Clinical efficacy of screw placement assisted with the 3D printing pre-installed screw channel model in the single complete segmented congenital hemivertebrectomy / 中华实用儿科临床杂志

Objective:To explore the clinical effect of the 3D printing pre-installed screw channel model in assisting screw placement of single complete segmented congenital hemivertebrectomy.Methods:Clinical data of 13 children treated with single complete segmented congenital hemivertebrectomy in the Department of Spine and Spinal Surgery of Henan Provincial People′s Hospital from August 2016 to January 2019 were retrospectively analyzed.Among them, there were 5 males and 8 females with the mean age of 9.9 (5-14) years.Categorized by the lesion location, 3 cases were located at T 9, 2 cases at T 10, 5 cases at T 11, 1 case at T 12, and 2 cases at L 1.During the operation, the 3D printing pre-installed screw channel model was used to assist the placement of pedicle screws.The accuracy of screw placement was assessed by the postoperative CT.All children were routinely examined by full-length anterior and lateral X-ray of spine in the standing position before and after surgery to measure the Cobb angles at the coronal and sagittal view.Furthermore, the correction rate of scoliosis and kyphosis after surgery and during follow-up was also calculated.The One-Way repeated measures ANOVA was used to compare the Cobb angle of scoliosis and kyphosis before surgery, after surgery and during follow-up. Results:A total of 85 pedicle screws were placed in 13 children, with the accuracy rate of screw placement of 95.3%.The mean surgery time and intraoperative blood loss were (216.9±28.3) min, and (478.5±132.6) mL, respectively.Scoliosis Cobb was corrected from (57.1±12.7)° to (12.7±4.7)° with a correction rate of (78.4±5.9)%, which was (14.2±7.0)° at the last follow-up.Kyphosis angle was corrected from (46.2±8.4)° to (13.2±4.4)° with a correction rate of (72.6±7.0)%, which was (14.0±3.4)° at the last follow-up.None of the children had serious complications like vascular and nerve damage.The mean postoperative follow-up was 12.3 (6-18) months.No significant loss of angle was detected during the follow-up period.There were significant differences in the lateral and kyphotic angles after surgery and during follow-up compared with preoperative ones (all P<0.05). No significant difference was detected between the postoperative lateral and kyphotic angles and those at the last follow-up (all P>0.05). Conclusion:The 3D printing pre-installed screw channel model used to assist screw placement of single complete segmented congenital hemivertebrectomy can improve the precision of screw placement and the orthopedic effect on lateral kyphosis.

Low dose of triptolide ameliorates podocyte epithelial-mesenchymal transition induced by high dose of D-glucose via inhibiting Wnt3α/β-catenin signaling pathway activation / 中国中药杂志

To explore the effects and molecular mechanisms of triptolide（TP）on improving podocyte epithelial-mesenchymal transition（EMT）induced by high dose of D-glucose（HG）, the immortalized podocytes of mice were divided into the normal group（N）, the high dose of D-glucose group（HG）, the low dose of TP group（L-TP）, the high dose of TP group（H-TP）and the mannitol group（MNT）, and treated by the different measures respectively. More specifically, the podocytes in each group were separately treated by D-glucose（DG, 5 mmol·L⁻¹）or HG（25 mmol·L⁻¹）or HG（25 mmol·L⁻¹）+ TP（3 μg·L⁻¹）or HG（25 mmol·L⁻¹）+ TP（10 μg·L⁻¹）or DG（5 mmol·L⁻¹）+ MNT（24.5 mmol·L⁻¹）. After the intervention for 24, 48 and 72 hours, firstly, the activation of podocyte proliferation was investigated. Secondly, the protein expression levels of the epithelial markers in podocytes such as nephrin and podocin, the mesenchymal markers such as desmin and collagen Ⅰ and the EMT-related mediators such as snail were detected respectively. Finally, the protein expression levels of Wnt3α and β-catenin as the key signaling molecules in Wnt3α/β-catenin pathway were examined severally. The results indicated that, HG could cause the low protein expression levels of nephrin and podocin and the high protein expression levels of desmin, collagen Ⅰ and snail in podocytes, and inducing podocyte EMT. On the other hand, HG could cause the high protein expression levels of Wnt3α and β-catenin in podocytes, and activating Wnt3α/β-catenin signaling pathway. In addition, L-TP had no effect on the activation of podocyte proliferation, the co-treatment of L-TP and HG could significantly recover the protein expression levels of nephrin and podocin, inhibit the protein expression levels of desmin, collagen I and snail in podocytes, thus, further improving podocyte EMT. And that, the co-treatment of L-TP and HG could obviously decrease the high protein expression levels of Wnt3α and β-catenin induced by HG in podocytes, and inhibit Wnt3α/β-catenin signaling pathway activation. On the whole, HG can induce podocyte EMT by activating Wnt3α/β-catenin signaling pathway; L-TP can ameliorate podocyte EMT through inhibiting Wnt3α/β-catenin signaling pathway activation, which may be one of the effects and molecular mechanisms .

