BACKGROUND:Anterior dislocation of the shoulder joint is mainly due to trauma caused by anterior labral capsular ligaments complex functional deficiency. At present, the main clinical use is conservative treatment, but the long-term effect is poor, and cannot achieve the desired results.
OBJECTIVE:To study the biomechanical characteristics of dual fixed anchors and their effects in recurrent anterior dislocation of the shoulder with severe bone defect.
METHODS:According to the treatment, 88 patients with recurrent anterior dislocation of the shoulder with severe bone defect were divided into conservative treatment group (n=44) and dual fixed anchor group (n=44). Japan AG-ISOKN material tensile tester was used to measure biomechanical properties of dual fixed anchors. Conservative treatment group received closed manipulative reduction. Dual fixed anchor group received dual fixed anchor fixation. The repair effects were compared between the two groups.
RESULTS AND CONCLUSION:(1) Biomechanical parameters:in dual fixed anchor bending test, limit strength was (3 534±321) N;limit displacement was (21.12±2.50) mm;the yield load was (2 342±154) N;yield shift was (13.10±53) mm. Maximum axial pul out force was (809±25.2) N. The maximum spin torque was (1.2±0.3) N?m. (2) Clinical test results:Total effective rate was 96%in the dual fixed anchor group and 86%in the conservative treatment group (P<0.05). Ranges of motion of anteflexion and lift and shoulder joint stability score were significantly higher in the dual fixed anchor group than in the conservative treatment group during final fol ow-up (P<0.05). Range of external rotation motion was significantly smal er in the dual fixed anchor group than in the conservative treatment group (P<0.05). The complication rate was lower in the dual fixed anchor group (11%) than in the conservative treatment group (25%) (P<0.05). (3) Results verified that dual fixed anchors have good biomechanical characteristics, may have ideal repair effect in the treatment of recurrent anterior dislocation of the shoulder with severe bone defect, and can improve functions and activities of the shoulder joint. The low complication rate is more conducive to shoulder reconstruction.

Pediatric acute myeloid leukemia(AML)is still a fatal disease.Recent evidence based clinical study indicated intensified chemotherapy contribute to improvement of pediatric AML survival,while supporting care was an important measurement to let patients tolerate more and more intensifying chemotherapy.Recent series of clinical trial reveals that benefit from more intensified chemotherapy will be limited.Combined risk stratification of genetics and minimal residual desease monitoring may further increase the survival.Tyrosine kinase inhibitors,Gemtuzumab ozogami-cin and Chimeric antigen receptors modified T cell based targeted therapy could be the only way to cure resistant AML. In this review,advance in conventional chemotherapy,hematopoietic stem cell transplantation,and targeted therapy for pediatric AML were reviewed.

Based on the analysis of 26 malignant trophoblastic tumor patients detected by CDFI (Color Dopper Flow Image) and PD between 2001 and 2005,the article is an attempt to explore the clinical significance of CDFI and PD in treating the trophoblastic diseases in the early stage,including diagnosing the pathologic process,judging the chemotherapy effect and predicting the pathologic changes.

Cochleae of guinea pig, cat, and human fetus were studied under SEM. After tbe treatment with osmic and tannic acids, they were dehydrated by a critical point drier, then coated with carbon and gold, and observed under a JSM-35 scanning electon microscope.The organ of Corti looks like a spiral staircase winding around the modiolus. It is wider at apex and narrower at base. The vestibular membrane is composed of squamous epithelia covered with microvilli. The tectorial membrane is mainly composed of parallel fibrils, but at its surface and marginal region, the fibillae interwoven. There are three rows of outer hair cells (OHC) and one row of inner hair cell (IHC) in the organ of Corti, and the head plate of pillar cells is set in between both kinds of cells. The stereocilia of OHC are arranged in W-form, whereas those of IHC are in a curved arrangement. All the cells observed have microvilli, however, in some of the animal specimens, the stereocilia are irregularly arranged, damaged or entirely disappeared owing to noise exposure.In the four-month fetal cochlea, the cuticular plates of OHC looks just like velvet balls, which afterwards become W-shaped stereocilia, while on the surface of IHC, primitive hair bundles develop into a curved arrangement.Certain broken organ of Corti shows cylindrical body of OHC and its cup-like supporting structure. Phalangeal processes of Deiter ceils and OHC are obliquely arranged forming an angle. The pillar cell body is thin above and thick below, and twined with very thin nerve network.The tunnel cavity can be exposed by removing the roof structures, then longitudinal nerve fibers going along the tunnel bottom may be clearly seen. These fibers belong to the spirotunnel bundle——an efferent branch of olivo-cochlear bundle.

Vibrio parahaemolyticus is an important food-borne pathogenic bacterium that widely exists in all kinds of seafood.As the traditional media and method were very costly-time and money,a new chromogenic medium(HKC vibrio)was designed in this assay.Through detecting the artificially contaminated samples and natural samples,the sensitivity,specificity and detection effect of HKC vibrio were studied and compared with CHROMagar vibrio and TCBS.The results showed that HKC vibrio had the same sensitivity as CHROMagar vibrio and TCBS,also had highly specificity.In conclusion,HKC vibrio was an invaluable medium which may improve the detection efficiency of Vibrio parahaemolyticus dramatictly.

