Objective To study the etiology,clinical presentation,MR images,treatment and prog-nosis of spontaneous spinal epidural and subdural hematoma.Methods From1995to2002,6cases diag-nosed as spontaneous spinal epidural and subdural hematoma were reviewed retrospectively.All of the pa-tients were males aging from30to68years with an average of 47years.The onset was acute while the pa-tients were in resting or light activity without prior history of any infection,administration of drugs or trau-ma.One patient had the history of hypertension,and another one was found to have diabetes after admission.The clinical characteristics were sudden pain involving neck,shoulder,chest and back,then dysfunction of motion and sensation of extremities and sphincter within few minutes.4cases of spontaneous spinal epidural hematoma were located at T 5~6 ,T 2~4 ,C 4~5 and C 6 ~T 1 respectively,and2cases of spontaneous spinal subdu ral hematoma at C 7 ~T 1 and C 7 ~T 2 respectively.Results All cases were proved with surgery and pathology.MR imaging showed occupying mass in the posterior or posteriolateral region inside the spinal canal.T 1 -weighted imaging was most useful owing to its typical signal changes with the hematoma.T 2 -weighted gra-dient echo sequence was capable to identify epidural and subdural spinal hematoma.Total laminectomy and hematoma debridement were performed.The outcome was closely related to the interval between the onset and surgery.The patients were followed up from6to18months with an average of 10months.All cases showed no significant improvement of spinal cord function except 5cases with incomplete recovery of sphincter function.Conclusion Spontaneous spinal epidural and subdural hematoma are rare entities.MRI is a most helpful diagnostic tool for this disorder.It should be stressed that early diagnosis and prompt surgical intervention are of great importance for prognosis of spontaneous spinal epidural hematoma.

How to remove the well fixed cement or cementless prosthesis and get a completely distal cement removal in the rTHR are critical to the outcome of revision. Because of higher rate of union, excellent intraoperative exposure, and adjustment of abductor tension, ETO has been widely applied to rTHR and complicated primary THR by foreign scholars. Furthermore, this technology has wide indications, very few contraindications, high cure rates,and low complications rate. ETO turns out to be a safe and effective revision technology. In the article, the indication, contraindication, complications and advantages of this technique were reviewed.
Arthroplasty, Replacement, Hip ; methods ; Humans ; Osteotomy ; adverse effects ; methods

Background Many studies and clinical trials of pharmacologic vitreolysis are already under way to try to improve vitreo-retinal surgery and to liquefy and detach the vitreous from the retina ultimately, including chondroitinase,hyaluronidase,dispase and plasmin. However, there has not been any report on purification of human plasminogen from cord blood plasma and inducing posterior vitreous detachment of the animal eye at present.Objective This study was designed to isolate and purify the production of human plasminogen (Plg) from cord blood plasma with ethanol precipitation and evaluate the efficacy of Plg in inducing posterior vitreous detachment (PVD).Methods Human Plg was Separated and purified from cord blood plasma by ethanol precipitation method. The protein band corresponding to Plg with molecular mass of 92 000 was revealed in SDS-PAGE and confirmed by MALDI-TOF and Mascot database. Anion-exchange chromatography and plasminogen activity assay kit were used to obtain purified Plg with biological activity. Twenty-five fresh pig eyes were enucleated and assigned to 5 groups and 5 eyes for each group. The normal eyes were used as control group. Balanced salt solution(BSS)of 0.1 ml was intravitreally group and standard substance group. All of the eyes were then incubatedfor 60 minutes under the 37 ℃. Retinal histopathology and ultrastructure were examined under the light microscopy, scanning electron microscopy ( SEM ) and transmission electron microscopy (TEM). Results The Plg with potential fibrinolytic activity was successfully extracted and purified from cord blood plasma by ethanol precipitation method. No posterior vitreous detachment (PVD) was seen in normal control group, BSS group and r-SK group following the intravitreal injection under the sem. However,PVD was demonstrated in r-SK+ Plg group and standard substance group under the SEM. The inner limiting membrane ( ILM ) and the retina were well preserved in all of the experimental eyes. No retinal morphology and ultrastructural abnormality were found under the light and SEM and TEM. Conclusion Ethanol precipitation is a feasible way to isolate and purify Plg from human cord blood plasma. Extracted Plg shows potential fibrinolytic intravitreal injection of Plg.