Pathomechanisms of pericyte-myofibroblast transition in kidney and interventional effects of Chinese herbal medicine / 中国中药杂志

In the kidney, pericyte is the major source of myofibroblast (MyoF) in renal interstitium. It is reported that pericyte-myofibroblast transition（PMT）is one of the important pathomechanisms of renal interstitial fibrosis（RIF）. Among them, the main reasons for promoting RIF formation include pericyte recruitment, activation and isolation, as well as the lack of pericyte-derived erythropoietin. During the PMT startup process, pericyte activation and its separation from microvessels are controlled by multiple signal transduction pathways, such as transforming growth factor-β（TGF-β）pathway, vascular endothelial growth factor receptor (VEGFR) pathway and platelet derived growth factor receptor (PDGFR) pathway;Blocking of these signaling pathways can not only inhibit PMT, but also suppress renal capillaries reduction and further alleviate RIF. In clinic, many traditional Chinese medicine compound prescriptions, single traditional Chinese herbal medicine (CHM) and their extracts have the clear effects in alleviating RIF, and some of their intervention actions may be related to pericyte and its PMT. Therefore, the studies on PMT and its drug intervention will become the main development direction in the research field of anti-organ fibrosis by CHM.

Comparative study on genotype distribution of HPV infection in the tissues of cervical squamous cell carcinoma and cervical adenocarcinoma / 医学研究生学报

Objective There are few large sample data reports of comparative study on genotype distribution of human papillomavirus (HPV) infection in the tissues of cervical squamous cell carcinoma and cervical adenocarcinoma in China. This study aimed to investigate the clinical value of genotype distribution of HPV infection in the tissues of cervical squamous cell carcinoma and cervical adenocarcinoma in regional (mainly in Jiangsu Province) patients.Methods We collected 1044 paraffin tissue specimens of female cervical squamous cell carcinoma (826 cases) and cervical adenocarcinoma (218 cases) in 29 hospitals from November 1978 to December 2017. HPV DNA was extracted from the tissues and through the combination of gene-chip and polymerase chain reaction technology, 23 genotypes of HPV were detected in all the tissues of cervical squamous cell carcinoma and cervical adenocarcinoma, and comparative study was conducted on the genotype distribution of HPV infection.Results Among 1044 cases of cervical squamous cell carcinoma and cervical adenocarcinoma, 901 were found with HPV and the detection rate was 86.30%. The detection rate of cervical squamous cell carcinoma was 91.53% (756/826), among which 16，18，58，33，52，31 types were the most common and the detection rate of 16 type was significantly higher than that of 18 types (56.84% vs 9.93%, P0.05).Conclusion The HPV detection rates are different in the regional female cervical squamous cell carcinoma and cervical adenocarcinoma tissues. 16,18,31,33,52 and 58 types are the most common genotypes in cervical squamous cell carcinoma and cervical adenocarcinoma. The detection rate of 16 type is overly higher than that of 18 type in cervical squamous cell carcinoma, while the detection rates of 16 type and 18 type in cervical adenocarcinoma are very close.

