Volume 90  ·   Issue 03  ·  2010

The rapid development of molecular biology, cell biology and tissue engineering has provided new methods for the treatment of orthopedic diseases, and then opened up new fields. The new methods mainly include tissue transplantation based on cytology or genetic modification of own cells, and finally achieved the purpose of biological repair. At present, the above techniques have been applied to many kinds of tissues ~ ([1-2]).

Objective To establish a 3D finite element model of L5/S1 motion segment with percutaneous axial lumbosacral interbody fusion (AxiaLIF) screw and conduct a preliminary analysis of biomechanical stress. Methods The titanium screw was implanted in L5 and S1 vertebral body. Solid model was established by CAD software according to the actual dimensions of screw. Then computer graphics were obtained from iges format and imported into the finite element analysis software to establish the finite element model. With the aid of Mechanical Virtual Human of China, a 3D finite element model of L5/S1 motion segment with AxiaLIF screw was established. Vertical compression, torque moment and bending moment were loaded respectively on the upper surface of L5 vertebrae to simulate the load stress in human body. Stress distribution of screw was obtained. Results Generally stress values were relatively low. Peak stresses of screw under three loading conditions were 175. 334 Mpa, 183. 765 Mpa and 146. 237 Mpa respectively. Stress value was relatively high at the central part of interbody fusion. And all the highest values were localized at the first thread below the central part. Result of comparison between three conditions; torque load was the highest, followed by vertical load and lateral bending. Conclusion Percutaneous axial lumbosacral screw can meet the normal loading conditions. Further clinical applications are recommended.

Objective To investigate the association between Trp2 allele polymorphism with degenerative disc disease (DDD) in a Chinese Han population. Methods A total of 125 DDD patients (58 males and 67 females, 51. 8±7. 6 years old), and 125 controls matched in sex and age (63 males and 62 females, 45. 3±8.3 years old) were recruited in the case-control study. Their peripheral blood samples were collected for DNA isolation. Based on NCBI genebank, the corresponding single nucleotide polymorphisms (snp)-SNP1 (rs7533552) and SNP2 (rs2077871) were identified. Hardy-Weinberg equilibrium was analyzed both in case and control groups. Then the case group was classified into different clinical phenotypes according to severity of degeneration, sole or multi-disc degeneration and different affected discs. Genotying of all selected SNPs was performed by SNP stream technology. The association analysis between phenotypes and SNPs was conducted. Pairwise linkage disequilibrium was calculated in control population using Haploview 4.0 software. Results SNP1 (rs7533552) , SNP2 (rs2077871) and corresponding SNP of Trp2 allele were gentyped and both polymorphisms distributed in line with Hardy-Weinberg equilibrium in case and control groups. Alleleic frequency of SNP1A, SNP1G, SNP2C and SNP2T (42% , 47% , 88% and 90% respectively) of case group were not significantly different from those of control group (48% , 53% , 88% and 10% respectively, all P>0.05). Genotypic frequencies of SNP1AA, SNP1AG, SNP1GG, SNP2CC, SNP2CT and SNP2TT in case group were not significantly different from those of control group (all P >0.05). However there was an association with genotypic frequencies of SNP2 and severity of disc degeneration (χ~2 = 6. 920, P = 0. 031). Conclusion Trp2 allele is one of risk factors for the development and severity of DDD in a Chinese Han population.

Objective To investigate the outcome for surgical treatment of bilateral thoracotomy in patients with lesions of left main bronchus invading carina by bilateral thoracotomy. Methods The clinical data of 4 patients with lesions of left main bronchus invading carina undergoing bilateral thoracotomy were retrospectively reviewed. Results There were two male and two female patients with a median age of 37. S (range:27-55) years old. Four patients were all accessed by bilateral thoracotomy, and received carinal reconstruction. Of these 4 patients, three patients received left pneumonectomy and one patient received carinal resection without concomitant pulmonary resection. Pathological results showed that one patient had tuberculosis. And other three patients were of 1 squamous cell carcinoma and 2 adenoid cystic carcinomas. Three patients received mechanical ventilation for a period of 3-21 days, one patient died of anastomotic dehiscence at 5 days postoperatively. Conclusion Bilateral thoracotomy is an alternative approach for relatively young patients with decent cardiopulmonary functions with lesions of left main bronchus invading carina. Operation type should be based on histopathological type and length of involved left main bronchus.

