Objective There are many methods to treat adult humeral shaft fracture. Plates fixation and intramedullary locking nail are two important methods. Though plate fixation are "gold criterion", there were many defects limited its development. With humeral intramedullary nail widely used, this study is to analysis and investigates the complications of locked nailing in humeral shaft fractures. Methods Between January 2000 and January 2004, 90 humeral shaft fractures (74 acute fractures and 16 delayed unions or nonunions) in 89 patients were treated with humeral intramedullary locking nails and followed up for an average of 25.4 months(12-34 months). There were 56 males and 33 females, with an average age of 39.3 years. Acute fractures included 62 closed, 7 Gustilo type Ⅰ, 3 type Ⅱ and 2 type Ⅲa open fractures. 12 nonunions had previous operations. 8 patients had radial nerve palsy. In general, acute fractures were treated with closed nailing and nonunions were treated with open nailing with bone grafting. 53 proximal humeral fracture were treated by antegrade nail, the others with distal humeral fracture were treated by retrograde nail. Results In total, 17 patients had 18 significant complications. 5 of them were persistent nonunions. There was no statistics difference between antegrade nail and retrograde nail. The others were protruded screws, fracture gap, shoulder impairment, elbow impairment, angular malunion, deep infection and postnailing radial nerve palsy. Conclusion The risk of operative comminution was significantly higher in retrograde nailing, and operative comminution resulted in a significantly higher risk of nonunion. Many complications of humeral locked nailing can be prevented by improving the implant design or surgical techniques.

Objective To study on the changes of the IL-6、IL-8、TNF-? in the type 2 diabetes with insulin resistance and the relation of plasma glucose or insulin resistance and cytokines. Methods (1) To assay the serum level of cytokines in 90 cases with type 2 diabetes mellitus (T2DM) and 30 normal controls. (2)To measure the level of fasting plasma glucose (FPG),hemoglohin A_1c (HBA_1c),fasting insulin(FINS),fasting C-peptide (FCP).(3) To analysis the relation of the level of FPG,HBA_1c,FINS,FCP and cytokines. Results (1) The serum levels of cytokines in T2DM group were significantly increase than in control groups,IL-6 and TNF-? in T2DM group with insulin resistance were significantly increase than in T2DM group without insulin resistance (2) There was significantly positively correlated between insulin resistance and the increasing of cytokine levels. Conclusion There is an excess activation of cytokines in T2DM,which is significantly correlated with insulin resistance. Cytokines play the important role in the occurrence and development of T2DM and insulin resistance.

Objective By analyzing the clinical and pathological characteristics of small intestinal neoplasms of patients presenting at our hospital,this study was to improve our cognition of this disease and the prognosis.Methods We collected and reviewed the medical records of 121 patients suffering from small intestinal neoplasms,who underwent surgery at Ruijin hospital from January 2003 to June 2009.Diagnosis was confirmed by pathological examination,and patients were followed-up.Results Intestinal hemorrhage,anemia and abdominal pain were the three main symptoms for all patients.CT,and gastrointestinal endoscopy were valuable for the diagnosis of small intestine neoplasms.Compared with open surgery,laparoscopic procedures can shorten the operation time and the postoperative length of hospital stay.Conclusions Surgical procedure is the key treatment for patients with small intestinal neoplasms.Long term follow-up plays important role in the detection of other synchronous or metachronous gastrointestinal tumors and improves the prognosis.

