Objective To explore the therapeutic effect of total hip replacement (T HR) in treating osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture .Methods From January 2003 to June 2012 ,32 cases (19 left hips and 13 right hips) of ONFH after failed internal fixation of femoral neck fracture were treated with THR .There were 18 males and 14 females with an age range from 35 to 62 years (mean ,50 .6 years) .The ONFH was diagnosed at 8-26 months (mean ,17 .1 months) after internal fixation ;the THR were conducted 15-48 months after first surgery (mean ,27 .2 months) .According to Fi‐cat classifi cation ,there were 8 cases at stage Ⅲ and 24 cases at stage IV .The Harris score was (40 .9 ± 9 .8) .The prosthesis of bi‐ology was used .Results All wounds healed by first intention .All cases were followed up for 6-48 months (mean ,28 .3 months) . The Harris score was (90 .8 ± 4 .4) at last follow‐up ,showing significant difference when compared with the preoperative value (P<0 .05) .The hip function were excellent in 25 hips ,good in 5 hips ,fair in 2 hip ,and the excellent and good rate was 93 .8% . There were 1 cases of periprosthetic femoral fracture(type C) ,2 cases of proximal femoral splitting fractures fractures .After corre‐sponding treatment ,fracture was healed in all cases .There were no complications (infection ,loosening dislocation or subsidence , etc) .Conclusion Total hip replacement is an effective method for the treatment of ONFH after failed internal fixation of femoral neck fracture .

ObjectiveTo study the anatomical characteristics of the renal pedicle and its clinical application during retroperitoneoscopic nephrectomy.MethodsThe imaging, surgical video and clinical data of 278 cases undergoing retroperitoneoscopic nephrectomy between July 2007 and September 2009 were retrospectively analyzed. The renal pedicle was found located at the psoas and the medial arcuate ligament of the diaphragm for anatomic landmark before the gap of the psoas. A statistical analysis of the mean operative time, the mean time to look for the renal pedicle, the mean intraoperative estimated blood loss, the mean time to ambulation, the mean time to resuming oral intake, the mean postoperative hospital stay day and the rate of complications was performed.ResultsAll the operations were performed successfully, with no conversion to open and blood transfusion. The mean time to find the renal pedicle was (3.5 ± 1.3 ) min, the mean operative time was (95.6 ±23.8) min, the mean estimated blood loss was (72.4 ±27.5) ml, the mean time to resuming oral intake was (2.1 ±0.7) d, the mean time to ambulation was (1.8 ±0.9) d, the mean postoperative hospital stay was (8.5 ± 2.7 ) d.ConclusionsDuring retroperitoneoscopic nephrectomy, the best anatomical space to look for the renal pedicle is the space before the psoas muscle. The exact location of the renal pedicle is under the diaphragm medial arcuate ligament about 2 - 4 cm, in the gap of the psoas muscle and the vena cava (abdominal aorta). Following this procedure could reduce the time to look for the renal pedicle, thus reducing operative time.

[Objective]To study Bone microdmage to osteoavascular epiphysis caput humeralis in teenagers of the guts outbreak mechanism and make a diagnosis and give treatment in early stage important point.[Method]The review was from 138 patients of the shoulder department ache with shoulder joint movable function obstacle that orthopedics out-patient service of 2004~2005.There was X-rays / CT,the blood bio-chemical 5 example among the teenager of the patients,it was observed by medium short-term curative effect.We was combined a related cultural heritage study,put forward to make a diagnosis and gave treatment to have the instruction meaning to the clinic of four expect to categorize a method,and to early,medium,later period the non-surgical operation treatment observation.[Result]In 138 patients,there were 5 teenager patients who were the epiphysis of head humeralis bone microdamage ON,through the function instauration was normal:Earlier period 2 cases of 1~4 weeks,middle period 2 cases of 5~8 weeks,the later period 1 case of 4~6 months.We choose the medicine of prescription with the independence,"Huo xue hua yu","Bu shen zhuanggu","Tong luo zhi tong" medicinal broth,the right amount internal use outside use,having already obtained good result.We have already observated the serious bone arthritis/canceration,resulting in serious result(in another report).[Conclusion]Once or more shoulder was bone microdamage lead the caput epiphysis humeralis occurrence ON of guts.We observe the sufferer whom had the clinical symptom,physical sign,according to the clinical performance,course of disease's long/short,imageology atc.The suggestion is divided into early,medium,night and most late four periods,for the convenience of the choice treatment measure.Because of various reason,long and non-healing cases might develop to the most later period of case,such as the avascular osteo arthritis/canceration.

