Objective To evaluate the effects of the sciatic nerve block on emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.Methods Sixty pediatric patients,aged 3-7 yr,weighing 12-20 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective foot orthomorphia,were randomly assigned to one of two groups (n =30 each):control group (group Ⅰ) and sciatic nerve block group (group Ⅱ).After induction of anesthesia,laryngeal mask airway was inserted,and artificial or mechanical ventilation was performed.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 0.5％-2.0％) and iv fentanyl 0.5-2.0 μg/kg.The sciatic nerve block on the affected side was performed under the guidance of a nerve stimulator,and 0.25％ bupivacaine 0.5 ml/kg was injected.Laryngeal mask airway removal time and emergence time were recorded.At 30 min of recovery from anesthesia,agitation was scored and the development of emergence agitation was recorded.Pain was evaluated with Faces Pain Scale-Revised (FPS-R) at 10 and 30 min of recovery from anesthesia.Adverse reactions including hypoxemia and nausea and vomiting were also recorded during recovery from anesthesia.Results Compared with group Ⅰ,the intraoperative consumption of fen tanyl and mean end-tidal concentration of sevoflurane were significantly decreased,laryngeal mask airway removal time and emergence time were shortened,and the incidence of emergence agitation,PPS-P scores and incidence of hypoxemia were decreased in group Ⅱ.Conclusion The sciatic nerve block is helpful in decreasing the development of emergence agitation following sevoflurane-based anesthesia in pediatric patients undergoing foot orthomorphia.

Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.

BACKGROUND: Apolipoprotein E (ApoE) gene polymorphism is associated with the onset of Alzheimer disease (AD), most of the researchers reported that ApoE ε4 allele accounts for familial AD as well as for sporadic AD.OBJECTIVE: This study was designed to validate the relationship between ApoE gene polymorphism and the sporadic AD in Aged Adults in Urumqi, and to evaluate the value of ApoE gene for prediction the risk of sporadic AD.DESIGN: Controlled comparative study based on patients.SETTING: It was conducted at the Institute of Clinical Medicine and the Neurological Department of Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: From January 2001 to January 2003, 60 aged inpatients and outpatients at the Neurological Department of Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA and elderly in the Old People's Home were screened for AD. Of all these participants,28 were males and 32 were females, with an age from 52 to 91, in average of (74.2±19.5) years old, They had 0-16 years education, in average of 4.43 years, 28 were illiterate, 13 were at primary school educational level,12 were at junior middle school educational level, 4 were at high school educational level and 3 were at college educational level. From February to December 2002, 90 genetically unrelated individuals with healthy physical examination findings in Xinjiang area were selected into control group, 59males and 31 females, with an age from 50 to 101 years old, in average of (69.9±25.5) years old, have 0-16 year's education, in average of 7.96years. Of all the controls, 14 were illiterate, 23 were at primary educational level, 25 were at junior middle school educational level, 21 were at high school educational level and 7 were at college educational level. Informed consents were obtained from all the participants.METHODS: 5 Ml blood samples, anticoagulated with ethylene diamine tetraacetic acid (EDTA), were drawn from each participant. Then genome DNA was extracted from peripheral white blood cells using the phenolchloroform method. A fragment containing polymorphism site in exon 4 of ApoE were amplified using the polymerase chain reaction (PCR), were digested with Hha I and were identified using electrophoresis and silver staining. Then, ApoE genotypes and the frequency of ApoE alleles were compared between AD group and control group.MAIN OUTCOME MEASURES: ① ApoE genotypes and the frequency of ApoE alleles were measured in AD group and control group. ② The frequency of ApoE alleles were calculated in participants with different sex,age and educational level in AD group and control group.RESULTS: Sixty patients with AD and 90 healthy individuals participated this investigation. All of them entered the statistical analysis procedure.① The frequency of ε3/ε4 and ε4/ε4 alleles was higher in AD group than in control group (26.67%,11.11%; 3.33%, 1.11%; P ＜ 0.05). The frequency of e2/ε3 in AD group were lower than control group (5.00%,14.00%, P ＜0.05). ② The frequency of ApoE ε4 allele were higher in AD group as compared with control group (17.50%, 7.22%, P ＜ 0.05). The frequency of ApoE ε2 allele were lower in AD group (6.67%, 13.33%, P ＜ 0.05). ③ The frequency of ApoE ε4 allele in females were higher in AD group than in control group (20.97%, 5.00%, P ＜ 0.01). ④ In AD group, patients ≥ 75 years old have a lower frequency of ApoE ε4 allele compared to those less than 75 years (8.57%, 30.00%, P ＜ 0.01). And in individuals less than 75 years old, the frequency of ApoE ε4 allele were higher in AD group than that in control group (30.00%, 7.02%, P ＜ 0.01). ⑤ In illiterate persons and the individuals with only primary school educational level, the frequency of ApoE ε4 allele were higher in AD group than that in control group (10.00%, 0.56%, P ＜ 0.001; 5.00%,1.12%, P ＜ 0.01).CONCLUSION: ① It is proved that ApoE ε4 allele is significantly associated with sporadicAD in Urumqi and ε3/ε4 is the major genotype. ② ApoE ε2 allele has a protective effect on onset of AD. ③ Those individuals，female,less than 75,lower educational level or carrying ApoE ε4 allele take a higher risk of AD.

