2013年 · 第126卷第15期

Abstract：Background It is necessary to develop some innovative methods to reveal and discover the novel (SLE)-related protein molecules.In the present study,matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDITOF MS) was employed to detect the differential expression of serum polypeptides in the patients with systemic lupus erythematosus (SLE) presenting with a family history or complicating with kidney injury so as to identify the proteins associated with the genetic factors and kidney injury in SLE.Methods The subjects recruited were divided into four groups,that is,a group of SLE patients with both family history and kidney injury,a group of SLE patients with only kidney injury but no family history,a group of SLE patients with neither family history nor kidney injury,and a control group consisting of healthy volunteers.By adopting MALDI-TOF MS analysis,the serum samples obtained from the three groups of SLE patients were examined and compared with those from the control group; the categorized peptide fingerprint profile was established via the biological data collected from the samples.Results The expression of protein with a m/z of 4207 Da increased significantly in SLE patients; the protein with a m/z of 2658 Da was expressed in all SLE patients; three proteins (with m/z of 1465,5332,and 5900 Da respectively) were expressed in the SLE patients complicated with kidney injury and the protein with a m/z of 1943 Da was expressed in SLE patients with family history.Conclusion A number of differential proteins were successfully detected and identified through MALDI-TOF MS detection and these proteins may be associated with the genetic basis of SLE and the complicating kidney injury。

Abstract：Background Endostatin is a potent inhibitor of tumor angiogenesis.In the preliminary studies,we developed a mutant endostatin containing Arg-Gly-Asp-Arg-Gly-Asp (RGDRGD) sequences.In this study,we compared the antitumor effects of mutant endostatin and Bcl-2 antisense oligonucleotides both in combination and individually.Methods The artificially synthesized Bcl-2 ASODN (antisense oligonucleotides) included a translation-initiation site and was transfected into the bladder cancer cells by Lipofectamine.Cell growth was investigated by the tumor cell growth chart,MTT assay,caspase-3 activity detection assay,AO/EB fluorescein stain,and the annexin V-FITC apoptosis detection assay.In the in vivo study,UM-UC-3 bladder cancer cells were subcutaneously implanted into nude mice and the growth of tumor was examined.The ultrastructure of the tumor tissues in the treated and control groups were observed.Results The cell growth chart showed that the cell population of the treated combination group decreased by 52.04％compared to the control group.The inhibition rate of the treated combination group was (79.66±6.79)％,whereas those of the individual ASODN and ES groups were (53.39±3.22)％ and (50.22±5.46)％ respectively.In the caspase-3 activity detection using AO/EB fluorescein stain and annexin V-FITC apoptosis detection assay,the co-inhibitory effect was higher than the individual inhibitory effects (P＜0.05).There were significant differences in the inhibition of the solid tumor growth in the in vivo study.Conclusions Our findings indicated that Bcl-2 antisense oligonucleotides enhance the antitumor effects of mutant endostatin both in vitro and in vivo.We noted the synergistic effects of Bcl-2 antisense oligonucleotides combined with mutant endostatin。

