Trauma is a global social problem, with the number of deaths up to 5.8 million all over the world annually. Currently, severe trauma has become the first cause of death in young adults in China. Nowadays, there are many problems in the trauma rescue system, including long pre-hospital transfer period, several secondary transfers, no information exchange between pre-hospital and in-hospital care, and the poor integrated treatment, which results in the situation that the overall treatment level of severe trauma in China is relatively low. In order to solve these problems, we carried out the research and promotion of severe trauma rescue standard, involving completing severe trauma information database, providing local rescue medical workers with standard training, and building up the information system for the linkage and warning of severe trauma. In addition, we developed and promoted the new standard system for severe trauma in 15 cities with 124 medical centers. Due to our research, the treatment ability of severe trauma in the pilot areas was enhanced, and the mortality and morbidity of severe trauma were reduced significantly. To sum up, we had got the expected results after implementing the project.

Objective：To investigate the efficacy of single time intra-articular different concentration of allogeneic bone marrow mesenchymal stem cells (BM-MSCs) injection in the treatment of Sprague-Dawley (SD) rat model of osteoarthritis (OA). Methods: In the study, 32 SD rats were equally randomized into 4 groups: control group, high concentration group (1×10⁷/mL BM-MSCs), low concentration group (5×10⁶/mL BM-MSCs) and high vs. low concentration group. The two knees of each rat were set up to a pair. The induction of OA was performed surgically randomly at one side in model group, and bilaterally in the other groups, which were through anterior cruciate ligament transaction (ACLT) and medial meniscus excising. After the operation, the SD rats were allowed free movement. Four weeks later, different concentrations of allogeneic BM-MSCs isolated from the SD rats, expanded in vitro and suspended in phosphate buffered solution (PBS) were delivered in the articular cavity of both knees; PBS was used as the control. After injection, we excised the femoral nerve and sciatic nerve to disuse the low limb. The cartilage histological sections of knees were scored by Mankin scoring system to assess the severity of the pathology. mRNA of collagen Ⅱ was detected by real time polymerase chain reaction (RT-PCR). eGFP was detected by fluorescence microscope. Assessments were carried out 4 weeks after the operation in model group, and 3 weeks after injection in the other groups. Results:Mankin scores of the BM-MSCs side and control side were 6.60±0.40 vs. 10.00±0.32 in low concentration group (P<0.05), and 5.40±0.51 vs. 9.60±0.51 in high concentration group (P<0.05). Mankin scores of high vs. low concentration group were 6.40±0.51 vs. 7.60±0.75 (P>0.05). mRNA expression of collagen Ⅱ of the BM-MSCs side in low concentration group was 106%±1% in contrast to the control side. As in high concentration group it was 108%±1%, and 102%±1% in high vs. low concentration group. Labeled BM-MSCs were detected unexpectedly in the synovial membrane but not in cartilage tissue three weeks from injection. Conclusion: BM-MSCs could promote cartilage repair and inhibit OA progression through a trophic mechanism. There was no difference between the two concentrations.

Objective： To study the influence of bone morphogenetic protein-7 (BMP-7) on chondrocyte secretion and expression of type Ⅱ collagen (Col-Ⅱ), aggrecan (AGG) and SRY-related high mobility group-box gene 9 (Sox9) mRNA in porous tantalum-chondrocyte composites. Methods: The articular chondrocytes were isolated from 3-week-old New Zealand immature rabbits and identified. The 2nd generation of chondrocytes with 1×10⁶/mL inoculate concentration was seeded in porous tantalum and divided into 4 groups, and control group (tantalum/chondrocyte), 50 μg/L BMP-7 group (50 μg/L BMP-7/tantalum/chondrocyte), 100 μg/L BMP-7 group (100 μg/L BMP-7/tantalum/chondrocyte), and 200 μg/L BMP-7 group (200 μg/L BMP-7/tantalum/chondrocyte). The proliferation of chondrocytes was measured by CCK-8 assay. The chondrocyte growth and morphology were observed by scanning electron microscopy (SEM). The synthesis of glycosaminoglycan (GAG) in chondrocytes was tested by dimethyl methylene blue (DMMB) colorimetric quantification method. Col-Ⅱ, AGG and Sox9 mRNA in chondrocytes were detected by realtime PCR. Results: The chondrocytes were spindle--shaped in 24 hours of primary cell culture and most cells became polygonal shaped in 4 days. The chondrocytes were affirmed by alcian blue, safranin O and Col-Ⅱ immunocytochemistry staining. The result of CCK-8 assay showed that the level of cell proliferation in 100 μg/L BMP-7 groups were higher than those in the other groups (P<0.05). The chondrocytes implanted into porous tantalum scaffolds with BMP-7 had better functions, by which cytoplasmic processes developed and extended to the surface and inner of porous tantalum by SEM observation. DMMB quantitative determination of GAG showed that GAG amount of chondrocytes in 100 μg/L BMP-7 groups was significantly higher than those in the other groups (P<0.05). The expressions of Col-Ⅱ, AGG and Sox9 mRNA in chondrocytes were up-regulated in the experimental groups, compared with the control group and the best effect appeared when concentration of BMP-7 was 200 μg/L. (P<0.05). Conclusion: BMP-7/tantalum/chondrocytes composites enhanced in vitro chondrocyte proliferation and extracellular matrix greatly, and can promote chondrogenic gene expression.