BACKGROUND:In joint surgery, the commonly used autologous chondrocyte transplantation often used to repair cartilage defects, and poor integration is one of the reasons that leading to failure repairing. Chondrocytes migration capability is proven to have correlation with integration and some pathways, such as Src-phosphorylated phospholipase Cγ1-extracellular regulated kinase 1/2 has been confirmed to have correlation with the migration ability of chondrocytes, but the correlation with the integration is stil unknown. OBJECTIVE:To determine the chondrocyte signaling pathways involved in autologous chondrocyte migration and their effects on cartilage integration in autologous chondrocyte implantation. METHODS:Articular chondrocytes were isolated from immature pig knee joints. The cells were divided into four groups:Src group, phosphorylated phospholipase Cγ1 group, extracellular regulated kinase 1/2 group and control group, then the Boyden chambers were used to quantify the chondrocyte migration. The chondrocytes/cartilage ring integration model was developed and cultured for 28 days, and then histology, biochemistry, biomechanics, western blot analysis and celltracking analysis were performed to observe the differences between the control group and the suppression groups. RESULTS AND CONCLUSION:The migration ability of chondrocytes was significantly decreased after pretreated with inhibitors. After the chondrocytes/cartilage ring co-cultured for 28 days, Western blot analysis showed that the pathway inhibitors has been presented in the entire culture cycle. The number and length of chondrocytes migrated into the integration area, col agen secretion level, matrix and mechanical strength in the control group were higher than those in three suppression groups. The results suggest that chondrocyte migration ability can affect the cartilage integration capability through Src-phosphorylated phospholipase Cγ1-extracellular regulating kinase 1/2 signal transduction pathway.

ObjectiveTo explore the clinical efficacy of minitype vascularized superficial peroneal artery's singleness perforator flap,and then to accurately repair skin and soft tissue defects of hands and foots. MethodsFrom November 2009 to January 2011,eight cases(one case of left foot,one case of right foot,three cases of left hand and 3 cases of right band,1.3 cm × 5.0 cm - 2.5 cm× 6.0 cm of skin and soft tissue defects)were treated by minitype vascularized superficial peroneal artery's singleness perforator flap.Based on preoperative applied anatomy papers, it was the superficial peroneal artery's perforator position in the middle of the lateral lower leg to the fibula head;We designed the flap based on the size and shape of skin defect,and then to analysize the flap design,lap cut,he vascular anastomosis of flap and recipient,effect and characteristics of survival. ResultsAll the flaps(1.5 cm × 5.2 cm-2.8 cm × 6.2 cm) survived and satified in shape and texture, they acquired good functional recovery postoperation;There was blister,dark purple but survival after the scab off on 1 patient;There was phalanx ostomyelitis and healed after treatment on 1 patient.ConclusionThe clinical effects were satisfactory for repairing small skin and soft tissue defect of hands and foots by minitype vascularized superficial artery's singleness perforator flap.

