Objective To explore the feasibility and a dv antages of video-assisted minimally invasive thyroidectomy by using the ultrason ic scalpel. Methods A total of 14 patients underwent cervical mini-incision video-assisted minimally invasive partial or subtotal thyroidectom y by using the ultrasonic scalpel. Results All the operations were successfully completed, without conversions to open surgery. The operation time was 30~70 min (mean, 45 min). Postoperative pathological findings showed no dular goiter. All the patients recovered uneventfully, without wound infection o r subcutaneous effusion. The cervical incision was 2.5 cm or so in length. Follo w-up for 3~17 months revealed barely visible scars in the 14 patients. Conclusions Miccoli thyroidectomy is simple to perform and offers excel lent cosmetic results.

Objective To investigate the risk factors and prognosis of no-reflow phenomenon in patients after percutaneous coronary intervention(PCI).Methods Retrospectively analyzed 524 patients with acute coronary syndrome after PCI of which 427 patients had detailed record.Angiographic no-reflow phenomenon was designated as TIMI≤2 flow without mechanical obstruction of embolism,thrombus,dissection and spasm.Normal flow designated as TIMI 3 flow.Using random count table of Excel,70 patients were randomized from 393 patients with coronary flow TIMI 3 after PCI as the control normal flow group.Results The no reflow group enrolled 34 patients.Compared with the normal flow group,their incidence of AMI and diabetes,the blood insulin level and mean leukocyte count were significantly higher.The incidence of MACE in and out of hospital was higher in the no reflow group than the normal flow group.Within the no reflow group,the EF decreased while the LVEDD increased significantly PCI.Conclusion History of diabetes,blood insulin level and leukocyte count may be the risk factors of no-reflow.On the other hand,the no reflow phenomenon maybe a prognostic factor of MACE,ventricular remodeling and heart function for patients after PCI.

Objective To evaluate the repeatability and accuracy of semi-automated software OsiriX in the assessment of cartilage volume in normal knees on 3.0T MR. Methods Thirty right knees of healthy subjects were scanned twice with 3.0T MR using 3D-FLASH sequence with selective water excitation. Cartilage volume of the patellar compartment was determined with a validated open-source software OsiriX and manual segmentation separately by 3 observers using MRI data sets. After calculating the cartilage volumes, the segmentation processing times, the repeatability and volume results were compared between two segmentations. Results ①Compared with the manual segmentation, a time saving of at least 50% for cartilage volume measurement was achieved with OsiriX software segmentation. ②The interobserver repeatability error was 4.88% and 9.82% with OsiriX software segmentation and manual segmentation, respectively;the intraobserver repeatability error of high experienced observer was 0.77% and 1.29%, the interindividual repeatability range were 0.14%-1.11% and 0.52%-1.61%, respectively. The repeatability error of OsiriX software segmentaion was proved to be significantly smaller than manual segmentation (P＜0.05). ③System difference between results obtained with OsiriX software measurement and manual measurement was (-3.80±3.93)% and absolute pairwise difference was (4.68±2.70)%. There was no statistical difference between the volume results measured using two techniques (t=0.92, P=0.36). Conclusion Compared to manual segmentation, cartilage volume measurement with OsiriX semi-automated segmentation is faster and has higher inter- and intraobserver repeatability with relatively fixed standard. This technique may therefore be used for clinical and multi-center trials of large sample.

