The key reason for reparative process interruption of femoral head necrosis is the formation of hardening layer, which make it hard for medicine to act on the necrosis center. The research on formation mechanism of hardening layer is limited and the reason for reparative process interruption is unknown. Based on lots of pathological section and literature data, four hypotheses about the reason for reparative process interruption are proposed, including resource competition, damage of stress, disturbance of nerves and stasis of blood vessel. The internal mechanism of incomplete reparation and chronicity of hardening layer was analyze from different aspects. The four hypotheses provides a new thinking for study the reason for reparative process interruption.

OBJECTIVE:To observe the clinical efficacy and safety of Biyuan tongqiao granule combined with Triamcinolone acetonide spray in the treatment of chronic rhinosinusitis. METHODS:120 patients with chronic rhinosinusitis were randomly divid-ed into observation group and control group,with 60 cases in each group. Control group was given Triamcinolone acetonide spray 220 μg,qd,in first week,decreasing to 110 μg,qd;observation group was additionally given Biyuan tongqiao granule 15 g,tid, on the basis of control group. Both groups were treated continuously for 10 weeks. The clinical efficacy of 2 groups were observed as well as the levels of MTR,IL-5 and IL-8,SNOT-20 score,VAS score and Lund-Mackey sinus CT score before and after treat-ment. The incidence of ADR was compared between 2 groups. RESULTS:Total effective rate of observation group was 93.3%, which was significantly higher 85.0% of control group,with statistical significance(P<0.05). There was no statistical significance in IL-5,IL-8,MTR,SNOT-20 score,VAS score and Lund-Mackey sinus CT score between 2 groups before treatment(P>0.05). IL-5 and IL-8 levels of 2 groups decreased significantly,while MTR,SNOT-20 score,VAS score and Lund-Mackey sinus CT score were decreased significantly;the observation group was better than the control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Biyuan tongqiao gran-ule combined with Triamcinolone acetonide spray is effective in the treatment of chronic rhinosinusitis,and can effectively improve the quality of life and relieve clinical symptom with good safety.

Objective To investigate the main causes and risk factors of recurrent retinal detachment (RRD) after silicone oil removal (SOR) in eyes with complex retinal detachment.Methods It was a retrospective case series study.A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study.All patients underwent vitrectomy operation.Additionally,they were given heavy water,membrane peeling,retinotomy or partial cutting,intraocular laser photocoagulation or frozen,gas-liquid exchange or direct oil exchange operation accordingly.Ninety-eight eyes with multiple holes,old retinal detachment,hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously.Intravitreal silicone oil was padded at the end of operation.Cutting,stripping or resection and 360° preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR.Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation.One week after SOR and during follow-up,the visual acuity,intraocular pressure (IOP),slit lamp microscope,and ophthalmoscope examination were examined with the same technique and methods as preoperation.The eyes were divide into two groups based on the attachment status of retina after SOR,which were reattached group (419 eyes) and redetached group (39 eyes) respectively.The following data were recorded.,the age of patients,ocular axial length,logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and IOP before vitrectomy operation and before and after SOR,the number of retinal breaks,the duration of silicone oil filling,the duration of follow-up,and the related factors during vitrectomy operation and SOR.The relation of age,sex,high myopia,the size and location of holes,aphakic eye,proliferative vitreoretinopathy (PVR) C3 level and above,previous history of failed retinal detachment operation,360° preventive laser photocoagulation,assistant scleral buckling surgery,SOR via corneal puncture to RRD after SOR were analyzed.Odds ratio (OR) and its 95％ confidence interval (CI) were calculated for the age ＜40 years old and gender.High myopia,assistant scleral buckling surgery and SOR via corneal puncture were further analyzed by multiple regression equation.Results After SOR operation,the total average logMAR BCVA was 0.86 ± 0.63.The average logMAR BCVA was 0.82 ± 0.59 and 0.99 ± 0.70 respectively for the reattached and redetached groups,which was not statistically different (F=1.559,P＞0.05).The number of high myopia eyes in the reattached and redetached groups were 116 and 22 eyes,respectively,accounted for 27.7 ％ and 56.4 ％,and the difference was statistically significant (x2=13.984,P＜0.01).Three eyes underwent vitrectomy with scleral buckling occured RRD,accounting for 3.1％; while 36 eyes underwent vitrectomy without scleral buckling occured RRD,accounting for 10.0％.The incidence of RRD between them was statistically significant (x2 =4.761,P＜0.05).The incidence of RRD was not retated to the PVR levels before the operation,previous history of failed retinal detachment operation,aphakic eye and preventive laser photocoagulation (OR=1.626,1.699,1.986,0.709; 95％ CI:0.836-3.162,0.832-3.658,0.921-4.279,0.268-1.875; P＞0.05).RRD had a close relation with high myopia and assistant scleral buckling surgery (OR=3.380,0.284; 95％CI:1.733-6.595,0.086-0.944; P＜0.05).The raise of risk derived from SOR via corneal puncture had no statistical significance (OR=2.119; 95％CI:1.043-4.306; P＞0.05).The incidence of RRD after SOR was 8.5％; of which,35.9％ originated from new breaks and 69.2％ were related to new breaks,in contrast,only 5.1％ originated from PVR but 51.3％ were related to PVR.Conclusions High myopia is an independent prognostic risk factor of RRD after SOR.Combined scleral buckling surgery is a protective factor of RRD after SOR.To the well reattached eyes before SOR,the new breaks seems to be the main cause of RRD,wheras PVR was probably a secondary phenomenon.

