Objective To compare the clinical efficacy of intramedullary pin versus plate fixation for displaced mid-shaft clavicle fractures.Methods The databases,PubMed,CENTAL and CBM,were searched according to the standards of the Cochrane Collaboration for all the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing intramedullary pin with plate fixation for treatment of displaced mid-shaft clavicle fractures.In addition,hand search was also conducted in relevant journals.Time limit for search was from the beginning till December 2013.Trial quality was assessed using the modified Jadad scale and effective data were pooled for Meta analysis with software RevMan5.2.7,including wound infection,hospital stay,wound size,intraoperative blood loss,operation duration,implant irritation,implant problems,delayed union,malunion,nonunion,total complications and Constant scoring.Results Three RCTs and 7 CCTs with 697 patients were included in our study.The modified Jadad scoring showed fine quality of the 10 trials.Intramedullary fixation was significantly superior to plate fixation in wound size,intraoperative blood loss,operation duration,hospital stay,wound infection,and symptomatic hardware (P ＜ 0.05),but led to a significantly higher rate of implant problems (P ＜ 0.05).However,no significant differences were identified in total complication rate,delayed union,nonunion,malunion or Constant score (P ＞ 0.05).Conclusions The superiority of intramedullary fixation for displaced mid-shaft clavicle fracture lies in its advantages of minimally invasion,such as limited incision,less intraoperative bleeding,shorter operation time and hospital stay,less wound infection and implant irritation.Ahhough intramedullary fixation may lead to a higher rate of implant problems,it shows no significant differences from plate fixation in bone healing and functional recovery.

Objective To investigate the distribution of interstitial Cajal-like cells(ICLC) in ampulla and the myoelectric activities of the sphincter of Oddi(SO) of adult guinea-pigs.Methods C-Kit immunohistochemical staining was carried out on whole-mount preparations of guinea-pigs' ampulla region.The myoelectric activities of SO were recorded by using the contact electrode on mucosa.Result C-Kit-positive ICLC were observed in both exterior and inner wall of ampulla.Some of these cells were distributed in the circular and longitudinal smooth muscle cell(SMC) layers assuming a spindle-like shape.Another sub-group of ICLC,which were located between the longitudinal and circular SMC layers,were shown to have oval or triangle cell bodies with projection of more than three long processes.These cells interlaced into a cellular network,closely resembling the interstitial cells of Cajal(ICCs),around the myenteric nervous plexus(ICC-MY) in the duodenum.At the inner side of circular SMC layer of the exterior wall,ICLC were similar to ICCs associated with the deep muscular plexus(ICC-DMP) of small intestine.In the inner wall of the ampulla,a large amount of ICLC were found in the SMC layers or bundles,running parallel with them.At the opening of the ampulla,a number of ICLC surrounded the opening to form a ring.The spontaneous rhythmic myoelectric activities could be recorded in the SO.Conclusion It is suggested that the ICLC might contribute to the regulation of the spontaneous rhythmic contraction,and it might be related to development of motility disorders of the SO.

Objective To discuss fluvastatin intervention on ventricular remodeling and plasma brain natri-uretic peptide( BNP) levels in dilated cardiomyopathy( DCM) .Methods 64 cases of DCM patients were selected and randomly divided into the intervention group and control group,each group in 32 cases.Both groups were treated with conventional drug therapy, including angiotensin-converting enzyme inhibitors,β-blockers, diuretics, etc.In conven-tional drug treatment intervention group based on the use of fluvastatin 40mg/d.Intervention in both groups before and 6 months after the intervention,plasma BNP levels were examined and ventricular remodeling indicators,analyzed and compared using Pearson Univariate correlation of each index.Results The total efficiency of the intervention group was higher than that of the control group(87.51%vs 65.63%,χ2 =4.730,P<0.05);6 months after the interven-tion groups,plasma BNP levels were significantly decreased left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD) and relative wall thickness(RWT) were significantly improvements.BNP levels and LVEF and RWT was negatively correlated( r=-0.45,-0.39,all P<0.05);Positively correlated with LVESD and LVEDD showed(r=0.35,0.44,all P<0.05),the difference was statistically significant.Conclusion Fluvastatin intervention can significantly reduce plasma BNP levels in DCM and improve ventricular remodeling.

To study the clinical significance of combined measurement of neuron specific enolase(NSE), carcinoembryonic antigen(CEA) and Cytokeratin19 fragment 21 1 (CYFRA 21 1 ) in the diagnosis of lung cancer. The serum levels of CEA, NSE, and CYFRA 21 1 in 75 lung cancer patients as well as in 22 benign pulmonary diseases patients were measured by radioimmunoassay. Patients with pulmonary adenocarcinoma had a highest CEA level. Small cell lung carcinoma (SCLC) patients had a highest NSE level, while patients with squamous cell carcinoma of lung had a highest CYFRA 21 1 level. The positive rate of the combination of CEA, NSE, and CYFRA 21 1 for lung cancers was 82 67%. The results suggested that the combined measurement of CEA, NSE, and CYFRA 21 1 was helpful in the diagnosis of lung cancer.

