BACKGROUND:The human telomerase reverse transcriptase (hTERT) is one of preferred growth factors for regulating proliferation and directional differentiation, has multiple biological effects, and laids the foundation for geneticaly engineered immortalized stem cel lines. OBJECTIVE: To investigate the effect ofhTERT gene-modified umbilical cord mesenchymal stem cel transplantation on acute kidney injury induced by ischemia and reperfusion in rats. METHODS:The human umbilical cord mesenchymal stem cels were cultured in vitro. Rat models of acute kidney injury induced by ischemia and reperfusion were established. Rat models were randomly divided into three groups. Rats in the control group were injected with 1 mL L-DMEM medium through caudal vein. Rats in the negative transfection group were injected with 1 mL umbilical cord mesenchymal stem cel suspension after empty virus transfection through caudal vein. Rats in the hTERT transfection group were injected with 1 mL umbilical cord mesenchymal stem cel suspension after PLXSN-hTERT transfection through caudal vein. RESULTS AND CONCLUSION:At 3 and 28 days after transplantation, hematoxylin-eosin staining showed renal tubular damage score in the hTERT transfection group < negative transfection group < control group (P < 0.05). At 28 days after transplantation, the number of CM-Dil-positive cels in the hTERT transfection group > negative transfection group > control group (P < 0.05). At 1, 3, 14, and 28 days, serum creatinine and urea nitrogen levels in the hTERT transfection group < negative transfection group < control group (P < 0.05). The results confirm that hTERT gene-modified umbilical cord mesenchymal stem cel transplantation has a significant repair effect on acute kidney injury in rats.

Objective To evaluate the interobserver reliability and intraobserver reproducibility of the subaxial cervical spine injury classification system (SLIC) and identify its guidance on clinical treatment of spinal cord injuries. Methods Thirty consecutive patients with subaxial cervical injury ad-mitted into our hospital between December 2007 and July 2008 were enrolled in this study and underwent neurological examinations followed by X-ray, CT, and MRI examinations. SLIC was evaluated in aspects of fracture morphology, disco-ligamentous complex (DLC) status and ncurologic status. According to the morphology in image, the fractures were classified into normal, compression, burst, distraction and trans-lation/rotation. According to injury severity, DLC was sorted into intact, indeterminate and disrupted types. Neurologic status was classified into intact, nerve root injury, complete/incomplete spinal cord in-jury and continuous spinal cord compression. The clinical and radiographic data of 30 patients with subax-ial cervical injury were evaluated prospectively by four groups of surgeons to count SLIC scores and decide treatment based on SLIC scores. The evaluation was done again three months later. Cohen' s unweighted kappa coefficients were calculated for the key parameters of each classification system ( morphology, neurologic status, DLCstatus, total score, and proposed management) to analyze the reliability and repreducibility of SLIC. Based on SLIC, the treatment method was selected and the neurological function recovery and the complications observed. Results The interrater Kappa statistics of all subgroups ( morphology, DLCstatus, total score, proposed management) were within the range of moderate to substantial reliability (0.47-0.69). Kappa coefficient was 0.83 for neurologic status, with high reliability. There was no statistical difference upon Kappa values in two evaluations. The interrater Kappa statistics of all sub-groups ( morphology, DLCstatus, total score, proposed management) were within the range of moderate to substantial reproducibility (0.53-0.78). Kappa coefficient was 0.89 for neurologic stares, with high repreducibility. The recovery rate of neuroiogie function was 79.2%. There was no aggravation of neurological status, with low incidence of complications. Conclusions SLIC has advantages of high reliability and reproducibility, simple use, exact evaluation and can facilitate decision-making in treatment of subaxial cervical spine injures.

