BACKGROUND:Anterior cruciate ligament is the important anatomic structure to maintain the knee joint stability. The tendon bone healing and clinical functional recovery after anterior cruciate ligament have attracted more attention. OBJECTIVE:To observe the healing of graft tendon and surrounding bone with histological method through the same diameter grafts matching with the bone tunnel of different sizes in the anterior cruciate ligament reconstruction surgery, and to detect the functional recovery with biomechanics. METHODS:Middle 1/3 of canine autologous tendon was selected as the anterior cruciate ligament graft, and then trimmed into the same diameter of 4 mm. Sixteen adult mongrel canine were randomly divided into four groups. The anterior cruciate ligament was resected completely, and the tibial and femoral tunnels were prepared on the end sites of tibia and femur with the diameters of 5, 4.5, 4 and 3.5 mm, then implanted into the tendon in prepared and linked into the bone tunnel. At 6 weeks after reconstruction, the experimental canine were sacrificed under general anesthesia to col ect the tissue and organs in the surgical area. Then the hematoxylin-eosin staining, biomechanical testing and statistical analysis were performed. RESULTS AND CONCLUSION:At 6 weeks after anterior cruciate ligament reconstruction, anatomical observation showed that there were no significant differences in growth of grafts and bone tunnels between groups;hematoxylin-eosin staining showed sharpey-like fibronectin could be seen in the tendon bone healing surface, and the col agen fibers in the 3.5 mm bone tunnel group were more compact and regular than those in the other groups;the biomechanical testing results in the 3.5 mm bone tunnel group were better than those in the other groups. The results indicate that during anterior cruciate ligament reconstruction, decreasing the diameter of bone tunnel that matched with grafts in order to make the tendon and the bone tunnel closely matched can provide a more stable cel biological and mechanical environment, accelerate the formation and transformation of tendon-bone healing interface, and can improve the quality of tendon-bone healing.

Objective To investigate the prognostic risk factors for surgery in patients with cirrhotic portal hypertension.Methods One hundred and sixty one patients with cirrhotic portal hypertension who received surgery in our hospital in the past 10 years were studied.The data were entered into a pre-designed form.24 predictors including patients′ age,sex,degree of liver atrophy,ChildPugh classification,coagulation profile,splenic size,renal function,blood pH,base excess (BE),operative time,volume of ascites,and intraoperative and postoperative hemorrhage were recorded and analyzed.For each of the predictors,2-3 subgroups were compared.Results Seven predictors were clearly related to surgical prognosis:postoperative bleeding within 30h (B0.356,P＜0.001) and a bleeding volume ＞2 L were awarded 3 points; liver volume (B-0.160,P＜0.001) and severe liver atrophy (antero-posterior diameter of the left liver lobe ≤55 mm,oblique diameter of the right lobe ≤110 mm) were awarded three points; blood pH (B0.141,P＜0.001),pH＜7.35 was awarded 2 points; BE (B-0.123,P＜0.001),BE＜-3 (mmol/L) was awarded 2 points; decrease in PLT (B0.065,P =0.015),PLT＜ 3 (T/L) was awarded 2 points; intraoperative bleeding (B0.062,P=0.014),bleeding volume ＞2 L was awarded 2 points; decrease in RBC (B0.053,P=0.024),＜3(G/L) was awarded 1 point.Of the 147 patients who recovered from surgery,all had ≤3 points,except one who had 4 points.Of the 14 patients who died,all had ≥5 points except one who had 4 points.Conclusions Postoperative bleeding (＞2 L),severe liver atrophy (antero-posterior diameter of the left live lobe ≤55 mm,oblique diameter of the right lobe ≤110 mm),blood PH＜7.35,BE ＜-3 (mmol/L),PLT＜30 000(T/L),intraoperative major bleeding (＞2 L) and RBC＜3 (G/L) were significant prognostic risk factors for surgery.For patients who had a score of 5-6 points; death was likely following surgery.A score ≥8 points should be considered as a contraindication to surgery.To reduce operative mortality,active treatment should be given before surgery to keep the score to be 4 points or less.