Application of ophthalmic ultrasonography in DR / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the value of ultrasonography in diabetic retinopathy ( DR) .?METHODS: Totally 103 cases ( 103 eyes ) of type 2 diabetes mellitus were selected from May 2015 to May 2017 in our hospital, there were 32 patients 32 eyes with non diabetic retinopathy ( NDR) , 40 patients 40 eyes with non proliferative diabetic retinopathy ( NPDR ) , and 31 patients 31 eyes with proliferative diabetic retinopathy (PDR), 40 healthy volunteers (40 eyes) were selected as control group, the maximum systolic blood flow velocity ( PSV ) , end diastolic velocity ( EDV ) and resistance index (RI) of the central retinal artery (CRA), posterior ciliary artery ( PCA ) and ophthalmic artery ( OA ) were detected by color Doppler ultrasound.?RESULTS:The difference of PSV, EDV and RI of CRA, PCA and OA in each group was statistically significant (P<0. 05). The PSV of CRA, PCA and OA in NDR group were 12. 38 ± 2. 10cm/s, 13. 36 ± 2. 55cm/s and 32. 04 ± 6. 07cm/s, significantly higher than that of NPDR group (9.70±1.67cm/s, 12.20±2.01cm/s and 27.40±4.32cm/s) and PDR group ( 7. 13 ± 1. 40cm/s, 10. 31 ± 1. 82cm/s and 22.10±3.51cm/s) (P<0. 05). EDV were 4. 67±1. 20cm/s, 5. 61 ± 1. 25cm/s and 8. 40 ± 1. 51cm/s, significantly higher than that of NPDR group (3. 52±1. 19cm/s, 5. 01±1. 30cm/s and 6.61±1. 67cm/s) and PDR group (2. 48±1. 02cm/s, 4. 11±1.04cm/s and 4. 01±1. 52cm/s) (P<0. 05). And RI were 0. 63 ± 0. 07, 0. 60 ± 0. 04 and 0. 77 ± 0. 05, was significantly lower than that of NPDR group (0. 72±0. 06, 0. 67±0. 05 and 0. 81 ± 0. 03) and PDR group (0. 80 ± 0. 09, 0. 74±0. 06 and 0. 86±0. 04) (P<0. 05).?CONCLUSION: Color Doppler ultrasound monitoring the hemodynamic changes of ocular blood vessels in diabetes can provide evidence for early detection of diabetic retinopathy.

Paeoniflorin improves regional cerebral blood flow and suppresses inflammatory factors in the hippocampus of rats with vascular dementia / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the delayed neuroprotection induced by paeoniflorin (PF), the principal component of Paeoniae radix prescribed in Chinese medicine, and its underlying mechanisms in rats subjected to vascular dementia (VD).</p><p><b>METHODS</b>A rat model of VD was induced by bilateral common carotid arteries occlusion (BCCAO). Low-dose or high-dose PF (20 or 40 mg/kg once per day) was administrated for 28 days after VD. The behavioral analysis of rat was measured by water morris. Regional cerebral blood volume (rCBV), regional cerebral blood flflow (rCBF) and mean transit time (MTT) were measured in the bilateral hippocampus by perfusion-weighted imaging (PWI). The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were measured by commercially available enzyme-linked immunosorbent assay kits. Protein levels were evaluated by western blot analysis. mRNA levels were evaluated by real time-polymerase chain reaction. Western blotting was used to estimate p65 translocation.</p><p><b>RESULTS</b>The behavioral analysis showed that PF could decrease the escape latency time (P<0.05), and increase the residence time of the original platform quadrant and the across platform frequency in water maze in VD rats (P<0.05). Likewise, PF remarkably promoted the rCBV (P<0.05), rCBF and decreased per minute MTT (P<0.05) in hippocampus of VD rats. Furthermore, PF decreased the release of IL-1β, IL-6 and TNF-α as well as inhibited the mRNA expression of IL-1β, IL-6 and TNF-α in the hippocampus of VD rats (P<0.05 or P<0.01). PF also could decrease the protein expressions of inducible nitric oxide synthase and cyclooxygenase-2 in the hippocampus of VD rats (P<0.05 or P<0.01). In addition, PF signifificantly inhibited the nuclear factor κB (NF-κB) pathway in the hippocampus of VD rats.</p><p><b>CONCLUSIONS</b>PF signifificantly attenuates cognitive impairment, improves hippocampus perfusion and inhibits inflflammatory response in VD rats. In addition, the anti-inflflammatory effects of PF might be due to inhibiting the NF-κB pathway. PF may be a potential clinical application in improving VD.</p>