Objective To assess the outcomes of modified spiral ileal orthotopic neobladder.Methods From January 1998 to January 2008, 32 patients (all male) underwent radical cystectomy and spiral ileal orthotopic substitution for muscle invasive bladder cancer. A segment of 40 to 45 cm ileal loop was isolated, detubularized, and reconfigured in spiral shape to form a pouch. Bilateral ureters were reimplanted by inserting the 1 cm distal segment into the pouch to form a Split-Cuff nipple.The bottom of the pouch was opened and anastomosed with the urethra (4 stitches). Results There were no perioperative deaths. The mean operative time was 281.2±48.7 min. Blood loss was 545.4±181.9 ml. Twenty cases required a blood transfusion, the mean volume of intraoprative blood transfusion was 430.8±235.9 ml. The average hospital stays were 26.8±9. 7 days. Rate of daytime continence was 93. 7% (30/32) while nighttime continence was 81.3% (26/32). Urodynamic studies were carried out in 23 cases 6 months after surgery. Neobladder capacity at first desire to urinate was 315.0± 33.4 ml(270-420 ml). The maximum neobladder capacity was 490. 3±39.7 ml(350-600 ml).The maximum flow rate (Qmax) was 16.5 ± 5.9 ml/s. Full resting pressure was 22. 5 ± 11.8 cm H2O. Peak voiding pressure was 78.3 ± 14.7 cm H2O. After mean 58. 4 months' follow up (range 22 to 132), 4 cases died of metastasis of bladder cancer. Conclusion Modified spiral ileal orthotopic neobladder is a reasonable option for treating invasive bladder cancer.

Objective To investigate the characteristic of the cisplatin-induced damage of hair cells in cochlear organotypic cultures. Methods Three to four-day-old (P3～4) C57 mice were used for this study. The cochlear basilar membrane was cultured for 6~8 hours and then treated with different doses of cisplatin(0?mol/L, 10?mol/L, 50?mol/L, 100?mol/L, 400?mol/L, 1000?mol/L,7 cochlears for 0-100?mol/L group, 6 cochlears for the rest dosage, control group used the dose of 0?mol/L)for 48 hours.TRITC-phalloidin and DAPI were used for stain. The entire cochlear hair cells were observed and counted under Nicon fluorescent microscope. Data was analyzed by LS for hair cells loss graph and SAS 8.0 for linear regression analysis. Results Hair cells loss had rarely been seen in the control group of cochlear tissue under the culture condition. How ever, in cisplatin treated groups, the hair cells loss increased from 14.5% to 78.4% with the concentration of cisplatin increased in the range of 10?mol/L-100?mol/L, while decreased from 48.8% down to 8.77% with the dose getting further higher to 400?mol/L and 1000?mol/L. Apoptosis was confirmed by the DAPI stain in the hair cells loss area. The hair cell loss shows no difference from the apex to the basal turn of the basilar membrane. Conclusion Cisplatin-induced hair cell death shows characteristic damage that it is dose-dependent in a certain range of dosage, and it decreases when the cisplatin dose higher than the one caus maximal damage under the condition of cochlear organotypic cutures. Apoptosis happens evenly in inner and outer hair cells in all turns of basilar membrane.

Accidents, Occupational ; Humans ; Hydrogen Sulfide ; poisoning

Osteomyelitis (OM) is still a major problem for orthopedists. Numerous studies have shown that genetic factors may play an important role in the pathogenesis of OM. As a third generation genetic marker, single nucleotide polymorphisms (SNPs) have received increasing attention from scholars who are studying genetic susceptibility to OM. In-depth research on the SNPs of susceptibility genes will help to explore new strategies for prevention, diagnosis and treatment of OM. This article reviews the research advances concerning gene SNPs and OM susceptibility.

