Objective To investigate the pathological changes of bone in situ lengthening for the gunshot bone defect, and to discuss the practical feasibility and biological basis of bone lengthening in the conditions of periosteum damage. Methods The 38 canines were randomly distributed into two groups and sustained the same gunshot bone defect in the mid femoral diaphysis. In one group, the femur were stabilized with Bastiani external fixator and 2 weeks later the fractured limb with fixation were lengthened 2-4 times per day at a speed of 0.5-1 mm/d until the normal length was reached. The control group only had external fixation without lengthening. 3, 6 and 12 weeks after injury, the canines were given 99mTc MDP and got radionuclide examination under SPECT (ADAC company, USA.). Pathological and X ray observation were carried out at 1, 2 ,3 ,6 and 12 weeks respectively after injury for comparison between two groups. Results The X ray measurement showed that the length of callus distraction in the bone lengthening group increased by (2.82?0.94)cm and the relative lengthening of bone is 19.3% (15.8%-21.4% ), compared with normal femur on the same X ray film. The count of radionuclide increased gradually at the region of bone defect in the lengthening group. While in the fracture ends, no significant difference was found in the development pattern through each radionuclide observation phase between two groups. The main mode of osteogenesis was endochondral ossification and the bone defect area was enriched by chondrocyte in the bone lengthening group. Conclusion There are no obvious negative influence on bone turnover and local blood flow in the bone lengthening for gunshot bone defect. The remained periosteum and bone fragment under gunshot injury may have important role in the progression of osteogenesis. The neogenetic capillary provided not only blood supply for healing of bone but also source of osteocyte for bone lengthening in the case of the periosteum and blood circulation damaged with gunshot wound.

To observe the local microcirculation changes in primary bone lengthening for gunshot bone defect treated by external fixators, the experimental study was carried out by using canine model of gunshot bone defect of extremities. 16 mongrel dogs were randomly divided into 2 groups, external fixators were used to distract early callus in one group and plaster was used for immobilization in the other group. The local microcirculation in the two groups was measured. The results showed: (1) Different from the normal fractures, the local blood flow of gunshot fractures was reduced in the first 3 days and then increased, at the 6th week it was close to the normal level. (2) There was no significant difference in the restoration of blood flow between the groups of external fixation and plaster immobilization. It is suggested that primary bone lengthening for gunshot bone defect by external fixators has no adverse effect on the restoration of the local blood flow.

Objective To compare the efficacy and safety of glargine(Lantus) versus biphasic insulin aspart 30 (30% free and 70% protamine-bound, BIAsp 30) after continuous subcutaneous insulin infusion treatment (CSII) in newly diagnosed type 2 diabetes mellitus. Methods A 20 week open and random study was performed. All 60 patients with newly diagnosed T2DM were randomly divided into two groups. Group B patients was treated by glargine and group A received treatment with BIAsp 30 administered immediately before dinner and breakfast. Blood glucose at 7 time points, glycosylated hemoglobin A1c(HbA1c) and hypoglycemia were observed. Results The postprandial glucose(PPG) was significantly lower in group B than in group A (P<0.05), and the frequency of hypoglycaemic episodes was lower in group B than in group A (P<0.05). The fasting blood glucose(FBG) was not different between two groups (P>0.05). And there was no difference between two groups in HbA1c and other adverse events. Conclusions Glargine is surperior to BIAsp30, not only in controlling the PPG but also in reducing the incidence of hypoglycemia.

Objective To explore the management strategy of hepatic trauma. Methods From January 1997 to January 2008, a retrospective study was performed on 112 cases of hepatic trauma. Base on the classification of AAST,non-operative treatment was used in 40 hemodynamic steady patients (grade Ⅰto Ⅱ), hepatic repair was therapeutic method to grade Ⅱ to Ⅳ (48 cases), while hepatectomy or plus selective ligation of hepatic artery were chosen for grade Ⅳ to Ⅴ (13 cases). Peripheral hepatic tamping or plus selective ligation of hepatic artery were effective therapeutic approaches to grade Ⅳ to Ⅴ (11 cases) according to damage control surgery. Results In the operative case.s, 60 cases were cured, 12 died. All non-operative cases were cured. Conclusions Non-operative management is widely becoming one of the most important strategies in the treatment of hepatic trauma with stable hemodynamics. Surgical intervention is still the principal measure of treatment for severe hepatic trauma. According to specific condition, appropriate operative procedures, damage control surgery and prompt management of associated injury will earn a higher success rate.

