BACKGROUND:For vertebral compression fractures treated by bal oon vertebroplasty, there were stil controversies in biomechanical and clinical studies about adjacent vertebral fractures is the result of osteoporosis progress, or the result of vertebral intervention and strengthening by injecting bone cement. More accurate conclusions can be obtained through more in-depth research and long-term fol ow-up. OBJECTIVE:To evaluate the effect of bal oon vertebroplasty on biomechanical properties of vertebral body with compression fractures and unstrengthened adjacent vertebral body. METHODS:Total y 40 pig specimens with vertebral compression fractures were prepared and randomly divided into study and control groups. Specimens in the study group were subjected to bal oon vertebroplasty. Specimens in the control group only wrapped with normal saline gauze. The biomechanical properties (vertebral height, maximum load), stress, strain and displacement values of specimens under 500 N loading in these two groups were compared. The stress and strain values of unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group were measured, and compared with the control group. RESULTS AND CONCLUSION:Compared with the original height, specimens in the study group can restore to its original height after bal oon vertebroplasty, the differences were not significant (P>0.05). The former, back, left and right vertebral height in the study group were significantly higher than those in the control group (P<0.01). After the bone cement augmentation, the stiffness of vertebral body in the study group was significantly lower than that in the control group, the maximum loading was significantly increased compared with that in the control group (P<0.05). Under a fixed loading of 500N, compared with the control group, the disc displacement value after the bal oon vertebroplasty was significantly reduced and the disc strain and stress values were significantly increased in the study group (P<0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group (P>0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body after the bal oon vertebroplasty between study group and control group (P>0.05). These results suggest that vertebral maximum loading and stiffness recover wel after the treatment of bal oon vertebroplasty for vertebral compression fractures, which can achieve the effect of preventing vertebral fractures again. Meanwhile, bal oon vertebroplasty treatment can not alter the biomechanical properties of adjacent vertebrae, and it is difficult to influence and lead vertebral fractures again, with a better security.

Objective To study the clinical efficacy and safety of posterior laminoplasty combined with foraminotomy in the treatment of mixed cervical spondylosis.Methods A total of 70 patients with mixed type cervical spondylosis from January 2012 to January 2014 in our hospital were randomly divided into observation group and control group.Patients in observation group received posterior laminoplasty com-bined with foraminotomy,and patients in control group received anterior cervical discectomy and fusion surgery.The operation time,intraoper-ative blood lossing,postoperative JOA scores and NDI scores between two groups were compared.The cervical curvature and range of motion were measured by X-ray.Results There was no significant difference in postoperative JOA scores,cervical curvature and range of motion be-tween two groups(P >0.05).The operative time and intraoperative blood loss of observation group was less than those of control group,the difference was no significance.The NDI scores of carrying and drive in observation group were higher than those in control group,while the NDI scores of other items between two groups had no significant difference(P >0.05).The incidence of complications in observation group was 10.81% (4 /37),the control group was 24.42% (8 /33),the difference between two groups was statistically significant,(χ2 =3.428, P <0.05).Conclusion The posterior laminoplasty combined with foraminotomy have good clinical effect for mixed type cervical spondylosis with advantages of a shorter operation time,simple operation,less intraoperative bleeding,lower incidence of complications,which is a kind of safe and effective surgical method.

bThis study explored whether the transplantation of modified marrow stromal cells (MSCs) has angiogenic effects in a left middle cerebral artery occlusion infarction/reperfusion (MCAO I/R) rat model and preliminarily examined the mechanism of angiogenesis following cerebral infarction. MSCs were isolated by using a direct adherent method and cultured. Vascular endothelial growth factor (VEGF) was transfected into MSCs by employing the liposome transfection. The transfection efficiency was measured by the optical density method. The protein expression of VEGF gene before and after transfection was measured by Western blotting. SD rat model of transient occlusion of the left middle cerebral artery was established by using an approach of intra-luminal occlusion. Tetrazolium (TTC) and HE staining were performed to observe the cerebral infarction. ELISAs were used to measure the levels of VEGF in the rat cerebral tissues. The expression patterns of angiopoietin-2 (Ang-2) and CD34 in cells surrounding the area of infarction were immunohistochemistrically observed. Ang-2 protein expression in the tissue surrounding the area of infarction was measured by Western blotting. VEGF expression in the MSCs increased after transfection at a rate of approximately 28%±3.4%. ELISA showed that the expression of VEGF in the cerebral tissue was significantly increased after induction of infarction, peaking on the 4th day and decreasing to the levels of the sham surgery group (normal) within 7 to 10 days. The VEGF level was significantly higher at each time point in the VEGF-MSC and MSC groups compared to the model group. Moreover, the VEGF level was higher in the VEGF-MSC group than in the MSC group and stayed relatively high until the 10th day. The immunohistochemical results showed that 10 days after the infarction, the number of Ang-2 and CD34-expressing cells in the area surrounding the infarction was significantly higher in the VEGF-MSC group and the MSC group compared to the model group. Moreover, the VEGF level was higher in the VEGF-MSC group than the MSC group. A similar trend in Ang-2 protein expression was revealed by Western blotting. In the MCAO rat model transfected with modified MSCs over-expressing VEGF, compared to the MSC transplantation group, the concentration of VEGF was significantly increased in the brain tissue after cerebral infarction. In addition, the level of Ang-2 was up-regulated, with angiogenesis promoted, the blood supply to the areas surrounding the cerebral infarction increased, and neurological function improved. We are led to speculate that the synergistic effects of VEGF and Ang-2 may be responsible for the angiogenesis following cerebral infarction.

