Staphylococcus albus (St albus) given intravenously to conscious rabbits produced a dose-dependent fever. When the St albus doses reached a certain limit, hyperthermic ceiling was approached. The pyrogenicity of plasma increased progressively along with the increase of St albus doses. When hyperthermic ceiling was approached, pyrogenicity of plasma stopped raising any further. Fever induced by St albus was associated with a dose related increase in the concentration of cAMP in csf as well as that in the plasma. The increase of cAMP in plasma and in csf was limited at the occurrence of upper limit of fever. It is concluded that cAMP may be an important central mediator in the fever induced by staphylococci, whilst the limitation of production and release of EP and the limitation of increase of cAMP in central nervous system may be two important factors in "staphylococcus hyperthermic ceiling".

Objective To investigate the surgical management of scoliosis in neurofibromatosis Ⅰ type. Methods Since 1983, the results of surgical intervention of 31 consecutive patients for scoliosis in neurofibromatosis were reviewed. There were 19 males and 12 females. The mean age of the patients was 15.4 years (range, 5 to 25 years). The type of curve in scoliosis included thoracic curve in 23 patients, lumbar curve in 3 and thoracolumbar curve in 5. There were 6 cases of thoracic curves associated with kyphosis. The mean Cobb angle of scoliosis was 85.9? ranging from 45? to 145?, and the mean Cobb angle of kyphosis was 81.3? ranging from 43? to 120? before operation. The surgical methods included posterior operation in 17 patients, anterior operation in 2, and combination of anterior and posterior in 12. The instrumentation used for internal fixation included Harrington rod in 7 patients,Luque rod in 3, combination of Harrington and Luque rod in 5 patients, CD in 4 patients, CDH in 3 patients,TSRH in 7, and PRSS in 2, 10 cases of whom only single rod fixation were used. Results The patients were followed up for an average of 9.4 years (range, 1-18 years). The correction rate of Cobb angle in scoliosis was 33.4% in scoliosis, and 39.6% in kyphosis postoperatively. The complications of the group consisted of Luque rod breakage in 1 patient, Harrington rod breakage in 1, Harrington rod and Luque wire breakage in 1,nonunion of bone graft and pseudarthrosis in 4, curve aggravation in 1. One patient underwent revision for three times because of recurrent hook dislodgement. Conclusion Scoliosis in neurofibromatosis should be operated early, sufficient bone graft and the solid instrumentation for internal fixation are required.

Objective To investigate the role of M3 receptor in the effect of penehyclidine hydrochloride(PHC) upregulating β-arrestin-1 expression in lipopolysaccharide(LPS)-induced human pulmonary microvascular endothelial cell(HPMVEC) injury.Methods.M3 shRNA transfected HPMVEC and normal HPMVEC cells were randomly divided into LPS group(A),LPS+pHC group(B),LPS+ M3 shRNA transfection group(C) and PHC+ LPS+ M3 shRNA transfection group(D).The cytoskeleton change was observed by laser scanning confocal.The LDH level in cellular supernate was detected.The VCAM 1 protein expression was examined by immunofluorescence chemistry.β-arrestin-1 protein expression was determined by Western blot and β-arrestin-1mRNA expression was measured by real-time PCR.Results Compared with the group A or C,F-actin cytoskeleton arrangement in the group B or D was neat,the LDH level and VCAM-1 protein expression were decreased,and β-arrestin-1 expression was increased;compared with group A or B,F-actin cytoskeleton arrangement in the group C or D was neat,the LDH level and VCAM-1 protein expression were decreased,while the β-arrestin-1 expression had no obvious change.Conclusion Silence M3 receptor is conducive to reduce LPS-induced HPMVEC injury.But the role of PHC up-regulating β-arrestin-1 expression has no necessary connection with M3 receptor.

[Objective]A prospective comparative evaluation of fulcrum bending radiographs(fulcrum)to determine curve flexibility and predict surgical correction in adolescent idiopathic scoliosis(AIS).[Method]A total of 64 consecutive patients with AlS according to inclusion and exclusion criterias who underwent surgical treatment were studied.All curve types were single-curve and the PUMC classification were Ia/Ib/Ic.All patients were divided into 4 groups according to the magnitude of Cobbs angle in preoperative standing anteroposterior radiograph:moderate thoracic curve(20 cases,40?60?),moderate lumbar curve(21cases,35?60?).The Cobbs angles were measured and the flexibility ratio was determined on fulcrum radiograph.The amount of correction obtained by fulcrum radiograph was compared with the amount of surgical correction by evaluating the differences from surgery as absolute values.The correlation of Cobbs angles between postoperative standing anteroposterior radiograph and fulcrum radiograph were analyzed.[Result]For the moderate thoracic curves,curve flexibility provided by fulcrum radiograph has no significant difference(P=0.141)from surgical curve correction,there was no significant difference(P=0.094)between the mean Cobbs angle on fulcrum bending and that on postoperative standing anteroposterior radiograph.The postoperative Cobbs angle was positively correlated with the preoperative Cobbs angle on fulcrum radiograph and the correlation degree in the moderate lumbar curve was relatively weak.[Conclusion]Fulcrum radiograph can only be used to assess the flexibility and correction of moderate thoracic curves in AIS.Pedicle screw instrumentation provides even more correction.

