Bone metastasis occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. Several sequences occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. Pain associated with osseous metastasis is thought to be distinct from neuropathic or inflammatory pain. Several mechanisms, such as invasion of tumor cells, spinal cord astrogliosis,and sensitization of nervous system, have been postulated to cause pain. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. These drags are associated with side effects, and tolerance to these agents necessitates treatment with other modalities. Bisphosphonates act by inhibiting osteoclast-mediated resorption and have been increasingly used in treatment of painful bone metastasis. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesions. 32p has been used for over 3 decades in the treatment of multiple osseous metastases. The myelosuppression caused by this agent has led to the development of other bone-seeking radiopharmaceuticals, including 89SrCl, and 153Sm-ethylenediaminetetramethylene phosphonic acid (153Sm-EDTMP). 89Sr is a bone-seeking radionuclide, whereas 153Sm-EDTMP is a bone-seeking tetraphosphonate; both have been approved by the Food and Drug Administration for the treatment of painful osseous metastases. While both agents have been shown to have efficacy in the treatment of painful osseous metastases from prostate cancer, they may also have utility in the treatment of painful osseous metastases from breast cancer and perhaps from non-small cell lung cancer. This article illustrates the salient features of these radiopharmaceuticals, including the approved dose, method of administration, and indications for use.

The arteries of the female internal genitalia were studied with transparent, X-ray photogaphyand corrosion method in 40 specimens from fetuses and babies. The uterine artery divides into ascending and descending branches along the lateral border ofthe uterus. The descending branches supply the cervix of the uterus and anastomose with thevaginal artery. The ascending branches ascends along the lateral border of the uterus to the originof the proper ligament of the ovary where it sendes out the fundus, uterine tube and ovarianbranches. In most cases, there is no convolution and without further branching in the remainingtrunk of the ascending branch. The ovarian artery is spiral in the suspensory ligament of the ovary. It is in this region or inthe mesovarium, the ovarian artery divides into 2--3 branches, that is to anastomose with theuterine artery and its ovarian and fimbrian branches of the uterine tube. The most common typeof anastomoses found in the hilum in the ovary and origin of the proper ligament is that theovarian branch of the uterine artery communicates with the ovarian artery. The uterine artery divides into 20-40 straight or convoluted branches in the uterine wall.Branches from the two sides anastomose near the midline of the uterus. The degree of convolutionand the number of branches and anastomoses in the uterine wall increase with age. Both ovarian and uterine artery supply blood to the ovary. There are about 20--30 branchesin the hilum of the ovary. They attain various spiral forms. The most common type of bloodsupply in the uterine tube is that the uterine tube and isthmus branches of the uterine artery anas-tomose with the fimbria branch of the ovarian artery and then send out 20--30 branches to encirclethe uterine tube.

Objective To investigate treatment method for existing and impending benign pathological femoral neck and trochanteric lesions.Methods A retrospective study wad done on 25 patients with benign proximal femur lesions treated between 2002 and 2004.All patients were treated with lesion curettage,cauterization,autografting and/or allografting.Then,dynamic condylar screw (DCS) or hip joint-span external fixator were selected according to the involved area of the lesion of the proximal femur.The duration of follow-up was mean 2.3 years (2-4 years).Results Sound bony union was seen on the radiographs of all patients by 3-6 months after surgery.There found no local recurrence or avascular necrosis of the femoral head,or complications like necrosis,infections or fractures.Function of the patients in the current series was graded excellent,assessed by the validated outcome measures MSTS-87,MSTS-93 and TESS lower extremity.Conclusion DCS or hip joint-span external fixator may be better alternative treatment of benign pathological femoral neck and trochanteric lesions,compared with conventional surgical methods such as simple bone grafting,traction and hip spica cast.

Objective To investigate the awareness of knowledge,attitude and behavior about disinfection and sterilization among clinical health care workers (HCWs).Methods 200 clinical HCWs were investigated randomly by using questionnaires.Results The average awareness rates of knowledge,attitude and behavior about disinfec-tion and sterilization among HCWs were 71 .49%,63.79%,and 86.45% respectively.The awareness rates of knowledge about the expiration dates of sterilized articles,classification of infectious diseases,and biological moni-toring were 49.43%,42.53%,and 23.56%,respectively;HCWs’attitude towards disinfection and sterilization:awareness rate of whether they paid attention to the new technology in specialty of central sterile supply was the lowest (26.44%);86.45% of HCWs thought they could master the aseptic operation technique,correct applica-tion method for sterile apparatus and related items,but easily ignored to check the integrity of aseptic packages and indicators before operation (67.24%).Conclusion The knowledge,attitude and behavior about disinfection and sterilization among HCWs still need to be improved,training on knowledge about disinfection and sterilization among HCWs should be strengthened.