Objective To observe the clinical results of different concentration NaCl solution in hemorrhagic shock resuscitation. Methods The 75 cases with hemorrhagic shock were divided into five groups by means of random number table. Treat the cases with 0. 9% (control group)、3%、4. 5% 、6% and 7.5% NaCl solution, respectively. Observe the changes of BP,、HR、 blood gas、renal function、electrolyte concentration of plasma, before and after treatment. Results After transfusion, compared with groups of 0. 9% NS, the mean BP of patients in other four groups rise more quickly but only the group of 4. 5% can last 30 minutes (P < 0. 05), and K~+ of plasma in groups of 6% ,7. 5% NS decline more obviously (P < 0. 05) , the group of 4. 5% maintain the best lever. Conclusion The mean BP of patients rise quickly and continue for a long time, in the group of 4. 5%. Meanwhile the internal environment of the body maintain relatively stable in the group of 4. 5%.

Objective To investigate the characteristic of precancerous conditions of cervical intraepithelial neoplasia (CIN) and its related high-risk factors among the married women in Beijing, China. Methods Based upon the method of cross-sectional survey, 6339 married women at reproductive age from 25 to 54 years old were selected randomly in a total of 137 communities of 12 districts or counties in Beijing from March 2007 to September 2008. The interview was carried out with unified questionnaires and gynecological examinations. And the cervical Pap smear was used for liquid-based cytological examination and the cervical secretion for detection of high-risk human papillomavirus (HPV) DNA. Furthermore, the women with abnormal cervical cytology received colposcopy and cervical biopsy. Results (1) Among 6,339 study subjects, 374 cases had CIN and the prevalence rate was 5.9% ; (2) For the cases with cervical cytology positive results, cervical biopsy showed an elevated level of abnormal cytology and an increased incidence of cervical lesions; (3) The peak age of CIN prevalence was 30 to 34 years old and there was a high grade of cervical neoplasia; (4) Among the population, the infection rate of high-risk HPV was 9. 9% and the infection rate of high-risk HPV in positive cytological group (41. 2%) was significantly higher than that in negative cytological group (6. 6%) ; (5) The infection rate and DNA load of high-risk HPV increased following the severity grade of CIN. Conclusion In Beijing, married women at 30 to 34 years old are the high-risk group in CIN incidence and the infection of high-risk HPV is an independent risk factor. Liquid-base cytology combined with high-risk HPV DNA test is a viable method to discover CIN in time and prevent the incidence of cervical cancer.

Objective To evaluate the safety, immunogenicity and protective efficiency of the oral whole cell/recombinant B subunit cholera vaccine in Beijing Olympic volunteers and workers. Method Analyzing the incidence rate of adverse reaction and Protective Rate (PR) after taking the vaccine in Olympic volunteers in 6 universities in Beijing; comparing the anti-cholera toxin(CT) detected with ELISA prior and after taking the vaccine in Olympic workers. Results The total rate of adverse reaction of Olympic volunteers was 0. 38% ; the main side effects were gastrointestinal symptoms ,such as bellyache and diarrhea which were mild and temple; the acute diarrhea incidence rate of Olympic volunteers after taking the vaccine was significantly lower than those not taking it ,the PR was 76. 27% ;the positive rate of anti-CT of Olympic workers after taking the vaccine was significantly higher than those before taking it, the levels of anti-CT titers declined after 6 months since they had taken the vaccine. Conclusion The results from above two observed population indicate that the oral rBS-WC cholera vaccine is efficient and safe.

