0.05; the holding vs neutral position, the disaster side and the healthy side all had significant difference,P0.05.This showed that the capability of stability of a-c joint were good. The Roentgenograms of shoulder elevation position raise showed that there was no impact in the a-c joint.[Conclusion]The results of small incision Dewar's operation is good in treating instability distal clavicular fracture.It has the advantages of minimally invasive,easy operation and fixation.

Objective To explore the clinical efficacy of small-incision Dewar's operation for acute acromioclavicular dislocation.Methods Without exposing the a-c joint,the coracoid tip with tendon were transferred to the clavicle to reconstruct the coracoclavicular ligaments.And then the a-c joint was statically fixed and dynamically replaced.Results A 1-to 9-year follow-up(mean,4.9 years)was available in 52 patients.According to the Lazzcano Criteria,44 cases had excellent and 7 cases had good results,only one was failed because of bolt prematurity at 2 month after the operation.Roentgenogram,CT,and MRI showed that the surface of the acromioclavicular joint was smooth,no arthritic sign of cirrhosis,hyperplasia,or theca.The signal of the a-c joint was uniform.The Roentgenograms showed that,at the neutrality position,the distal end of the clavicle of the injured side was higher than that of the healthy side.The D/W of the healthy side was 0.432?0.101,which was significantly higher than that in the injured side(0.523?0.083,t=2.188,P=0.042).The difference between the neutrality and hold of the healthy side was 0.116?0.025,while that of the injured side was 0.087?0.016(t=1.114,P=0.280).The Roentgenograms of the raise position showed no impact in the a-c joint.Conclusions Small incision Dewar's operation is an effective,safe,and minimally invasive method for the treatment of acute acromioclavicular dislocation.

Objective To evaluate effect of two-stage exchange total hip arthroplasty (THA) using an antibiotic-loaded cement spacer in the treatment of hip infection secondary to hip surgery.Methods From January 2005 to January 2010,6 consecutive patients with infected hip secondary to hip surgery,including 2 males and 4 females,aged from 43 to 68 years (average,59.7±9.2 years) were treated with two-stage exchange THA.There were 3 cases of femoral neck fracture treated with compression screws fixation,1 case of femoral head necrosis treated with bone graft,and 2 cases of early stage femoral head necrosis treated with core decompression and local interventional therapy respectively.Debridement and insertion of antibioticloaded cement spacer was performed in the first stage.After eradication of infection,it was converted to THA in the second stage.All patients were followed up regularly.Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested.Harris score was used to evaluate the function of the hips.Results All patients were followed up for an average of 46 months (range,24 to 81 mouths).Five of 6 patients were successfully converted to THA after an average of 14 weeks.One patient accepted the second debridement and reinsertion of a spacer owing to the abnormal values of ESR and CRP; this case was converted to THA successfully 12 weeks after the second debridement.Harris hip score improved from preoperative 35.6±3.3 to 57.8±5.4 between the two stages and 92.3±5.7 at final follow-up.One patient suffered deep vein thrombosis in the infected extremity and pulmonary embolism.There was no reinfection after THA.Conclusion Twostage exchange THA using an antibiotic-loaded cement spacer can obtain satisfactory results for the treatment of hip infection secondary to the hip surgery.

