BACKGROUND:Recent reports only concern vertebroplasty for mild to moderate vertebral compression fractures, but seldom address vertebroplasty for severe vertebral compression fractures such as vertebral colapse. OBJECTIVE:To evaluate the efficacy and imaging features of percutaneous vertebroplasty for severe vertebral compression fractures. METHODS:A total of 25 patients underwent single-level vertebroplasty for vertebral compression fractures. Imaging features were then analyzed including location, pattern of compression, extent of colapse, pre- and post kyphotic angle and adjacent disc height before and after vertebroplasty. RESULTS AND CONCLUSION:60% (16/25) patients involved the thoracolumbar junction. The height of colapsed vertebral body was 14%-30% of original vertebral body. The average height of colapse was 5.17 mm or 22% of original vertebral body. Kyphotic angle before vertebroplasty ranged from 0-33° (averagely 16°) with an average correction of 12° after vertebroplasty. Average disc height before vertebroplasty was 7.3 mm above and 7.7 mm below. Visual analogue scale score was significantly higher preoperatively than that postoperatively, showing significant difference in pain improvement (P< 0.015). These data suggest that percutaneous vertebroplasty is safe and effective in the treatment of single level severe vertebral compression fractures.

Objective To study the effect and safety of dexmedetomidine on the intraoperative fentanyl requirements and cerebral hemodynamics in patients undergoing intracranial tumor surgery.Methods 62 patients scheduled for intracranial tumor surgery were selected and divided into observe group (31 cases) and control group(31 cases).Dexmedetomidine (0.5 μg/kg) was loaded in observe group,and followed by a continuous infusion of a rate of 1.0pμg · kg-1 · h-1 half an hour later.Saline was infused in the same time and the same way in control group.Dose of anesthetic and change of cerebral hemodynamics were recorded and compared.Results The mean heart rate and mean arterial blood pressure were lower in observe group than the underlying value when inducing anesthesia and during the operation (all P ＜ 0.05),while that happened after operation starting 60 minutes later in control group(all P ＜0.05).The mean heart rate and mean arterial blood pressure were lower in observe group those that in control group (all P ＜ 0.05).Dose of fentanyl and end-tidal sevoflurane concentration were lower in observe group(all P ＜ 0.05).Conclusion Dexmedetomidine used for cerebral hemodynamics stabiliby in intracranial tumor surgery has obvious curative effect and good safety.And it could decrease the dose of anesthetics and anesthesia adjuvant.

Aim To investigate the skeletal effects of ginseng flower bud(GF)on osteopenia induced by D-galactose using histomorphometry and biomechanical properties.Methods Fifty three-month-old male Sprague-Dawley rats were randomly divided into five groups.Rats in NS group(NS)were treated with NS(5 mL·kg-1·d-1)by subcutaneous injection and daily oral gavage with vehicle as control.Rats in the other four groups were given D-galactose at the dose of 100 mg·kg-1·d-1 by subcutaneous injection.Solvent control was performed between NS and DG: gastric irrigation with distilled water of 10 mL·kg-1·d-1.Other groups were: CP was gastric irrigated with integrated medicine(stanozolol 0.54 mg·kg-1·d-1+piracetam 432 mg·kg-1·d-1),GF(L)with ginseng flower bud of 0.486 g·kg-1·d-1 and GF(H)with ginseng flower bud of 2.43 g·kg-1·d-1 for 14 weeks.The longitudinal proximal tibial metaphyseal(PTM),the fifth lumbar vertebral body(LVB)and tibial shaft(Tx)sections were performed undecalcifiedly and used for bone histomorphometric analysis.858 Mini Bionix materials testing system was used to analyze the biomechanic properties of right femur via three-point bending test.The left femur was dried and assimilated,whose bone calcium(Ca),phosphate(P)content and bone hydroxyproline content were tested.Results Compared with D-glagatose group,in PTM of D-galactose treated rats,the％Tb.Ar was increased both in GF(L)and GF(H)treated groups.While the Tb.Sp was decreased.％Oc.S.Pm and Oc.N/mm decreased in GF(L),and those in GF(H)were decreased as well.In Tx,％Ct.Ar was raised,while％Ma.Ar was decreased in GF(L)and GF(H).The elastic load of femur was increased.Conclusions Compared with DG group,there are significant differences in bone histomorphometry of Tx and PTM in all doses of GF,but no significant changes are detected in hydroxyproline,Ca,and P content of femur.

