Objective To evaluate the blood-saving effect of tranexamic acid in elderly patients undergoing total hip replacement.Methods One hundred and sixty ASA Ⅱ or Ⅲ patientss of both sexes,aged 65-70 yr,with a body mass index of 16-22kg/m2,undergoing total hip replacement,were randomly divided into 2 groups(n =80,each):control group(group C)and tranexamic acid group(group T).Anesthesia was induced with midazolam,fentanyl,etomidate and atracurium.The patients were tracheal intubated and mechanically ventilated.PEr CO2 was maintained at 35-45 mm Hg.Aneslhesia was maintained with propofol,remifentanil and atracurium.Before the skin incision,tranexamic acid 15 mg/kg was infused over 15 m in in group T,while the equal volume of normal saline was given instead in group C.Hemoglobin(Hb),platelet count(PLT),prothrombin time(PT),and activated partial thromboplastin time(APTT)were monitored during operation to guide blood transfusion.Intraoperative and postoperative blood loss and allogeneic blood transfusion were recorded.Postoperative complications were also recorded.Results There was no significant difference in the amount of intraoperative blood loss between the two groups(P ＞ 0.05).The amount of postoperative blood loss was significantly smaller and less allogeneic red blood cell was transfused in group T than in group C(P ＜ 0.05).No complications occurred after operation in either group.Conchusion Tranexamic acid has blood-saving effect in elderly patients undergoing total hip replacement,but the clinical value is limited.

Objective: To investigate the expressions of tumor stem cell markers EpCAM (epithelial cell adhesion molecule) and CD133 proteins in human primary hepatocellular carcinoma, and to explore their relationships with clinicopathological features and the prognosis. Methods: The expressions of EpCAM and CD133 in liver cancer tissues from 70 patients with primary hepatocellular carcinoma were detected by immunohistochemistry. The survival analysis was performed, and the correlations of EpCAM and CD133 with the clinicopathological features and the prognosis were analyzed using SPSS (Statistical Package for the Social Sciences) software package 17.0. Results: The positive rates of CD133 and EpCAM proteins were both significantly higher in liver cancer tissues than those in paracancerous tissues (P < 0.01). Aberrant expression of CD133 was observed in the paracancerous tissues. The positive expression of CD133 was positively correlated with vascular invasion in liver cancer tissues (P < 0.05). The expression level of EpCAM in poorly differentiated liver cancer with vascular invasion in patients with preoperative AFP level over 400 ng/mL was significantly higher (P < 0.05). There was a positive correlation between EpCAM expression and CD133 expression (P < 0.01). The survival of patients with strongly positive expression of CD133 (or EpCAM) was inferior to that of patients with moderately-weakly positive expression of CD133 (or EpCAM). In the subgroup of preoperative AFP level over 400 ng/mL, the survival of patients with moderately-strongly positive expression of EpCAM was inferior to that of patients with weakly positive expression of EpCAM. The factors of the number of tumors, preoperative AFP level, tumor capsule and CD133 expression were independent predictors of prognosis of primary hepatocellular carcinoma. Conclusion: CD133 and EpCAM may be associated with the progression of primary hepatocellular carcinoma, and their high expression may indicate poor prognosis, thus it is suggested EpCAM (+) AFP (+) primary hepatocellular carcinoma subtype has features of high-grade malignancy. Copyright © 2012 by TUMOR.

Hepatocellular carcinoma(HCC)is a common world wide disease.Transcatheter arterial chemoembolization(TACE)has been the first choice for the unresectable midadvanced ones.However, TACE has its own limitation such as high recurrence rate and many complications, what's more, recurrence induced by neovascularization which is stimulated by activation of vascular endothelial growth factors promoted by ischemia and hypoxia in local tissues after the embolization always reduce the effect of treatment.And combination of TACE and anti-angiogenesis therapy is capable to make up the shortage of each other and reduce the recurrence rate, which has been a hot issue for non-surgical treatment of HCC.

The serum manganese, chromium, zinc and copper levels of 63 cases with coronary heart disease and 33 normals were determined by the inductively couple plasma emission spectroscopy. The concentrations of Mn, Cr, Zn and Cu were 0.02145 ?0.0107 ppm, 0.0230 ?0.0167 PPm, 0.905?0.278 ppm 1.056 ?0.404 PPm and the Cu/Zn ratio was 0.973 ?0.395 in normals.In comparing with normals, a significant increase in the serum zinc concentration (P

OBJECTIVE:To study the effects of trimetazidine on endothelin and nitric oxide(NO)in patients with unstable angina pectoris.METHODS:80 patients with unstable angina pectoris were randomly assigned to trimetazidine group(n=40)or conventional treatment group(n=40).The levels of endothelin(ET)and NO before treatment and at 4 weeks after treatment were determined.Meanwhile,another 40 healthy volunteers were assigned to normal control group and their fasting levels of ET and NO on resting were determined.RESULTS:In unstable angina pectoris patients,the NO level decreased significantly but plasma ET level increased significantly,showing significant difference as compared with the normal control group(P0.05).The level of NO increased markedly and the ET level decreased markedly in trimetazidine-treated group after treatment,showing significant differences as compared with before treatment(P

