Bone metastasis occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. Several sequences occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. Pain associated with osseous metastasis is thought to be distinct from neuropathic or inflammatory pain. Several mechanisms, such as invasion of tumor cells, spinal cord astrogliosis,and sensitization of nervous system, have been postulated to cause pain. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. These drags are associated with side effects, and tolerance to these agents necessitates treatment with other modalities. Bisphosphonates act by inhibiting osteoclast-mediated resorption and have been increasingly used in treatment of painful bone metastasis. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesions. 32p has been used for over 3 decades in the treatment of multiple osseous metastases. The myelosuppression caused by this agent has led to the development of other bone-seeking radiopharmaceuticals, including 89SrCl, and 153Sm-ethylenediaminetetramethylene phosphonic acid (153Sm-EDTMP). 89Sr is a bone-seeking radionuclide, whereas 153Sm-EDTMP is a bone-seeking tetraphosphonate; both have been approved by the Food and Drug Administration for the treatment of painful osseous metastases. While both agents have been shown to have efficacy in the treatment of painful osseous metastases from prostate cancer, they may also have utility in the treatment of painful osseous metastases from breast cancer and perhaps from non-small cell lung cancer. This article illustrates the salient features of these radiopharmaceuticals, including the approved dose, method of administration, and indications for use.

The arteries of the female internal genitalia were studied with transparent, X-ray photogaphyand corrosion method in 40 specimens from fetuses and babies. The uterine artery divides into ascending and descending branches along the lateral border ofthe uterus. The descending branches supply the cervix of the uterus and anastomose with thevaginal artery. The ascending branches ascends along the lateral border of the uterus to the originof the proper ligament of the ovary where it sendes out the fundus, uterine tube and ovarianbranches. In most cases, there is no convolution and without further branching in the remainingtrunk of the ascending branch. The ovarian artery is spiral in the suspensory ligament of the ovary. It is in this region or inthe mesovarium, the ovarian artery divides into 2--3 branches, that is to anastomose with theuterine artery and its ovarian and fimbrian branches of the uterine tube. The most common typeof anastomoses found in the hilum in the ovary and origin of the proper ligament is that theovarian branch of the uterine artery communicates with the ovarian artery. The uterine artery divides into 20-40 straight or convoluted branches in the uterine wall.Branches from the two sides anastomose near the midline of the uterus. The degree of convolutionand the number of branches and anastomoses in the uterine wall increase with age. Both ovarian and uterine artery supply blood to the ovary. There are about 20--30 branchesin the hilum of the ovary. They attain various spiral forms. The most common type of bloodsupply in the uterine tube is that the uterine tube and isthmus branches of the uterine artery anas-tomose with the fimbria branch of the ovarian artery and then send out 20--30 branches to encirclethe uterine tube.

Objective To investigate the awareness of knowledge,attitude and behavior about disinfection and sterilization among clinical health care workers (HCWs).Methods 200 clinical HCWs were investigated randomly by using questionnaires.Results The average awareness rates of knowledge,attitude and behavior about disinfec-tion and sterilization among HCWs were 71 .49%,63.79%,and 86.45% respectively.The awareness rates of knowledge about the expiration dates of sterilized articles,classification of infectious diseases,and biological moni-toring were 49.43%,42.53%,and 23.56%,respectively;HCWs’attitude towards disinfection and sterilization:awareness rate of whether they paid attention to the new technology in specialty of central sterile supply was the lowest (26.44%);86.45% of HCWs thought they could master the aseptic operation technique,correct applica-tion method for sterile apparatus and related items,but easily ignored to check the integrity of aseptic packages and indicators before operation (67.24%).Conclusion The knowledge,attitude and behavior about disinfection and sterilization among HCWs still need to be improved,training on knowledge about disinfection and sterilization among HCWs should be strengthened.

Objective To investigate treatment method for existing and impending benign pathological femoral neck and trochanteric lesions.Methods A retrospective study wad done on 25 patients with benign proximal femur lesions treated between 2002 and 2004.All patients were treated with lesion curettage,cauterization,autografting and/or allografting.Then,dynamic condylar screw (DCS) or hip joint-span external fixator were selected according to the involved area of the lesion of the proximal femur.The duration of follow-up was mean 2.3 years (2-4 years).Results Sound bony union was seen on the radiographs of all patients by 3-6 months after surgery.There found no local recurrence or avascular necrosis of the femoral head,or complications like necrosis,infections or fractures.Function of the patients in the current series was graded excellent,assessed by the validated outcome measures MSTS-87,MSTS-93 and TESS lower extremity.Conclusion DCS or hip joint-span external fixator may be better alternative treatment of benign pathological femoral neck and trochanteric lesions,compared with conventional surgical methods such as simple bone grafting,traction and hip spica cast.

The lymphatic drainage of the ileocecal region was studied on 40 fetus and infant cadavers through the method of lymphatic injection. The lymphatics of the terminal part of the ileum in most cases ascend to the ileo- colic nodes.Part of these lymphatics lead to the nodes around the cecal or the ileal branches of the ileocolic artery.There is a single case,in which part of these lymphatics end directly in the superior mesenteric nodes. The lymphatics of the appendix mostly run parallel to the appendicular artery and lead to the ileocolic nodes.In some cases 1—2 lymphatics end in the appendicular nodes, and the nodes along the cecal or the ileal branches of the ileocolic artery. The lymphatics of the cecum mostly open into the anterior cecal nodes.Part of these lymphatics end in the ileocolic nodes.It is only in a few cases that 1—2 lymphatics of the cecum run to the posterior cecal nodes or the nodes situated at the cecal branches of the ileocolic artery.