The diagnosis and treatment of prostate cancer are being improved due to the popularized screening of prostate specific antigen. Advanced prostate cancer, in spite of its response to androgen deprivation therapy, may finally develop into castration-resistant prostate cancer (CRPC) and shorten the overall survival of the patients. Many efforts have been made by worldwide researchers for new approaches to the management of CRPC, including new hormonal therapy, cytotoxic chemotherapy, immunotherapy, and bone metastasis-targeted therapy. This paper reviews the emerging agents undergoing clinical evaluation and drugs that have received approval for the treatment of CRPC in order to provide doctors and patients with more treatment options for CRPC and improve the overall survival rate and quality of life of the patients.
Androgen Antagonists ; Bone Neoplasms ; prevention & control ; Humans ; Immunotherapy ; Male ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms, Castration-Resistant ; therapy ; Quality of Life

Objective: To set a quantified diagnostic standard for large intestinal cancer of spleen qi deficiency syndrome. Methods: The spleen qi deficiency syndrome was identified by experts on the basis of clinical epidemiological investigation of 311 patients suffering from large intestinal cancer. Corresponding points were assigned to the correlative factors (traditional Chinese medicine symptoms) on the basis of symptom differences between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome. The best threshold was determined by receiver operating characteristic curve (ROC) according to syndrome differentiation from expert team, and the quantified diagnostic standard was established. The syndrome identification from the expert team which was regarded as golden standard was tested retrospectively. Results: All the traditional Chinese medicine symptoms possibly related to spleen qi deficiency syndrome were analyzed based on the opinions of experts, and 28 symptoms were confirmed as candidate correlative factors. The occurrence of 11 symptoms between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome showed statistical differences by means of crosstabs analysis (P<0.05). The 11 symptoms were filtered by logistic regression analysis, and tiredness, fatigue, loose stool, and poor appetite were finally determined as the symptoms relative to large intestinal cancer. These four symptoms were analyzed with conditional probability conversion and endowed with 16, 11, 4 and 8 points respectively. The diagnostic standard of spleen qi deficiency syndrome of large intestinal cancer was over 13 points. The sensitivity, specificity and accuracy of retrospective examination were all above 80%, and its positive likelihood ratio was 9.89. Conclusion: The quantified diagnostic standard for spleen qi deficiency syndrome of large intestinal cancer is in accordance with clinical characteristics of large intestine cancer and the characteristics of TCM syndrome diagnosis.

Objective To determine the perioperative risks of partial hepatectomy by determining the preoperative liver functional reserve in patients with hepatocellular carcinoma (HCC),and to compare the model for end-stage liver disease (MELD) score with the Child-Pugh classification in predicting prognosis.Methods We reviewed the clinical data of 202 patients with HCC who underwent partial hepatectomy.The MELD score and the Child-Pugh classification were determined preoperatively.Results The incidence of postoperative liver dysfunction happened in 44.0％ of Child A patients,50％ in Child B patients,41.6％in patients with a MELD score below 14,and 91.7％ in patients with a MELD score of ＞ 14.The difference between the rates of postoperative liver dysfunction in patients with a preoperative MELD score above 14 and below 14 was significant (P ＜ 0.05),while that between patients with Child-Pugh A and B was insignificant (P ＞ 0.05).The incidences of postoperative liver dysfunction in patient with a MELD ＜ 8,8 ≤ MELD ≤ 14,MELD ＞ 14 were 38.2％,57.6％ and 91.7％,respectively,indicating that there was a positive co-relationship between the MELD score and the incidences of liver dysfunction.The Spearman rank correlation test showed the MELD score was significant correlated with the Child-Pugh score (r =0.404 ; P ＜ 0.05).The areas under the ROC curves of the MELD score and the Child-Pugh score were 0.703 and 0.587 (P ＜ 0.05).Conclusions The MELD score predicted postoperative liver dysfunction more accurately than the Child-Pugh classification.HCC patients undergoing partial hepatectomy with a preoperative MELD score ＞ 14 had a high perioperative risk.To ensure the safety of partial hepatectomy,HCC patients with a preoperative MELD score ＞ 14 requires active preoperative preparation,bringing the score near to or less than 14.

