Objective To discuss the efficacy of micro-diameter and multiple-drilling core decompression in treatment of early femur head necrosis. Methods Sixty-eight patients with early femur head necrosis were selected, and they were divided into 2 groups by random digits table method. The experiment group (35 cases) underwent the micro-diameter and multiple-drilling core decompression (3.0-4.0 mm Kirschner wire or drill), and the control group (33 cases) underwent traditional instruments surgery. Results The operative time, hospital stay and pain score of postoperative hip joint Harris score in experiment group were better than those in control group:(41.2±7.4) min vs. (74.3±10.2) min, (9.7±2.3) d vs. (14.3±4.2) d and (43.56±2.12) scores vs. (37.21±1.19) scores, and there were statistical differences (P<0.01 or<0.05). There were no statistical differences in blood loss and overall hospital costs between 2 groups (P>0.05). There were no statistical differences in the total score of hip joint Harris score at 3 and 6 months after surgery (P>0.05). The total scores of hip joint Harris score at 12 and 24 month after surgery in experiment group were significantly higher than those in control group:(93.11± 2.43) scores vs. (91.23±2.89) scores and (85.23±2.43) scores vs. (73.54±2.89) scores, and there were statistical differences (P<0.05). Conclusions The micro-diameter and multiple-drilling core decompression is applied to the early femur head necrosis with less trauma, shorter operative time, higher clearance rate of necrotic bone and slower disease progression compared with traditional instruments. The micro-diameter and multiple-drilling core decompression makes patients' hip function get a satisfactory recovery with certain clinical applications.

Objective To investigate the therapeutic effect of tripterygium wilfordii and prednisone in old patients with primary nephrotic syndrome. Methods 78 elderly primary nephrotic syndrome patients were randomly divided into two groups. 42 patients in treated-group were treated with tripterygium wilfordii and prednisone while 36 patients in control-group were treated with prednisone only. The curative effect,24 hours urinary protein, serum albumin,plasma lipid and renal function were detemined after six months. The responses of the patients were classified as complete remission(CR) ,partial remission(PR) and NO-response. Results After six months treatment, there were 24 patients got to CR,12 patients to PR,and 6 patients remained refractory to treatment group. While there were 13 patients got to CR,10 to PR,and 13 as refractory in the control group. The general effective rate in the treatment group was 85.7% ,which was markedly higher than that of the control group,which is 66. 67% (P＜0. 05). The recurrence rate in the treatment group and control group were 14. 3% and 36. 1% respectively (P＜0. 05 ). Conclusion The curative effect of tripterygium wilfordii and prednison on elderly primary nephrotic syndrome is markedly better than prednisone only.

Objective To compare the placement of peripherally inserted central catheters(PICC)by using vascular ultrasound guidance system and traditional method.Methods Totally 938 patients undergoing PICC were divided into the traditional method group and the vascular ultrasound system and microintroducer techniques group according to the puncture time.The differences in the one-attempt success rate and the overall success rate of the placement and the incidences of complications were compared between the two groups.Results The one-attempt success rate was 93.01％ in the traditional method group and 98.76％ in the vascular ultrasound system and microintroducer techniques group(P =0.005).The successful rate of PICC placement was 100％.The incidence of complication was 11.29％ in the traditional method group and 2.47％ in the vascular ultrasound system and microintroducer technique group(P =0.000).Conclusion The PICC placement using vascular ultrasound guidance system and microintroducer techniques can increase one-attempt success rate and decrease complications.

Objective To study the relationship between essential hypertension(EH)with serum homocysteine(HCY),uroten-sinⅡ(UⅡ),angiotensin converting enzyme(ACE)and N-terminal pro-brain natriuretic peptide(NT-proBNP).Methods By collec-ting the clinical cases,UⅡwas determined by ELISA and HCY,ACE and NT-proBNP were simultaneously detected by ELISA.The detection results were analyzed and compared between the patients with essential hypertension(EH group)and the healthy con-trols.Results The levels of serum HCY,UⅡ,ACE and NT-proBNP in the EH group were significantly increased compared with the healthy control group;the area under curve (AUC)of serum HCY,UⅡ,ACE and NT-proBNP in the ROC curve in the EH group were 0.93,0.765,0.792 and 0.972 respectively,which showed clinical diagnostic significance.Conclusion The levels of HCY,UⅡ,ACE and NT-proBNP are highly expressed in EH and have significant differences compared with the healthy popula-tion,which has the diagnostic value to EH.