Abstract：Background The traditional lamina osteotomy replantation method is prone to nerve root injury and low back pain recurrence.Our team has proposed a modified approach that improves the osteotomy site and its fixation procedure.The aim of this study was to evaluate the clinical efficacy of traditional and modified lamina replantation methods in treating unstable lumbar disc herniation.Methods From March 2008 to August 2011,124 patients with unstable lumbar disc herniation were enrolled and randomly divided into the following two groups according to random digital table:group A (traditional group) consisting of 61 patients who underwent traditional laminectomy replantation,and group B (modified group) consisting of 63 patients who underwent modified lamina replantation.Both surgeries were performed by the same surgeons.The two groups had no significant difference in gender,age,symptoms,time of onset and the prominent segment.Visual analogue scale (VAS),Oswertry disability index (ODI),and Japanese Orthopaedic Association (JOA) scores,operative time,blood loss,complication rate,radiographic healing rates,and low back pain recurrence rates were compared between the two groups.Results There were 121 patients followed up for more than one year,and the follow-up rate was 97.6％.Nerve injury occurred in two patients (3.3％) in the modified group and 12 patients (20.0％) in the traditional group.Dural injury occurred in one patient (1.6％) in the modified group and seven patients (11.7％) in the traditional group.Pseudarthrosis occurred in two patients in the modified group and in 18 patients in the traditional group with 1-year fusion rates of 96.7％ and 70.0％,respectively.Recurrence of lower back pain after one year was noted in three patients (4.9％) in the modified group,and in 15 (25.0％) in the traditional group.Leg pain recurrence was noted in one patient (1.6％) in the modified group and in three cases (5.0％) in the traditional group.The one-year healing rates of nerve injury,dural injury,replantation lamina and low back pain recurrence rates after one year were significantly different (P＜0.05) between the two groups.At two weeks,three months,six months and one year postoperatively,both groups had significant improvement in VAS,ODI,and JOA scores from their preoperative values (P＜0.05).No significant difference was detected between the short term postoperative scores between groups A and B (P＞0.05).However,a significant difference was found one year later (P＜0.05).Conclusions Compared to the traditional approach,the modified technique for lamina replantation showed lower rates of dural and nerve damage,a higher lamina healing rate,a lower back pain recurrence rate,and better clinical scores.It is a safe and effective operation for lumbar spine surgery。

Abstract：Background Multiple apical muscular ventricular septal defects (VSDs) remain a challenge for surgeons because of their anatomical features.We used single patch with intermediate fixations to repair multiple apical muscular VSDs through right ventriculotomy.Methods We analysed the data of 16 children (median age 8 months,range 2 months to 144 months) with multiple apical muscular VSDs who underwent a single patch technique via apical right ventriculotomy.Perioperative data were collected and analysed,and the patients were followed up for three months to 66 months (median,46 months) to investigate the outcomes.Results All patients recovered from cardiopulmonary bypass easily with median of cardiopulmonary bypass time 87 minutes and of aortic crossclamp time 53 minutes.No surgically related death occurred and no patient required reoperation.One patient died of pseudomonas pyocyanea infection on day 11 postoperatively.Residual shunt happened in one patient with a diameter of 2 mm and spontaneously closed in 12 months after operation.Two patients presented slightly reduced right ventricular volume and apical hypokinesia postoperatively and recovered 24 and 36 months later respectively.No other complication was found during the three months to 66 months follow-up.Conclusion Our experiences using a single patch technique with intermediate fixations via right ventriculotomy in the management of multiple muscular VSDs had favourable outcomes。

Abstract：Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents' psychological and behavior.This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients' age and their physiological and psychological health.We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery.Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest.The funnel chest index,the Symptom Checklist-90,and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients.A sample of 234adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing.Age groups were adopted as an independent variable,and other factors in funnel chest patients were dependent variables.Results There was a significant difference in the relapse rate for funnel chest in the different age groups (x2=11.883,P=0.008).There was a higher relapse rate in patients of ≤10 or ≥19 years old than in patients of 11-18 years old.There was a significant difference in the SCL-90 total score in the different age groups (F=12.538,P=0.0001),the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90.There was a significant difference in the standard score of E (introversion/extraversion) in the different age groups (F=10.06,P=0.0001).There was also a significance in the funnel chest index before surgery in the different psychological scales (P＜0.01),with a higher funnel chest index score associated with more obvious psychological trauma.Age and the number of variables,including the relapse rate,SCL-90 score,standard score of E,and standard score of N in the EPQ were significantly correlated (correlation indices were 0.402,0.623,－0.505,and 0.473,respectively,P＜0.01).Conclusions There are higher complication rates after surgery and relapse rates when funnel chest patients are too young or too old.There is more obvious psychological trauma in patients with a high funnel chest index.Our results indicate that the best age for surgery for funnel chest is 14-16 years。

