Objective To investigate the safety and efficacy of ExoSeal vascular occluder in bridging therapy for patients with acute ischemic stroke(AIS).Methods The clinical data of 142 AIS patients,who received mechanical thrombectomy in the bridge-connected vascular lumen after full dose recombinant tissue plasminogen activator(rt-PA)thrombolysis at the Weifang Municipal People's Hospital of China between June 2018 and December 2020,were retrospectively analyzed.An 8-F femoral arterial sheath was used for the performance of endovascular mechanical thrombectomy in all patients.After the interventional procedure finished,the hemostasis of femoral artery puncture point was achieved by using manual compression(MC)method in 68 patients(MC group)and by using a 7-F ExoSeal vascular occluder method in 74 patients(ExoSeal group).The success rate of puncture point hemostasis and the incidence of puncture point-related complications were compared between the two methods.Results The success rate of surgery in the ExoSeal group was 94.6％,which was obviously higher than 83.8％in the MC group(P=0.037).During the period from the time of finishing surgery and the time of discharge,11 patients(16.2％)in the MC group and 4 patients(5.4％)in the ExoSeal group developed puncture point-related complications(P=0.030),and 6 patients(8.8％)in the MC group and 2 patients(2.7％)in the ExoSeal group developed deep vein thrombosis(P=0.109).No arteriovenous fistula,pseudoaneurysm,acute ischemia of the ipsilateral lower limb,puncture point-associated major bleeding,or other complications that required vascular surgery or interventional therapy occurred in all patients.Conclusion ExoSeal vascular closure device can be safely used in AIS patients who are receiving mechanical thrombectomy in the bridge-connected vascular lumen after thrombolysis.It carries high success rate for femoral artery puncture point hemostasis,besides,it can reduce the incidence of puncture point hematoma.

Objective:To evaluate Castor single-branch covered-stent in the treatment of Stanford B aortic dissection(TBAD)with insufficient anchorage zone.Methods:Clinical data of 25 TBAD patients (proximal healthy landing zone ≤15 mm) treated with Castor branched stent-graft at Weifang People's Hospital from Apr 2019 to Sep 2021 were analyzed retrospectively.The stent model was selected according to preoperative CTA examination and intraoperative angiography,the operation result and follow up data were reviewed.Results:The operation success rate was 100%,the mean operative time was (137.8±35.8)min, and the mean blood loss was (52.8±24.5)ml. There were 2 cases of internal leakage (IA) and it was disappeared after balloon dilation, Branched stent stenosis occurred in 2 cases and relieved by balloon dilatation. The mean follow-up time was 14.6 months, and the patency rate of branch stent was 100% during the follow-up period. The true lumen diameter of thoracic aorta was significantly expanded and the false lumen diameter was significantly reduced 3 months after surgery compared with that before surgery ( P<0.05). Conclusion:Castor stenting in the treatment of TBAD with insufficient proximal anchoring area is simple and feasible, with satisfactory short term clinical effect.

Objective To evaluate the clinical and radiological features of Gorham disease. Methods Clinical and radiological features of Gorham disease were retrospectively analyzed by reviewing the eleven cases from our hospital and the cases reported in the domestic literature in the past fifty years. The diagnoses of all these 11 patients were in accordance with the diagnostic criteria established by Wells and Gray et al. All patients had X?ray plain film, four had CT scan and five had MR examination, with one had additional contrast?enhanced MR examination. Results There were 7 males and 4 females, age ranged from 16 to 66 years with a median age of 32 years. There were six cases involving hand, one involving ulnar and radial bones, one involving acetabulum and three involving jaw bones. The main clinical manifestations were pain, swelling, limited activity, and focal muscular atrophy occurred in 7 cases. On X?ray plain films, the affected bone became thin and the cortexes were not smooth and became coarse in 6 cases. Local lucent area was seen in 5 cases and massive bone absorption was seen in 6 cases. The residual bones showed a tapering appearance in 1 case. Pathological fracture occurred in 1 case. On CT scans, the affected bone became thin and the cortexes became coarse in 4 cases. Local lucent area was seen in 1 case. Massive bone absorption was seen in 3 cases. The adjacent muscular atrophy and widened intermuscular fat space occurred in 2 cases (atrophic bone absorption). On MRI, normal signal intensity of bone marrow disappeared and demonstrated low signal on T1WI and high signal on T2WI. The signal could be homogeneous or heterogeneous. There were widespread strip and patchy high signal areas in the soft tissue around the absorption areas in 4 cases, which resembled the edema?like signal. In 1 case, there was irregular widespread soft tissue mass around the absorption areas with heterogeneous high signal on T2WI. The adjacent muscle showed atrophy, and the intermuscular fat space became wide. There were a total of 92 cases reported cases in the literature including our 11 cases. There were 63 males and 29 females. The onset age ranged from 10 to 40 years in 66/92(72%)cases. The lesion affected one bone in 24 cases, affected two or more bones in 68 cases, out of which 9 cases had single center distribution, 59 cases had multiple centers distribution. Pectoral girdle, pelvis, maxillofacial bones, and hand were the most common sites of involvement in decreasing order. Forty three cases had muscle atrophy and 8 cases had soft tissue mass. Conclusion Gorham disease should be considered when atrophic bone absorption in one bone or continuous bones occurs that does not match clinical symptoms, with soft tissue atrophy but no bone sclerosis or periosteal reaction in the osteolytic areas.

