Objective To evalute the feasibility of a double hand allogroft to reconstuct the limbs'function. Methods A brain dead donor was chosen under the test of blood group in ABO and Rh,HLA match,PRA and the mixed leukocyte culture.The level of the transplantated hands was 5 cm proximal to the wrists The procedure of the allotransplantation was similar to that of the autologous replantation.The immunosuppressants were taken two days before the operation,in the operation and after the operation. The circulation,the vital signs and the rejection were under the supervision. Results The progress was satisfactory. No rejection was found postoperation.After 10 weeks the callus in both ends of radius and ulna was obvious.After 5 months sensation recovered.After 7 months the internal fixation(plates and screws) was removed and tenolysis was done. Now the recipient could use engrafted hands to wash face,make the bed,wear clothes,brush teeth,peel oranges,eat with a spoon,tie the shoelace slowly,pick up a telephoneor and use the conroller of Television. Conclusions With the immunosuppressive agents,the double hands allograft can survive.The growth rate of bone and nerve is faster than that of autologous replantation.

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement.The vertebral height is restored and the decreased loading ability of the fractured vertebral body is re-strengthened with pain relief.The effect of the method is widely demonstrated in those conditions.At the same time, the relative problems, such as the complications are being lucubrated and discussed.The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more.By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various.The mechanisms and correlative factors are still not clear-cut either.The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0％ to 63％.The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification,failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on.Great controversy still exists on the correlation between those possible factors and the re-fractures.More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.

Objective To evaluate the effects of different rates of remifentanil infusion on cardiovascular response to tracheal intubation in older patients. Methods Thirty ASA Ⅰ-Ⅲ patients aged 65-75 yrs weighing 50-80 kg scheduled for elective abdominal operation were randomly divided into 3 groups (n = 10 each) according to the remifentanil infusion rate: group A 0.05 ?g?kg-1?min-1; group B 0.1 ?g?kg-1?min-1 and group C 0.15 ?g ?kg-1?min-1. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Radial artery and subclavian vein were cannulated for BP and CVP monitoring and blood sampling. ECG, BP, HR and SpO2 were monitored during anesthesia. After 10 min stabilization induction of anesthesia was commenced with remifentanil infusion for 10 min. Midazolam 0.1 mg?kg-1 was then given Ⅳ. Succinylcholine 1.5 mg?kg-1 was given to facilitate intubation after the patients lost consciousness. BP and HR were recorded immediately before induction of anesthesia (T0, baseline), immediately after intubation (T1 ) and at 2, 5 and 10 min after intubation (T2 ,T3 ,T4 ) . Cardiovascular intubation response was defined as increase in SP or HR by 15% of the baseline value within 2 min after intubation. Blood samples were taken at T0-4 for determination of plasma concentration of norepinephrine (NE) and epinephrine (E) by HPLC. Side effects such as chest wall rigidity and hypotension were also recorded. Results The cardiovascular intubation response rate was significantly higher in group A (80%) than in group B (10% ) and C (10% ) . The incidence of side effects was significantly higher in group C (70% ) than in group B (20%) and A. Plasma NE and E concentrations were significantly increased after intubation in group A (at T2-4) and B (at T2,3) as compared with baseline values at T0; while in group C only plasma NE concentration was significantly increased at T2 and T3 and there was no significant change in plasma E concentration after intubation. The plasma NE and E concentrations were significantly higher in group A (T2-4) and B (T2,3) than in group C. Conclusion The appropriate infusion rate of remifentanil for tracheal intubation is 0.10 ?g?kg-1 ?min-1 in older patients.

Objective To discuss the application of serum hs-CRP and lipids detection and the correlations between them in type 2 diabetes mellitus.Methods The levels of serum hs-CRP,TC,TG, HDL-C,LDL-C,ApoA1,ApoB were all measured in 49 type 2 diabetic patients and 53 normal cases.Results The type 2 diabetic group had significantly higher hs-CRP, TC,TG, LDL-C, ApoB and lower HDL-C than the control group. The concentration of serum hs-CRP correlated positively with TG,ApoB and negatively with HDL-C.Conclusion Serum hs-CRP level is associated with serum lipid level and inflammatory response might play an important role in the pathogenesis of type 2 diabetes mellitus. In type 2 diabetic mellitus there is an increased risk of development of cardiovascular diseases.

Objective To investigate the feasibility of labeling iris pigment epithelial(IPE)cells of rabbits with 5-(and 6-)carboxyfluorescein diacetate succinimidyl ester(CFSE). Methods Enzyme-assisted microdissection was used to isolate the cultured rabbit′s IPE cells.The third or forth subcultured IPE cells were incubated with 2.5,5,10,20,and 40 ?mol/L of CFSE for 1,5,and10min respectively.The fluorescence intensity was detected by flow cytometry,and the leakage of CFSE and its dyeing were observed by fluorescence antibody labeling. Results Incubation with 20 ?mol/L CFSE under 37℃for1minute was the most optimal condition for IPE cells labeling.The coloration of IPE cells stained by CFSE lasted 4 weeks.There was no leakage of dye from labeled rabbit IPE cells to non-labeled human IPE cells in mixed culture process. Conclusion With the advantages of high rate of dyeing,long time of tracing,safety and convenience,CFSE can be used as a new method to label the rabbit′s IPE cells.