Abstract：Background Magnetic resonance imaging (MRI) is commonly utilized as part of the diagnostic workup for the clinical diagnosis of glioblastoma multiforme (GBM),further guiding the clinical treatment of this aggressive cancer.Recent research has shown that microRNAs (miRNAs) may act as oncogenes,or in some cases,tumor suppressor genes that in turn may reflect the genotypic features of GBM.This study aimed to investigate the relationship between MRI features and miRNA gene expression in patients with glioblastoma multiforme.Methods In order to identify the relationship between the radiographic findings of MRI and those identified changes in miRNA gene expression of GBM,we reviewed the MRI images of GBM patients and compared them with the identified miRNA expression profiles utilizing microarray analysis of paired GBM tumor samples.We chose five MRI imaging features:(1) contrast tumor enhanced/necrosis ratio,(2) contrast tumor enhanced/T2 ratio,(3) multiple lesions,(4)hemorrhage,and (5) necrotic volume.The relationship between these five imaging features and miRNA expression was studied using significance analysis of microarrays analysis.Results We found that the expression of miRNAs such as hsa-miR-892b,hsa-miR-892a,and hsa-miR-888 was inversely correlated with an enhanced/necrosis ratio ≥1.The miRNAs such as hsa-miR-95,hsa-miR-498,and hsa-miR-1300 were associated with a contrast tumor enhanced/T2 ratio ≥1.The miRNAs such as hsa-miR-612,hsa-miR-524-3,and hsamiR-1282 were associated with multiple lesions identified on MRI and the expression of miR-221 was associated with hemorrhage by GBM.The expression of miR-let-7,including miR-let-7f,miR-let-7i,and miR-let-7f-1*,was downregulated in the hemorrhage group.The gene expression of miRNAs such as hsa-miR-140-5p,hsa-miR-30e,and hsa-miR-301a was relatively low when compared with the larger necrotic volume group as identified by MRI.Conclusions The miRNA gene expression profiles correlate with several selected MRI features of patients with GBM.Further analysis of key imaging features of MRI with correlation with miRNA gene expression patterns may help to guide treatment decisions based on these unique correlative profiles of GBM。

Abstract：Background Few characteristic changes of linear electroencephalograph (EEG) have been reported in schizophrenia.The aim of the present study was to investigate the changes in temporal-spatial dimensional properties of EEG under different cognitive tasks in patients with schizophrenia.Methods EEG was recorded by using EEG-1518K system and mapping system (Nihon Kohden Tomioka Corporation,Japan) in 45 schizophrenic patients and 47 healthy adults (normal control,NC) under five states:eyes closed,eyes open,mental arithmetic test with eyes closed,memory test with eyes open,and number cancellation test.Correlation dimension (D2) and point-wise correlation dimension (PD2) were calculated for all EEG analyses.Results (1) There were no significant differences of D2 and PD2 between NC and schizophrenic patients under states of eyes open and closed.(2) Compared with NC,schizophrenic patients showed decreased performance of D2 in mental arithmetic test with eyes closed and number cancellation test (mental arithmetic test with eyes closed:Nc 5.9±0.6,Sch 3.0±0.8; number cancellation test:Nc 6.0±0.6,Sch 4.4±0.7; P ＜0.05 or P ＜0.01).(3) Schizophrenic patients also showed decrease performance of PD2 in mental arithmetic test with eyes closed,memory test with eyes open,and number cancellation test (mental arithmetic test with eyes closed:Nc 6.9±0.7,Sch 4.0±0.8; memory test with eyes open:Nc 6.6±0.8,Sch 5.0±0.9; number cancellation test:Nc 7.1±0.7,Sch 4.8±0.9; P ＜0.05 or P ＜0.01).Conclusions Nonlinear dynamic analysis provided a new approach in clinical investigation of EEG signals.It was helpful to further understand the cerebral mechanism in schizophrenic cognitive process。