Pathogenesis and treatment of insulin resistance in chronic kidney disease and interventional effects of Chinese herbal medicine / 中国中药杂志

The kidney is the target organ of insulin with abundant insulin receptors. Thereinto,the renal intrinsic cells including glomerular podocytes,endothelial cells,mesangial cells,renal tubular epitheliums and collecting duct epithelial cells are all highly sensitive to insulin as the effector cells. Furthermore,the structural and functional abnormalities of these cells are closely related to insulin and its receptors activity. It is reported that the chronic kidney disease（CKD）patients have systemic or renal insulin resistance（IR）. IR is not only the pathogenic factor of CKD but also one of the mechanisms of CKD progression. The pathogenic factors of IR in the CKD patients include the systemic factors and the local factors in muscles and fat cells. The pathogenesis of IR is related to glomeruli,proximal tubules,collecting ducts and corresponding renal intrinsic cells such as podocytes,mesangial cells,renal tubular epitheliums and collecting duct epithelial cells. IR-related signaling pathways include insulin receptor substrate（IRS）/phosphatidylinositol 3 kinase（PI3K）/serine threonine kinase（Akt）pathway,adenosine monophosphate activated protein kinase（AMPK）pathway,glucose transporter4（GLUT4）pathway,nuclear factor（NF）-κB pathway and mitogen activated protein kinase（MAPK）pathway. Among them,IRS1/PI3K/Akt2 is the main signaling pathway of IR in podocytes of glomeruli, thus intervening its activity can improve podocyte injury. In clinic,some classical oral hypoglycemic agents and diuretic including metformin,rosiglitazone,glibenclamide,thiazolidinedione and spironolactone,as well as some extracts from Chinese herbal medicines including astragalus polysaccharides,quercetin,puerarin,emodin,berberine,curcumin and geniposide can both affect insulin and its receptor activity,and regulate IR-related signaling pathways,thereby ameliorating IR and CKD progression. Overall,the pharmacological studies based on IR-related signaling pathways in the renal intrinsic cells of CKD will become one of the developmental directions in the future.

Effects and mechanisms of Shenkang injection promoting extracellular matrix degradation via regulating ERK1/2/MMPs signaling pathway in renal failure rats / 中国中药杂志

This study aimed to clarify preliminarily the effects and mechanisms of Shenkang injection (SKI) promoting extracellular matrix(ECM)degradation via regulating extracellular-signal regulated protein kinase(ERK)1/2/matrix metalloproteinases(MMPs)signaling pathway in renal failure rats. Twenty rats were randomly divided into 4 groups：the Sham group,the Model group,the SKI group and the Enalapril maleate(EM)group. The model rats with renal failure were induced by intragastric administration of adenine and unilateral ureteral obstruction(UUO). After modeling, the rats in SKI group and EM group were intervened by intraperitoneal injection of SKI or intragastric administration of the EM suspension,while the rats in Sham group and Model group were administrated with distilled water respectively for 3 weeks. The 24 h urinary protein excretion(Upro)and urinary N-acety1-β-D-glucosaminidase(UNAG)in all rats were tested after drug administration. All rats were sacrificed after drug administration for 3 weeks,blood and kidney were collected,renal morphological characteristics were observed. Furthermore,serum biochemical indices and the protein expressions of collagen type IV(CIV),MMP-2,MMP-9,tissue inhibitors of metalloproteinase(TIMP)-1,ERK1/2 and phosphorylated-ERK1/2(p-ERK1/2)in the kidney were evaluated respectively. The results indicated that,after the intervention of SKI,serum creatinine(Scr),blood urea nitrogen(BUN),uric acid(UA),albumin(Alb),Upro,UNAG and renal morphological change in model rats were improved at different levels,respectively. Moreover,these actions were similar to EM. In addition to these,SKI adjusted the protein expressions of MMP-2,MMP-9 and TIMP-1,and down-regulated the protein expressions of p-ERK1/2 in the kidney. Moreover,these actions were different from EM. In conclusion,SKI promotes ECM degradation and delays the progression of renal failure possibly through regulating ERK1/2 signaling pathway activation in the kidney and intervening MMPs/TIMP-1 expressions in vivo.