Objective To investigate the appropriate dose of unfraction heparin and low molecular weight heparin (LMWH) in hemodialysis patients. Methods Thirty-eight hemodialysis patients were enrolled and randomly allocated into four groups. The initial bolus dose for the Low-dose (LH, n = 10) and high-dose heparin (HH, n = 10) groups were 35 U/kg and 55 U/kg, respectively. The repeated maintenance dose for both groups were 10 U/kg·h and 16 U/kg·h, respectively. Fragmin were administered as single bolus (60 U/kg or 80 U/kg) at 30 minutes before hemodialysis in Low-dose LMWH (LLMWH, n = 10) and High-dose LMWH (HLMW,n=8) group, respectively. Furthermore, the dialysis circuits in LUFH and LLMWUFH groups were primed with with 4 mg/dl heparinized saline before hemodialysis. Glass bead active clotting time (gbACT), clot rate (CR)and platelet function (PF) were examined using Sonoclot analysator at 0 h ,2 h and the end of hemodialysis at the arterial circuit and 2 h at the venous circuit. Results (1) LH and LUFH: the increase of gbACT and decrease of CR at the arterial circuit and the venous circuit at 2 h of hemodialysis were significant compared with baseline. While they recovered at the end of hemodialysis. No difference between the two groups at different time points was found, either. (2)LLMWH:No change were found in gbACT during hemodialysis. CR at the arterial circuit and the venous circuit were significantly decreased at 2 h and recovered at the end of hemodialysis. (3) LI.MWUFH:gbACT at the arterial circuit was significantly increased only at 2 h of hemodialysis. CR at the arterial circuit and the venous circuit at 2 h of hemodialysis were significantly decreased and recovered when hemodialysis finished. (4) HH and HLMWH: gbACT were significantly increased and CR were rapidly decreased at both the arterial circuit and venous circuit at 2 h of hemodialysis. Conclusion Low-dose heparin was effective and safe as anticoagulant in hemodialysis. Low-dose low-molecular-weight heparin was efficient in anticoagulation to some extent. However, High-dose low-molecular-weight heparin, high-dose heparin and flushing with heparinized saline may increase the risk of hemorrhage.

：Objective To develop asurgical technique using a periosteal flap wrapped autologous hamstring tendons in ACLreconstruction and to examine its short-term outcome. Methods A total of 110 patients (110knees) were included. The experimental group (n =52) received ACL reconstruction withhamstring tendons wrapped in periosteum. In the other 58 patients, ACL was reconstructedwith autologous hamstring tendons. The mean post-operative follow-up was 19 (12-25)months. All patients were assessed at 12 months post-operation. The parameters of efficacyevaluation included IKDC score, Tegner score, modified HSS score, KT-1000 arthrometerreading and a radiographic assessment using anteroposterior and lateral radiographs. Theincidence of femoral and tibial bone tunnel enlargement between two groups was comparedwith χ~2 test Results Clinical outcomes in experimental group(periosteum-wrapped grafts) were dependent on the wrap-up of periosteum, bone tunnel,graft fixation and postoperative rehabilitation. The good or excellent outcomes werereported in approximately 90% of the experimental group. And 44 patients showed normal ornearly normal knee function according to IKDC criteria KT-1000 tests showed an averagemaximal manual side-to-side difference of 1. 7±1. 1 mm. Forty patients showed theoutcomes of KT-1000, Lachman's knee ligament test and pivot-shift testing. The evaluationof the level of activity using the Tegner score revealed that 40 patients regained theirpre-injury activity level. And 44 patients showed full knee extension and 42 patientsshowed full knee flexion after surgery. The average HSS score showed no significantdifference between experimental group (90. 6±0. 57 points) and control group (89. 9±0. 8points) (t=0.714, P>0.05). The KT-1000 measurement (133 N) was larger in control group(2. 3±1. 0 mm) than in experimental group (1.7±1. 1 mm). There was significantdifference in laxity between two groups (t =6.427, P <0. 05). At 12 monthspost-operation, tunnel enlargement could be observed in both groups. The averageenlargement of femoral tunnel was less in experimental group (17. 3%) than control group(34. 5%) (χ~2 = 4. 17, P < 0. 05). And the enlargement of tibial tunnel wasless in experimental group (19.2%) than control group (36.2%) (χ~2 =3. 90, P < 0. 05).Conclusions The surgical technique using a periosteal flap wrapped with autologoushamstring tendons in ACL reconstruction has definite clinical efficacies. It can enhancethe stability of knee and prevent the enlargement of bone tunnel.

