Objecfive To identify what factors contribute to the occurrence of avascular necrosis (AVN) of the femoral head after pediatric femoral neck fractures. Methods A series of 33 pediatric femoral neck fractures who had been admitted to our institution between June 1994 and April 2006 were retrospectively reviewed. There were 1 case of type Ⅰ,15 type Ⅱ,14 type Ⅲ and 2 type IV according to Delbet classification. The mean age at injury was 10.7(3.7 to 14.1) years, and the mean follow-up was 3.4(1 to 12.2)years. All patients were followed up until union was achieved. AVN occurred in 16 cases, including 8 cases of Ratliff type Ⅰ,3 of Ratliff type Ⅱ,4 of Ratliff type Ⅲ and 1 unclassified. Age at injury, fracture type, degree of displacement, quality of reduction and type of fixation were calculated and analyzed with respect to AVN. Results AVN occurred in 4 cases (36.4%)under 10 years old and in 12 cases (54.5%)10 years old or more. Eight cases (53.3%)of AVN occurred in Delbet type Ⅱ and 6 cases (42.9%) of AVN occurred in type Ⅲ.One case (25.0%)of AVN occurred in non-displaced group and 14 cases(53.8%)in displaced group. Ten cases(50.O%)of AVN occurred in the group whose reduction quality was satisfactory and 6 cases(66.7%)in unsatisfactory reduction group. Thirteen cases (48.1%)of AVN occurred in the unstable fixation group and 2 cases (50.0%)in the stable fixation group. Conclusion Fracture type, degree of displacement, quality of reduction and age at injury can affect the occurrence of AVN of the femoral head after pediatric femoral neck fractures.

Objective To explore the status of lymph node dissection under thoracoscopic surgery and open surgery in patients with thoracic esophageal carcinoma. Methods 16 cases of thoracic esophageal cancer received thoracoscopic surgery from August 2012 to June 2015 as minimally invasive group (group M), 17 cases of thoracic esophageal cancer with the same pathological staging received traditional open surgery during the same period as control group (group C), the number of lymph nodes and the positive rate of lymph node metastasis were compared. Results In group M, the total number of 228 lymph nodes, mean (14.27 ± 5.61) pieces, the positive rate was 12.50%; while in group C, the total number of 241 lymph nodes, mean (16.20 ± 6.24) pieces, the positive rate was 11.76%. Two different pathological staging in patients with lymph nodes dissection has no significant difference ( >0.05). In group M, 7 cases with lymph node metastasis, 45 metastatic lymph nodes, metastasis rate was 43.75 %, 19.74 % degree of metastasis; while in group C, 8 cases with lymph node metastasis, 55 metastatic lymph nodes, metastasis rate was 47.06%, transfer degree was 22.82%.Conclusions Minimally invasive surgery can achieve the same effect with the traditional open chest surgery, in treatment of thoracic esophageal cancer with high operability.

Japan has accumulated much experience in medical education through a long time exploration.Through some reform measures,such as training talent physicians,reforming education systems,choosing core teaching courses,and establishing comprehensive education system,Japanese medical education has been well promoted,which will be helpful to our country's medical education reforms.

Background and purpose:Correct target positioning is an important factor affecting the precision of stereotactic body radiotherapy (SBRT) in patients with lung tumors. This study investigated the setup errors in patients with malignant lung tumors receiving SBRT with cone-beam CT (CBCT) and analyzed the factors influencing setup errors.Methods:Twenty-nine patients with solitary malignant lung tumors were enrolled in the study. Each patient underwent SBRT with CBCT before each treatment. Setup errors in CBCT were obtained according to the matched and planned CT images in anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. The expanding margins of clinical target volume (CTV) to planning target volume (PTV) according to the analyzed setup errors were then calculated. And the influencing factors of setup errors were analyzed.Results:A total of 155 CBCT images from 29 patients were obtained during the treatment. The setup errors were (-1.68±3.62), (-1.34±3.90) and (0.36±2.15) mm in the AP, SI and LR directions, respectively. The absolute setup errors were (3.16±2.42), (3.29±2.48) and (1.74±1.30) mm in the AP, SI and LR directions, respectively. The suggested expanding margins of CTV to PTV were 9.6, 10.0 and 5.3 mm in the AP, SI and LR directions according to the setup errors. The setup errors in the AP direction of peripheral lesions and in the SI direction of inferior, right and metastatic lesions were relatively larger(P=0.007, 0.008, 0.000 and 0.000)..Conclusion:In patients with malignant lung tumors receiving SBRT, the setup errors were more obvious in the SI and AP directions. Tumor motion management techniques including CBCT, breath-holding technique are required to reduce the setup error in patients with lung tumors receiving SBRT.