Objective To analyze the pattern of normal bone marrow on whole body diffusionweighted imaging (WB-DWI) and its influence factors.MethodsA total of 98 healthy volunteers (male 47 and female 51). All volunteers underwent WB-DWI at 1.5 T MR scan. The ADC value,the signal intensity on DWI obtained with a b value of 800 s/mm2 ( SIDWI ),and the signal intensity on short time inversion recovery images ( SISTIR ) of thoracic vertebrae,lumber vertebrae,bilateral head of femur,bilateral neck of femur,bilateral superior segment of femur,bilateral inferior segment of femur,bilateral ilium,bilateral head of humerus,bilateral scapula were measured and compared with ANOVA test and StudentNewmar-Keuls test.The normal appearance of bone marrow on WB-DW[ was assessed. The relationship between the SIDwI and the ADC,and the SIDWI and the SISTIR of bone marrow were analyzed.The ADC of bone marrow between male and femaIe were compared. Spearman correlation analysis was performed for different age groups.Results( 1 ) Bone marrow signal intensity was different among 98 healthy volunteers.Bone marrow in 69 healthy volunteers (female 24,male 45 ) showed low to intermediate signal intensity,whereas in the remaining 29 healthy volunteers (female 27,male 2) showed high signal intensity.(2) The SIDWI of thoracic vertebrae ( median 44.54),lumber vertebrae ( median 35.01 ),head of femur ( median 13.61 ),neck of femur ( median 16.00),superior segment of femur ( median 21.45 ),ilium ( median 25.77),head of humerus (median 18.35),scapula (median 36.12) was positively correlated with the ADC [ (0.55 ±0.08) × l0-3,(0.53 ±0.08) × 10-3,(0.30 ± 0.10) × 10-3,(0.42 ± 0.16) × 10-3,(0.74±0.14) ×l0- 3,(0.49±0.10) ×10-3,(0.36±0.13) ×10-3,(0.49±0.11) × 10-3mm2/s]and the SISTIR ( median 61.81,64.99,53.27,69.08,73.10,66.35,73.16,79.81 ),r =0.513 and 0.695,0.741 and 0.764,0.443 and 0.489,0.641 and 0.656,0.510 and 0.648,0.475 and 0.715,0.366 and 0.446,0.437 and 0.739 ;P ＜ 0.01. (3) There was significant difference of the ADC of bone marrow in different bone,F =138.69,P ＜ 0.01. Student-Newman-Keuls test revealed that no significant difference was found in the ADC between thoracic vertebrae and lumbar vertebrae,ilium and scapula,head of humerus and inferior segment of femur ( P ＞ 0.05 ),and significant difference was found in the ADC values between the remaining two groups ( P ＜ 0.05 ). The bones associated with decreasing ADC values were superior segment of femur,thoracic vertebrae and lumber vertebrae,ilium and scapula,neck of femur,head of humerus,head of femur and inferior segment of femur. ( 4 ) The ADC values of bone marrow of female subjects in thoracic vertebrae [ (0.59 ±0.07) × 10-3 mm2/s],lumber vertebrae [ (0.58 ±0.06) × 10 -3 mm2/s],head of femur ( median 0.33 × 10 -3 mm2/s),neck of femur ( median 0.53 × 10 -3 mm2/s),superior segment of femur ( median 0.81 × 10-3 mm2/s),inferior segment of femur ( median 0.32 ×10-3 mm2/s),ilium [ (0.52 ± 0.09 ) × 10-3 mm2/s ],head of humerus (median 0.42 × 10-3 mm2/s),scapula [ (0.53 ± 0.09) × 10-3 mm2/s] were significantly higher than those of male subjects [ (0.51 ±0.07) × 10-3,(0.48 ±0.07) × 10-3,median 0.23 × 10-3,median 0.31 × 10-3,median 0.66 × 10-3,median 0.23 × 10-3,(0.46 ±0.10) × 10-3,median 0.27 × 10-3,(0.45 ±0.11 ) × 10 3mm2/s].(5)There was significant negative correlation between the ADC values of bone marrow and age in thoracic vertebrae,lumber vertebrae,head of femur,neck of femur,superior segment of femur,ilium,head of humerus for female subjects,r =-0.549, -0.629, -0.329, -0.524, -0.338, -0.548 and -0.416,respectively,P ＜ 0.05.There was no significant correlation between ADC values and age in inferior segment of femur and scapula for female subjects and all the regions for male subjects ( P ＞ 0.05 ).Conclusions The ADC and the SIsTIR of bone marrow correlates with the SIDW1.The ADC values of bone marrow is affected by age and sex,and is different for different bones.

