Objective To analyse the effect of recombinant endostatin on Treg, CD8 +T cells, tumor specific growth factor (TSGF) in peripheral blood of patients with advanced esophageal gastric junction adenocarcinoma and clinical efficacy observation.Methods 52 patients who were diagnosed with acute cerebral infarction in our hospital were collected.All patients were randomly divided into experimental group and control group, 26 cases in each group.The control group was given OLF chemotherapy, the experimental group was treated with OLF chemotherapy regimen combined with recombinant endostatin.21 days was 1 cycle, a total of 4 cycles.After treatment, the levels of Treg, CD8 +T cells, serum TSGF and clinical efficacy were detected in all patients.ResuIts After treatment, compared with control group,the peripheral blood Treg was significantly lower in the experimental group (P<0.05); the peripheral blood CD8 +T cells level in the experimental group was significantly higher (P<0.05);the serum TSGF level in the experimental group was significantly lower ( P<0.05 ); the effective of patients in the experimental group was higher ( P<0.05 ) . ConcIusion Recombinant endostatin can significantly reduce the levels of Treg and serum TSGF in patients with advanced esophageal gastric junction adenocarcinoma, improve the level of CD8 +T cells, and improve the efficiency of treatment, have guiding significance to clinical.

Objective　To investigate the association of gene polymorphism of cytotoxic T lymphocyte-associated antigen 4（CTLA-4） with autoimmune thyroid diseases. Methods　The A／G transition polymorphism at position 49（exon 1，codon 17） of the CTLA-4 gene was determined by polymerase chain reaction restriction fragment length polymorphism （PCR-RFLP）method in 122 autoimmune thyroid diseases patients which included 87 Graves’ disease （GD） patients and 35 Hashimoto's thyroiditis（HT） patients， as well as 84 control subjects. We detected their thyroid function by ELISA technique， and the thyroid autoimmune antibodies （TGAb，TPOAb） by indirect immunofluorescent technique. Results　The strong association of the CTLA-4／G49 allele with AITDs was seen in our study（66.4％ vs 36.9％ P＜0.0001）. The G allele in GD patients was significantly increased compared with control subjects（69.5％ vs 36.9％， P＜0.0001）. In HT patients， the frequency of G allele was also higher than control subjects（58.6％ vs 36.9％，P＜0.01）， and there was no significant difference between HT and GD groups. When GD and HT subjects were stratified with respect to sex， neither female nor male patients demonstrated evident association of G49 allele with gender.Conclusions　The polymorphism of CTLA-4 gene （exon 1 condon 17 position 49）confers susceptibility to AITDs. This association is independent of sex.

Objective To investigate the feasibility and clinical effects of suture anchors technique for acute distal avulsion fracture of patella. Methods From January 2007 to July 2009, 33 patients(18males and 15 females, ranging from 28 to 72 years, with an average of 49.3 years) were treated with the suture anchors technique. The average time from injury to surgery was 3.5 days(2 to 7 d). Injury reason: traffic accident in 12 cases, injured in daily life in 11 cases, sports injury 9 cases, no clear trauma history in one case. The Bostman evaluation system, follow-up X-ray, and knee mobility were used to analyze the clinical effects of suture anchors technique. Results All patients obtained the follow-up and the average time was 16.5 months(12 to 23 months ). One patient suffered foreign body reaction, and his wound healing was good after operation. The remaining patient wound healing was good. No complications were found in all patients,such as popliteal fossa artery, tibial nerves or peroneal nerve complication. Bostman patella fracture functional score 27.3±2.3 points at the sixth months follow up, 28 cases were rated as excellent, 5 cases were good, and the excellent and good rate was 100%. Six months later, X-ray showed bone healing, knee activity recovered well. The Range of Motion was extension for -2.5°±2.1° and flexion for 122°±5.3°. Conclusion Suture anchors fixation in treatment of acute distal avulsion fracture of patella has a good efficacy, safety and reliability advantages, and without the second operation. This technique provides an alternative in lower pole patella fracture.