Objective To explore the clinical value of renal biopsy in the diagnosis of atypical lupus nephri-tis(LN). Methods The clinical and renal pathological data of 28 cases with atypical LN were analyzed retrospective-ly. Results All 28 patients could not fulfill the ACR diagnostic criterion,misdiagnosed as primary nephritic syndrome 21 eases,chronic glomerulone-phritis syndrome 4 cases ,asymptomatic hematuria 2 cases and asymptomatic proteinuria 2 cases,all renal biopsy showed changes consistent to lupus nephritis,pathological types:3 cases were class Ⅱ,4 cases were class Ⅲ,21 cases were class Ⅳ ,7 cases were class Ⅴ,2 cases was class Ⅳ+ Ⅴlupus nephritis,the clinical manifestations of nephritic syndrome were mostly pathological type Ⅳ and Ⅴ, the chronic glomerulonephritis syndrome showed diversification of pathological type, asymptomatic hematuria and/or proteinuria were mostly pathological type Ⅱ and Ⅲ. Conclusion clinical manifestations of atypical LN is no specific and easy to be misdiagnosed. Renal bi-opsy has great value in the diagnosis of atypical LN.

Objective To find out more optimal surgical approach for glioblastoma located in sensofimotor cortex and language area. Methods A respective review of 27 cases of glioblastomas located in sensorimotor and language area were operated, via the transsylvian-opercular approach, ineluding outcomes of microneurosurgery between January 2005 to December 2007. Results Among of 27 cases, tumors in 21 cases were covered by opereular cotex and were totally resected, tumors protruded into sylvian and wrapped around middle cerebral artery in 6 cases. 3 of them were totally removed, others were subtotally. Neurofunction of 26 cases were preserved of one were injuried. Conclusion Transsylvian-opercnlar approach for resection of glioblastomas located in subcortex of sensorimotor and language area is more optimal surgical approach, which not only ensure tumor resection with great degree, but preserve neurofunction well.

Objective To explore the correlationship between level of bFGF (basic fibroblast growth factor) in serum and synovia and X-ray severity (Kellgren-Lawrence Grading System) in patients with knee OA. Method 68 patients with knee OA were enrolled into this study. Knee OA grading was evaluated according to the Kellgren-Lawrence classification. bFGF levels in both serum and synovia were examined using enzyme-linked immunosorbent assay. Results The level of bFGF in serum and synovial fluid in patients with knee OA were positively correlated with radiographic severity (r = 0.619, P < 0.001 and r = 0.603, P < 0.001, respectively). Further analysis revealed that there was a positive correlation between the level of bFGF in serum and in synovia fluid (r = 0.688, P < 0.001). Conclusions Levels of bFGF in serum and synovial fluid were significantly increased in patients with OA, and levels of bFGF were positively correlated with radiographic severity. These findings indicate that bFGF levels may be a biomarker of disease severity and could play an crucial part in the pathophysiology of degenerative process in OA.

