Adult ; Bone Neoplasms ; Humans ; Male ; Nose Neoplasms ; Osteoblastoma ; Skull Base Neoplasms

OBJECTIVE:To evaluate the efficacy and safety of tiotropium bromide in the treatment of COPD patients and pro-vide evidence-based reference for the clinical treatment. METHODS:PubMed,EMBase,Medline,Cochrane Library,CJFD,Wan-Fang and VIP database were retrieved to collect the randomized controlled trial(RCT)of tiotropium bromide(test group)vs. place-bo(control group)in the treatment of COPD. The data was extracted and the quality was evaluated by Rev Man 5.0 software. RE-SULTS:A total of 19 studies were included,involving 16 318 patients. Meta-analysis shows that the FEV1[MD=0.13,95%CI (0.12,0.14),P<0.001],FVC[MD=0.20,95%CI(0.20,0.25),P<0.001] in test group were higher than control group,SGRQ score [MD=-2.94,95%CI(-3.38,-2.49),P<0.001] and COPD exacerbation rate[RR=0.83,95%CI(0.77,0.90),P<0.001] in test group were lower than those in control group ,but the dry mouth rate was higher than that of control group[RR=2.07,95%CI(1.34, 3.20),P<0.001],there were significant differences in 2 groups . CONCLUSIONS:Tiotropium bromide has good efficacy in the treatment of COPD. However,it may cause dry mouth. Due to the methodological limitations of included studies,it remians to be further verified by large-sample and high-quality RCT.

Pharmacogenomics is a discipline studying the influence of genetic differences on drug effectiveness .It promises to op-timize the effect of medicine and reduce side effects .It is one of the most effective ways to predict the drug reaction in human body by using pharmacogenomics , which can achieve the goal of precision medicine .With the rapid development of the genetical test technolo-gies, the in vitro individual genome testing projects with the properties of high throughput , and measurable and low cost are better to be applied in medical practice and guiding for making individualized medicine plan .The study elucidated the progress in single nucleotide polymorphism and its clinical application , and focused on the strategic effects of pharmacogenomics on individualized treatment and gene diversity for guiding medicine .

BACKGROUND:The smal intestinal submucosa has good biocompatibility and biodegradability, and also contains a variety of growth factors that can significantly promote celladhesion, proliferation and differentiation. Currently, the smal intestinal submucosa has been widely used in bone and cartilage, blood vessels, skin, bladder, smooth muscle and pancreatic tissue repair, showing good performance as a tissue-engineered cellscaffold.
OBJECTIVE:To investigate the in vitro feasibility of tissue engineered periosteum constructed by porcine smal intestinal submucosa and osteoblasts differentiated from bone marrow mesenchymal stem cells.
METHODS:Bone marrow mesenchymal stem cells were harvested from 2-week-old healthy New Zealand rabbits by using adherent method, and then cells were cultured, induced, differentiated and identified in vitro. Fol owing induced differentiation and identification, the bone marrow mesenchymal stem cells were compounded with porcine smal intestinal submucosa to fabricate tissue engineered periosteum. The adhesion, growth, and proliferation of cells on the materials were observed.
RESULTS AND CONCLUSION:At 5 days after inoculation, the cells receiving osteogenic induction could quickly adhere and proliferate on the surface of porcine smal intestinal submucosa and be interconnected;at 10 days, the desmosomes formed among the cells, cellprocesses from osteoblasts were visible and attached to the smal intestine submucosa;at 15 days, cellproliferation and secretion of matrix appeared, and multi-layer membrane-like structure formed on the surface of the smal intestine submucosa. These findings indicate that after osteogenic induction, the bone marrow mesenchymal stem cells can be combined with porcine smal intestinal submucosa to construct a tissue engineered periosteum, which is hoped to be an ideal scaffold for tissue engineering.