Objective To analyze the imaging features of primary lymphoma of the bone,and discuss the special feature of the floating ice sign. Methods Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination (3 cases simultaneously with enhancement).Results Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur(10, 24.4%), followed by the ilium(8, 19.5%). Lesions were found in the metaphyses of the long bone in 11 cases (64.7%). Floating ice sign was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9.8% of all cases. Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases (90.2%). MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT,could strongly imply the diagnosis of primary lymphoma of the bone. Floating ice sign was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma.

Objective To detect the expression and effect of human tumor necrosis facctor related apoptosis-inducing ligand(hTRAIL)in vitro by using a novel double expressing adenoviral vector encoding hTRAIL and firefly lueiferase (luc) gene (Ad-hTRAIL-luc),in which luc wag used, as reporter gene.Methods A549 cells were transduced with the adenoviral vector encoding enhanced green fluorescent protein (EGFP) gene(Ad-EGFP)at variable multiplicity of infection(MOI).Adenoviral transducfion efficiency wag determined 48 h later.A549 cells were transduced with Ad-hTRAIL-luc at variable MOI.and the following tests were performed 48h later,respectively:the expressive ratio of hTRAIL and the apeptotic ratio of A549 cells were meagnred by flow eytometer;counts per minute(cpm)of luminescence were measurde by scintiUation counters. A549 cells were transduced with Ad-luc at variable MOI, and cpm of luminescence was measured by scintillation counters 48 h later. After A549 cells were transduced with AdhTRAIL-luc,the expressive ratio of hTRAIL,the apoptotic ratio of A549 cells and cpm of luminescence were analyzed by one-way ANOVA.The positive ratio of EGFP and cpm of luminescence (Ad-luc) were analyzed bv nonparametric ANOVA.Results After A549 cells were transfected with Ad-hTRAIL-luc,the expressive ratio of hTRAIL on the cell membrane of the groups were(2.37±0.04)/,(3.16±0.03)/,(3.64±0.03)/,(3.96±0.02)/,(4.24±0.02)/,(4.34±0.02)/ respectively,which showed significant difference between each other (P＜0.01);and the apoptotic ratio of A549 cells were (1.52±0.04)/,(2.93±0.02)/,(3.39±0.02)/,(3.64±0.02)/,(3.86±0.02)/,(4.08±0.02)/,(4.20±0.02)/,respectirely,and it showed significant difference between each other (P＜0.01);cpm of luminescence were 465 561±26 801,1 038 576±29 417,937 655±23 197,786 432±20 028,524 288±16 338,401 566±15 961,respectively,and it also showed significant difference between each other(P＜0.01).There was a positive relationship between the expressive ratio of hTRAIL and cell apoptotic ratio of A549 cells (r=0.984,P＜0.01).Conclusion The double expressing adenoviral vector Ad-hTRAIL-luc can transfer luc and hTRAIL gene to A549 cells efficiently,and the activity of luc may reflect the effect of hTRAIL as well as the expression of hTRAIL.