Abstract：Background Whether plasma can transfer the protective effect(s) of remote ischemic preconditioning (RIPC) between animals remains unresolved.We therefore investigated the effects of plasma collected 48 hours after transient limb ischemia on blood pressure recovery during myocardial ischemia reperfusion (IR) in homogenic rats.Methods Plasma was collected from Lewis rats,and the donor rats were randomly assigned to 2 groups:transient limb ischemia and control (n =8 each).Transient limb ischemia was achieved by four cycles of 5-minute ischemia and 5-minute reperfusion by noninvasive ligation and deligation of the both legs using elastic rubber bands after anesthesia.In the control group,no ligation was performed.Forty-eight hours later,whole blood was collected,and the plasma spun off.Study Lewis rats underwent 30-minute left anterior descending coronary artery occlusion followed by 180-minute reperfusion,and were randomly assigned to 2 groups (group A and group B,n =24 each),each further subdivided into 3subgroups (n =8 each).The subgroups of group A received normal saline (group A1),plasma of control rats (group A2),plasma of transient limb ischemia rats (group A3) respectively at 1 hour before IR; the subgroups of group B received normal saline (group B1),plasma of control rats (group B2),plasma of transient limb ischemia rats (group B3) respectively at 24 hours before IR.BIOPAC systems were used to measure hemodynamics of rats during myocardial ischemia-reperfusion.Results Systolic blood pressure (SBP) after IR in group B3 was different from that in groups B1 and B2 (B3 vs.B1,P=0.007; B3 vs.B2,P =0.039) at the beginning of reperfusion and 30 minutes after reperfusion.SBP was higher in group B3 than in groups B1 and B2 at the beginning of perfusion (B3 vs.B1,P=0.010; B3 vs.B2,P=0.002) and 30 minutes after reperfusion (B3 vs.B1,P=0.001; B3 vs.B2,P=0.001).SBP did not differ among subgroups A1,A2 and A3.Diastolic blood pressure and heart rate did not change in group A or group B.Conclusions The transfusion of plasma collected 48 hours after transient limb ischemia into homogenic rats 24 hours before IR can improve the SBP recovery during reperfusion.This may suggest that cardioprotective effect of late phase of RIPC is transferable via plasma。

Abstract：Background Taiwan has implemented a National Health Insurance (NHI) program to provide uniform comprehensive coverage since 1995.Forced by the severe financial deficit,global budgeting is introduced to replace the original payment system in Taiwan's NHI.Under global budgeting system,the total budget is distributed to six geographical regions in Taiwan.There is no pre-determined budget for each hospital.In order to investigate the longitudinal trend of how global budgeting influences health care resource,it is essential to estimate the efficiency of resource allocation in Taiwan's NHI.Methods Data Envelopment Analysis (DEA) and Malmquist index (MI) are used to investigate the 8-year panel data of 23 cities and counties which was collected from the annual report from the Department of Health,Taiwan,China.A value of MI greater than 1 indicates that total factor productivity progress has occurred,while a value of MI less than 1 indicates productivity loss.Results As a result,37 of the 184 DMUs in the analysis were found to be relatively efficient during the period,in which 14 of 23 DMUs are efficient in 2002 right after adopting globe budgeting.A trend of MI declines between 2002 and 2009implies the volume of health care services decrease after adopting global budgeting system.Production efficiency has been improved after global budgeting implies that behaviors of health providers control cost and avoid wasting resource at macro level.Conclusions The regressive MI indicates the hospitals redistribute health care resource to eliminate unnecessary treatment and to control the growth of service volume under global budgeting system.Hence,a trend of declining MI focuses on health care resource redistribution rather than efficiency improvement in this study。

Abstract：Background Thyroid peroxidase (TPO) is an important autoantigen in Hashimoto's thyroiditis (HT),and almost all epitopes are located in TPO ectodomain.The glycosylation of TPO might contribute to breaking self-tolerance,therefore,purified glycosylated recombinant TPO ectodomain is prerequisite of elucidating its role in the pathogenesis of HT.The aim of our study was to investigate whether the glycosylation has influence on the antigenic determinants of recombinant TPO.Methods Bac-to-Bac baculovirus expression system was used to generate recombinant human TPO ectodomain.The antigenicity was analyzed by antigen specific enzyme-linked immunosorbant assays (ELISAs).The glycosylation of recombinant human TPO ectodomain of High Five insect cell origin was detected by lectin-ELISAs.Results TPO ectodomain was recovered from the culture media as a soluble protein,and it was fused with a hexahistidine tag which allowed purification by nickel-affinity chromatography.The recombinant TPO ectodomain could be recognized by all the 54 HT patients and three TPO monoclonal antibodies.Fucose,sialic acid and galactose were all detected on the recombinant TPO ectodomain.Sera TPOAb binding decreased slightly after non-specific deglycosylation of TPO by periodic acid.Conclusions High Five insect cells derived recombinant human TPO ectodomain had N-glycosylation sites,which might have little effect on recognition by serum TPOAb。

