Objective To investigate regional cerebral blood flow (rCBF) in hypodense areas of the brain after severe traumatic brain injury (sTBI). Methods CT perfusion (CTP) was performed in 42 patients with sTBI during the period of 2011 to 2013. According to the findings of CT scans , hypodense lesions were divided into contusion- or infarction-associated regions. Regional cerebral blood volume (rCBV) of < 15 mL/(100 g·min) was used as the threshold of severe ischemia; rCBF, rCBV, and regional mean transit time (MTT) for the hypodense lesions were analyzed, and the incidence of severe ischemia was compared between the two groups. Results A total of 62 hypodense lesions were identified in the patients. 45 of the 62 hypodense lesions were associated with contusion, and 17 of the lesions were associated with infarction. The mean CT density was significantly lower in the hypodense regions than in the contralateral mirror regions (P<0.05), and there was no significant difference in the mean CT density between the two types of lesions (P > 0.05). Cerebral perfusion was significantly lower in the contusion-associated hypodense regions than in the contralateral mirror regions (P<0.05). In the contrast, cerebral perfusion in the hypodense areas associated with infarction did not significantly differ from that in the contralateral mirror regions (P>0.05). A reduction in rCBF<15 mL/(100 g·min) was found in 25 of the hypodense regions associated with contusion, but only one of those associated with infarction. Conclusions Cerebral perfusion in contusion-associated hypodense areas decreases significantly , but not in infarction-associated hypodense areas. Correct identification of cerebral perfusion in the hypodense areas is helpful for developing therapeutic strategies.

Objective To investigate the outcome after ventriculoperitoneal (V-P)shunt for post-traumatic hydrocephalus (PTH). Methods A retrospective study investigated the outcome of 51 patients after head injury, who had undergone V-P shunt due to PTH.The Glasgow outcome scale (GOS),age and intracerebral pressure(ICP) were analyzed. Results Twenty-two of 33 patients with COS 3 or less than 3 scores had clear-cut benefit from V-P shunt,while only 6 of 18 patients with GOS 4 scores did.Tbe GOS before V-P shunt had correlated with the GOS 6 months after operation. The patients with GOS 3 or less than 3 scores had good outcome than patients with COS 4 scores (P<0.05). Patients' age and ICP before the V-P shunt did not influence the outcome (P>0.05 ). Conclusion V-P shunt has much benefit for the patients with PTH, GOS before operation is a best predictive parameter for outcome after V-P shunt.

(0.05)).② The differences in D_R,D_V,Vmax and T_R between the study group and control group were statistically significant (P

AIM: To elucidate the effect of calcitonin gene-related peptide (CCRP) in the therapy of atherosclerosis.METHODS:Effect of CGRP on cell cycle kinetics of cultured vascular smooth muscle cells(HA-VSMC) was investigated by flow cytometry. The expression of cyclins D 1 and E required for initiation of S phase were also studied by immunochemistry method. RESULT: CGRP was shown to arrest VSMC in the G 0/G 1 phase of cell cycle and reduced expression of cyclins D 1 and E. CONCLUSION:CGRP inhibits proliferation of HA-VSMC by arresting cells in G 1 phase via limiting accumulation of cyclin D 1 and E. It might play a role in the therapy of atherosclerosis.

Objective To identify the Banna viruses isolated in northwestern part of Yunnan prov-ince in order to make the difference clear between the isolates and other Banna viruses isolated in other parts of Yunnan. Methods Three isolates of Banna vires isolated in 2005 and 2006 were identified by morpholo-gy, RNA-PAGE profile and molecular biologic method. Nueleotide and amino acid sequences of segment 12 of the 3 isolates were sequenced and analyzed. Results Three Banna viruses were isolated from mosquitoes collected in northwestern part of Yunnan during 2005 and 2006. Electron microscopy study showed that they are spherical with a diameter of 70 nm, no envelope but two layers of eapsid. It was found that the genome of the 3 isolates composes of 12 segments presenting band profile of 6-6 in RNA-PAGE. Nueleotide acid se-quence analysis about segment 12 showed that the identity was 99% between the 3 new isolates, 98% and 90% between the 3 isolates and the strains isolated in other parts of Yunnan, China and Indonesia, respec-tively. Phylogenetie analysis based on segment 12 gene showed that 3 new isolates clnstered in the same branch with the viruses isolated in other parts of Yunnan. The same difference of amino acids was found between Banna viruses isolated in China and Indonesia strains in the analysis of segment 12. Conclusion Banna virus strains were firstly isolated from mosquitoes collected in northwestern part of Yunnan province. Nueleotide acid sequence analysis of the 3 new isolates showed higher identity with strains isolated in other parts of Yunnan.

