Objective To explore the use of lamivudine alone induced the poor response,especially the related factors of the occurrence of YMDD.Methods Retrospective analysis of 160 cases of the poor answering cases after lamivudine treatment,the baseline parameter values,the time appearing to the poor answering and the HBVDNA load in treatment were analyzed,to study their relationship with poor response.Results The lamivudine prolonged,the poor response to the probability gradually increase.The mutation rate in the 12nd month was 19.67％ and in the 36th month was 49.18％ ( P ＜ 0.05 ).Response to the many reasons,the YMDD mutation is the more common one.The relationship among HBVDNA load,ALT level on baseline and the rate of poor response emergence,the YMDD mutation rate was clear.By comparison in groups,the difference was significant (P＜0.05).Conclusion The lower baselins of ALT level,the higher of HBVDNA load,the greater probability of the poor response and the YMDD mutation.

[Objective]To discuss the perioperative management of thoracolumbar fractures fixed with latero-anterior screw-plate system.[Method]The entry point and direction of screw on 30 thoracic and lumbar vertebra specimens were marked based on the principle and demand of implantation of latero-anterior screw-plate system and were determined exactly by anatomic landmarks in order to make reference for operation.Sixty patients with thoracolumbar fractures were treated with anterior decompression,bone grafting and internal fixation from January 2000 to June 2007.Reference data such as the length of vertebral body screw and plate and the height of bracing gotten from the patients'X-ray and CT findings before operation were compared with practical data measured during operation.The entry point and the direction of screw were determined exactly by anatomic landmarks of thoraco lumbar vertebrae and were checked by X-ray during operation.[Result]The judgement of the entry point and the direction of screw was easy and accurate during operation and the reference data were in coincidence with practical data.The effects of operation were satisfactory.[Conclusion]The perioperative management is both scientific and practical.The surgical complications can be reduced in this way.

[Objective]To explore the mechanism of hip joint capsule contracture induced by intragluteal injection. [Method]Thirty young Chinese rabbits were divided into four groups of A(n=6),B(n=6),C(n=6) and D(n=12) at random.Rabbits in groups A,B and C were treated with deep intragluteal injection of penicillin dissolved in 2% benzyl alcohol(group A),2% benzyl alcohol(group B)and penicillin dissolved in physiologic saline(group C).Rabbits in group D were treated with immobilization of unilateral hip joint and deep intramuscular injection of physiologic saline on the homolateral buttock.Each rabbit was injected twice a day for 20 days.Specimens were obtained at 30,60 and 90 days after first injection and the evaluation of the functions of hind limbs was obtained at the same time.The thickness of hip joint capsules were measured with micrometer and sections of joint capsules were stained by Sirius red and were observed with microscope and polarization microscope.[Result]Capsules of hip joint in group A and B became thicker and contractural,and the change of joint capsules was reflected in the change of motion of hind limbs.Sections in groups A and B showed shrinked capsules with thick collagens in disordered arrangement;while there were no gluteus contracture and contracture of joint capsule in the other groups.[Conclusion]Deep intragluteal injection of penicillin dissolved in 2% benzyl alcohol or 2% benzyl alcohol into young rabbits can cause contracture of hip joints.The contracture of joint capsule is largely induced by tissue trauma and repair of joint capsules.The limited locomotion of hip joint induced by the contracture of gluteal muscle does not play an important role in the contracture of joint capsule.

National advanced training course of traditional Chinese orthopedic and traumatology in anatomy experiment is a short-term courses designed for grassroots doctors.Special training content and methods are designed for the multi-level cadets in the short-term courses.How to use teaching staff advantage to optimize course setting and improve the teaching effects will be discussed in this article.

Objective To investigate the expressions of Sema4D and HER-2 in breast cancers and their relationship with microlymphtic vessel density (MLVD).Methods MLVD and expressions of Sema4D and HER-2 were detected in 110 cases of breast cancer tissues by immunohistochemistry.The relationship of Sema4D and HER-2 expressions with clinicopathologic parameters was analyzed.Results The positive expression rate of Sema4D and HER-2 was 71.82％ (79/110) and 33.64％ (37/110),respectively,with a statistically significant differences compared to those in the control group ( P ＜0.01 ).The positive expression rates of Sema4D and MLVD in cases with lymphatic metastasis were higher than that without lymphatic metastasis ( P ＜ 0.01 ).The expressions of Sema4D and HER-2 were closely correlated with the histological grade,TNM stage,lymph node metastasis,and expression of ER of breast cancers ( P ＜0.05),but were not related to tumor size and expression of PR (P ＞ 0.05 ).On univariate analysis,the disease-free survival rate of patients with Sema4D positive expression was better than those with its negative expression ( P ＜ 0.05).Sema4D expression was positively correlated with the HER-2 expression ( r =0.535,P ＜ 0.01 ).Conclusions Sema4D may play important roles in the carcinogenesis and development of a breast cancer.

Objective:To investigate the immunomodulatory effect of Astragalus Saponin on macrophages and explore the mechanisms of its immunomodulation.Methods:By adding different concentrations of AS into cultured mice peritoneal macrophages,the influence of AS on synthesis of nitro oxide(NO)was observed by NO Kit(enzymic method).MTT assay was used to determine the cytotoxicity of macrophages induced by AS.The morphological changes of the macrophages were identified by Transmission Electron Microscope.LSCM and specificity fluorescent probe Fluo-3/AM were applied to observe the change of Ca2+ in the macrophages induced by AS.Results:AS could significantly increase NO synthesis,enhance the capacity of mice peritoneal macrophages for cytotoxicity to carcinoma cells.The surface projections of the macrophages were exhibited multiplicating,thickening and extenting via Transmission Electron Microscope.Augmented intracellular Ca2+ in the macrophage was observed by LSCM.Conclusion:AS can enhance the immune functions of macrophages,the increase of intracellular Ca2+ be one of the mechanisms of its immunomodulatory effects.