[Objective]To investigate the characteristics of fatal pulmonary embolism (PE) due to peri-operative orthopedic surgery and provide clinical recommendations for surgeons.[Method]Form September 2000 to September 2006,15 cases of fatal PE were treated.All cases were retrospectively analyzed,assessed and compared regard to specific risk factors,diagnostic process,treatment results and preventive measures.[Result]Orthopedic surgery may lead to proximal deep vein thrombosis (DVT),especially in patients with spinal cord injury,lower extremity or pelvic fracture.Fatal PE is surprisingly common and is not necessarily heralded by dramatic symptoms or signs associated with DVT,but can lead to substantial morbidity and mortality.So the preventive,diagnostic and therapeutic strategy of PE of orthopedic surgery is different form chronic PE.[Conclusion]The morbidity of fatal PE duo to peri-operative orthopedic surgery is insidious but serious.Thrombolytic treatment can improve the survival rate for patients with acute pulmonary embolism.

head and neck region. Postoperative recurrence rate was 42 10%, five year survival rate was 8 33%. Not a single case was found to be malignant degeneration of neurolemmoma or neurofibromatosis, nor as a result of radiotherapy. It is suggested that MNST is a primary soft tissue malignant tumor, and early complete excision is the key treatment. The biological characteristics of this tumor as revealed in this study suggest that it is different from what was reported in the foreign literature.

Objective To evaluate the efficacy of video-assisted mini-thoracoscopy(VAMT) for radical resection of lung cancer.Methods From April 2002 to December 2008,radical resection of lung cancer was performed on 39 patients by VMAT in our hospital.A 1.5-cm and a 7-to 10-cm incision were made during the operation.Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels,perform lobectomy,and remove the lymph nodes in the mediastinum and pulmonary portal.Results The operation was completed in all of the cases.No peri-operative death occurred.The patients received chest drainage for 4 to 7 days after the operation(mean,4.5 days).Post-operative pathological examination showed primary non-small cell lung cancer(NSCLC) in 37 cases,metastatic cancer in 1,and carcinoid in 1.In the 37 patients with NSCLC,9 were stage Ⅰa,13 were Ⅰb,5 were Ⅱa,7 were Ⅱb,2 were Ⅲa,and 1 was Ⅲb.Follow-up was available in 35 patients for up to 2 to 12 months in 4,13 to 24 months in 15,25 to 36 months in 8,37 to 48 months in 6,and 49 to 60 months in 2 cases.Among the 35 cases,totally 4 patients died of tumor recurrence or metastasis,1 patient survived with tumor,and the other 30 survived without tumor.The 1-and 3-year survival rate of stage Ⅰ and Ⅱ were 100%(21/21) and 91%(10/11) respectively.All of the 3 stage Ⅲ patients died of recurrence or metastasis in 19,11,and 14 months respectively after the surgery.Conclusions VAMT is effective for radical resection of lung cancer in a short term.Combination of traditional procedure and VAMT is safe and reliable for the disease.

Objective To investigate the structural changes during the early stage of spinal cord injury,and the relationships between these structural changes and patients' motor recovery.Methods The clinical data of 25 patients with spinal cord injury collected from 2012 October to 2014 March were analyzed retrospectively.The spinal cord injury patients were split into two groups (Good recoverers group and Poor recoverers group) according to the clinical outcome of motor recovery at 6 months follow-up,and there were 10 Good recoverers (ASIA grade:1 A,4 B,3 C,and 2 D) and 15 Poor recoverers (ASIA grade:7 A,3 B,3 C,and 2 D).The study also recruited 25 matched healthy controls.The mean age of Good recoverers,Poor recoverers and healthy controls were 37.9± 13.9,35.8± 11.5 and 36.5±9.3,respectively.Structural MRI was used to investigate the regions with brain structural changes among the three groups.Pearson correlation analysis was used to explore the relationships between these structural changes and patients' motor recovery.Results Compared to healthy controls group,both poor recoverers and good recoverers had significantly decreased cortical thickness in the bilateral primary motor cortex.Poor recoverers exhibited more serious and widespread structural damages,in addition to reduced cortical thickness in the primary motor cortex,poor recoverers also showed decreased cortical thickness in the right SMA and premotor cortex when compared to healthy controls.Compared to the healthy controls group,poor recoverers showed reduced white matter volume in the right primary motor cortex and posterior limb of the internal capsule;good recoverers showed no significant difference in white matter microstructure.Furthermore,these structural changes at the internal capsule and primary motor cortex were associated with the motor recovery rate at 6 months follow-up (r=0.75,P＜ 0.001;r=0.76,P＜ 0.001,respectively).Conclusion These findings suggest that spinal cord injury causes significant anatomical changes in the human sensorimotor system in the early phase,and these structural changes directly affect the motor recovery of spinal cord injury.Future treatment aimed at promoting neural function recovery of spinal cord injury patients should pay close attention to the injured brain.