10.3969/j.issn.2095-4344.2013.26.011

Objective To analyze the complete genome sequence of a Shenzhen coxsackievirus A2 strain CVA2-SHZH13-01 and its evolution.Methods RT-PCR was used to amplify the complete genome of CVA2-SHZH13-01 strain.The PCR products were purified and sequenced to analyze their genetic character-istics.Results The complete genome of CVA2-SHZH13-01 strain was 7400 bp in length, encoding 2191 amino acids.CVA2-SHZH13-01 strain was highly similar with the novel recombinant CVA2-HK (431306) strain isolated from Hong Kong sharing the nucleotide homology of 98.3%, 98.8%, 99.0%, 99.2%, 98.8%and 98.9%in 5′UTR, P1 ( VP1 to VP4) , P2, P3, 3′UTR regions and complete genome, respec-tively.CVA2-SHZH13-01 strain was highly identical to the international standard strain CVA2-Fleetwood showing the homology of 81.6% in nucleotide sequences in P1 region, but closely associated with EV71-SHZH03 and EV71-GD2009 strains (82.8%-88.7%) in P2 and P3 regions.The phylogenetic analysis in-dicated that CVA2-SHZH13-01 strain belonged to the CVA2-HK (431306) variant.Data from analysis of amino acid in P1 region showed that there were three amino acid mutations in CVA2-SHZH13-01 strain including aa5L→F, aa666S→G and aa671T→I as compared with CVA2-HK (431306) strain.Conclusion CVA2-SHZH13-01 strain belonged to CVA2-HK (431306) variant.

Objective To evaluate the effect of fentanyl on the efficacy of low-dose ropivacaine for spinal anesthesia in patients undergoing anorectal surgery.Methods Forty ASA Ⅰ or Ⅱ patients,aged 20-55 yr,with body mass index 18-28 kg/m2,scheduled for anorectal surgery,were randomly divided into 2 groups (n =20 each):0.5％ ropivacaine 7.5 mg group (group R) and 0.3％ ropivacaine 6.0 mg+ fentanyl 10 μg group (group RF).A catheter was implanted into the subarachnoid space (L3.4 interspace) and advanced caudally until lumbar region.Group R received hyperbaric 0.5％ ropivacaine 1.5 ml.Group RF received 2.0 ml mixture of hyperbaric 0.3％ ropivacaine 6.0 mg and fentanyl 10μg.The onset time of sensory and motor block,upper level of sensory block,and duration of sensory and motor block were recorded.Motor block was assessed by modified Bromage scale.Results Compared with group R,the duration of sensory and motor block was significantly shortened,and modified Bromage scores were significantly decreased in group RF (P ＜ 0.05 or 0.01),and no significant change was found in the onset time of sensory and motor block and upper level of sensory block between the two groups (P ＞ 0.05).Conclusion 0.3 ％ ropivacaine 6.0 mg combined with fentanyl 10 μg provides satisfactory spinal anesthesia for anorectal surgery,with lower degree and faster recovery of motor block.

Although the Shanghai's basic health insurance always takes the leading position nationwide in the aspects of coverage, funding level, security level, etc, it still cannot avoid the contradictory problems brought by the rapidly rising demand for health care, poor results of funds management, etc. Commercial health insurance has its u-nique advantages in terms of funds and personnel management. Therefore, they can play their complementary role to the basic medical insurance in order to improve the basic health insurance system. Based on the perspective of com-mercial health insurances, this paper explores the basic health insurance system in Shanghai from the aspects of man-agement patterns, governing body, insurance objects, funding modalities and insurance programs.

Objective To evaluate the values of combined detection of soluble mesothelin related proteins (SMRP)and carbohydrate antigen 1 25 (CA1 25)in the diagnosis of malignant peritoneal mesothelioma.Methods 20 patients with malignant peritoneal mesothelioma were selected as the malignant group,50 patients with benign ovar-ian tumor were selected as the benign group,60 healthy women were selected as the control group.Enzyme -linked immunosorbent assay(ELISA)was adopted to detect serum SMRP levels and electrochemiluminescence immunifaction (ECLI)was adopted to detect serum CA1 25 levels.The SMRP,CA1 25 levels were compared among all groups,the sensitivity,specificity of SMRP and CA1 25 in the diagnosis of peritoneal malignant mesothelioma were analyzed. Results Serum levels of SMRP,CA1 25 in malignant group were (1 4.8 ±1 .6 )μg/L,(1 89.1 ±1 5.3 )μg/Lrespectively,which were significantly higher than those in the benign group[(3.9 ±0.9)μg/L,(28.6 ±4.2)μg/L] (t =27.40,49.61 0,all P <0.01 )and the control group[(2.8 ±0.7)μg/L,(1 6.9 ±3.8)μg/L](t =29.877, 53.334,all P <0.01 ).The sensitivities of SMRP,CA1 25 detection alone for malignant peritoneal mesothelioma diag-nosis were 65.0%,50%,respectively,while their specificities were 83.6%,79.1 %.The sensitivity and specificity of combined detection of SMRP and CA1 25 for malignant peritoneal mesothelioma were 95.0% and 93.6%.Conclusion SMRP has some value in the diagnosis of peritoneal malignant mesothelioma.SMRP combined with CA1 25 detection can markedly improve the diagnostic sensitivity and specificity for malignant peritoneal mesothelioma.