10.3969/j.issn.2095-4344.2013.25.007

ObjectiveTo review the etiology and classification of cholangiectasia. MethodThe clinical data of 1098 patients with cholangiectasia treated from January 2000 to December 2009 were retrospectively analyzed. Results For the 1098 patients, 69 patients (6.3％) had congenital choledochal cyst, and 1029 patients (93.7％) had secondary cholangiectasia which were secondary to 22 diseases, The top 5 of the etiological diseases were bile duct stones (366 patients, 33.3 ％), pancreatic head carcinoma (137 patients, 12.5％), peri-ampullary carcinoma (122 patients, 11.1％), cholangiocarcinoma (68 patients,6.2％),and chronic pancreatitis or pancreatic head cyst (62 patients,5.6 ％). ConclusionsCholangiectasia can be divided into two major categories (congenital and secondary). Congenital choledochal cyst accounted for 6.0％, secondary cholangiectasia accounted for 94 ％.The most common etiologies were bile duct stones, pancreatic head carcinoma and peri-ampullar carcinoma.

Objective To detect the expression of CD133 in hepatic cell lines SMMC7721 and bcl-7402, and to investigate the possibility of CD133 as the surface marker of liver cancer stem cells. Methods The cell cycle and expression of CD133 in hepatic cell lines SMMC7721 and bcl-7402 were detected by flow eytometry. Magnetic cell sorting was used to isolate CD133-positive and CD133-negative cells. The differences in morphology, proliferation and differentiation between CD133-positive and CD133-negative cells were observed and analyzed by one-way ANOVA and u test. Results The percentages of CD133-positive cells in SMMC7721 and bcl-7402 cell lines were 0.7% -1.0% and 1.7% -8.9%, respectively. The percentages of CD133-positive cells in G0>/G1> phase in the 2 cell lines were 85.3% and 89.4%, which were significantly higher than CD133-negative cells and unsorted cells (F = 14.49, 38.84, P <0.05). The in vitro proliferation capability of CD133-positive cells was greater than that of CD133-negative cells and unsorted cells, especially during day 1-3 and day 5-7 (F =49.32,784.04, 89.91, 152.83, P < 0. 05). During the cultivation, the proportion of the CD133-positive cells decreased as time passed by, and the proportion of CD133-positive cells was nearly the same as unsorted cells on day 15 (u =O. 271, P <0.05). Conclusions CD133-positive ceils have strong capability of proliferation and differentiation in SMMC7721 and bcl-7402 cell lines in vitro. CD133 is one of the surface markers of liver cancer stem cells.

Objective To discuss methods treating complex distal radius fractures(types B and C fractures according to AO classification). Methods Seventy-eight patients(83 fracture parts)with complex distal tadius fractures were treated by surgical operation from June 2005 to June 2007.There were 51 males and 27 fenlalcs at an average age of 34.6 years.According to AO Classiiication.there were 12 typc B1 fractures,22 types B2 and B3,21 type C1,16 type C2 and 12 typc C3.The operation in-volved open reduction,external fixator,bone grafting for correcting the palm tilted angle and the ulna devi-ated angle. Results AIl patients were followed up for an average period of 10.5 months.After opera-tion the sinking or displacement of the articular surface was less than 2 mm.with average palm tilted an-gle of 10.6°and average ulna deviated angle of 20.3°.All fractures were healed.The ioint function was assessed by Gatrland and Werley score,which showed excellent result in 33 patients,good in 41.fair in 7 and poor in 2,with excellence rate of 89%. Conclusions Surgical operation is effective for treat-ment of complex distal radius fractures,for it can reduce the itaiured articular surface.correct the palm tilted angle and the ulna deviated angle and eliminate forearnl longitudinal shortening stress.

Public relationship has an outstanding effect on virtue education. Public relationship can regulate behavior, culture noble ethics, coordinate interpersonal relations and improve the ability of society adaptation for medical students. Public relationship can also build up good image of medical students, and improve their comprehensive qualities.