Objective:To compare the therapeutic effects between sequential therapy of external-internal fixation and internal fixation alone in the treatment of high-energy pilon fracture.Methods:A total of 61 patients with high-energy pilon fracture were enrolled by our team for this retrospective analysis who had been treated from January 2015 to July 2017. They received sequential therapy of external-internal fixation (the sequential group) or internal fixation alone (the internal group). In the sequential group of 26 cases, there were 19 males and 7 females (aged from 18 to 65 years), 4 cases of type C1, 8 cases of type C2 and 14 cases of type C3 by the OTA classification, and 7 cases of closed injury and 19 cases of open injury. In the internal group of 35 cases, there were 25 males and 10 females (aged from 19 to 64 years), 6 cases of type C1, 13 cases of type C2 and 16 cases of type C3 by the OTA classification, and 21 cases of closed injury and 14 cases of open injury. The 2 groups were compared in terms of postoperative infection, fracture reduction, fracture union time, nonunion, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, short form 36 health survey questionnaire (SF-36) and reduced range of motion between healthy and affected ankles.Results:There was no significant difference between the 2 groups in gender, age, fracture type, injury cause or follow-up time ( P>0.05), but a significant difference in soft tissue injury favoring the sequential group ( P=0.010). There were no significant differences between the 2 groups in postoperative infection rate [15.4% (4/26) versus 17.1% (6/35)], fracture reduction, fracture union time [(7.4±3.4) months versus (6.5±3.2) months], nonunion rate [7.7% (2/26) versus 8.6% (3/35)], AOFAS ankle-hindfoot score (71.7±29.4 versus 74.4±19.5), or SF-36 (83.1±9.9 versus 83.8±7.9) ( P>0.05). The reduced range of motion between healthy and affected ankles at 6 months postoperation in the sequential group (34.6°±7.2°) was significantly greater than that in the internal group (23.7°±5.1°) ( P<0.05), but there was no significant difference between the 2 groups in the reduced range of motion between healthy and affected ankles at 2 years postoperation (26.0°±11.1° versus 21.8°±11.3°) ( P>0.05). Conclusion:Although both sequential therapy of external-internal fixation and internal fixation alone can lead to fine clinical efficacy in the treatment of high-energy pilon fracture, the former may be more suitable for the patients with severe soft tissue injury.

Objective To evaluate MRI diagnostic value for single lesion characteristics in the splenium of corpus callosum.Methods MRI features,clinical data,and parts of follow-up results of 9 cases with single lesion in the splenium of corpus callosum were analyzed retrospectively.Results (1)Clinical manifestations:headache and dizziness occurred in 4 cases,syncope in 3 cases,fever in 2 cases, physical activity barriers in 2 cases.(2)Clinical diagnosis:hypoglycemic encephalopathy were rescaned one month later in 3 cases, in which the previous lesion completely disappeared.Clinical experience of encephalitis were improved after treatment in 2 cases. Cerebral infarction,epilepsy,brain injury and degeneration were diagnosed respectively in each one case,in which lesion still existed after treatmented.(3)Image findings:despite the different clinical manifestations,image features of all cases were quite similar. Round or foliated like lesions of slightly long T1 and long T2 signals in the splenium of corpus callosum were presented in all cases. High signals on diffusion weighted imaging and low signals on the ADC were showed with same lesions,andno obvious enhancement after contract media injected was seen.Conclusion Single lesions in the splenium of corpus callosum are showed in many diseases. The image features of hypoglycemic encephalopathy or encephalitis have certain characteristics (single lesion is reversible).Accurate diagnosis need to combine with clinical data and medical history.