10.3969/j.issn.2095-4344.2013.26.011

The lymphatic drainage of the ileocecal region was studied on 40 fetus and infant cadavers through the method of lymphatic injection. The lymphatics of the terminal part of the ileum in most cases ascend to the ileo- colic nodes.Part of these lymphatics lead to the nodes around the cecal or the ileal branches of the ileocolic artery.There is a single case,in which part of these lymphatics end directly in the superior mesenteric nodes. The lymphatics of the appendix mostly run parallel to the appendicular artery and lead to the ileocolic nodes.In some cases 1—2 lymphatics end in the appendicular nodes, and the nodes along the cecal or the ileal branches of the ileocolic artery. The lymphatics of the cecum mostly open into the anterior cecal nodes.Part of these lymphatics end in the ileocolic nodes.It is only in a few cases that 1—2 lymphatics of the cecum run to the posterior cecal nodes or the nodes situated at the cecal branches of the ileocolic artery.

Objective To elucidate whether taking Ⅱ b/Ⅲ a receptor antagonist instead of oral antiplatelet drugs during perioperative in patients with drug-eluting stent implantation undergoing non-cardiac surgery would play a preventive role of stent thrombosis,without increasing surgical bleeding.Methods Six patients aged 60 -75 years old with drug-eluting stent implantation within 1 year taking dual antiplatelet drugs without any chest pain,and whose heart function classification for two (NYHA) were enrolled.They underwent surgical treatment due to ineffective conservative treatment of surgical disease,5 days before surgery intravenous infusion tirofiban 0.1 μg/( kg · min) micro pumps continuously instead of oral dual antiplatelet drugs,2 hours before surgery stop tirofiban and re-application of tirofiban 0.1 μg/( kg · rain) after surgery in the intensive care unit,and replacing tirofiban with oral dual antiplatelet as soon as possible according to the situation.Analyze cardiovascular events,especially stent thrombosis events and seriously bleeding,tirofiban adverse drug events during perioperative.Results Six patients have no perioperative malignant ischemic ventricular arrhythmia,angina,myocardial infarction,sudden cardiac death,no massive bleeding and adverse drug reactions.Conclusion Substitution of oral dual antiplatelet drugs for Ⅱ b/Ⅲ a receptor antagonists to prevent stent thrombosis treatment during perioperative in patients with drug-eluting stent implantation undergoing non=cardiac surgery may be feasible and safe,but needs to be further confirmed through large sample of randomly controlled trials.

The origin and the course of the thoracic duct and its opening into the vein were studied in 150 cadavers including 15 fetuses and 138 infants. They are classfied into 5 types.1. The normol type of the thoracic duct begins in the abdominal cavity as a single trunk, It ascends along the right side of the aorta and empties into the venous system on the left side at the root of the neck. This type of the duct which is described in the general text book, occurred in 84.67 per cent.2. The two-trunk type of the thoracic duct begins in the abdominal cavity as two trunks and ascends along the each side of the aorta. The two trunks join together at different levels in the thorax forming a single trunk which empties into the venous system on the left side at the root of the neck. This type of the duct occurred in 10.66 per cent.3. The bifurcated-type of the thoracic duct starts in the abdominal cavity as a single trunk and passing cephalad on the right side of the aorta and divides into two branches at the level of the 6th～4th thoracic vertebra, The right branch opens into the venous svstem on the right side and the left branch opens into the venous system on the left side. This type of the duct occurred in 3.33 per cent. The type which ascends along the left side of the aorta was found.4. The right thoracic duct begins in the abdominal cavity as a single trunk and runs its entire course along the left side of the aorta. The termination opens into the right jugular venous angle. This type of the duct occurred in 0.67 per cent.5. The left thoracic duct begins in the abdominal cavity as a single trunk and ascends along the left side of the aorta. It empties into the left jugular venous angle. This type of the duct occurred in 0.67 per cent.