The sustainable development of the teaching staff is crucial to the overall advancement of medical education reform under the background of medical and educational collaboration. With the support of the Shanghai Key Teachers' Teaching Incentive Program, Shanghai Jiao Tong University School of Medicine has established the interdisciplinary and inter-school teaching teams for undergraduate students and broken though the "last mile" of fully implementing the medical teaching reform of organ-system integrated curriculum in the country. Meanwhile, we also has reformed hourly remuneration system, formulated rules and regulations corresponding to each link, and improved the supervision mechanism, which has consolidated the mechanism of medical and educational collaboration, promoted the development of community for teachers and comprehensively improved the quality of medical education.

The sustainable development of the teaching staff is crucial to the overall advancement of medical education reform under the background of medical and educational collaboration. With the support of the Shanghai Key Teachers' Teaching Incentive Program, Shanghai Jiao Tong University School of Medicine has established the interdisciplinary and inter-school teaching teams for undergraduate students and broken though the "last mile" of fully implementing the medical teaching reform of organ-system integrated curriculum in the country. Meanwhile, we also has reformed hourly remuneration system, formulated rules and regulations corresponding to each link, and improved the supervision mechanism, which has consolidated the mechanism of medical and educational collaboration, promoted the development of community for teachers and comprehensively improved the quality of medical education.

bThis study explored whether the transplantation of modified marrow stromal cells (MSCs) has angiogenic effects in a left middle cerebral artery occlusion infarction/reperfusion (MCAO I/R) rat model and preliminarily examined the mechanism of angiogenesis following cerebral infarction. MSCs were isolated by using a direct adherent method and cultured. Vascular endothelial growth factor (VEGF) was transfected into MSCs by employing the liposome transfection. The transfection efficiency was measured by the optical density method. The protein expression of VEGF gene before and after transfection was measured by Western blotting. SD rat model of transient occlusion of the left middle cerebral artery was established by using an approach of intra-luminal occlusion. Tetrazolium (TTC) and HE staining were performed to observe the cerebral infarction. ELISAs were used to measure the levels of VEGF in the rat cerebral tissues. The expression patterns of angiopoietin-2 (Ang-2) and CD34 in cells surrounding the area of infarction were immunohistochemistrically observed. Ang-2 protein expression in the tissue surrounding the area of infarction was measured by Western blotting. VEGF expression in the MSCs increased after transfection at a rate of approximately 28%±3.4%. ELISA showed that the expression of VEGF in the cerebral tissue was significantly increased after induction of infarction, peaking on the 4th day and decreasing to the levels of the sham surgery group (normal) within 7 to 10 days. The VEGF level was significantly higher at each time point in the VEGF-MSC and MSC groups compared to the model group. Moreover, the VEGF level was higher in the VEGF-MSC group than in the MSC group and stayed relatively high until the 10th day. The immunohistochemical results showed that 10 days after the infarction, the number of Ang-2 and CD34-expressing cells in the area surrounding the infarction was significantly higher in the VEGF-MSC group and the MSC group compared to the model group. Moreover, the VEGF level was higher in the VEGF-MSC group than the MSC group. A similar trend in Ang-2 protein expression was revealed by Western blotting. In the MCAO rat model transfected with modified MSCs over-expressing VEGF, compared to the MSC transplantation group, the concentration of VEGF was significantly increased in the brain tissue after cerebral infarction. In addition, the level of Ang-2 was up-regulated, with angiogenesis promoted, the blood supply to the areas surrounding the cerebral infarction increased, and neurological function improved. We are led to speculate that the synergistic effects of VEGF and Ang-2 may be responsible for the angiogenesis following cerebral infarction.
Angiopoietin-2 ; genetics ; metabolism ; Animals ; Bone Marrow ; metabolism ; pathology ; Cerebral Infarction ; genetics ; metabolism ; pathology ; Male ; Neovascularization, Pathologic ; genetics ; pathology ; Rats ; Rats, Sprague-Dawley ; Stromal Cells ; metabolism ; pathology ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

