[Objective]To evaluate the clinical results of posterior hemivertebra resection and correction with transpedicular instrumentation for congenital scoliosis.[Method]From July 2002 to December 2006,thirty-nine consecutive cases,including 22 males and 17 females,underwent posterior hemivertebra resection and correction using transpedicular instrumentation.The average age at surgery was 8.3 years ranging from 3 to 15 years.There were 30 cases with fully segmented hemivertebra and 9 cases with partial segmented hemivertebra.Instrument included 16 cases of ISOLA,10 cases of CD-Horizon,10 cases of Moss-Miami and 3 cases of TSRH.The pre-and post-operative standing radiographic and at final follow-up were measured,and the Cobb's angles in the coronal and sagittal plane were analyzed,respectively.[Result]The average follow-up was 2.8 years ranging from 1 to 4.5 years.The Cobb's angle in coronal plane was corrected from 48? to 13?postoperatively and 13.2? at final follow-up,representing 70.2% correction rate.The kyphosis was corrected from 39? to 12.1? postoperatively and 12.7? at final follow-up,representing 68.7% correction rate.All cases had bony fusion,there was no neurological complication,no implant failure or infection.One case had crankshaft phenomenon.[Conclusion]Posterior hemiveterbra resection with instrumentation is a safe and effective treatment option for congenital scoliosis.Congenital scoliosis should be treated in early age.

Objective To evaluate the therapeutic effect and toxicities of low dose Gemcitabine combined with Oxaliplatin in the treatment of advanced or metastatic uroedthelial carcinoma.Methods A total of 42 patients pathologically confirmed advanced or metastatic urothelial carcinoma (23 bladder cancer cases,11 ureteral carcinoma cases,and 8 renal pelvic carcinoma cases) were reviewed.Karnofsky score for each patient before treatment was more than 60.Combined treatment with Gemcitabine and Oxaliplatin regimen was as follows:Gemcitabine 700 mg/m2,iv infusion at day 1,8 and day 15,Oxaliplatin 100 mg/m2,iv infusion at day 2.The regimen was administered for more than 2 cycles (every 4 weeks) and the response rate was evaluated.The regimen was used in palliative chemotherapy and adjuvant chemotherapy,respectively.Results According to WHO evaluation criteria on therapeutic effectiveness,7 patients (16.7％) had complete response,13 patients (30.9％) had partial response,14 cases (33.3％) remained stable status,and 8 cases (19.1％) had progression.The overall response rate was 47.6％.The main side effects included thrombocytopenia,leucopenia,nausea,vomiting and alopecia,which were mild to moderate and disappeared when the chemotherapy was ceased.No chemotherapy related death occurred.Conclusions Combined treatment with low dose Gemcitabine and Oxaliplatin is effective for advanced or metastatic urothelial carcinoma,with mild and tolerable toxicities.

Objective To study the etiology,diagnosis,treatment and prophylaxis strategy of the urogenital fistula caused by gynecological and obstetrical surgery.Methods Data of 64 cases with urogenital fistula,who were admitted into second hospital of Tianjin medical university and Tianjin first central hospital from January 1992 to December 2012,were analyzed retrospectively.In Tianjin first central hospital,those cases include vesicovaginal fistula in 10,ureterovaginal fistula in 7 and urethro-vaginal fistula in one case.In second hospital of Tianjin medical university,those cases include vesicovaginal fistula in 26,ureterovaginal fistula in 18,urethro-vaginal fistula in 1 and ureterouterine fistula in one case.The median age was 42 years old (range 21-53).The history of diseased ranged from 16 days to 30 years.All patients were diagnosed by methylene blue test,cystoscopy,ureteroscopy,intravenous urography,ultrasound,computed tomography (CT) and magnetic resonance urography (MRU).The primary fistula was diagnosed in 50 cases and the recurrence was found in 14 cases.Single fistula existed in 56 cases and multiple fistulas were found in 8 cases.In 36 patients with vesicovaginal fistula,transabdominal repair of vesicovaginal fistula (n =20),transpubic surgery (n=10) and transvaginal surgery (n=6) were chosen.In 25 patients with ureterovaginal fistula,ureterocystostomy (n =10),ureterotomy with holmium laser (n =8),ureteral stent placement (n =6) and ureteral stricture excision and bladder-psoas suspension (n=1) were used.Two patients with urethro-vaginal fistulae were cured by the Latzko technique.One patient had uretero-uterine fistula and cured by ureteral stricture excision,ureterocystostomy and bladder-psoas suspension.Results Fifty-five(86％) cases were cured by single-stage surgical treatment and nine patients experienced more than two times of surgical treatment.The incipient patients have a higher success rate of first surgery than recurrent patients (92％ vs.64％,P＜0.05).Single and multiple fistulas have no significant difference about the surgical successive rate (88％ vs.75％,P＞0.05).In cases with vesicovaginal fistula,the success rate of vaginal and abdominal approaches are the same 85％ (P＞0.05).In cases with ureterovaginal fistula,abdominal and endoscopic approaches were 100％ and 85％,respectively (P＞0.05).The mean duration of follow was 20 months (range 3-48).There was no recurrence during follow-up.Conclusions Urogenital fistula caused by gynecological and obstetrical operation can be cured by surgery.Recurrent fistula is a challenge for diagnose and treatment,preoperative need reasonable operation mode to improve the success rate of operation.Both open surgery and endourology approaches are effective treatment options in management the urogenital fistula.