Objective To analyze the different approaches and their indications in the laparo-scopic treatment of upper urinary tract transitional cell carcinoma. Methods 94 patients with upper urinary tract transitional cell carcinoma were divided to two groups. Group A (63 cases) with renal pelvic and ugper ureteral carcinoma were treated with retroperitoneal approach laparoscopic surgery and transurethral reseetoscope surgery. Group B (31 cases) with middle ureteral carcinoma including 6 cases with ureteral local infiltration were treated through 70° recumbent position transperitoneal ap-proach laparoscopic surgery combined with bladder cuff resection. The operative time, blood loss, the intestinal functional recovery time and post-operative complications were recorded. Results All 94 procedures were successfully completed, with no complication during the surgery. The mean operation time of A and B group was 156.5 and 160.8 min;the mean blood loss was 80 and 86 ml; the mean hos-pital stay was 8 and 8. 5 d; the time of bowel functional recovery of group A and group B was 24-48 and 24-72 h, respectively. 84 cases were followed-up with mean follow-up time of 23 months. Three eases and 5 cases were found having bladder tumor in the group A and group B. The incision and port metastasis was not found. Conclusions It is safe and feasible to treat the upper urinary tract transi-tional cell carcinoma laparoscopically. The selection of operating approach is mainly based on the loca-tion and local infiltration status of the tumor.

This article reviews the training model of orthopedic residents in the world's top orthopedic hospitals, such as Hospital for Special Surgery Affiliated to Cornell University and The Affiliated Hospital of Harvard University Medical School, and it is found that there are differences between China and the US in the training of orthopedic residents in the aspects of the admittance system of physicians, the setting of training contents , and the training model of orthopedic residents . The training of orthopedic residents in the US adheres to the concept of elite education and pays attention to the construction of tutors and learning atmosphere. The enlightenment to the training of orthopedic residents in China includes further clarification of the training objectives of orthopedic residents , improvement of the stage-based training system , integration of excellent medical teaching resources , and improvement of teaching methods and assessment systems.