Objective To evaluate changes in cerebral blood flow before and after cranioplasty by 256-slice Spiral CT perfusion imaging,and evaluate the effect of cranioplasty on the cerebral blood flow in patients with skull defect.Methods 256-slice spiral CT scan was performed in 20 cases with early cranioplasty surgery,CTP check time points were 1 to 2 days before and 10 to 14 days after cranioplasty surgery.We recorded the the CBF and CBV of the cortex,basal ganglia,and thalamus and other parts,MTT on rCBV,parameter values rCBF,MTT and 1TrP etc.and analyzed and compared.(RCBF,rCBV,MTT and TTP) Results The CBF of cortex after cranioplasty at injured side had statistically significant increase (P＜0.05).The CBF of cortex,basic nuclei,thalamus on contrateral had no statistically significant difference.The cerebral blood flow on both sides of the basal ganglia and the thalamus was increased after surgery,but there was no significant difference between before and after surgery (P＞0.05) Conclusion Cranioplasty can significantly improve the ipsilateral cortex cerebral blood flow,and CT brain perfusion can accurately assess changes in brain tissue blood flow before and after cranioplasty.

Animals ; Cholesterol ; blood ; Hyperlipidemias ; blood ; drug therapy ; Leptin ; pharmacology ; therapeutic use ; Male ; Mice ; Mice, Inbred Strains

Objective To summarize the experience and clinical characteristics in liver re- transplantation following adult-to-adult living donor liver transplantation.Methods Due to biliary complication (2 cases),vascular complication (2 cases),chronic rejection (1 case) and hepatitis recur- rence (1 case),liver re-transplantation was performed on 6 patients through modified piggyback liver transplantation.Vascular anastomosis was performed between the hepatic arteries of donor livers and receptor abdominal aorta in 1 case,and the rest were subjected to end-to-end homonymic vascular anastomosis.Results No operative death occurred.Due to primary non-function,1 died after the ope- ration.During the follow-up period,1 had anastomotic stricture of hepatic artery after the operation and was cured by percutaneous venoplasty.The survival of the rest patients was 12,9,6,4 and 3 months respectively.Conclusion Peritoneal adhesion is the operative difficulty for liver re-transplantation following adult-to-adult living donor liver transplantation.

OBJECTIVETo compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults.

METHODSReports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis.

RESULTSSeven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P < 0.000 01], hospital stays time [WMD = -4.72, 95% CI (-5.18, -4.25), P < 0.000 01], bearing load time [WMD = -29.54, 95% CI (-30.77, -28.31), P < 0.000 01], total complications rate [WMD = 0.15, 95% CI (0.11, 0.22), P < 0.000 01], the good rate of Harris scores [WMD = 1.09, 95% CI (0.54,1.32), P < 0.05]. However, there were no statistical significance in the rate of deep venous thrombosis [WMD = 1.09, 95% CI (0.47, 2.55), P > 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

At present, cancer is still one of the most serious threats to human health. Despite the wide application of multiple cancer therapies in clinical practice, the therapeutic effects of most cancers are still far from satisfactory. In recent years, the discovery of regulated cell death may be a good first step on the road to treat cancer. Ferroptosis is triggered by lipid peroxidation of unsaturated fatty acids in cell membrane catalyzed by iron ion. It has been widely concerned as an emerging target for cancer therapy. With the booming of biomedical nanotechnology, ferroptosis as an emerging therapeutic target has attracted extensive attention. Here, we review the advance on the intersection of ferroptosis and biomedical nanotechnology. First, the research background of ferroptosis and nano-preparation as well as the feasibility of ferroptosis-based nano-drug delivery systems (nano-DDS) for cancer treatment are presented and analyzed. Then, the strategies for inducing ferroptosis based on nano-DDS are summarized, mainly including: the promotion of Fenton reaction, the inhibition of glutathione peroxidase 4 (GPX-4) and the restriction of the cysteine-glutamate exchange transporter (system Xc^-). Furthermore, the combination therapy strategies based on biomedical nanotechnology induced ferroptosis are also discussed. Finally, we shine the spotlight on the prospects and challenges of ferroptosis-based nanotherapeutics in clinical application.