Production of IL-1β and Inflammasome with Up-Regulated Expressions of NOD-Like Receptor Related Genes in Toxoplasma gondii-Infected THP-1 Macrophages

Toxoplasma gondii is an obligate intracellular parasite that stimulates production of high levels of proinflammatory cytokines, which are important for innate immunity. NLRs, i.e., nucleotide-binding oligomerization domain (NOD)-like receptors, play a crucial role as innate immune sensors and form multiprotein complexes called inflammasomes, which mediate caspase-1-dependent processing of pro-IL-1β. To elucidate the role of inflammasome components in T. gondii-infected THP-1 macrophages, we examined inflammasome-related gene expression and mechanisms of inflammasome-regulated cytokine IL-1β secretion. The results revealed a significant upregulation of IL-1β after T. gondii infection. T. gondii infection also upregulated the expression of inflammasome sensors, including NLRP1, NLRP3, NLRC4, NLRP6, NLRP8, NLRP13, AIM2, and NAIP, in a time-dependent manner. The infection also upregulated inflammasome adaptor protein ASC and caspase-1 mRNA levels. From this study, we newly found that T. gondii infection regulates NLRC4, NLRP6, NLRP8, NLRP13, AIM2, and neuronal apoptosis inhibitor protein (NAIP) gene expressions in THP-1 macrophages and that the role of the inflammasome-related genes may be critical for mediating the innate immune responses to T. gondii infection.

Effects and mechanisms of UCG ameliorating renal interstitial fibrosis by regulating TGF-β1/SnoN/Smads signaling pathway in renal failure rats / 中国中药杂志

This study was aimed to demonstrate preliminarily the effects and mechanisms of uremic clearance granule (UCG) ameliorating renal interstitial fibrosis (RIF) by regulating transforming growth factor (TGF)-β1/SnoN/Smads signaling pathway in vivo. Fifteen rats were randomly divided into 3 groups：the normal group,the model group and the UCG group. The rats with renal failure were induced by intragastric administration of adenine and unilateral ureteral obstruction (UUO). After modeling,the rats in the UCG group and in the other groups were intervened by intragastric administration of UCG and distilled water respectively during 3 weeks. The body weight and 24 h urinary protein excretion (Upro) in all rats were tested after drug administration. All rats were killed after drug administration for 3 weeks,blood and kidneys were collected and weighted,kidney appearance and renal morphological characteristics were observed. In addition,serum biochemical indices and the protein expressions of TGF-β1,SnoN,phosphorylated Smad2/3 (p-Smad2/3) and Smad7 in the kidney were evaluated respectively. The results indicated that,after the intervention of UCG,the general state of health,kidney appearance,serum creatinine (Scr),blood urea nitrogen (BUN),uric acid (UA),albumin (Alb),Upro and renal morphological change in model rats were improved in different degrees,respectively. Moreover,UCG down-regulated the protein expressions of TGF-β1 and p-Smad2/3,and up-regulated the protein expressions of SnoN and Smad7 in the kidney. In conclusion,UCG reduces extracellular matrix (ECM) synthesis and delays the progression of renal failure via possibly multi-targeting at regulating TGF-β1/SnoN/Smads signaling pathway in vivo.

Pathomechanisms of podocyte injury in diabetic nephropathy and interventional effects of Chinese herbal medicine / 中国中药杂志

Podocyte injury is closely related to proteinuria in the progress of diabetic nephropathy(DN). The pathological characters of podocyte injury mainly refer to the change of podocyte form and function, including foot process effacement, reduction of podocyte number and density, podocyte apoptosis, podocyte epithelial-mesenchymal transdifferentiation(EMT)and podocyte hypertrophy. These pathological damages are controlled by multiple signaling pathways in the kidney, such as mammalian target of rapamycin(mTOR)/autophagy pathway, transforming growth factor(TGF)-β1 pathway and Notch pathway. For podocyte injuries induced by high glucose or in murine models of DN, some Chinese herbal medicine(CHM)extracts, such as multiglycoside of Tripterygium wilfordii(GTW), triptolide(TP), astragaloside IV(AS-IV), astragalus polysaccharide(APS)and Panax notoginseng saponins(PNS), have the protective effects in vivo or in vitro. The preliminary studies in China showed that GTW improves podocyte injury in the DN model rats probably through regulating the activity of mTORC1 signaling pathway in the kidney. Therefore, it is the developmental direction for the further study to clarify the interventional effects of CHM based on podocyte injury-related signaling pathway in DN.