Objective To investigate the effect of thymopentin combined with routine medication on serum interleukin 17A(IL-17A),chemokine 12 (CXCL12) levels and transient receptor potential channel 1 (TRPC1)expression in elderly patients with chronic obstructive pulmonary disease (COPD).Methods 156 COPD patients were selected as study objects.They were randomly divided into two groups(n =78) according to the digital table.The control group received routine treatment,and the observation group received subcutaneous injection of thymopentin on the basis of routine treatment.Before and after treatment,the CD3+,CD4+,CD8+,CD4+/CD8+ levels were tested to compare the immunologic function of the two groups.Before and after treatment,the FEV1,FEV1/FVC,PEF were tested to compare the pulmonary ventilation function of the two groups.The IL-17A,CXCL12 levels in peripheral blood and TRPC1 level in bronchoalveolar liquid before and after treatment were tested and compared between the two groups.The adverse effect was compared.Results Before treatment,the CD3+,CD4+,CD8+ and CD4+/CD8+ between the two groups had not statistically significant differences (all P ＞ 0.05),which of the control group after treatment had no significant change (all P ＞ 0.05),the CD3+,CD4+,CD4+/CD8+ of the observation group [(65.17 ± 2.39) ％,(41.06 ±2.15) ％,(1.50 ± 0.74) ％] were significantly higher than control group [(52.66 ± 2.38) ％,(32.30 ± 2.05) ％,(0.80 ± 0.81) ％] (all P ＜ 0.05),and the CDs+ of the observation group [(24.02 ± 2.23) ％] was significantly lower than control group[(32.66 ± 1.97) ％,P ＜0.05].Before treatment,the FEV1,FEV1/FVC,PEF,the IL-17A,CXCL12 levels and TRPC1 level had no statistically significant differences between the two groups(P ＞ 0.05).After treatment,the peripheral blood IL-17A [(24.18 ± 3.69) pg/mL],CXCL12 levels [(193.50 ± 2.90) pg/mL] and TRPC1 level in BALF [(7.69 ± 1.14)ng/L] in the observation group decreased significantly(P ＜ 0.05),which in the control group also decreased significantly [IL-17A (34.25 ± 3.74) pg/mL,CXCL12 (205.37 ± 3.21) pg/mL,TRPC1 (14.25 ± 1.20)ng/L] (P ＜ 0.05),which of the observation group were significantly lower than those of the control group(all P ＜0.05).The incidence rates of adverse effects of the two groups were t6.67％,12.82％,there was no statistically significant difference(P ＞ 0.05).Conclusion Thymopentin combined with conventional therapy can effectively improve the elderly COPD patients'immunologic function and pulmonary ventilation function,decrease the inflammatory factor,relieve inflammatory reaction and it is safe and effective.

Objective To summarize the clinical manifestations,diagnosis and treatment of the primary hyperparathyroidism (PHPT).Methods The clinical data of 89 patients with PHPT admitted during 1991 to 2013 were retrospectively analyzed.Results The mean age of the 89 patients was (44.7 ± 15.8) years (13-86 years),male to female ratio was 1 ∶ 2.1.79％ of the 89 patients were symptomatic.62％ of the 89 patients had been misdiagnosed.52％ had been misdiagnosed as kidney stones or bone diseases (fracture,tumor,and metabolic bone disease).The remaining subjects had been misdiagnosed as peptic ulcer,rheumatoid arthritis or pancreatitis.The median serum parathyroid hormone (PTH) level in 88 patients was 697.3 pg/ml (26.4-5 000.0 pg/ml,n =88),the mean serum calcium level was (3.03 ± 0.56) mmol/L (n =88).The 24 h urine calcium was (10.02 ± 4.73)mmol/24 h (n =36).The sensitivity of localization of the parathyroid lesions with technetium-99m methoxy-isobutylisonitrile (99mTc-MIBI) was 96％,being higher than ultrasound (71％),CT (71％),and MRI (72％) (P＜0.05,respectively).79 cases had been treated surgically.The median serum PTH level was 748.2 pg/ml (46.1-5 000.0 pg/ml) before surgery,79.9 pg/ml (11.35-838.0 pg/ml) 15 minutes after surgical removal of the lesions (P＜0.05 vs preoperative) and 22.9 pg/ml (2.3-1 203.0 pg/ml) on the first postoperative day (P＜0.05 vs preoperative).Serum calcium was (3.03 ± 0.56) mmol/L before surgery,(2.25 ± 0.37) mmol/L on the first postoperative day (P＜0.05 vs preoperative) and (2.08 ± 0.36) mmol/L on the second postoperative day (P＜ 0.05 vs preoperative).After the operation,42 cases(53％) had perioral and limb numbness,2 cases (3％) had hoarseness of voice and bucking while drinking,1 case(1％) had tetany.All these symptoms were improved after calcium supplementation.67 patients (85％) had been diagnosed as parathyroid adenoma pathologically,7 patients (9％) as hyperplasia,3 patients (4％)as cysts,and 2 patients (3％) as carcinoma.Among 67 cases of adenomas,62 cases had a single parathyroid adenoma,1 case with multiple parathyroid adenomas,and 4 cases with ectopic parathyroid adenomas.The ectopic lesions were located below the thyroid,in the rib cage,left mediastinum,and above the sternum.Conclusions The majority of domestic PHPT was symptomatic.Delayed diagnosis of PHPT is still very frequent.The clinical presentations of PHPT are variable,determination of serum calcium and PTH level simultaneously is the keypoint for early identification and diagnosis of PHPT.The clinician should be familiar with the various clinical manifestations of PHPT and thus enhance understanding of pathogenesis of the disease.99mTc-MIBI scintigraphy remained the first choice of preoperative imaging localization of the parathyroid lesions,followed by ultrasound,CT,and MRI.Surgical removal of the lesions is effective and safe.