OBJECTIVE:To improve the system of management and maintenance for the purification air-conditioning system in PIVAS,and to further strengthen the management of cleaning environment. METHODS:The cleanness monitoring project of purifi-cation air-conditioning system in PIVAS of our hospital was introduced in terms of temperature and humidity record,pressure differ-ence record,airborne particles detection,settling microbe monitoring report. And the monitoring results were analyzed. RESULTS:The temperature and humidity,pressure difference of clean area in PIVAS of our hospital are both in line with the standard of Phar-macy Intravenous Admixture Quality Management Specification (2010 edition),i.e. temperature at 18-26 ℃,relative humidity of 40%-65%;negative pressure difference between antibiotics,hazardous drug dispensing area and second dressing room are 5-10 Pa. The number of airborne particles (average static particle/m3) at various cleanness degrees in clean area are all in line with the standard of GMP(2010 edition),i.e. maximal allowable number of airborne particles(≥0.5 μm)were 3 520/m3(100 degree);352 000/m3 (10 000 degree);3 520 000/m3 (100 000 degree). The percentage of qualified static settling microbe detection reach 100%in clean area,which is in line with the standard of Settling Microbe Detection Method in Clean Room(Area) of Pharmaceu-tical Industry,i.e. criteria for settling microbe(90 mm)CFU/0.5 h≤1(100 degree);≤3(10 000 degree);≤10(100 000 degree). The percentage of qualified dynamic settling microbe detection is in low level,especially those of dispensing room and secondary dressing room only reaches 80%. CONCLUSIONS:It’s important for effective hospital infection control in PIVAS,the quality im-provement of intravenous injection,the safety guarantee of drug use in patients to further improve standard operation procedure of purification air-conditioning system management and maintenance,and manage and maintain the purification air-conditioning sys-tem completely and scientifically.

Objective To study the effect of compound hypertonic saline solution (HSD) on sepsis.Methods 133 male Wistar rats were divided into four groups,sham operation group (n =15),cecal ligation and puncture (CLP)group (n =45),CLP plus normal saline (NS) group (n =45),and CLP plus HSD group (n =28).A rat model of sepsis was reproduced by CLP,and the rats in sham operation group received celiotomy without ligation and puncture.All rats in four groups received subcutaneous injection of 30 mL/kg 0.9％ sodium chloride after laparotomy.The rats in CLP plus NS group and CLP plus HSD group received infusion of 5 mL/kg 0.9％ sodium chloride or 7.5％ sodium chloride/6％ dextran post CLP via jugular vein for 3 hours,with the infusion rate of 0.4 mL·kg-1·min-1.The survival rate of each group was observed 9 hours and 18 hours after laparotomy.Mean arterial pressure (MAP) at 0,9,18 hours were monitored.Blood specimens were collected from all rats 0,9 and 18 hours after laparotomy,respectively,for measurement of the plasma levels of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β),and procalcitonin (PCT).The rats were all sacrificed,and their lung tissues were harvested for the neutrophil count in bronchoalveolar lavage fluid (BALF),myeloperoxidase (MPO) activity in lung tissue,wet/dry weight ratio (W/D) of lung,and pathological changes in lung tissue.Results There was no death in the sham operation group.The survival rates at 9 hours and 18 hours were 62.2％ and 31.1％ in the CLP group,57.8％ and 35.6％ in the CLP plus NS group,85.7％ and 64.3％ in the CLP plus HSD group,and they were all significantly higher compared with those of the CLP group and the CLP plus NS group (P ＜ 0.05 or P ＜ 0.01).MAP levels in the CLP group and the CLP plus NS group were significantly lower than those in sham operation group,and the plasma levels of TNF-α,IL-1β and PCT were significantly higher compared with those of sham operation group,while there was no difference between CLP group and the CLP plus NS group.MAP and the plasma levels of TNF-α,IL-1β and PCT in the CLP plus HSD group were significantly improved compared with those of the CLP plus NS group at 9 hours and 18 hours [MAP (mmHg,1 mmHg =0.133 kPa) at 9 hours:102±5 vs.94±6,18 hours:90±2 vs.72±3; TNF-α (ng/L) at 9 hours:284.19±57.18 vs.329.67±45.79,18 hours:263.46±42.58 vs.349.68±52.40; IL-1β (ng/L) at 9 hours:219.28±39.21 vs.263.47±32.36,18 hours:195.98±39.06 vs.250.10±41.57; PCT (μg/L) at 9 hours:2.32±0.37 vs.4.52±0.75,18 hours:2.89±0.62 vs.5.02±0.84; P ＜ 0.05 or P ＜ 0.01].The ratio of neutrophils in BALF,MPO activity and lung W/D at 18 hours in the CLP group and the CLP plus NS group were significantly higher than those of the sham operation group,while they were all significantly lower in the CLP plus HSD group than those of the CLP group and the CLP plus NS group [ratio of neutrophils in BALF:0.094±0.019 vs.0.148±0.062,0.151 ±0.055; MPO (U/g):1.19±0.45 vs.2.31 ±0.79,2.64±0.69; lung W/D ratio:4.02 ± 0.63 vs.5.14 ± 0.59,5.12 ± 0.83,all P ＜ 0.05].Under light microscope,no pathobiological changes were found in sham operation group.The lung tissues in the CLP group and the CLP plus NS group showed congestion,edema,infiltrating inflammatory changes,while the inflammatory changes in the lung tissue in the CLP plus HSD group were significantly alleviated.Conclusion HSD can obviously ameliorate the circulatory failure in septic rats,alleviate immune disturbance and acute lung injury,and improve the survival rate of rats with sepsis.