Clinicopathological Features and Immunohistochemical Alterations of Keratinocyte Proliferation, Melanocyte Density, Smooth Muscle Hyperplasia and Nerve Fiber Distribution in Becker's Nevus

BACKGROUND: Although Becker's nevus (BN) is a relatively common disease, the systematic studies of clinicopathological and immunohistochemical results are poorly reported. OBJECTIVE: To investigate the clinicopathological features and immunohistochemical alterations of keratinocyte proliferation, melanocyte density, smooth muscle hyperplasia and nerve fiber distribution in BN. METHODS: Clinical and pathological data were collected in 60 newly-diagnosed BN cases. Immunohistochemical stain of Ki-67, Melan-A, keratin 15, smooth muscle actin and protein gene product 9.5 was performed in 21 cases. RESULTS: The median diagnostic and onset age was 17 and 12 years, respectively. Skin lesions usually appeared on the upper trunk and upper limbs. The pathological features included the rete ridge elongation and fusion and basal hyperpigmentation. Epidermal Ki-67, Melan-A and keratin 15 expression and dermal nerve fiber length were significantly higher in lesional and perilesional skin than in normal skin (p<0.05~0.01), while smooth muscle actin expression was upregulated only in skin lesion (p<0.05). CONCLUSION: Although the clinical diagnosis of BN is often straightforward, histopathology is helpful to differentiate from other pigmentary disorders. The hyperproliferation of keratinocytes, melanocytes, arrector pili muscle and dermal nerve fibers could be involved in the pathogenesis of BN.

Expressions of fatty acid binding-protein 5 and dihydrolipoamide dehydrogenase in skin lesions of symmetrical acrokeratoderma / 中华皮肤科杂志

Objective To investigate the expressions of fatty acid-binding protein 5 (FABP5)and dihydroli-poamide dehydrogenase(DLD)in skin lesions of symmetrical acrokeratoderma(SAK), and to explore their significance. Methods Biopsy specimens were obtained from skin lesions on the wrists and perilesional skin of 9 patients with SAK, and from normal skin in the wrists of 9 healthy volunteers (control group). Reverse transcription PCR (RT-PCR)and immunohistochemical staining were performed to measure the expressions of FABP5 and DLD in these specimens. Results RT-PCR showed no significant differences in the mRNA expressions of FABP5 or DLD between lesional, perilesional and normal control skin specimens(both P > 0.05). Immunohistochemically, there was a significant increase in the extent and intensity of staining for FABP5 in SAK lesions. Concretely speaking, FABP5 was strongly expressed in the stratum corneum, granular and spinous layers in SAK lesions, but weakly expressed in the stratum corneum, granular and spinous layers in perilesional skin, and only in spinous and basal layers in normal control skin. The expression of DLD decreased in SAK lesions, and was observed only in the stratum corneum and spinous layer in a few cases of SAK. However, the full-thickness epidermis stained positive for DLD in perilesional skin, with the nuclei and cytoplasm both stained deep brown. Conclusion The overexpression of FABP5 in SAK lesions may participate in dysdifferentiation of keratinocytes, while the down-regulation of DLD expression suggests an imbalance in energy metabolism.