ObjectiveTo study the effect of Rehabilitative Ankle-Foot Orthoses training program on walking function of hemiplegic patients after stroke .Methods95 patients were randomly divided into two groups: observed group (49 cases) and control group (46 cases). The patients of control group were trained by routine rehabilitation training program, the patients of observed group were trained by Rehabilitative Ankle-Foot Orthoses and routine rehabilitation training program.ResultsAfter training, either observed group or control group showed significant improvement at walking function and ADL(P<0.01), but the improvement on observed group were more marked than coutrol group(P<0.01 and P<0.05). ConclusionsThe ability of walking in acute stroke patients were obviously improved, and the degree of the disability of them was decreased by Rehabilitative Ankle-Foot Orthoses.

Objective To investigate the different effect among ropivacaine,bupivacaine,lidocaine on analgesia after harvesting grafts from the scalp in burn patients. Methods 84 patients who need harvesting grafts from the scalp after burn were divided in 4 groups random-ly(n=21). Patients in group C hypodermically injected with saline 200 mL were control,while patients in group R injected with 0. 05% ropi-vacaine 200 mL,group B with 0. 188% bupivacaine,and group L with 0. 1% lidocaine. Motor activity assessment scale( MAAS) and visual analogue scale(VAS) were made before anesthesia(T0) and 20 min,5 h,10 h after awake of patients. VAS were made focus on head and body in part. Vital signs were also monitored and recorded for assessment of security. Results All patients in 4 groups had passed the period of operation safely. Patients in group R have better VAS than other groups. Conclusion Low concentration ropivacaine hypodermically injec-tion of head is helpful to relieve the pain after harvesting grafts from the scalp.

ObjecfiveTo explore clinical value of 64-slice spiral CT coronary angiography in diagnosing coronary atherosclerotic heart disease. as compared to that with selective coronary angiography.MethodsOne hundred and thirteen patients who underwent both 64-slice spiral CT coronary angiography as well as selective coronary angiography at an interval of no more than one month at Zhongshan Hospital.Shanghm in 2006 were selected for the study and their imaging reports were analyzed and compared.ResultsImages of 910 segments of coronary arteries were collected and assessed.Sensitivity,specificity and likelihood ratio for negative test result of 64-slice spiral CT coronary angiography in diagnosis of coronary atherosclerotic heart disease were 73.8 percent.97.0 percent and 24.4,respectively,with an overall agreement of 93.2 percent,positive predictive value of 82.7 percent and negative predictive value of 95.0 percenL ConclusionsSixty-four-slice spiral CT coronary angiography has hish specificity,negative predictive value and positive likelihood ratio,with high accuracy,in diagnosing coronary atherosclemtic heart disease.

Objective To compare the results of the anterior approach (AA) with the conventional approach in the treatment of large hepatocellular carcinoma (HCC).Methods We searched the Medline,PubMed,Cochrane Library,Wanfang database on randomized clinical controlled trials and non-randomized clinical controlled trials comparing AA with the CA in right hepatic resection for large hepatocellular carcinoma.The data were analyzed with the RevMan5 software.Results Five non-randomized clinical controlled trials (NRCTs) and three randomized clinical controlled trials involving 615 patients (304 in the AA group,311 in the CA group) were enrolled into the analysis.There was no significant difference in the operation time between the two groups.Compared with the CA,the AA had lower intraoperative blood loss (WMD=-680.2 ml; 95％CI,-1023.97～-336.43;P=0.0001),blood transfusion rate (OR=0.38;95％ CI,0.25～0.59;P＜0.0001),intraoperative tumor rupture (OR=0.33;95％CI,0.11～0.97;P=0.04),surgical complication (OR=0.59;95％CI,0.38 ～ 0.93 ; P =0.02),hospital mortality (OR =0.37 ; 95 ％ CI,0.21 ～ 0.67 ; P =0.0009),and hospital stay (WMD=-4.75 d;95％CI,-7.82～-1.67;P=0.002).Conclusion AA is superior to CA in the treatment of larger.The operation time is the same for the 2 approaches.