Objective To explore the role of sulodexide(SDX)in neointimal hyperplasia of arteriovenous fistulas(AVFs)in chronic kidney disease(CKD)rats and its possible mechanism.Methods A total of 18 male rats(weighing 300±50 g)were randomly and equally divided into AVF group,CKD+AVF group(CKD induction followed by AVF surgery and then gavaged with normal saline for 2 months),and CKD+AVF+SDX group[treated as in the CKD+AVF group but with 8 mg/(kg·d)SDX gavage].HE staining was used to observe the degree of neointimal hyperplasia.The expression of Hippo pathway related molecules,Yes-associated protein(YAP),pYAP and connective tissue growth factor(CTGF,YAP downstream target protein,one of mesenchymal marker)was detected by immunofluorescence assay.After human umbilical vein cell fusion EAHy926 cells were treated with 0,2.5,5,10,20 or 40 μg/mL SDX for 24 h,and with 2.5 μg/mL SDXfor24,48 or 72 h,respectively,CCK-8 assay was used to measure cell survival rate.Moreover,the serum sample from CKD rat was used to treat EAHy926 cells,and then the cells were treated with SDX or YAP inhibitor verteporfin.The expression levels of YAP,pYAP,CTGF and endothelial cell marker CD31 were detected by Western blotting.Results HE staining and immunofluorescence assay showed that CKD rats had serious neointimal hyperplasia in AVFs(P＜0.05),and slightly lower expression of pYAP and enhanced expression of CTGF(P＜0.05)when compared with the rats of the AVF group.While,SDX treatment alleviated the neointimal hyperplasia of AVFs,enhanced the expression of pYAP and reduced the expression of CTGF(P＜0.05).CCK-8 assay showed that cell survival rate was decreased significantly in a dose-and time-dependent manner after SDX treatment(P＜0.05).Western blotting revealed that SDX increased the expression of pYAP and CD31 while inhibited the expression of CTGF in EAHy926 cells(P＜0.05),which was consistent with the effect of verteporfin treatment.Conclusion SDX can block YAP activation caused by CKD and attenuate neointimal hyperplasia in AVFs.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective:To explore the utility of the muscle redistribution technique (MRT) in the signal recognition of an intelligent bionic prosthesis.Methods:Between December 2016 and April 2017, 4 male patients were treated with muscle redistribution procedures. Among them, 3 were upper limb amputees of the distal 1/3 of the forearm, at the carpometacarpal joint and at the midcarpal joint. One was a lower limb amputee at the distal 1/3 of the lower leg. In each case, 4-6 muscles and tendons in the stump were transferred and the tendons were anchored in different areas of the skin. When the muscle contracted actively, the tendon pulled the skin, resulting in obvious deformation of the skin in different areas. The skin′s deformation, capacitance signal data and postoperative complications were used as indicators in the evaluations. To measure the capacitance signals the patients were asked to grip, flex and extend the wrist, and flex and extend the fingers , or dorsi- and plantar-flex the ankle, and flex and extend the toes. With the help of capacitance sensors the limb′s deformation was analyzed.Results:Three months after the surgery the patients were able to actively control contraction of the transferred muscle and produce skin deformation. At the final follow-up, the effective deformation rate was 80% (16/20). Two kinds of classifiers were identified by linear discriminant analysis and quadratic discriminant analysis. In the upper limb, the overall recognition accuracies were 97.27% and 100% respectively, and the recognition accuracy of each action was 100%. In the lower limb, the overall recognition accuracies were 95.32% and 100%, and the recognition accuracy of each action was again 100%. In one case wound healing was delayed and several dressing changes were required.Conclusions:MRT can effectively output motion intentions and increase the number and intensity of motion signals. The procedure provides a novel way for better control of intelligent bionic prostheses.

Objective To analyze kinematic characteristics of children with spastic cerebral palsy during walking based on the method of gait analysis. Methods The gait of 14 children with spastic cerebral palsy and 16 healthy children, who were required to walk back and forth on level ground at normal speed, was tested using portable gait analyzer. The gait differences between diseased side and healthy side of lower limbs for children with spastic cerebral palsy, as well as the gait differences between children with spastic cerebral palsy children and healthy children were compared. Results For children with spastic cerebral palsy, single step time, swing time and toe-off time of diseased side were significantly longer than those of healthy side (P＜0.05), while step frequency, velocity and terminal stance were significantly shorter than those of healthy side (P＜0.05). Compared with healthy children, gait cycle time, single step time, stance time, swing time, percentage of stance phase, mid stance phase, pre-swing stage and toe-off time for diseased side of children with spastic cerebral palsy were significantly longer (P＜0.05). Stride, velocity, step frequency and terminal stance of the children with spastic cerebral palsy were significantly lower than those of healthy children (P＜0.05). Pulling acceleration for children with spastic cerebral palsy also decreased compared with healthy children (P=0.05). Conclusions The stability of children with spastic cerebral palsy decreased during walking, and their single step time, swing time, toe-off time and pulling acceleration might be considered as the sensitive indicators.

