ObjectiveTo probe into the clinical efficiency of reconstruction to person who had composite tissue defect of the floor of mouth and the lower part of face with the free forearm flap and free iliac bone in the same term.MethodsBefore the surgery, the surgeon should carefully evaluate the scope and shape of defects in 11 cases who had the composite tissue defects of the floor of mouth and the lower part of face, to design the individual forearm flap, so that it matches with the defect region. During surgery, the first resumption of defects using titanium plates forming the basic shape of mandible and the occlusal relationship,then used to re-sawing to take modeling of the iliac bone,transplanted free iliac bone and fixed after the inside of the titanium plate, thereby restoring the continuity of mandible missing.ResultsFree forearm flap and free iliac bone all survived in 11 cases, the success rate of 100％. The patients were followed up for 6 to 12 months, although the shape of restoration areas were different levels of fat, but eating, swallowing and other oral function had been well improved, 7/11 could enter normal diet, 4/11 to enter liquid diet, At the same time, the patients in social activities can communicate in a language daily, sensory function of skin flap and facial appearance has been satisfactory recovery.ConclusionConformal free forearm flap and free iliac bone is an ideal way to reconstruct the composite tissue defects of the floor of mouth and the lower part of face in the same period, not only safe, practical prognostic effect, and also can significantly improve the patients quality of life, which is worthy of reference and use.

Thorough excavation and artful utilization of various kinds concrete and invisible learning resources contribute to the cultivation of excellent postgraduates.In postgraduate education of anesthesiology Xuzhou Medical College utilizes time,network,technique platform,research outcome,self-potentiality and clinical patients resources,which produces an active effect and has important instructional significance.

ObjectiveTo explore the curative effect in the patients with internal endometriosis by interventional therapy.MethodsUsing Seldinger technique,34 cases with internal endometriosis wereperformed bilateral uterine artery embolization.Observed postoperative menstrual quantity,dysmenrrhea degree,anemia and the change of the volume of uterine lesions.ResultsAll the patients were followed up for 1-3 years,menstrual quantity average decreasd of 59.1％P ＜ 0.05 ),the symptoms of dysmenorrhea was significantly eased in 28 cases (82.4％,28/34).All the patients of anemia haemoglobin were back to normal,volume of uterus average reduced 43.8％P ＜ 0.05 ),lesion was obviously smaller or disappear.Ultrasonography showed myometrium and blood flow signal of lesion was was obviously reduced.Conclusion Internalendometriosis by interventional therapy can get good results,symptoms improve significantly.

Objective To discuss the relationship between human leukocyte antigen (HLA) gene heredity and morbidity of cerebral infarction by a random survey on the allele expression of HLA-A, B and DRB1 seats of patients with cerebral infarction. Methods The genotypes of HLA-A, B and DRB1 alleles in 94 patients with cerebral infarction and 122 healthy blood donors were detected by polymerase chain reaction-sequencing based typing (PCR-SBT) method. Results Sixteen alleles in HLA -A locus,32 alleles in HLA -B locus and 25 alleles in HLA -DRB1 locus expressed themselves in these patients with cerebral infarction. The gene frequency of HLA -A*1102 in patients was lower than that in healthy controls, and negative association was found between HLA -A* 1102 allele and cerebral infarction (RR=0.06,P=0.019). Conclusion The research reveals susceptibility association of HLA -A*1102 with patients having cerebral infarction, displaying close genetic immunity correlation between HLA alleles and pathogenesis of cerebral infarction. So, the research in this paper is useful in the clinical prediction of this disease.

Objective To investigate the awareness rate,treatment rate and control rate of mineral and bone disorder in patients with moderate or advanced stage chronic kidney disease (CKD). Methods The awareness rate,treatment rate and control rate of mineral and bone disorder were evaluated based on a questionnaire and related laboratory examinations in 503 CKD stage 3 to 5 patients. Results The awareness rate of mineral and bone disorder in patients with moderate or advanced stage CKD was highest in hemodialysis patients,moderate in peritoneal dialysis patients and lowest in non-dialyzed patients (all P ＜0.01).The total scores of the questionnaire were lowest in non-dialyzed patients [6 (5,8)] and were significantly higher in peritoneal dialysis [11 (9,12)] and hemodialysis patients [13 (11,15)] (P＜0.01).The extent of awareness was negatively correlated with age (r=-0.11,P＜0.05),and positively correlated with educational background (r=0.226,P＜0.01),duration of CKD (r=0.597,P＜0.01) and duration of dialysis (r=0.366,P＜0.01).The source of knowledge was mainly from publicity and education made by medical staff,which accounted for 94.0％,79.5％ and 69.4％ respectively in nondialyzed,peritoneal dialysis and hemodialysis patients.The treatment rate was significantly higher in peritoneal dialysis (88.6％) and hemodialysis patients (96.9％) than that in non-dialyzed patients (58.2％) (all P＜0.01).According to K/DOQI guideline,the control rate of serum calcium,phosphorus,calcium and phosphorus product and parathyroid hormone (PTH) were much better in non-dialyzed patients as compared to dialyzed ones.The percentage of number of lab indicators meeting the standard was significantly higher in non-dialyzed patients as compared to dialyzed ones (P＜0.01).According to KDIGO guideline,the control rate of serum phosphorus was significantly lower in hemodialysis patients (23.6％) than that in peritoneal dialysis (36.9％) and non-dialyzed patients (46.7％) (P＜0.01). Conclusions In non-dialyzed patients with moderate or advanced stage CKD,the awareness rate and treatment rate of mineral and bone disorder are relatively low,and the control rate is relatively high.Whereas in dialyzed patients,the awareness rate and treatment rate are relatively high,and the control rate is relatively low.

