BACKGROUND: SSh as a Hedgehog signal protein can promote bone development, growth and remodeling.OBJECTIVE: To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) combined with Shh modified nano-hydroxyapatite/collagen (nHAC) in the repair of femoral defects in rats.METHODS: Forty-eight Sprague-Dawley rats were randomly divided into four groups, and the model of femoral defects was established in these rats. At 14 days after modeling, experimental group was implanted with the BMSCs/Shh modified nHAC, scaffold group was implanted with simple nHAC, cell scaffold group was implanted with BMSCs/nHAC,and blank control group was without any implantation. At 3, 6, 9, 12 weeks after repair, X-ray examination, bone density measurement and bone biopsy in bone defect area were performed.RESULTS AND CONCLUSION: (1) X-ray examination: The Lane-Sandhu X-ray score and bone mineral density value in the experimental group at different time points after operation were significantly higher than those in the other three groups (P < 0.05). (2) Hematoxylin-eosin staining: 12 weeks after repair, a small amount of bone tissues but no bone marrow formed in the scaffold group; a small amount of bone tissues with absence of bone marrow formed in the cell scaffold group, and the residual scaffold was visible; in the experimental group, the scaffold was completely absorbed,and mature bone and medullary cavity formed with presence of bone marrow. (3) Scanning electron microscope observation: 12 weeks after repair, irregular arrangement of bone fibers and a large number of bone fossae were observed in the scaffold group; the cell scaffold group showed a large number of osteoblasts, but bone fibers still arranged irregularly; in the presence of the Haversian system, a large number of regularly arranged bone trabeculae were detective in the experimental group. These results elucidate that the Shh modified nHAC/BMSCs complex can promote the repair of bone defects.

BACKGROUND:As one of the most serious pathological types of lumbar disc herniation, the nucleus pulposus of prolapsed style lumbar intervertebral disc herniation is like a cord or mass. And the nucleus pulposus compresses nerve roots and dural sac, which brings severe low back pain and/or cauda equina injury symptoms.OBJECTIVE:To compare the clinical efficacy of simple discectomy under the Quadrant system and minimally invasive transforaminal lumbar interbody Concorde fusion (MIS-TLIF) in the treatment of prolapsed and sequestrated lumbar disc herniation.METHODS:From January 2012 to January 2015, 58 patients with prolapsed and sequestrated lumbar disc herniation were enrolled in this study, including 36 patients in simple Quadrant group and 22 patients in MIS-TLIF group.RESULTS AND CONCLUSION:Significant difference was recorded in the visual analogue scale scores and Oswestry disability index at 1 week, 3 months and 18 months postoperation compared with preoperation in the two groups (P < 0.05). Compared with the simple Quadrant group, the visual analogue scale scores of low back pain and Oswestry disability index were significantly decreased in the MIS-TLIF group at postoperative 18 months (P < 0.05), but there was no significant difference in the visual analogue scale score of leg pain between two groups (P > 0.05). There were two patients with recurrent lumbar disc herniation in the simple Quadrant group. In summary, simple discectomy under the Quadrant system could achieve the similar satisfied effect as the MIS-TLIF, but the MIS-TLIF provides less low back pain.

BACKGROUND: Polylactic acid copolymer bone scaffold has excellent biodegradability, and it is easy to be shaped and can promote the formation and growth of bone tissue and blood vessel.OBJECTIVE: To observe the effects of adipose-derived stem cells(ADSCs)/poly(lactic-co-glycolic acid) (PLGA) complex on the biomechanical properties after fracture healing in osteoporotic bone.METHODS: Sixty Sprague-Dawley rats were randomly divided into four groups: blank control group received no treatment; the bilateral tibial fracture model was made after 3 months of bilateral ovarian resection in model group; the bilateral tibial fracture model was made and ADSCs were implanted into the bone after 3 months of bilateral ovarian resection in cell therapy group; the bilateral tibial fracture model was made and the PLGA/ADSCs complex was implanted after 3 months of bilateral ovarian resection in combined treatment group.The bone mineral density, callus thickness, biomechanical parameters and the microstructure of the trabecular bone were detected.RESULTS AND CONCLUSION: (1) The bone density: The bone density of the model group was significantly lower than that of the blank control group (P < 0.05); the bone mineral density of the cell therapy group and the combined treatment group was higher than that of the model group (P < 0.05), but lower than that of the control group (P < 0.05); and the bone mineral density of the combination treatment group was higher than that of the cell therapy group (P < 0.05). (2)Thickness of the callus: The thickness of the callus in the cell therapy group and combined treatment group was higher than that of the model group and blank control group (P < 0.05); moreover, the thickness of the callus in the combined treatment group was higher than that of the cell therapy group (P < 0.05). (3) Biomechanical test: The failure load, stress and shear strength, elastic modulus were decreased in the model group compared with the blank control group (P < 0.05), while the shear strain increased (P < 0.05). Compared with the model group, the failure load, ultimate stress, shear strength, elastic modulus were increased in the cell therapy group and combined treatment group (P < 0.05), and the shear strain was decreased (P < 0.05). Moreover, the combined treatment group showed more changes in these biomechanical parameters (P < 0.05). (4) The trabecular bone microstructure: The model group presented with trabecular derangement, spacing increases, and even fracture and lacuna. After ADSCs or ADSCs/PLGA transplantation,the trabecular bones increased in number, thickness, and spacing, and the number of lacunae reduced. In conclusion,ADSCs combined with PLGA in the treatment of osteoporotic fracture can significantly improve the biomechanical parameters of bone tissue after healing.