The United States Food and Drug Administration approved the prostate-specific antigen (PSA) test in 1986 for monitoring the progression of prostate cancer;in 1994,the test was approved for the early detection of prostate cancer.1 The application of the PSA test has significantly increased the detection rate of prostate cancer。

Abstract：Background Immediate intravesical instillation of chemotherapeutic agents after transurethral resection (TUR) of nonmuscle invasive transitional cell bladder cancer has recently been suggested and has been proven to decrease the tumor recurrence rate significantly.This study is to evaluate the efficacy and safety of immediate intravesical instillation combined with regular instillations of Pirarubicin (THP(○R)) as prophylaxis compared to regular instillations only after TUR operation.Methods This was a prospective,randomized,multi-center,clinical study.Patients diagnosed with non-muscle invasive bladder cancer (Ta and T1) pathologically and suitable for TUR were enrolled randomly into two groups.In the study group,the patients received intravesical instillation within 24-hour post TURBT,followed by regular intravesical therapy using 30 mg/50 ml of THP(○R) once a week for 8 weeks,and then once a month to 1 year postoperatively Among the patients.In the control group,patients received regular instillation only.Results A total of 403 patients were enrolled into this study from 26 institutions in China.Among the potients,210 were enrolled into the study group and 193 were enrolled into the control group.At the median follow-up of 18 months,the recurrence rate was 7.8％ in the study group,significantly lower than that in the control group (14.3％; P=0.042).Subgroup analysis showed that the recurrence rate in low and intermediate-risk patients was significantly lower in the study group (6.8％) than in the control group (14.0％; P=0.047),although no significant differences were found in high-risk patients.Conclusion One immediate dose of THP(○R) 30 mg after TURBT followed by regular intravesical therapy appears well tolerated and more effective than regular intravesical therapy for preventing tumor recurrence,especially in low and intermediate-risk patients。

Abstract：Background Living donor kidney transplantation is becoming popular in China,whereas,in clinical situations,some kidney donors may be sub-optimal,namely marginal living donor.The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center.Methods Between January 2001 and December 2009,888 kidney transplantations were performed in our center; 149were living donor kidney transplantations.The living donors and recipients were followed up regularly after the operation.Of the living donors,30 donors were marginal,who were older than 60 years or suffered from kidney anomaly or some benign diseases.Among the non-marginal living kidney transplantations,58 donors and recipients had complete perioperative and follow-up data.We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age,follow-up period,donor's serum creatinine at the last follow-up,recipient's serum creatinine at the last follow-up,and graft survival at the last follow-up.Results The mean age of donors in the marginal and non-marginal living donors were (55±9) (37-66) and (43±12) (30-59) years.The mean follow-up times of the marginal and non-marginal groups were (26.4±13.4) months and (28.8±14.8)months.The donor and recipient serum creatinine levels at the last follow-up were (1.16±0.20) mg/dl and (1.30±0.24) mg/dl in the marginal group,and (1.12±0.32) mg/dl and (1.34±0.32) mg/dl in the non-marginal group.Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year.Actuarial 3-year graft survival was 96.7％ in the marginal group and 100％ in the non-marginal group.No significant differences were detected between the two groups with regard to these data.Conclusion Utilization of highly selective marginal living donors can be a safe,feasible,and effective way for the treatment of patients with end stage renal disease。