Objective： To investigate the results of treating patients with recurrent anterior shoulder dislocation using open Latarjet technique in a retrospective study, and to discuss the detail of the surgical technique and the results of the procedure. Methods: In the study, 22 patients with recurrent anterior shoulder dislocation treated with open Latarjet technique were followed up. The average duration of the follow-up was 66.0 months. An X-ray film and a CT scan were performed before the surgery to evaluate the degenerative change of the gleno-humeral joint and the bony defect of the glenoid. An X-ray film and a CT scan were repeated at the end of the final follow-up to find out if there was any progression of the degenerative change of the gleno-humeral joint and if the transferred coracoid process united. Physical examinations, American Shoulder & Elbow Surgeons (ASES) score, Constant-Murley score and Rowe questionnaire were used to evaluate the patients’ shoulder function before the surgery and at the end of the final follow-up. Results: Before the surgery the average forward elevation, external rotation and internal rotation were 158.2°±28.7°, 55.3°±15.2° and T10 (T3-buttock) respectively. The average ASES score, Constant-Murley score and Rowe score were 77.6±17.5, 88.3±12.5 and 40.2±12.0, respectively. At the end of the final follow-up, no redislocation happened. The average forward elevation, external rotation and internal rotation were 167.7°±12.7°, 54.3°±16.5° and T10 (T3-L3), respectively(P=0.138, P=0.765, P=0.439).No sigificant restriction was detected after the surgery regarding forward elevation,external rotation and internal rotation. The mean ASES score, Constant-Murley score, and Rowe score significantly improved to 93.7±9.1 (P=0.001), 95.6±5.6 (P=0.008) and 96.4±4.4 (P<0.001) respectively after the surgery. A progression of the degenerative change of the gleno-humeral joint was detected in 3 patients. A non-union of the transferred coarcoid was detected in 1 patient. Conclusion: Open Latarjet procedure is effective in treating the recurrent anterior shoulder dislocation patient with severe glenoid defect. No significant progression of the degenerative change of the gleno-humeral joint is detected in average 5-year follow-up.

Objective： To compare efficacies and complications of total hip arthroplasty (THA) with subtrochanteric osteotomy for treating patients with Hartofilakidis types C1 and C2 developmental dysplasia of the hip (DDH).Methods: Retrospective analysis was performed in 32 patients with DDH who underwent THA. These patients were divided into two groups according to Hartofilakidis classification, 17 patients in type C1 and 15 in type C2. Their HSS and WOMAC scores, leg length discrepancy (LLD), hip joint image data and complications were evaluated. Results: HSS scores in type C1 was changed from preoperative 43.7±4.6 to postoperative 87.2±7.1 (P<0.001), together with WOMAC scores 43.6±4.3 to 87.5±6.7 (P<0.001). HSS scores in type C2 was changed from preoperative 44.4±5.4 to postoperative 86.5±8.0 (P<0.001), together with WOMAC scores 44.1±4.1 to 86.7±8.1 (P<0.001). Four cases in type C2 and one case in type C1 presented intraoperative fracture which all healed during the postoperative follow-up. The postoperative X-ray films showed that the joint prosthesis location was satisfactory, the surrounding bone was not dissolved and the bone at femur osteotomy site healed with no infection. Conclusion: For unilateral high dislocation DDH patients, THA with femur osteotomy can be effective and safe. No significant differences were found between types C1 and C2, however intraoperative fracture in type C2 should be paid attention to.

Objective：To identify the characteristics and risk factors of the refractures after percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP).  Methods:A retrospective analysis of 148 patients who had undergone PKP or PVP between March 2006 and October 2013 inPeking University People’s Hospital was conducted. In the study, 29 patients with 42 refractured vertebra and 119 patients without refracture were included.  All the patients were observed for a time of (34.4±26.8) months. Clinical, imaging and procedure related factors (gender, age, height, weight, body mass index, the level of the injured vertebra, the time interval between the procedure and the refracture, the level of the refractured vertebra, the bone cement volume injected, performed PKP or PVP，performed unilateral or bilateral, the percentage of anterior vertebral height restoration, the correction of the Cobb angle, cement diffusion, bone mineral density, presence or absence of diabetes mellitus, history of fractures of the whole body, anti-osteoporosis treatment, cement leakage) for each group were analyzed by Cox proportional hazards regression analysis. Results:Of all the patients,16 (55.17%, 16/29) had refractures in the adjacent vertebra, and 13 (44.83%, 13/29) had refractures in the nonadjacent vertebra. Refractures within 3 months accounted for 31.03% (9/29) of all the refractures, and within 1 year accounted for 55.17% (16/29). Both older age (P=0.027, HR=1.051, 95% CI=1.006-1.098) and a history of fractures of the whole body (P=0.012, HR=0.386, 95% CI=0.184-0.812) were statistically significant as the independent risk factors for predicting refractures. Others were not associated with refractures (P>0.05). Conclusion:Older age and a history of fractures of the whole body are the independent risk factors of the refractures after PKP and PVP. The mechanism of the refractures after PKP and PVP is mainly the natural development of osteoporosis.

