Objective To evaluate the clinical outcome of the technique of step-by-step in situ rod bending used in posterior internal fixation of lumbar burst fractures.Methods A retrospective case control analysis was conducted on 76 cases of lumbar burst fractures hospitalized between March 2007 and March 2014.There were 48 males and 28 females,with a mean age of 40.4 years (range,18-57 years).Fractured segments included L1 in 32 cases,L2 in 24,L3 in 14 and L4 in 6.According to the different rod bending methods,the subjects were divided into preliminary rod bending group (34 cases) and in suit rod bending group (42 cases).Operation time,amount of bleeding during and after operation,restoration of anterior vertebral height and Cobb angle,and visual analogue score (VAS) were compared between groups.Results Seventy patients were followed up for 12-36 months (mean,20.9 months).One patient in preliminary rod bending group presented internal fixation loosening,and had implant removal 9 months after operation.No implant breakage occurred.Comparison of preliminary rod bending group and in situ rod bending group showed significant differences in operation time [(88.1 ± 16.0)min vs.(79.9 ± 14.7)min],amount of bleeding during operation [(88.3 ± 21.2) ml vs.(74.0 ± 12.5) ml],amount of bleeding after operation [(71.5 ± 17.3)ml vs.(62.1 ± 16.0) ml],restoration of anterior vertebral height [(74.1 ±7.8) ％ vs.(79.5 ± 8.5) ％],and restoration of Cobb angle [(10.2 ± 2.7) °vs.(8.8 ± 2.6) °] (P ＜0.01 or 0.05).VAS presented no significant differences between preliminary rod bending group and in situ rod bending group before operation [(7.5 ± 0.9) points vs.(7.2 ± 1.0)points] and 1 week after operation [(2.9 ± 0.7) points vs.(3.0 ± 0.7) points] (P ＞ 0.05),while there was significant difference 9 months after operation [2.2±0.7)points vs.(1.9 ±0.7)points] (P＜0.01).Conclusion In suit rod bending for lumbar burst fractures has advantages over preliminary rod bending in terms of operation time,blood loss,precise restoration and back pain.

Objective To investigate the effect of Treg cells and Th17 cells on the pathogenesis of SLE in patients with SLE,by detecting levels of serum IL-10 and IL-17 in patients with systemic lupus erythematosus (SLE).Methods Selected 54 patients with SLE diagnosed in Suzhou Municipal Hospital Affiliated to Nanjing Medical University from July 2013 to July 2015 as subjects,and 19 healthy persons were selected as control group.Using double antibody sandwich method (ELISA) to detect the levels of IL-10 and IL-17 in two groups.Using indirect immunofluorescence and western blot method to detect ANA,dsDNA,RNP,Sm,SSA and SSB in patients with SLE.Then compared and correlation analysed the level of IL-10 and IL-17,the levels of IL-10 and IL-17 in ANA,RNP,Sm,SSA and dsDNA groups were analyzed simultaneously.Results The level of IL-10 and IL-17 in SLE were 63.7±89.0 pg/ml and 87.7±123.0 pg/ml,and control group were 20.8±8.9 pg/ml and 18.5 ± 111.6 pg/ml,with the statistically significant difference (trL10 =3.484,tIL-17 =4.076,P＜0.01).The level of positive group in SLE were 176.5±93.2 pg/ml and 237.2±107.5 pg/ml,and negative group were 16.2±5.7 pg/ml and 12.9 ±8.3 pg/ml,with the statistically significant difference (tIL-10 =6.875,tIL-17 =8.843,P＜0.01).The level of IL-10 was positively correlated with IL-17 level in SLE (r=0.96,P＜0.05).The level of IL-10 and IL-17 in ANA high titer group were 91.8±100.8 pg/ml and 135.5±140.9 pg/ml,ANA low titer group were 44.5±76.7 pg/ml and 54.4±98.5 pg/ml,with the statistically significant difference (tIL10 =2.215,tIL-17 =2.345,P＜0.05).The level of IL-10 and IL-17 in anti ds-DNA antibody positive group were 87.1 ± 101.1 pg/ml and 122.4 ± 137.1 pg/ml,negative group were 27.4± 50.1 pg/ml and 28.6 ± 61.6 pg/ml,with the statistically significant difference (tIL-10 =2.904,tIL-17 =3.443,P＜0.05).Conclusion The levels of IL-10 and IL-17 were significantly increased and there was positive correlation.It was explained that the anti-inflammatory and pro-inflammatory response existing at the same time in SLE patients and Treg cell and Th17 cell may also play an important role in the occurrence and development in SLE.