Abstract：Background Humoral immunity is an important factor for long-term survival of renal allograft.Here we performed a four-year follow-up to explore the clinical significance of monitoring anti-human leukocyte antigens (HLA) and anti-major histocompatibility complex class Ⅰ-related chain A (MICA) antibody expression after kidney transplantation.Methods We obtained serial serum samples from 84 kidney transplant patients over a four-year period.All patients were followed up at least 6 months after transplantation and had at least two follow-up points.Anti-HLA and anti-MICA antibody titres and serum craatinine (SCr) levels were evaluated at each follow-up.Patients were divided into 4 groups:HLA(+)MICA(-),HLA(-)MICA(+),HLA(+)MICA(+) and HLA(-)MICA(-).The impact of post-transplant antibody level on kidney allograft function was evaluated.Results Antibodies were detected in 38.1％ (32/84) of the renal allograft recipients.HLA,MICA and HLA+MICA expression was observed in 18.89％,14.44％ and 5.93％ of the recipients respectively.The most frequent anti-HLA and anti-MICA specific antibodies identified were A11,A24,A29,A32,A33,A80; B7,B13,B37; DR17,DR12,DR18,DR52,DR53,DR1,DR4,DR9,DR51; DQ7,DQ4,DQ8,DQ2,DQ9,DQ5,DQ6 and MICA02,MICA18,MICA19,MICA07,MICA27.As the time after transplantation elapsed,more recipients developed de novo antibody expression.Total 11.91％ (10/84) of the recipients had de novo antibody expression during the follow up.The average level of SCr and the percentage of recipients with abnormal allograft function were significantly higher in recipients with anti-HLA and/or antiMICA antibody expression than those without.The appearance of anti-HLA and anti-MICA antibody expression always preceded the increase in SCr value.Conclusions Anti-HLA and anti-MICA antibody expression has predictive value for early and late allograft dysfunction.The presence of donor specific antibody is detrimental to graft function and graft survival。

Abstract：Background Sunitinib has been proved an effective new option for treatment of metastatic renal cell carcinoma (mRCC).Analysis of clinical data of 22 patients,who were exposed to sunitinib for at least 1 year,was conducted to evaluate the long-term efficacy and safety of sunitinib for the treatment of mRCC.Methods A total of 54 patients with mRCC were treated with sunitinib malate,50 mg/d orally,on a 4-weeks-on and 2-weeks-off dosing schedule in Peking University First Hospital.Treatment continued until disease progression,unacceptable adverse events (AEs),or death.Among them,22 patients continued treatment for at least 1 year.The clinical data of these 22 patients were prospectively collected for analysis.AEs were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events,Version 3.0.Tumor response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors.Results Median progression-free survival was 19.5 months until last follow-up.The best efficacy results achieved were complete response,partial response,and stable disease for 2,9,and 11 patients,respectively.Objective response rate was 50％.The most common AEs were hand-foot syndrome (95％) and hypertension (91％).Other common AEs were thyroid-stimulating hormone elevation (82％),platelet decrease (77％),and loss of appetite (77％).Only one patient withdrew from treatment for cardiac infarction.Another nine patients experienced dose modifications or short-term suspensions.Conclusion Long-term exposure to sunitinib malate showed encouraging efficacy in the treatment of mRCC.At the same time,the tolerability was good。

Abstract：Background The Red Cross of China and Ministry of Health jointly started a pilot program of organ donation after cardiac death to overcome the shortage of available organs since 2010.The purpose of this qualitative study were to compare the consent rate of organ donation between young donor families and adult donor families; to explore and determine factors associated with differences in willingness to donate organs between them.Research objective was to provide a rationale for further preparation of professionals involved in this sensitive work.Methods Between March 2010 and June 2012,24 young deceased patients including donors and non-donors and 96 potential adult donors were collected,and consent rates of young donors' families and adult donors' families were calculated.A X2 test analysis to compare the consent rates of the two groups was conducted.We studied through semistructured interviews 15 parents of young donors and 15 relatives of old donors who were interviewed for petition of consent.Data collection and analysis of the overall study were performed according to the grounded theory methodology.Factors that influenced the families' decisions were identified and classified.We found the differences in willingness to donate organs between the two groups.Results The consent rate of young donor families was 66.67％,while the consent rate of adult donor families was 26.04％.Young donor families easily consented to organ donation than adult donor families (P＜0.005).The donors' families had been affected by various factors throughout the process of deciding to give consent for donation.The findings led to the formulation of an empirically based model of interlinking categories that influence families' decision-making process in organ donation.These factors are grouped into five main categories:(1) personal factors,(2) conditions of organ request,(3) interpersonal factors,(4) ethical factors,and (5) traditional views.The funeral tradition influenced the young donor parents' consent to donation,but had no relation with family decision of adult donors.And the family members of young donors are relatively less,who are more likely to reach a consensus.Conclusions Young donor families influenced by traditional funeral beliefs are easier to consent to organ donation than adult donor families.Family members of young donors are relatively less who are more likely to reach a consensus.Acceptance of the expanded criteria donors may improve the organ donation rates,especially those of the advanced age。