According to the requirements of the regulatory authorities, degree of modification (DP) should be included in the characterisation of the PEGylated protein drug substance, and is one of the critical quality attributes for quality control. In this study, based on the fundamental assumption that the refractive index (RI) signal and the ultraviolet (UV) signal of PEGylated protein are equal to the sum of the corresponding signal produced by the polyethylene glycol (PEG) and protein parts of the conjugates in their uncoupled state, we developed a method to determine the DP of PEGylated recombinant human growth hormone (inpegsomatropin). In this method, 20 μL of 1 mg·mL^-1 human growth hormone (hGH) standard, 2 mg·mL^-1 PEG reference substance and 1 mg·mL^-1 drug substance solution were each injected to size exclusion chromatographic (SEC) column for separation, detected with ultraviolet and refractive index (UV-RI) detectors in series. Finally, the DP was calculated as the formula derived from the fundamental assumption. The developed SEC-UV-RI method showed good specificity, repeatability (RSD = 0.63%, n = 9) and accuracy, with a recovery of 100.0%, compared with the result obtained from the simultaneously established classical acid hydrolysis method, demonstrating pretty handleability and accessibility, and is appropriate for quality control test of DP for this drug substance.

Objective To assess regional left ventricular systolic function in patients with hypertrophic cardiomyopathy (HCM) using real-time three-dimensional echocardiography (RT-3DE).Methods Twenty-five patients with HCM which was asymmetric septal hypertrophy,and twenty healthy subjects were enrolled in the study.The apical four-chamber view of left ventricular was acquired by RT-3DE.The left ventricular volume-time curves were analyzed quantitatively with Tomtec 4D LV-Analysis 3.0,and regional end-diastolic volume and end-systolic volume of left ventricular (rEDV,rESV),the time to minimum systolic volume (rESVT),regional stroke volume (rSV),regional ejection fraction (rEF),regional-global ejection fraction (rgEF) and the parameters of left ventricular dyssynchrony were measured.Results In the HCM group,the values of Tmsv16-Dif,Tmsv16-SD,Tmsv16-Dif％,Tmsv16-SD％ were significantly lower compared with the control group (P ＜ 0.01),and rEDV,rSV,rEF and rgEF in hypertrophic segments were lower than those in non-thickening and mild-thickening segments (P ＜0.05).In the control group,there were no significant difference of those parameters among all segments (P ＞0.05).The values of rEDV,rSV and rgEF in hypertrophic segments decreased in the HCM group (P ＜0.05),at the basal level,rEF in hypertrophic segments decreased,at the apical level,it increased,but the differences at the mid-ventricular level between the two groups were not significant;the values of rEF and rgEF in non-thickening and mild-thickening segments increased (P ＜0.05).Conclusions RT-3DE could sensitively detect left ventricular dyssynchrony and accurately assess regional left ventricular volume and function of different segments in patients with HCM.

BACKGROUND:The reported time of bone marrow mesenchymal stem cel s induced to differentiate into chondrocytes is different. Few studies have observed and compared the cel s’ dynamic transformation during the induction process.
OBJECTIVE:To observe the dynamic differentiation and the mature time of rabbit bone marrow mesenchymal stem cel s which were directional y induced to chondroblasts for 8, 11, 14, 17, 20 days.
METHODS:Bone marrow was aspirated from the femur of New Zeal rabbits, and bone marrow mesenchymal stem cel s were isolated by gradient centrifugation. After cultivation and amplification, bone marrow mesenchymal stem cel s at passage 3 were directional y induced to chondrocytes by the serum-free medium containing transforming growth factor beta-1. The experiments were divided into five groups according to different induction time points:8 days, 11 days, 14 days, 17 days, 20 days. Then cel ular morphology, toluidine blue staining, typeⅡ col agen immunohistochemistry, aggrecan content in induction medium, and chondrogenic differentiation in each group were observed and compared.
RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cel s had apparently transformed in morphology at 8 days of induction, and presented obvious chondrocytes’ morphology at 14 days. The aggrecan in induction medium could be detected at a low level at 4 days, significantly increased at 8 days, and maintained slow increasing at 20 days. At 14 days, the metachromatic particles could be found by toluidine blue staining, and the col agen type Ⅱimmunohistochemistry was significantly positive in cel climbing slice. Experimental findings indicate that, bone marrow mesenchymal stem cel s that are monolayer cultured in a high density can be induced into chondroblasts at the effect of transforming growth factor beta-1 and other factors. There are a few chondroblasts in the early induction process, then cel s begin to have chondrocytes morphology and function after induced for 8 days, and may differentiate to mature chondrocytes at 14 days. In addition, they can keep a high biological activity in the induction process.