BACKGROUND: As an ideal scaffold of cartilage tissue engineering, demineralized bone matrix (DBM) has been widespread used. But some of biological characters remain poorly understood.OBJECTIVE: To determine the degradation capacity, interval porosity and adhesion rate of mesenchymal stem cells (MSCs) onto DBM in vitro.DESIGN, TIME AND SETTING: An observation experiment in vitro was complicated in Institute of Orthopedics, Second Hospital of Lanzhou University from January 8~(th) to April 15~(th) in 2005 and Central Laboratory of Guilin Medical University from August 1~(st) to November 15~(th) in 2007.MATERIALS: One chinchilla rabbit was killed under anesthesia. Referring to the method described by Urist, DBM was made by cancellated bone harvested from metaphysis and vertebral body METHODS: DBM was soaked into phosphate buffered solution to determine its degradation capacity; liquid replacement method was used to test its interval porosity; The 3~(rd) passage MSCs at a concentration of 1×10~8/L were cocultured with DBM in vitro and adhesion rate of MSCs onto DBM was tested using cytometry.MAIN OUTCOME MEASURES: The degradation capacity, interval porosity and adhesion rate of MSCs onto DBM.RESULTS: The degradation rate of DBM was accelerated with the prolonging of time, and the complete degrading time was about 10-12 weeks; The holing rate tested was (77.15±3.44)%; The 3~(rd) passage cells had a higher adhesive rate of 71.25% onto DBM.CONCLUSION: DBM degradation curve is consistent with MSCs proliferation curve, indicating a satisfactory adhesion capacity and interval porosity and DBM is an ideal biological scaffold material for cartilage tissue engineering.

BACKGROUND:Several researches have highlighted the selective dissolution of Ni ion from the nickel-titanium (NiTi) alloy during the corrosion process,which can lead to potential damage to human body.Different surface treatments will improve the corrosion resistance of NiTi implants.In modern medicines,it is necessary to analyze the characteristics of surface modified NiTi implants.OBJECTIVE:To study the effects of coated and uncoated materials made by elastic nickel-titanium alloy internal fixator on fracture healing and to compare the effects of continuous compressive stress after internal fixator of different types on fracture healing by setting up control group of bone nail internal fixation.DESIGN,TIME AND SETTING:A randomized,controlled,animal experiment was performed at the Laboratory of Tissue Engineering,Institute of Orthopedics,Second Hospital Affiliated to Lanzhou University between September 2004 and March 2005.MATERIALS:Diamond-like carbon coated and nickel-titanium alloy and uncoated nickel-titanium alloy embracing fixator (type 4H8-40) were provided by Lanzhou Ximai Memory Co.,Ltd.,China.Intramedullary nails (type ZQY-01) were purchased from Tianjin Jinxingda Industries Co.,Ltd.,China.METHODS:Thirty Chinchilla rabbits of 4-6 months old were randomly divided into 3 groups (n = 10):diamond-like carbon coated nickel-titanium alloy embracing fixator (group A),uncoated nickel-titanium alloy embracing fixator (group B),and intramedullary fixator (group C).Following anesthesia by injection of 1% sodium pentobarbital (25 mg/kg),transverse fracture models in middle part of the femur were made through a lateral femoral incision and fixed with diamond-like carbon coated nickel-titanium alloy embracing fixator,uncoated nickel-titanium alloy embracing fixator,and intramedullary fixator respectively.MAIN OUTCOME MEASURES:The inorganic substance level,osteocalcin,alkaline phosphatase (ALP) and tumor necrosis factor (TNF) expression in callus surrounding fracture site were detected 4 weeks postoperatively.Ni ion level in muscles surrounding fracture site,live tissue,and brain tissue were also detected.RESULTS:Inorganic substance level and ALP,osteocalcin,and TNF expression were significantly higher in the groups A and B than in group C (P＜0.05).Ni ion level in the liver tissue,brain tissue,and muscles surrounding the fracture were significantly lower in the groups A and C than in group B (P＜0.05).CONCLUSION:Elastic fixation promotes fracture healing.Diamond-like carbon coated nickel-titanium alloy embracing fixator has a better histocompatibility than uncoated group.