BACKGROUND:Pretreatment is a dominant way to increase the histocompatibility of biomaterials,but many pretreatments are not satisfactory due to some reactions,such as calcification,cytotoxic reaction and reducing the tension resistance.OBJECTIVE:To investigate the effect of immunogenicity,scaffold tension and cell growth factor on the non-pretreated scaffold biomaterials,and to prepare the homograft decellularized scaffolds.DESIGN:Contrast observation for the histomorphology.SETTING:The experiments were carried out in the Department of General Surgery,Affiliated Hospital of Nantong University from June 2006 to March 2007.MATERIALS:Wistar rats of SPF grade were adopted in this study.Sodium dodecyl sulfate from BioteehGrade Company(U.S.A.);basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) from Peprotech Company(UK);dynamometer from Suzhou Electrical Element First Factory (China).METHODS:The vena cava inferior from rats were selected as experimental materials,we decellularized the epithelial cells from vein according to the improved Booth's methods with low osmotic Tris buffer containing sodium dodecyl sulplate,and then reserved the extracellular matrix.After fixing,the decellularized scaffold was stained by hematoxylin and eosin,the collagen fibers were observed and photographed by light microscope and scanning electron microscope.Changes of the intensity of the scaffolds were measured before and after decellularization.The deceilularized scaffolds were transplanted subcutaneously at homogeneity rats to observe whether the scaffolds had induced immunological rejection.In combination with bFGF and/or VEGF,the scaffolds were transplanted subcutaneously at homogeneity rats and took out two weeks later,in order to exam the new vessels in the scaffolds by immunohistochemistry.Dynamometer was applied to compare the change of the intensity of the scaffolds before and after transplantation.MAIN OUTCOME MEASURES:Change of the intensity of the scaffolds after decellularization and transplantation.Formation of new vessels in scaffolds.Local rejection of the scaffold subcutaneously transplanted into rats.RESULTS:The endothelial cells of the vein were completely removed when incubated with Tris buffer containing 0.03% sodium dodecyl sulfate for 48 hours.Results of hematoxylin and eosin staining,light microscope and scanning electron microscope showed that,the main components of extracellular matrix (collagen fiber) were reserved.There was no significant difference in the morphological structure and the intensity of collagenous scaffolds before and after decellalarization (P＞0.05).There was no apparent reject reaction at the embedded site,local incisions healed well.New vessels could be observed in the scaffolds two weeks later.There was no significant difference in the intensity of collagenons scaffolds before and after inoculation (P＞0.05).CONCLUSION:The low osmotic Tris buffer containing 0.03% sodium dodecyl sulfate is suitable for decellularizing the vein.The homograft collagenous scaffolds exhibit no rejection after transplantation,and the intensity of the scaffolds does not descend.VEGF and bFGF can improve the growth of new vessels in the decellularized scaffolds,and have a synergistic effect.

Objective To detect 14 genes including fibrillin-1(FBN1) and so on mutations in 17 patients with Marfan syndrome(MFS) and family members of 2 patients and to investigate the correlation between FBN1 gene mutation and MFS.Methods Genomic DNAs were extracted from whole blood sample of 17 patients and 43 family members.After DNA samples were amplified by polymerase chain raction(PCR), we used capture panels to get target genes which would be sequenced by Illumina HiSeq2500 Analyzers(Illumina, SanDiego, USA).The target genes included ACTA2、CBS、FBN1、FBN2、MYH11、COL3A1、SMAD3、TGFBR1、TGFBR2、MYLK、MSTN、COLA2、TGFB2 and SLC2A10.The results of sequencing would be compared with multiple databases, including NCBI dbSNP, HapMap, 1000 human genome dataset and database of 100 Chinese healthy adults, to find gene mutation.Finally, these mutations would be validated using conventional Sanger sequencing methods.Results A total of 10 FBN1 mutations and 1 actin alpha2(ACTA2) mutation in 17 patients were identified, of which 8 FBN1 mutations and 1 ACTA2 mutation were novel.One FBN1 mutation was underwent family investigation and we found in this family, all patients had this mutation and others did not have it.Conclusion Missense mutation of c.7280G>A in the 59th exon of FBN1 gene is new pathogenic mutation for MFS.The other 8 novel mutations may be the pathogenic factors of MFS.