AIM:To investigate the effect of hypoxia-preconditioned human umbilical cord mesenchymal stem cell-derived exosomes(hUCMSC-Exos)on pulmonary vascular endothelial-mesenchymal transition(EndMT)in hypoxic pulmonary hypertension(HPH).METHODS:(1)Primary hUCMSCs were isolated and cultured by tissue adhesion method,and hUCMSC-Exos were extracted by ultrafiltration and identified.(2)Twenty-four SPF male SD rats were ran-domly divided into normoxia(N)group,hypoxia(H)group,hypoxia+normoxic hUCMSC-Exos group and hypoxia+hypoxia-preconditioned hUCMSC-Exos group,with 6 rats in each group.The rats in H group and intervention groups were placed in a cabin that simulated the hypoxic environment at an altitude of 5 000 m,and normoxic hUCMSC-Exos,hypoxia-precon-ditioned hUCMSC-Exos or equivalent volume of PBS were injected through the tail vein on the 3rd,5th,7th,10th and 14th days in hypoxia environment.After 21 d of modeling,the right ventricular systolic pressure(RVSP)and right ven-tricular hypertrophy index(RVHI)of the rats were detected,and the pathological changes of lung tissues were observed by HE staining.(3)After starvation for 12 h,human pulmonary arteriole endothelial cells(HPAECs)were randomly di-vided into normoxic control(N-Con)group,hypoxic model(H-Con)group,hypoxia+normoxic hUCMSC-Exos group and hypoxia+hypoxia-preconditioned hUCMSC-Exos group.The migration ability and tube formation ability of HPAECs were detected by Transwell assay and tube formation experiment.The expression of CD31 and α-smooth muscle actin(α-SMA)in HPAECs was detected by immunofluorescence double-staining.The protein levels of CD31,VE-cadherin,α-SMA and vimentin in pulmonary vessels and HPAECs were assessed by Western blot.RESULTS:(1)The HPH rat model was suc-cessfully established after 21 d of hypoxia,and EndMT occurred in pulmonary vessels.Compared with N group,the levels of RVSP,RVHI,percentage of vascular wall area(WA%)and percentage of vascular wall thickness(WT%)in H group were significantly increased(P＜0.01),pulmonary vascular wall thickening and the protein levels of CD31 and VE-cad-herin were significantly decreased(P＜0.01),while the protein levels of α-SMA and vimentin were significantly increased in pulmonary vessels(P＜0.05 or P＜0.01).Compared with H group,the RVSP,RVHI,WA%and WT%(P＜0.01)were significantly decreased(P＜0.05 or P＜0.01),and pulmonary vascular remodeling was attenuated after normoxic or hypoxia-preconditioned hUCMSC-Exos intervention.After hypoxia-preconditioned hUCMSC-Exos intervention,HPH pul-monary vascular remodeling and EndMT formation were significantly inhibited.(2)After 48 h of hypoxic treatment,the migration,tubule formation and EndMT of HPAECs were induced.Compared with H-Con group,cell migration and tube formation were significantly decreased after hypoxia-preconditioned hUCMSC-Exos intervention(P＜0.01).The protein levels of CD31 and VE-cadherin were increased,while the protein levels of α-SMA and vimentin were decreased(P＜0.05 or P＜0.01).CONCLUSION:Hypoxia-preconditioned hUCMSC-Exos attenuate the formation of HPH pulmonary vascu-lar remodeling by inhibiting pulmonary vascular EndMT.

Objective To evaluate the effect of emergent microsurgery in treatment of patients with hematoma-type anterior circulation ruptured aneurysm.Methods The clinical data and therapeutic effect of emergency microsurgery for 32 patients with hematoma-type anterior circulation ruptured aneurysm were analyzed retrospectively.Results Finally 32 patients underwent emergency craniotomy clipping and hematoma removal in 24 h.Among them,15 cases underwent decompressive craniectomy.One week after the operation,CTA revealed that all aneurysms were completely clipped.One patient with communicating hydrocephalus were treated with ventriculoperitoneal shunt,and 6 patients had different degrees of cerebral infarction.After 6 months of follow-up,the Glasgow outcome scale (GOS) showed that there were 5 cases of grade 5 (15.6％),12 cases of grade 4 (37.5 ％),12 cases of grade 3 (37.5％),2 cases of grade 2 (6.3％) and 1 case of grade 1 (6.3％).The prognosis satisfaction rate was 53.1％ (17/32).Conclusion Emergent microsurgery is effective in the treatment of patients with hematoma-type anterior circulation ruptured aneurysm.

Objective To evaluate the effect of emergent microsurgery in treatment of patients with hematoma-type anterior circulation ruptured aneurysm.Methods The clinical data and therapeutic effect of emergency microsurgery for 32 patients with hematoma-type anterior circulation ruptured aneurysm were analyzed retrospectively.Results Finally 32 patients underwent emergency craniotomy clipping and hematoma removal in 24 h.Among them,15 cases underwent decompressive craniectomy.One week after the operation,CTA revealed that all aneurysms were completely clipped.One patient with communicating hydrocephalus were treated with ventriculoperitoneal shunt,and 6 patients had different degrees of cerebral infarction.After 6 months of follow-up,the Glasgow outcome scale (GOS) showed that there were 5 cases of grade 5 (15.6％),12 cases of grade 4 (37.5 ％),12 cases of grade 3 (37.5％),2 cases of grade 2 (6.3％) and 1 case of grade 1 (6.3％).The prognosis satisfaction rate was 53.1％ (17/32).Conclusion Emergent microsurgery is effective in the treatment of patients with hematoma-type anterior circulation ruptured aneurysm.