Objective To evaluate the diagnostic value of the C 2 “hypertrophic sign” in the axis fracture.Methods 37 cases with C 2 fracture confirmed by radiography,CT and operation partly retrospectively analysed,there were 29 men and 8 woman.After trauma all cases were examined by X-ray and 11 cases by CT scan.27 cases underwent operation.Results The incidence rate of the C 2 “hypertrophic sign” was 53.13%.This sign characterized by the distance increased between the anterior and posterior of the axis on the lateral conventional radiography compared with that of C 3 vertebrae.The maximal increasing distance was 11 mm and minimal one was 2.3 mm with average 4.3 mm.Fracture line and swollen soft tissue in front of the vertebra were showed in some cases.Conclusion The C 2 “hypertrophic sign” is main radiographic sign of C2 fracture.

Objective To explore the isometric attachment site of the posterolateral structure in the femoral lateral condyle and introduce the method of knee posterolateral complex(PLC) reconstruction with the semitendinosus tendon. Methods Isometric reconstruction of the chronic PLC injury of knee joint in 18 cases, were performed with the semitendinosus tendon from February 2001 to February 2005. Of all patients, there were 12 males and 6 females, average age was 39 years old(range, 19-52 years old). All cases were chronic injuries, with duration of 1.5-14 months. 3 cases were simple PLC injury, 10 cases were PLC injury with posterior cruciate ligament(PCL) injury, 2 of which had undergone PCL reconstruction about 6.5 months. 3 cases combined with anterior cruciate ligament(ACL) injury, 2 cases combined with ACL and PCL injury. To put in the double semitendinosus tendon from the bony tunnel of anatomical insertion of the fibular collateral ligment in caput fibulae and put out from the bony tunnel of anatomical insertion of the popliterofibular ligment in the caput fibulae, then fix them respectively in the isometic bony tunnel of the femoral lateral condyle. The posterolateral stability of the knee was evaluated mainly through examination varus instability of knee and external rotation range of leg. Results It was relatively isometric from the femoral attachment site of the popliteal tendon to the anatomical insertion of the popliterofibular ligment in the caput fibulae. The better isometric attachment site was from the anatomical caput fibulae attachment site to 8-10 mm in front of the anatomical femoral attachment site of the lateral collateral ligament. The average follow-up period was 14 months(12-24 months). There was no varus knee instability in full extension. At 30? flexion, one-grade varus instability was found in 2. At 30? and 90? flexion, external rotation range increased by 6? in 3 cases, remained the same in 14 cases, and decreased in 1 case, all compared with the healthy side. Conclusion The method provided good stability for the knee and acquired satisfactory clinical results.

Objective To analyze the hidden blood loss following primary total hip arthroplasty (THA) and put forward corresponding treatment measures.Methods A retrospective study was done on the 138 patients with hip disease managed with THA for the preliminary unilateral replacement from January 2009 to January 2011.There were 48 males and 90 females,at age range of 45-71 years (mean,62 years).The pre-and post-operative blood routine and intra-and post-operative blood loss and transfusion were analyzed and hidden blood loss during peri-operation period was evaluated.Results All the patients were trnsfused with autologous blood intra-operatively.Intra-operative blood loss was (495 ± 105) ml and postoperative drainage volume was ( 121 ±29) ml.In addition,116 patients were given red cell suspension (RCS) and blood plasma to raise the level of hemoglobin and the RCS transfusion volume was (600 ± 225) ml.The total blood loss was (1 521 ±156) ml including hidden blood loss of (822 ±96) ml (57.2％).No obvious differences were observed in the indicators between males and females.Conclusions Hidden blood loss is an important factor that affects the prognosis of the patients treated by THA.In order to secure their safety in perioperative period and benefit their recovery,assessment of the amount of bleeding in THA should fully take the hidden blood loss into consideration and prompt treatment measures should be taken to fully and effectively recover their effective circulation blood volume.