BACKGROUND: Recently emerged immunosuppressive scheme combined with basiliximab following liver transplantation, such as the early steroid withdrawal or half amount of steroid. Many studies demonstrated that it would not increase the rejection rate in reducing the use of steroid. However, there were rare reports addressing whether it was safe and effective to replace the steroid by basiliximab. OBJECTIVE: Through the application of non-steroid and early steroid withdrawal immunosuppressive scheme in patients of hepatocellular carcinoma following liver transplantation, to evaluate the therapeutic effect and safety of two treatments. METHODS: A total of 80 patients of hepatocellular carcinoma receiving liver transplantation were divided into the experimental and control group. In the experimental group, 33 patients were applied with non-steroid treatment (Tacrolimus+mycophenolate mofetil+basiliximab); additionally 47 patients were applied with early steroid withdrawal treatment (Tacrolimus+mycophenolate mofetil+ steroid). Steroid was reduced gradually from the first day after transplantation to discontinuation after 1 month. The rates of rejection, infection, cancer recurrence and 1 -year survival were measured. RESULTS AND CONCLUSION: Compared to the control group, the rates of infection and cancer recurrence were significantly smaller in the experimental group (P < 0.05). However, there was no significantly difference between 2 groups in the rates of rejection and 1 -year survival (P > 0.05). It revealed that the non-steroid treatment can be safely and effectively applied in the patients with hepatocellular carcinoma following liver transplantation. The non-steroid treatment can significantly cut down the infection rate and cancer recurrence rate, which has no effect on the rejection and 1 -year survival rate.

Objective To evaluate the interstital MR lymphography using positive lymphotropic contrast agent for differentiation of metastatic lymph nodes from inflammatory lymph nodes hyperplasm.Methods Eighteen New Zealand white rabbits weighted at 2.0-2.5 kg were used.Inflammatory hyperplastic popliteal lymph node model was established in 9 rabbits by injection of complete freund adjuvant into the interdigitial skin of the dorsal aspect of one hind leg,and tumor-bearing popliteal lymph node model was established in another 9 rabbits by injection of VX~2 tumor cell suspension.The popliteal lymph nodes of another hind leg of all 18 rabbits were assigned to the normal contral group.In each group,every rabbit underwent MR lymphography examination before and after the inoculation.Volumes of 0.2 ml of Gd[DTPA-bis(2-aminoethoxy)ethane]polymeric contrast agent(Gd-poly-DTPA-EOEA)injection were injected subcutaneously into the dorsal feet of both hind legs of two groups of rabbits.T_1-weighted 3D gradient-echo images were obtained,and source images were used to reconstruct images of MIP before and after the administration of agent.The maximum short-axis diameter(MSAD)of each popliteal lymph node was measured on the enhanced 3D MIP images,and the signal-to-noise ratio(SNR)measurement was performed in the largest popliteal node of each rabbit at each time point in delayed scan.Independentsamples t test was used to compare the sizes of popliteal nodes in MSADs between inflammatorily hyperplastic and tumor-bearing nodes after the inoculation,and the values of SNRs of popliteal nodes at each time point between inflammatorily hyperplastic,tumor-bearing and normal popliteal lymph nodes.Imaging results of the popliteal nodes were analyzed and correlated with pathological findings.Results All of the rabbits were successfully inoculated except of the 2 rabbits in tumor-bearing nodal group.The size in MSAD of 13 inflammatorily hyperplastic and 11 tumor-bearing nodes was(1.32±0.14)and(1.33±0.12)cm,respectively.There was no significant statistical difference between the sizes of the two groups(t=0.186,P＞0.05).At the time of 5,15,30,60,90,120 minutes after the injection of the agent,the value of SNR of 9 inflammatorily hyperplastic and 9 contralateral normal nodes was 17.31±0.37 and 17.19±0.29,27.42±0.50 and 27.39±0.48,38.44±0.47 and 38.19±0.27,37.10±0.09 and 36.97±0.10,36.32±0.61 and 36.20±0.80,34.60±0.44 and 34.71±0.32,respectively.There was no significant statistical difference between the values of the two groups(t=0.78,0.14,1.43,1.00,0.36,-0.62,respectively,P＞0.05).The value of SNR of seven tumor-bearing and seven contralateral normal nodes was 6.00±0.22 and 17.21±0.28,7.87±0.16 and 27.17±0.23,8.14±0.24 and 38.16±0.19,8.09±0.28 and 36.94±0.30,7.59±0.20 and 35.96±0.72,7.50±0.14 and 34.81±0.27,respectively.There was significant statistical difference between the values of the two groups(t=-84.00,-182.72,-261.27,-186.48,-100.22,-239.00,respectively,P＜0.01).At each time point,inflammatorily hyperplastic nodes had significantly higher values of SNRs compared to tumor-bearing nodes(t=83.97,174.07,158.49,152.71,96.06,154.57,respectively,P＜0.01).A complete or part signal filling defect occurred in the tumor-bearing lymph node on the MR lymphographic images.Conclusions The internal anatomy and function of the lymph nodes were effectively visualized by interstitial MR lymphography with positive lymphotropic contrast agent,which provide a sensitively diagnostic way for the differentiation of benign lymph nodes from malignant ones.