The management of periprosthetic fracture following total knee arthroplasty (TKA) remains a challenging problem. Periprosthetic fractures are increased with increasing TKA times,aging,and increased activity after TKA. Periprosthetic fractures after TKA involves the femur,tibia,or patella,in particular at the supracondylar region of the femur. In addition,periprosthetic fractures can also occur in operation. According to fracture morphology,various cause factors,and the timing of fracture,a number of treatment options are available to treat this complex problem. Appropriate fracture classification would assist clinical physicians to evaluate fracture site,type,bone loss and prosthesis fixation. Because of the complexity,periprosthetic fractures often require tailored treatment to attain a more individualized treatment strategy to promote fracture healing,reconstruct bone mass and maintain joint function. Recently,with improving internal fixation materials and surgical techniques,the methods of surgical treatment of periprosthetic fracture have made great progress.

The relative content of DNA-RNA and the nuclear area/nucleolar area ratio of the hyperplastic tissue,glottic polypus,dysplastic tissue of grade I to I laryngeal squamous cell carcinoma were measured in 33 cases with image analysis technique.It was found that the changes of DNA-RNA content and the ratio of nuclear/nucleolar area were parallel to those of the severity of the carcinoma,and RNA was markedly increased in grade 11 and I dysplastic tissue.On the basis of the current grading of laryngeal pathology,the combined determination of DNA-RNA can provide more sensitive indicators to the stages of malignant degeneration of the laryngeal squamous cell carcinoma.

OBJECTIVE: Polyurethane (PU) and silicon rubber have good biocompatibility, excellent mechanical properties, easy processing and controlled properties, etc. Therefore, their researches exhibit an important significance in the designs of the medical appliance and body apparatus.DATA SOURCES: The computer respectively indexed the database articles of abroad El, SCI, CA, Science Direct (Elsevier) and Chinese periodical full text from January 1995 to May 2006, the indexed words were "Silicon rubber, polyurethane, medical materials", the article language category was limited respectively in English and Chinese.STUDY SELECTION: The relevant articles (full text) that meet the study were selected by the first trial. Inclusion criteria: ① Related to silicon rubber and polyurethane. ② The medical rubber apparatus and body organ design. Exclusion criteria: The repetitive studies.DATA EXTRACTION: Collect totally 122 relevant articles that use the medicinal rubber materials, and expel the repetitive or similar research,therefore 16 articles meeting the request.DATA SYNTHESIS: ① Medicinal gum, hose and other products: The medical stopper used for sealing is requested to have the flexibility,resistant to cold, water, oil and disinfectant, and pinprick can still keep the original closeness and gastightness, etc. ② The abroad body organs: The material of repairing fracture, skull, meninges, bridge, auricle, mandible,windpipe, tear bolt, lung membrane, heart valve, stomach, intestine,peritoneum, penis, knuckle, muscle, knee membrane, skin and breast. ③ The research and expectation of the medicinal silicon rubber and polyurethane offer more medicinal apparatus and body organ.CONCLUSION: The study of the medicinal silicon rubber and polyurethane make people design and produce more cheap artificial organ and medicinal apparatus. More materials were applied to the clinic, so that satisfy the demand of many patients.

Objective To explore the feasibility and t he efficacy of laparoscopic splenectomy of massive splenomegaly in the treatment o f hereditary spherocytosis in children. Methods Seven children with massive splenomegaly underwent laparoscopic splenectomy. Their age ranged 1~14 years (mean, 8.8 years), and their body weight was 10~57 kg (mean, 33.8 kg) . Three children had an accompanying cholelithiasis: 2 of them received a concom itant cholecystectomy and 1 of them, cholecystotomy. Results A ll the operations were successfully performed under laparoscope, and hand-assist ed splenectomy through a small incision was applied in 1 child because of bleedi ng of the splenic vein. The duration of operation was 50~150 min (mean, 90 min), the intraoperative blood loss was 30~500 ml (mean, 117 ml), and the length of h ospitalization, 4~10 d (mean, 5.5 d). The red blood cell counts had significantl y increased 3 days following the operation (t=2.652, P

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.

