Objective To summarize the surgical techniques and results of displaced complex ac-etabular fractures.Methods Ninety-eight cases of complex type o f acetabular fracture with dislocation were treated with open reduction and inte rnal fixation from March 1990to Sept ember 1999.Of the 98cases,fractures of the posterior column an d wall was seen in 9cases,T -shaped in28cases,transverse and posterior wall in 22cases,anterior and hemi-transverse in 2cases,both column in 37cases.Kocher -Langenbeck approach was adopted in 28cases,ilio-inguinal approach in 21cases,extended iliofemoral approach in 16cases,and double approachs(K -L +ilio-inguinal)in 33cases.Results Sixty-two cases(63.3%)had anatomic reduction,32cases(32.7%)satisfactory reduction,4cases(4.1%)unsatisfactory reduction.The rates of anatomic reduction in the early 4.5years and the latest 4.5years of this study were 50.0%and72.4%respectively.Seventy-eight cases were followed up from 2to 10yea rs,excellent and good rate for clinical results in anatomic and non-anatomic reduction group were 83.9%and 36.4%respectively,the difference was very significant (P

Objective To summarize the surgical techniques and results of b oth-column acetabular fracture through combination of ilioinguinal and Kocher-La ngenbeck approaches. Methods Between March 1990 and July 2001, 66 patients affec ted by both-column acetabular fractures were treated surgically through the comb ination of ilioinguinal and Kocher-Langenbeck approaches. There were 39 males an d 27 females with an average age of 37 years (range, 19 to 56 years). According to Letournel classification, all patients were diagnosed as the both-column frac tures of acetabulum. Of 66 patients, 14 were associated with dislocation or subd islocation of femoral head, 8 with dislocation of ipsilateral sacro-iliac joint, and 8 with intra-articular fragments. The interval from injury to operation was within 2 weeks in 24 and more than 2 weeks in 42. The surgical indications were as follows: 1) dislocation of both column fractures over 3 mm; 2) anterior colu mn fracture associated with severe posterior column comminuted fracture or poste rior wall fracture; 3)injury lasting more than 2 weeks; 4) injury associated wit h femoral head dislocation; 5) injury associated with intra-articular fracture f ragment. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta and the Epstein criterion separately; the d’A ubigne rating scale was used for the functional results. Results The average ope rative time was 4 hours, the average blood loss was 1 400 ml. Anatomic reduction were obtained in 57 cases (86%), satisfactory reduction in 6 (9%) and unsatisfa ctory in 3 (5%). The follow-up were from 2 to 13 years with an average of 6 year s. The clinical results were 89% excellent and good, 6% fair and 5% poor respect ively; the roentgenographic results were 82% excellent, 10% fair and 8% poor res pectively. 5 cases(8%) with Grade Ⅲ heterotopic ossification were found in Ko cher-Langenbeck approach, and no heterotopic ossification was in ilioinguinal ap proach. There was 1 deep infection (1.5%) in the ilioinguinal approach, and no i nfection in the Kocher-Langenbeck approach. Conclusion The results achieved thro ugh the combined approaches were significantly better than that of the both-colu mn acetabular fractures using the extended iliofemoral approach. The combined ap proach is an ideal method for the operation of the both-column acetabular fractu res with an excellent exposure, satisfactory reduction, shorter operating time, less blood loss, and lower operative complication rate.

Objective To study the effect of cyclosporine combined with eleven acid testosterone on serum T helper cells in patients with chronic aplastic anemia.Methods A total of 86 patients with chronic aplastic anemia received treatment in our hospital were collected as the research objects,and divided into experimental group and control group,patients in the experimental group received eleven acid testosterone combined with cyclosporine therapy,patients in the control group received eleven acid testosterone therapy.Blood routine indexes,Th1,Th2,Th17 and Treg cells contents of the two groups before and after treatment were compared.Results Before treatment,hemoglobin content,leukocyte count,platelet count,peripheral blood Th1,Th2,Th17 and Treg cells contents of the two groups had no significant difference(P>0.05).After two courses of treatment,hemoglobin content,leukocyte count,platelet count of the experimental group were significantly higher than those of the control group.After two courses and four courses of treatment,peripheral blood Th1 and Th17 contents of experimental group were significantly lower than those of the control group,Th2 and Treg contents were significantly higher than those of the control group.Conclusion Eleven acid testosterone combined with cyclosporine treatment could be more effective to stimulate hematopoiesis,regulate immune function and T lymphocyte subsets content,it′s an effective method for the treatment of chronic aplastic anemia.