Objective To retrospectively analyze the surgical methods and efficacy in 70 cases of type A aortic dissection patients over 65 years old.Methods From January 2005 to May 2012,70 type A aortic dissection patients over 65 years old received surgical treatment.Among them,there were 47 males aged 65 to 78 years old with mean 71,23 females,aged 65 to 72 years old with mean 68.55 cases were acute onset,while 15 cases were chronically onset.Different surgical methods were selected depend on patients' situations.We followed up all patients after discharged from hospital to continue to observe their health situation and evaluate the therapeutic effects.Results After surgery,eight patients died in the hospital,62 patients were recovered and discharged from the hospital.The mortality rate is 11.4％.During the follow up period from 3 to 72 months,there were no dead,aneurysm rupture and others severe complications.9 cases received endovascular graft exclusion within 6 months after discharged from hospital.The survival patients were satisfactory healed with their daily living activity resumed.Conclusion For over 65 years old patients with aortic dissection,the accurate and rapid selection of surgical method could improve the survival rate and the quality of life with a lower occurrence rate of complications.

Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living (ADL) is fulfilled.Methods A three-dimensional generic parametric and visually kinematic simulation module of THA was developed.Range of motion ( ROM ) of hip flexion ≥ 110°,internal-rotation ≥30° at 90° flexion,extension ≥30° and external rotation ≥40° were defined as the normal criteria for ADL.ROM of hip flexion ≥ 120°,internal-rotation ≥45° at 90° flexion,extension ≥30° and external rotation ≥40° were as the severe criteria.The ranges of changes in general ratios (GRs) of head-neck,femoral neck antevemion ( FNA ),operative inclination (OI) and anteversion (OA) of acetabulur components were 2.0-2.92,0°-30°,10°-60°,and 0°-70° respectively.Within the limits of the upper two activity criteria,the synchronous OA of acetabulur components was calculated with every 5°change in OI of the cup,and the collodiaphyseal angle ( CDD ) was set as 135°.The safe-zone of combination of acetabulur operative anteversion (OA) and inclination (OI) was defined as the area that fulfilled the two mentioned criteria of ROM without cup-neck impingement.All parameters were analyzed by using SAS 6.12 software.Results The safe zone of acetabdar angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria.When the CDD angle was 135°,the sum of average aeetabular OA and acetahular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and the sum of average acetabular OA and acetabular OI plus 0.873 times of the FNA equaled to 92.04° in severe criteria.Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle.The higher demand of ROM of hip joint requires the smaller safe zone of acetabular angle,as can be corrected by increasing the GR of head-neck.The optimum combination between the sum of average acetabular OA and acetabular OI ( Y) plus FA (X)in the normal criteria and severe criteria can be estimated by using the following formulae:Y1 =-0.816X1 + 84.76 (R2 =0.993 ),Y2 =-0.873X2 + 92.04( R2 =0.999) respectively.