Objective To provide imaging anatomy basis for percutaneous nephrolithotomy ( PCNL) by measuring relative displacement and changes in anatomical position of kidney and colon under the prone and low-oblique supine positions.Methods Forty-six patients scheduled for PCNL underwent 64-slice spiral CT scan under the prone and low-arch oblique supine position before the PCNL.The horizontal distance of kidney and colon,the distance from colon and analog puncturing line,the distance between the kidney and colon were measured and compared between the 2 positions.Results The distance from colon and analog puncturing line under the low-oblique supine and prone positions were as follows,the left (26.56 ±15.36) mm versus (12.25 ±13.16) mm (t=3.527,P<0.05),the right (25.85 ±14.26) mm versus (13.57 ± 12.53) mm (t=3.234,P<0.05).The differences of the rest distances between the 2 positions were not significant ( P>0.05).Conclusions The distance between colon and analog puncturing line increases in the low-arch oblique supine position,because the colon shifts to the ventral.The PCNL in low-arch oblique supine position may reduce the incidence of colon injury,and improve surgical safety.

Objective To analyze the form and classification of adult knit supercilium,at the same time,to explore the principle and clinical effects of botulinum toxin type A injections in knit supercilium treatment.Methods Retrospective analysis of morphology and treatment was carried out in 104 Chinese adults knit supercilium.The patients were randomly enrolled in study group that were subjected to botulinum toxin type A injection for the first time in treatment of glabella wrinkles.Forms of wrinkle supercilium were classified;Targeted point injection of botulinum toxin type A was adapted,with the minimum dose to achieve satisfied effect.The treatment interval was over 4-6 months.treatment methods and effects were explored.Results Chinese knit supercilium according to the form was divided into 6 different types:U-shaped (19 cases),Ⅲ shaped (30 cases),V-shaped (20 cases),hanging needle shaped (19 cases),Ω shaped (10 cases),and reverse Ω shaped (6 cases).During observation period,there was no serious adverse reactions after treatment.Conclusions Stand ardization of personalized botulinum toxin type A injections for patients with knit supercilium plays a positive role.

Objective To analyze the epidemiologic features of visceral leishmaniasis in different age groups in China from 2005 to 2012,and to provide a scientific basis for prevention and treatment of the disease.Methods The visceral leishmaniasis cases were obtained from China disease epidemic monitoring information system from 2005 to 2012.All the cases were divided into subgroups by demographic characteristics:infant (＜1 year old),childcare (≥1 and ＜4 years old),child (≥4 and ＜15 years old),adult (≥15 and ＜65 years old) and senior adult (above 65 years old).The epidemiologic features,such as gender,season of disease onset and area distribution of visceral leishmaniasis were analyzed.Results The total reported visceral leishmaniasis from 2005 to 2012 were 2 979,among which cases in infant,childcare,child,adult and senior adult were 24.9％,21.7％,20.0％,32.4％ and 1.0％,respectively.Infant cases were most reported in April; childcare cases in December which began to increase since September; child cases in October and adult and senior adult in March.The reported cases were mainly from Xinjiang,Gansu and Sichuan areas.However,age characteristics differed among regions,which were mainly infants,both childcare and children,and adults,respectively in this three areas.The duration from onset to diagnosis was shortest in infant group (11 d) and longer in adult group (15 d).Conclusions The number of visceral leishmaniasis cases in different age groups peaks in different months.Regional distribution is not even.Cases are most concentrated in Xinjiang,Gansu and Sichuan areas.Infants predominate in Xinjiang,childcare and children in Gansu and adults in Sichuan.

Objective To investigate the effect of N-myc downstream regulated gene 2 (NDRG2) on the apoptosis of bladder cancer cells by regulating the signal transducer and activator of transcription 3(STAT3) signaling pathway.Methods The expression level of NDRG2 in human bladder cancer cell BIU-87 and immortalized cell SV-HUC-1 was detected by Western blot.NDRG2 over expression vector and empty vector control (pcDNA3.1),siRNA-NDRG2,siRNA control were transfected into BIU-87 cells.After transfected 48 h,the expression level of NDRG2,Cleaved caspase 3,STAT3,p-STAT3,JAK2,p-JAK2 were detected by Western blot,the cell proliferation and apoptosis were measured by MTT and flow cytometry.After adding inhibitor AG490 of 45 μmol/L in cultured BIU-87 cells,MTT assay was used to detect cell proliferation and flow cytometry was used to detect the cell apoptosis,Western blot to detect the expression level of Cleaved caspase 3,STAT3,p-STAT3,JAK2,p-JAK2.Results The expression level of NDRG2 in bladder cancer cells was higher than that in bladder epithelial cells.The cell survival rate of pcDNA3.1/NDRG2 group was lower than that of pcDNA3.1 group,the difference was statistically significant (P ＜ 0.01).The cell survival rate of siRNA-NDRG2 group was higher than that of siRNA control group (P＜ 0.01).The apoptosis rate of pcDNA3.1/NDRG2 group was higher than that of pcDNA3.1 group (P ＜ 0.01).The apoptosis rate of NDRG2 siRNA group was lower than that of siRNA control group (P ＜ 0.01).The level of p-STAT3 and p-JAK2 in pcDNA3.1/NDRG2 group was lower than that in pcDNA3.1 group (P＜ 0.01).The survival rate and apoptosis rate of BIU-87 cells cultured with AG490 were in agreement with the trend of pcDNA3.1/NDRG2 after transfection.Conclusions NDRG2 could promote the apoptosis of bladder cancer cells,and its mechanism may be related to STAT3 signaling pathway.

