0.05).[Conclusion]Composite of heterogeneous deproteinized bone+autogeneous MSCs+rhBMP2 has the same ability of autogeneous bone graft to repair big experimental segmental tibia defect,thus it can be used as a scaffold in tissue engineering and for further study of immunogenicity and ossification ability.

[Objective]To evaluate therapeutics for lumbar tuberculosis. [Method]Data from 65 patients treated with five different therapeutics were retrospectively reviewed.Group A(n=14) was treated with focal debridement.Group B(n=15) with focal debridement and bone grafting fusion.Group C(n=9) with posterior focal debridement plus bone grafting fusion and internal fixation.Group D(n=12) with posterior fixation and anterior focal debridement plus,bone grafting fhsion.Group E(n=15) with anterior focal debridement plus bone grafting fusion and anterior internal fixation.Patients all received routine support and anti-tuberculosis therapy before and after operation.Follow-up, erythrocyte sedimentation rate was studied,and bone fusion and kyphosis correction with X-ray plain film and 3D-CT reconstruction were evaluated.[Result]There were not damages occurring in the great vessels,nerves or ureters.No recurrence was found during the follow-up of 12~16 months(average 13 months).Grafting bone were all fused after 4~6 months with an average time of 3.8 months.There was no missing of angel of kyphosis correction,complications of looseness or break of internal fixation.[Conclusion]Efficient anti-tuberculosis therapy and the debridement is the key for treatment of tuberculosis.The selection of fusion or internal fixation is depended on the severity of tuberculosis.Reasonable selection may improve the therapeutic effect of lumbar tuberculosis.

BACKGROUND: For its extensive sources and specific biological characteristics, heterogeneous deproteinized bone (DPB) as the tissue-engineered scaffold material gets a good application prospect in repair of large segmental bone defects.OBJECTIVE: To prepare scaffold material by compositing modified heterogeneous DPB with recombinant human bone morphogenetic protein 2 (rhBMP2) and evaluate the osteogenic ability in repairing large segmental long bone defects in large-sized animals.METHODS: Twenty-four goats were randomly and evenly divided into three groups: DPB, autologous bone, and DPB+rhBMP2. Bone defects (20% in length) were made in the middle and lower segments of the right tibia of each goat, and according to group design,different bone grafts were implanted and fixed using semi-ring slot external fixer. At 4-24 weeks after surgery, X-ray examination was performed once every other 4 weeks. At 24 weeks after surgery, newly formed bones were taken out for determining the repair effects of bone defects through duat-energy X-ray analysis, histological observation, and biomechanical analysis.RESULTS AND CONCLUSION: The prepared DPB exhibited a three-dimensional porous structure, with a porosity of (78.5±6.45)% and pore size of (472.5±7.02) μm. Time-dependent bone repair was found in each group. Results regarding anti-compression test, three-point anti-bend test, and anti-torsion test were greatest in the autologous bone group, followed by the DPB+rhBMP2 group, and lastly the DPB group. There were no significant differences in tibial bone density, bone mineral content,anti-compression pressure and ultimate pressure, anti-bending load and ultimate toad, anti-torsion torque and ultimate torque between autologous bone group, DPB+rhBMP2 group and normal bone control group. These findings indicate that modified heterogeneous DPB composited with rhBMP2 has osteogenic ability equivalent to autologous bone in repairing large segmental long bone defects in goat tibias. Therefore, it can be applied as tissue-engineered scaffold material.

