The arterial supply of the human metatarsals in 90 lower limbs,ranging in age from newborn to87 years,was studied by perfusion method. The blood supply of the metatarsals is derived from the nutrient artery,the periosteal arteries,the epiphyseo-metaphyseal arteries and the pseudoepiphyseal arteries. The proximal and distal branches of the nutrient artery supply the inner two-thirds or three-fourths of the cortex. The periosteal arteries give off a few twigs penetrating into the cortex and supplying the outer one-third or one-fourth of the cortex. The radiate form epiphyseo-metaphyseal arteries derived from superficial plexuses in continuity with the periosteal networks on the shafts, supply the base of the first metatarsal, and the heads of the other four. The pseudoepiphyseal arteries, penetrating the non-articular areas of the bones, supply the bases of the second, third, fourth and fifth metatarsals and the head of the first. The sources of the nutrient arteries to the metatarsal vary with the different bone . The nutrient arteries to first metatarsal bone usually originate from the ramus plantaris profundus and the first plantar metatarsal artery, while the nutrient arteries to the other metatarsal bones mainly derive from the plantar metatarsal arteries, the plantar arch and its perforating branches. The clinical significance of the arterial distribution to the metatarsals is discussed.

BACKGROUND: There have been some prospective, randomized, controlled studies regarding the feasibility and safety of laparoscopic gastrectomy for gastric cancer, but controversy exists.OBJECTIVE: To systemically assess the feasibility and safety of laparoscopic gastrectomy for gastric cancer.METHODS: A computer-based online research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy published between January 1994 and December 2009 was performed in PubMed, Ovid Medline, Web of Knowledge, EMbase, Chinese Journal Full-text Database and Wanfang Database. Meta analysis of acquired data was performed through the use of RevMan 5.0 software. The inverse variance method was used to test the significance of continous data, while the Mantel-Haenszel method was used for dichotomous data. The chi-square test was used for evaluation of data heterogeneity. Homogenous data was calculated using the fixed effect model, and heterogeneous data was calculated using freedom model. Statistical data was expressed as 95% confidence interval. Funnel plot was used for sensitivity analysis to show potential publication bias.RESULTS AND CONCLUSION: Five papers that corresponded to inclusion criteria were included in this study. Among 326 cases included, 164 underwent laparoscopic gastrectomy and 162 received open gastrectomy. Meta analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy (both P ＜ 0.01), but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay (P ＜ 0.01). But there was no significant difference in terms of time to resumption of oral intake, postoperative complications,postoperative morbidity rate, and tumor recurrence. Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node. The five papers adopted two different modes to remove lymph nodes, so subgroup analysis was also used. Results showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy. All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.

Objective To observe the effects of diabetic health education on improving the diabetic knowledge score(DKS) and glucose metabolism.Methods 119 diabetic patients were randomly divided into two groups,in addition to conventional therapy,the experimental group of 64 cases received one month diabetic health education,however,the control group of 55 cases was only treated with conventional therapy.Drug therapy of all patients was not changed during the observation.The changes of fasting blood glucose(FBG),post-prandial two-hour blood glucose(PBG),glycosylated hemoglobin(HbA 1c),diabetic knowledge score were detected.Results FBG,PGB,diabetic knowledge score were significantly improved after diabetic health education in experimental group(P0 05).Conclusion Diabetic health education can improve the DKS and glucose metabolism in diabetic patients.

Objective To investigate whether oral administration of probiotics can reduce complications induced by interventional therapy in patients with primary hepatic carcinoma and liver cirrosis.Methods Two hundred and sixty four patients with primary hepatic carcinoma and liver cirrhosis who underwent transarterial chemoembolization(TACE) were randomly divided into two groups.and patients in experimental group were given probiotics but not in control group.Shoa-term clinical manifestations.liver functions,blood routine and pain scores were compared between two groups.Results On the day 3 after therapy,the incidence of abdominal distension and constipation in experimental group were less than that in control group(x2=18.22 and 55.22,P=0.000);On the day 7 after therapy,the incidence of abdominal distension,constipation and infection in experimental group were less than that in control group(x2=5.35,13.5 and 19.14,P=0.021,0.000 and 0.000).There were no significant difference in other clinical manifestations,liver function,blood routine and pain scores between the two groups. Conclusion Oral administration of probiotics can reduce the incidence of some short-term complication induced by interventional therapy in patients with hepatic carcinoma and liver cirrhosis.