Objective To evaluate the incidence of asymptomatic carotid stenosis (ACS) in patients with peripheral arterial occlusive disease (PAOD) who was admitted for revascularization.Methods 229 PAOD patients were evaluated by carotid ultrasound preoperatively and divided into severe ACS group (ACS ≥ 70％) and non severe ACS group (ACS ＜ 70％).The clinical characteristics and associated risk factors of the two groups were analyzed.Results The incidence of severe ACS was 19.7％,age,blood pressure,total cholesterol and fibrinogen levels in severe ACS group were significantly higher than those in non-severe ACS group (P ＜ 0.05),the more severe the symptoms of PAOD are,the higher is the incidence of severe ACS.Age,hypertension and hypercholesterolemia were all predictors of severe ACS.Conclusions The severity of PAOD is positively correlated with the incidence of severe ACS.Age,hypertension and hypercholesterolemia are independent risk factors for severe ACS.

Objective To explore the clinical value of the duplex ultrasonography (duplex US) for evaluating the re-stenosis after peripheral arterial bypass grafting. Methods Eighty prosthetic grafts of sixty-three patients with femoral-pop-liteal arterial bypass grafting were follow-up regularly by duplex US. They were divided into non significant stenosis group (n=56), the significant stenosis group (n=15) and occlusion group (n=9) according to the tube diameter and arterial blood flow-ing parameters, which changed postoperatively. The diagnostic results were compared and analyzed between duplex US and digital subtraction angiography (DSA). The peak flow velocity of middle grafts (MG) to 40 cm/s was defined to evaluate risk of graft occlusion. Results The diagnostic coincidence rate of duplex US and DSA for grafts stenosis classification was 90%. The diagnostic sensitivity of duplex US to grafts stenosis was 91.7%, and the specificity was 92.9%. The positive pre-dictive value was 84.6%for grafts stenosis, and the negative predictive value was 96.3%, the false positive rate was 16.7%, and the false negative rate was 8.3%. The grafts occlusion rate was higher in MG<40 cm/s group than that of MG≥40 cm/s group. Conclusion There was a good consistency with Duplex US and DSA for the diagnosis of peripheral artery bypass graft restenosis. Duplex US showed characteristics of non-invasive, simple and easily accepted by patients.

BACKGROUND: Autologous bone marrow is the only tissue that contains abundant osteoinductive osteogenitor cells and is the first-choice transplantation materials for treatment of bone nonunion. Artificial bone with osteoinductive capacity can provide a supporting effect for the in-growth of osteocytes. Iliac periosteum can be used for treatment of bone nonunion due to the advantages including abundant blood circulation, easy harvesting, and able to improve local arterial blood supply. BJECTIVE: To treat refractory bone nonunion in limbs using artificial bone with autologous bone marrow combined with iliac periosteum transplantation, and to compare the therapeutic efficacy to artificial bone with autologous bone marrow transplantation and simple iliac periosterum transplantation. METHOD: Thirty-nine refractory bone nonunion limbs from 36 patients were assigned to three groups: artificial bone with autologous bone marrow combined with iliac periosteum transplantation (combination group, n = 19), artificial bone with autologous bone marrow (bone marrow group, n = 9), and autologous iliac periosteum (iliac periosteum group, n = 11). The time for bone healing, limb function score 1 month after fixture removal, and postoperative X-ray score were evaluated. RESULTS AND CONCLUSION: All initial 39 limbs acquired bone union and were followed up for an average period of 18.5 months. The combination group yielded better therapeutic effects than the bone marrow group and the iliac periosteum group in terms of the time for bone healing, limb function score 1 month after fixture removal, and postoperative X-ray score (P < 0.05). These findings indicate that artificial bone with autologous bone marrow combined with iliac periosteum transplantation exhibits better clinical therapeutic effects in treatment of refractory bone nonunion in limbs.