Objective To explore the role of apparent diffusion coefficient (ADC) value of diffusion-weighted imaging (DWI) in the differentiation between benign and malignant bone tumors. Methods Echo planar imaging DWI was performed in 18 patients with benign tumor or tumorous lesion and 26 patients with malignant tumor of bone. Three b-values (0, 500 and 1000 s/mm2) were applied. The lowest, highest, and whole ADC values were measured for each lesion, respectively. Results The lowest ADC values of benign bone tumor[ mean( 1.28±0. 49) ×10-3mm2/s ] were significantly higher than that of malignant tumor [ mean ( 0. 92±0. 35 )×10-3mm2/s, t = 2. 839, P < 0. 01 ]. The whole ADC values of benign bone tumor [ mean (1.62±0. 51 ) ×10-3mm2/s] were significantly higher than that of malignant tumor [ mean ( 1.21±0. 36) ×10-3mm2/s, t = 3. 092, P < 0. 01 ]. However, there were much overlapping between benign and malignant bone tumor in the lowest and whole ADC values. There was no significant difference for the highest ADC values between benign [. Mean ( 2. 02±0. 55 )×10-3mm2/s] and malignant bone tumor[ mean( 1.71±0. 65 ) ×10-3mm2/s, t = 1. 669, P > 0. 05 ]. Excluding cases of bone cyst and aneurismal bone cyst, the lowest, highest, and whole ADC values of benign bone tumor was (1.11± 0. 31 )×10-3mm2/s, ( 1.88±0. 49)×10-3mm2/s, and( 1.45±0. 35 )×10-3mm2/s, respectively. There was no significant difference for the lowest, highest, or whole ADC values between benign and malignant bone tumor (t = 1. 728, 0. 964, and 2. 012, respectively, P > 0. 05). Conclusion ADC value is useless for the differentiation between benign and malignant bone tumors.

Objective To explore the dynamic changes of diffusion tensor imaging(DTI) in spinal cord of goats with persistent compression injury. Methods Eighteen goats weighted 20--25 kg were divided into three groups with completely random design: A, B and C. A balloon catheter was inserted into the epidural space at C3-4 level via intervertabral foramen for each goat. The balloon was inflated by injection of variable volumes of saline in group A and B 10 days following operation. The volume of saline was 0. 3 ml in group A and 0. 2 ml in group B,respectively. The compression sustained for 40 days. Group C served as uncompressed control without injection of saline. The locomotor rating score was applied to each group. Conventional MRI and DTI were performed. The apparent diffusion coefficient (ADC)and fractional anisotropy (FA) values were measured. Histopathological assessments of the compressed spinal cord were performed 50 days following operation with light microscope and transmission electron microscopy. Results Before operation, the locomotor rating score was 5, the ADC value was ( 1.23 ± 0. 05 ) × 10-3 mm2/s and the FA value was (0. 72 ± 0. 05 ) each group. Of six goats in Group A, the locomotor rating score severely decreased and reached( 1.5±0. 4)on the 40 th day after compression. The ADC value at compression site decreased soon and reached the minimum (0. 75±0. 04) × 10-3mm2/s on the 5 th day after compression. Then the ADC value increased gradually, restored normal on the 10 th day or so, then became markedly higher than normal and reached( 1.61±0. 05) × 10-3mm2/s on the 40 th day. The FA value at compression site decreased soon, reached(0. 54±0. 04)on the 1st day, then decreased gradually and reached(0. 43 ± 0.05) on the 40 th day. It appeared high signal intensity on T2WI on the 10 th day. In Group B, the locomotor rating score was moderately decreased and reached(3.4±0. 5 )on the 40 th day. The ADC value at compression site decreased slightly firstly, reached( 1.08±0. 04) × 10-3mm2/s on the 1st day, restored normal on the 20 th day or so, then increased gradually, became higher than normal and reached ( 1.27 ± 0. 05) × 10-3mm2/s on the 40 th day. The FA value increased slightly firstly, reached (0. 78±0. 05 )on the 1st day, then decreased gradually, restored normal on the 15 th day or so, became lower than normal and reached(0. 67±0. 05) on the 40 th day. There was no abnormality on conventional MRI. In Group C, the locomotor rating score, ADC value and FA value remained unchanged. There was no abnormality on conventional MRI. There were dynamic changes over time of the ADC value and FA value in Group A and B, which was more marked in Group A than that in Group B ( repeated measurements analysis of variance, F=426. 7 for the ADC value and F =7895.2 for the FA value, P < 0. 01 ). Histopathologically, swelling and degeneration of axons and neurons as well as the disarrangement of myelin sheathes could be seen. The pathological changes were more marked in Group A than in Group B. In Group C, no abnormality could be seen. Conclusion There are dynamic changes of DTI in cervical spinal cord with compressive injury that correlated with the degree and duration of compression. The ADC value decreased firstly, restored normal and then increased. The FA value increased firstly, restored normal and then decreased in mild compression while solely decreased in serious compression.