Objective To investigate the effects of the extent of regional lymph node dissection on the prognosis of patients with T4 gallbladder carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with T4 gallbladder carcinoma who underwent radical cholecystectomy in the 4 medical centers between January 2013 and December 2016 were collected,including 31 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,16 in the First Affiliated Hospital of Xi'an Jiaotong University,11 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 6 in the Affiliated Hospital of North Sichuan Medical College.There were 27 males and 37 females,aged from 35 to 77 years,with a median age of 59 years.Sixty-four patients underwent radical cholecystectomy and regional lymph node dissection.According to the extent of intraoperative lymph node dissection,25 patients (13 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,6 in the First Affiliated Hospital of Xi'an Jiaotong University,4 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 2 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct,hepatoduodenal ligament,back of head of pancreas,next to common hepatic artery and celiac trunk were allocated into the extended dissection group,39 patients (18 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,10 in the First Affiliated Hospital of Xi'an Jiaotong University,7 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 4 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct and hepatoduodenal ligament were allocated into the control group.Observation indicators:(1) postoperative complications;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival up to January 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was evaluated with the independentsample t test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.The survival curve was drawn using the KaplanMeier method,and the comparison of survival rates was done by the Log-rank test.Results (1) Postoperative complications:64 patients with T4 gallbladder carcinoma underwent successful radical cholecystectomy and regional lymph node dissection,without intraoperative death.Twelve patients had different degrees of postoperative complications.Four of 7 patients undergoing extended radical cholecystectomy had postoperative complications.Twenty-five patients in the extended dissection group were cured by conservative treatment,including 4 with intraperitoneal infection and 2 with pancreatic leakage,with a complication incidence of 24.0％ (6/25).Thirtynine patients in the control group were cured by conservative treatment,including 5 with intraperitoneal infection and 1 with gastric retention,with a complication incidence of 15.4％ (6/39).There was no statistically significant difference in the complication incidence between the two groups (x2=0.284,P＞0.05).(2) Follow-up and survival situations:64 patients were followed up for 1-60 months.The postoperative overall median survival time was l l months.The postoperative median survival time,1-,3-and 5-year cumulative survival rates were respectively 18 months,80％,16％,9％ in the extended dissection group and 8 months,21％,4％,0 in the control group,with a statistically significant difference in the prognosis between the two groups (x2=14.744,P＜ 0.05).Conclusions On the premise of practiced surgical skill,extended regional lymph node dissection cannot increase incidence of surgical complication in patients with T4 gallbladder carcinoma after radical resection.Actively extending lymph node dissection up to near common hepatic artery,peri-celiac trunk and back of head of pancreas can improve long-term survival and prognosis.

Objective:To evaluate the efficacy of proximal humerus internal locking system (PHILOS) via the minimally invasive plate osteosynthesis (MIPO) in the treatment of proximal humeral fractures.Methods:This retrospective study analyzed 30 elderly patients with proximal humeral fracture who had been treated by PHILOS via MIPO from September 2016 to March 2020 at Department of Orthopedic Surgery, People’s Hospital of Zhuxi County. They were 19 females and 11 males with an average age of 60.96 years (from 45 to 80 years). All patients were treated by closed reduction. After fracture reduction was confirmed by fluoroscopy, a minimally invasive incision was made below the acromion, with a couple of suture wires reserved at the rotator cuff attachments. A PHILOS plate was inserted at 4 mm lateral to the intertubercular sulcus, with the suture wires passing through the proximal suture holes on the PHILOS. After a lag screw was first screwed up into the compression hole on the PHILOS plate, the crossing suture wires were tightened up to resist the rotator cuff stress and maintain the internal inclination of the humeral head. Kirschner wires were used to temporarily stabilize the reduction. After satisfactory reduction and fine plate positions were confirmed by fluoroscopy, locking nails were screwed up. The internal inclination of the affected humeral head was compared between preoperation and the last follow-up. The therapeutic efficacy was evaluated by the shoulder Neer scoring system, and the visual analogue scale (VAS) pain scores and complications were recorded at the last follow-up.Results:All the 30 patients were followed for 6 to 18 months (average, 12 months). There was no incision infection, neurovascular injury, or internal fixation failure. Anatomical reduction was achieved in 25 patients and functional reduction in 5. The inclination of the humeral head was significantly improved. The VAS scores at the last follow-up averaged 1.9. Follow-up X-ray examination showed that bony union was achieved after 6 to 18 months (average, 9 months) for all patients. At the last follow-up, the inclination angle of the affected humeral head was 130°±5°, significantly improved compared with the preoperative 90°±11.2° ( P<0.05). All patients had good functional recovery of the shoulder. The efficacy was, according to the Neer shoulder scores at the last follow-up, excellent in 22, good in 6 and fair in 2 cases. Conclusions:Treatment of proximal humeral fractures using PHILOS via MIPO technique is suitable for patients with osteoporotic fracture, and may lead to fine therapeutic efficacy.