Objective：To investigate the clinical characteristics of vertebral compression fracture (VCF) in glucocorticosteroidinduced osteoporosis (GIOP) and risk of vertebral refracture after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Methods:In the study, 570 cases who received PVP or PKP as treatments of VCF from January 2010 to December 2013 were retrospective reviewed, of which 42 were GIOP and 21 were followed up as GIOP group, and the other 528 were primary osteoporosis and 391 were followed up, of which 84  were selected as Control group based on age and gender. The fracture location, ratio of single segment fracture and multiple segments fracture in the two groups were compared. In the final follow up, the reoperation rates for vertebral refractures by the Kaplan-Meier method in the two groups were  compared.Results:The follow up periods were (24.0±13.1) months in GIOP group and (25.8±14.4) months in control group（P>0.05）. In GIOP group, there were 11 cases with onesegment fracture, 2 with two-segments fracture, 3 with three-segments fracture, 2 with four-segments fracture, 2 with five-segments fracture and 1 with eight-segments fracture. In Control group, there were 67 cases with one-segment fracture, 12 with twosegments fracture, 3 with three-segment fracture, and 2 with four-segments fracture. The ratio of single segment fracture in GIOP group was significantly lower than that in Control group（52.4% vs. 79.8%，P=0.01）. There were 50 fracture segments in GIOP group and 109 fracture segments in Control group. The ratios of fracture segments located in thoracic segments（T1-T10）, thoracolumbar segments（T11-L1）and lumbar segments（L2-L5）were 18%, 46% and 36% in GIOP group and 11.9%, 58.7% and 29.4% in Control group（P>0.05）. The refracture rate in GIOP group was higher than that in control group （23.8% vs. 6.0%）. The survival rate was lower in GIOP group than that in control group （P<0.01）. Conclusion: The predilection site of VCF was similar in GIOP and primary osteoporosis (thoracolumbar segments> thoracic segments> lumbar segments). The risk of multiple segments VCF was higher in GIOP than in primary osteoporosis. The risk of vertebral refractures after PVP or PKP was higher in GIOP than in primary osteoporosis.

Objective：To explore the relationship between spino-pelvic sagittal and coronal parameters in Lenke 1 group of adolescent idiopathic scoliosis (AIS). Methods: The subjects were retrospectively collected from 2005 to 2013. On the posteroanterior and lateral radiographs, apical vertebra (AV), Cobb angle of main thoracic curve (MT), pelvic incidence (PI), C7 translation ratio (C7TR) and other sagittal parameters were measured and recorded. Comparison and correlation studies were conducted between these parameters using specific softwares. Results: In the study, 51 subjects, including 18 males and 33 females, were recruited, aged (14.9±2.0) years averagely. The apical vertebra ranged from T7 to T11,with mean MT being 49.6°±16.7°, and mean PI 44.7°±6.7°. Significant correlation existed between PI and PT, SS, LL, as well as between LL and SS, TK (P <0.05). Significant differences were found in TK, LL and SS among the different LM groups, but no difference in the other sagittal parameters. AV had no significant correlation with any sagittal parameter. MT was significantly correlated with TK, LL and SS, but its correlation with PI was not significant. Conclusion: Most of sagittal parameters were significantly correlated in Lenke 1 adolescent idiopathic scoliosis, forming a regulation chain of spine-pelvic sagittal balance on the basis of PI. Significant correlation exists between some sagittal and coronal parameters.

Objective：To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dislocations. Methods:From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up. There were 49 men and 14 women with a mean age of (40.3±10.6) years. The mean time from injury to surgery was (10.3±5.3) d. According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with type Ⅲ injury. All the patients with type Ⅲ injury claimed high level of sport activity. The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken. All the patients were routinely followed up after the surgery. The visual analogue score (VAS), American shoulder and elbow surgeons(ASES) score and University of California Los Angeles(UCLA) score were employed to evaluate the postoperative shoulder function. The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Results:The mean follow-up time was (29.6±6.0) months (range: 24 to 43 months). No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’s age ［(41.0±10.5) years vs. (38.0±10.8) years］, gender (male/female，24/8 vs.25/6), classification (Ⅴ/Ⅲ，22/10 vs.23/8), time from injury to surgery ［(10.6±4.9) d vs.(10.1±5.7) d］, dominant involvement (19/32 vs.17/31)and mean follow-up time ［(29.8±6.4) months vs.(29.5±5.5) months］, P>0.05. At the end of the last followup, no significant difference was noted between the two groups regarding the mean forward elevation ［(164.4±17.2) degrees vs.(162.6±12.9) degrees］, mean external rotation ［(60.9±17.0) degrees vs.(57.3±15.8) degrees］, mean internal rotation ［(T12±3 vertebrae) vs.(T12±3 vertebrae)］, mean ASES scores (96.0±5.1 vs. 94.5±3.8)and UCLA scores (34.2±1.5 vs. 33.7±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).Conclusion:Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function. The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.

Objective：To apply modified proximal femoral nail anti-rotation (PFNA) fixation techniques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler. Methods:A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014. In the study, 60 cases were followed for average 13 months. The operation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements (tip apex distance, TAD) and hip function scores were analyzed.Results:In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were (70.5±12.5) min, (34.9±6.1) mL, (63.6±9.7) s respectively. In conventional PFNA group，they were (80.6±17.1) min, (47.8±6.7) mL, (68.5±8.7) s respectively. There were significant differences in the above respects between the two groups (P were 0.006, 0.013, and 0.022 respectively). There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups (P＞0.05). Conclusion:Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture. Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluoroscopy time significantly, make the procedures simpler and acquire satisfactory results.

