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.

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.

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.

10.3969/j.issn.2095-4344.2013.26.011

Objective This paper analyzed the development and current situation of patents from first class hospitals in Shanghai,reflecting the development of scientific researches,providing medical science research management with data support as the basis of decision making.Methods Based on patent search and analysis of State Intellectual Property Office of The P.R.C and Incopat,a technology innovation intelligence platform with global patent information,patents from first class hospitals in Shanghai published before the year of 2015 are analyzed from aspects including patent category,legal status,time trend,applicants of invention patent,proprietor and inventors of authorized invention patents,transfer of invention patents,etc.Results First class hospitals in Shanghai had 1979 invention patents,which accounted to 56.38％ of the total.71.21％ of invalid invention patents fell into abeyance because of withdraw,rejection,and abandon,which was 2.47 times of those due to termination.Eight hospitals including Shanghai Ninth People's Hospital and Huashan Hospital were at the top of both the invention patent application list and the authorized invention patent list,both accounting to more than sixty percent.Conclusions The number of invention patents has gone through germination stage,developing rapidly in recent years,the ratio of authorized inventions appears to decline slightly after rise.The reasons of patent invalidation are worthy of attention,the information about legal status of patents can be reasonably used,applicants and inventors shows uneven distribution,patent quality should be emphasized with quantity rise,cross regional and cross border cooperation can bring about complementary advantages.

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.

A total of 35 patients with hallus valgus (56 feet) received treatment at the Department of Orthopedics, the Sixth People's Hospital, Shanghai Jiao Tong University between January 2004 and June 2005 and were recruited into this study. These patients underwent osteotomy of proximal first metatarsal and internal fixation with poly (L-lactic acid) (PLLA) absorbable pins. All patients were followed up for 4-22 months. Excellent outcomes were found in 27 patients (44 feet) and good results in 8 patients (12 feet). The mean healing time of surgical region was 6 weeks, nonunion or delayed union was not found. There were 3 cases suffering from complications post surgery. Two of them presented with peripheral wound red swelling, considering as a result of extraneous material-caused aseptic inflammatory reaction. This phenomenon would be regressed 2-4 weeks after hydropathic compress of ethanol gauzes and timely renewal of dressings. There was 1 case who suffered from protrution of absorbable pin 1 week after fixation and received reposition and plaster fixation. Bone displacement and nonunion were not found. This complication maybe results from excessively large bone pore due to shaking of electrodrill, which leads to loosening of absorbable pins.