BACKGROUND:The vascularization plays a key role in bone formation and reconstruction. Bioactiveβ-tricalcium phosphate has a porosity and absorbability that al ow a possibility of constructing vascularized bone.
OBJECTIVE:To explore the blood supply and construction of the central vascularizedβ-tricalcium phosphate, as wel as the mechanism of vascularization in artificial bone for its further clinical application.
METHODS:The lumbar dorsal artery of New Zealand rabbits was isolated and prepared into vascular bundle. At the experimental side, the vascular bundle was implanted into channel of theβ-tricalcium phosphate, then fil ed with the autologous tiny bone particles, and embedded into the latissimus dorsi muscle. Animals without the vascular bundle implantation were taken as the control group. The samples were determined for the morphology and histology at 4, 8, and 12 weeks post-surgery.
RESULTS AND CONCLUSION:The site where the vascular bundle was implanted appeared foramen nutriens-like structure, the blood vessels were abundant and smooth. The central vascularized tricalcium phosphate were fil ed with new-born vessels at 4-8 weeks. The newly formed bone and bone metabolism appeared at 4 weeks and newly formed bones were more mature at 12 weeks. In the control group, there were only a few new-born vessels, the newly formed bone was immature. The central vascularizedβ-tricalcium phosphate can significantly improve the vascularization of artificial bone. This model can probably serve as a new method for tricalcium phosphate in clinical use.

[Objective] To evaluate the feasibilitiy,methods and therapeautical effects of the posterior circumferential fusion (PCF) combined with short -segmental pedicle screw system fixation for the treatment of lumbar spondylolisthesis(LSL). [Method] From October 2002 to March 2006, 44 cases of LSL were treated with decompression for spine canal stenosis, circumferential fusion and short-segmental pedicle screw system fixation. There were 15 male and 29 female, average age was 48. 6 (ranged, 31~68) years. The diagnoses of LSL and stenosis were confirmed by X-ray and CT. According to Newman classification, 15 of them were the degenerative type and 29 were isthmic type. According to Meryerding classification of LSL, 17 patients had degree I, 24 patients had degree Ⅱ and 3 patients had degree Ⅲ spondylolisthesis. The levels of LSL was between L4 and L5,in 18 patients and between L5 and S1 in 26 cases.[Result]The follow-up period was 18~36 months , averaged 26 months.Seventeen patients with degree Ⅰ spondylolisthesis were all reduced anatomically after surgery. Twenty-four patients with degree Ⅱ spondylolisthesis were reduced anatomically except for 6 patients with Ⅰ degree residual spondylolisthesis. 3 patients with degree Ⅲ spoadylolisthesis were reduced anatomically except for 2 spatients with Ⅰ degree residual spondylolishesis. The effect was evaluated according to Hou Shuxun's evaluation standard, the results were excellent in 28 cases, good in 13 cases, and fair in 3 cases. The excellent and good rate was 93.2%. No complication such as interfixation failure and nerve pedicle injury or cauda equine injury were found. All cases got bony union in 3 to 10 months (mean 4.2 months) postoperatively. All patients had normal disc height and no loss of spondylolisthesis reduction. [Conclusion] The PCF combined with short-segmental pedicle screw system fixation is reasonable options in treating the LSL. It can improve the fusion rate of the spine and maintain good intervertebral space and good lordosis of the lumbar spine. The satisfactory clinical result is relied on the completely understanding of the characteristics of PCF and short-segmental pedicle screw fixation.