Objective To study the clinical manifestations and treatment methods of hyperprolactinemia (HPRL), a common disorder encountered in clinical practice, and explore its association with prolactinomas. Methods The clinical data, hormone profile and imaging data of 166females with documented HPRL, admitted to our hospital from January 2005 to January 2010, for over a period of 5 years, including 4 years of retrospective analysis and 1 year of prospective study, were retrospectively analyzed. Results Most patients aged 20-40 with abnormal menstruation as their most common symptom; 141 patients (84.9％) appeared abnormal menstruation and 1 14 (68.7％) with galactorrhea. Microadenoma was noted in 62 patients (37.3％), nonfunctioning pituitary macroadenoma involved stalk occurred in 26 patients (15.7％). As compared with that in patients with idiopathic HPRL ([93.9±20.4]ng/mL), the level ofprolactin in patients with microprolactinoma ([161.2±60.6]ng/mL) was significantly higher (P＜0.05); as compared with that in patients with prolactin microadenoma, the level of prolactin in patients with domperidone caused drug-induced HPRL ([240.2±29.4]ng/mL) was obviously increased (P＜0.05). Conclusion We cannot confirm whether a HPRL patient has prolactinomas only through detecting the level of prolactin. Microprolactinoma is the most common cause of HPRL, followed by idiopathic cause.

Objective To evaluate the feasibility and safety of stent implantation in treating patients with symptomatic vertebral artery kinking.Methods Thirty-six patients with vertebral artery kinking confirmed by DSA and accorded with the stent implantation indications were chosen in our study;these patients were performed stent implantation.The stenosis and haemodynamics changes,and recent and postoperative complications were observed; Malek scale was adopted to evaluate the clinical efficacy during the 1-year follow-up.Results The success rate of stent implantation for patients with symptomatic vertebral artery kinking was 100％.The percentage of stenosis was significantly reduced from(76％±15％)to(8％±3％)after stenting(P＜0.05); the mean flow velocity of kinking lesion was obviously decreased from([45.4±22.3]cr/s)to([31.8±15.1]em/s,P＜0.05); cerebellum hematoma was noted in 1 patient subcutaneous hematoma of puncture point in 2 and femoral artery pseudoaneurysms after the stenting in 1; all these complications did not cause serious consequences.Malek scale indicated that 31 patients got 1 point,3 got 2 points,1 got 3 points,1 got 4 points and no one got 5 points; 31patients were asymptomatic during the 1-year follow-up; no significant in-stent restenosis was found.Conclusion Symptomatic vertebral artery kinking can be treated safely and effectively with stent implantation.

Objective To explore the clinical effect of direct posterior restoration and screw-rod (plate) internal fixation technique for the treatment of children with congenital atlantoaxial subluxation.Methods Seven children with congenital atlantoaxial subluxation,admitted to our hospital from April 2008 to March 2011, were chosen in our study; and 3 of them were combined with tonsil hernia of cerebellum and 3 with occipitalization. Japanese Orthopedic Association (JOA) scale was used to evaluate the patient's condition. Five patients were treated by internal fixation with occipital bone screw-axis (C2) pedicle screw and 2 were with atlas C1-C2.Articulatio atlantoepistrophica repositioning was performed during the operation. The post-operative improvement degree and therapeutic effect of these patients were assessed based on the JOA scores and imaging. Results All the patients were followed up for 1-15 months (average 3.2 months). The clinical symptoms of all patients improved significantly. The positions of all screws were fine 1 month after operation. Three-dimensional CT showed that occipital/interbody fusions were good in 3 patients.JOA scores after the surgery were 7-16 with an average scores of (12.03±3.58),which were significantly different as compared with those before the surgery ([7.56±3.16], P＜0.05). Conclusion Direct posterior restoration and internal fixation technique is a safe and effective method for the treatment of children with congenital atlantoaxial subluxation.