颈椎前路椎体骨化物可控前移融合对后纵韧带骨化物和内植物影响的有限元分析

背景:颈椎前路椎体骨化物可控前移融合对颈椎力学的影响尚未明确,既往研究主要集中在颈椎前路椎体骨化物可控前移融合的手术技巧、中长期疗效和术后并发症等。目的:运用有限元方法分析颈椎前路椎体骨化物可控前移融合对颈椎后纵韧带骨化物和内植物生物力学的影响。方法:选择一名健康男性志愿者进行全颈椎薄层CT扫描,应用有限元分析软件构建正常全颈椎模型,与既往文献进行对比验证其有效性;随后在模型上构建累及C4、C5和C6节段的连续型颈椎后纵韧带骨化物的术前模型;以术前模型为基础,创建颈椎前路椎体骨化物可控前移融合手术三维有限元模型,约束2个模型C7椎体下表面,于C1椎体上表面施加50 N的轴向力和1.0 N·m的力矩,在屈伸、侧弯、旋转6个工况下,分析颈椎前路椎体骨化物可控前移融合对骨化物和内植物应力的影响。结果与结论:①从术前模型得出骨化物应力主要集中在C4/5节段,在前屈、后伸、左侧弯、右侧弯、左旋转、右旋转6个工况下骨化物最大应力分别为10.1,148.6,68.9,74.8,83.8和85.1 MPa;②颈椎前路椎体骨化物可控前移融合术后,骨化物应力集中分布区域未见明显改变,但该手术会改变骨化物应力大小,除在前屈位颈椎前路椎体骨化物可控前移融合模型骨化物应力较术前模型增大(+44.7%)外,在其他5个工况下,骨化物应力较术前模型明显降低,其中后伸位下降最明显(-74.1%),在左侧弯、右侧弯、左旋转、右旋转下骨化物应力分别下降62.2%,63.3%,66.4%,67.9%;③钛板、螺钉应力主要集中在头尾两端,后伸应力最大(149.5 MPa),前屈应力最小(43.3 MPa);4个椎间融合器应力主要集中在C3/4、C6/7融合器,应力主要分布在融合器的上下表面周围,后伸应力最大(30.8 MPa),前屈应力最小(11.5 MPa);内植物(钛板、螺钉和椎间融合器)应力主要集中于头尾两端,应力较大易导致头尾两端钛板、螺钉断裂和内植物下沉;④提示颈椎前路椎体骨化物可控前移融合能明显降低骨化物应力,可能有助于防止过度增生从而压迫神经,在术后需密切关注头尾两端螺钉松动、断裂或钛板移位、断裂等情况。

显微镜辅助下超声骨刀在颈椎前路骨化物切除中的应用及临床疗效

目的 探讨颈椎前路减压中显微镜下超声骨刀较传统椎板咬钳在颈椎病前路骨化物中的优缺点及临床疗效比较。方法 回顾性分析空军军医大学第二附属医院2017年5月至2019年6月行颈椎前路减压融合手术的32例患者,18例为超声骨刀组,14例为枪钳减压组。评估两组患者的手术时间、术中失血量、术后引流量、住院时间、并发症、神经功能JOA评分、NDI指数及影像学椎管占位率、颈椎Cobb角及融合率。结果 两组患者均顺利完成手术,随访12~24个月,平均(16.18±3.33)个月。术后超声骨刀组出现1例喉返神经损伤,枪钳减压组出现2例脑脊液漏、2例喉返神经损伤,两组均未导致严重并发症。超声骨刀组的手术时间、术中失血量、术后引流量较枪钳减压组少(P<0.05);但两组的住院时长相当,差异无统计学意义(P>0.05)。两组末次随访时NDI指数较术前明显降低(P<0.05),JOA评分较术前显著增高(P<0.05);超声骨刀组的JOA评分、JOA改善率优于枪钳减压组,两组比较差异有统计学意义(P<0.05);但两组的末次随访时NDI指数比较,差异无统计学意义(P>0.05)。两组术后椎管占位率较术前明显降低(P<0.05),颈椎Cobb角较术前明显增加(P<0.05);超声骨刀组末次随访时颈椎Cobb角优于枪钳减压组(P<0.05);但末次随访时两组椎管占位率、融合率比较,差异无统计学意义(P>0.05)。结论 显微镜下超声骨刀在颈椎前路减压术可以显著减少出血及缩短手术时间,改善功能恢复。