OBJECTIVEThe term "premature thelarche" refers to isolated breast development before 8 years of age in female, without any other signs of sexual maturation, while "gynecomastia" is the presence of breast tissue in males. This study aimed to investigate the prevalence of premature thelarche and gynecomastia in Chinese infants and toddlers, identify the potential risk factors, and explore the influence of early breast development on physical growth, mental development and psychomotor development.

METHODA total of 1 510 full term and healthy children at the age of 0-48 months were sampled by stratified cluster random sampling method from 8 provinces from 2011-2012. Weight, height and breast development were assessed by senior primary pediatricians, while Bayley Scale of Infant Development-I (BSID-I) was used to measure the mental developmental index (MDI) and psychomotor developmental index (PDI) for children aged 2-30 months. Social-demographic Questionnaires were completed by the caregivers.

RESULTThe combined prevalence of premature thelarche and gynecomastia was 1.6% (23/1 475), girls 2.2% (15/695), boys 1.0% (8/780), all within 2 years of age. The birth weight, feeding patterns in first 4 months, delivery mode, weaning time and social economic status were not significantly associated with the breast development. However, lower father's education level (OR = 3.632, 95%CI = 1.565-8.432) as well as smoking mother (OR = 18.960, 95%CI = 1.590-226.304) were significantly related to breast development even after adjusting for potential confounders. Lower weight (-0.479 ± 0.648 vs. 0.005 ± 0.987, P < 0.05) and height (-0.602 ± 1.042 vs. 0.008 ± 0.986, P < 0.05) Z score were found in breast development group, even after adjusting for age, gender and father' education level. Neither mental development (t = -0.082, P > 0.05) nor psychomotor development (t = 1.054, P > 0.05) was associated with breast development.

CONCLUSIONWe showed a similar prevalence of premature thelarche with the data reported in similar studies reported from other countries. Among the 0-48 months old infants and toddlers, Father's education level and smoking mother were both related to breast development. Breast development was significantly associated with physical growth, but had no correlation with the mental or psychomotor development.

African Continental Ancestry Group ; Body Height ; Body Weight ; Breast ; growth & development ; Child Development ; Child, Preschool ; Cross-Sectional Studies ; Environmental Exposure ; Female ; Gynecomastia ; epidemiology ; etiology ; Humans ; Infant ; Infant, Newborn ; Male ; Multivariate Analysis ; Prevalence ; Puberty, Precocious ; epidemiology ; etiology

Objective:To construct a value evaluation framework for high-value medical consumables,providing a guidance for medical insurance access and hospital access management scenarios in China.Methods:It conducted literature review,qualitative in-terviews and quantitative surveys.A total of 12 experts were invited for qualitative interviews,while 100 experts from four fields of health technology assessment,medical insurance,hospital management,and clinical practice participated in the quantitative survey.Through those process,it generated the composition of the value framework and the scoring of each item.Differences in ratings be-tween different scenarios and experts were analyzed through chi-square tests.The recommendation level for each item was graded.Re-sults:A comprehensive value evaluation framework for high-value medical consumables was established,which included 6 core dimen-sions,comprised 16 items for secondary dimensions and 50 items for tertiary dimensions.It showed significant differences between the medical insurance access and hospital access scenarios,as well as among different fields of experts in the same scenario.furthermore,grading the items in two scenarios.The medical insurance access scenario had 8 highly recommended items,and the hospital access scenario had 24 highly recommended items.Conclusion:Value evaluation should encourage multi-dimensional assessments and inter-disciplinary participation,continually improving the management of high-value medical consumables in medical insurance and hospital access.