Objective： To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design (CAD) softwares, e.g. Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimensional (3D) anatomy. Intra-class correlation coefficient (ICC) was used to test the reliability of intra- and inter-observers. The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femoral nail anti-rotation (PFNA) were retrospectively analysed and used to measure bilateral proximal femoral anatomical parameters, including 2D and 3D femoral neck-shaft (NS) angle and femoral neck anteversion (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings. ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data. Results: The established measurement method hasdexcellent consistency within the intra- and inter-observers, with all the ICCs higher than 0.9. The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles. The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values < 0.001). In PFNA group, 57% of the differences between the 2D post-operative injured side’s and intact side’s NA angles were higher than 15°, which was more than 15.78% in InterTAN group. The paired student T-test showed no significant difference between the post-operative injured side’s 2D or 3D NS angles and the intact side’s respective 2D or 3D angles in PFNA group (P values were 0.925 and 0.367, respectively), but in InterTAN group, the post-operative injured side’s 2D or 3D NS angles were significantly smaller than the intact side’s respective angles (P values were 0.033 and 0.009, respectively). Conclusion: By analyzing and comparing bilateral proximal femoral anatomical parameters after two kinds of IM nailings procedures, the differences between the bilateral post-operative NA angles in PFNA group were significantly larger than those in InterTAN group. There was significant correlation between the NA angles of the injured sides and NA angles of IM nailings in both the groups.

Objective：To measure vertical axis length of humerus head in patients with proximal humeral fractures and to evaluate the use of structure screws in proximal humerus internal locking osteosynthesis system (PHILOS). Methods:From January 2007 to February 2014,117 patients with proximal humerus fracture were treated by PHILOS plate. Preoperatively, all the patients tookanteroposterior X-ray of shoulder, and the vertical axis length of humerus head were measured, and the use of structure screws in PHILOS plate was observed.Results: There were 40 male and 77 female patients; The vertical axis length of humerus head in male patients was (47.64±3.44) mm, and the rate of structure screw use was 52.5%; The vertical axis length of humerus head in female patients was (42.46±3.21) mm, and the rate of structure screw use was 32.5%. The vertical axis length of humerus head and the rate of structure screw use had significant difference in the male and female groups （P<0.05）.Conclusion: The rate of structure screw use was low in the treatment of proximal humerus fracture by PHILOS plate, especially for women. We should improve the design of plate according to the anatomical characteristics of Chinese.

Objective：To study the effectiveness of inferior pole fracture of patella treating by the new tension band. Methods:From Dec. 2011 to Dec. 2013, 21 patients with inferior pole fracture of patella were treated with the new tension band which consisted of cannulated screw, titanium cable and shims. There were 21 patients［10 males, 11 females, the average age was 54 years(21 to 79)］,of whom,all were “fell on knees”. Results:The average operation time was 89 min (57-197 min),the follow-up visits were done from 7-31 months (average 18 months), the bone healing time was from 8-12 weeks (average 10.5 weeks). The post operation assessment was done by Bostman score, from 20-30 (average 27)，10 excellent,and 11 good. No complication occurred.Conclusion:The new tension band is the effective treatment for inferior pole fracture of patella. The internal fixation is reliable, it is simple to operate, and patients can take exercises as early as possible. Therefore, the new tension band has a better clinical value.

Objective：To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation. Methods: In the study, 6 cases of pelvic injury associated with complete anterior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed. We described the history and severity of injury, emergency treatment, and fracture radiology. In all the cases, the surgical treatment and postoperative functional exercise were performed. We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience. Results:All the 6 patients with fractures recovered without infection and nerve symptoms after surgery. Their X-rays showed good reduction of sacroiliac joints. All the cases were followed up on an average of 1.6 years. Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1. The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick. The 2 patients with low scores could not resume the original work.Conclusion:Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.

Objective：To investigate the characteristics and perioperative management of hemophilia patients with fracture.Methods: Retrospectively, we analyzed 8 patients with hemophilia combined with fracture, who were admittted to our department from 2005 to 2013. Six patients were with hemophilia A and two with hemophilia B; Based on the severity of hemophilia, 2 cases were light, 3 moderate and 3  severe; Based on the location of fracture, 4 cases were femoral neck fractures, 1 femoral intertrochanteric fracture, 1 bilateral distal femur fractures, 1 tibiofibula fracture, and 1 humerus intercondylar fracture. Blood coagulation factor replacement therapy was conducted preoperatively, intraoperatively and postoperatively, All the patients underwent closed or open reduction and internal fixation or joint replacement. Also, we analyzed the perioperative complications and observed whether the fracture healed.  Results: The average age was 33.5 years (14 to 47 years); In 6 cases, fractures occurred at femur, accounting for 75% of all the fractures; Femoral neck fracture was treated by closed reduction and hollow screws  fixation; Femoral intertrochanteric fracture, distal femur fracture, and tibiofibula fracture were treated by open reduction and internal fixation with plate; Humerus intercondylar fracture was treated by elbow joint replacement. Intraoperative bleeding was from 50 to 600 mL, an average of 262 mL; Perioperatively, the average use of FⅧ/activated prothrombin complex concentrates (APCC) was 358 U/kg (125 to 554 U/kg). Postoperatively, poor wound healing was observed in 2 patients, and the condition improved after symptomatic treatment; In patients with internal fixation, all the fractures united, and the average healing time was 14 weeks. No complications such as fixation loosening or rupture occurred after internal fixation.Conclusion: Hemophilia combined with fracture mainly occurred in the young, and the site of fracture was given priority to femur. With perfect preoperative preparation, on the basis of the replacement therapy, hemophilia combined with fractures was safe for surgical treatment, and postoperative fractures healing wasgood. But the risk of poor wound healing was high.