Objective To explore the clinical effect of Weifuchun tablet combined with chemotherapy on patients with advanced non-small cell lung cancer (NSCLC).Methods Sixty-eight patients with advanced NSCLC was randomly divided into control group (n =34) treated with cisplatin + gemcitabine and treatment group (n =34) treated with Weifuchun tablet (1.436g × 2/d) and cisplatin + gemcitabine.After two treatment cycles,the clinical effect in both groups were evaluated.Results The clinical efficacy in the treatment group was 52.94％ (18/34),which in the control group was 41.18％ (14/34),there was no statistically significant difference between the two groups(x2 =0.94,P ＞ 0.05).The quality of life and the level of T lymphocytes were markedly improved,and the reduction of hemoglobin,leucocyte,and platelet,and nausea reaction were all significantly inhibited in treatment group compared with that in control group after two treatment cycles (x2 =4.12,4.66,5.96,4.12,5.90,all P ＜ 0.05).Conclusion Weifuchun tablet combined with chemotherapy effectively ameliorates the clinical symptoms of the patient with advanced NSCLC,reduces the toxic and side effects caused by chemotherapy,and improves the quality of life,which is worthy in the clinic.

Objective Tyrphostin AG1024(3-Bromo-5-t-butyl-4-hydroxybenzylidenemalonitrile) is a specific insulin like growth factor type Ⅰ receptor tyrosine kinase blocker,this study is to investigate the effect of AG1024 on the proliferation and apoptosis of hepatocellular carcinoma cell lines.Methods Treated with AG1024 on vailed concentrations(0～40 μmol/L),human hepatocellular carcinoma cel lines HepG2 and SMMC-7721 were observed for morphological and molecular biology changes,the effect of AG1024 on the cell lines proliferation invasion ability as well as apoptosis was evaluated. Results MTT showed that AG1024 dose-dependently inhibited the proliferation of hepatocellular carcinoma cells,flow cytometry suggested that AG1024 significantly promoted cell lines apoptosis,the cell invasion assay indieated that AG1024 significantly inhibited cell's invasion ability.RT-PCR showed over-expression of IGF-IR in liver cancer cells.and AG1024 dose-dependently increasedtheexpressionofcytochreme C. According totheresultsof Western, blotting,the phosphor-ERK and procaspase-3 were down-regulated while the total ERK remained unchanged. Conclusion AG1024 as a specific IGF-IR blocker blocks the downstream signaling cascade and thus inhibits the proliferation of hepatocellular carcinoma cells and induces cell's apoptosis.

BACKGROUND: Minimally invasive percutaneous pedicle screw fixation possesses the advantages of less blood loss, less muscle and soft tissue dissection, and rapid recovery; however, accuracy of the screw positioning is the key to be successful.OBJECTIVE: To explore the application value of self-designed spinal localizer in the screw positioning for minimally invasive percutaneous pedicle screw fixation.METHODS: 428 patients with thoracolumber disorders were subjected to minimally invasive percutaneous pedicle screw fixation at the First Affiliated Hospital of University of South China, from March 2009 to March 2015, and randomly underwent the preoperative screw positioning by self-designed spinal localizer or one of traditional localizing methods (iliac crest, ribs, symptomatic vertebral appearance, skin marker, Kirscher wire, puncture needle localizations). The location accuracy, positioning time and radiographic times were compared among methods.RESULTS AND CONCLUSION: (1) Compared with the traditional localization methods, the self-designed spinal localizer was superior in accurate rate (P < 0.05), cost less positioning time (P < 0.05) and received less radiation (P < 0.05). (2) To conclude, the self-designed localizer exhibits a certain application value, which is an ideal method in preoperative localization for minimally invasive percutaneous pedicle screw fixation.