Aim To investigate the effects of predni-sone on trabecular microstructure and biomechanical properties of femur in a rat model of type II collagen-induced arthritis (CIA ) using micro-CT and biome-chanics.Methods Forty 8-week-old male Lewis rats were randomly divided into 2 groups:control (CON ) group with 6 rats,and the remaining 34 rats were used to establish the CIA model.3 weeks after immunization screening CIA rats were randomly divided into CIA group,CIA plus prednisone 4.5 mg · kg-1 · d -1 group and CIA plus prednisone 9 mg · kg-1 · d -1 group.Rats in CON group were given vehicle as well as in CIA group.Rats in the other two groups were treated with prednisone at 4.5 mg·kg-1 ·d -1 or 9 mg ·kg-1 · d -1 .After 90 days treatment,all rats were euthanized,and the left femur was collected for biome-chanics,micro-CT scanning and three-dimensional re-construction.Results Micro-CT data showed that tra-becular thickness,trabecular number,bone volume/total volume,bone mineral density in CIA group were significantly lower than those in CON group.While tra-becular separation,structure model index were signifi-cantly higher than those in CON group.Compared with CON group,biomechanical properties (elastic load, maximum load,break load and stiffness)were signifi-cantly decreased in CIA group.Compared with CIA group,bone volume/total volume and trabecular num-ber were increased,while trabecular separation was significantly decreased in two prednisone groups.Com-pared with CIA group,there was no significant change in biomechanical properties in two prednisone groups. Conclusions Treatment with prednisone for 3 months can ameliorate the damage of trabecular microstructure of the femur in CIA rats,but it has no effect on biome-chanical properties and bone mineral density.

Objective To investigate the effect of small bone window hematoma ventriculoscope for clinical treatment of hypertensive cerebral hemorrhage.Methods From January 2014 to June 2017,80 patients with hypertensive cerebral hemorrhage in Zhejiang Rongjun Hospital were selected and randomly divided into two groups according to the digital table,with 40 cases in each group.The control group underwent conventional craniotomy hematoma removal surgery,the observation group received small bone window hematoma ventriculoscope treatment.The operation situation,hospitalization time,clinical efficacy and nerve function defect score,ADL score,the incidence rate of complications were compared between the two groups.Results There was no statisticall significant difference in operation time between the two groups (t =0.284,P ＞ 0.05).The amount of intraoperative bleeding of the observation group was (35.47 ± 10.69) mL,which was significantly less than (96.85 ± 27.54) mL of the control group (t =13.141,P ＜ 0.05).The hospitalization time of the observation group was significantly shorter than the control group[(8.52 ±2.31) d vs.(11.79 ± 3.05) d] (t =5.405,P ＜ O.05).The total effective rate of observation group was 92.5 ％ (37/40),which was higher than 75.0％ (30/40) in the control group (x2 =4.501,P ＜ 0.05).After treatment,the neural function defect score and daily life ability score of the observation group were (17.59 ± 2.98) points,(82.45 ±6.03) points,respectively,which were significantly higher than those of the control group[(22.17 ± 3.06) points,(73.21 ± 5.12) points] (t =6.782,7.388,all P ＜ 0.05).The incidence rate of complications of the observation group was 5.0％ (2/40),which was significantly lower than 20.0％ (8/40) in the control group (x2 =4.114,P ＜ 0.05).Conclusion Small bone window craniotomy evacuation of hematoma in the treatment of hypertensive cerebral hemorrhage,not only has significant clinical efficacy,but also has the advantages of less intraoperative blood loss,rapid postoperative recovery,less complications and so on.