ObjectiveTo investigate the modification method of Cervical Spine Injury Severity Score System and discuss diagnosis and treatment strategy of lower cervical spine injuries.Methods Treatments of lower cervical spine injuries were selected according to the injury severity graded by the modified Moore' s classification system.Conservative therapy could be adopted for the patients with stability quantification rating ＜ 3 points or for the those with stability quantification rating =3 points but without spinal cord or nerve root compression.Surgical treatment was recommendable for the patients with stability quantification rating =3 points and with spinal cord or nerve root compression.Surgical therapy could be required for the patients with stability quantification rating ≥4 points and with risk of lower cervical instability.The higher the stability quantification score implied the stronger the surgical indications.Lower cervical spine injury combined with spine cord or nerve root compression had absolute surgical indications.At the same time,therapies were selected based on patients' other factors.ResultsBased on basic principles of the modified Moore' s classification system together with opinions of the patients and their relatives,14 patients were managed with surgical treatment and 16 with conservative treatment.Among the patients with complete spinal cord injury (Grade A),two patients treated surgically showed no obvious signs of spinal function recovery,but their nerve root irritation symptoms disappeared; the other one patient who needed surgery but received conservative treatment had no change of the spinal cord function and nerve root irritation.The patients with incomplete spinal cord injury (Grades B,C and D) treated surgically obtained certain degree of spine cord function recovery,with their American Spinal Injury Association (ASIA) score raised by 0.5 grade on average.However,the patients who needed surgery but received conservative treatment gained average increase of ASIA score for 0.5 grade.Imaging examination showed that patients without combined spinal injuries obtained interbody fusion after surgery,with normal alignment and height of the cervical vertebra but without presence of vertebral shift or instability. ConclusionsThe modified Moore' s classification system takes patients' spiaal injury condition and other factors into consideration in selection of conservative or surgical treatment,which improves the Cervical Spine Injury Severity Score System to some extent and has prospect of clinical application.

Objective:To learn the cognition and attitudes of psychometric ethics of graduate students whose major was clinical psychology or counseling psychology,and to investigate whether ethics training could influence their cognition and attitude.Methods:Researchers distributed the questionnaire online regarding cognition and attitudes of psychometric ethics among clinical and counseling psychology graduate students.Seventy-six feedbacks were collected (4 students were learning ethics courses,27 students had learned ethics courses,45 students hadnt learned ethics courses).The questionnaire included the Psychometric Cognition Questionnaire (PCQ),Situational Judgement Questionnaire (SJQ) and Psychometric Attitude Questionnaire (PAQ).The first two sets of questionnaires reflected ethics knowledge.The last one showed ethics attitudes and behavioral tendencies.Results:The correct rates in participants who had learned or were learning ethics were 76.5％ and 75.1％ at the first and second set of questionnaires,while were 73.9％ and 74.2％ in other participants.The correct rates of three major clauses in PCQ were 90.3％,67.7％ and 74.2％,significantly higher than participants who never learned ethics,whose correct rates were 88.9％,66.7％,and 44.4％ (Ps ＜ 0.05).There were no significant differences in SJQ between those who had learned or was learning ethics and those who had never learned ethics (Ps ＞0.05).Participants who had learned or were leaning ethics scored in sum in PAQ that had no significant differences with those who had never learned ethics(Ps ＞ 0.05).Conclusion:Clinical and counseling psychology graduate students master considerable level of knowledge on ethics and attitude.Ethics training is essential for acquiring psychometric ethics.

Objective To survey the cognitive attitude and participation intention for stakeholders of public hospitals,in order to provide basis for public hospitals social evaluation.Methods 621 stakeholders of public hospitals were subject to the questionnaire survey.Results 76.7%(475/619) stakeholders held it as necessary to independently launch the public hospitals social evaluation,and held that the evaluation subjects selection should be professional(83.8%),independent(67.7%),authoritative (55.6%),and proactive(46.1%).The survey also recommended that social evaluation of public hospitals should have such indexes as government investment (80.2%),social supervision (76.0%),and information disclosure system(7 1.1%).The overall willingness rate of stakeholders to participate in the public hospital social evaluation was 7 1.6%.Conclusions Development of the social evaluation index system of public hospitals and diversified evaluation subj ects are key to developing the theory and practice system of public hospitals social evaluation.