Background Bevacizumab is primarily aimed at pathologic angiogenesis for off-label uses such as the treatment of ocular neovascular disorders.However,as a new anti-fibrotic and anti-angiogenic agent following trabeculectomy,the safety and efficacy of bevacizumab by multiple-time and high-dose subconjunctival injection are still under study.Objective This study was to assess the safety and efficacy of bevacizumab after multiple-time and high-dose subconjunctival injections.Methods Regular trabeculectomy filtration surgery was performed on both eyes of 18 clean New Zealand White rabbits 0.1ml of bevacizumab(25g/L) was subconjunctivally injected intraoperatively and 3,5,7 days postoperatively in the left eyes of rabbits,and no any intervene in the right eyes were as normal controls.Bleb morphology was examined every 2 days and graded based on Moorefield's criteria and compared between the bevacizumab-treated eyes and normal saline(NS) eyes.The animals were sacrificed at 10,20 and 30 days after surgery respectively.The histopathological changes of the blebs were detected by hematoxylin and eosin stain to evaluate the cellular element around the bleb,and Masson stain was used to assess the degree of fibroblast proliferation.The degree of vascularity of bleb was identified by anti-vWf stain.Approval of this protocol was obtained and permitted from People's Hospital Institutional Animal Care and Use Committee of Peking University.The use of experimental animals complied with the Regulation for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results Compared to the NS-treated eyes,bevacizumab-treated eyes showed the larger and more diffusely elevated blebs with the significant difference(2.48±0.22cm2 versus 1.73±0.27cm2,t=5.194,P＜0.05).The survival time of the filtration bleb in bevacizumab panel was longer in bevacizumab-treated eyes compared to control eyes,showing a significantly difference between them(21.0±1.56 days versus 12.5±1.97 days,t=3.830,P=0.005).Histological and immunohistochemical analysis confirmed that bleb and adjacent conjunctiva vascularity(A value) was significantly less in bevacizumab-treated eyes than that in control eyes at 20 days after surgery with the difference value 14320.7±4134.9(t=12.275,P＜0.05),and fibroblast deposition value was evidently diminished after bevacizumab treatment at 30 days following surgery in comparison with control eyes with the mean difference 0.27±0.03(t=15.980,P＜0.05＝.Conclusion Repeated subconjunctival injection of bevacizumab can effectively prolong the survival time of bleb in a rabbit model of trabeculectomy and limit the degree and area of vascularization in 30 days following surgery.Bevacizumab inhibit fibroblast-meditated tissue formation significantly in the later phase of vascularization after trabeculectomy.

Objective To explore a reasonable,accuracy and effectual proposition model for medical imaging examination.Methods Mean scores and their standard deviation and distribution as well as the difficulty,discrimination,reliability and validity of the test paper were analyzed for the 2005 grade 7-year program students by using SPSS 13.0 statistic software.Results The scores of the 67 copies of test paper displayed a normal distribution,with the mean score of 73.76 and standard deviation of 11.88.The difficulty,reliability and validity indexes of the test paper were 0.74,0.78 and 0.25 respectively.The difficulty,discrimination,reliability and validity indexes of subjective items were higher than those of objective items(0.76 vs.0.73,0.94 vs.0.90,0.71 vs.0.68,0.32 vs.0.22,respectively).Conclusions We should keep quite high proportion of subjective items and make detailed scoring standard in medical imaging examination.Furthermore,as a supplement,objectively items such as multiple choice questions can expand the scope of knowledge examined.