Objective To investigate the species and drug resistance of pathogens causing bloodstream infections in hospitalized patients,and provide scientific evidence for antimicrobial use and control of healthcare-associated blood-stream infection.Methods From January 1 to December 31,2012,16 428 blood specimens were performed blood culture,pathogens were isolated and performed antimicrobial susceptibility testing.Results Of 16 428 blood speci-mens from 5 546 patients,384 (6.92%)were positive for blood culture,398 pathogenic isolates were detected,of which gram-positive bacteria,gram-negative bacteria,and fungi accounted for 23.62% (n=94),68.34% (n=272),and 8.04% (n=32)respectively,positive rate of blood culture were highest in 61-80 age group(8.26%), the top five departments of positive rate of blood culture were departments of burn,traditional Chinese medicine, cardiac intensive care unit,transplantation and traumatology;gram-positive cocci were highly susceptible to vanco-mycin,teicoplanin and linezolid,one Enterococcus faecium strain was found to be resistant to vancomycin;Among gram-negative bacilli,Enterobacteriaceae were highly susceptible to amikacin and carbapenems;drug resistance rates of Acinetobacterbaumannii and Pseudomonasaeruginosa to carbapenems was 70.97% and 35.90% respective-ly.Conclusion Gram-negative bacteria are the major pathogens causing bloodstream infection,positive rate of blood culture of elderly people is high.It is necessary to conduct regular surveillance on distribution and drug resistance of pathogens.

Objective To compare the therapeutic effect of Qingre Anchuang Tablets(QAT) processed by new or old technology on rabbit ear acne.Methods Experimental rabbit ear acne was induced by coal tar.After the modeling,the rabbits were administrated with QAT processed by new or old technology.The thickness,weight and PGE2 level of the acne ear were measured,and the pathological changes of the acne ear were also examined.Results QAT processed by new or old technology could decrease the thickness,weight and PGE2 level of the ear significantly,and relieve the pathological changes of the acne ear.The effects of QAT processed by new technology was better than that of QAT processed by old technology.Conclusion QAT processed by new technology has a better therapeutic effect on rabbit ear acne than QAT processed by old technology.

【Objective】 To observe the promoting action of spleen-strengthening and Qi-promoting herbs on enteral nutrition(EN) for patients after abdominal surgery.【Methods】 Sixty patients after abdominal surgery were equally randomized into groups A and B.The two groups received oral use or tube feeding of enteral nutrition(Fresubin).Group A received oral use or tube feeding of the decoction with spleen-strengthening and Qi-promoting actions(composed of Radix Pseudostellariae,Rhizoma Dioscoreae,Fructus Hordei Germinatus,Pericarpium Citrus Reticulata,Radix Notoginseng) additionally.The treatment lasted one week.Before and after EN treatment,the contents of hemoglobin(Hb),total lymphocyte count(TLC),albumin(Alb),serum total protein(TP) and the ratio of albumin and globumin(A/G) were observed.【Results】After EN treatment,the above laboratory parameters were increased in the two groups as compared with those before treatment(P

BACKGROUND:Thoracolumbar spine as highly concentrated stress, often prone to vertebral fractures. With the further development of the biomechanics and anatomical structure of the spine, posterior open reduction and internal fixation with pedicle screw has been widely accepted by clinicians. OBJECTIVE:To explore the clinical results and safety of percutaneous pedicle screw fixation system (Viper system) used in thoracolumbar compression fractures. METHODS:We retrospectively analyzed 40 patients with thoracolumbar compression fractures from Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital and Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from January 2013 to February 2014. According to the type of graft, patients were randomly divided into experiment group and control group, with 20 patients in each group. They were respectively subjected to Viper percutaneous pedicle screw fixation system and open reduction and pedicle screw fixation. RESULTS AND CONCLUSION:Al vertebra got bone unions. Operative time and time to bone union were shorter in the experiment group than in the control group. Moreover, intraoperative blood loss was less in the experiment group than in the control group. Cobb’s angle, height percentage of leading edge and wedge angle were similar between the two groups. However, at 12 months after internal fixation, height percentage of leading edge was lower in the experiment group than in the control group. Visual Analogue Scale scores and Oswestry Disability Index were noticeably improved after fixation in both groups. Visual Analogue Scale scores and Oswestry Disability Index were lower in the experiment group than in the control group immediately after fixation. These results suggest that compared with open reduction and pedicle screw fixation, Viper percutaneous pedicle screw fixation system for thoracolumbar compression fractures can stably restore the structure and function of spine, and does not increase perioperative complications.