颈椎前路椎体骨化物复合体前移融合术治疗严重颈椎后纵韧带骨化症

目的报道一项治疗严重颈椎后纵韧带骨化症的新技术,可在不切除骨化物的前提下实现神经的直接减压,弥补传统前路或后路减压手术的不足。方法颈椎前路椎体骨化物复合体前移融合术的手术操作步骤主要包括处理椎间隙、去除椎体前部骨质、安装钛板和椎间融合器、椎体两侧开槽和椎体骨化物复合体前移等。收集2例经该术式治疗的严重颈椎后纵韧带骨化症患者的临床资料并进行分析。结果颈椎前路椎体骨化物复合体前移融合术通过将椎体骨化物复合体游离并前移,实现脊髓和神经根的直接减压。2例患者手术顺利,脊髓减压彻底,神经功能恢复良好,无特殊并发症发生。结论颈椎前路椎体骨化物复合体前移融合术的设计兼顾了前路直接减压的有效性和后路间接减压的安全性,初步疗效证明其可作为严重颈椎后纵韧带骨化症的一种治疗方案。

颈椎前路椎体骨化物复合体前移融合术再手术治疗颈椎后纵韧带骨化症效果观察(附12例分析)

目的探讨颈椎前路椎体骨化物复合体前移融合术(ACAF)对颈椎后纵韧带骨化症颈椎后路手术治疗后疗效不佳或症状加重患者的治疗效果。方法选择2016年2月至2017年2月在我院住院治疗的既往因颈椎后纵韧带骨化症行颈椎后路手术治疗后疗效不佳或症状加重患者12例,其中男7例、女5例,年龄52~74岁,平均(63.92±6.54)岁,再次手术均采用ACAF术式。采用日本骨科协会(JOA)评分和视觉模拟量表(VAS)评分评估患者ACAF术前及术后3、6、12个月和末次随访时的神经功能和疼痛情况。结果 12例患者均获得随访,随访9~21个月,平均(14.92±3.75)个月。所有患者ACAF术后神经功能均得到不同程度恢复,JOA评分由术前9.33±1.93升高为末次随访时的14.67±2.01,差异有统计学意义(t=3.184,P<0.05),患者神经功能改善率为(71.9±21.8)%;VAS评分由术前5.25±1.42降低至末次随访时的0.92±0.83,差异有统计学意义(t=4.025,P<0.05)。结论 ACAF作为颈椎后纵韧带骨化症的翻修手术初步取得了较好的临床疗效,能够有效改善患者的神经功能,可作为颈椎后纵韧带骨化症翻修手术的选择方案之一。

胸椎后路椎体骨化物复合体前移技术治疗多节段严重胸椎后纵韧带骨化症

目的介绍一种治疗多节段严重胸椎后纵韧带骨化症的术式。方法报道1例接受胸椎后路椎体骨化物复合体前移技术治疗的严重多节段胸椎后纵韧带骨化症病例,介绍手术步骤并分析临床资料。手术主要包括以下步骤:游离椎体骨化物复合体(前移节段上下椎间盘的松解、游离肋骨、放置椎板固定板、游离椎板)、置入椎弓根螺钉、安装钛棒、前移椎体骨化物复合体。结果患者术后神经功能恢复良好,改良日本骨科协会评分(m-JOA)改善率为75%。手术耗时480 min,术中出血1 000 mL,术前测量椎管狭窄率为86.6%(T2/3)、68.2%(T4),术后椎管狭窄率降低为58.8%(T2/3)和45.9%(T4)。结论胸椎后路椎体骨化物复合体前移技术通过后方入路将椎体骨化物复合体进行游离,借助钉棒系统将椎体骨化物向腹侧推移,达到对脊髓的直接减压。该病例证明此技术治疗严重多节段胸椎后纵韧带骨化症具有可行性,且技术简单,操作均位于椎管外,无需切除骨化物,理论上减压操作安全有效,但该技术的临床效果仍需更多的临床研究加以验证。