Objective To investigate the clinic pathologic features of young patients with renal malignant tumour by comparing with older patients. Methods The clinical data of 83 younger adults(age,≤40 years) with renal cell carcinoma and 703 cases of older renal cell carcinoma (age＞40 years)was analyzed and compared retrospectively. All of the patients were surgically treated between 1986and 2007. Results Among patients with symptoms, younger female patients were more likely to have abdominal pain(12/27, 44.4% vs. 154/703, 21.9%)and mass (2/27, 7.4% vs. 154/703,1.3%)than older (P＜0.05). The older groups were more likely to have dear cell carcinoma than in the younger(501/703, 71.3% vs. 47/83, 56.6%)(P＜0.05). The rate of PRCC has the trends to be higher in young patients than that in older patients (21/83, 25.3% vs. 118/703, 16.8%) (P=0.054),especially in male patients (17/56, 30.4 %) (P=0.011). The rate of MFH and leiomyosarcoma was significantly higher in young patients than that in older patients (6/83, 7.2% vs. 12/703,1.7%) (P＜ 0.05), especially in female patients (4/27,14.8%). Younger male patients were more likely to have a higher incidence of small tumors (T≤4 cm)(24/56,42.9 % vs. 173/703,24.6 % )(P＜0.05)and a lower incidence of big RCC(T＞7 cm) than older patients(12/56,21.4% vs. 295/703,42.0%) (P＜0.05). Conclusion Younger female renal cell carcinoma patients tends to have worseprognosis than older patients, while younger male patients have better prognosis due to different pathology.

Objective To investigate the method and efficacy in treating acetabular bone defects by the use of titanium wire mesh and impact bone allograft in revision total hip arthroplasty.Methods Twenty-two patients (22 hips) with acetabular bone defects in revision total hip arthroplasty were treated with wire mesh and impact bone allograft from January 2008 to December 2013.There were 7 males and 15 females in the present study.The average age of the patients at the surgery was 64.8 (37-78) years.According to Paprosky classification,there were 9 cases of type ⅡA,4 cases of ⅡB,7 cases of ⅡC and 2 cases of ⅢB.Twenty cases with aseptic loosen and 2 with periprosthetic infection were underwent revision surgery.Deep frozen cancellous bone allograft was sterilized and morselized to particles with the size of 7 to 10 mm.After removal of loosed acetabular component,the bone grafts were impacted into the acetabular defects area to restore the bone quantity.Titanium wire mesh with appropriate diameter was chosen to fix on impacted bone graft and fixed acetabulum with screws.Polyethylene cup was cemented in the mesh wire with proper position.Harris hip score system was used to evaluate the hip joint function.The AP pelvis X-ray was taken at 1 week,3 months,12 months and annually thereafter postoperatively to evaluate the rotation center,fusion of the bone graft and loosening of cup.Results All patients were followed up with the average period 5.1 years (3-7 years).The average Harris hip score before revision was 43.75±13.45,while the score was 85.33±7.84 at last follow-up (t=7.930,P=0.000).The average height of hip rotation center of surgical side was 3.49±0.77 cm before surgery,while its height at last follow-up was 2.22±0.22 cm (t=4.390,P=0.005).The distance between hip rotation center and the base of acetabulum was 3.54±0.45 cm before surgery,while its value was 3.52± 0.76 cm at last follow-up.All the bone grafts came to infusion with the average time 12 months (9-15 months).There was no case with cup migration more than 4 mm or rotation greater than 5° at last follow-up.One patient had the symptom of sciatic nerve injury.No case was with infection or dislocation.Conclusion In the treatment of acetabular bone defects,wire mesh and impact bone allograft with cemented cup in revision total hip arthroplasty can reconstruct hip rotation center and the acetabular bone quantity effectively.Satisfied early-midterm curative effects could be acquired by using this method.