Objective To review the treatment results of intracytoplasmic injection(ICSI) of epididymal or testicular sperm obtained from 38 obstructive azoospermic patients.Methods Sperm was retrieved by percutaneous epididymal sperm aspiration(PESA) or testicular sperm extraction(TESE).Intracytoplasmic injection was performed.The rates of fertilization and clinical pregnancy were evaluated.Control group was set up in which intracytoplasmic injection was performed using sperm of ejaculation.Results Forty-one treatment cycles were performed in the 38 obstructive azoospermc patients.The rates of fertilization and clinical pregnancy were 73.3% and 53.6%.Thirty-three treatment cycles were done in the 31 ejaculatory ones.The rates of fertilization and clinical pregnancy were 75.1% and 48.4%.No significant difference was seen between the two groups.In the obstructive azoospermia group,22 clinical pregnancies were achieved including 13 live deliveries and 3 ongoing pregnancies and 6 miscarriages.In the ejaculatory group,16 clinical pregnancies were achieved including 10 live deliveries and 5 ongoing pregnancies and 1 miscarriages.Conclusions ICSI with PESA or TESE is an effective method for treatment of obstructive azoospermic patients.

Objective To investigate the role of miR-223 in the pathogenesis of acute gouty inflammation.Methods The subjects were divided into 3 groups:65 acute gout patients (AG),50 inter-critical gout patients (IG),and 45 healthy controls (HC).The peripheral blood mononuclear cells (PBMCs) and the clinical laboratory parameters were all collected.The expression of miR-223 in the PBMCs was detected using realtime fluorescent quantitative polymerase chain reaction (RT-qPCR) (TaqMan probe).The PBMCs of 5 healthy people were stimulated with monosodium urate (MSU) (100 μg/ml) for 12 h,and then,miR-223,NLRP3 mRNA and IL-1β production were all measured using RT-qPCR and ELISA respectively.All data were analyzed by SPSS 17.0 statistical software,Wilcoxon rank sum test,t test and Spearman's correlations analysis were used for statistical analysis.Results ① The expression of miR-223 in AG and IG groups was both significantly decreased than that in the HC group (8±17 vs 26±76,P＜0.05;9±17 vs 26±76,P＜0.05;respectively),AG group was significantly decreased than that in the IG group [8(17) vs 9(17),Z=11.387,P＜0.01].② After stimulated with MSU in healthy controls,IL-1β production and NLRP3 mRNA were both significantly increased [(86±5) pg/ml vs (13±6) pg/ml,t=21.042,P＜0.01;5.2±0.4 vs 1.2±0.4,t=14.640,P＜0.01;respectively],while the expression of miR-223 was significantly decreased (0.34±0.20 vs 1.05±0.24,t=-5.164,P＜0.01).Conclusion The data suggests that miR-223 might be involved in the patho-genesis of spontaneous regulation,but further study is needed to discover the exact mechanism.

Objective To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer by systematic review and meta-analysis.Methods The literature database before February,2012 was extensively searched to retrieve the comparative studies of LATG and open total gastrectomy(OTG) with a relevance of study goal.The inclusion and exclusion criteria were formulated.Aftera quality evaluation,the data was extracted.The Cochrane collaboration RevMan 5.1 version software was used for meta-analysis.Results There are ten studies meeting the inclusion criteria for meta-analysis.The total sample size of these studies was 942 cases.Compared to OTG,LATG experienced longer operation time [weighted mean difference(WMD) =41.12 min,95％ confidence interval(CI):20.62-61.63,P ＜0.01)],less blood loss(WMD =-198.36 ml,95％ CI:-300.94--95.78,P ＜ 0.01),earlier time to flatus(WMD =-0.80 days,95％ CI:-1.17--0.42,P＜0.01),shorter hospital stay(WMD =-4.02days,95％ CI:-6.03--2.01,P ＜ 0.01) and decrease in overall complications [relative risk (RR) =0.55,95％ CI:0.40-0.76,P ＜ 0.01)].The number of dissected lymph nodes,proximal or distal resection margin and mortality were similar between the two groups.Conclusions Laparoscopy-assisted total gastrectomy is a safe and feasible procedure with less blood loss,less overall complications and quick recovery.

Objective To evaluate the clinical feasibility of quality assurance of helical tomotherapy intensity modulated radiation therapy (IMRT) through a series of clinical case studies. Methods Tomotherapy planning system was used to provide optimized IMRT treatment plans. To verify the dose of IMRT plans,the cylindrical Virtual Water phantom,0.056cm3 AISL, ion chamber and EDR2 film were used for getting the absolute and relative doses from tomotherapy IMRT planning. The film and ion chamber were placed into the phantom. The doses of the interesting points and isodose distribution of the axial plane were measured,then the results were compared with those from the calculation in planning system for verification. Before the irradiation,kVCT images of the phantom were registered by tomotherapy MVCT images. So the setup of phantom was guided for verifying the position. Results The isedose distribution (on the axial plane) measured by the film was well consistent with that calculated by tomotherapy planning system. The error between the measured dose and predicted dose in the measured points was less than 3%. The setup error of the phantom was able to be kept within 1 mm. There was 2 mm offset along the vertical direction of couch from the virtual isocenter to beam isocenter,which should be considered during the phantom/patient setup. Conclusions The procedures for quality assurance of tomotherapy IMRT are feasible in our experience. And helical tomotherapy IMRT QA system has been constituted.