Objective To investigate the clinical features and specific characteristics of magnetic resonance image (MRI) in preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome (RPLS) . Methods The investigators analyzed the combined clinical, laboratory and neuroradiographic features of 20 preeclampsia-eclampsia patients with RPLS and 15 preeclampsia-clampsia controls with normal MRI findings. Results Patients with RPLS had more tendency to have headache, seizure, visual disturbance, confusion and altered mental status than controls. Neuroimaging showed diffuse edema predominantly in posterior cerebral white matter bilaterally. Clinical features and neuroradiological alterations disappeared after appropriate treatments were started. Twenty RPLS patients had a significantly higher level of uric acid (442±77 mmol/L) than those without RPLS (350±88 mmol/L) (P < 0. 05). However no difference was observed for other indices. Conclusion Preeclampsia-eclampsia patients with RPLS have typical clinical and imaging findings, and the syndrome is reversible with appropriate treatment Perhaps endothelial damage is related to the pathogenesis of RPLS. Monitoring the level of uric acid in patients with preeclampsia-eclampsia is of vital significance to discover RPLS in an early stage.

Objective To explore the neuronal activity in globus pallidus intemus in patients with Parkinson's disease (PD) and dystonia. Methods Thirteen patients with Parkinson's disease and eight with dystonia undergoing stereotactic surgery of globus pallidus intemus were studied. Microrecording in globus pallidus intemus and electromyography on contralateral limbs to surgery were simultaneously performed. Single unit analysis, interspike intervals (ISI) and coefficient of variation of ISI were performed. ANOVA and Student t-test were employed to compare neuronal firing in globus pallidus intemus between two patient groups. Results One hundred and eight neurons were identified from PD patients, including 19.4% tremor-related neuronal activity, 55. 6% neurons with tonic firing and 25. 0% neurons with irregular discharge. Further analysis revealed that neurons with tonic firing had a mean firing rate of(103.7±25. 5) Hz; neurons with irregular discharge had a mean firing rate of (63. 4±16. 1) Hz. Forty-five neurons were identified from patients with dystonia, including 37.8% neurons with tonic firing and 62.2% neurons with irregular discharge. Further analysis showed that neurons with tonic firing had a mean firing rate of (50. 2±19. 1) Hz; neurons with irregular discharge had a mean firing rate of(28.5±10. 5) Hz. ANOVA showed that a significance of firing rate of tonic firing and irregular discharge in globus pallidus intemus was reached between two patient groups (P <0. 001). The mean firing rate of two patterns of neuronal activity in PD were significantly higher than those in dystonia (Bonferroni test, both P <0. 05). Conclusion The data sopport the current view that an increased neuronal firing rate in globus pallidus intemus is associated with PD whereas a decreased neuronal firing rate is associated with dystonia.

：Objective To observe thecharacteristics of sensory gating P50 in generalized anxiety disorder (GAD) and inobsessive compulsive disorder (OCD) patients. Methods Auditory evoked potentials P50 wererecorded in 41 GAD patients, 69 OCD patients and in 58 normal controls by theconditioning/testing paradigm presented with auditory double clicks stimuli, usingAmerican Nicolet Bravo instrument. Results (1) No significant differences was found inlatencies of S1-P50 and S2-P50 among these three groups (P> 0. 05). (2) Significantdifferences were found in indices of S1-P50 amplitudes (NC:6±3, GAD: 3±2, OCD: 5±3, P<0. 01) , S2-P50 amplitudes(NC:2±1, GAD: 4±1, OCD: 2±1, P<0. 01), S2/S1, S1-S2and 100(1-S2/S1) . (3) Compared with NC, GAD and OCD patients showed a decreased S1-P50amplitude and OCD patients also showed an increased S2-P50 amplitude. (4) P50 inhibitionsignificantly decreased in GAD and OCD patients. The values of S2/S1 ratio were 39%±22%in NC, 50%±29% in GAD and 88%±42% in OCD (P<0. 01). (5) Both S1-S2 and 100 (1-S2/S1)decreased in GAD and OCD patients(NC: 3±2, 61±22; OCD: 1±1,15±22; GAD: 3±3, 50±29. P<0. 01). (6) Compared with GAD, OCD patients showed a lower S2/S1 ratio (P <0. 01)and a higher value of S1-S2 (P < 0.01) and 100 (1-S2/S1) (P < 0. 01). Conclusion Theanxiety disorder patients has sensory gating deficits. The inhibition deficit can bemeasured by auditory evoked potential P50. And S2/S1 ratio, S1-S2 and 100(1-S2/S1) may bebiological markers of GAD and OCD patients.