Objective To establish HPLC method for the simultaneous detgrmination of 9 effective components ofTanreqing injection.Methods The Agilent TC-C18 (2) (250 mm×4.6 mm, 5μm) column was used, the mobile phase consisted of acetonitrile (A) acetonitrile-0.1% formic acid aqueous solution (B) in a gradient mode, the flow rate was 1.0 ml/min,the column temperature was 30℃, the injection volume was 10μl, and the detecting wavelength was at 280 nm.Results All the 9 effective components showed a good linear relationship. TheRSDof the precision, reproducibility and stability tests were less than 2%. The average recoveries of the 9 effective components were in the range of 99.3%-103.1%.Conclusion This analysis method is simple, accurate and has a good specificity, which can be suitable for controlling the quality of Tanreqing injection.

Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.

Objective Anti-calcification and surface modification of the transcatheter heart valve is the priority research area and development direction of bioprosthesis heart valve.In present study,the Arginine-Glycine-Aspartic acid(RGD) coating technology and anti-calcification with epoxy chloropropane(EC) treatment were applied to investigate surface modification property of the transcatheter heart valve compared to the traditional anti-calcification method with glutaraldehyde (GA) treatment to demonstrate the improvement of structure and surface biological properties of the transcatheter heart valve.Methods Morphological characteristics of mesenchymal stem cells(MSCs) seeded on the transcatheter heart valve with the various anticalcification treatments were observed by scanning electron microscopy and the apoptosis rates of MSCs seeded on the transcatheter heart valve with the various anti-calcification interventions were studied by TUNEL staining.The cell adhesion and expression of the cytoskeletal protein,Vinment of MSCs treated as described were analyzed by cell-counting method and fluorescence immunohistochemical method respectively.Results The apoptosis rate of MSCs was markedly decreased while the expression of vinment and the cell adhesion strength of MSCs were elevated in the groups of GA-EC and RGD-EC treatments.The biological indices of RGD-EC group has significant difference(P ＜ 0.05) compared with GA group.Conclusion Biological properties of the surface of transcatheter heart valve can be remarkably improved by GA-EC and RGD-EC anti-calcification treatments.

Objective To explore the best range of international normalized ratio for anticoagulation treatment after mitral valve replacement (MVR) and double valve replacement (DVR).Methods We conducted a follow-up study involving 1592 patients who received the warfarin anticoagulant therapy after MVR or DVR in our hospital.Clinical data was collected including the admission information,the dose of warfarin and the INR level,and the occurrence of bleeding and thrombosis were recorded.The patients were divided into 2 (MVR and DVR) groups in terms of the different valve prostheses,and then each group was assigned to four subgroups according to their INR level ( A:INR=1.4-1.7;B:INR=1.7-2.0;C:INR=2.0-2.3;and D:INR=2.3-2.6) to compare the incidence of bleeding and thrombosis among these subgroups.Results The analysis of the incidence of bleeding:In MVR group,the subgroups with different INR levels had significant difference with participants with INR level at D having higher incidence of bleeding than the other 3 groups (Group A:x2=17.991,Group B:x2=13.436,Group C:x2=7.186;P＜0.01 ).We observed significant difference in DVR groups (x2=19.067,P＜0.01 ) with the increased incidence of bleeding of INR level at D compared with the other three groups ( Group A:x2=16.736,Group B:x2=10.486,Group C:x2=7.773;P＜0.01 ).The analysis of the occurrence of thrombosis;The groups of MVR and DVR had no significant differenceson in the incidences of thrombosis in all the levels of INR ( P ＞ 0.05 ).No significant statistical differences were found on the incidence of bleeding and thrombosis at INR level 1.4-2.3 ( P ＞ 0.05 ) Conclusion The present study suggestes that the level of INR at 1.4-2.3 is appropriate after the anticoagulation therapy in the MVR and DVR groups.

