Objective To explore the application value of self-made directional arcuate bone drill during vertebroplasty by observing its operative effects for osteoporosis in vitro . Methods EDTA-Na2 was used to soak the prepared vituline osteoporotic vertebral bodies in vitro .A total of 40 osteoporotic vertebral bodies were randomly divided into Group A and B , with each group having 20 vertebral bodies for vertebroplasty .The Group A underwent a puncture by routine straight bone drill , while the Group B received a puncture by self-made directional arcuate bone drill with the arc directing toward the contralateral , which terminated when the drill reached the first 1/3 of vertebral body .Finally, statistical analysis was conducted on the distance between the bone drill bit and exterior margin of contralateral vertebral body , as well as whether bone cement reached or went over the vertebral sagittal midline . Results The osteoporotic vertebral bodies were successfully prepared in vitro by using EDTA-Na2 immersion decalcifying for 9 days. In the Group A, the drill bit was (2.50 ±0.32) cm away from contralateral exterior margin of vertebral bodies , which was significantly different from that in the Group B (0.90 ±0.26) cm (t=17.354, P=0.000).The bone cement reached or went over the vertebral sagittal midline in 11 vertebral bodies in the Group A and in 19 vertebral bodies in the Group B , with statistical difference ( Fisher’ s test,P=0.004).The intraspinal bone cement leakage occurred in 9 vertebral bodies in the Group A and 4 in the Group B, without significant difference between the two groups (Fisher’s test,P=0.176). Conclusion The self-made directional arcuate bone drill can build an osseous channel that reach or go over the vertebral sagittal midline and guide bone cement distributed to contralateral puncture , which avoids the disadvantages of bilateral vertebral pedicular puncture .The result shows that the self-made directional arcuate bone drill has more adventages in vertebroplasty than that of traditional straight bone drill but doesn ’ t have significant advantages in preventing bone cement leakage .

OBJECTIVETo explore therapeutic effects of Modified pinning combined with external tension band for the treatment of Gartland type III humeral supracondylar fractures in children.

METHODSFrom February 2009 to November 2010, 79 children with Gartland type III humeral supracondylar fractures were treated by modified pinning (pinning cross internal and external condyle assisted with lateral condyle) combined with external tension band (crossing needle end and hooking around) through lateral approach of elbow. There were 47 males and 32 females, with an average age of 8.7 years (ranging from 2.5 to 14 years). The time from injury to operation was 2 h to 8 d. The elbow joint function and Carrying angle were observed before and after treatment. The Flynn criteria were used to evaluate therapeutic effects.

RESULTSSixty-one patients were followed up (18 patients' data were lost) for 6-30 months (mean 13.5 months). According to Flynn criteria, 53 patients got excellent result, 7 good and 1 fair.

CONCLUSIONTreatment of child Gartland type III humeral supracondylar fractures with modified pinning combined with external tension band through lateral approach of elbow is believed to be an ideal method, which has advantages of reliable fixation, rapid recovery and less complications.

Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Fracture Fixation ; instrumentation ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Mechanical Phenomena ; Radiography ; Treatment Outcome

Objective To study the expressions of PTTG and bFGF proteins and their relationship with microvessels density(MVD)in esophageal carcinoma.Methods Immunohistochemical SP method was used to detect the expression of PTTG and bFGF proteins in 48 esophageal carcinoma tissues and the same para-cancerous tissues.MVD was evaluated by immunohistochemieal staining with antibody CD34.Results The positive rate of PTTG and bFGF was 68.8%(33/48)and 70.8%(34/48)respectively.Rate of PTTG protein expression in esophageal carcinoma tissues was significantly higher than that in para-cancerous tissues(8.3%and 12.5%,P＜0.05).The positive rate 0f PTTG,bFGF and MVD was correlated with lymph node metastasis and TNM stage.There was no relationship with age,sex,tumor size MVD(P＜0.05).Conclusion PTTG and bFGF are over-expressed in esophageal carcinoma.Increased PTTG may play an important role in carcinogenesis and development of esophageal carcinoma by promoting the expression of bFGF protein which may induce an angiogenesis.