Objective：To evaluate the effectiveness of conducting multiple arthroplasty to treat multiple joints disease in terms of quality of life (QOL) and function improvement. Methods:We compared our results with the reported results of single and dual arthroplasty to see if there is any improvement in QOL, functional scores or complications. In this study, 13 patients admitted to Department of Adult Reconstructive Surgery, Beijing Jishuitan hospital from 2005 to 2009 were included. Questionnaires SF-36 were used to evaluate the QOL. Harris hip score, American Knee Society Score (KSS) were used to evaluate the joint function. The patients were evaluated before surgery to the latest follow up. Results:SF-36 has changed as follow: physical function 4.17±14.43→65.83±24.76,  role physical 25.00±26.11→60.42±45.8, bodily pain 23.83±21.41→76.88±20.89, general health 53.33±33.87→76.67±14.67, vitality 50.42±17.25→71.67±16.28, social functioning 29.17±33.50→73.96±33.90, role emotional 22.08±35.61→77.77±41.03, mental health 53.33±25.70→82.67±14.41, which indicated that they all improved greatly after the surgery (P<0.05). Harris score increased from 37.68±14.71 before the surgery to 83.36±13.54 after the surgery. KSS has also showed sharp improvement (P<0.001) in both clinical score (42.52±23.83→77.74±20.67) and function score (-2.61±22.56→65.65±30.76).Conclusion:Multiple arthroplasty is one of the most effective methods which can markedly improve the quality of life in patients with multiple joints disease. But complications are common and joint functions are relatively poor.

Objective： To explore the effect of inherent depression on chronic visceral hypersensitivity. The differences of visceral sensitivity, colitis, and brain activation between Fawn-Hooded (FH/Wjd) and Sprague-Dawley(SD) rats were identified after neonatal colon acetate stimulation. Methods: The specific pathogen free Fawn-Hooded (FH/Wjd) and Sprague-Dawley(SD) rats were used to establish irritable bowel syndrome (IBS) model. The visceral sensitivity was measured by colorectal distension (CRD). The expression of 5-hydroxytryptamine (5-HT), mast cell (MC), indoleamine 2,3-dioxygenase (IDO) in colon and IDO in specific cerebral regions were detected through immunohistochemistry. Results: Abdominal withdrawal reflex (AWR) scores showed that visceral sensitivity of acetate-enema groups was significantly higher than that of saline-enema groups (FH/Wjd:2.44±0.04 vs.1.96±0.07, P<0.05; SD: 1.75±0.13 vs.1.32±0.05, P<0.05). Furthermore, FH/Wjd rats of IBS group scored significantly higher than SD rats of IBS group (2.44± 0.04 vs.1.75 ± 0.13, P<0.05). The MC amounts of both SD and FH/Wjd IBS group rats were significantly more than those of their control groups (FH/Wjd:43.24 ± 1.72 vs. 24.92 ± 1.38, P < 0.01. SD: 23.80 ± 1.28 vs. 14.24 ± 0.92, P < 0.01). Besides, the MC amounts of control and IBS group of FH/Wjd rats were significantly more than that of SD IBS group rats (P<0.01). The IDO and 5-HT positive cells in colonic mucosa of IBS group of both SD and FH/Wjd rats were significantly more than those of their control groups, respectively(P <0.01). The IDO, 5-HT positive cells in colonic mucosa of both control and IBS group of FH/Wjd rats were significantly more than those of both control and IBS group of SD rats (control:IDO,24.64 ± 2.22 vs. 15.52 ± 1.39;5HT,21.32± 1.26 vs. 12.72±1.12. IBS: IDO，44.92±2.31 vs. 20.85±1.72; 5-HT, 31.84±1.57 vs. 19.65±1.09.P <0.01). The expression of IDO in prelimbic cortex (PrL) areas of FH/Wjd IBS rats was significantly higher than that of IBS group of SD rats (49.60 ± 4.31 vs. 35.60 ± 2.42, P <0.01), and the expression of IDO in rostral anterior cingulate cortex (rACC) areas of FH/Wjd IBS rats was significantly more than that of FH/Wjd control rats (45.44±1.16 vs. 34.08±2.76, P <0.01). Conclusion: Inherent depressive FH/Wjd rats were more sensitive to neonatal colon acetate stimulation, presenting as visceral hypersensitivity which maybe associated with increased MC amounts and over-expression of 5HT and IDO in colon, suggesting that depression disorder may aggravate functional disturbance of gastrointestinal tract by regulating the response to inflammatory stimulation.