Objective To analyze the distribution and antibiotic resistance of the microorganisms isolated from blood samples in the Cardiovascular Institute,Beijing Fuwai Hospital,for clinicians to improve antimicrobial therapy.Methods Blood samples were cultured and bacterial isolates were identified and tested for their susceptibility to antimicrobial agents.Results A total of 2 017 (8.3％) strains of microorganisms were isolated from 24 348 blood samples.Finally,1 009 nonduplicate strains were analyzed,including gram positive cocci (n=574,56.9％),gram negative bacilli (381,37.8％),and Candida species (54,5.4％).The top gram positive cocci were coagulase-negative Staphylococcus (31.8％),Streptococcus (11.0％),Staphylococcus aureus (5.5％),Enterococcus faecalis (4.0％),and Enterococcus faecium (1.5％).The top gram negative bacilli were Acinetobacter baumannii (6.7％),Pseudomonas aeruginosa (6.0％),Escherichia coli (5.7％),Klebsiella pneumoniae (4.3％),Stenotrophornonas maltophilia (3.5％),and Enterobacter cloacae (3.3％).Candida albicans was the most frequently isolated Candida species.Staphylococcus isolates were sensitive to linezolid,vancomycin,tigecycline,and quinupristin-dalfopristin.Enterococcusfaecalis were sensitive to linezolid,tigecycline,high level streptomycin,high level gentamicin,penicillin,ampicillin,and vancomycin.Enterococcus faecium were less sensitive than Enterococcus faecalis.All Enterococcus strains were sensitive to linezolid,tigecycline,high level streptomycin,high level gentamicin,and vancomycin.Gram negative bacilli were relatively sensitive to cefoperazone-sulbactam,piperacillin-tazobactam,cefepime,amikacin and carbapenems.A.baumannii and P.aeruginosa isolates showed lower susceptibility to carbapenems than E.coli,K.pneumoniae and E.cloacae.Conclusions The distribution of the pathogens isolated from blood samples was relatively stable in the past five years in our hospital.Gram positive cocci are more prevalent than gram negative bacilli in blood samples.Clinicians should select antimicrobial agents according to the distribution of pathogens and the antimicrobial resistance profile.

Objective To investigate the diagnostic value of contrast enhanced ultrasound in breast cancer. Methods Thirty-six cases including 51 typical and 22 atypical breast cancer were examined with injecting contrast agent before operation. The enhanced charaters of perfusion pattern, enhanced level, and modes were observed and reanalyzed when pathology was got. Results There was no statistical meanings in perfusion pattern, enhanced level and mode between typical and atypical breast cancer. They all enhanced like branch or annulus with high lever and there were 3 enhanced modes:"fast in slow out"(48% ,35/73) ,"lastly fast in slow out"(44% ,32/73) and "same in same out"(8% ,6/73). Conclusions The enhanced modes of breast cancer showed "fast in slow out" , "lastly fast in slow out"and "same in same out", enhanced like "branch or annulus" and high level enhanced. Contrast enhanced ultrasound can increase the diagnostic accuracy in the early stage of breast cancer.

Objective:To investigate the effects of Zinc sulfate on preventing human umbilical veins endothelial cells ( HUVECs) from oxidative stress. Methods:Hydrogen peroxide was used to stimulate HUVECs to build the oxidative stress model in vitro. HUVECs were divided into normal group, H2 O2 group, Zinc sulfate group and Zinc sulfate treated group. Method of nitrate reductase was used to detect the content of nitric oxide ( NO ) and ELISA was used to detect the content of endothelin ( ET ) in supernatant in different groups. The level of HO-1,SOD and CAT of HUVECs were measured by Western blot. Apoptosis of HUVECs was examined by TUNEL as well. Results: Zinc sulfate could enhance the content of NO and decrease the content of ET in the supernatant,which induced by hydrogen peroxide on HUVECs. Zinc sulfate could also increase the level of HO-1, SOD and CAT obviously and decrease the apoptosis cells significantly induced by H2 O2 . Conclusion: Zinc sulfate play an important role in resisting oxidative stress in HUVECs, and maybe prevent HUVECs from oxidative stress damage. Zinc sulfate is expected to be an effective medicine on improving endothelial cells anti-oxidative ability.

