Objective to analyze the influence obstetric factors of the small for gestational age(SGA)in twins,so as to direct the clinical prenatal supervision in clinic. Methods A retrospective study of the SGA was performed,the general data of 1 514 patients admitted in obstetrics and gyne-cology of Shengjing Hospital during 2001 to 2014 were analyzed by Logistic regression analysis. Results the incidence of the SGA in twins was 10.89%. the protective factors were male fetus,assisted reproductive technology(ARt)and gestational diabetes mellitus(GDM). the risk factors were the female fetus and hypertensive disorders in pregnancy. Conclusion the gender of fetus,assisted reproductive technology(ARt),gestation-al diabetes mellitus(GDM),hypertensive disorder complicating pregnancy are the influential factors of the SGA in twins. We recommend a further pre-pregnancy and pregnancy care which is of significance for the prevention of SGA.

Objective To investigate the histological changes and collagen phenotype of a semitendinosus autograft after reconstruction of posterior cruciate ligament(PCL) in rabbits. Methods Twenty skeletally mature New Zealand white rabbits were divided into two groups. In group 1, the PCL of the right knees of 18 mature New Zealand white rabbits were resected and immediaterly reconstructed with double-band semitendinosus antograft. Then the rabbits were respectively killed at 3, 6, 12, 26 and 52 weeks after the operation, to obtain the the semitendinosus autografts. Group 2 consisting of the other 2 rabbits was served as control group, and semitendinosus tendons and PCL were obtained. All specimens were staining with hematoxylin and eosin, toluidine blue and immunohistochemical methods of type Ⅰ, Ⅲ collagens to analyze the histological changes and collagen phenotype of a semitendinosus autograft, and compare those with normal semitendinosus tendons and PCL. Results Histological results demonstrated that there was obvious difference at the cell formation between normal semitendinosus tendon and PCL. After postoperative 52 weeks the graft was similar to the normal PCL, while the alignment of graft was still different from that of normal PCL through necrosis, cell growing in, collagen formation and remolding. Immunohistochemistry result demonstrated: the staining of type Ⅰ collagen in graft was low at first, then increased gradually; the staining of type Ⅲ collagen was low at first, increased quickly, then decreased, at 52 weeks it was present in local areas. But positive reactions for type Ⅰ collagen were localized in collagen fibers, and those for type Ⅲ collagen were localized in synovium in normal PCL. Conclusion The study showed the semitendinosus autograft was still different in cell formation from normal PCL at 52 weeks after PCL reconstruction with semitendinosus.

Traditionally the cultivation mechanisms of pathological postgraduates can not fully adapt to the demand of research and society in China,to some extent,which impedes the development of pathology.Combining our practical conditions with overseas experiences,we try to make the beneficial thinking and adjustment on the existing cultivation mechanisms.

Great difficulties and challenges are existed in the training of clinical type postgraduate of neurosurgery because of the acute onset,server illness and difficult diagnosis of neurosurgical diseases.This paper proposed countermeasures of combing theory with clinical practice and strengthening comprehensive ability after analyzing problems of inadequate professional knowledge,lack of doctor-patient communication and insufficient clinical thinking and innovating ability.The aim was to cultivate the overall quality of postgraduates,making them more qualified for the difficult task of being neurosurgery clinicians.

Objective To study the effects of continuous passive motion(CPM)on tissue blood oxygen saturation(StO2)in the edge of wound after anterior cruciate ligament(ACL)reconstruction in rabbits.Methods Twenty male New Zealand rabbits,aged 8 months,received an ACL reconstruction by using double semitendinous tendon autograft in the right hind leg.The rabbits were randomly divided into 2 groups postoperatively,namely Cage activity group(n=10)and CPM group(n=10),treated with cage activity and activity by rabbit knee joint continuous passive motion apparatus respectively.On the following day after operation,a near-infrared optical device and ODISseyTM Tissue Oximeter were applied to measure the changes of tissue oxygen saturation(StO2)in the edge of the wound in each cycle(with flexion of 30?-110?)and various CPM speeds(2.35?/s,3.2?/s,and 8?/s),and the optimal CPM range and speed was thus selected for analyzing the changes of StO2 in local tissues of wounds with various angles of CPM in knee joint before the operation and on the 2nd,4th,6th,8th,10th,and 14th postoperative days.Results There was a significant difference with regard to StO2 between CPM group and Cage activity group(P0.05),however,a significant difference was observed among different time points(before the operation,and 2,4,6,8,10,14 days after the operation)(P