OBJECTIVETo compare the efficacy differences between acupuncture at Zhibian (BL 54) through Shuidao (ST 28) and regular acupuncture for polycystic ovary syndrome.

METHODSOne hundred and one patients, by using random digital table, were randomly divided into an observation group (49 cases) and a control group (52 cases). Patients in the observation group were treated with acupuncture at Zhibian (BL 54) through Shuidao (ST 28) as main acupoints, and accompanied acupoints were selected according to syndrome differentiation. Elongated needles (175 mm in length) were inserted at Zhibian (BL 54) with an angle of 200 with sagittal plane. The insertion depth was 100-115 mm, reaching Shuidao (ST 28) and making acupuncture sensation arrive at diseased location. Patients in the control group were treated at the same acupoints with regular acupuncture technique. The menstruation condition was ignored for patients in both groups. The treatment was given once a day, 15 times as one session, and 5 consecutive sessions were given. The basic temperature and level of sex hormone were observed before and after treatment in the two groups, and clinical efficacy was compared.

RESULTSThe cured rate was 65.3% (32/49) and the effective rate was 91.8% (45/49) in the observation group after treatment, which was significantly superior to 48.1% (25/52) and 63.5% (33/52) in the control group (both P<0.01). The number of patients with typical biphasic fever and patients with atypical biphasic fever in the observation group was higher, than that in the control group, but that of unidirectional temperature was less than that in the control group (P<0.05). After treatment, the follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, testos terone (T) were significantly reduced in the observation group (P<0.01, P<0.05); the LH and T were also apparently reduced in the control group (P<.01, P<0.05). The reduction of FSH, LH, LH/FSH and T in the observation group after treatment was more significant than that in the control group (P<0.05, P<0.01).

CONCLUSIONAcuouncture at Zhibian (BL 54) through Shuidao (ST 28) could significantly improve the basic temperature of patients with polycystic ovary syndrome, and regulate hormone level of reproductive endocrine, which is superior to regular acupuncture.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Middle Aged ; Polycystic Ovary Syndrome ; blood ; therapy