Objectives To identify the effects of tuberculin purified protein derivative (PPD) sensitization on attenuating pulmonary T helper 2 (Th2) reaction and eosinophil infiltration in ovalbumin sensitized mice, and to search for the possibility of its clinical use in the management of asthma in a new way.Methods　Sixty C57BL/6 mice were sensitized with PPD and then with ovalbumin and aluminum hydroxide, and randomized into 4 groups: ovalbumin (OVA), pre-PPD, post-PPD and control groups. Aerosol PPD were administered 3 h before or after ovalbumin challenge in the pre-PPD and post-PPD groups respectively, and control group received aerosol PPD only. IL-4, IL-5 expression was detected by immunocytochemistry in situ hybridization. Lung slides were stained with eosin and hemotoxylin, and pathological changes were observed.Results　Ovalbumin aerosol inhalation caused a mixed inflammatory infiltration dominated by CD4+ T lymphocytes and eosinophils in the lung of sensitized mice. 87.5%-89.7% and 89.0%-89.2% of the CD4+ T lymphocytes were IL-4 mRNA+ and IL-5 mRNA+ respectively. 88.7%-91.2% of IL-4 mRNA+ cells and 89.8%-90.6% of IL-5 mRNA+ cells were CD4+ T lymphocytes in OVA group. Aerosol administration of PPD markedly suppressed IL-4 and IL-5 expression, and lung eosinophil infiltration. It was more effective in pre-PPD group. 76.6%-78.0% of IL-4 mRNA+ and 73.8%-79.7% of IL-5 mRNA+ cells were CD4+ and 78.1%-84.9% and 78.4%-85.3% of the CD4+ cells were IL-4 mRNA+ or IL-5 mRNA+ respectively in pre-PPD group, both were markedly lower than that of OVA group. CD4+ percentage of IL-4 mRNA+ and IL-5 mRNA+ cells were 80.7%-82.0% and 78.0%-83.9% in post-PPD group, which were markedly lower than that of OVA group.Conclusions　Sensitization with PPD by intraperitoneal injection and then challenged by PPD inhalation markedly suppressed IL-4, IL-5 expression and eosinophil infiltration, and attenuated pulmonary Th2 reaction in ovalbumin sensitized mice. This induces Th1 type reaction and inhibits Th2 cell differentiation. It may be beneficial for glucocorticoids dependent or resistant patients.

Objective In order to understand the chondrogenesis differentiation of mesenchymal stem cells in either hydrogel or pellet culture,we applied the two methods and reveal the possible mechanism and for further investigation.Methods In C3H10T1/2 chondrogenic differentiation,we apply extracellular matrix hydrogel mixed the cell suspensions of freshly prepared (including scaling chondroitin sulfate,sodium hyaluronate synthesis and cross-linking agent) co-culture system and high cell density pellet formed by centrifugation.Chondrogenic differentiation of C3H10T1/2 was induced by treatment with TGF-β3 (10 ng/ml),dexamethasone (100 nmol/L),ascorbic acid (50 ug/ml),1 ∶ 100 dilution ITS+Premix and high glucose-DMEM medium with 0.2 volume fraction fetal bovine serum.And high glucose-DMEM medium with 0.2 volume fraction fetal bovine serum is for control group.Histochemistry staining was utilized to identify extracellular proteoglycan and real-time PCR was performed to assess gene expression of SOX9,collagen Ⅱa1/Ⅹa1 and aggrecan for the 1st,2nd and 3rd week respectively.Results In the hydrogel model for 3 weeks chondrogenic differentiation,the expression of master transcription factor SOX9 was upregulated in both culture models.While the marker genes of collagen Ⅱa1 and collagen Ⅹa1 were all promoted in hydrogel culture,the aggrecan gene expression was peaked in pellet culture.In addition,immunocytochemistry analysis of the hydrogel and pellet for 3 week illustrated the expression of extracellular matrix and more obviously in the hydrogel model.Conclusion In compared with pellet culture,the MSCs in the hydrogel were more likely promoted chondrogenesis leading to the eventual expression of marker genes.And the hydrogel would be applied in regeneration of cartilage injury.