颈椎后路加前路巨大骨化物切除减压术

目的 探讨颈椎后路加前路手术在巨大骨性致压物切除中的应用价值和注意事项。方法 对 12例先经后路扩大椎管再经前路直接切除巨大骨化物患者的临床资料及手术治疗结果 ,进行了回顾性分析。结果 术后随访 3.4年 (3个月～ 10年 ) ,JOA评分提高 5分 (1～ 7分 ) ,优 6例 ,良 5例 ,差 1例 ,疗效持久。结论 局限性巨大骨化物单纯行后路减压疗效不持久 ;先行后路椎管扩大为前路手术提供了安全余地 ,使前路直接切除骨化物成为可能 ;术中应扩大显露 ,仔细操作。

不离断后纵韧带的前路椎体-骨化物复合体可控前移融合术治疗颈椎多节段后纵韧带骨化症的疗效

目的:评估不离断后纵韧带颈椎前路椎体-骨化物复合体可控前移融合术(anterior controllable ante-displacement and fusion,ACAF)治疗颈椎多节段后纵韧带骨化症(ossification of the posterior longitudinal lig-ament,OPLL)的手术疗效.方法:回顾性分析2017年10月~2019年11月在我院行ACAF治疗的多节段颈椎OPLL患者73例,其中采用不离断后纵韧带的ACAF治疗的42例纳入非离断组(男32例,女10例,年龄55.8±9.7岁,随访时间2.4±0.4年),采用离断后纵韧带的ACAF治疗的31例纳入离断组(男25例,女6例,年龄56.7±11.4岁,随访时间2.3±0.3年).记录两组患者的手术时间、出血量、住院时间和手术相关并发症.在术前和术后12个月的颈椎CT上测量椎管占位率、前移距离(术后椎管前后径-术前椎管前后径)、减压宽度、椎管前后径,评估手术减压情况;在术后7d和12个月的颈椎正侧位、动力位X线片和CT上观察棘突间隙活动变化、融合器内外骨桥形成以及椎体间总高度,评估术后骨融合程度.术前和末次随访时对患者进行JOA评分并计算JOA改善率,评估神经功能恢复情况.结果:非离断组手术时间212.9±33.8min,出血量489.8±199.0ml,住院时间7.2±2.0d;离断组手术时间257.4±33.2min,出血量598.9±241.3ml,住院时间8.9±3.2d,两组间差异有统计学意义(P<0.05).术前、术后12个月的椎管占位率、减压宽度、前移距离和椎管前后径,两组间差异无统计学意义(P>0.05).非离断组术后12个月的骨融合率明显高于离断组[棘突间隙活动(92.9%vs 74.2%),融合器内外骨桥(88.1%vs 61.3%)],差异有统计学意义(P<0.05).非离断组的总并发症发生率(9.5%)显著低于离断组(32.2%),差异有统计学意义(P<0.05).末次随访时JOA评分和神经功能改善率,两组间差异无统计学意义(P>0.05).结论:与离断后纵韧带相比,不离断后纵韧带的ACAF能够在保证减压效果的情况下,有效降低手术难度,减少手术时间、出血量和并发症,促进术后康复和骨融合.

前路椎体骨化物复合体可控前移技术治疗颈椎后纵韧带骨化症的脊髓原位减压效果

目的:观察颈椎前路椎体骨化物复合体可控前移(anterior controllable antedisplacement fusion,ACAF)技术治疗颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的脊髓原位减压效果。方法:回顾分析2017年6月~2018年12月我院收治的78例OPLL患者的人口学信息、影像资料以及术后指标(年龄、性别、症状持续时间、椎管侵占率和骨化累及椎体数量)。其中采用ACAF治疗42例,单开门椎管扩大椎板成形术(简称单开门椎板成形术open-door laminoplasty,LAM)治疗36例,平均随访时间21.7±4.0(12~30)个月。比较两组患者术前及末次随访时的JOA评分、脊髓面积、Cobb角、Kang′s分级以及C5神经麻痹、脑脊液漏、吞咽困难等并发症情况。结果:末次随访时,ACAF组与LAM组相比,在JOA评分(14.17±0.81分vs 13.81±1.12分,P<0.05)、脊髓面积(74.12±4.48mm^2 vs 70.36±5.60mm^2,P<0.05)、Cobb角(20.07°±1.28°vs 9.99°±0.65°,P<0.05)和Kang′s分级(0.93±1.40 vs 2.00±0.89,P<0.05)方面具有优势。对比ACAF组与LAM组的术后并发症,两组间C5神经麻痹(4.8%vs 11.1%)、脑脊液漏(2.4%vs 2.8%)、吞咽困难(9.5%vs 0%)无统计学差异。ACAF组2例出现C5神经麻痹的患者未能顺利完成原位减压。结论:ACAF手术可通过恢复椎管容积和形态实现脊髓原位减压,减压效果良好。在恢复颈椎曲度和脊髓位置形态方面,ACAF较LAM为优。