Objective The study was to probe into the causes and strategies of decompensation after operation in adolescent idiopathic scoliosis in order to reduce the operative mistakes and be aware of pitfalls in scoliosis surgery.Methods From July1997to December2001,174patients underwent the operation of three-dimensional correction of adolescent idiopathic scoliosis,ten of them developed postoperative decom-pensation.Other four patients with postoperative decompensation were referred to our hospital,who received the primary operation for idiopathic scoliosis at the local hospital.In all,fourteen patients with decompensa-tion were retrospectively reviewed including3male and11female cases aging from12to23years(range,15.7years).The criteria of postoperative decompensation was defined as trunk shift more than2mm,shoul-der tilting,aggravated distal lumbar rotation in coronal plane,the plumb line of center of C 7 deviating the from the posterior edge of S 1 and kyphosis of thoracic-lumbar junction more than10degree in sagittal plane.Results The analysis was made depending on preoperative and postoperative X-ray films,the causes of de-compensation after surgery included classification error,inappropriate fusion level,over correction for tho-racic curve and insufficient knowledge of lumbosacral hemicurve in this group.According to the patientssubjective symptoms and decompensation conditions,ten of the patients were treated surgically,which in-cluded re-fusion and fixation for3patients,fusion level extension for6patients and fusion of the upper tho-racic curve after removing major thoracic curve instrumentation for one patient.The other four patients re-ceived conservative therapy with brace.The patients were followed up from1to3years(average,18.9months),except one case followed up to6months.Twelve patients regained spinal balance;two patients re-mained more than20mm trunk shift.Conclusion Although operative treatment is frequently used for idio-pathic scoliosis,it is important to recognize the necessity for operative intervention,indication for surgery.The adolescent idiopathic scoliosis should be operated according to the curve type and flexibility,the appro-priate fusion level and operative procedures can contribute to lessen the postoperative decompensation.If postoperative decompensation occurs,therapeutic decision should be made according to subjective symptoms and the decompensation type of the patients.

Objective To evaluate the clinical manifestation and operative treatment for the scolio-sis of Marfan syndrome, and analyze its clinical outcomes as well. Methods The retrospective study cov-ered 10 patients including 8 females and 2 males with an average age of 12.9 years (9 to 16 years), who had undergone operations from January 1990 to December 2002. The Cobb's angle in the coronal and sagittal plane, the trunk shift, the apex rotation and shift were evaluated both before and after operation respectively. In the group, there were four cases with family history. Of the 10 cases, the classification of scoliosis was single curve in two cases, double curves in six cases and three curves in two cases. Results All the pa-tients were followed up for a mean time of 15 months, ranged from 4 months to 3 years. The trunk shift changed from the mean distance of 2.17 cm to 1.41 cm. The apex rotation decreased about 1?. The apex shift changed from the mean distance of 4.57 cm to 2.14 cm. The mean Cobb's angle in the coronal plane changed from 88? to 42?. The correction rate was about 46.38% (18.18% to 81.54%). The Cobb's angle on the final follow-up was 46?( 11? to 96?), and the mean lost angle was 4?. The mean Cobb's angle of the thoracic kyphosis was 20?(-10? to 52?) preoperatively and 23?(0? to 35?)postoperatively, and 24?( 0? to 35?) on the final follow-up. The Cobb's angles of the thoracolumbar kyphosis of 5 cases improved from 85? to 10? after operations, and there was no angle loss on the follow-up. Conclusion The three dimensional corrective instrumentation can be used effectively for the correction of the scoliosis of Marfan syndrome. The critical points for the successful operation are the simultaneous correction of the coronal and sagittal plane deformities, prevention of the dural expansion in the lumbar or lumbosacral canal, rigid and multi-segmental internal fixation, extensive and ample bone fusion, and correct external fixation after operation.

Objective To investigate the changes of the intervertebral angle and retrolisthesis of the last instrumented vertebrae (LIV) after anterior correction and instrumentation in adolescent idiopathic scoliosis patients. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent anterior correction and instrumentation in recent 4 years, their Cobb angle of the curve, correction rate, trunk shift, LIV rotation, obliquity between LIV and the pelvis, intervertebral angle and retrolisthesis of the LIV were measured and analyzed. Results There were total 50 patients included. The apex of the main curve was located at thoracolumbar junction or lumbar spine. The coronal Cobb angle of the main curve were 47.78??9.39? and 10.32??8.50? before and after surgery respectively, with an average correction rate of 79.05%. The average rotation of LIV before surgery was 1.54??0.58?, and improved to 1.06??0.47? after surgery. The obliquity between LIV and the pelvis before and after surgery were 23.80??7.91? and 9.16??9.46? respectively. The intervertebral angle was 3.72??3.05? before surgery, and -2.22??5.85? on Bending films, 1.56??5.97? after surgery respectively. The changes were of significance in the intervertebral angle after surgery compared with that before surgery(P=0.029). The angle was 4.87??7.95? at final follow up, the change was also significant compared with that after surgery(P=0.038). 19 patients had LIV retrolisthesis postoperatively, and the average retrolisthesis distance was (4.79?1.75) mm. There were significant differences between the patients with retrolisthesis and the patients without retrolisthesis in apical vertebral rotation and intervertebral angle on Bending films(P=0.047 and P=0.033) respectively. Conclusion The intervertebral angle is much improved after anterior correction and instrumentation surgery, but it increases gradually at follow up. The retrolisthesis of LIV may be correlated with the apical vertebral rotation before surgery and the intervertebral angle on Bending films.