Objective: To estimate the probability of N2 lymph node metastasis and to assist physicians in making diagnosis and treatment decisions. Methods: We reviewed the medical records of 739 patients with computed tomography-defined stage Ⅰ non-small cell lung cancer (NSCLC) that had an exact tumor-node-metastasis stage after surgery. A random subset of three fourths of the patients (n=554) were selected to develop the prediction model. Logistic regression analysis of the clinical characteristics was used to estimate the independent predictors of N2 lymph node metastasis. A prediction model was then built and externally validated by the remaining one fourth (n=185) patients which made up the validation data set. The model was also compared with 2 previously described models. Results: We identified 4 independent predictors of N2 disease: a younger age, larger tumor size, central tumor location, and adenocarcinoma or adenosquamous carcinoma pathology. The model showed good calibration (HosmerLemeshow test: P=0.923) with an area under the receiver operating characteristic curve (AUC) of 0.748 (95% confidence interval, 0.710-0.784). When validated with all the patients of group B, the AUC of our model was 0.781 (95% CI: 0.715-0.839) and the VA model was 0.677 (95% CI: 0.604-0.744) (P =0.04). When validated with T1 patients of group B, the AUC of our model was 0.837 (95% CI: 0.760-0.897) and Fudan model was 0.766 (95% CI: 0.681-0.837) (P<0.01). Conclusion: Our prediction model estimated the pretest probability of N2 disease in computed tomography-defined stage Ⅰ NSCLC and was more accurate than the existing models. Use of our model can be of assistance when making clinical decisions about invasive or expensive mediastinal staging procedures.

Objective: To anslysis the hemodynamic states of vertebrobasilar dolichoectasia based on computational fluid dynamics technique. Methods: The original DICOM format image data from a patient with vertebrobasilar dolichoectasia (VBD), were imported by the Mimics software directly,and the 3D Objects were constructed.The simulation of model was made with Ansys software, the hemodynamic parameters such as streamlines, wall shear stress(WSS) and wall pressure were described. Results: There was stable laminar flow in proximal basilar artery and was no blood flow mixed by bilateral vertebral artery.However, Spiral flows were appeared in distal tortuous basilar artery. The low WSS regions in the vertebrabasilar junction section and inferior segment of basilar artery were coincide with the high wall pressure regions.It could be speculated the initial growth regions might be located in the vertebrabasilar junction section and inferior segment of basilar artery.Local regions with low WSS and high wall pressure might be associated with the occurrence and development of VBD. Conclusion: CFD numerical simulation maybe can provide a theoretical basis for the role of hemodynamic factors in occurrence and development of VBD.

Objective: To differentiate human embryonic stem cells (hESCs) into keratinocytes (K-hESCs) and analyse the expression characteristics of biomarkers of K-hESCs. Methods: The hESCs of line H9 were seeded on matrigel in mTeSR1 medium. The hESCs were directly differentiated into keratinocytes in epithelial differentiation medium with bone morphogenetic protein 4, retinoic acid and N2 supplement. The karyotype of K-hESCs was analyzed, comparing the gene expression differences of K-hESCs with human gingival epithelial cells (HGECs), human immortalized oral epithelial cells (HIOECs) and HaCaT by Realtime PCR. Molecular characteristics of the cell differentiation were observed throughout the process by immunocytochemical techniques. Results: H9hESCs were successfully differentiated into the cells that exhibited characteristics of keratinocytes in epithelial differentiation medium. The karyotype of K-hESCs was 46, XX; and the keratinocyte gene p63 expression in K-hESCs was significantly lower than that in HaCaT (P<0.05), but there was no significant difference of p63 expression in K-hESCs, comparing with that in HGECs and HIOECs (P>0.05). Conclusion: H9-hESCs could be directly differentiated into K-hESCs. The gene expression of K-hESCs was similar to that of epithelial cells in the early stage of monolayer cells differentiation with high proliferative activity.

Objective: To analyze the prognosis about periodontal ligament healing of replanted permanent teeth in children and to examine the associated factors. Methods: The sample consisted of 49 children with 61 avulsed permanent teeth, whose injuries had been managed in the period from 2000 to 2012. The clinical data of replanted teeth were collected, and the follow-up period was no less than 12 months. The factors were analyzed in relation to postoperative outcomes, classified as functional periodontal healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). Results: The functional healing rate was 23.0%, while replacement resorption rate was 72.1%. The replacement resorption (ankylosis) was usually observed earlier by clinical examination than by radiographic examination. 86.0% (40/47) resorptive processes were diagnosed within the first year. Physiological storages, such as milk, saline and saliva were significantly better to periodontal ligament healing than nonphysiological storages, such as tap water and sterilizing solutions (chloramine and alcohol). Functional healing was found significantly more frequent in canines and premolars. Conclusion: The factor significantly affecting periodontal ligament healing is storage medium. Replacement resorption is the most common type of root resorption. The replacement resorption diagnosis must combine the radiographic examination with the clinical examination. It is better to follow up more than 1 year after tooth replantation.

Objective: To evaluate the adaptation of different materials for gingival layer in Class Ⅱ restorations using Micro-CT.  Methods: Eighteen extracted human premolars were selected, and Class Ⅱ cavities were prepared. The teeth were randomly divided into six groups and restored using layering technique. Six materials were used for gingival layer, including four injectable materials: Beautifil Flow Plus F00 (F00), Beautifil Flow F10 (F10), Filtek Z350 Flowable (Z350F), FujiⅡ LC CAPSULE (Fuji), and two packable materials: BeautifilⅡ (BF), Filtek Z350 (Z350). The restored teeth were scanned with micro-CT and the images were 3D reconstructed to evaluate the volumes and the distribution of the voids on the restorationtooth interface of the gingival layer. The volume of the voids were statistically analyzed using nonparametric Jonckheere-Terpstra tests. Results: The volumes (mm3) of the voids on the restorationtooth interface were: Z350F (0.000 15), F10 (0.000 39), F00 (0.012), Fuji (0.070), Z350 (0.16) and BF (0.20). There were significant differences between Z350F/F10 and Fuji/Z350/BF (P<0.05). Most of the voids were found on the point-line angles of the cavities. Conclusion: The voids on the restoration-tooth interface were mainly on the point-line angles of the cavities. Injectable materials with high flowablility could reduce the restorationtooth interface voids significantly when used for the gingival layer in Class Ⅱ restorations.