胸椎后路椎体-后纵韧带骨化物复合体可控前移治疗多节段连续型胸椎后纵韧带骨化症疗效观察

目的:探讨胸椎后路椎体-后纵韧带骨化物复合体可控前移固定减压技术治疗多节段连续型胸椎后纵韧带骨化症(thoracic ossification of posterior longitudinal ligament,T-OPLL)的临床疗效.方法:回顾分析2018年5月~2020年6月于我院脊柱外科接受胸椎后路椎体-后纵韧带骨化物复合体可控前移固定减压技术治疗的22例多节段连续型T-OPLL患者,记录手术一般情况,统计患者发病节段、临床表现及并发症情况,并根据术前、术后的疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、Frankel分级、CT、MRI检查评估手术效果.结果:随访时间13~17(14.95±1.33)个月;手术时间200~310min(238.19±34.73min),出血量900~1800ml(1345.45±230.38ml);患者术前、术后3个月、12个月、末次随访时VAS评分分别为7.59±0.73分、3.50±0.51分、2.41±0.50分、1.55±0.51分;术前和术后3个月、12个月、末次随访时的VAS评分差异有统计学意义(P<0.05).患者术前、术后3个月、12个月、末次随访时JOA评分分别为4.64±1.84分、5.73±1.78分、6.82±1.33分、9.23±0.81分;术前和术后3个月、12个月、末次随访时的JOA评分差异具有统计学意义(P<0.05),末次随访时JOA评分改善率平均为(73.64±12.57)%.末次随访时患者Frankel分级改善1~3级(术前14例B级、4例C级、4例D级均恢复至E级).末次随访时无内固定松动、断钉断棒等并发症,骨化物未见明显进展.结论:胸椎后路椎体-骨化物复合体可控前移固定减压技术能够借助钉棒固定系统将骨化物前移,实现对脊髓的原位减压,是一种安全有效的新术式,为胸椎后纵韧带骨化症的治疗提供了新思路.

前路骨化物复合体前移融合与后路椎板成形术治疗颈椎OPLL比较

[目的]比较前路骨化物复合体前移融合术(AOCAF)与后路椎板成形术(PL)治疗颈椎后纵韧带骨化症(OPLL)的临床效果。[方法] 2017年8月~2018年4月于本院手术治疗的OPLL患者94例,按手术方式分为AOCAF组45例,PL组49例。比较两组JOA及VAS评分,影像测量椎管矢状径、颈椎生理曲度、椎管狭窄率,采用多元逻辑回归分析影响神经功能的因素。[结果]两组患者手术顺利,均未发生血管、神经损伤等严重并发症。两组患者术后随访7~12个月,两组患者末次随访时的JOA评分均较术前显著增加(P<0.05),而VAS评分显著降低(P<0.05);末次随访时AOCAF组的JOA评分和VAS评分显著优于PL组(P<0.05);尽管术前两组间上述评价的差异均无统计学意义(P>0.05)。影像测量方面,术前两组患者椎管矢状径、椎管狭窄率比较差异均无统计学意义(P>0.05);末次随访时,两组椎管矢状径较术前显著增加(P<0.05),而椎管狭窄率则较术前显著降低(P<0.05);末次随访时,AOCAF组椎管矢状径、颈椎生理曲度和椎管狭窄率显著优于PL组(P<0.05)。逻辑回归表明:术前患处椎体矢状径是影响术后神经功能恢复的主要因素(P<0.05)。[结论] AOCAF对颈椎OPLL疗效优于PL,而影响术后神经功能恢复的主要因素是术前患处椎体矢状径。