Objective To compare the effect of endoscopic retrograde cholangiopancreatography sphincterot-omy plus laparoscopic cholecystectomy(ERCP/S +LC)and laparoscopic common bile duct exploration(LCBDE)in the treatment of cholecystolithiasis patients with concurrent choledocholith.Methods Retrospective analysis was made of information of 280 cholecystolithiasis patients with concurrent choledocholith,who were randomly divided into group A (n =60)and group B (n =220).group A was arranged with LCBDE and group B was treated ERCP/S +LC. The operation time,hospital stay after operation,hospitalization fee,size of common bile duct calculi,stone clearance rate and the incidence of postoperative complications were compared.Results The operation time,hospital stay after operation,hospitalization fee,size of the common bile duct calculi,stone clearance rate and the incidence of postopera-tive complications of group A &B were (95.58 ±22.66)m vs.(87.46 ±40.25)m,(15.18 ±5.46)d vs.(14.32 ± 4.21)d,(2.45 ±0.32)ten thousand yuan vs.(2.89 ±0.64)ten thousand yuan,(1.12 ±0.34)cm vs.(1.39 ± 0.38)cm,96.6% vs.91% and 1.6% vs.3.2%.There was no significant difference in calculus clearance rate between the two treatments(χ2 =1.44,P >0.05 ).Patients in LCBDE group spent slightly less on hospitalization expenses than patients in ERCP/S +LC group,but there was no significant difference shown(t =0.923,P >0.05). Patients in ERCP/S +LC group had suffered a relatively high incidence of complications than patients in LCBDE group,and significant difference was found(χ2 =4.17,P <0.05).Conclusion Both LCBDE and ERCP/S +LC are effective minimally invasive therapies for concurrent cholecystolithiasis and choledocholith,and should be clinically applied in accordance with their specific characteristics.

Objective To discuss the indications and efficacy for treating tibia insertion avulsion fracture of the posterior cruciate ligament(PCL)by the mean of the end of ligament suture via arthroscopy.Methods Twenty-one cases of tibia insertion avulsion fracture of PCL were treated with suture the end of ligament via arthroscopy from June 2007 to June 2009,including 14 males,7 females,with a mean age of 31.5 years(range,13-52 years).The insertion avulsion fragment was fixed to the tibia with two strands of 5Ethibond threads via arthroscopy.Two bone tunnels(2.5 mm in width)were made from the anterior part of the tibia to the posteromedial(at 4:30 toward)and posterolateral(at 7:30 toward)of the tibia bone bed respectively.Then the sutures were pulled out through the two bone tunnels and tied to the door-nail.Reduction and healing of the avulsion fragment,relaxation and mobility degree of knee,and the influence of osteoepiphysis to teenage patients were observed after surgery.KT-2000 value and Lysholm score were calculated.Results All cases were followed up from 10 to 24 months,with an average of 13.5 months.All the fragments were united without displacement in all cases according to X-ray films.One case showed posterior drawer test(+),but the tibia insertion was healed.The knee extension in all cases was unlimited,and 10° to 15° flexion limitation was found in 2 cases.The average range of flexion was 140.5°±3.8°.On average,KT-2000 value was(1.2±0.4)mm,Lysholm score was 95.2±2.7.Conclusion For treating the avulsion fracture of PCL,suture the end of ligament via arthroscopic transfixion can get a reliable fixation and a satisfied function of the knee,especially,which is suitable for the small avulsion fracture fragments,the adolescent patients with premature epiphysis.

Objective To explore the application effect of self management mode during internship of nursing interns.Methods 100 nursing students were randomly divided into the experimental group (self management group)and the control group(traditional pattern group),50 cases in each gronp,The control group adopted strict practice management according to the traditional method,the experimental group adopted self management mode.Times of being late,absenteeism,academic achievement and operation performance were compared between two groups.Results Times of being late,absenteeism in the experimental group were less than those of the control group,while academic achievement and operation performance in the experimental group were significantly lower than the control group,the difference between the two groups were statistically significant.Conclusions The implementation of self management mode for nursing interns can effectively improve the nursing students' ability of self management,improving the teaching quality,ensure nursing safety.It is worthy of clinical application.