The combination of biochemistry analyzer and medical expert system was proposed in this report. Biochemistry analyzer is one of the most important analytical instrument used in clinical detection. It could take immunological examination and biochemical analysis for blood, urine, pleural effusion and cerebrospinal fluid and other body fluids. Medical expert system is an intelligent program system with knowledge and experience of a large number of medical specialists. It could use the knowledge and method of medical experts to solve and deal with problems in the field. This system mainly includes human interface, inference engine, interpreter, knowledge acquisition procedures, integrated database and knowledge base. Some parts of system design, such as the expression and design, and interpretation mechanism of the knowledge base, have been interpreted in details. It adopts production as an expression of knowledge. Generally, knowledge was expressed as if the conditions, then the conclusion form. Interpretation mechanism use the error counter propagation of neural network to train the algorithm (BP algorithm for short).The combination could automatically conduct comprehensive analysis of various data generated by the instruments, and then obtain the science theoretical foundation and the most reasonable specialist conclusions. This report provides an overview of the system design of medical expert system.

OBJECTIVE:To improve the synthesis technology of sorafenib tosylate (Ⅰ). METHODS:The intermediate N-methyl-(4-chlorpyridin-2-yl)carboxamide(Ⅳ)was obtained by chlorination and amidation with 2-picolinic acid as the starting com-pound. Meanwhile,N-[4-chloro-3-(triflouromethyl)phenyl]-N′-(4-hydroxyphenyl)urea (Ⅶ) was prepared from aminophenol and 4-chloro-3-trifluoromethyl phenyl isocyanate,which was obtained from 4-chloro-3-(trifluoromethyl)aniline(Ⅴ)by reaction with initiator triethylamine. Sorafenib tosylate was synthesized from Ⅳ and Ⅶ with potassium tert-butoxide by condensation and salt for-mation. The target compound was characterized by 1H-NMR. RESULTS:The target compound was confirmed as Ⅰ,with the over-all yield of 74% [based on 4-chloro-3-(trifluoromethylanilin)]. The purification of chromatogram was 94%. Optimized technology improves yield and simplifies multi-step intermediate decompression,distillation and purification process;the application of initia-tor shortens the duration of reaction. CONCLUSIONS:Ⅰ is prepared successfully,and raw material can be obtained easily and is easy to operate with high yield.

ObjectiveTo evaluate the diagnostic value of high-frequency ultrasonography for dorsal wrist cyst.MethodsThe ultrasonographic characteristics of 136 dorsal wrist cysts were retrospectively studied and compared with the pathological results, the locations and the imaging characteristics of the cysts were analysed, hence to conclude the diagnostic value of high-frequency ultrasonography.ResultsBased on the anatomical location diagnosed by high frequency ultrasound, the 136 dorsal cysts were divided into three types: extensor retinaculum cysts, synovial tendon sheath cysts and dorsal interosseous ligament cysts, each accounted for 1.5% (2/136), 24.3% (33/136) and 74.2% (101/136) of the study group. The most frequently detected locations for dorsal cysts were dorsal scapholunate ligament,tendinous sheath of extensor digitorum and extensor indicis, as well as tendinous sheath of extensor carpi radialis longus and brevis,each accounted for 60.3% (82/136), 8.1% (11/136) and 6.6% (9/136) of all dorsal wrist cysts respectively. Dorsal wrist cysts had typical ultrasonographic features on 2-D gray-scale ultrasonography, the extensor retinaculum cyst demonstrated as a well-marginated, small-sized and oval anechoic area, which was commonly located in the oedematous extensor retinaculum, but it had no adjunction with the extensor tendon, and it was accompanied with dorsal scapholunate ligment cyst frequently. Synovial tendon sheath cyst demonstrated as a oval or eggplant-shaped anechoic area which was usually winding around the extensor tendon, but it had no adjunction with the dorsal interosseous ligament and the extensor retinaculum. Meanwhile, the dorsal interosseous ligament appeared to be normal strip-like echo texture with a smooth and clear margin. Dorsal interosseous ligament cyst demonstrated as a out-of-shape anechoic area and located superior to the injured ligament. Meanwhile, the impaired ligament was thickened with uneven margin and decreased echo texture. No blood lfow signals was detected in all dorsal wrist cysts by color doppler lfow imaging.ConclusionHigh-frequency ultrasonography can be used to diagnosis dorsal wrist cysts, and can be served as the preferred imaging modelity to guide the clinical treatment.

This article was aimed to study the chemical constituents in groups of effective components extracted from Xiaoxuming Decoction. Twelve compounds were isolated and purified by dynamic axial compression column chromatography. Their chemical structures were identified by spectral analysis. The results showed that twelve compounds were isolated and identified as octacosanoic acid(1), cetanol(2), oroxylin A(3), wogonin(4), baicalein(5), tetrandrine(6), fangchinoline(7), wogonoside(8), baicalin(9), paeoniflorin(10), amygdalin(11), manntol(12). It was concluded that all compounds were isolated from this compound prescription for the first time.

Metastatic encephaloma from lung carcinoma is one of the nost common intracranial tumors,which is paid to more and more attentions in Neurosurgery.Patients with metastatic neoplasm suffer great physiological and psychological pain for short survival time and survival of poor quality.In terms of treatment,surgery is the major method for metastatic encephaloma of lung cancer.But the subject range of surgery is limited to many factors,therefore many patients can not be treated with surgery.In order to solve the issue of applicability restriction,diversified adjuvant treatment strategies appear successively,such as chemotherapy,targeted therapy,immunotherapy.It has been verified by a number of clinical evidences that these therapies can prolong lifetime and improve living quality of patients.But at the present stage,there is no an uniform standard for the treatment of metastatic encephaloma from lung carcinoma.To give full play the role of each treatment,it is important to understand the advantages and disadvantages.Only in this way,can the patient's interests be optimized.