Objective To investigate risk factors for postoperative delirium in elderly patients with hip fractures and determine whether the delirium can influence the outcome of hip fracture.Method A retrospective case control study was performed for 521 patients (≥60 years) with hip fractures treated surgically from January 2012 to December 2014.There were 170 males and 351 females, with the age of (79.3±8.3)years.Confusion assessment method (CAM) was applied to diagnose delirium after surgery, and the subjects were divided into delirium group (n=159) and control group (n=362) according to the presence of delirium.Univariate and multivariate analyses were performed to identify the riks factors for postoperative delirium, including age, gender, comorbidities, body mass index, American Society of Anesthesiologists (ASA) classification, type of fracture, haemoglobin, PaO2, albumen, type of anesthesia, type of anesthesia, amount of bleeding, time between admission to surgery, length of operation, type of operation and amount of blood transfusion.Perioperative complications and mortality within 1 year after operation were compared between the two groups.Results Univariate analysis revealed dementia, ASA classification, haemoglobin, PaO2, albumen, interval between admission to surgery, anesthesia method, operation time, and surgery methods were risk factors for postoperative delirium incidence (P<0.05).While multivariate analysis showed only dementia (OR=6.211, 95%CI 2.482-23.498), long interval between admission to surgery (OR=3.505, 95%CI 1.478-6.342), arthroplasty (OR=2.015, 95%CI 1.783-3.481), and PaO2≤60 mmHg (OR=2.766,95%CI 1.783-5.039) were the significant risk factors for postoperative delirium after hip surgery in the elderly.Incidences of lung infection, wound infection, cardiovascular events, cerebrovascular events and deep venous thrombosis in delirium group were higher than those in control group, but only incidences of lung infection and wound infection reached significant differences (P<0.05).Mortality in delirium group was higher than that in control group within 1 year after operation, but there was significant difference only within 3 months after operation (P<0.05).Conclusions Incidence of delirium is high after hip fracture surgery in the elderly.Dementia, long interval between admission to surgery, arthroplasty and PaO2≤60 mmHg are significant risk factors for postoperative delirium incidence, and the delirium patients are associated with high early mortality.

Posterior pilon fracture is a special and unique type of ankle fracture,and its injury mechanism and treatment principles are different from those of the trimalleolar fracture in the Lauge-Hansen classification,and also different from those described for the classic pilon fracture.The fractures have a low incidence and generally poor prognosis.The prevalence of posterior pilon fractures is 6.4％ of all trimalleolar fractures,and 5.6％ of all pilon fractures based on computed tomography images.The pathological features of posterior pilon fractures are different from those of the traditional ankle fracture and the classic pilon fracture,and it is very important to differentiate a posterior pilon fracture from the others.Because of the low incidence and high variation in fracture morphology,there is controversy over the practicable classification of posterior pilon fractures based on clinical features,such as injury mechanism,fracture classification and surgical approach.An ideal fracture classification system can reveal the injury mechanism and severity,guide the treatment,and predict prognosis.At present,no classification method is based on the injury mechanism,and none can summarize fracture morphology and guide treatment.The purpose of this study was to review the injury mechanism,clinical characteristics,classifications,treatments,and outcomes of posterior pilon fractures,to promote surgeons’ understanding of posterior pilon fracture and reduce perioperative complication.

Objective To evaluate the efficacy,indications and clinical outcomes of the treatment of thoracolumbar fractures by short segmental pedicle screws fixation at the level of the fracture.Methods Thirtytwo patients with thoracolumbar fracture,who underwent surgical procedure of short segmental pedicle screws fixation at the level of the fracture from 2007 to 2010,were followed up.X rays were performed preoperatively and postoperatively to locate the injured vertebral segment height and fractured kyphosis vertebral (Cobb angle).Frankel standard was used to assess the spinal cord function.Results All patients were followed up for 12 to 20 months and were in satisfying condition in the reduction of fracture.After surgery,the height of fractured vertebral body leading edge recovered from preoperative (32.4％ ～69.3％,averaged (51.6 ± 17.8)％ ) to (85.6％ ～99.2％,averaged (92.8 ±6.2)％ ) after two weeks and (90.6％ ～97.8％,averaged (93.8 ±3.6)％ ) at the last follow-up.Fractured vertebral Cobb angle was recovered from the preoperative ( 12.8 ° ～ 30.5 °,averaged [20.8±9.1] °) to (0° ～7.8 °,averaged [4.9 ±3.2] °) two weeks later and (2.0° ～ 12.0°,averaged [ 6.2 ± 4.6 ] o at the last follow-up.Cobb angle of the injured vertebral segment and the extend of vertebral compression were significantly improved after the angle was corrected ( P ＜0.01 ).Conclusion Using reduction and short segment pedicle screw fixation at the fracture level would be helpful to correct kyphotic vertebral compression and restore the height of injured vertebrate,which was also of benefit to increase the stability of short-segment posterior fixation system and reduce the loss of correction in a long run.