The spatial structure of hemolymph node in the rat is studied by light, transmission and scanning electron microscopy after the fixation of arterial perfusion. The structure of hemolymph node is similar to that of the normal lymph node, and main characteristic is that a number of the red cells are seen in it. The erythrocytes were carried to the afferent lymphatic vessel and reach the medullary sinus, many erythrocytes travel through the rsubcapsula and cortical sinuses, and reach the lymphatic tissue of the local cortex with selectivity, and going through the paracortical zone and the sinus wall to the medulary sinus. Most of the red blood cells are phagocytosed by macrophages in the sinuses. The subcapsular and cortical sinuses of hemolymph nodes connect with medullary sinuses, and form a reticular lymphatic passage. Reticular cells in the sinuses constitute a spatial each other. There are macrophages, lymphocytes, plasmocytes and numerous red blood cells in the nets. Macrophages are anchored on the reticular cells by their pseudopodla, traping and phagocytosing the red cells and foreign matters. Sometimes a macrophage is found closely associated with lymphocytes.

Objective:To evaluate the role of nuclear factor erythroid 2-related factor/ heme oxygenase-1 (Nrf2/HO-1) signaling pathway in dexmedetomidine-induced reduction of oxygen-glucose deprivation and restoration (OGD/R) injury to microglia.Methods:BV-2 microglia were cultured in high-glucose DMEM culture medium supplemented with 10% fetal bovine serum in an normal culture incubator at 37 ℃ (5%CO 2-21%O 2-74 %N 2). The cells were seeded in 96-well plates at a density of 1.5×10 4 cells/ml (200 μl/well) or 6-well plates at a density of 2×10 5 cells/ml (2 ml/well) and divided into 5 groups ( n=30 each) using a random number table method: control group (group C), dexmedetomidine group (group D), group OGD/R, OGD/R+ dexmedetomidine group (group OGD/R+ D) and OGD/R+ dexmedetomidine+ ML385 group (group OGD/R+ D+ ML). The cells in group C were continuously cultured in a normal culture incubator for 26 h. In group D, dexmedetomidine at the final concentration of 10 μmol/L was added, cells were incubated for 2 h, and then were continuously incubated in a normal culture incubator for 26 h. In OGD/R, OGD/R+ D and OGD/R+ D+ ML groups, the culture medium was replaced with glucose-free DMEM culture medium, cells were cultured for 2 h in an incubator at 37 ℃ (5%CO 2-1%O 2-94 %N 2), the culture medium was replaced with high-glucose DMEM culture medium containing 10% fetal bovine serum and then the cells were cultured for 24 h in a normal incubator.Dexmedetomidine at the final concentration of 10 μmol/L was added at 2 h before OGD in OGD/R+ D and OGD/R+ D+ ML groups.Nrf-2 inhibitor ML385 at the final concentration of 4 μmol/L was added at 30 min before dexmedetomidine was added in group OGD/R+ D+ ML.Cells in 6 wells in each group were selected randomly for assessment of cell viability (by methyl thiazolyl tetrazolium assay) and apoptosis (using flow cytometry), and for determination of the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the supernatant (using enzyme-linked immunosorbent assay), the expression of Nrf2 in nucleus, Nrf2 and HO-1(by Western blot ) and the expression of HO-1 mRNA (by real-time polymerase chain reaction). Results:Compared with group C, the cell viability was significantly decreased, cell apoptosis rate and concentrations of TNF-α, IL-6 and IL-10 in the supernatant were increased, and the expression of Nrf2 in nucleus, Nrf2, HO-1 and its mRNA was up-regulated in OGD/R and OGD/R+ D groups ( P<0.05), and no significant change was found in each parameter mentioned above in group D ( P>0.05). Compared with group OGD/R, the cell viability and IL-10 in the supernatant concentration were significantly increased, cell apoptosis rate and concentrations of TNF-α and IL-6 in the supernatant were decreased and the expression of Nrf2 in nucleus, Nrf2, HO-1 and its mRNA was up-regulated in group OGD/R+ D ( P<0.05), and no significant changes were found in the parameters mentioned above in group OGD/R+ D+ ML ( P>0.05). Compared with group OGD/R+ D, the cell viability and concentration of IL-10 in the supernatant were significantly decreased, cell apoptosis rate and concentrations of TNF-α and IL-6 in the supernatant were increased and the expression of Nrf2 in nucleus, Nrf2, HO-1 and its mRNA was down-regulated in group OGD/R+ D+ ML ( P<0.05). Conclusion:The mechanism by which dexmedetomidine alleviates OGD/R injury to microglia may be related to promoting the activation of Nrf2/HO-1 signaling pathway and inhibition of inflammatory responses.