Objective Non-traumatic and posteromedial subchondral osteonecrosis of trochlea tali (NTPSOTT) is a special type of necrosis of the talus , for which early diagnosis and treatment are particularly important .This study investigated the clinical ef-fectiveness of autogeneic cancellous bone transplantation in the treatment of NTPSOTT . Methods We retrospectively analyzed 21 cases of NTPSOTT treated by autogeneic cancellous bone transplantation and evaluated using the Clinical Rating System of the American Orthopedic Foot and Ankle Society ( AOFAS) , Visual Analogue Scale ( VAS) , and X-ray and CT examinations . Results The pa-tients were followed up for 12-26 months and all healed desirably , with the graft well integrated into the surrounding tissue , but no as-similation, collapse of the articular surface , or narrowing of the joint space .The last follow-up visit revealed significantly improved AOFAS score (90.55 ±6.73 vs 50.87 ±11.42, P=0.009) and VAS score (1.32 ±0.81 vs 6.43 ±1.66, P=0.027) as compared with the baseline . Conclusion Autogeneic cancellous bone transplantation is preferable for the treatment of NTPSOTT , which can effectively reduce the pain in the ankle , maintain the joint space , and protect the function of the ankle .

Objective To evaluate the contribution of gyrA and parE detection in Ureaplasma genotyping.Methods Sixty Ureaplasma isolates were selected with the Mycoplasma IST kit.The gyrA and parE were amplified by PCR.The DNA was sequenced and compared with the corresponding sequences in GenBank.Results The nucleotide sequence of gyrA had 100% identity in serovar 1,3,6,14 and 100%identity in serovar 2,4,5,7～13,too.But the sequence had 91%identity between the two groups.The nucleotide sequence of parE had 98%～99% identity in serovar 1,3,6,14.And it had 100% identity in erovar 2,5,7,8,11 and 100% identity in serovar4,12,13.But it had only 90% identity between the two groups.Ureaplasma parvum(Up),Ureaplasma urealyticum(Uu)and Up+Uu infection were found 68.3%(41/60),21.7%(13/60)and 10%(6/60) of clinical specimens,respectively.In Up isolates,serovar 3 was 48.8%(20/41).Conclusion Ureaplasma can be divided into two genotypes(Up and Uu)by gyrA analysis.And Up can be divided into four subtypes which correspond to serovar 1,3,6,14,respectively.Serovar 3 is the main isolate in our research.

OBJECTIVE To investigate antimicrobial resistance and molecular epidemiology profiles of meticillin-resistant Staphylococcus aureus(MRSA)sampled from lower respiratory tract.METHODS Totally 107 MRSA strains were isolated from lower respiratory tract specimens at Shanghai Pulmonary Hospital between Dec 2005 and Dec 2006.PVL genes were detected by PCR.The genotypes of SCCmec were identified by multiplex PCR.The antimicrobial resistance of MRSA were tested by Kirby-Bauer agar dilution.We also performed the homology of 32 MRSA strains using pulsed-field gel electrophoresis(PFGE).RESULTS All of the 107 MRSA strains were negative in the PVL locus detection and the most frequent SCCmec types were type Ⅲ(81.3%),the others including type Ⅱ(15.9%),type Ⅳ(2.8%),type Ⅰ and type Ⅴ were not found in this group.Those 3 different types of SCCmec were all resistant to ?-lactam antibiotics,less resistant to rifampin,and susceptible to vancomycin,teicoplanin and daptomycin.The resistant rate of those 3 types were different to the non-?-lactam antimicrobial drugs such as trimethoprim/sulfamethoxazole,clindamycin,erythromycin,gentamicin,levofloxacin,and tetracycline,the resistant rate in the types Ⅱ and Ⅲ was significantly higher than the type Ⅳ.PFGE analyses assorted the 32 MRSA strains into 4 PFGE patterns:pulsotype A(25 strains),including subtypes A1(17strains),A2(1 strain)and A3(7 strains);pulsotype B(5 strains),pulsotype C(1 strain),and pulsotype D(1 strain).CONCLUSIONS This study does not found positive PVL locus in the MRSA strains in our hospital,the most frequent SCCmec types are type Ⅲ and some are type Ⅱ.PFGE presented that there are outbreaks of MRSA in ICU ward and TB ward No 5 at that time and the pandemic strains are subtypes A1 and A3,most of these MRSA strains are multiple resistant,which deserves attention from both the clinical staff and infection-control department of the hospital.