BACKGROUND: Lumbar spondylolysis is the common cause of teenagers' low back pain. It should apply internal fixation if conservative treatment is invalid. There are a variety of surgeries, which aims to alleviate pain and bony fusion of pars defect.OBJECTIVE: To observe clinical outcome of bone graft of pars defect plus temporary single segmental pedicle screw rod fixation for adolescent lumbar spondylolysis.METHODS: A total of 32 adolescent patients of lumbar spondylolysis were treated by bone graft of pars defect plus temporary single segmental pedicle screw rod fixation. All the patients had bilateral spondylolysis. 20 patients had no lumbar spondylolisthesis, while the others had I° spondylolisthesis. All the patients received lumbar radiograph, CT and MRI. Visual analogue scale and Oswestry disability index were utilized to evaluate pain improvement before and after operation. MacNab was used to assess efficacy. Bone graft healing at isthmus was observed with lumbar CT after fixation. The internal fixation was removed after bone fusion, then the motion of the fixed segment and the degeneration of adjacent intervertebral disc occurred were recorded.RESULTS AND CONCLUSION: (1) Completed bone fusion of pars defect was achieved in all the patients. The average period of bone union was 7.4 months. (2) The visual analogue scale and Oswestry disability index scores were significantly improved after surgery in all patients (P < 0.05). (3) The fixed segment reserved the motion after internal fixation removal. The signal of adjacent intervertebral disc of fixed segment had no changes compared to preoperative MRI. (4) Bone graft to repair isthmus defect plus temporary single segmental screw rod fixation for adolescent lumbar spondylolysis is very effective, the bone fusion is completed, and temporary fixation may effectively alleviate the degeneration of adjacent disc.

BACKGROUND: Most scholars believed that injured vertebral body needs to be fixed in the open surgery of thoracolumbar vertebral fractures; however, it is unclear whether injured vertebra needs to be fixed in the minimaly invasive surgery. OBJECTIVE: To investigate the clinical outcomes of minimaly invasive percutaneous self-dilating pedicle in repair of injured vertebral fixation in thoracolumbar vertebral fractures. METHODS: Totaly 36 patients with thoracolumbar vertebral fractures without nervous system injury who received treatment in Honghui Hospital, Xi’an Jiaotong University Health Science Center from February 2013to February 2014 were enroled and divided into injured vertebral fixation and cross-injured vertebral fixation groups (n=18/group). Patients in these two groups were al subjected to minimaly invasive percutaneous self-dilating pedicle treatment. The injured vertebral body, upper, and lower vertebrae of injured vertebral body were fixed in injured vertebral fixation group, and the upper and lower vertebrae of injured vertebral body was fixed in cross-injured vertebral fixation group. RESULTS AND CONCLUSION: Compared with the injured vertebral fixation group, the cross-injured vertebral fixation group had smaler incisions, less intraoperative blood loss, less operation tine and intraoperative X-ray fluoroscopy time (P < 0.05). After one year of internal fixation, the anterior vertebral height, anterior vertebral height percentage and kyphotic Cobb angle of patients in these two groups improved compared with those before internal fixation (P < 0.05), but there were no significant differences in anterior vertebral height percentage, kyphotic Cobb angle and Oswestry disability index between these two groups (P > 0.05). These results demonstrate that anterior vertebral height cross-injured vertebral fixation has the similar clinical effect with injured vertebral fixation, but cross-injured vertebral fixation had more advantage in the operation. Therefore, there is little significance of conducting injured vertebral fixation in the surgery of minimaly invasive percutaneous self-dilating pedicle in repair of thoracolumbar vertebral fractures.

Objective To evaluate the therapeutic effect of modified dual plating and less invasive stabilization system(LISS) in the complex fractures of tibial plateau.Methods One hundred and sixty-eight patients with complex fractures of tibial plateau were divided into two groups by the therapeutic methods,89 patients were in modified dual plating group while 79 patients were in LISS group.The advantages and curative effect of two groups were retrospectively analyzed.Results The excellent and good rate in modified dual plating group was slightly higher than that in LISS group [89.9％ (80/89) vs.86.1％ (68/79)],and there was no significant difference (P ＞ 0.05).No patient occurred deep site infection,severe nerve damage,phlebothrombosis in two groups.In modified dual plating group,the operation time and bleeding volume was (89.2 ± 13.6) min and (188.4 ± 45.6) ml,the hospital stay and healing time was (16.5 ± 1.8) d and (13.3 ±2.1) months.In LISS group,the operation time and bleeding volume was (74.3 ± 12.5) min and (236.5 ±65.5) ml,the hospital stay and healing time was (16.7 ± 2.1) d and (11.4 ± 1.5) months.There was no significant difference (P ＞ 0.05).Conclusion The therapeutic effect of modified dual plating and LISS have no significant difference for complex tibial plateau fractures.