BACKGROUND: An important development orientation of osteomyelitis treating is to prepare a drug delivery system which has the characteristics of excellent biocompatibility, degradable, lengthen drug-released time, source sufficient, as well as use security. Alginate and chitosan can be used as drug delivery system due to the superordlnary biological properties. OBJECTIVE: To explore the feasibility and safety of alginate/chitosan incorporated vancomycin (VCM/ACA) as release carrier, in addition, to compare the difference from systematic injection. DESIGN, TIME AND SETTING: An in vivo drug concentration determination, matching grouping experiment. The experiment was performed at the animal and orthopedics laboratories, Affiliated Zhongshan Hospital of Dalian University from August 2008 to March 2009. MATERIALS: The alginate solution and vancocin solution was uniform mixed followed by adding CaCO_3 and citrate sodium solution, then the mixed liquor was prepared for vancocin-calcium alginate gel beads with microcapsule preparation instrument. After that, the vancocin-calcium alginate gel beads were reacted with chitosan/vancocin mixed liquor and cellulose acetate to prepare for VCM/ACA release carrier. METHODS: Forty rabbits were prepared for middle of left femur bone defect models, and then randomized divided into 2 groups, with 20 animals in each group. In the local medication group, VCM/ACA release carrier was inlaid to the defects. In the systemic administration group, rabbits were intravenous injected 10% vancocin (10 mg/kg). MAIN OUTCOME MEASURES: The drug concentrations in the serum and bone tissues of the local medication group was detected by high performance liquid chromatograph at hours 0.5, 1, 6, 24, 72 and weeks 1, 2 after operation. In the systemic administration group, the drug concentrations in the serum, bone and muscle tissues were measured at minute 10 and hours 0.5, 1, 6, 24, and 72 after operation. In addition, histological sections of body tissues were prepared to look for signs of systemic toxicity of the implants. RESULTS: The serum drug concentrations of the systemic administration group were obvious greater than the local medication group at each time points prior to 24 hours, which less than the local medication group at hour 24. The drug concentration in bone and muscle tissues of local medication group were significant greater than the systemic administration group at different time points, which sustained for at least 2 weeks, while serum concentration in the systemic administration group was much lower than minimum inhibitory concentration after 24 hours. However, no multiple tissues revealed histological evidence of toxicity. CONCLUSION: There has feasibility and safety in vivo in course of ALM/VCM release carrier, which has superior effect to systemic administration.

Objective To summarize the effect of supra-arch branches bypass combined with endovascular aortic repair for aortic diseases.Methods From January 2012 to August 2015,120 cases of thoracic aortic diseases (aortic dissection 103,aortic aneurysm 16,penetrating aortic ulcer 1) received hybrid operation in Guangdong Cardiovascular Institute.Vascular bypass was established among the brachiocephalic arteries,followed by endovascular repair through femoral artery either one-stage or two-stage.Patients were followed up for 3-24 months.Results Technical success was achieved among all the patients.Five patients died after the operation(one patient had retrograde aortic dissection,2 patients had pericardial tamponade,one patient had apnea,and one patient had respiratory and cardiac arrest.The death rate is 4.1％),4 patients had stroke,among them,symptoms were relieved in three patients,one patient was not cured.Total 92 patients were followed-up and had no symptoms of up-limb ischemia or dizziness.CT scan showed bypass graft and endovascular stent patency.6 patients had endoleak (type Ⅰ b 2 cases,type Ⅱ 3 cases,and type Ⅲ 1 case),distal aortic dissection occurred in one patient,three patients had mild contrast agent leakage around the distal endovascular stent,type A aortic dissection occurred in one patient,there were no late stage death.Conclusion Supraarch branches bypass combined with endovascular aortic repair for treating aortic disease is minimally invasive,safe,and can reduce the incidence of postoperative complications.

Objective To investigate the effect of lymphatic flow impedement on intestinal bacterial translocation in rats with obstructive jaundice. Methods Murine obstructive jaundice model was established by ligating lower choledochus. Sixty rats were divided into three groups: sham-operative group (group A), obstructive jaundice group (group B), and obstructive jaundice with thoracic duct ligation group (group C). At post-op day 15 vena cava inferior blood? portal vein blood were drawn, and endotoxin, TNF-?, IL-6 were determined. Baterial culture of mesenteric lymph nodes and lung were measured with aseptic manipulation. The extreme intestinal lumen mucosa and lung were studied pathologically. Results Blood concentration of endotoxin increased in group B and C ( P