Objective To study the safety of transcatheter arterial chemoembolization(TACE)via the intercostal artery(ICA)for hepatic carcinoma.Methods A total of 24 patients with hepatic carcinoma(HCC)fed by the ICA underwent TACE via the artery in our hospital.Among the cases,15 were mass type and 9 were nodular type.Plain and enhanced CT or MRI scan were performed before the operation.During the procedure,we carried out intercostal arteriography.Selected catheterization of the feeding branch and then TACE were done.The ICA angiographic features,tumor location,clinical observation,laboratory tests,and imageology were evaluated after the surgery.Results In our cases,the HCCs supplied by the ICA collaterals were located at segments six and/or seven.Angiography showed that all the ICA collaterals originated from the right side at the levels of T8(7.5%,3/40),T9(15.0%,6/40),T10(47.5%,19/40),or T11(30.0%,12/40).The procedure was completed in 22 of the patients.CT scan performed after the procedure showed that the tumor was completely filled with lipiodol in 87.5%(21/24)of the cases.The serum level of AFP decreased significantly in 82.6%(19/23)of the patients.Three patients complained of severe pain at the shoulder after the operation,1 patient had skin itching during TACE,and 5 developed skin erythema after the procedure.Conclusions HCC supplied with ICA collaterals are often detected in the patients who have the tumor at the right posterior segment(S6 and S7)and had received TACE for several times.TACE via the ICA is safe but may leads to skin injuries.

Objective To research for a new method of arthroscopic total meniscectomy with simple instru- ments. Methods One hundred and sixty nine cases were followed up for short period that had been operated on with a forward knife, a back cutting knife, a punch and a 30?scope from Nov. 1992. to Aug. 1998. Results The av- erage time of operation was 78 minutes. The operations had no injury to cartilage and ligament. It is necessary for only 7 .9 percent of patients to take analgesic intramuscularly after operation. Eight patients had a transient tourniquet paral- ysis. All of them could begin to work and exercise after postoperative 2 weeks. Conclusion As compared with the method introduced by David Sisk ,this method has the advantages of simple instruments, fewer ports and complications and minimal trauma Either lateral meniscus or medial meniscus can be cut off by the same method. This method is a safety and a better way to arthroscopic meniscectomy.

In oder to make the bone tunnel in optimal position, effective and firm fixation, early functional recov- ery and minimally operative injury we reported a new technique in reconstructive anterior cruciate ligament(ACL)using patellar tendon autograft fixed with interference screw. With the assistance of arthroscopy 74 patients with ACL rupture were treated between October 1997 and April 1999. The clinical results showed that the operative injury was minimal, fixed bone grafts were accurate and the reconstructed ACL was isometricity. The reconstructed ligament could be fixed biologically and firmly because of used patellor tendon autograft with bone grafts at two end. Clinical experience of ar- throscopic - assisted ACL reconstruction was summarized.

Objective To report the first case of disseminated trichosporonosis in China.Methods A series of clinical,histopatholog ic,and mycologic studies were carried out in a 20year-old-female patien t,who had no definite underlying disease.The causative fungus was identified according to culture,biochemical t est and DNA sequencing.Results Abundant fungal spores,yeasts and h yphae were shown in the specimens tak en from infectious granulomas.The fungal c olonies in the culture of skin lesion s or crusts,liver,oral psedomembra ne,vagina,nasal cavity,urine,and sto ol were the same.The colonies exhibi ted creamy white to yellowish in colo r,rugose on the surface,and hyphae at t he periphery.Under microscopy,there were a lot of rectangular arthrospores,round or oval spores w ith or without buddings,as well as br anched and septate filaments.The isolated fungus was unanimously identified as Trichosporon asahii(No.AS 2.2174)through culture,bio-chemistry and molecular biology tests.The patient's condition was impr oved obviously after the combinatio n treatment of amphotericin B liposom e(Amphotec)and fluconazole.Conclusion The extensive and lasting systemic impairments caused by T.asahii have scarcely been reported at home a nd abroad.Combination therapy with amphotericin B and fluconazole is effective.

Objective To report Trichosporon asahii first isolation and identification of TH chosporon asahii in chain.Methods A clinical infection fungus strain was isolaled from mouth pseudomembrane vaginal,nasal secretions,urine,faces,and live puncture tissue,injured skin tissue of a female patient,who had no clear underlying disease.Through cultured in medium,biochemical assay,identification of the bacterial race molecular biology test and DNA sequencing.Result We demostrated that the fungus strain was unanimously identified as Trichosporon asahii.Conclution The Trichosporon asahii could induce the disseminated Trichosporonosis.