Analysis on arthroscopic debridement and visco supplement for the treatment of degenerative osteoarthropathy of ankle / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate effects of arthroscopic debridement and visco supplement for the treatment of degenerative osteoarthropathy of ankle.</p><p><b>METHODS</b>From October 2008 to May 2012, 30 patients with degenerative osteoarthropathy of ankle were treated with arthroscopy after ineffective treatment with conservative methods. Two patients lost follow-up. Among the patients, 19 patients were male and 9 patients were female, ranging in age from 28 to 56 years old, with a mean of (40.0+ 5.9)years old. Patients who had inflammatory or postinfectious arthritis,rheumatoid,gout,tuberculosis were excluded. Other exclusion criteria included previous arthroscopic treatment for ankle osteoarthropathy, intraarticular corticosteroid injection within the previous 6 months, a major neurologic deficit, serious medical illness and pregnancy. Articular cartilage iijuries were classified according to Outerbridge by the same doctor. Follow procedures were involved in the surgery: synovectomy,debridement or excision of fragments of articular cartilage or chondral flaps and osteophytes that prevented full extension. Microfracture of chondral defects was not performed. Ogilvie-Harris criteria was used to evaluate therapeutic effects.</p><p><b>RESULTS</b>According to Ogilvie-Harris criteria, 10 patients got an excellent results, 14 good, 3 poor and 1 bad. The mean VAS score of pain decreased from preoperative 7.5+/-1.3 to postoperative 2.4+/-2.3. The score of dorsiflexion range (ROM-D) had no obvious change after operation [preoperative(27.0+/-7.3)degree and postoperative(29.0+/-5.6)degree]. The mean Tegner score increased from preoperative 2.7+/-1.3 to postoperative 5.6+/-2.2.</p><p><b>CONCLUSION</b>Synovectomy, debridement or excision of chondral flaps and osteophytes under arthroscopy, as well as scheduled intraarticular sodium hyaluronate injection should be recommened to treat ankle degenerative osteoarthropathy.</p>

Preliminary application of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects and application value of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws.</p><p><b>METHODS</b>Thirty-two cases of severe scoliosis were retrospectively analysed in our hospital from June 2009 to June 2011,which were treated by posterior total pedicle screws with intraoperative CT including 12 males and 20 females with an average age of 16.8 years ranging from 10 to 38 years. There were 19 cases combined with thoracic kyphosis among 32 cases. Multiple planar reconstruction technology of intraoperative CT was applied to assess screw position. The numbers (rates) of pedicle screws were calculated and evaluated as different grades in upper thoracic vertebra (T1-T4) ,middle thoracic vertebra (T5-T8), lower thoracic vertebra (T9-T12) and lumbar vertebra. The pedicle screws of 2 grade and 3 grade were defined as malpositioned screws. Times of applicating intraoperative CT were calculated. Cobb angle of all cases and kyphosis angle of the cases combined with thoracic kyphosis were measured before and after surgery. Scoliosis correction rates and kyphosis correction rates were calculated.</p><p><b>RESULTS</b>There were 686 pedicle screws placed in thoracolumbar of 32 patients (including 544 thoracic pedicle screws,142 lumbar pedicle screws) and 14 patients underwent osteotomy. The rate of malpositioned screws in thoracolumbar was 7.3% by evaluating with intraoperative CT,and it respectively was 5.6%,11.1%, 6.7% and 4.3% in upper thoracic vertebra, middle thoracic vertebra,lower thoracic vertebra and lumbar vertebra. The malpositioned screws were amended in surgery. The mean times of intraoperative CT was 2.6 times (ranged from 2 times to 4 times). The mean preoperative Cobb angle was 95 degrees (ranged from 78 degrees to 123 degrees) and the mean postoperative Cobb angle was 340 (ranged from 19 degrees to 53 degrees). The mean correction rate of Cobb angle was 64%. The mean preoperative kyphosis angle of the patients combined with thoracic kyphosis was 69 degrees (ranged from 46 degrees to 82 degrees) and the mean postoperative kyphosis angle was 32 degrees (ranged from 22 degrees to 45 degrees). The mean correction rate of kyphosis angle was 54%. Four patients suffered cerebrospinal fluid leak after surgery. No infection, vascular lesion and nervous lesion were found. All patients had an average 18-month follow-up (ranged from 12 to 26 months). No broken nails, broken rods and pseudarthrosis were founded.</p><p><b>CONCLUSION</b>Application of in traoperative CT in severe scoliosis with posterior total pedicle screws can detect and amend malpositioned screws timely in surgery, to avoid secondary surgery for malpositioned screws and protect the safety of surgery. The effects of surgery is satisfactory.</p>

Submucosal tunneling endoscopic resection for esophageal leiomyoma originating from muscularis propria / 中华消化内镜杂志