Objective To investigate the accuracy and reproducibility of multi echo data imagine combination (MEDIC) sequence with water excitation at 3. 0 T in swine knee cartilage. Methods Sagittal MEDIC sequences (0.6 mm slice thickness, isotropic) were acquired twice at 3. 0 T MRI in 30 swine knees. The knee cartilage was then removed and the volume was directly measured with water substitution method. The cartilage volume was also determined with a validated open source image software OsiriX by two observers ( A and B). The cartilage volumes obtained by two methods were compared. The reproducibility of MEDIC for quantitative measurement was accessed by the root-mean-square (RMS) of variation coefficient. Interobserver and intraobserver precision errors were compared using a paired students t-test. The accuracy of MEDIC for quantitative measurement was determined by the random pairwise differences, systematic pairwise differences and the Pearson correlation coefficients. Time of semiautomatic and manual segmentation were recorded. Results Time was saved about 75% by using semiautomatic segmentation methods [(4.0 ±1.5) min] versus manual segmentation [(16.0 ±0.9) min]. Interobserver precision errors (RMS CV%for paired analysis) between A and B for cartilage volume measurement were (2. 66 ±0. 82) ml and(2. 61 ±0.81) ml, t=0.24, P=0. 81 (patella); (2.40 ±0.69) ml and(2.49 ±0. 85) ml, t= -0.45,P =0. 65 (medial femoral condyle) ;(2. 28 ±0.74) ml and(2.41 ±0. 78) ml, t = -0. 66, P = 0. 51 (lateral femoral condyle);(3.43±1.28) ml and(3. 51 ±1. 08) ml, t= -0.26, P=0.79 (femora trochlea) with sagittal MEDIC. Intraobserver precision errors ( RMS CV% for paired analysis) of observer A for the first and second cartilage volume measurement were(2. 64 ±0. 62) ml and(2. 67 ±0. 60) ml, t = -0.19, P =0. 85(patella); (2.43 ±0.60) ml and(2. 39 ±0.59) ml, t =0.26, P = 0. 80 (medial femoral condyle);(2. 26 ±0. 56) ml and (2. 30 ±0. 57) ml, t = - 0.27, P = 0. 78 (lateral femoral condyle); (3.40 ±1.20) ml and(3.47 ±1. 11) ml, t = -0.23, P = 0. 82 (femora trochlea) with sagittal MEDIC. The cartilage volume of direct measurement were (2.73 ±0.97 ) ml ( patella ) , (2. 28 ±0. 66 ) ml ( medial femoral condyle) ,(2. 18 ±0. 55) ml (lateral femoral condyle) and (3. 39 ±1.31) ml (femora trochlea).Correlation coefficients between MEDIC and direct measurement for cartilage volume measurement were high [r = 0.95, t = 16. 10, P<0.05 ( patella); r=0.92, t = 12.42, P<0.05 (medial femoral condyle); r =0.94, t = 14.58, P < 0.05 (lateral femoral condyle) and r = 0.98, t = 26.06, P < 0. 05 (femora trochlea) ]. Conclusion Using image software OsiriX, sagittal MEDIC sequence permits accurate and precise measurement of cartilage volume at reasonable acquisition and segmentation time at 3.0 T MRI in swine knee.

OBJECTIVETo compare efficacy of unilateral external fixators and locking compression plates in treating type C fractures of the distal radius.

METHODSFrom January 2009 to June 2010, 76 patients with distal radius fracture were treated with LCP and external fixators, 54 patients were followed up. Among them, 29 cases were male and 25 cases were female with an average age of 45.31 (ranged, 24 to 68) years old. There were 29 patients in LCP group. According to AO classification, 8 cases were type C1, 7 cases were type C2 and 14 cases were type C3. There were 25 cases in external fixators group. According to AO classification, 6 cases were type C1, 8 cases were type C2 and 11 cases were type C3. Radial height, volar tilt and radial inclination were compared, advanced Gartland-Werley scoring were used to assessed wrist joint function after 6 and 12 months' following up.

RESULTSTwo cases were suffered from nail infection in external fixators group. Fifty-four patients were followed up from 12 to 24 months with an average of 21.3 months. Radial height was (9.60 +/- 0.72) mm, volar tilt was (9.55 +/- 0.80) degrees and radial inclination was (21.40 +/- 0.78) degrees in LCP group,while those were (9.40 +/- 0.70) mm, (9.47 +/- 0.71) degrees and (21.20 +/- 0.73) degrees in external fixtors group, and with no statistical significance (P>0.05). Advanced Gartland-Werley score after 6 months' following up was 3.31 +/- 1.17 in LCP group, 5.56 +/- 1.58 in external fixtors group, and with significant difference (t=-5.99,P<0.05); after 12 months' following up, advanced Gartland-Werley score was respectively 2.66 +/- 1.01 and 3.08 +/- 1.00, but with no statistical meaning (t=-1.55, P>0.05).