两种前路术式治疗严重颈椎后纵韧带骨化症的疗效及神经功能恶化率对比

目的:比较颈椎椎体骨化物复合体可控性前移融合术(anterior controllable antedisplacement and fusion,ACAF)与颈前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)治疗严重颈椎后纵韧带骨化症(ossification of the posterior longitudinal ligament,OPLL)的疗效及术后神经功能恶化率.方法:回顾性分析2018年3月~2019年3月在我院接受颈前路手术治疗的72例严重OPLL患者(椎管侵占率≥50%)的临床资料,其中35例采用ACAF治疗(ACAF组),37例采用ACCF治疗(ACCF组),术后随访6~12个月.收集两组患者手术时年龄、性别、随访时间,术后2周内神经功能恶化发生情况、原因及预后,术前、术后2周内及末次随访时采用JOA评分评估神经功能,同时在术前和末次访时的颈椎CT和MRI检查图片上观察骨化物类型,测量椎管侵占率、椎管最狭窄处的减压宽度、椎管面积及脊髓前后径.结果:两组患者手术时年龄、性别比、随访时间、骨化物类型、术前椎管侵占率、椎管面积、脊髓前后径、JOA评分等均无统计学差异(P>0.05).术后2周内,ACCF组有10例出现神经功能恶化,发生率为27.0%,其中6例系术中损伤脊髓,2例为硬膜外血肿压迫脊髓,2例为骨化物残留;ACAF组2例出现神经功能恶化,发生率为5.7%,均因骨化物残留所致.两组术后神经功能恶化率有统计学差异(P<0.05).末次随访时,ACAF组减压宽度大于ACCF组(18.5±2.5mm vs 16.9±1.9mm),差异有统计学意义(P<0.05);椎管面积及脊髓前后径两组间比较差异无统计学意义(144.9±31.2mm^(2) vs 142.1±22.3mm^(2),P>0.05;5.5±0.5mm vs 5.2±1.4mm,P>0.05);两组患者JOA评分较术前均明显改善,ACAF组JOA评分改善率大于ACCF组[(79.5±8.7)%vs(68.9±20.3)%,P<0.05].结论:相较于ACCF,ACAF治疗严重颈椎OPLL能够获得更加满意的临床疗效,且降低了术后神经功能恶化率;但在开展ACAF早期仍存在发生术后神经功能恶化的潜在风险.

Environmentally benign and economic synthesis of covalent triazine-based frameworks

Covalent triazine-based frameworks（CTFs） are important microporous materials with a wide range of applications.Here,we demonstrate an environmentally benign and economic synthetic pathway to CTFs.The monomers used for CTFs,aromatic nitriles,were obtained by cyanation using nontoxic potassium hexacyanoferrate（Ⅱ） in place of commonly used toxic cyanides.Then,the CTFs were synthesized by trimerization of the corresponding cyano monomers in molten zinc chloride.A series of CTFs was synthesized,and the highest Brunauer-Emmett-Teller surface area measured in this series was 2404 m^2/g.Among the synthesized CTFs,CTF_（DCP） exhibited excellent CO_2 adsorption properties,with a CO_2 uptake of 225 mg/g at 0℃.

Ni@Pd core-shell nanoparticles supported on a metal-organic framework as highly efficient catalysts for nitroarenes reduction

Ni@Pd core-shell nanoparticles with a mean particle size of 8–9 nm were prepared by solvothermal reduction of bivalent nickel and palladium in oleylamine and trioctylphosphine.Subsequently,the first-ever deposition of Ni@Pd core-shell nanoparticles having different compositions on a metal-organic framework（MIL-101）was accomplished by wet impregnation in n-hexane.The Ni@Pd/MIL-101 materials were characterized by powder X-ray diffraction,Fourier transform infrared spectroscopy,transmission electron microscopy,and energy-dispersive X-ray spectroscopy and also investigated as catalysts for the hydrogenation of nitrobenzene under mild reaction conditions.At 30 °C and 0.1 MPa of H2 pressure,the Ni@Pd/MIL-101 gives a TOF as high as 375 h–1 for the hydrogenation of nitrobenzene and is applicable to a wide range of substituted nitroarenes.The exceptional performance of this catalyst is believed to result from the significant Ni-Pd interaction in the core-shell structure,together with promotion of the conversions of aromatics by uncoordinated Lewis acidic Cr sites on the MIL-101 support.