Objective To establish a new rat model of biliary atresia by pure ethanol injection into the common bile duct.Methods A catheter was inserted and fixed in the common bile duct in male SD rats .Saline (8 rats) or pure ethanol (16 rats) was injected through the catheter ,respectively, and the biochemical and pathological changes in the rats were examined .Results SD rats in the experimental group were divided into a persistent injury and a restoration of liver dysfunction groups according to pathological and biochemical detection .In the persistent injury group , biochemical impair-ments were significantly higher at 8 weeks after ethanol injection than those in the control group and restoration group .Dis-tinct pathological changes in the liver were observed using HE , SMA, and Masson staining .Conclusions It is a reliable animal model of biliary atresia induced by injection of pure ethanol into the common bile duct in the rat .It will provide a useful tool in future studies of biliary atresia .

Objective To investigate the prevalence of thyroid nodules among residents of Ningbo City and to explore the risk factors for thyroid nodules.Methods Totally 3 596 residents aged 6-70 were selected by multistage stratified cluster random sampling in Ningbo City,2011.Thyroid ultrasound examination was performed in all participants,while salt iodine and urinary iodine were measured.Possible risk factors for thyroid nodules were analyzed by single factor and multi-factor logistic regression.Results The prevalence rate of thyroid nodules in residents of Ningbo City was 22.66％ (815/3 596),with standardized prevalence rate of 17.69％.Female [(odds ratio (OR) =2.06,95％ confidence interval (CI) =1.74-2.43],groups of aged 18-(OR =3.42,95％ CI =1.22-9.61),aged 40-(OR =13.06,95％ CI =4.80-35.51),aged 65-(OR =16.67,95％ CI =5.97-46.54) and occasional consumption of seafood habits (less than twice per week,OR =1.23,95％ CI =1.02-1.49) were significant associated with thyroid nodules.Conclusions There is no link Letween iodine nutrition and thyroid nodules.It is demonstrated that female and aged ≥ 18 groups have higher risk of thyroid nodules; frequent consumption of seafood seems to be a protective factor.

Objective To evaluate the safety and clinical efficacy of CT-guided 125I seeds interstitial implantation in treating the refractory liver cancers that show poor response to commonly used therapies. Methods A total of 40 patients with refractory clinically or pathologically-proved liver cancer were enrolled in this study, the diseases included primary liver cancer (n = 27, with coexisting portal vein cancerous thrombus in 2) and metastatic liver cancer (n = 13). CT-guided 125I seeds interstitial implantation was performed in all patients. Preoperative plan of seeds implantation protocol was formulated by using the treatment plan system (TPS); the 125I seed activity was 0.6 -0.8 mCi and the peripheral matching dose (MPD) was 100 -140 Gy. The procedure of 125I seeds interstitial implantation was performed under local anesthesia in all patients. By using percutaneous trans-hepatic puncturing and single-or multiple-needle technique, the 125I seeds were implanted along a line parallel to the long axis of the tumor and/or tumorous thrombus with an interval of 0.5 -1.0 cm. The short-term efficacy was evaluated by modified response evaluation criteria in solid tumors (mRECIST), and the median time to tumor progression (mTTP) and the median overall survival time (mOS) were calculated by Kaplan and Meier method. Results The technical success rate was 100%. The diameter of the tumor was 1.5 -12.0 cm (mean 4.0 cm), and a total of 1 748 125I seeds were implanted in 40 patients (mean 44 seeds per patient). The short-term effective rate was 37.5%(n = 15), including complete remission in 8 cases and partial remission in 7 cases, the stable disease was seen in 15 cases (37.5%), and the disease control rate was 75%. The mTTP was 7.0 months (95%CI:4.524-9.476 months), while mOS was 10 months (95%CI: 6.901 -13.099 months). The procedure-related adverse reactions included small amount of subcapsular hemorrhage (n =2, 5%), intrahepatic migration of 125I seeds (n=2, 5%), pain at liver area (n=1, 2.5%); and no special treatment was needed in these patients. One patient developed high fever with chills 3 hours after the procedure, which was relieved after symptomatic and antipyretic treatment. Conclusion For the treatment of refractory liver cancers, CT-guided 125I seeds permanent interstitial implantation, used as a remedial therapy, is safe and effective. This technique is worth popularizing in clinical practice.