Objective To discuss clinical results of self-made anatomical dynamic hip lock plate (ADHLP) in treatment of intertrochanteric fractures. Methods ADHLP was applied in 73 patients in-eluding 52 males and 21 females at age range of 19-92 years ( mean 54.7 years). Fractures were caused by traffic accidents in 32 patients, sllp in 21, fall from height in nine and other factors in 11. According to the Evans' s classification system, there were 42 patients with type Ⅰ fractures, 17 with type Ⅱ, nine with type Ⅲ and five with type Ⅳ. Self-made ADHLP was applied to manage various fractures with differ-ent operation strategies. The curative effect of ADHLP was observed for evaluation of ADHLP. Results The operation lasted for mean 60 minutes (40-90 minutes). The volume of blood loss was mean 200 ml (100-400 ml). All patients were followed up for 6-48 months (average 36 months), which showed that the function of hips was satisfactory, with excellence rate of 99%. There were no complications like coxa yam, femoral head eoncis, rotation displacement, iatrogenic fracture, infection or internal fixation break and loosening. Conclusions ADHLP takes advantages of reasonable vitodynamics, wide operation in-dicatioas, convenient operation, minor trauma, fast recovery, stable fixation and few complications for in-tertrochantefie fractures, especial]y osteoporotie and gemntal patients.

Objective To investigate the treatment of Navicular bone fracture with Herbert screw.Methods Twenty-three patients with Navicular bone fracture were collected.They were all conducted with CT scan diagnosis and type,the small incision and targeting wire was used in operation.The Herbert screw was used to fix with pressure,plaster was also used to fix.After operation,the activity training was executed gradually.Results We conducted follow-up of 6-18 months in 23 patients,with an average of 12 months.All patients got bone-healing,the healing time ranges from 7 to 10 weeks,with an average of 9 weeks.There was one case of screw penetrating cortical bone,and one case of mild deformity healing,among the other 23 cases there were no complications including infection,nonunion,necrosis,osteoarthritis'etc.Conclusion The treatment of Navicular bone fracture with Herbert screw fixation can get firm fixation,function training and healing early,and it's worth of clinical promotion.

BACKGROUND: Scaffolds are an important part in bone tissue engineering. However, no perfect scaffolds have been developed for bone tissue engineering yet.OBJECTIVE: To evaluate the repair of rabbit radial defects by poly (L-lactic acid)/tricalcium phosphate(PLLA/TCP) scaffolds prepared by rapid prototyping(RP) technology so as to find a new carrier for growth factors.DESIGN: A completely randomized controlled study was conducted. SETTING: Orthopaedic institute of a military medical university.MATERIALS: The study was conducted in the General Orthopedic Institute,Fourth Military Medical University of Chinese PLA, from May 2001 to February 2002. Twenty clean New Zealand rabbits with body mass of(2.5 ±0. 5) kg for this study were obtained from the Experiment Animal Center of Fourth Military Medical University of Chinese PLA. The animals were divided into experiment group and control group with 10 rabbits in each group.INTERVETIONS: PLLA/TCP scaffolds prepared by RP technology and loaded with or without bovine bone morphogenetic protein (BMP) were used to repair the rabbit radial defects of 15 mm.MAIN OUTCOME MEASURES: Main outcomes: ① microscopic observation results of transplanted materials of the two groups; ② degradation rate of scaffolds. Secondary outcomes: ① gross observation; ② radiographic results; ③ bone density.RESULTS: At week 12, bone defect healing in experiment group was good. X-ray examination showed continuous bone callus and partial molding of different degrees. Degradation rate of scaffolds was 39.6%, and bone density in the defected part reached 70% of the normal level. All the indexes of experiment group were superior to those of control group, and no healing was found in the defected area in control group.CONCLUSION: PLLA/TCP scaffolds prepared by RP technology and loaded with bovine BMP can repair radial defects of 15mm in rabbits.

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.

Objective To analyse the effect of endoscopic thoracic sympathectomy of palma-plantar hyperhidrosis. Methods Between January 2006 and January 2009,77 cases with palma-plantar hyperhidrosis were operated by thoracoscope. Fifty-two cases of palma-axillary-plantar hyperhidrosis were performed sympathectomy of T2-T4 and 25 cases of palma-plantar were performed sympathectomy of T2-T3.Bilateral procedures were completed in the same position. Results After operation palmar hyperhidrosis and armpits hyperhidrosis all were cured. Of soles, 7 cases were completely dry, 34 cases nearly dry, 32 cases unchanged and 4 cases worse. There was no significant difference in the change of plantar hyperhidrosis between sympathectomy of T2-T3 and T2-T4 (P ＞ 0.05). Conclusions Bilateral single port for endoscopic thoracic sympathectomy produces slighter trauma and patients easily accept it. Plantar sweating can be relieved or nearly relieved in partial patients after thoracic sympathectomy. There is no difference in the effect of plantar hyperhidrosis between sympathectomy of T2-T3 and T2-T4.