Objective To report our self-designed guide module for placement of posterior column lag screws in anterior-posterior column acetabular plate using CT reconstruction data.Methods The CT scan data of 50 normal adult pelves were collected from February 2012 to April 2013,involving 30 males and 20 females with an average age of 46.4 years(range,from 25 to 69 years).The data were imported into Mimics 10.01 software for reconstruction of semi-pelvic models.Virtual cylindrical implants were placed intraosseously in both the left and the right posterior columns.The perpendicular distance (OP) from the insertion point O of the virtual cylindrical implant to the arcuate margin (P) and the distance (PI) from the point P to the point I,the crosspoint of the extension line of the ischial ramus and the arcuate margin were measured respectively.The angle (∠φ) between the direction of screws and the plane of guide module and the angle (∠θ) between the direction of screws and the long axis of guide module were also measured respectively.Results The average length of PI was 0.98 ± 0.13 cm,with 1.08 ± 0.22 cm in females and 0.95 ± 0.27 cm in males.The difference between genders was not statistically significant (P ＞ 0.05).The average length of OP was 1.09 ± 0.26 cm,with 1.06 ± 0.29 cm in females and 1.12 ± 0.24 cm in males.The gender difference was not statistically significant either (P ＞ 0.05).The mean value of ∠ φ was 55.43° ± 3.64°,with 55.33° ± 4.00° in females and 55.50° ±3.43° in males.The difference between genders was not statistically significant (P ＞ 0.05).The ∠θ value in females was 39.21 ° ± 2.45° and 35.58° ± 2.31 ° in males.The gender difference was statistically significant (P ＜ 0.05).Conclusions In design of the guide module,the nail holes should be located about 1 cm away from both the posterior edge and the medial edge,the angle between the screw direction and the module plane should be approximately 39° in females and 35° in males,and the angle between the screw direction and the long axis of the module approximately 55°.

Objective To summarize the experience in application of amputation of secondary structures of splenic pedicle and self-made spleen-removing bag in laparoscopic splenectomy the using 3-hole method. Methods The clinical data of 11 patients receiving the procedure from June 2007 to April 2009 in our hospital were retrospectively analyzed. Results Advantages of the procedure were less bleeding, small wound, quick recovery and no occurrence of postoperative complications. Six cases had slight postoperative pain. All 11 patients were cured. Conclusion The technique of amputation of secondary structures of splenic pedicle is safe and feasible in laparoscopic splenectomy using the 3-hole method.

Objective To investigate the genotype and mutation frequency of thalassemia in child patients of Shenzhen region so as to provide evidences for the gene diagnosis and genetic counseling of thalassemia.Methods A total of 1 206 child patients suspected with thalassemia were retrospectively analyzed.The gene deletion of α-thalassemia was detected by Gap-PCR.The point mutations of α-thalassemia and β-thalassemia were determined by reverse dot blot(RDB)-PCR.The specimens suspected with HKαα and rare gene mutations were determined with nested PCR and gene sequencing,respectively.Results The detection rate of thalassemia was 76.9％ (927/ 1 206).Among them,α-thalassemia accounted for 40.5％ (489/1 206),and--SEA/αα was the most common gene mutation(75.1％);β-thalassemia accounted for 33.7％ (406/1 206),and the main IVS-2-654 (C→T) and CDM1-42 (-TCTT) heterozygous mutations accounted for 35％ and 32.5％,respectively.In addition,there were 32(2.7％) β-thalassemia patients with α-thalassemia mutation,1 patient with HKαα/ααQS,1 α-thalassemia patient with CD61 (AAG→TAG)/--SEA and 1 β-thalassemia patient with CD5 (CCT→C).Conclusion The are complicated gene mutation types and rare gene mutations of thalassemia in child patients of Shenzhen region.