Objective To evaluate the causes,clinical manifestations and diagnosis of tarsal tunnel syndrome. Methods Operation was performed for 18 patients ( 21 sides) with tarsal tunnel syndrome. Preoperative Takakura index was 3-7 points with an average of 6.4 points. Ganglion was found in 15 cases (17 sides), varicosity in 2 cases (3 sides) and lipoma in 1 case. Results The symptoms disappeared without recurrence in 0.5 to 17 years' follow-up (average 7.3). Postoperative Takakura index was 9-10 points (average 9.7). Conclusion Tarsal tunnel syndrome is rare in the clinical practice with varied causes and different clinical manifestations. Operation can be performed with satisfactory results for the patients unsuitable for conservative treatment.

BACKGROUND:Percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures has achieved very good results.
OBJECTIVE:To discuss and resolve some problems related to thoracic and lumbar vertebroplasty.
METHODS:225 patients (78 males and 147 females) aged 53 to 92 years old were included in this study. They al accepted percutaneous vertebrolplasty and we observed and made a record about some questions related this surgery during perioperative period.
RESULTS AND CONCLUSION:Six cases (2.7%) missed diagnosis. More than two-third of the compression degree were found in sixteen cases (7.1%). Forty-five (12.8%) vertebrae suffered from bone cement leakage in twenty-nine cases (12.9%). Recurrent fractures appeared in ten cases (4.4%). Multiple vertebrae fractures appeared in seventy-nine cases (35.1%). (1) Strategies for missed diagnosis:conduct preoperative physical examination careful y;avoid missing the point of pain;increase MRI scanning when necessary. (2) Coping strategies for severe vertebral fractures:place the needle into the paral el endplates as far as possibly;puncture along the lumbar spine pedicle base and the lateral thoracic pedicle. (3) Coping strategies for cement leakage:when cement leakage over the lower edge of the end plate occurred in operation, we should immediately put the C-arm X-ray machine into anteroposterior position to determine the orientation of the leakage and stop injecting;we should continue to inject the bone cement into the no leak-side to ensure the fil ing amount of vertebral bone cement. (4) Coping strategies for recurrent fractures:reoperation. (5) Coping strategies for multiple fractures:patients with multiple fractures often have a feature of poor constitution and more complications. So, it is necessary to shorten the operation time, and determine unilateral or bilateral puncture ways depending on the degree of vertebral compression to save operation time.

Objective To investigate the expression ofTNF- α mRNA and cytokeratin 20(CK20)mRNA in different tissue of colonic cancer patients, and the relations between the expression and the classify,invasion, as well as Dukes stage of colonic cancer. Methods RT-PCR method was used to detect the ex-pression of TNF-α mRNA and CK20 mRNA in 30 cases of colonic cancer, included cancer tissue,para-cancer tissue and normal tissue. Results The positive rate of TNF- α mRNA expressions in cancer tissue, para-cancer tissue and normal tissue were 70.0%, 43.3% and 20.0%, and the positive rate of CK20mRNA expressions were 63.3%, 33.3% and 16.7%, there were significant difference among the three tissues(P ＜ 0.01 ). But the expression of CK20 mRNA in para-cancer tissue had no significant difference compared with normal tissue (P＞ 0.05). The expression ofTNF- α mRNA was closely correlated with that of CK20mRNA.TNF- α mRNA and CK20 mRNA showed no significant difference in expressing of colonic cancer tissue (P ＞ 0.05 ), but TNF- α was closely correlated with Duke stage and depth of tumor invasion (P ＜ 0.05 ).Conclusion The expression of TNF- α mRNA is objective indicator associated with the invasion of the colonic cancer.

Objective To determine the expression of peroxisome proliferators-activated receptors (PPARs), nuclear factor-κB (NF-κB) and activity of superoxide dismutase (SOD) in rats with obstructive jaundice induced by bile duct ligation (BDL) and elucidate the molecular regulation mechanisms of hepatic injury due to obstructive jaundi(c)e. Methods All rats were sacrificed on the 7th day and 19th day after BDL and blood and liver tissue samples were obtained. SOD enzyme activity was detected by SOD kit. RT-PCR was performed to determine the mRNA expression of PPARs in all groups. The detection of PPARs protein and activation of NF-κB were performed using an immunohistochemical method. Results The activities of normal SOD and CuZn-SOD were decreased compared to the sham group (P＜0.01), and the decrease on 19th day after BDL were more significant. The level of PPARs expression in the BDL groups liver except the PPARβ in the BDL 7th group was reduced compared to the sham group (P＜0.01), and the level on the 19th day after BDL were more significantly reduced. PPARs protein expression was significantly inhibited (P＜0.01) in the sham group. SOD in BDL groups had significant positive correlation as compared with PPARs protein expression (P＜0.01), but NF-κBp65 protein expression had significant negative correlation as compared with PPARs protein expression (P＜0. 01). Conclusion PPARs are inhibited in expression level, and this inhibition becomes more significant as the pathological process progresses. PPARs might be key regulatory factors for SOD and NF-κB. The low expression of PPARs might be one of the important molecular mechanisms in liver injury due to obstructive jaundice.

Objective To summarize our experience in diagnosis and treatment of splenic tumors.Methods A retrospective study of the clinicopathologic data of 92 cases of splenic tumor was performed.Results There were 47 benign and 45 malignant tumors.The preoperative confirmed diagnostic rate by B-US was 85.87%(79/92),by CT was 91.30%(84/92).Splenectomy was performed in 81 cases,tumor resection or partial splenectomy in 7 cases,needle aspiration of splenic cyst in 3 cases and biopsy in one case.The 1-,3-,5-,10-year survival rate of malignant tumor was 68.29%,31.70%,14.63%,0.24%,respectirely.Conclusions Imaging studies are the main diagnostic methods of splenic tumors.Splenectomy is the treatment of choice for primary splenic malignant tumor.Splenic benign tumor does not require any other therapy after operation.Splenic malignant tumor requires adjuvant treatment.