Objective: To present the surgical technique and to evaluate the results of the modified arthroscopic Latarjet procedure. Methods: Arthroscopic Latarjet procedure has proven to be a reliable method of treatment for difficult anteroinferior instability of the shoulder joint. However, there is no anterior capsule reattachment and too much subscapularis damage for the classic procedure. From February 2013, we modified the classic procedure with reattachment of anterior joint capsule and muscle-tendon junction splitting of subscapularis. Coracoid graft position was evaluated using CT scanning. Results: From March 2012 to August 2014, 51 modified Latarjet procedures were successfully performed arthroscopically for patients with anterior shoulder instability. According to the CT scanning at the final follow up, the graft was flush with the glenoid in 94.1%, and medially placed in 5.9%. Vertical positioning was perfect in 96.0% (2 to 5 o’clock), too high in 2.0%, and too low in 2.0%. There were no cases of recurrent dislocation or subluxation. Conclusion: The modified arthroscopic Latarjet procedure has shown satisfactory results with good graft positioning. It is a minimal invasive and accurate approach, which combines the advantages of the open procedure.

Objective： To investigate the validity and the outcome of a new surgery method that utilizes lateral great toe flap to decoratively reconstruct the thumb pulp loss. Methods: From Jan. 2009 to Jan. 2014, 22 cases with unilateral thumb pulp defect were included, for whom, lateral great toe flap was deployed to reconstruct the thumb. Blood circulation was re-established by the anastomosis of the digital vessels of toes and fingers in 18 cases, the other 4 cases were conducted by a dorsal metatarsal artery and vein anastomosed to the deep branch of the radial artery and the dorsal metacarpal vein respectively; as for the nerve repair, toe-to-finger digital nerve anastomosis was performed. The donor sites were covered by full-thickness inguinal skin grafts. Results: All the 22 flaps survived without complications. With 6 to 12 months follow-up, the surviving fingers all presented aesthetically pleasant appearance with vivid loops and whorls. Normal functions like sweating were restored as well, and the two-point-discrimination ranged 3.0 to 6.0 mm (4.2 mm in average). The skin grafts to the donor sites healed uneventfully, the appearance and functions of the feet were unaffected. Conclusion: Lateral toe flap should be the first-line choice for reconstructing thumb defect, as it conveniently restores both functions and outlook.

Objective: To evaluate the cytotoxicity of four dentin filling materials and two dentin adhesives with a dentin barrier test and to compare the results with those in a conventional filter diffusion test in order to investigate the advantages of the dentin barrier test. Methods: Eugenol cement, zinc phosphate cement, adhesive glass ionomer cement, composite resin and two self-etching adhesives (REMI BOND and Adper Easy One) were tested. In the dentin barrier test, L929 mouse fibroblasts were three-dimensional cultured in polystyrene meshes. The dentin disks were cut from the human third molars, near the pulp and in parallel with the occlusal surface, and their permeability within the measurement area was evaluated by a hydraulic permeability device. A mesh with the cells was placed in the “pulp cavity” of the chamber and one dentin disk was put on the cell mesh and its “pulp side” was in contact with the mesh. The test materials and controls were in contact with the “occlusal side” of the dentine disks for 24 h. The cell viability was obtained with MTT assay and the results were expressed as a percentage of control tissues. The Mann-Whitney U test was used to make the statistical analyses. In the filter diffusion test, after a 24 h contact between the test materials and the filters with monolayer cells, the filters were dyed and the grades of cytotoxicity were decided. Results: A mean permeability of the dentin disks near the pulp was 0.293 μL/(min·cm²·cmH₂O)（1 cmH₂O=0.098 kPa）; In the dentin barrier test, Eugenol cement, REMI BOND and Adper Easy One respectively reduced the cell survival rates to 82%, 63% and 54%. Other materials showed no or very low toxic reactions; In the filter diffusion test, the lightcuring composite resin was moderately cytotoxic, the dental adhesive glass ionomer cement was mildly cytotoxic and the others were severely cytotoxic; All the six materials in the dentin barrier test had lower cytotoxicity than in the filter diffusion test. Conclusion: The cytotoxicity of the test materials using the dentin barrier test with threedimensional cell cultures is lower than that in the filter diffusion test, which has good correlation with the clinical situation.

