale was less in the trial group than the control group (P < 0.05). These findings suggest that the thin-thickness micro-skin covered with heterogeneous skin is likely to be a better treatment to repair large ful-thickness skin burn by increasing the thickness of micro-skin, and it can obtain better wound healing quality.

OBJECTIVE: To analyze the characteristics soft tissue profile in Hunan Han adults with normal occlusion and to explore the differences of the soft tissue profile in gender, region and race. METHODS: Lateral cephalometric radiographs were performed for 323 volunteers (164 females and 159 males) from Hunan Province. The digital cephalometric radiographs were imported into the WinCeph8.0 measurement and analysis system in a same computer. According to the Holdaway analysis method, the mean and standard deviation were calculated. Then the results were compared to the data from Liaoning, Nepalese, Japanese, North American Caucasians. RESULTS: The normal value of cephalometric facial soft tissue profile in Han population adults with normal occlusion in Hunan Province were obtained. There were significant differences in subnasale to H line (Sn-H), upper lip tension, lower lip sulcus depth (Si-PgsLs), and soft tissue chin thickness (Pg-Pgs) between males and females (all P<0.05). Compared with Liaoning Province, significant regional differences in soft tissue facial angle (FH-NsPgs), upper lip sulcus depth (Ss-Ls), Sn-H, lower lip thickness, upper lip thickness, H angle, lower lip to H line (Li-PgsLs), Si-PgsLs, and Pg-Pgs were found in Hunan Province (all P<0.05). Compared with the Japan, significant regional differences in FH-NsPgs, nose prominence (Sn-Pn), lower lip thickness, upper lip tensity, H angle, Li-PgsLs, Si-PgsLs, and Pg-Pgs were found in Hunan Province (all P<0.05). Compared with the Nepalese, significant regional differences in Sn-Pn, Ss-Ls, Sn-H, skeletal profile convexity (A-NPs), basic upper lip thickness, upper lip tensity, H angle, Li-PgsLs and Pg-Pgs were found in Hunan Province (all P<0.05). Compared with the North America, significant regional differences in Sn-Pn, Ss-Ls, Sn-H, A-NPs, basic upper lip thickness, upper lip tensity, H angle, Li-PgsLs, Si-PgsLs and Pg-Pgs were found in Hunan Province (all P<0.05). CONCLUSION There are both similarities and differences in facial soft tissue profile between males and females with normal occlusion in Hunan Province. The characteristics of facial soft tissue profile in Hunan Province are different from that in Liaoning area, Nepal, Japan and North America.
Adult ; Asian Continental Ancestry Group ; Cephalometry ; European Continental Ancestry Group ; Face ; anatomy & histology ; Female ; Humans ; Lip ; anatomy & histology ; Male ; Reference Values

Clinical decision-making is a series of activities of medical scheme selection, which determines the direction of medical behavior and the level of patients' welfare. In practice, clinical decision-making is not only restricted by medical technology factors, but also by non-technical factors. Therefore, it is necessary to analyze and predict the possible influence of non-technical factors in clinical decision-making. Game theory is a scientific system of strategic choice, which can effectively predict and analyze the impact of non-technical factors on clinical decision-making process. According to the game analysis results between doctors and patients, medical management and pharmaceutical enterprises, we can predict the non-technical impacts in clinical decision-making and their influence paths, guide clinical decision-makers to choose excellent strategies, abide by rationality and give up moderately, so as to improve the level of clinical decision-making and the welfare of patients.