BACKGROUND:The bone morphogenetic protein 2 (BMP2)/vascular endothelial growth factor (VEGF) dual gene activated nanobone putty has been constructed in the previous experiments.
OBJECTIVE:To investigate the effects of osteogenesis and osteogenic gene expression in mice by implanting BMP2/VEGF dual gene activated nanobone putty.
METHODS:Twenty-four Kunming mice (48 sides) were randomly divided into four groups. Animals in each group (12 samples) were injected different materials into the right thigh muscle pouches:nanobone putty+hBMP2/VEGF plasmid;nanobone putty+hBMP2 plasmid;blank plasmid+nanobone putty;nanobone putty only. The effects of osteogenesis were evaluated by radiography, histology and molecular biology analysis in 2, 4 weeks after operation.
RESULTS AND CONCLUSION:Bone-like tissues were observed in groups of nanobone putty+hBMP2/VEGF plasmid and nanobone putty+hBMP2 plasmid after operation. There was apparent BMP2 and VEGF mRNA expression in group of nanobone putty+hBMP2/VEGF plasmid. Group of nanobone putty+hBMP2/VEGF plasmid was significantly better than group of nanobone putty+hBMP2 plasmid in the alkaline phosphatase levels, the speed of osteogenesisas and amount of new bone (P<0.05). Groups of blank plasmid+nanobone putty and nanobone putty had no obvious osteogenesis performance. Either BMP2/VEGF dual gene activated nanobone putty or BMP2 gene activated nanobone putty had the osteogenic ability in vivo. And the former was significantly enhanced in the speed and quality of osteogenesis.

Objective To verify BMP-2 and VEGF gene activated nanobone paste can effectively enhance the vertebral bone of ovariectomized goat.Methods From January,2011 to May,2016,the goats had been neutered by ovariectomy 6 months earlier to induceosteoporosis.Then surgery to established the model of vertebral bone defected with nanobone implanting,and the operation vertebrae divided randomly into 3 groups:control group,nanobone group and double gene activated nanobone group.Three months after operation the goats were sacrificed and removed the vertebrae.Micro CT analysis of micro three-dimensional structure of trabecular bone,scanning electron microscope (SEM) analysis of the two-dimensional structure of the vertebrae,the structure of trabecular bone was evaluated by movat pentachrome staining.Results The dual gene activated nanobone group compared with the nanobone group,the bone volume fraction (BV/TV) significantly increased (85％ at 1.2 mm vs 43％ at 1.2 mm,P ＜ 0.05);the dual gene activated nanobone group compared with nanobone group,in the largest ROI (1.2 mm),TbTh increased 10.9％ (374 ± 26.2 μm vs 337 ± 22.3 μm,P ＜ 0.05);Trabecular distribution coefficient (TbPf) was significantly decreased (7.519 ± 0.184 mm-1 vs 7.529 ± 0.261 mm-1,P ＜ 0.05);In the largest ROI (0.8 mm),trabecular distribution coefficient (TbPf) was significantly decreased (283 ± 36.4 μm vs 327 ± 31.2 μm,P ＜ 0.05),In the largest ROI (0.8 mm),the trabecular bone volume (Tbn) was increased 20％(1.404 ± 0.283 mm-1 vs 1.173 ± 0.224 mm-1,P ＜ 0.05);Cortical thickness over the implantation area showed asignificant increase of 43％ in vertebrae(P ＜ 0.05);The histological analysis revealed a more extensive osseointegration of the dual gene activated nanobone group,with the presence of anabundant osteoid tissue and an osteoblastic celllining.Conclusion BMP-2 and VEGF gene activated nano bone paste can effectively enhance the vertebral bone of ovariectomized goat.