Objective To observe the expression of the transforming growth factor beta 1, the basic fibroblast growth factor and the core protein of proteoglycan on the convex and concave sides of apex and end vertebral cartilagnous endplate in adolescent idiopathic scoliosis. Methods There were 12 cases in the study group. There were 4 males and 8 females. The age of patients at the surgery ranged from 12 to 20 years(with an average of 14.9 years). The Cobb angle ranged 43? to 102? (mean, 65.1?) preoperatively. The diagnosis of idiopathic scolisis was made based on radiography, CTM and/or MRI to rule out congenital, neuromyeputhic and other scolisis. All patients underwent anterior correction procedures. The sections of the convex and concave side of the resected apex and end vertebral cartilage endplate were examined with S-P immunohistochemistry and the results were analyzed with image analysis system. Results The transforming growth factor beta 1, the basic fibroblast growth factor and the core protein of proteoglycan were all expressed in the cytoplasm of chondrocytes in the cartilaginous endplate. With non-parameter Wilcoxon rank test, the area density and quantity density of the transforming growth factor beta 1, the basic fibroblast growth factor on the concave curve of the apex and end vertebrae are expressed in a significantly higher level than those of the convex curve at the apex and end vertebrae(P0.05). Conclusion There was a significantly higher expression of TGF?1 and bFGF, while a lower expression of the core protein on the concave side, which suggest a possible aetiological factor or a secondary change in the development of AIS.

Objective A two-stage renovation has nowadays been considered as the optimal mode for the treatment of infected total hip joint.Extensive bone defects were often found during the subsequent operation,and they should be repaired by using allograft to attain stability of the implants.The purpose of present study is to investigate the efficacy and safety of employing bone allograft in repairing the femoral defect caused by post-operation infection of hip arthroplasty in the second stage operation.Method From Mar.2001 to Dec. 2006,a total of 20 patients(20 hips)with infected total hip arthroplasty were treated with bone allograft on the femoral side in the second operation.Impaction bone grafting technique was performed for 16 patients using bone allograft combined with cemented stems,and un-ce- mented prosthesis combined with bone strut allograft were used in the other 4 cases.A regular follow-up was done and the outcomes were evaluated using the Harris Hip Score System and radiography.Result All patients were followed-up clinically and radiographically for an average of 20.3 months(4-61 months).No re-infection was found at the last time of follow-up.The mean Harris Hip Score was in- creased from 34.2 before operation to 87.7 after operation.90% of the patients were satisfactory with the results.Conclusion The bone allograft can be used for reconstructing bone defects in the patients after infection of total hip arthroplasty,either with combined with ce- mented stems or non-cemented stems.It is an effective and safe way in dealing with femoral bone defect after infection of total hip arthro- plasty.

Objective In this study, we tested the ability of platelet-rich plasma to enhance bone consolidation during distraction osteogenesis in a rabbit model of leg lengthening. Methods Twenty New Zealand white rabbits, which were randomly divided into two groups, the PRP treated group and the control group (n=10). Osteotomy will be made under the tibiofibular junction of left tibia, and 1cm tibia shaft will be removed through a second osteotomy. The tibia will be shorted for 1cm and then fixed by Orthfix unilateral lengthener with 4 pins. Lengthening will start 7 days after the osteotomy surgery, at a rate of 1.0 mm/day, in two steps, for 10 days. 500ul PRP were respectively injected into the distraction gaps at the end of the 10-day lengthening and at 10 days before termination. No management in the control group. The animals were terminated at day 20 following final lengthening. Serial radiographs will be taken at the day of surgery, day 12, day 17, day 27, day 37, using a C-arm radiography system. The excised bone specimens were scanned by X-ray and Micro-CT, and the bone mineral content(BMC) and the bone mineral density(BMD) of the regenerates were calculated and compared. Results The regenerate of PRP treated group was significantly better than the control group. The X-ray figures showed that the regenerate was significantly more than the control group. The figures of micro-CT 3D reconstruction showed that the growth and remodel of the regenerate in PRP treated group was better than the control group. Micro-CT examination of regenerates demonstrated a significantly greater bone mineral content(BMC) and the bone mineral density(BMD) in the PRP treated group compared to the control group(P