Objective To evaluate the features of ultrasound and elastography of chronic lymphocytic thyroiditis (CLT) with different thyroid functions,analyze the course of the disease and provide a basis for clinical treatment.Methods A total of 77 patients with CLT were retrospectively analyzed in the Department of Ultrasound,Fourth Affiliated Hospital of Harbin Medical University from September 2013 to September 2014.The patients were divided into four groups based on thyroid function,including 20 patients with hyperthyroidism,18 patients with hypothyroidism,20 patients with subclinical hypothyroidism,and 19 patients with euthyroidism.According to 6 indicators consisted of the thyroid size (volume,thickness of the lateral lobe,thickness of the isthmic portion),flow classification(0,Ⅰ,Ⅱ,Ⅲ),the peak systolic velocity (PSV) of the superior thyroid artery(STA),resistance index (RI) of the STA,echo types (diffuse,localized) and ultrasound elastic rate (E2/E1),the features of ultrasound and elastography of CLT were analyzed.According to the thyroid echo types and different thyroid functions,the change of E2/E1 was analyzed and the relationship between E2/E1 in different thyroid function and thyroid function (thyroid stimulating hormone,TSH) was compared.Results The volume,thickness of the lateral lobe of hypothyroidism,subclinical hypothyroidism,hyperthyroidism and euthyroidism groups were respectively as follows:(14.25 ± 4.15),(11.79 ± 3.22),(9.84 ± 2.63),(5.61 ± 1.35) ml and (2.35 ± 0.27),(2.15 ± 0.24),(1.97 ± 0.16),(1.62 ± 0.22) cm,and the differences between different groups were statistically significant (F =27.77,35.56,all P ＜ 0.05).The thickness of the isthmic portion was respectively as follows:(0.53 ± 0.09),(0.47 ± 0.06),(0.44 ± 0.06),(0.38 ± 0.06) cm,and the differences between different groups were not statistically significant (F =14.76,P ＞ 0.05).The PSVs were respectively as follows:(50.53 ± 10.61),(42.93 ± 7.81),(64.96 ± 12.20),(34.74 ± 6.05) cm/s,and the differences between different groups were statistically significant (F =36.06,P ＜ 0.05).The RIs were respectively as follows:0.59 ± 0.04,0.60 ± 0.02,0.63 ± 0.02,0.60 ± 0.02,and the differences between different groups were not statistically significant (F =7.66,P ＞ 0.05).Patients with euthyroidism had Color Doppler Flow Imaging (CDFI) pattern 0 (52.6％,10/19).Patients with subclinical hypothyroidism had CDFI pattern Ⅰ (60.0％,12/ 20).Patients with hypothyroidism had CDFI pattern Ⅱ (66.7％,12/18).Patients with hyperthyroidism had CDFI pattern Ⅲ (55.0％,11/20).The thyroid gland echo in CLT groups was mainly diffuse hypoechoic pattern (62.3％,48/ 77).Focal hypoechoic pattern and diffuse hypoechoic pattern without heterogeneous linear hypoechoic were mainly seen in the groups of hyperthyroidism and euthyroidism (66.7％,26/39).Diffuse hypoechoic pattern with heterogeneous linear hypoechoic and nodular changes were mainly seen in the groups of hypothyroidism and subclinical hypothyroidism (86.9％,33/38).The E2/E1 in focal hypoechoic pattern,diffuse hypoechoic pattern without heterogeneous linear hypoechoic pattern,diffuse hypoechoic pattern with heterogeneous linear hypoechoic and nodular changes were by turns:1.30 ± 0.48,1.68 ± 0.38,1.97 ± 0.55,2.27 ± 0.63,and the differences between different groups were statistically significant (F =32.47,P ＜ 0.05).The E2/E1 in hyperthyroidism,euthyroidism,subclinical hypothyroidism,and hypothyroidism were by turns:1.12 ± 0.50,1.69 ± 0.12,2.21 ± 0.20,2.45 ± 0.32,and the differences between different groups were statistically significant (F =64.54,P ＜ 0.05).The correlation coefficient between E2/E1 and serum TSH was 0.742,which was significant (P ＜ 0.01) in different thyroid function groups.Conclusions CLT with different thyroid functions has different features of ultrasound and elastography.E2/E1 can reflect the hardness of the thyroid parenchyma to a certain extent,and assess the thyroid function and the course of the disease,can prevent the occurrence of hypothyroidism early.