CONCLUSIONLCP and external fixtors can receive good curative effects in treating type C distal radius fracture, and LCP can obtain obviously short-term efficacy, while there is no significant difference between two groups in long-term results. For serious distal radius comminuted fracture which unable to plate internal fixation, external fixators is a better choice.

Adult ; Aged ; Bone Plates ; External Fixators ; Female ; Fracture Fixation, Internal ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius ; surgery ; Radius Fractures ; surgery ; Treatment Outcome ; Young Adult

Objective To explore how to establish and safeguard the peripherally inserted central catheters(PICC) maintenance network for the management and practical activity of PICC,so as to provide continuous high-quality PICC maintenance for discharged patients with PICC. Methods 40 nurses each year from 10 cities and 100 country hospitals affiliated with Shanxi Quality Control Center to train in the 1st and 2nd affiliated hospital of Xi`an Jiaotong University were choosen as 214 PICC maintainers. These maintainers were taken into the inner-net of 1st affiliated hospital of Xi`an Jiaotong University management system complete the PICC maintenance net of Shanxi province. Results After the establishment of maintenance network, the number of patients with PICC increased (from 610 cases in 2008 to 1 434 cases in 2014);A large number of PICC management had been down by the qualified nurses in primary hospitals; Duration of PICC in patients days was prolonged; The PICC related complications including thrombophlebitis, catheter infection,occlusion or dislodgment and unplanned extubate were significantly decreased (P < 0.05 respectively). Conclusions Establishment of PICC maintenance network can provide patients with standardized and convenient PICC maintenance service,decrease the incidence of catheter which related complications and ensure patient safety. The application of PICC maintenance network should be used more and more.

BACKGROUND:Because the content of oral and maxil ofacial anatomy is various and complex, only the traditional way of multimedia cannot display the anatomical structures from multi-angle and al-round. The development of virtual reality technology in oral and maxil ofacial anatomy of three-dimensional reconstruction research is rapid, causes the attention of many scholars, and has become a hot spot. OBJECTIVE:To develop a three-dimensional digital model of tooth, dentition and skul , and establish a multimedia database of oral and maxil ofacial anatomy to facilitate network sharing and information dissemination so as to provide new method for teaching of basic and clinical oral medicine. METHODS:Extracted teeth with intact crown and root, dentition and skul were chosen. Each specimen was taken at horizontal and vertical direction by the camera in the center of turntable. Al the images obtained were treated using Photoshop CS5 for dressing and compression. The image data were input into The VR Worx system, fol owed by parameters and hotspots setting and the compression. Final y, the three-dimensional digital models were reconstructed and output with QuickTime VR format into disk. RESULTS AND CONCLUSION:Three-dimensional digital models of tooth and skul were constructed with photography and the VR Worx 2.6 software, which could faithful y reproduce the anatomical characteristics of teeth, dentition and skul s, and facilitate researchers to rotate and scale for observation. Also, it was easy for hotspot-marking. On the platform of digital photography and The VR Worx software, it is feasible to establish the three-dimensional digital model of tooth and skul . This approach is the entity reconstruction, and the reconstructed model appears clear, vivid, and is easy to be saved and promoted.

BACKGROUND:With the rapid development of medical technology, computer image technology and the urgent needs of computer-aided clinical teaching, the application of virtual reality technology in oral and maxilofacial anatomy has become an issue of concern. OBJECTIVE:To summarize the application of virtual reality technology in oral and maxilofacial anatomy, thereby providing the better methods for clinical and basic research of oral medicine, laying the foundation for building the digital repository, and realizing the informatization and networking construction. METHODS:A computer-based retrieval was performed by the first author in the CNKI and PubMed databases to search papers related on the virtual reality technology applied in oral and maxilofacial anatomy published between January 2004 and December 2014, using the key words of “tissue engineering, virtual reality, oral and maxilofacial anatomy, digital, 3D reconstruction, multimedia, teeth, skul” in Chinese and English, respectively. According to inclusion and exclusion criteria, 52 papers were included in the final analysis. RESULTS AND CONCLUSION:The application of virtual reality technology in oral and maxilofacial anatomy mainly includes 3D digital model and virtual digital database of human body. 3D medical reconstruction software includes 3D-Doctor and Minics that support the original data sources including continuous fault anatomical images, varieties of image data and 3D scanning data. A variety of virtual reality technologies can successfuly reproduce the tooth, dentition and oral and maxilofacial anatomy, laying the foundation for building the virtual reality platform in oral clinical application and teaching.