Objective To exPlore the effect of mammalian target of raPamycin ( mTOR ) inhibitor eVerolimus on radiosensitiVity of human non_small cell lung cancer cell line in vitro by using eVerolimus to inhibit mTOR signaling Pathway of A549. Methods Human non_small cell lung cancer cell line A549 was subjected to radiation alone or in combination with eVerolimus treatment. The 50%inhibition concentration ( IC50 ) of eVerolimus in A549 cells was detected by methylthiazol tetrazolium ( MTT) assay in vitro. EVerolimus at the 20%inhibition concentration ( IC20 ) was used to Pretreat A549 cells for 24 h. Cells were then irradiated by X_ray with 2,4,6,8 Gy. The cell surViVal fraction was comPuted by clone formation. Cell surViVal curVe was fitted by multitarget one_hit model, and mean lethal dose ( D0 ), dose quasithreshold ( Dq ), surViVal fraction at 2 Gy ( SF2 ), and sensitization enhancement ratio (SER) were calculated. The exPression ofγ_H2AX was determined by Western blotting and then the relatiVe gray Values were analyzed. Results EVerolimus significantly imProVed the sensitiVity of A549 cells to radiation. The D0 , Dq and SF2 of eVerolimus+irradiation grouP were significantly lower than those of irradiation grouP. The SER was 1. 36. The residual amount of γ_H2AX Protein in the eVerolimus + irradiation grouP was significantly higher than that of the irradiation grouP. Conclusion EVerolimus inhibiting mTOR signaling Pathway can increase the radiosensitiVity of A549 cells.

Experiments were conducted to investigate the suitability of the multistage in-situ reaction analyzer based on a micro fluidized bed ( MFB-MIRA) for measuring the rapid change of the gas concentration during gas-solid reactions. The results showed that the control performance of capillary temperature had a great impact on the stability of on-line measurement. Based on the observed regular patterns, the capillary temperature control system was equipped with a precision temperature controller. The control precision of capillary temperature reached ± 0 . 2℃, which guaranteed the high stabilities of the sampling flow rate and the chamber vacuum. The measured results of the modified gas monitoring system showed the periodic fluctuations of the on-line measurement were eliminated. The stability of measurement was significantly improved. The fluctuating range and relative standard deviation of the measured response to O2 in air changed from 1. 9% and 0. 5% to 1. 4% and 0. 2%, respectively. A pressure regulating device was also developed to control the absolute pressure at the gas sampling point. The control precision reached ± 0. 02 kPa. The measured results showed that the response of the process mass spectrometer was positively correlated with the absolute pressure at the sampling point, indicating the necessity of the pressure regulating device. The accuracy and repeatability of process mass spectrometer were improved. This study has enhanced the suitability of MFB-MIRA for studying rapid gas-solid reactions and broadened the scope of reliable applications of MFB-MIRA and process mass spectrometer.

Objective To clarify the role of pentraxin 3 (PTX3) in the development of peripheral arterial disease (PAD) in maintenance hemodialysis (MHD) patients. Methods One hundred and sixteen patients undergone MHD therapy in our center for more than 3 months were enrolled in the study. Clinical data were collected for analysis. Ankle-brachial index (ABI) was used to estimate the presence of PAD. Patients were divided into PAD group (ABI<0.9) and nonestimate the association of PAD with PTX3 as well as other potential risk factors. Results The incidence of PAD was 18.1% (21/116). Plasma level of PTX3 was significantly higher in PAD patients than that in non-PAD patients [(5.55 ±2.63) μg/L vs (2.32 ±1.29)μg/L, P<0.01].Univariate analysis showed ABI values were negatively correlated with plasma PTX3 levels (r =-0.548, P<0.01), high-sensitivity C-reactive protein (hsCRP), age, blood glucose and triglyceride. ROC curve of PAD revealed that area under curve (AUC) of PTX3 was 0.901 (P<0.01). With the cut-off value of PTX3 as 4.06 μg/L, the diagnostic sensitivity and specificity in PAD were 81.0% and 91.5%. ROC curve of PAD showed that AUC of hsCRP was 0.640 (P<0.05). With the cut-off value of hsCRP as 3.33 mg/L, the diagnostic sensitivity and specificity in PAD were 57.1% and 56.8%. Using Logistic regression, plasma PTX3 was found to be associated with PAD (0R=9.755, 95%CI:2.359-19.354, P=0.001). Conclusions The PAD incidence of MHD patients in our center is 18.1%. Plasma PTX3 level is significantly correlated with the presence of PAD in MHD patients. The sensitivity and specificity of PTX3 are higher than those of hsCRP for PAD diagnosis.