BACKGROUND: There are few reports about vascularization in the repairing of bone defect by heterogeneous deproteinized bone.OBJECTIVE: To verify the vascularization characteristics of heterogeneous deproteinized bone, tissue engineering scaffold material, in the repairing of large segmental bone defect.DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed between March 2005 and February 2007 at the Third Military Medical University, Chongqing, China.MATERIALS: Twenty-four 10 to 12 months old goats, weighing (22.5±2.5)kg, were obtained from the Animal Center of the Third Military Medical University, Chongqing, China. Segmental bone defects of 20 percent right tibia middle and inferior diaphysis of the 24 goats were made.METHODS: The 24 goats were divided into test group (n=16) and control group (n=8) randomly. Goats in test group were implanted with deproteinized bone+autologous MSCs+recombinant human bone morphogenetic protein-2 (rhBMP-2), goats in control group were implanted with autograft bone, and all fixed with half-ring sulcated external fixator. Every 4 weeks, 3 goats were killed after ink perfusing through femoral artery. A thick slice of new bone tissue was made to observe the vascularization.MAIN OUTCOME MEASURES: Vascularization of new bone observed through gross anatomy and imaging; vascular network of new bone observed through thick section, blood vessel amount and area measured by Image-proplus really image analysis software.RESULTS: No goat was infected or dead. Animal soft tissue was dyed black, blood vessels'size, ditribution and network structure were observed in subcutaneous tissue, fascia and periosteum. At 4 weeks postoperation implant margin became crude in the defect area; at 8 weeks postoperation transparent bone absorbing area of different size and irregular shape appeared; after 12 weeks postoperation high-dense calcification shadow appeared at the ends of defect bone and new bone connected with the ends completely. On 4 to 24 weeks postoperation, the blood vessel amount became large, alignment became regular, and their size and distribution became uniform. It showed no significant difference in blood vessel amount and area between 2 groups (P>0.05).CONCLUSION: Composite of heterogeneous deproteinized bone+autologous MSCs+rhBMP-2 has the same vascularization degree. of autogeneous bone graft in repairing of large segmental tibia defect.

BACKGROUND:Half-ring sulcated external fixator is a bone external fixation device.Its structure is relatively simple,with multi-plane fixed,and small occupying space.So far,there are few experimental reports about construction of tibial defect model by it in large animals.OBJECTIVE:To validate the practicality and repeatability of half-ring sulcated external fixator in establishing tibial defect models in goats.DESIGN,TIME AND SETTING:The randomized controlled observation was performed at the Animal Laboratory of the Third Military Medical University from March 2005 to February 2007.MATERIALS:Nine healthy adult(Animal Center of Third Military Medical University);Half-ring sulcated external fixator,made by Professor Li of the Third Military Medical University;Osseous pin,ψ2.5 mm,Shanghai Medicai Instruments Co.,Ltd.METHODS:After animals were anesthetized,two needles were threaded in the same plane of cancellous bone about 1.5-2.0 cm above the superior articular surface of the tibia,named group 1.The angle between the two needles was 40°.One needle was threaded at the place of 3.0 to 5.0 cm under the group 1 and parallel with optional needle of the group 1,named group 2.Needles of group 4 were threaded at the cancellous bone that was 2.0 cm from the joint surface of inferior extremity of the tibia.One needle was threaded at the place of 3.0 to 5.0 cm from group 4 and parallel with optional needle of the group 4.The included angle between these two needles of group 2 and group 3 was 60°.There were totally 6 needles.Tibia was fixed by half-ring sulcated external fixator.According to the length of the tibia from X-ray,tibia and periosteum were amputated by wire saw between the two needles in the middle and inferior segment of the tibia to make segmental bone and periosteal defects of 20 percent of tibia.MAIN OUTCOME MEASURES:①Postoperative general state of the animals and effect of half-ring sulcated external fixator.②Self-repair of bone defects by X-ray and Lane-Sandhu scoring standards.RESULTS:Of the 9 selected goats,1 died of postoperative infection,and 1 developed pinhole infection and supplemented.All the others survived and were included in final analysis.The goats were awake within 2-6 hours after surgery and able to stand up to eat.The loosening nuts were screwed up.No external fixation failure or loosening was found.No skin was necrotic.Injured limb could touch the ground in 2 days,but could not bear load until 2 weeks.The goats could walk in three weeks with a slight limp,then moved freely without claudication in four weeks after the operation.At the 5th week after operation,the radiographs showed little periosteal reaction.At the 10th week after operation,sclerosis was found in the fracture ends,and medullary cavity started to close.Fifteen weeks after operation,the medullary cavity closed and periosteal reaction did not aggravate.Inaddition.Lane score was 0 at any time point.No bone formation was found in the histological examination at 5,10 and 15 weeks after operation,and Lane score was 0 at any time point.CONCLUSION:The goat model established in goat tibia with 20%defects by the half-ring sulcated external fixator shows no bone healing after 15 weeks by X-ray or histological exanimation,indicating this is a practical and repetitive method to establish animal models of large segmental defect for bone tissue engineering.