Objective To study the receptors signaling of prostaglandin E2 on the differentiation of regulatory T (Treg) cells and Th17 cells.Methods The expression of prostaglandin E2 receptors (EP1/EP2/EP3/EP4) on the MACS-purified CD4+CD62L+ T (Th0) cells was analyzed by flow cytometry and reverse transcription polymerase chain reaction (RT-PCR).The quantity of CD25+Foxp3+ cells was examined by flow cytometry,the expression of FoxP3 mRNA and RORγt mRNA were detected using real-time RT-PCR,the level of IL-17 in the culture supernatants was detected by enzyme-linked immunosorbent assay (ELISA).ANOVA,LSD-t,Dunnett T3 were used for statistical analysis.Results EP1,EP2,EP3,EP4 were expressed on Th0 cells at different levels,and EP2 [(89.7±9.1)％] had the strongest expression.PGE2 [(3.0± 2.2) ％],EP2 agonist [(4.5± 1.0) ％] and EP4 agonist [(8.8 ±2.5) ％] decreased the quantity of CD25 +Foxp3 + cells compared with the control group [(28.6±6.8)％] (t=7.156,P=0.021; t=6.958,P=0.032; t=5.359,P=0.044).PGE2(0.210±0.020),EP1 agonist (0.833±0.045),EP2 agonist (0.227±0.025) and EP4 agonist (0.450±0.060) decreased the expression of Foxp3 mRNA compared with the control group (1.000) (t=23.817,t=5.026,t=23.313,t=16.581; all P=0.000).PGE2 [(22±6)pg/ml],EP2 agonist [(24±5)pg/ml]and EP4 agonist [(207±19) pg/ml] decreased the secretion of IL-17 compared with the control group [(678±87) pg/ml] (t=14.925,P=0.004; t=14.873,P=0.004; t=10.480,P=0.008).PGE2 (0.141±0.027),EP1 agonist (0.869±0.033),EP2 agonist (0.176±0.029) and EP4 agonist(0.371±0.042) decreased the expression of RORγt mRNA compared with the control group (1.000) (t=34.046,t=5.184,t=32.673,t=24.962,all P=0.000).Conclusion EP1,EP2,EP3,EP4 receptors are expressed on CD4+CD62L+ T (Th0) cells at different levels.Prostaglandin E2 inhibits the differentiation of Treg cells and Th17 cells via the EP2 and EP4 receptors signaling.

Objective Probe into different method safe and effective fixation method,clinical result and cliniical to indications of different treatments in intertrochanter fracture of femur in the old elderly.Methods Adopting the femur near end dissecting type to lock the stencil plate fixation 14 of 58 cases of old intertrochanter fracture of femur separately.the hip screw of motive force(DHS) fixation was used in 24,femur near end stencil plate fixation in 20,and the blood loss,operation time,ossicle split off situation and fracture heal time were compared among the three groups.Sanders grade results and complications were followed up.Results Postoperative follow up Was done in all patients,from 8 months to 3 years,averaged 1.5 years.three groups of skill type fine rate of the three groups being 92.9%,92%,90%respectively.Conclusions Different methods showed good clinical results in treating the old intertrochanter fracture of femur,each having its indications.Operation should be done should follow based on fracture type,age,physique factors and patient's osteoporosis intensity,choosing the best healing solution by characteristics of intermal flxation while each combining.The hook board(ALHP)is suitable for old patients with serious osteoporosis,DHS for Evans Ⅰ,Ⅱ types and some Evans Ⅲ type,and femur near end dissecting type stencil plate for Ⅳ and Ⅴ types fractures.