The article introduced the content of medical genetics in USMLE,and compared it with Chinese official teaching material. Medical genetics is an important part of USMLE and the USMLE questions come from real clinical cases and pay more attention to clinical experience. To adapt to the international trend,Chinese teaching material can clarify the genetic-related illness in detail. Clinical case is a good guide for PBL(Problem-Based learning)teaching. The medical genetics were called for in Chinese Practicing Physician Qualifications Test.

Objective: To study the relationships between the expressions of E-cadherin and ki-67 in the tissues of heatocellular carcinoma(HCC)and the prognosis of HCC patients after hepatectomy as well as their clinical pathology. Methods: We examine the expressions of E-cadherin and ki-67 in 255 HCC tissues by tissue microarray and PV-6000 two-step method of immunohistochemistry and analyze the correlations between their expressions and clinical pathological data, 1-year recurrent rate and overall survival time after hepatectomy. Results: The expression of E-cadherin correlated with the tumor size and the 1-year recurrent rate of positive group was higher than that of the negative group. The expression of ki-67 correlated with vascular invasion and differentiation of the tumor, the positive group showed a higher 1-year recurrent rate and a shorter overall survival time. Multivariate Cox regression analysis indicated that the expression of ki-67 was an independent risky factor. Conclusions: The negative expression of E-cadherin and the positive expression of ki-67 predict a higher recurrent rate of early stage. The expression of ki-67 is an independent risky factor which can be used to evaluate the prognosis of patients with HCC after hepatectomy.

BACKGROUND:In animal experiments, transplantation of autologous nucleus pulposus cellscan effectively repair the intervertebral disk degeneration. However, nucleus pulposus cells have a poor ability of proliferation in vitro, which limits its application as seed cells in treatment of intervertebral disk disease.
OBJECTIVE:To construct recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase and observe the human telomerase reverse transcriptase mRNA expression in human nucleus pulposus cells in vitro.
METHODS:After the plasmid pSNAV2.0-pRSV-hTERT was constructed and identified, recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase were constructed, amplified and purified by AAVMaxTM package and purification system. The optimal multiplicity of infection for human nucleus pulposus cells was detected by recombinant adeno-associated virus type-2 vector carrying enhanced green fluorescent protein. According the optimal multiplicity of infection (5 × 104 v·g/cell), three different multiplicity of infection (1×104, 5×104, 1×105 v·g/cell) of recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase were determined to transfect the first passage human nucleus pulposus cells in vitro. In control group, the cells were transfected with adeno-associated virus type-2 vector without human telomerase reverse transcriptase. At 1, 2, 4 weeks after transfection, mRNA expression of human telomerase reverse transcriptase in human nucleus pulposus cells were semi-quantitatively detected by RT-PCR.
RESULTS AND CONCLUSION:The recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase was successful y constructed, and the titer of the obtained vector was more than 2×1011 v·g/mL. The optimal multiplicity of infection was 5×104 v·g/cell. The mRNA expression of human telomerase reverse transcriptase in human nucleus pulposus cells could be detected in different multiplicity of infection (1×104, 5×104, 1×105 v·g/cell). At 2 weeks post-transfection, mRNA expression of human nucleus pulposus cells was the highest (P<0.05), as detected by semi-quantitative RT-PCR. Moreover, the stable and high mRNA expression of human telomerase reverse transcriptase could be detected at 4 weeks post-transfection. In control group, no human telomerase reverse transcriptase mRNA expression was found. The recombinant adeno-associated virus type-2 vector carrying human telomerase reverse transcriptase can be successful y constructed, and can mediate a stable mRNA expression of human telomerase reverse transcriptase in human nucleus pulposus cells. Our findings provide a novel strategy of enhancing the properties of nucleus pulposus cells.