Objective To evaluate the relationship between extracelluar signal?regulated protein kinase 1∕2 (ERK1∕2) and signal transducer and activator of transcription 3 (STAT3) signaling pathways involving in cardioprotection induced by diazoxide postconditioning in rats. Methods Sixty adult male Sprague?Dawley rats, aged 3 months, weighing 240-260 g, were randomly divided into 5 groups ( n=12 each) using a random number table: sham operation group ( SH group ) , ischemia?reperfusion ( I∕R ) group, diazoxide postconditioning group ( D group ) , ERK1∕2 inhibitor U0126 group ( U group ) , and STAT3 inhibitor Stattic group ( St group) . Myocardial I∕R was produced by occlusion of anterior descending branch of the coronary artery followed by 120 min reperfusionIn I∕R and D groups, 0?4% dimethyl sulfoxide 1 ml and 7 mg∕kg diazoxide ( in 1 ml of 0?4% dimethyl sulfoxide) was injected through the femoral vein at the onset of reperfusionIn U and St groups, U0126 100 μg∕kg and Stattic 500 μg∕kg were injected through the femoral vein at 10 min before reperfusion, and the other procedures were similar to those previously described in group DAt 120 min of reperfusion, the rats were sacrificed, and myocardial specimens were obtained from the left ventricle for determination of myocardial infarct size, cell apoptosis, and ERK1, ERK2 and STAT3 mRNA expression ( real?time PCR), and phosphorylated ERK1∕2 ( p?ERK1∕2) and phosphorylated STAT3 (p?STAT3) (using Western blot). Apoptosis index (AI) was calculated. Results Compared with group S, the myocardial infarct size and AI were significantly increased, and the expression of ERK1, ERK2 and STAT3 mRNA, p?ERK1∕2 and p?STAT3 was down?regulated in group I∕R. Compared with group I∕R, the myocardial infarct size and AI were significantly decreased, and the expression of ERK1, ERK2 and STAT3 mRNA, p?ERK1∕2 and p?STAT3 was up?regulated in group D. Compared with group D, the myocardial infarct size and AI were significantly increased in U and S groups, the expression of ERK1, ERK2 and STAT3 mRNA, p?ERK1∕2 and p?STAT3 was down?regulated in group U, and the expression of STAT3 mRNA and p?STAT3 was down?regulated, and no significant change was found in ERK1 and ERK2 mRNA and p?ERK1∕2 expression in group S. Conclusion STAT3 signaling pathway is located downstream of ERK1∕2 signaling pathway in the mechanism by which diazoxide postconditioning reduces myocardial I∕R injury in rats.

Objective To evaluate the role of signal transducer and activator of transcription 3 (STAT3) signaling pathway in the reduction of myocardial ischemia-reperfusion (I/R) injury by diazoxide postconditioning in rats.Methods Sixty adult male Sprague-Dawley rats,aged 3 months,weighing 240-260 g,were randomly divided into 5 groups (n =12 each):sham operation group (S group),I/R group,vehicle group (V group),diazoxide postconditioning group (D group),and STAT3 signaling pathway inhibitor Stattic group (St group).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch of coronary artery followed by 120 min reperfusion.In V and D groups,0.4％ dimethyl sulfoxide and 7 mg/kg diazoxide (in 1 ml of 0.4％ dimethyl sulfoxide) were injected through the femoral vein at the onset of reperfnsion,respetively.In St group,Stattic was injected through the femoral vein 10 min before reperfusion,and the other procedures were the same as those in D group.The infarct size (IS) and myocardial apoptosis were detected by TTC staining and TUNEL,respectively.Apoptotic index (AI) was calculated.STAT3 mRNA expression in myocardial tissues was detected using RT-PCR.Western blot was used to detect the phosphorylation of STAT3.Results Compared with S group,the IS and AI were significantly increased and the expression of STAT3 mRNA and phosphorylation of STAT3 were decreased in I/R group (P ＜ 0.05).Compared with I/R group,the IS and AI were significantly decreased and the expression of STAT3 mRNA and phosphorylation of STAT3 were increased in D group (P ＜ 0.05).There was no significant difference in IS,AI,expression of STAT3 mRNA and phosphorylation of STAT3 between V group and St group (P ＞0.05).Compared with group D,the IS and AI were significantly increased and the expression of STAT3 mRNA and phosphorylation of STAT3 were decreased in St group (P ＜ 0.05).Conclusion STAT3 signaling pathway is involved in the reduction of myocardial I/R injury by diazoxide postconditioning in rats.

0.05). The positivity rate of anti-HCV in patients with liver cirrhosis was 7.1%.