Objective Cervical heterotopic heart transplantation model was established in different inbred strains of mice with modified cuff technique. Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients, respectively. Mice were randomly assigned into four groups: control group (the donor hearts were perfused through coronary artery with 200 μl, 0℃～4℃ St. Thomas Ⅱ solution during 2 to 3 min, then they were immersed in it for 15 min), CsA group ( the donor hearts were perfused with the same method as for the control's and intraperitoneal injection of CsA 5 mg· g-1 · d -1 was given after surgery ), H2-B1 transfection group (the donor hearts were perfused through coronary artery with 200 μl, 0℃ -4℃ St. Thomas Ⅱ solution contained with 30 μg H2-Bl plasmid vectors during 2 to 3 min, then they were immersed in it for 15 min ), and H2-B1 + CsA group ( the donor hearts were perfused with St. Thomas Ⅱ solution contained H2-Bl gene plasmid and intraperitoneal injection of CsA was given after surgery as mentioned above. ). At 1,3 and 7 days after transplantation, three allografts were harvested at each time points in all of the groups, respectively, for pathological examination and analysis of CD40 expression with immunohistochemistry assays. The expression of Th1/Th2 cytokines were also determined with flow cytometry. The survival time of rest allografts were observed. Results Histological features for rejection were observed more apparent in the grafts of control group than those in other groups, especially those in H2-Bl + CsA group. The expression of CD40 in H2-Bl + CsA group and CsA group was lower significantly than that of the control group ( P ＜0.01 ), so was the expression of CD40 in the H2-Bl group as compare with that of the control group (P ＜0.05). No significant difference between H2-Bl group and CsA group (P ＞0.05 ) at 7 days was observed. The expression of IL-2, TNF-α (Th1 cytokines) in control group was much higher than that in other groups, and the expression of IL-4 ( Th2 cytokine) in control group was much lower ( P ＜0.05 ). The level of IL-4 in CsA group increased significantly at 3 days ( P ＜ 0.05 ), with a peak level at 7 days after transplantation (P＜0.01). The survival time of grafts was significantly prolonged in CsA group (P＜0.01), H2-Bl group (P＜0.05) and H2-Bl+CsA group(P＜0.01). Conclusion Treating the donor hearts with H2-Bl plasmid vectors at the time of transplantation may suppress rejection in the heart allografts and prolong the survival time through some presumed mechanisms such as preventing upregulation of CD40 expression, relucing the production of IL-2 and TNF-α, increasing the production of IL-4, and as a result, inducing immune tolerance, as well as improving the function of transplanted heart grafts.

Objective To investigate the application value of serum pancreatic isled autoantibodies and biochemical indicators in classification diagnosis of type 1 diabetes mellitus (T1DM ) and type 2 diabetes mellitus (T2DM ) .Methods The clinical data and laboratory detection results in 99 cases of T1DM and 577 cases of T2DM were retrospectively analyzed .The levels of pancreatic isled autoantibodies and biochemical indicators were compared between the two groups and their characteristics were analyzed .Re‐sults The positive rates of single detection and combine detection of glutamic acid decarboxylase autoantibodies (GADA) ,insulino‐ma‐associated antigen‐2 autoantibodies (IA‐2A ) ,islet cell autoantibodies (ICA ) and ZnT8 autoantibodies (ZnT8A ) in the T1DM group were higher than those in the T2DM group ,the differences were statistically significant (P<0 .05) .The onset age ,fasting and postprandial 2 h CP ,fasting and postprandial 2 h insulin(2 h INS) ,triglyceride(TG) and body mass index (BMI) in the T1DM group were lower than those in the T2DM group ,while the levels of fasting and postprandial 2h blood glucose ,glycosylated hemo‐globin(HbA1c) and high‐density lipoprotein cholesterol(HDL‐C) were higher than those in the T2DM group ,the differences were statistically significant (P<0 .05);however total cholesterol and low‐density lipoprotein cholesterol levels had no statistical differ‐ence between the T1DM group and T2DM group (P>0 .05) .Moreover ,the fasting and postprandial 2 h CP levels in the T1DM group showed decreasing trend as the T1DM course extending ,and the difference had statistical difference among different disease courses ;but the fasting and postprandial 2 h CP levels in the T2DM group had no obvious decreasing trend .The areas under the receiver operating characteristic(ROC) curve of fasting and postprandial 2 h CP for differential diagnosis of T1DM and T2DM in the patients with the disease course < 2 year were 0 .902(95% CI:0 .850-0 .954) and 0 .905(95% CI:0 .852-0 .958) respective‐ly .The suitable threshold value of fasting CP was 0 .283 nmol/L ,its sensitivity and specificity were 82 .6% and 89 .2% ,respective‐ly ,which of postprandial 2 h CP was 0 .421 nmol/L ,its sensitivity and specificity were 84 .8% and 89 .2% respectively . Conclusion T1DM and T2DM are different in onset age ,BMI value ,serum GADA ,IA‐2A ,ICA ,ZnT8A ,insulin ,CP ,glucose , HbA1c ,TG and HDL‐C levels ,which may assist clinic in their classification diagnosis .

Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.