AIM: To investigate the effects of calcitonin gene-related peptide (CGRP) on cultured anoxic-reoxygenation human umbilical vein endothelial cells. METHODS:In the present experiment, an anoxic-reoxygenation model was established by using cultured human umbilical vein endothelial cells. The uptake rate of trypan-blue and calcium and magnesium contents of endothelial cells and lactic dehydrogenase (LDH) activity in medium and malondialdhyde (MDA) content of endothelial cells were measured 60,120 and 180 min after anoxia and 30 and 60 min after reoxygenation, and the effects of 1?10 -8 mol/L CGRP on anoxic-reoxygenation endothelial cells were studied. RESULTS: The findings showed that, as anoxia prolonged, the uptake rate of trypan-blue and LDH activity and MDA content gradually elevated and, during reoxygenation, these parameters sharply increased. Calcium and magnesium levels gradually declined as anoxia prolonged, and during reoxygenation calcium content significantly increased. Meanwhile, 1?10 -8 mol/L CGRP might significantly reduce the uptake rate of trypan-blue and LDH activity and MDA content during anoxia and reoxygenation and lessen the increase in calcium content and the loss of magnesium during reoxygenation. CONCLUSION: These results showed that CGRP might have a direct protective function to endothelial cells afflicted with anoxic-reoxygenation injury by inhibiting lipid peroxidation, attenuating calcium overload and loss of magnesium and enzyme.

AIM: To evaluate the effect of cardiac pacing with a His bundle lead on cardiac electrophysiological and haemodynamical action in dogs and the experience of location technique with His bundle pacing lead. METHODS: With opening chest operation in general-anesthetized dogs, a special lead was located at His bundle based on a typical "H" wave and narrow duration of the QRS wave recorded in ECG; Platinum leads were fixed at the epicardium of the right ventricular apex (RVA) respectively, forming HisB- VVI pacing,RVA- VVI pacing. Cardiac electrophysiological and haemodynamical parameters were compared in sinus rhythm and the different pacing models. RESULTS: The threshold of HisB pacing is similar to that of RVA pacing. Cardiac output(CO)is increased about 18.81% in HisB- VVI pacing than self. It is decreased about 5.41% in RVA- VVI pacing. SV is similar to self,but it is 25.59% higher in HisB- VVI than RVA- VVI . LVSW and RVSW in His B- VVI pacing is superior to that in RVA- VVI . CONCLUSION: His bundle pacing significantly improves cardiac function compared with the RVA- VVI pacing because it can maintain normal physiological electronic activation sequence and systolic synchrony and have a better haemodynamics effect.neral-anesthetizeddogs,as

BACKGROUND:Bone morphogenetic protein-2 (BMP-2) is a key to bone formation and repair.However,it has some disadvantages such as easy to lose and degrade and difficult to sustain continuous effect.OBJECTIVE:To study the preparation and properties of silk fibroin/chitosan/nano-hydroxyapatite (SF/CS/nHA) scaffold loading BMP-2.METHODS:After silk degumming,dissolution and purification,2％ SF solution was obtained.BMP-2 was dissolved in 2％ CS solution,and then fully mixed with equal volume of SF solution and proper amount of nHA.At last,the SF/CS/nHA scaffold loading BMP-2 was prepared using freeze-drying method as experimental group.The SF/CS/nHA scaffold was soaked in the BMP-2 solution as control group.The scaffold porosity was measured by Archimedes method,the surface morphology of the scaffold was observed by scanning electron microscope,the compressive strength was measured by universal testing machine.Scaffolds in the two groups were soaked in PBS,and the release of BMP-2 was measured by ELISA method at different time points.RESULTS AND CONCLUSION:(1) The scaffolds in the two groups had irregular porous structure,interconnected pores and uneven pore wall.There was no significant difference between the two groups in mean pore diameter,porosity and maximum compressive strength.(2) On the 1st day,the release rate of BMP-2 was 4.63％ in the experimental group,and the release curve increased slowly.After 28 days,the release curve of BMP-2 was transferred to the plateau stage.But in the control group,the release rate of BMP-2 on the 1stday was 58.84％,and it was a significant initial burst release.The release curve increased rapidly,and was transferred to the platform stage on the 10th day.The release rate of BMP-2 release was significantly different between the two groups at days 1,2,4,10 (P ＜ 0.05).These results show that the SF/CS/nHA scaffold loading BMP-2 could sustainably and slowly release BMP-2.