Objective To analysis the victim's help-seeking behavior of domestic violence. Methods Using a multi-stage sampling strategy,306 victims of domestic violence were randomly selected and face-to-face interviewed. A self-designed help-seeking questionnaire of domestic violence was administered. Results 33.7%victims felt nowhere to seek help. The three leading helpers they seek were the other family member (34.6%),neighbor and friend( 17.0% ) and community office ( 12.5% ) ,and the community office had highest prevalence of effect (71. 1% ). The prevalence of seeking help from other family member and Women's Federation were highest in urban victims (P＜0.01) ,and seeking help from community office was highest in rural victims (P＜0.01). The three leading helpers were other family member (27.3%) ,community office ( 15.8% ) and neighbor and friend ( 10.9% ) by male victims, and other family member ( 38.0% ), neighbor and friend ( 20.0% ) and community office ( 10.8% ) by female victims. The prevalence of seeking help from neighbor and friend was higher in female than in male ( 20.0% vs 10.9%, x2 = 3. 980, P＜ 0.05 ). Adult victims seek help from other family member were less than children and the elderly (31.6% vs 42.0% and 46.9%, x2 =5.993, P＜0.05),and the elderly seek help from community office were more than adults and children (28.1% vs 12. 1% and 4.0%, x2 =9.930, P＜0.01 ). The victims with higher level of education were with higher prevalence of feeling nowhere to seek help (47.8%). Seeking help from other family member and community office were most in victims with lower level of education( 38.5% and 24.0% ,respectively) and were least in victims with higher level of education ( 17.4% and 0,respectively, P ＜ 0.05, P ＜ 0. 01 ). Conclusion Help-seeking behaviors of victims of domestic violence are varied by geographic settings,age,gender and education levels.

Objective To evaluate the relationship between GATA-3 and T-bet and inhibition of the differentiation of human T helper cells by morphine.Methods Ten healthy volunteers,aged 20-50 yr,weighing 50-70 kg,were enrolled in the study.Peripheral venous blood samples were taken in the early morning.Peripheral blood mononuclear cells (PBMCs) were isolated and assigned into 5 groups (n=10 each).PBMCs were incubated routinely (group C).PBMCs were incubated in the presence of PMA and ionomycin (group P),morphine 50 μg/ml (group M),morphine 50 μg/ml + naloxone 50 μg/ml (group MN) or naloxone 50μg/ml (group N),and were then stimulated with PMA and ionomycin for another 4 h.The percentage of Th1 and Th2 cells was detected by flow cytometry.The Th1/Th2 ratio was calculated.Interferon (IFN)-γ and interleukin (IL)-4 concentrations in the supematant were determined using ELISA.The activities of GATA-3 and T-bet were analyzed by EMSA.Results Compared with group P,the percentage of Th1 and Th2 cells,Th1/Th2 ratio,IFN-γand IL-4 concentrations in the supernatant,and GATA-3 and T-bet activities were significantly decreased in group M,the percentage of Th1 cells,Th1/Th2 ratio,and IFN-γ concentration in the supernatant were significantly decreased in group MN (P ＜ 0.05 or 0.01).Compared with group M,the percentage of Th1 and Th2 cells,Th1/Th2 ratio,IFN-γ and IL-4 concentrations in the supernatant,and GATA-3 and T-bet activities were significantly increased in group MN (P ＜ 0.05 or 0.01).There was no significant difference in the indexes mentioned above between groups N and C (P ＞ 0.05).Conclusion Morphine inhibits the differentiation of human T helper cells by activating opioid receptors,which may be related to the inhibition of GATA-3 and T-bet activities.

Social evaluation governance strategy was introduced to study the social management path for public hospitals.On the basis of definition of social governance and social evaluation theory, clarification of the concepts and relationship logic of public hospital′s social evaluation,and analysis of the context analysis of their social evaluation policy,the paper discussed the establishment of social evaluation and governance theory logic framework of public hospitals.In terms of such realization paths as the purposes,indexes,entities,and methods of the evaluation,as well as result release and application of the evaluation,recommendations were made.