Objective To evaluate the clinical efficiency and safety of thiazolidinediones (TZDs) on treat-ment of patients with nonalcoholic fatty liver disease (NAFLD). Methods The published controlled clinical trials about TZDs on treatment of patients with NAFLD from 1998 to 2008 were identified by searching in the full-text data base,such as Medline, PubMed, Ovid, EMCC, CBM Disc, CNKI, Wanfang, Weipu data and so on, as well as by searching of cross references from original articles and reviews. The enrollment standard was formulated strictly ac-cording to the designs of trials, and Meta analysis was performed by software package of Review Manage 4.2. Further-more, the statistic test, sensitivity and publication bias about the combined statistic data were revealed by referring to forest-graph and funnel-plot. Results All of the 473 patients in 18 controlled clinical trials were enrolled in this study. The weighted mean diffrerence of serum ALT, AST,TC,TG and BMI, HOMA-IR before and after treatment with TZDs 32. 24 (18.98-45.49) (Z=4.77,P<0.05),20.32 (2.30-38.35) (Z=2.21,P<0.05),0.26 (-0.01-0.54)(Z=1.88,P=0.06),0.63 (0.33-0.93) (Z=4.14,P<0.01),and -0.06 (-0.66-0.55) (Z=0.19, P=0.85),2.63 (1.33-3.93) (Z=3.96, P<0.01). In all papers, the improvement of hepatic tissue after treatment with TZDs in patients with NAFLD was observed in only 6 articles, which demonstrated the hepatic steatosis, inflammation and fibrosis [WMD (95% CI) 1.59 (1.08-2.10), 1.45 (0.90-2.00), 0.72 (0.12-1.32), Z= 6.08,5.16,2.33,P<0.05],especially the degree of NASH activity index,whose WMD (95% CI) was 4.21 (3.13-5.28) and Z=7.66,P<0.01, were improved significantly in the 104 NASH patients taken this kinds of drugs. There were 7 patients exiting from the all chnical trial, and the main adverse effects in patients accepting treat-ment with TZDs were debility, dizziness, edema of lower extremity, weight gain, indisposition of gastrointestinal tract, elevated liver enzyme and so on, which were similar to the control group. Conclusions The therapeutic effects of TZDs on NAFLD is confirmed. Not only are the serum liver enzyme,TC,TG and HOMA-IR in patients with NAFLD improved, but this new euglycemic agent has no acutely adverse effect in clinical application,which confirms the clin-ical efficiency and safety of TZDs on treatment of patients with NAFLD.

This study aimed to identify Belamcandae Rhizoma, Iridis tectori Rhizoma and their adulterants by ITS2 sequence. All the DNA samples of Belamcandae Rhizoma, Iridis tectori Rhizoma and their adulterants were extracted. The ITS2 sequence were succesfully amplified, and purified PCR products were sequenced. All the sequences were assembled using the CondonCode Aligner V3.7.1. The Kimura 2-Parameter (K2P) genetic distances and the Neighbor-Joining (NJ) phylogenetic tree were calculated by using MEGA5.1. Results indicated that the maximum intraspecific genetic distances of Belamcandae Rhizoma was 0, and the average GC content was 52.22%;the maximum intraspecific genetic distances of Iridis tectori Rhizoma was 0.004, and the average GC content was 67.87%. The maximum K2P intraspecific genetic distance of Belamcanda chinensis, Iris tectorum were both lower than the minimum interspecific genetic distance of adulterants. Additionally, the ITS2 sequences in each of these polytypic species were separated into pairs of divergent clusters in the NJ tree. The NJ tree based on ITS2 sequence indicated that Belamcandae Rhizoma, Iridis tectori Rhizoma and their adulterants could be distinguished clearly. It could be concluded that ITS2 barcode can be used to correctly identify Belamcandae Rhizoma, Iridis tectori Rhizoma from their adulterants, and ensure their safety in use.

Objective To investigate the accuracy of fetal weight estimation by modiefied uterine fundal height.Methods Totally 547 pregnant women admitted to maternity ward of the Second Affiliated Hospital of Chongqing Medical University from December 1,2013 to April 30,2014 with childbirth were chosen as the subject.The modified uterine fundal height were measured by the uterus inclination and modiefied fundal height admeasuring apparatus,normal uterine fundal height and and abdomen circumfer-ence were measured by tape.The fetal weight was estimated by utilizing modified uterine fundal height.Results The modified fun-dal height was(31.7±2.30)cm,which was significantly higher than that normal fundal height(34.7 ± 2.46 )cm(t = 54.25,P <0.01).The accuracy rate of modified uterine fundal height for fetal weight estimation with empirical formulas,Yuan′s,Zhuo′s,Lin′s,Zen′s,Gu′s were 68.4%,69.7%,59.4%,67.8%,69.3%,78.4%,respectively.The accuracy rate of normal uterine fundal height for fetal weight estimation with the same formulas were 53.4%,34.4%,54.3%,46.1%,38.8%,45.9%,respectively.The accuracy rate of modiefied uterine fundal height for fetal weight estimation with empirical formulas,Yuan′s,Lin′s,Zen′s,Gu′s were significantly higher than that of utilizing normal uterine fundal height estimation with the same formulas(P <0.01).Conclusion Modified uterine fundal height has better accuracy in estimating fetal weight,it has a important clinical significance.