This paper has analysed the particularity of practice and teaching of oral and maxillofacial surgery.Binding with the change of medical pattern in recent years,the change of relation of doctors and patients as well as the present of "the People's Republic of China Practical Doctor Law"and "Rules of Sitling Malpractice",it has discussed that we should simultaneously think highly of raising to practice ability, reinforcing education of medical ethics, emphasizing legal consciousness and deepening ethics idea during practice teaching of oral and maxillofacial surgery,which can ensure well development of interns.

Objective To conduct a biomechanical evaluation of the four internal fixation methods to treat transverse acetabular fracture and find the b est one. Methods The transverse acetabular fracture models were created by osteo tomy in 12 pairs of embalmed cadaveric hip joints, and fixed with one of the fou r different methods: an anterior column plate (P/N), an anterior column plate w ith a posterior column screw (P+S), a posterior column plate with an anterior screw (S+P) and two posterior column plates (N/P?2). The biomechanical stabi lity was evaluated on longitudinal displacement, level displacement and stiffnes s measurements for fixed fracture fragments which were under 800 Newton vertical compression load. Results The longitudinal displacement in S+P was 3.99mm, in P+S 4.09mm, in N/P?2 5.07mm and in P/N 5.66mm; the level displacement in S+P was 0.015mm, in P+S 0.016mm, in N/P?2 0.022mm and in P/N 0.025mm; the average stiffness in S+P was 205.77N/mm, in P+S 207.52N/mm, in N/P?2 162.36N/mm and i n P/N 146.67N/mm. There were significant differences between the groups of S+P and P+S and the groups of N/P?2 and P/N (P

Objective To assess the outcome of fixation of Rüedi-Allg(o)wer type Ⅱ and Ⅲ pilon fracture using multiple low-profile plates (MLPP) via multiple incisions.Methods A retrospective study was made on 21 cases of pilon fracture immobilized using MLPP via multiple incisions between July 2007 and March 2012.There were 7 cases of Rüedi-Allgower type Ⅱ and 14 type Ⅲ.Fractures were reduced and fixed based on X-ray films and CT scans for fracture line and effect area.Quality of reduction was evaluated by Burwell-Charnley radiological score.Ankle and hindfoot functions were evaluated by American Orthopedic Foot & Ankle Society ankle-hindfoot scale.Fracture types,healing rate,and wound complication incidence were recorded.Results All fractures were healed,with the excellence rate of 95％ (20/21).According to AOFAS score,the results were rated as excellent in 11 cases,good in 6,fair in 4,with the excellence rate of 81％.None suffered from wound infection,except for wound dehiscence in 1 case and traumatic arthritis in 5.Conclusion Treatment of pilon fractures by MLPP via multiple incisions can reduce wound complications,promote reduction and stabilization of fracture,and satisfy the demand of early movement and late weight bearing of the ankle.

A child case of acute myocardial ischemia induced by symptomatic myocardial bridge (SMB)was reported and relevant literatures were reviewed in this article.The case and literatures indicate that myocardial bridge is a rare congenital coronary artery anomaly in children.The pathogenesis may be related to stenosis,spasm,arteriosclerosis of coronary artery because of myocardial bridge compression during systole.Clinical manifestations include chest pain,malignant arrhythmia,syncope,cardiac arrest and myocardial infarction.The diagnosis of myocardial bridge is based on cardiac imaging.SMB patients should be first treated with β-adrenergic; if ineffective,surgical treatment or implantable automated cardiac defibrillator shonld be chosen.The patients complicated with hypertrophic cardiomyopathy have worse conditions with high mortality.