Objective To compare the efficacy, tolerance and cost of interferon (IFN) α-2b and adefovir (ADV) in patients with chronic hepatitis B (CHB) for two years. Methods The treatmentnaive outpatients with CHB were treated with IFN α-2b or ADV according to intention to treat.Among 77 patients, 34 were treated with recombinant IFN α-2b 5 MU once every other day subcutaneously (IFN group), 43 were treated with ADV 10 mg/day orally (ADV group). The medications were stopped or the regimens were changed due to intolerant adverse reactions or without effects according to intention to treat. The patients were followed up for 24 months. The therapeutic effects, adverse reactions, compliance and cost of two initial treatments were compared. The data were analyzed by Fisher exact probability test. Results The complete virological response (HBV DNA＜500 copy/mL) rates after 12 months of therapy in IFN group and ADV group were 41.2% (14/34)and 67. 4 % (29/43), respectively, while the alanine aminotransferase (ALT) normalization rates were41.2% (14/34) and 93. 0% (40/43), respectively. The rates in ADV group were both significantly greater than those in IFN group (both P＜0.01). There were no statistically significant differences of HBeAg negative rate and HBeAg seroconversion rate between the two groups. In IFN group, the expulsion rate was 23. 5% (8/34), the therapy was discontinued in 8. 8% (3/34) of patients due to adverse reactions and the medication was changed in 47.1% (16/34) of patients. In ADV group, there were no adverse reactions associated with medication during 2-year therapy and patients were well tolerant, the expulsion rate was 7.0% (3/43) and the regimen in 9.3% (4/43) of patients was changed (P＜0.01). The comparison of therapeutic cost between the two groups showed that the cost of anti-viral therapy, management with adverse reactions and laboratory examinations in IFN group were all higher than those in ADV group. The average cost per person of two years was increased with RMB 4855 yuan in IFN group. Conclusion In HBeAg-positive CHB patients, ADV is cost-effective and suitable choice for initial antiviral treatment.

AIM:To observe the effects of Tianma Gouteng Decoction on mRNA expression of L-Type Calcium Channel ?1 C subunit (CaL-?1C) and plasma membrane calcium-ATPase (PMCA1) in vascular smooth muscle cells of spontaneously hypertensive rat (SHR). METHODS:Twelve-week-old SHRs were assigned randomly to 5 groups:group A (treated with Tianma Gouteng Decoction),group B (treated with Tianma Gouteng Decoction excluded concha haliotidis),group C (treated with Nifedipine),group D (treated with concha haliotidis),group E (treated with normal sodium,NS),each group consisted of 9 rats was adminstrated,once a day for 4 weeks and mRNA expression of CaL-?1C and PMCA1 was measured with RT-PCR half-fix-quantify method. RESULTS:After 4-week-treatment,both Tianma Gouteng Decoction,Tianma Gouteng Decoction excluded concha haliotidis and Nifedipine could regulate downward mRNA expression of CaL-?1C in vascular smooth muscle cells and regulate upward mRNA expression of PMCA1 in vascular smooth muscle cells,concha haliotidis has no effect on mRNA expression of CaL-?1C and PMCA1. CONCLUSION:Tianma Gouteng Decoction can regulate downward expression of CaL-?1C,and regulate upward expression of PMCA1 at the same time,and meliorate the Ca 2+ overload in vascular smooth muscle cells with hypertension.

Objective To evaluate the usefulness of the submucosal tunnel ureteroileostomy using ileovalvular segment as afferent loop in preventing ureteral refluxes and upper urinary tract infection in detenia ceacal-colon continent urinary diversion. Methods Ten patients underwent submucosal tunnel ureteroileostomy in detenia ceacal-colon continent reservior and detenia coloneobladder and the follow up for ureteral reflux and upper urinary tract infection was carried out from 1998 to 2001. Results The patients were followed up for 6 to 36 months.No evidence of ureteral reflux and upper urinary tract infection was observed.Unilateral hydronephrosis was found in one patient caused by the ureteroileal anastomotic stricture. Conclusions Submucosal tunnel ureteroileostomy is an effective fashion for detenia ceacal-colon continent urinary diversion in preventing the postoperative complications of ureteral reflux and upper urinary tract infection.

[Objective]To investigate the treatment and results of reconstruction with composite type metal raiser block of proximal tibia AORI type Ⅱ bone defect in total knee arthroplasty(TKA).[Method]Nine patients(12 knees)of reconstruction with composite type metal raiser block of proximal tibia AORI type Ⅱ bone defect in TKA were followed from August 2004 to May 2008.There were 3 males with 3 knees and 6 females with 9 knees.The average age was 69 years ranging from 48 to 76 years.[Result]The average follow-up time was 26 months,ranging from 6 to 42 months.All genu varum and genu valgum were corrected.Pain disappeared and the motion of the knee was satisfactory.The HSS knee score improved from preoprative 14.5(range 10-25)to postoprative 85.5(range 74-95).The movement range improved from preoprative 74.6?(range 15?-100?)to postoprative 110.3?(range 80?-155?).[Conclusion]The appliance of composite type metal raiser block for proximal tibia AORI type Ⅱ bone defect in total knee arthroplasty is helpful for the constancy of prothesis and the achievement rate of opration.

Anhedonia is the loss of pleasure or lack of reaction to pleasurable stimuli, which is a promising phenotype of depression. In order to explore the potential biological mechanism, the recent ad?vances were summarized from researches focused on depression with anhedonia from neuroanatomy,inflamma?tion and immunology,and molecular genetics. The structural and functional brain imaging showed that the ac?tivity in reward?related brain regions of the depressive disorder with an anhedonia was changed during re?ward?related tasks.In addition,some other genetic studies based on the related neurotransmitter,such as do?pamine, together with the findings from the researches on immunological inflammation, may shed light on finding the potential targets for novel antidepressants,besides the 5?HT.