Extraction, Purification and Identification of Bone Morphogenetic Protein in Conditioned Medium of Osteosarcoma Cell (MG-63)

Objective: To find out a method of extraction and purification of bone morphogenetic protein (BMP) from osteosarcoma cell conditioned medium, and evaluate the biological activity of BMP.Methods: Conditioned medium of osteosarcoma cell lines (MG-63) was collected, concentrated and dialyzed. The concentrated protein was purified through gel chromatography on Sephcryl-S-100. The purified protein was tested by BMP monoclonal antibody (McAb), its molecular weight (MW) was determined by SDS-PAGE and its biological activity was demonstrated by heterotopic ossification.Results: The purified protein was proved to be BMP by BMP McAb, had a satisfactory heterotopic ossification, and its MW was about 21 kD.Conclusion: BMP existed in the conditioned medium of osteosarcoma cell and had a satisfactory biological activity after purification. Because osteosarcoma cell can be cultured and grew for a long timein vitro, this method will be helpful to a vast extraction of BMP and clinical application. Key words osteosarcoma cell - conditioned medium - bone morphogenetic protein - protein purification This project was a key scientific and technological program of Hubei Provicial Scientific and Technological Committee (No. 002p1503).

Influence of Functional Groups and Modification Sites of Metal-Organic Frameworks on CO2/CH4 Separation:A Monte Carlo Simulation Study

In order to explore the influence of modification sites of functional groups on landfill gas （CO2/CH4） separation performance of metal-organic frameworks （MOFs）, six types of or- ganic linkers and three types of functional groups （i.e. -F, -NH2, -CH3） were used to construct 36 MOFs of pcu topology based on copper paddlewheel. Grand canonical Monte Carlo sim- ulations were performed in this work to evaluate the separation performance of MOFs at low （vacuum swing adsorption） and high （pressure swing adsorption） pressures, respectively. Simulation results demonstrated that CO2 working capacity of the unfunctionalized MOFs generally exhibits pore-size dependence at 1 bar, which increases with the decrease in pore sizes. It was also found that -NH2 funetionalized MOFs exhibit the highest CO2 uptake due to the enhanced Coulombic interactions between the polar -NH2 groups and the quadrupole moment of CO2 molecules, which is followed by -CH3 and -F functionalized ones. Moreover, positioning the functional groups -NH2 and -CH3 at sites far from the metal node （site b） exhibits more significant enhancement on CO2/CH4 separation performance compared to that adjacent to the metal node （site a）.

Allelopathic interactions between Prorocentrum micans and Skeletonema costatum or Karenia mikimotoi in laboratory cultures

Algal allelopathy is an ecological/physiological phenomenon that has focused attention on the interactions among algae and the production of algal toxins. We investigated the allelopathic interactions between the dinoflagellate genus Prorocentrum micans and diatom genus Skeletonema costatum and between P. micans and dinoflagellate genus Karenia mikimotoi using bi-algal cultures. Because the effects were species-specific and size-dependent, we evaluated the effect of different initial densities. At low densities of P. mieans and high densities of S. costatum inoculated into the same medium, the growth of R rnieans was weakly restrained, whereas the growth of S. costatum was significantly suppressed. S. costatum and K. mikimotoi were strongly inhibited by P. micans, in both the bi-algal cultures and enriched filtrates. Direct cell-to-cell contact was not necessary to gain a competitive advantage, thus, our results suggest that P. micans inhibited the growth of S. costatum and K. mikimotoi by the release of allelochemical（s）. Last, a mathematical model was used to simulate growth and interactions between P. micans and S. eostatum and between P. micans and K. mikimotoi in bi-algal cultures.