Objective To investigate the role of nitric oxide(NO)in the spinal cord sensitization in a rat model of neuropathic pain.Methods Thirty-two male adult Wistar rats weighing 200-300 g were randomly divided into 4 groups with 8 animals in each group:group Ⅰ sham operation;group Ⅱ L-NAME pretreatment + sham operation;group Ⅲ CCI and group Ⅳ L-NAME pretreatment + CCI.Neuropathic pain was induced by chronic constrictive injury(CCI).The animals were anesthetized with intraperitoneal pentobarbital 40 mg/kg.The right sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 3-0 silk thread.In group Ⅰ and Ⅱ the sciatic nerve was exposed but not ligated.In group Ⅲ and Ⅳ L-NAME 250 μg in normal saline 10 μl was injected into subarachnoid space over 30 seconds at 15 min before sham operation or CCI.The paw-withdrawal threshold to nociceptive thermal stimuli(PWTT)was measured before operation(baseline)and on the 3rd day after operation.Four rats in each group were killed on the 4th and 7th day after operation,and lumbar segment of the spinal cord(L4-5)was removed for determination of expression of pCREB in the dorsal horn of spinal cord by immuno-histochemical technique.Results The paw-withdrawal threshold to nociceptive thermal stimuli(PWTT)was significantly decreased on the 3rd day after operation as compared with the baseline before operation in all 4 groups.The PWTT on the 3rd day after operation was significantly higher in group Ⅰ,Ⅱ and Ⅳ than in CCI group(group Ⅲ),but there was no significant difference in the PWTT after operation among the 3 groups(Ⅰ,Ⅱ,Ⅳ).The expression of pCREB in the dorsal horn neurons of spinal cord was significantly upregulated in CCI group (Ⅲ) as compared with the other 3 groups.Conclusion Spinal cord NO induces hyperalgesia in neuropathic pain through release of pCREB in spinal cord dorsal horn.

Objective To explore the wound healing of semi-toe nail flap donor site after transplantation. Methods To repair small wounds,on 13 toes the first metatarsal dorsal flaps were applied,and on 7 toes the second toe digital flaps were applied.While,to repair large wounds,free flaps were applied,including foot inside flaps on 3 toes,peroneal artery perforator flaps on 5 toes,tarsal lateral artery flaps on 2 toes,and phil bowel artery inside branch flaps on 3 toes.Wounds remaining on semi-toe nail flaps of 7 toes were all covered with fibular island flaps of the first toes. Results Twenty cases were followed up,and the rang between 6 months to 5 years.The nail margin was exposed out of the lateral flaps in 2 cases.The first toes and the second toes appeared nearly normal in the other 18 cases.The flaps appeared smooth,flexible appearance with nice color and no ulceration.Seven cases applied with free flaps recovered protective sensibility with no complaint. Conclusion To cover wounds on semi-toe nail flaps of the first toes and the second toes with flaps is an ideal treatment method.The method of free flap transplantation is superior to vascular pedicle flap graft.

Objective To test the releasing property of a self-developed plastic drug delivery implant of anti-infective nano-hydroxyapatite(nano-HA)so as to provide a new local drug delivery system(LDDS)for treatment of osteomyelitis.Methods The nano-HA was used as the core carrier to load gentamicin(GM).It was coated with poly hydroxybutyrate-co-hydroxyvalerate /polyethylene glycol(PHBV/PEG)to prepare the nano-HA-PHBV/PEG-GM microspheres which were mixed with the fibrin sealant(FS)to develop a plastic implant.Then its antibacte rial and in vitro releasing properties were investigated.Results The plastic LDDS implant was found to have a fine drug delivery capability.The bacterial growth inhibition zone was found around the LDDS for 56 days in the antibacterial test.Three samples were soaked with liquid of PBS(phosphate buffered saline).The titer of GM released within the first day was 154.3 ?g/mL,and then the releasing maintained a slow level in the following days.After 49 days'releasing,the titer was 6.9 ?g/mL which was still higher than the MIC(2 ?g/mL)(minima l inhibitory concentration)of GM.Conclusion The plastic LDDS has a fine in vitro releasing property and may have a widespread application in treatment of osteomyelitis.