Objective To further recognize the coronary artery three vessel disease by studying the abnormal change of the electrocardiogram(ECG)and echocardiography of ischemic heart disease patients and unstable angina pectoris patients,and to analyze the results of coronary angiography.Methods Coronary arteriography for 2 654 patients diagnosed as ischemic heart disease,unstable angina pectoris,were conducted and the result of coronary arteriography were compared with the ECG and echocardiography.Results There were certain statistically significant correlation among the ECG,echocardiography abnormal change and three vessel coronary artery disease(ECG:χ2 =9.02,P <0.01;echocardiography:χ2 =14.36,P <0.01).The sensitivity,specificity,false positive rate,and false negative rate of ECG were 71.46%,27.47%,62.26% and 28.50% respectively.The sensitivity,specificity,false positive rate, and false negative rate of echocardiography were 61.27%,27.08%,72.91% and 38.72% respectively.ECG′s change of patients appear in 8 or more leads when angina pectoris attacks exist,the incidence of chest lead terminal positive T wave were higher than 90.00%.Ⅲ lead fQRS wave group or low voltage changeed and AVR lead ST seg-ment elevation were accounting for 82.61% and 56.52% respectively.Conclusion There are certain correlation and predictive value among the ECG,echocardiography and three vessel coronary artery disease.There are characteristic waveform change of ECG when angina pectoris attacks exist.

Objective:To explore the effect of different tidal volumes (VT) on the hemodynamics of right heart in acute respiratory distress syndrome (ARDS) rats induced by oleic acid (OA).Methods:Sixty adult male Sprague-Dawley (SD) rats were divided into control group ( n = 20), ARDS model group ( n = 20), low VT (LVT) group ( n = 10) and high VT (HVT) group ( n = 10) by random number table. ARDS model was reproduced by injecting OA 0.15 mL/kg through a jugular vein. The control group was given the same amount of normal saline. The success of modeling was judged by the oxygenation index (PaO 2/FiO 2) 2 hours after modeling, at the same time, the lung tissues were collected, the wet/dry weight (W/D) ratio was determined, and the lung histopathological changes were measured by lung injury score. The rats in the LVT group and HVT group were given mechanical ventilation with VT of 6 mL/kg or 20 mL/kg for 4 hours, respectively at 2 hours after modeling. The rats in the control group and the ARDS model group maintained spontaneous breathing. After mechanical ventilation for 4 hours, the heart rate (HR), right ventricular systolic pressure (RVSP), the maximum rate of rising of right ventricular pressure (dp/dt max), and the blood pressure (BP) were measured. Meanwhile, arterial blood samples were collected for blood gas analysis, including pH value, arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2) and PaO 2/FiO 2. Results:The rats in the ARDS model group showed symptoms of respiratory distress 1 hour after modeling, and the lung tissue samples showed obvious patchy bleeding 2 hours after modeling, while the control group showed no such changes. The PaO 2/FiO 2 in the ARDS model group was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 294.3±5.9 vs. 459.0±4.4, P < 0.01], and the lung W/D ratio and lung injury score were significantly higher (lung W/D ratio: 8.24±0.25 vs. 4.48±0.13, lung injury score: 0.60±0.03 vs. 0.12±0.02, both P < 0.01). It indicated that ARDS model was successfully reproduced. The arterial blood gas analysis and hemodynamic parameters of the ARDS model group were significantly worse than those of the control group. After 4-hour mechanical ventilation, the blood gas parameters of the LVT group were better than those of the ARDS model group and the HVT group [pH value: 7.36±0.02 vs. 7.24±0.02, 7.13±0.01; PaO 2 (mmHg): 92.4±2.1 vs. 61.8±2.3, 76.6±2.2; PaCO 2 (mmHg): 49.6±1.7 vs. 61.8±1.8, 33.6±1.3; PaO 2/FiO 2 (mmHg): 440.0±10.2 vs. 274.3±21.4, 364.7±10.5; all P < 0.05]. HR, BP and dp/dt max in the LVT group were significantly higher than those in the ARDS model group and the HVT group [HR (bpm): 346.9±5.4 vs. 302.3±10.1, 265.5±12.2; BP (mmHg): 125.4±2.2 vs. 110.0±2.5, 89.2±2.8; dp/dt max (mmHg/s): 1 393.3±30.3 vs. 1 236.4±20.5, 896.1±19.5; all P < 0.05], and RVSP was significantly lower than that in the ARDS model group and the HVT group (mmHg: 31.3±0.4 vs. 34.0±1.0, 38.8±0.9, both P < 0.05). Conclusion:Mechanical ventilation with low VT can improve the hemodynamic parameters of the right ventricle and protect the function of the right heart in ARDS rats.