Abstract：Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons.We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue.Methods Sixteen patients with bone and soft tissue defects were included.The mean age of the patients was 31.5 years.The average time from injury to initial surgery was 14.4 weeks.The average soft tissue and bone defect sizes were 92.9cm2 and 8.7 cm,respectively.Local flaps were created to reconstruct the soft tissue defects.The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis.Results Two myocutaneous flaps and 14 reverse island flaps were applied.All transferred flaps survived.Fifteen patients healed with equal leg length,and one healed with a residual leg-length discrepancy of 1.5 cm.One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics.No patient developed pin loosening.All patients walked without assistance.Fifteen patients returned to their work,and one lost her job.The results were evaluated using the Paley bone and functional assessment scores.The bone assessment results were excellent in 14 and good in two patients.Functional assessment scores were excellent in 13,good in two,and fair in one patient.Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue。

Abstract：Background Thoracolumbar burst fracture is a common clinical injury,and the fracture mechanism is still controversial.The aim of this research was to study the formation of intracanal fracture fragments in thoracolumbar burst fractures and to provide information for the prevention of thoracolumbar bursts fractures and reduction of damage to the nervous system.Methods A nonlinear three-dimensional finite element model of T11-L3 segments was established,and the injury processes of thoracolumbar bursts were simulated.The intact finite element model and the finite element model after the superior articular were impacted by 100 J of energy in different directions.The distribution and variation of stress in the superior posterior region of the L1 vertebral body were analyzed.Abaqus 6.9 explicit dynamic solver was used as finite element software in calculations.Results A three-dimensional nonlinear finite element model of the thoracolumbar spine was created.In the intact model,stress was concentrated in the superior posterior region of the L1 vertebral body.The stress peak was a maximum for the extension impact load and a minimum for the flexion impact load.The stress peak and contact force in the facet joint had close correlation with time.The stress peak disappeared after excision of the superior articular process.Conclusions The three-dimensional nonlinear finite element model was suitable for dynamic analysis.The contact force in the facet joint,which can be transferred to the superior posterior vertebral body,may explain the spinal canal fragment in thoracolumbar burst fractures。

Abstract：Background Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization.However,statistical studies do not include any analyses of Beijing's geriatric population.Using data from the Beijing Emergency Medical Center,we present the main characteristics of traffic injuries involving the elderly in Beijing.We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.Methods In a longitudinal,retrospective study,data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010.Personal information,time of injury event,emergency care response time,road user type,striking vehicle type,injury site,and severity of injury were analyzed using x2 tests and Logistic regression analysis.Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing,and the morbidity rate decreased from 2004 to 2010 (P ＜0.001).The mean age was (72.92±5.67) years,and 911 (53.40％) of the victims were male.The majority of victims sustained head and lower limb injuries and were classified as being of medium severity.Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64％) and pedestrian victim injuries (79.19％).Our statistical analysis found three factors for injury severity:abdominal injuries (P ＜0.001),number of injury sites (P=0.027),and head injuries (P=0.034).The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing.However,traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence。

Abstract：Background Symbrachydactyly is defined as a combination of short fingers with syndactyly.There are few published reports estimating the incidence of symbrachydactyly.The aim of this study was to investigate the clinical features and the outcome of surgical treatment for congenital symbrachydactyly.Methods One hundred and twenty webs of thirty-four patients of symbrachydactyly were involved in the study.The sex ratio was 21 males/13 females.The age ranged from 1 year to 8 years,average 2.6 years.Four cases had both hands involved and 30 patients had one hand involvement.Release of the syndactylous digits webs were completed by one surgical procedure in 14 cases and more than one surgical procedure in 20 cases; 3 to 6 months between the procedures.In the meantime,some of the associated hand deformities were treated.Results Postoperative follow-up time was 10 to 18 months,average 12 months.All the fingers involved in this study were separated successfully.However,6 fingers had scar tissue contracture and 8 had web scar adhesion.All complications needed further surgical treatment.Parents of 94.1％ of the patients were satisfied with the overall function of the hand,and 76.5％ were satisfied with the cosmetic appearance of hand.Conclusions The combination of syndactyly and brachydactyly is the main clinical feature in symbrachydactyly.Separation of the digital webs can greatly improve the function of the hand.However,more work needs to be done to improve the cosmetic appearance of the hand。