ObjectiveTo retrospectively evaluate the clinical efficacy of endoscopic submucosal tunnel resection for esophageal leiomyoma originating from muscularis propria.MethodsA total of 16 patients with esophageal mass originating from muscularis propria were recruited with informed consents from January 2011 to November 2011,and underwent esophageal submucosal tunneling endoscopic resection.ResultsAll lesions were completely resected.Histological examinations confirmed the diagnosis of leiomyona,and immunohistochemical staining indicated active hyperplasia in 9 cases.Intraoperative mediastinal,subcutaneous and retroperitoneal emphysema occurred in one patient,and the patient recovered one week later.No other complications or death were recorded.The patients were followed up for six months on average,and no cases of recurrence were found.ConclusionEndoscopic submncosal tunnel resection of esophageal leiomyoma originating from the muscularis propria is a minimally invasive,safe and effective procedure.

Milestones and enlightenments of healthcare resources integration at home and abroad / 中华医院管理杂志

Covered herein are the milestones and researches made on healthcare resources integration in China and abroad,focusing on characteristic horizontal and vertical integration of healthcare resources based on medical service value chain.It also analyzed influencing factors on healthcare resources integration,such as health insurance payment and informationization.With reference to global experiences,suggestions are made on the horizontal integration of the resources,in terms of governance,operation mechanism,health insurance payment,informationization and discipline development.

Epigenetic Modulation of Gene Expression during Keratinocyte Differentiation

BACKGROUND: Epigenetic modulation of gene expression occurs by various methods, including DNA methylation and histone modification. DNA methylation of specific genes may affect the chromatin structure, preventing access by the transcriptional machinery. Although gene expression is dramatically changed during keratinocyte differentiation, there is no evidence of epigenetic modulation during the process of epidermal stratification. OBJECTIVE: We investigated whether epigenetic modulation is involved in keratinocyte differentiation-specific gene regulation. METHODS: We used trypsin to produce epidermal fragmentation (named T1-T4) and performed a morphological analysis using hematoxylin-eosin stain and cytokeratin expression based on reverse transcription polymerase chain reaction. We then constructed a DNA methylation microarray. RESULTS: Each epidermal fragment showed morphological features of the epithelial layer. T1 represented the basal layer, T2 was the spinous layer, T3 was the granular layer, and T4 was the cornified layer. The level of the K14 proliferation marker was increased in the T1 fraction, and the level of K10 differentiation marker was increased in the T2-T4 fractions. Using a methylation microarray with the T1 and T4 fractions, we obtained many hypermethylated and hypomethylated genes from differentiated keratinocytes. CONCLUSION: The importance of epigenetic modulation in target gene expression during keratinocyte differentiation is identified.

A survey on the attitudes of doctors towards health insurance payment in the medical consortium / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Medical consortium is a specific vertical integration model of regional medical resources. To improve medical resources utilization and control the health insurance costs by fee-for-service plans (FFS), capitation fee and diagnosis-related groups (DRGs), it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.</p><p><b>METHODS</b>A questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.</p><p><b>RESULTS</b>The statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS, whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.</p><p><b>CONCLUSIONS</b>There are some obvious differences on doctors' attitudes towards health insurance payment in 3 different levels hospitals. Thus, it is feasible that health insurance payment should be supposed to the doctors' attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.</p>

Sox9 Increases the Proliferation and Colony-forming Activity of Outer Root Sheath Cells Cultured In Vitro

BACKGROUND: beta-catenin plays a pivotal role in hair follicle development and hair growth cycle. OBJECTIVE: The aim of this study was to identify beta-catenin-regulated genes in cultured human hair outer root sheath (ORS) cells. METHODS: Primary cultured ORS cells were transduced with recombinant adenovirus expressing N-terminal truncated beta-catenin (constitutive active form), and beta-catenin-regulated genes were identified. RESULTS: Overexpression of the constitutively active form of beta-catenin led to induction of Sox9 expression at both mRNA and protein levels. To investigate the potential role of Sox9, we made the recombinant adenovirus expressing green fluorescent protein-tagged Sox9, and then transduced into cultured ORS cells. Interestingly, Sox9 induced the expression of keratin 15, increased the proliferation of ORS cells in vitro, and enhanced colony-forming activity. CONCLUSION: Our results suggest that Sox9 is a beta-catenin-regulated gene in ORS cells, and has potential importance in the regulation of hair follicle homeostasis.