Objective To evaluate the feasibility and effect of transthoracic echocardiography(TTE)on guiding the occlusion of the soft-rim atrial septal defect(ASD).Methods Sixty two patients with the soft-rim ASD were enrolled.The size of ASD was measured and rim of ASD was observed by TTE on various views by using color Doppler system with tissue harmonic function before occlusion,and filmy rim of ASD with flapping which could not sustain occluder was eliminated.The size of occluder was selected by integratively judging the size of ASD and"sustainable diameter of ASD"The waist size of occluder was measured after releasing occluder and compared with the longest diameter of ASD and"sustainable diameter of ASD"measured by TTE.Results The longest diameter of ASD measured by TTE before occlusion was 11-35 mm[average(21.6±5.2)mm],the "sustainable diameter of ASD"was 15-37 mm[average(25.6±5.(J)mm],the size of selected occluder was 18-44mm[average(30.7±5.5)mini and the waist size of released occluder was 13-35 mm[average(24.2±5.6)mm].Fine correlation was existed between the longest diameter of ASD measured by TTE and the waist size of released occluder(r=0.86,P＜0.000I).Morever,improved correlation was found between the"sustainable diameter of ASD"measured by TTE and the waist size of released occluder(r=0.89,P＜0.0001).Occluder was firmly fixed without falling in all patients.Conclusions TTE with tissue harmonic function can be used to measure the size of soft-rim ASD and the"sustainable diameter of ASD".It is a feasible,and effective method on guiding occlusion of soft-rim ASD.

Objective To provide supportive evidences for the diagnosis of primary major depres-sive disorder (MDD) by analyzing the alterations of proinflammatory cytokines such as IL-1α, IL-6, IL-18, TNF-αas well as the total complement activity (CH50) in serum samples.Methods Hamilton Depression Rating Scale ( HAMD) was used to rate the severity of depression with the patients who were diagnosed as primary MDD.Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of IL-1α, IL-6, IL-18 and TNF-αand the CH50 in serum samples from 49 patients and 40 healthy subjects .Results Pa-tients with MDD showed significantly different levels of IL-6, IL-18, TNF-αand CH50 in serum samples as compared with that in healthy subjects (P<0.05).No significant difference with the level of IL-1αwas ob-served between the patients with MDD and healthy subjects (P>0.05).There were significant gender differ-ences with levels of IL-1αamong the patients with MDD (P<0.05).However, no significant differences with the levels of IL-6, IL-18, TNF-αand CH50 were found between male and female patients (P>0.05). Conclusion The changes of CH50 and certain proinflammatory cytokines such as IL-6, IL-18 and TNF-αmight be involved in the progression of MDD , suggesting the possibility of using them as indicators for the di-agnosis of MDD.

Objective To establish a big animal model of secondary infection of acute necrotizing pancreatitis (ANP). Methods Thirty young pigs were allocated to experiment group ( n = 20 ) or control group (n = 10). The ANP model was induced by retrograde injection of a mixture solution of 5% sodium taurocholate and 5% trypsin (0. 5 ml/kg body weight) into the main pancreatic duct and ligation of the proximal end of the main pancreatic duct, and then the second step was injecting 3 ～ 4 ml living Escherichia coli (E coli) suspension (108/ml) to the necrotic area of the pancreas by fine needle aspiration technique under CT guidance in the experiment group, and by injecting 3 ～ 4 ml inactivated E coli in the control group using the same method. Multi-slice spiral CT dynamic enhanced scan was performed in both groups 1 day and 2 or 3 days after ANP modeling and 5 days after bacterial injection to calculate the CTSI score. Serum amylase, blood WBC count and blood bacterial culture was performed in both groups. 5 days later, the animals were scarified to observe the infected or necrosis foci, and perform smear, bacterial culture and pathologic examinations of the tissue around the infected or necrosis foci. Results The ANP secondary infection model was successfully established in 16 of the 20 animals in the study group, with a success rate of the 80.0% (16/20). There were 17 foci where the positive rate of bacterial culture was 100% (17/17 foci), and the success rate of blood bacterial culture was 68.8%(11/16). In the control group, the ANP model was established successfully in 7 of 10 animals (70%), except for one case of contamination, only one foci was identified;the positive rate of bacterial culture and the success rate of b|ood bacterial culture was 14.3% (1/7). Serum amylase and white blood WBC count increased with similar trends, WBC count in the study group was significantly higher than that in the control group (P<0.01). The mean CT severity index(CTSI) was all ≥4 in beth groups, indicating the severity was moderate to severe. Conclusions A stable and reliable model of secondary infection of ANP in big could be established satisfactorily by injecting active E. coli into the pancreatic necrosis tissue under CT guidance, which helps further pathogenic mechanism studies and clinical studies, especially imaging studies.