Clinical benefits of biochemical markers of bone turnover in Egyptian children with chronic liver diseases

AIM： To investigate the association between serum insulin-like growth factor 1 （IGF-1）, osteocalcin, and parathyroid hormone （PTH） levels with the etiology and clinical condition of patients with chronic liver disease. METHODS： Eighty children with hepatocellular damage were divided into 3 groups according to the etiology of disease infection： bilharziasis （9 patients）, hepatitis B virus （HBV, 12 patients） and hepatitis C virus （HCV, 29 patients）. The Child score index was found as A in 24 patients, B in 22 patients, C in 4 patients. Thirty healthy children served as control group.HBsAg, HBcAbIgM, HBcAbIgG, and anti-HCV were detected using ELISA technique. HCV-RNA was measured by reverse transcription polymerase chain reaction （RT-PCR）. Antibllharzial antibodies were detected by indirect haemagglutination test. Liver function tests were performed using autoanalyser. Serum IGF-1, osteocalcin and PTH levels were measured by ELISA technique. Abdominal ultrasonography was also conducted. RESULTS： Serum IGF-1 level was significantly lower in all patient groups with liver diseases, while serum osteocalcin and PTH levels were significantly elevated in patients with HBV and HCV infections compared with the control group. Serum osteocalcin and PTH concentrations were measured with the severity of liver disease from Child A to C. Child A patients unexpectedly showed significantly reduced IGF-1 levels in comparison to patients staged as Child B or C. Serum osteocalcin level was negatively correlated with albumin （14.7 ± 0.54 vs 3.6 ± 0.10, P 〈 0.05）, while that for PTH was positively correlated with total protein （70.1 ± 2.17 vs 6.7 ± 0.10, P 〈 0.05） in patients with HCV infection.

Effects of IGF-Ⅱ on promoting proliferation and regulating nitric oxide synthase gene expression in mouse osteoblast-like cell

Objective: To investigate the effects of insulin-like growth factor Ⅱ (IGF-Ⅱ) on promoting cell proliferation, regulating levels of cellular nitric oxide (NO) and mRNA transcriptions of inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS) in mouse osteoblast-like cells. Methods: Mouse osteoblastic cell line MC3T3-E1 was selected as the effective cell of IGF-Ⅱ. After the cells were treated with IGF-Ⅱ at different concentrations for different time duration,3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) colorimetric assay was used to examine cell proliferation,and nitrate reductase method was applied to detect NO concentrations in cell culture supernatants and quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) was employed to determine transcription levels of cellular iNOS and eNOS mRNAs. Results: After the MC3T3-E 1 cells were treated with IGF-Ⅱ at concentration of 1 ng/ml for 72 h, 10 and 100 ng/ml for 24,48 and 72 h respectively, all the MTT values increased (P<0.05 or P<0.01) with obvious dosage-time dependent pattern. NO levels of the MC3T3-E1 cells treated with 100 ng/ml IGF-Ⅱ for 48 h, and with 1, 10 and 100 ng/ml IGF-Ⅱ for 72 h were remarkably lower than that of the normal control, respectively (P<0.05 or P<0.01). After the cells were treated with 100 ng/ml IGF-Ⅱ for 48 h cellular iNOS mRNA levels were significantly decreased (P<0.01). But the levels of eNOS mRNA in the cells treated with each of the used IGF-Ⅱ dosages for different time duration did not show any differences compared with the normal control (P>0.05).Conclusion: IGF-Ⅱ at different concentrations could promote proliferation of mouse MC3T3-E1 cell. This cell proliferation promotion was associated with the low NO levels maintained by IGF-Ⅱ. Higher concentration of IGF-Ⅱ could down-regulate iNOS gene expression at the level of transcription but not affect transcription of eNOS mRNA, which might be one of the mechanisms for IGF-Ⅱ maintenance of the low NO levels in MC3T3-E 1 cells.

A Clinical Investigation on 30 Cases of Senile Benign Renal Arteriolosclerosis Treated by Huang Qi Gu Jing Yin

Huang Qi Gu Jing Yin (HQGJY[symbol: see text]decoction of Astragalus root for Strengthening the Essence) was used in a controlled clinical trial for treatment of senile benign renal arteriolosclerosis. In the therapeutic group (n = 30), cure, marked effect and no effect were obtained respectively in 18 (60%), 9 (30%) and 3 (10%) cases with the total effective rate being 90%; the corresponding figures in the control group (n = 30) were 10 (33.3%), 9 (30%) and 11 (36.7%) with the total effective rate being 63.3%. The significant difference (P