Objective To explore the patterns and features of biological effects of ?-ray irradiation combined with microwave on the mouse hematopoietic system, and to provide theoretical and experimental basis for understanding the possible mechanism of the bone marrow injury caused by the combined action of microwave and ?-ray irradiation. Methods 216 healthy KM mice were randomly divided into the following four groups: normal control, microwave (S frequency range, 50mW/cm~2), ?-ray irradiation (5.5Gy), microwave combined ?-ray radiation (5.5Gy + 50mW/cm~2). They were sacrificed at 6h, 1, 3, 7, 14, 28, 90 and 180 days after radiation, respectively, then the histological and ultrastructural changes in the bone marrow and the peripheral hemogram were observed. Results Histopathological changes: the bone marrow appeared to be obviously injured either by radiation or microwave exposure, characterized by undergoing four phases, namely apoptosis-necrosis, void, regeneration and recovery phase. However, the pathological changes were more obvious and the recovery was slower in microwave combined ?-ray radiation group. Peripheral hemogram: the numbers of leucocytes, erythrocytes and platelets, and the content of hemoglobin decreased in both ?-ray irradiation group and microwave combined ?-ray radiation group, and the decrease in microwave combined radiation group was more remarkable. Ultrastructure: the bone marrow hematopoietic cells underwent obvious degeneration, apoptosis and necrosis in microwave combined ?-ray radiation group especially at 6 hours after radiation. Conclusion ?-ray combined with microwave could induce hematopoietic dysfunction and pathomorphological changes in hematopoietic organ, which were mainly caused by ?-ray, and the changes were aggravated.

Objective To evaluate the diagnostic method for and surgical effect on hilar cholangiocarcinoma. ] Methods The clinical features, diagnosis, surgical therapy and long term result were retrospectively analysed on 192 cases of hilar cholangiocarcinoma admitted into our hospital from Jan.1984 to Jun.1999Results] MRCP delineated 100%(44/44) of the hilar tumors. 153 cases underwent exploration. 88 cases treated by internal or external drainage have survived for 3～15 months. Tumor resection was performed on 53 cases, and orthotopic liver transplantation on 2 cases, with a resection rate of 36%(55/153) including radical resection in 38 cases (median survival period was 31 months). 17 cases undergoing palliative resection have a median survival period of 13 months. Conclusion MRCP was an ideal noninvasive preoperative examination for identifying hilar cholangiocarcinoma. Routine frozen section of the bile duct margin should be adopted. Radical resection definitely prolongs survival period. For Bismuth type Ⅲ、Ⅳ without extrahepatic metastasis, orthotopic liver transplantation was an effective surgical therapy.

Students generally felt difficult in studying during clinical practice and the orthopedics teaching quality was unsatisfactory due to the discrepancies existed among teaching of anatomy,imagie and orthopedics clinical practice concerning the time,content,requirement and method.Students' understandings of anatomy and image knowledge were improved through launching theoretical study by means of lectures and case discussion.Students' understandings of orthopedics diseases were promoted through preoperative diagnosis and intraoperative conformation using anatomy and image knowledge for the patients they were responsible for.In all,orthopedics clinical teaching quality was promoted through applying these measures.

Objective To investigate the effect of vascularized fibula with fibular flap to repair limb bones and soft tissue defects.Methods Transpositional fibulas were used to repair tibiae defects in 4 cases.Free fibular transplantation was used in 6 cases,including folded fibular transplantation in 3 cases distal femur repair in 2 cases,calcaneus repair in I case.Hole fibular transplantation was used in 11 cases to repair tibia radius and metatarsal bones.Semi-fibular transplantation was used to repair metacarpal bone defects in 2 cases.All transplanted bones were together with the flap to repair bones and soft tissue defects.Results Twenty cases were all survived,with bone healing time of 6 to 10 weeks,and weight bearing time of 3 to 6 months,fifteen cases were followed up for 6 months to 4 years,and the results showed that their transplanted bones became thicker,their lower limbs recovered to normal walking,hand grip function recovered,the transplanted flaps were elastic.Conclusion Vascularized fibula and fibular flaps transplantation was an effective way to repair limb bones and soft tissue defects.