Abstract：Background Endophthalmitis can be a devastating complication after pars plana vitrectomy.The incidence of post-vitrectomy endophthalmitis is significantly lower than that of endophthalmitis occurring after other intraocular operations.However,normal post-operative pain and inflammation may mask endophthalmitis and lead to delayed diagnosis and grave visual consequences.This study aimed to summarize the outcomes of cases that underwent pars plana vitrectomy over a 10-year period and to analyze the characteristics of post-vitrectomy endophthalmitis.Methods A retrospective observational case study was conducted on all the cases who underwent pars plana vitrectomy in the Beijing Tongren Hospital between January 1,2002 and March 31,2012.All cases of endophthalmitis that occurred during a period of 10 years and 3 months were reviewed,and the possible risk factors,clinical findings,causative organism(s),and the sources of infection were analyzed.Results Within the 10-year observational period,14 patients developed endophthalmitis after pars plana vitrectomy.The incidence of post-vitrectomy endophthalmitis (0.05％) was lower than that reported previously from the same center (0.12％).Staphylococcus epidermidis (five patients,35.71％) was the most common organism identified in aqueous or vitreous cultures.Eight patients (57.14％) had diabetes mellitus.There was no statistically significant difference (P ＞0.05) in the incidence of endophthalmitis between period 1 (with antibiotic pretreatment) and period 2 (without antibiotic pretreatment).Surgical procedures for the treatment of endophthalmitis were performed in 10 patients (71.43％).Conclusions This series of cases showed that the incidence of endophthalmitis after pars plana vitrectomy is lower than what was previously reported in our hospital.A variable degree of corneal edema with relatively normal or mildly increased intraocular pressure was one of the commonly observed characteristics of post-vitrectomy endophthalmitis.Staph.epidermidis was the most common causative organism,and antibiotic pretreatment did not lower the incidence of post-vitrectomy endophthalmitis。

To the editor:We read with great interest the article by Guo and co-authors 1 published in the current issue of Chinese Medical Journal.These authors 1 assessed the effect of aliskiren on arterial stiffness,compared with ramipril in mild to moderate essential hypertensive patients.The study revealed that aliskiren (150 mg/d)could improve arterial stiffness and its effect was similar to ramipril (5 mg/d) in mild to moderate hypertensive patients.This study gives detailed and valuable information and highlights the effects of aliskiren on arterial stiffness compared with ramipril.Some comments may be of interest。

To the editor:A 61-year-old woman presented to our hospital with dull right lower quadrant abdominal pain and diarrhea.The pain,which had been initially noted about 7 days prior,was worsening.The patient denied fever,bloody stool,or weight loss in recent months.She had no significant medical or surgical history.Physical examination revealed a soft but distended abdomen with hypoactive bowel sounds.Laboratory data revealed mild leukocytosis。

Sporadic fundic gland polyps (FGPs) account for 0.8％-1.9％ of all gastric polyps and are observed in patients undergoing esophagogastroduodenoscopy (EGD) in whom they account for more than 50％ of all gastric polyps.1,2The prevalence is increasing in recent years possibly due to decreased Helicobacterpylori (H.pylori) infection rate and long-term proton pump inhibitor use.3'4 Generally,sporadic FGPs are assumed to be benign polyps with no risk of malignant transformation.1'2 We evaluated the feasibility of predicting sporadic FGPs based on typical endoscopic appearance in a large database of 47 771 endoscopies。

Pulmonary artery aneurysm is a rare condition caused by both congenital and acquired etiology.Diverse causes include congenital heart diseases,vasculitis,infections,neoplasm,complications in connective tissue diseases,pulmonary artery hypertension,Hughes-Stovin syndrome,and trauma,among which,vasculitis in Behcet's disease is the most common cause.1 Mortality from this rare condition is high due to the tendency to rupture and limitations in available treatment。