Objective To investigate the incidence of acute kidney injury (AKI) post-orthotopic liver transplant (OLT) and its association with prognosis. Methods Data of 28 patients received single OLT in our hospital from 2004 to 2006 were retrospectively analyzed. The incidence of AKI was investigated by new acute kidney injury network (AKIN) criteria. The follow-up was over one year. The prognosis of AKI patients at day 28 and 1 year was evaluated by Kaplan-Meier survival analysis. The association between AKI and prognosis was examined. Results A total of 193 patients were enrolled. The average age was (48.07±10.02) years old. The ratio of male to female was 4:1. One hundred and sixteen (60.1%) patients of post-OLT AKI were found, whose AKI stage 1, 2 and 3 were 50.0%, 21.6% and 28.4% respectively. Ten (8.6%) patients required renal replacement therapy (RRT) after OLT. In AKI post-OLT patients, day 28 and 1 year mortality were significantly higher than those in non-AKI patients (15.5% vs 0, 25.9% vs 3.9%, respectively, both P<0.05). Kaplan-Meier survival analysis showed the 1-year survival rates of AKI stage 1, 2, 3 post-OLT and non-AKl were 84.0%, 81.0%, 42.4% and 90.9%, respectively. The 1-year survival rate of non-AKI was significantly higher than that of AKI stage 1, 2, 3. The 1-year survival rate of AKI stage 3 was significantly lower than that of stage 1 and 2. There was no significant difference between AKI stage 1 and 2. Sct at 1 year post-OLT was significantly higher than that of baseline [(88.35±37.15) vs (73.70±33.88) μmol/L, P<0.05). The change of Scr value at 1 year compared to baseline in AKI patients was similar to non-AKI patients. However such change in AKI stage 2 and 3 was higher than that in stage 1. Conclusions The incidence of AKI post-OLT is quite high and associated to the poor prognosis in short and long periods. Renal function may decrease gradually which is associated to the AKI stage pest-OLTI.

Objective To evaluate the efficacy and safety of the TVT-Secur procedure for female stress urinary incontinence (SUI). Methods Analyze retrospectively the preoperative, intraoperative and postoperative complications and follow-up data of 27 SUI patients from October 2008 to May 2010. 20 cases were simple SUI, and 7 cases were mixed SUI. The average age was 56.1 ± 10.7 years (range, 35-77), the average parity was 2.8-±- 1.4 (range, 1-6), the average body mass index was 25.6±2.5, and the average course of the disease was 6.8±7.2 yeas (range, 1-30). Two cases had past history of pelvic surgery without any anti-incontinence surgery. Mashall-marchett test was positive in all patients, with an average abdominal leak point pressure (ALPP) of 60.9±27.5 cm H2O (range, 27- 120 cm H2O). The mean International Consultation on Incontinence-Short Form (ICIQ-SF) score was 11.2 ± 1.8 (range, 7- 14) before surgery. Results 27 patients underwent TVT-Secur procedure, of which 19 cases underwent "U" procedure, and 8 cases underwent "H" procedure. The mean operation time was 15.3±1.4min (range, 13- 19 min). There were no intraoperative bladder or urethral injury, and no obturator vessel or nerve damage. The blood loss was 10 to 50 ml, and the maximum urinary flow rate was 25. 4±13. 1 ml (range, 4-50 ml). Three eases had mild dysuria(11. 1%), and 3 cases had wound effusion(11. 1%). Followed up for 12. 6 ±6. 7 months (range, 3-21 months). 10 cases complained of bladder overactivity symptoms such as frequency, urgency, and urge incontinence, and no case had vaginal erosion. Therapeutic efficacy: 15 cases were cured (56%), 8 cases were improved (30%), and 4 cases were ineffective (15%). Conclusions TVT-Secur procedure is a simple, safe and minimally invasive surgery, while the cure rate is low. The long-term efficacy needs great amount of clinical data and long-term follow-up to prove.