OBJECTIVETo study the methods and therapeutic effects of posterolateral tibial plateau fractures with an extended anterolateral approach.

METHODSFrom January 2011 to December 2013, 15 patients with posterolateral tibial plateau fractures were treated by extended anterolateral approach, including 9 males and 6 females, with an average age of (38.4±7.7) years old ranging from 23 to 70 years old. Seven patients were on the left knees and 8 patients were on the right knees. The injury causes included traffic accidents in 6 cases, falling from height in 7 cases, and falling down when walking in 2 cases. The time from injury to operation was 2 to 14 days (means 5.6 days).

RESULTSAll patients were followed up with an average of 19.7 months ranging from 12 to 30 months. All patients were followed with anteroposterior and lateral X ray and CT films, which showed anatomic reduction or near anatomic reduction. The follow up CT scan showed an anatomic reduction in 14 patients and step and gap measurement of 3 mm in 1 case. The average radiographic bony union time was 9.6 weeks (ranged from 8 to 14 weeks). There were no wound complications, nonunion, plate loosening or breakage, valgus knee deformity, or fracture redisplacement. No patients sustained neural or vascular injuries, with knee extension of (2.1±2.1)° and knee flexion of (120.6±18.9)° at the final follow up. The total Rasmussen score averaged (25.0±2.8) points, the result was excellent in 10 cases, good in 4 cases, fair in 1 case.

CONCLUSIONSThe extended anterolateral approach has the advantage of allowing visualization of the posterolateral tibial plateau fragments, therefore facilitating its reduction. The approach also ensures safe and adequate posterior placement of a lateral buttress plate because the plate can be placed more posteriorly than can occur through an anterolateral approach.

OBJECTIVE: To explore the genetic basis for a child featuring hypotonia, ataxia, and delayed development syndrome (HADDS). METHODS: Whole exome sequencing was carried out for the child. Candidate variant was verified by Sanger sequencing of the child and his parents. RESULTS: The child was found to harbor a de novo heterozygous c.625G>A (p.Arg209Trp) variant of the EBF3 gene, which has caused substitution of Arginine by Tryptophan. The variant may has impaired the binding affinity of EBF3 with DNA and altered its subcellular localization, and ultimately decreased the transcriptional activity of the EBF3 gene. CONCLUSION The c.625G>A variant of the EBF3 gene probably underlay the pathogenesis of HADDS in this child. Above finding has expanded the spectrum of EBF3 variants and enriched the clinical manifestations of the HADDS.
Child ; Humans ; Ataxia/genetics* ; Intellectual Disability/genetics* ; Muscle Hypotonia/genetics* ; Mutation ; Syndrome ; Transcription Factors/genetics* ; Exome Sequencing ; Male

OBJECTIVETo investigate the clinical effects of surgery reduction and internal fixation through posteromedial knee approaches in the treatment of posteromedial condylar split fracture of tibial plateau.

METHODSFrom January 2006 to July 2009,21 patients with posteromedial condylar split fracture of tibial plateau were treated by posteromedial knee approaches. Among the patients, 14 cases were males and 7 cases were females,ranging from 28 to 68 years old with an average of 36.9 years old. For traumatic causes, 14 cases were injured by traffic accident and 7 cases by fall. Compound injury, 15 cases combined with anterior cruciate ligament injury and tibia insertion avulsion fracture; 14 cases combined with posterolateral de-pressed tibial plateau fracture. Rasmussen assessment criteria was used to evaluate the therapeutic effects.

RESULTSAll patients were followed up,from 12 to 30 months with an average of 17.3 months. All patients didn't undergo infection,looseness and rupture of fixation,nonunion of fracture,inversion and eversion of the knee or displacement of fracture. All cases attained anatomical reduction after operation,only 1 patient felt numbness of posterior lower part of the calf. According to Rasmussen assessment criteria, 12 cases got an excellent result, 7 good and 2 fair.

CONCLUSIONIt is beneficial for the postermedial knee approaches to be used in the reduction and fixation of posteromedial condylar split fracture of tibial plateau. It has advantages of clearly exposure, convenient placement of the internal fixation, less trauma and good therapeutic effects.

Adult ; Aged ; Bone Nails ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Fractures, Closed ; surgery ; Humans ; Knee Injuries ; surgery ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Tibial Fractures ; surgery

Adult ; Aged ; Early Diagnosis ; Female ; Fractures, Ununited ; diagnosis ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Tomography, Spiral Computed ; Young Adult

OBJECTIVETo investigate the clinical manifestations, pathological features, diagnosis and treatment of stromal tumor in the seminal vesicle.

METHODSWe retrospectively analyzed 1 case of stromal tumor of the seminal vesicle, reviewed relevant domestic and international literature, and summarized the clinical manifestations, pathological features, diagnosis and treatment of the tumor.

RESULTSThe patient was a 50 years old male, who underwent excision of the tumor together with the seminal vesicle. Pathology showed it to be stromal tumor of the seminal vesicle. Ultrasonography and CT found no recurrence 10 months after surgery.

CONCLUSIONStromal tumor of the seminal vesicle is rare and easy to be misdiagnosed. Digital rectal examination, and ultrasonography, CT and MRI of the urinary system are useful for its diagnosis. The currently accepted treatment is surgical removal of the tumor, and the prognosis is good.

Cystadenoma ; Genital Neoplasms, Male ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Seminal Vesicles