Objective To report a new approach of splenic hilar lymph nodes dissection in radical gastrectomy for gastric cancer. Methods 193 cases of gastric cancer patient receiving radical resection of gastric cancer between May 2008 and October 2008 were studied. The tail and body of spleen and pancreas were thoroughly freed with retroperitoneal way retrogressively and extruded out of abdominal cavity in 80 cases. The other 113 cases received operation with routine way. Results In 80 cases who received operation with retroperitoneal approach retrogressively, the total splenic hilar lymph nodes were 519, the positive ones were 65, the positive rate was 12.5 %; In the other 113 cases the total splenic hilar lymph nodes were 565, the positive ones were 58, the positive rate was 10.3 %. The positive rate had statistic significance between these two groups. Conclusion Extruded splenic hilar lymph nodes dissection with retroperitoneal approach retrogressively is safe and has the same effect with splenectomy in gastric cancer operation.

Objective The purpose of this study was to assess the antibacterial effects of hematoporphyrin monomethylether-photodynamic therapy (HMME-PDT) on Enterococcus faecalis within infected simulated lateral canals in vitro with different energy.Methods Simulated lateral canals were prepared on extracted teeth.The specimens were infected with Enterococcus faecalis and then were randomly divided into eight groups.Group A was considered as negative control,its specimens were irrigated with physiological saline.Group B was the positive control,they were irrigated with 5.25％ NaClO.Other groups were incubated with HMME at concentration of 40 μg/ml for 5 min,followed by exposure to light at 532 nm for 120 s with different powers in a spiral pattern.Groups were named C-H,in corresponding with the power 50,60,70,80,90,100 mW.Microbial samples (the dentin chips from simulated lateral canals) were taken before and after the treatments.The survival fractions in each simulated lateral canal was calculated by counting colony-forming units(CFUs).Results 1.The HMME-PDT-treated groups resulted in a significant reduction in the number of E.faecalis in simulated lateral canals compared with the negative controls(P＜0.05).2.The antibacterial effects of group D、E、F、G、H were higher than the NaCl0-irrigated group(P＜0.05).3.The difference of antibacterial effects between the F、G、H groups was in significant(P＞0.05).Conclusion HMME-PDT had significant inhibitive efficacy on Enterococcus faecalis within infected simulated lateral canals and the efficacy was power-depended.It can play the best effect with the power of 80 mW.

Objective To Study the effect of efflux pump-inhibitors(EPI)-Verapamil in photodynamic therapy (PDT) using hematoporphyrin monomethylether (HMME) as photosensitizer on the cariogenic bacteria in dental plaque biofilms.Methods According to the administrator order of the verapamil and photosensitizer in PDT,streptococcus mutans,streptococcus sanguis,eosinophilic lactobacillus and actinomyces viscosus were used to establish the dental plaque biofilm model.The experiment was divided into five groups,group A was incubated with the photosensitizer and verapamil group,group B using verapamil before incubated the photosensitize,group C suing photosensitizer before incubated verapamil,group D with PDT only,group E was control group.After laser treatment,the influence of the dental plaque biofilms was observed by confocal laser scanning microscope.Results As saline-treated group is a group of normal the dental plaque biofilms.In PDT only group,compared with the saline group,red fluorescence increased significantly,the bacteria lose accumulation capacity,and were isolated and scattered in dispersed state.In PDT plus verapamil group,compared with only PDT group,green staining increased,bacterial activity increased.In group B,cells were incubated with verapamil before incubated the photosensitizer group,green staining increased significantly,red fluorescence reduced,indicating live bacteria increased,and bacteria activity was significantly increased.Conclusion PDT is an effective method in eliminating cariogenic bacteria of dental plaque biofilms.Bacterial efflux pump inhibitors can lower HMME-PDT inhibition cariogenic bacteria in dental plaque biofilm,and pre-verapamil administration could significantly inhibit the effect of PDT treatment of dental caries.