Objective To study the relationship between the number of outpatient complaints and the time or the outpatient amounts.Methods A retrospective analysis of 1289 cases of outpatients' medical complaints with basic records since 2009 in our hospital was carried out.The time regularity of the number of outpatient complaints,or the complaint rate was analyzed.And the correlation between the outpatient amounts and the number of outpatient complaints,or the complaint rate was also analyzed.Results In our hospital,the mean monthly number of outpatient complaints was (23.44±8.41)cases; the mean monthly outpatient account was (246 000±27 417)cases.The differences among monthly outpatient complaints,outpatient accounts and monthly complaints rate among every years were statistically significant.Within one year,the outpatient complaints numbers were lowest in February and January.And the outpatient complaints rate was low in November,January,February and December.There were statistically significant correlation between the monthly outpatient complaints and monthly outpatient accounts,and between the monthly outpatient complaints rate and monthly outpatient accounts.Conclusions There was time regularity in the outpatient complaints rates in one year.And there was certain correlation between the outpatient complaints rate and the outpatients' accounts.

Objective To discuss the therapeutic options for treatment of subaxial cervical dislocation combined with facet locking. Methods There were 49 patients with cervical dislocations including 7 patients with dislocation at C3,4, 15 at C4,5, 14 at C5,6 and 13 at C6,7. Eleven patients were with old dislocation, with duration of dislocation ranging from 2 hours to 61 days. Neurologic status of the patients according to Frankel scale was graded A in 14 patients, grade B in nine, grade C in 10 and grade D in nine. All patients were treated surgically after closed reduction with skull traction. Results The successful reduction rate was 63% for fresh dislocation, with average improvement of 0.65 grade for spinal cord function. All bone grafts got fusion at four months after operation. Conclusion Therapeutic options are based on fresh or old dislocations, paraplegia or not, intervertebral disk injury severity, and reduction or not through traction for patients with lower cervical dislocations.

BACKGROUND:Studies have demonstrated that tetrandrine has protection on acute spinal cord injury,but the specific mechanism remains poorly understood.OBJECTIVE:To study the protection of tetrandrine on rat acute spinal cord injury and to study its mechanism from apoptosis pathway.METHODS:A total of 100 rats were randomly divided into 4 groups.All rats were prepared for spinal cord injury models using modified Allen method except that in the sham-surgery group.Methylprednisolone and tetrandrine was injected into rats in the methylprednisolone and tetrandrine groups by tail intravenous injection prior to and at 24,48 hours after model preparation.The same volume of physiological saline was injected in the sham-surgery and model groups.Basso-BeatUe-Bresnahan(BBB score)was recorded at 8 hours,1,3,7 and 14 days after model preparation.The morphological changes of spinal cord injury sites were observed by hematoxylin-eosin staining and the expressions of bcl-2 and bax were determined by immunohistochemistry.RESULTS AND CONCLUSION:The BBB score of methylpradnisolone and tetrandrine groups were significantly higher than that model group at 7 and 14 days(P<0.05),but there were no significant difference between the methylprednisolone group and tetrandrine group(P>0.05).Hematoxylin-eosin staining showed that the spinal cord injured severely at 3-7 days,the injury degree in the methylpradnisolone group and tetrandrine group was slighter than that of the model group,with smaller bax expression and greater bcl-2 expression(P<0.01).The findings demonstrated that,tetrandrine is able to protect neurons from apoptosis and promote the nerve function recovery by inhibiting the expression of Bax and promoting the expression of Bcl-2.Its effect is not inferior to methylprednisolone.