Objective:To study the effects of endothelial progenitor cells(EPCs)on the osteogenesis of bone marrow mesenchymal stem cell (BMSCs)sheet-implant complex.Methods:EPCs were added to the BMSC sheets,and the expression of osteogenesis-relat-ed genes was examined by real time PCR.Cell sheets were wrapped around implants to construct cell sheet-implant complexes and the complexes were subcutaneously transplanted into SCID mice.The complexes were harvested 8 weeks after operation and observed by micro-CT and histological examination.Results:The BMSC sheet with EPCs showed higher expression of Runx2,ALP,BMP2 and VEGF in the in vitro test;higher bone volume ratio,greater amount of new bone tissue and higher expression of Runx2 and BMP2 in the in vivo test.Conclusion:EPCs can improve the osteogenesis of BMSC sheet-implant complex.

Objective To investigate the clinical effect of primary internal fixation combined with flap transfer for Gustilo Ⅲ B open fracture of lower extremity with severe soft tissue defct.Methods From January,2008 to January,2013,15 patients with Gustilo Ⅲ B open fracture of lower extremity and severe soft tissue defect were treated with primary internal fixation combined with flap transfer.Among them,there were 2 cases of foot and ankle fracture,9 of lower-tibia and fibula,3 of upper-tibia and fibula and 1 of distal femur fracture.The areas of the flaps were 10 cm × 8 cm-28 cm × 16 cm.Three cases were treated by bone grafting because of bone defect.Results All patients were followed up for 6-24 months.All flaps were survived,and only small area of 2 cases with the distal necrosis were cured by changing the dressing; In 1 case,the wound was infection and healed after anti-infective and drainage treatment; 13 cases had bone union in primary stage,and the other 2 cases were achieved delayed union; the average healing time was 7.2 months,and no case of osteomyelitis was noted; the time of wound healing was 12-36 days,with an average of 18.1 days.According to lower extremity function evaluation form,the excellent and good rate was 86.6％.Conclusion It is a safe and effective strategy to treat the Gustilo Ⅲ B open fractures of lower extremity and severe soft tissue defect with primary internal fixation combined with flap transfer,which has advantages of reliable fixation,covering the wounds with satisfaction,recovering exercise early,shorten the treatment period,alleviating the suffering of patients and so on.

Objective:To evaluate of the feasibility of low-dose CT(LDCT)in the reconstruction of three-dimensional(3D)model of maxillofacial hard and soft tissues.Methods:Lightspeed 16-slice spiral CT scanner was used to scan one adult cadaveric head specimens with conventional parameters(280 mA)and low dose parameters(200,150,100,50,35,25,15 and 5 mA)respectively;the 3D model of the hard and soft tissues were reconstructed with Mimics 10.01 software,and 3D comparison were carried on with Geomagic 11.0 software.A comparison of the surface morphology of the hard and soft tissues of the 3D models with different scanning parameters was made.Results:With the reduction of the tube current,the model surface became rough gradually.Compared with the 280 mA scan results,the model surface produced by 35 mA scanning was still fairing,when the dose fell to less than 25 mA,the model surface became rough and the exact shape of the model could not be recognized.The same results of model surface were pro-duced after registration.Conclusion:The low-dose (35 mA)CT can be used to reconstruct 3D model of the maxillofacial hard and soft tissues.

Objective To assess the correlation between coronary heart disease and common carotid artery and femoral artery atherosclerosis with two-dimensional color Doppler ultrasound (2D-CDUS). Methods Ninety patients with coronary heart disease were divided into three subgroups according to the extent of coronary artery stenosis observed with coronary angiography, and 50 normal subjects were taken as normal group. Ultrasound examination with high-frequency linear array probe was performed to measure IMT of common carotid and femoral artery in order to observe the plaque and extent of stenosis, the formation of blood dynamics, physical characteristics and hemodynamic environmental parameters. Results Among the coronary disease groups, common carotid artery and the femoral artery IMT, atherosclerotic plaque in the number, rate and all points increased along with the degree of coronary artery stenosis increasing. Physical characteristics and its hemodynamic environmental parameters had some changes with the increase of atherosclerosis. Conclusion The atherosclerosis of common carotid artery and the femoral artery are closely related with coronary atherosclerosis.