Objective To study the differentiation of bone marrow mesenchymal stem cells in artery tissue under different calcification environments.Methods We made a vascular calcification model using warfarin,vitamin K1 and vitamin D3.After the model was successfully made,we took artery tissue of normal SD rat arteries and calcified arteries co-cultured with MSC,which were divided into three groups.The normal group included normal artery tissue with MSC; calcified inducers group included calcified inducers (dexamethasone with β-glycerophosphate and ascorbic acid),normal arterial tissue and MSC; calcification group included calcified artery tissue and MSC.Each group was cultured for 3 weeks.On the 10th day of the experiment,osteoprotegerin (OPG) protein secretion was detected by ELISA.After three weeks,changes of cell morphology were observed using inverted microscope,and total protein content and alkaline phosphatase (ALP) activity were detected by ELISA.In additional,the Ror2 (receptor tyrosine kinase-like orphan receptor 2) mRNA expression was detected by using RT-PCR method.Results MSC in calcification group spontaneously proliferated and differentiated to osteoblast-like cells.Compared with normal group,calcification group showed that the total protein content,ALP activity of bone metabolism markers,OPG were significantly elevated,while Ror2 mRNA expression was significantly decreased.MSCs in calcified inducers group did not differentiate to osteoblast-like cells,and the total protein content and OPG were increased,while ALP activity had no significant difference as compared with the normal group.However,Ror2 mRNA expression was lower in calcified inducers group than in normal group,while was higher than that in calcification group.Conclusions MSCs proliferate into bone-like differentiation in vascular calcification environment and aggravate the vascular calcification.And in normal vascular with calcified inducers environment,MSCs proliferate into smooth muscle cell differentiation and rehabilitate the vascular calcification.These phenomenons may be related to the Ror2 expression in artery.

AIM:To investigate the effects of Compound Rhizoma Coptidis ( Rhizoma eoptidis,Radix suctellariae,Cortex phellodendri Chinensis,Fructus gardeniae and Radix et Rhizoma glycyrrhizae) on vascular calcification in rats treated with warfarin and vitamin D_3.METHODS: Thirty-two male SD rats were assigned randomly into control group,calcified group,Compound Rhizoma Coptidis prevented group and treated group.The later three groups were treated with warfarin,and subcutaneously injected with vitamin K_1 and vitamin D_3 for one week to induce extensive calcification of the aorta.Compound Rhizoma Coptidis was given before the first warfarin dose in prevented group and the drug was given after the modeling in the treated group.The control group was treated with normal saline.The calcification in the aorta was analyzed and osteoprotegerin (OPG) mRNA and protein were determined using histomorphometry,RT-PCR and immunohistoehemistry after 4 weeks of drug intervention.RESULTS : The results of 32 rats was analyzed compared to the control group,the area of darkly stained regions by Von Kossa staining and the level of calcium content in aorta wall increased significantly[(608.32±42.29) μg/g vs (1 139.47±230.03) μg/g,P ＜0.05].The OPGmRNA and protein decreased in aortic sections.No artery calcification could be detected in Compound Rhizoma Coptidis prevented group and a little artery calcification could be detected in Compound Rhizoma Coptidis treated group.The level of calcium content in aorta wall significantly lower[(854.77±12.99) μg/g,(875.78±27.23 ) μg/g].The expresion of OPGmRNA and the protein significanfly increased in Compound Rhizoma Coptidis prevented and treated groups.CONCLUSION:Compound Rhizo-ma Coptidis may prevent or regress the vegcular calcifiation,that seems dependent on the upregression of aortic OPG levels.

10.3969/j.issn.2095-4344.2013.25.024

Objective: It is difficult to repair large-area Ⅲ?burn wound in children.Here we introduce the advantages of the back skin donor site in repairing Ⅲ?burn wound in children.Methods: This clinical study included 15 children with Ⅲ?burn,ranging in age from 18 months to 11 years(mean 7.6 years),with the Ⅲ?burn wound area averaging at 12.6% of the total body surface.The back skin donor site was used to repair the wound.The functional site,such as the joint,was preferentially considered if the skin graft was not enough for all the wounds.Results: Most of the skin grafts survived and the donor sites on the back healed very well.The patients were followed up for six months to three years,which revealed that the skin grafts remained soft without dysfunction and the scar hyperplasia was mild on the donor site.Conclusion: The back donor site supplies larger-area skin with good quality.The donor site heals fast.After healing,patients could sleep on back and compress the scar so as to prevent scar hyperplasia,and the scar does not affect the patient's appearance.With all these advantages,the back donor site is a good choice for repairing Ⅲ?burn wound in children.