Objective To elucidate the mechanism of anti-inflammatory effect of dexamethasone and methotrexate on pulmonary Th2 reaction and eosinophil infiltration in ovalbumin sensitized mice, and search for the possibility of aerosol administration of other anti-inflammatory drugs in the management of asthma except for glucocorticoids.Methods Sixty C57b1/6 mice were sensitized and challenged with ovalbumin, aerosol dexamethasone and methotrexate were administered after challenge. Mice lung were fixed in paraformaldehyde and IL-4, IL-5 expression was detected by immunocytochemistry-in situ hybridization. Lung slides were also stained with eosin and hematoxylin, and pathological changes were observed.Results Ovalbumin aerosol inhalation caused a mixed inflammatory infiltration dominated by CD4+ T lymphocytes and eosinophils in the lung of sensitized mice. 85.2%-88.2% and 81.4%-91.8% of the CD4+ T lymphocytes were IL-4 mRNA+ or IL-5 mRNA+ respectively, and few CD8+ T lymphocytes were IL-4 or IL-5 positive (<2%). 78.8%-80.8% of IL-4 mRNA+ cells and 78.0%-86.8%of IL-5 mRNA+ cells were CD4+ T lymphocytes. Aerosol administration of dexamethasone and methotrexate after challenge inhibited IL-4 and IL-5 expression, and lung eosinophil infiltration were attenuated. And dexamethasone was more effective. These two drugs had no effect on the ratio of IL-4 or IL-5 expression of CD4+ T lymphocytes, and the percentages of CD4+ T lymphocytes of the IL-4 mRNA+ or IL-5 mRNA+ cells were not affected. The anti-inflammatory effect was non-specific. In addition, aerosol administration of dexamethasone enhanced IL-4 expression and methotrexate promoted eosinophil infiltration 12 h after challenge.Conclusion Aerosol administration of dexamethasone and methotrexate attenuated pulmonary Th2 reaction in ovalbumin sensitized mice. Aerosol administration of drug exerts its effect at the site of inflammation, which is more effective with less side effects. But at the beginning, aerosol administration might promote inflammation. In this way, oral or intravenous injection of glucocorticoids should be given to moderate to severe asthmatic patients, and aerosol gulcocorticoids should be adminstered after the disease was under control. Methotrexate was less effective than dexamethasone but more irritative, and should not be given by inhalation, Intravenous injection of methotrexate should be administrated to asthmatic patients who respond poorly to glucocorticoids as an auxiliary therapeutic measure.

Objective To clarify the influencing factors of defensive medicine and provide ideas for preventing and re-solving defensive medicine.Methods Literature related to defensive medicine was searched,personnel related to de-fensive medicine were interviewed,and literature and interview data were coded with the method of grounded theo-ry,and related concepts and categories were summarized.Results After three levels of coding,52 initial concepts,23 initial categories,7 sub-categories and 3 main categories were sorted out,and the correlation among influencing factors was analyzed to build a three-dimensional model of"doctor-patient relationship-institutional system-social environment"influencing factors and their mechanism of action.Conclusion The influencing factors of defensive medi-cine mainly include doctor-patient relationship,institutional system and social environment.The three factors have an impact on defensive medicine through different mechanisms of action,which provides qualitative evidence for comprehensive analysis of factors in related studies of defensive medicine.

Objective To clarify the influencing factors of defensive medicine and provide ideas for preventing and re-solving defensive medicine.Methods Literature related to defensive medicine was searched,personnel related to de-fensive medicine were interviewed,and literature and interview data were coded with the method of grounded theo-ry,and related concepts and categories were summarized.Results After three levels of coding,52 initial concepts,23 initial categories,7 sub-categories and 3 main categories were sorted out,and the correlation among influencing factors was analyzed to build a three-dimensional model of"doctor-patient relationship-institutional system-social environment"influencing factors and their mechanism of action.Conclusion The influencing factors of defensive medi-cine mainly include doctor-patient relationship,institutional system and social environment.The three factors have an impact on defensive medicine through different mechanisms of action,which provides qualitative evidence for comprehensive analysis of factors in related studies of defensive medicine.