Objective: To evaluate the influence of the implant-supported porcelain bridges made from non-precious metals using spark erosion techniques, and to discuss the feasibility and details of making the implant restoration by spark erosion technique. Methods: The study included 12 patients (9 males and 3 females) with 92 units implant-supported non-precious porcelain bridge from Sep. 2011 to Feb. 2013. All the patients received implant treatment in Department of Oral Implantology, Peking University School and Hospital of Stomatology. The total of 52 implants, were from Nobel Biocare implant system, Camlog implant system and Ankylos implant system. The implant analogs were connected in sequence with a copper wire to guarantee conductivity. The implant electrodes represented one electrode and the superstructure the other. During spark-erosion machining, the cast holding the implant electrodes and the prosthetic framework were moved toward one another, causing an electrical erosion of the protruding elements. Results: After the spark-erosion machining, the minimum gap between the framework and abutment was 0.21 mm, which was two units bridge. The maximum was 2.59 mm, which was 11 units bridge with 6 implants. The average gap was 0.68 mm. After the spark-erosion machining, the bridge fitted well with the passive position stability. Conclusion: The method of making implantsupported non-precious porcelain bridge reduces costs on patients. Spark erosion has the potential to provide implant framework with an excellent fit. The patients are satisfied with the clinical results.

Objective：To compare two digital methods of quantitatively accessing the degree of facial asymmetry by three-dimensional data. Methods: The three-dimensional data of 20 subjects were got by the FaceScan, and then were input to the reverse engineering software Imageware 13.0 and Geomagic 12. Their mirror data were acquired and superimposed with the original data by the methods of interactive closest points (ICP) and Procrustes analysis (PA). The mid-sagittal planes of the two methods were extracted respectively, the degree of facial asymmetry and the distance of 21 automatic landmarks to midsagittal plane were calculated and compared. Results: The paired t test was taken and t=1.346, P=0.193. Conclusion: We can safely come to the conclusions that for the subjects with no evident facial asymmetry, there are no significant difference between the PA and the ICP methods for extracting the mid-sagittal plane from three-dimensional data.

Objective: To analyze the clinical features of oral emergency patients in general health, and to guide the oral emergency patients in the treatment, and prevention of accidents. Methods: The retrospective study was performed on the day visits to the emergency department in Peking University School and Hospital of Stomatology from February to November 2013.The basic information of the newly diagnosed adult, their overall health status, American society of anesthesiologists(ASA) classification and oral diagnosis information were analyzed and summarized.Results:The cardiovascular and cerebrovascular diseases（6.4%）, hypertension（13.4%）, endocrine system diseases（4.2%）were most common in the patients. With the increase of age, the associated systemic diseases had increased in number and in ASA classification. Periapical disease（24.6%）, dental pulp disease（24.4%）, and periodontal disease（18.0%） accounted for about 2/3. Conclusion:The general health status of patients with oral emergency worsened with the increase of age. Oral surgeons should make risk assessment before treatment. ASA classification system can help doctors predict the patient risk, take corresponding measures in advance, and help to reduce the occurrence of accidents.

Here we report a case of leukocyte chemotactic factor 2 (LECT2)-associated renal amyloidosis (ALect2) in our hospital. A 68yearold male presented with massive proteinuria, hematuria, and hypertension. The renal function was normal. Light microscopy of the renal biopsy revealed glomeruli，interstitium and arteriole with amorphous pink acellular deposits on hematoxylin and eosin stain. The deposits were strongly stained for Congo red and presented apple green birefringence viewed with polarized light. Ultrastructural examination revealed nonbranching fibrils (diameters ranging from 8 nm to 12 nm) distributed in glomerular mesangium, subendothelia and renal interstitium. Immunohistochemistry and immunoelectron microscopy using a polyclonal antiLECT2 antibody showed that the amyloid deposits and the fibrils were stained positively. ALect2 presented proteinuria，with or without acute/chronic renal dysfunction clinically and all compartments of the kidney were involved.

A 36-year-old woman had an 8-year history of systemic lupus erythematosus (SLE) and was being treated with 10 mg/d of prednisone. She presented with a 6-month history of intermittent fever and multiple painful multi skin erythematous macules in her button, hips and extremities that had slowly enlarged to 8 cm×4 cm in diameter. The lesions started as painful erythematous macules, which eventually ulcerated and scared. Laboratory tests showed leukopenia, protenuria, positive anti-double strand DNA and hypocomplementemia. Cultures of the bottom ulcer were E. Coli, fugus and Tuberculous mycobacteria were both negative. Biopsy was performed and revealed necrosis of epidermis, thrombus and cellulose degeneration in epidermis with neutrophils karyorrhexis and vasculitis. Her SLE was active, so she was prescribed antibiotics for 2 weeks and prednisone was added to 60 mg/d for a month. However her skin ulcers did not relieve. When prednisone was added to 120 mg/d with combination therapy of cyclophosphamide and hydroxychloroquine, her skin ulcer cicatrized gradually.

Pregnancy-related pelvic ring disease brings great suffering to pregnant women, including the separation of the pubic symphysis and sacroiliac joint pain. Hormonal changes leading to ligamentous laxity is the main reason for pregnancy-related pelvic ring disease. In normal pregnant cases, and the physiologic widening at the symphysis is about 3-7 mm. When the widening of the symphysis is more than 10 mm, it may lead to symptoms and need active treatment. Currently the diagnosis of the pubic symphysis separation is based on the clinical symptoms and signs. The treatment of acute pubic symphysis separation bases on conservative therapy, includes bed rest and physical therapy. But when the widening of the symphysis is more than 4 cm, the surgery intervention may be a good treatment. If the conservative treatment is not obviously effective, the surgery consists of plate fixation in the pubic symphysis and sacroiliac screw fixation. Other indications for the surgical intervention include inadequate reduction, recurrent diastasis, intractable symptoms, and open rupture.