Objective To investigate the effects of ω-3 polyunsaturated fatty acids (ω-3 PUFA) on systemic inflammatory response and intestinal mucosa barrier in rats with traumatic brain injury and hemorrhagic shock (TBIS).Methods A total of 36 male Wistar rats were equally randomized into 3 groups:sham operation group,TBIS model group,and ω-3 PUFA pretreatment group.The serum levels of tumor necrosis factor-α (TNF-α),8-iso-prostaglandin F2 a (8-iso-PGF2 a),interleukin (IL)-1 β,and IL-10 were measured by enzyme linked immunosorbent assay (ELISA).HE staining was performed for morphological assessment of the intestinal tissue and evaluation of the intestinal mucosa damage index (IMDI).The marked bacilli of the mesenteric lymph nodes,lung,liver,spleen,and kidney tissue were counted under a fluorescent microscope.Results Compared with those in the sham group [ (38.15 ± 6.37) ng/ml,(84.91 ± 17.22) pg/ml,(2.52 ± 0.83 ) μg/L,(2.86 ± 0.82) μg/L,0.36 ±0.14,and 8.33％ ],the serum levels of TNF-α [ (328.11 ±20.09) and (244.37 ±21.82) ng/rrl],8-iso-PGF2a [ (263.47±55.19) and (176.35±41.63) pg/ml],IL-1β [ (27.06±2.61) and (18.91 ±1.78) μg/L],IL-10 [ (7.63 ± 1.29) and (9.52 ± 4.66) μg/L],the IMDI (4.18 ±0.39 and 3.31 ±0.40),and the positive rates of bacterial translocation (56.67％ and 35.00％ ) were significantly higher in both the TBIS model group and ω-3 PUFA group ( all P ＜ 0.01 ).Compared with TBIS model group,the levels of TNF-α,8-iso-PGF2 a,and IL-1 β,the IMDI,and the positive rate of bacterial translocation were significantly lower ( all P ＜ 0.05 ) and the levels of IL-10 were significantly higher in the ω-3 PUFA group (P ＜0.01 ).Conclusion The supplementation of ω-3 PUFA can remarkably inhibit the systemic inflammatory response and protect the integrity of intestinal mucosa in rat with TBIS.

Objective To analyze the mammographic findings of triple-negative breast cancer [TNBC,which is estrogen receptor (ER) negative,progesterone receptor (PR) negative,and human epidermal growth factor receptor 2 ( HER2 ) negative ] and triple-positive breast cancer ( TPBC,which is ER positive,PR positive,and HER2 positive ),and to evaluate the relationship of immunohistochemologic receptor status and mammographic findings.MethodsThe immunohistochemistry results of 631 cases with breast cancers were reviewed,including 117 cases of TNBC and 44 cases of TPBC.All of the patients took mammography at initial diagnosis.We retrospectively evaluated the visibility,morphology,distribution and size of the lesion (masses and calcifications) and breast density on mammography of TNBC,and compared them with those of TPBC.The age onset and tumor sizes of TNBC and TPBC were compared by using Chi-square test and t test.ResultsThe visibility rate of TNBC and TPBC on mammography were 88.0％(103/117) and 90.9％ (40/44),and the difference between them was insignificant ( x2 =0.055,P ＞0.05).TNBC was more frequently associated with merely a mass (56/103) than TPBC (12/40) (x2 =6.860,P＜0.01 ),and the mean diameter of the mass of TNBC [ ( 2.6 ± 1.4 ) cm ] was larger than that of TPBC [(2.0 ± 0.6) cm](t =2.087,P ＜ 0.05). TNBC were less frequently associated with microcalcifications (37/103) than TPBC ( 24/40 ) ( x2 =7.423,P ＜ 0.01 ).Mammographic density and lesion visibility were similar between the two different immunophenotypes of breast cancers.The mean age of TNBC (52±9) was more than that of TPBC (48 ±8) (t =2.759,P ＜0.01).Infiltrating ductal carcinoma was the main pathologic type of both groups.Basal-like breast cancer accounted for 49％ (57/117 ) of TNBC while none happened in TPBC.ConclusionsTNBC shows merely a mass with indistinct margins,lager size and is less associated with microcalcifications.These mammographic features might be useful in diagnosing triple negative breast cancer.