Objective To investigate the anatomy of upper cervical vertebrae's stable reconstruction by poster arch of atlas screw by anatomic study. Methods To collect the anatomical data of 39 dry atlas with the average inner diameter of vessel of atlas, the average high and wide of the screw point of poster arch of atlas, the average high and wide of poster arch of atlas beneath the groove for vertebral artery, the tract length of poster arch screw, the tract length of lateral mass screw, the direction and angle of poster arch screw, and the direction and angle of lateral mass. Statistical comparison were performed with Student test between the tract length of poster arch screw and the tract length of lateral mass screw. Results The average inner diameter of vessel of atlas was (26.8±2.58) mm(21.7-31.0 mm). The screw point high and wide of poster arch of atlas were (6.83±1.97) mm and (6.40±1.36) mm respectively. The average high and wide of poster arch of atlas beneath the groove for vertebral artery were (4.37±1.11) mm and (8.05±1.33) mm respectively. The tract length of poster arch screw were (30.54±1.705) mm. The direction and angle of poster arch screw was 15°-20° incline laterally and 0°-5°incline cephalo. 25.6%(10 cases) patients with the diameter less than 3.5mm beneath the groove for vertebral artery. The direction and angle of lateral mass screw was 32.05°±6.03° incline medially and 5° incline cephalo. There were significant differences between the tract length of poster arch screw and the tract length of lateral mass screw(t=59.528, P＜0.001 ). Conclusion About 74.4% patients can reconstruct the upper cervical stable by poster arch of atlas screw. The technique can gain instant upper cervical stable, and reduce the risk of injury of blood vessel by over explore the atlas arch compare with the technique of lateral mass screw fixation of atlas. The technique is worth to promoting with its character of safe, easy perform and rigid fixation.

Objective To study the effects and mechanism of Huangqi against myocardium injury induced by ischemia and reperfusion in rats. Methods Totally 30 male Sprague-Dauley rats were randomly divided into three groups: control group (C group), ischemia/reperfusion group (I/R group), ischemic pretreatment with Huangqi group (H+I/R group), with 10 rats in each. The left anterior descending (LAD) coronary artery was ligated to establish the ischemia/reperfusion heart model. Huangqi was administered before the model was established in the H+I/R group. The pathologic changes of myocardial tissues (under light and electron microscopy), content of creatine kinase (CK), lactate dehydrogenase (LDH), malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) in serum, as well as activities of Na~+K~+-ATPase and Ca~(2+)-ATPase in myocardial tissues were observed. Results Light and electron microscopic examination showed that the necrotic degeneration and pathologic changes of myocardiocytes in Huangqi group were significantly milder than those in the model group. The levels of CK, LDH, MDA were decreased significantly in Huangqi group (P<0.05), the activities of SOD, Na~+K~+-ATPase and Ca~(2+)-ATPase in myocardial tissues in Huangqi group significantly increased (P<0.05). Conclusion Huangqi shows a significantly protective effect on myocardial I/R injury in rats. The mechanism may be related to multiple factors, including improving microcirculation, forming anti-oxygen free radicals and decreasing calcium overload.

ObjectiveTo analyse the state of traumatic conditions, associated injury and complications of patients with acute spinal cord injury (SCI) and provide the therapeutic principles of early treatment.Methods1352 cases with acute SCI were studied retrospectively.ResultsAmong patients, 875 cases had complete SCI and 477 cases had incomplete SCI. Complications included pulmonary infection, urinary system infection, bedsore and so on. The associated injuries included craniocerebral injury, fractures of limbs and pelvic, hemopneumothorax and so on. Conservative treatments involved high doses of methylprednisolone pulse therapy (MPPT), hyperbaric oxygen treatment (HOT), the use of dehydrating and neurotrophy agents, etc. The operation of decompress and internal fixation was applied in cases with spinal instability, vertebral dislocation and spinal compression. The associated injury was treated by specialist.ConclusionThe key point of raising remedy level includes thinking highly of field first aid, prompt and perfect early treatment, dealing with associated injury, preventing secondary SCI and complications and early rehabilitation directions.