Objective To investigate the risk factors of gallbladder neoplastic polyps,to determine the proper surgical indications,and to understand more about the clinical characteristics of gallbladder adenoma.Methods The clinical data of 748 patients diagnosed to have polypoid lesion of gallbladder (PLG) and underwent cholecystectomy from January 1998 to December 2012 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively reviewed.Results Among 748 patients,340 had abdominal symptoms.Postoperative histopathology showed non-neoplastic polyps (n =659),gallbladder adenoma (n =68),gallbladder cancer (n =15) and no polyps (n =6).The mean diameters of the nonneoplastic lesions and the neoplastic polyps were (9.38 ± 3.44) mm and (14.55 ± 5.71) mm,respectively (P ＜ 0.01).The average age of the patients with non-neoplastic lesions was (44.14 ± 11.42) years and (47.39 ± 12.82) years in those with neoplastic polyps (P ＜ 0.05).The proportion of solitary PLG was 41.4％ (253/611) and 59.59％ (47/79) for the non-neoplastic lesions and the neoplastic polyps respec tively (P ＜ 0.01).The size of PLG (13.34 ± 4.18 mm vs.20.07 ± 8.19 mm,P ＜ 0.05) and the age of the patient (45.78 ± 11.66 years vs.54.13 ± 15.82 years,P ＜0.05) between the gallbladder adenoma and gallbladder cancer groups were significantly different.Gallbladder adenoma or dysplasia was identified in 66.7％ (10/15) of gal1bladder cancer specimens.Conclusions Patients with PLG and with abdominal symptoms,large size (≥ 10 mm),old age (≥50 y) and solitary polyp are indications for cholecystectomy.Gallbladder adenoma may develop to gallbladder cancer within 10 years.

Objective To investigate the laboratory examination,diagnosis and treatment of 57 cases of Acute Promyelocytic Leukemia.Methods The clinical manifestation,laboratory morphology-immunology-cytogenetics-molecular (MICM) classification,treatment and follow-up were analyzed retrospectively among 57 newly diagnosed cases of acute pmmyelocytic leukemia (APL) patients from January 2011 to December 2013 in Xiangya Hospital,Central South University.Results In 57 patients,the first symptom was given priority to with bleeding (73.7％),fever (26.3％),and the organ infiltration accounted for 29.8％.The phenotype of CD13 + CD33 + CD34-HLD-RA-was 59.6％ in 57 patients,CD13 + CD33 +CD34 + HLD-RA + was 8.8％,and the remaining 18 cases were not classic phenotypes.The positive percentage of PML/RARa was 93.0％ by fluorescence in situ hybridization (FISH),and the remaining 4 cases were other rare abnormal.Except one case gave up the treatment,the other 56 cases of APL patients reached 100％ complete remission rate under early screening and diagnosis,relatively standardized and effective treatment.Conclusions Hemorrhage is the most common clinical symptoms of M3.MICM classification,especially the FISH technology,is the main laboratory basis for diagnosis of M3.After the treatment of early specifications currently,M3 can almost be cured.

Objective To compare the value among three hilar cholangiocarcinoma (HCC) staging systems,Bismuth-Corlette classification,TNM staging system and MSKCC classification,in predicting the resection rate and prognosis of HCC patients.Methods The clinical and histopathological data of 154 HCC cases were analyzed retrospectively.Three different staging methods were performed respectively to analyze the correlations with respectability and survival.Chi-square test and Kaplan-Meier analysis were applied to find clinical and histopathological factors related to prognosis.Results There was no significant difference in resectability between Bismuth-Corlette classification or TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ.The resection rates of MSKCC T1,T2 and T3 were 68.6％,44.8％,19.2％respectively (x2 =20.03,P =0.000).With higher T stage,resection rate obviously declined.The survival predicted by TNM staging and MSKCC classification was better than Bismuth-Corlette classification.Tumor differentiation,LN involvement,distant metastasis,margin status,TNM stage and MSKCC classification were significantly correlated with survival.Conclusions The MSKCC classification predicted resectability better than Bismuth-Corlette classification and TNM staging system,while both MSKCC classification and TNM staging system predicted survival better than Bismuth-Corlette classification.Clinical and histopathological factors such as tumor differentiation,LN involvement,metastasis,margin status,TNM staging,MSKCC classification were correlated with survival.