Objective To evaluate the value of low-dose contrast-enhanced 4D DSA acquired from 320-detector row CT on the diagnosis of the hepatic artery complications after liver transplantation. Methods 320-detector row CT were performed in fifth patients with liver dynamic enhanced using volume CT body-perfusion protocol, hepatic artery phase images obtained after intravenous injection of 50 ml of contrast at a rate of 6 ml/s were acquired based on 4D DSA. The time-density curve (TDC) of the hepatic artery was delineated. The time to peak, peak contrast enhancement were recorded. The data of artery phase were sent to workstation to reconstruct the hepatic artery with VR, MIP and MPR. Results The delay mean time and the peak CT value of hepatic artery was 20(10. 0-24. 2) s and 373(310-440) HU; 4D DSA revealed hepatic artery pseudo-aneurysm (n=2) , and hepatic artery mild stenosis(n =3) , moderate stenosis (n =4) , severe stenosis(n = 1) and occlusion (n = 1). Compensatory circulation was seen in 2 cases. 4 patients were appeared segmental stenosis and hepatoportal arteriovenous fistulas (HPAVF). Hepatic arterial branch are decreased and opened in 9 cases and 4cases. 4D DSA also displayed other signs including hepatic hemangioma and the splenic artery aneurysms (SAA) and ectasi (n = 1) , donor-recipient hepatic artery mismatch (n=3). Conclusion 4D DSA provided a safe, noninvasive and accurate method for guiding the diagnosis of hepatic artery complication and play an effective role after liver transplantation.

Objective To construct the human aquaporin-4 (AQP4) expressing vector and detect anti-AQP4 antibody in serum of patients with neuromyelitis optica (NMO). Methods RNA was extracted from human glioblastoma and AQP4 cDNA obtained through RT-PCR. The fragment was cloned into the lentiviral expressing vector (iDUET101) and transformed into competent strain Hb101 for later amplification; plasmids were extracted from the amplified positive-bacteria-colony, sequenced and transfected into HEK-293T cells. Expression of AQP4 was identified by RT-PCR, Western blot and immunofluorescence assay. And anti-AQP4 antibody in human serum was tested. Results The sequence of target fragment matched with that of human AQP4 fragment sequences (NM_001650) completely. The constructed AQP4 fragment transfected in HEK-293T cell was tested by immunofluorescent examination and it exhibited obvious fluorescence located in cell membrane. Western blot test was positive. And the fragment was about 34 KD. Cellular immunofluorescence examination showed 11 examples of 12 NMO patient serums (91. 7%) were positive, 4 in 34 multiple sclerosis (11. 8%) positive and negative in all 50 serum samples of healthy controls. Conclusion The HEK-293T cell transfected with lentivirus-AQP4 vector can express stably. And the expressed fragment may be applied in clinical examination.

Chronic subdural hematoma (CSDH) is a common disease of craniocerebral trauma, accounting for about 10% of intracranial hematomas. It mostly occurs in the elderly, and most of them have a history of head trauma. The symptoms usually appear more than 3 weeks after injury, usually 1 month ~ ([1]). The incidence rate in the elderly is about 16.5/100,000 people. The onset of the disease is hidden, and the clinical manifestations are mostly without obvious characteristics, and the surgical effect is good. However, it has been found that about 8% ~37% of patients have postoperative hematoma recurrence, and about 80% of asymptomatic patients have different degrees of residual retention ~ ([2]) after re-examination of skull CT. Preventing hematoma recurrence has become the focus of CSDH treatment.

A 9-year-old girl was admitted to the hospital due to intermittent fever for 5 months and involuntary movement for 2 months. Admission status: 5 months ago, she started to have intermittent fever, accompanied by sore throat, cough and swollen lymph nodes. She went to the local hospital and was given anti-inflammatory and antipyretic treatment. The symptoms improved, but she still had intermittent low fever.