Objective To investigate the differentiatial diagnostic value of 99Tcm-methoxyisobutylisonitrile ( MIBI ) SPECT combined with localizable CT in the evaluation of oxygen intervention for suspicious lung lesions,and to establish a cost-effective imaging modality in the detection of malignant lung lesions.Methods From September 2008 to March 2009,47 consecutive patients with suspicious malignant lung lesions underwent 99Tcm-MIBI SPECT/CT prospectively. Patients with suspicious pneumonia were treated with antibiotics for about 4 d before imaging. All patients were cannulized with a nostril tube for oxygen inhalation before 99Tc-MIBI injection. SPECT combined with localizable CT of the chest was performed at 10 min and 2 h after 99Tcm-MIBI injection. The uptake ratios of lesion to contralateral normal lung parenchyma(early uptake ratio:EUR and delayed uptake ratio:DUR) were compared using independent-samples ttest. In addition,the diagnostic efficiency of uptake ratios of lung lesions was analyzed with receiver operating characteristic (ROC) curve. Results Forty-seven patients ( primary lung cancers:32,metastatic tumors of the lung:4,benign lung diseases:11 ) had 51 lung lesions,including 39 malignant and 12 benign lung lesions. The sensitivity,specificity,accuracy,positive predictive value (PPV),and negative predictive value (NPV) were 94.9% (37/39),83.3% ( 10/12),92.2% (47/51),94.9% (37/39) and 83.3% ( 10/12),respectively. The EUR of malignant lesions was 2.95 ± 1.16,whereas of benign lesions was 1.43 ±0.33. The DUR of the malignant lesions was 3.19 ± 1.74,whereas of benign lesions was 1.60 ±0.32. Both EUR and DUR were significantly different between malignant and benign lung lesions,respectively (t= -4.44,-3.12,respectively,both P＜0.01). The ROC curve showed that EUR value ≥1.625 provided the sensitivity of 97.4% (38/39) and specificity of 83.3% (10/12); DUR value ≥ 1.75provided the sensitivity of 94.9% (37/39) and specificity of 83.3% (10/12). Conclusion 99Tcm-MIBI SPECT combined with localizable CT imaging in oxygen intervention has a potential value in differentiating malignant from benign lung lesions.

OBJECTIVETo observe the therapeutic effect of self-formulated Xiaokang Zhongzi Recipe (XZR) in treating male infertility with positive antisperm antibody (AsAb).

METHODSOne hundred and ten male infertility patients with positive AsAb were randomly assigned, according to randomized digital table, to the trial group treated with XZR, and the control group, treated with prednisone, 55 in each group. Clinical therapeutic effect and adverse reactions of the drugs were observed after 3 months of treatment.

RESULTSIn the trial group after treatment, 38 patients (69.1%) were cured, 14 (25.4%) improved and 3 treated in vain (5.5%, including 2 dropped out). While in the control group, the corresponding numbers were 12 (21.8%), 11 (20.0%) and 32 (58.2%, including 4 dropped out, 20 remained AsAb positive and 8 with AsAb reverted to positive after negative conversion). The negative conversion rate and average negative conversion time in the trial group and the control group were respectively 94.5%, (45 +/- 14) days and 41.8%, (62 +/- 21) days. Significant difference between the two groups was shown in therapeutic effectiveness and average negative conversion time (P < 0.01). Adverse reactions occurred in 3 cases (5.5%) in the trial group and 8 (14.5%) in the control group.

CONCLUSIONXZR is better than prednisone in treating male infertility with positive AsAb, and with fewer and milder adverse reactions.

Adult ; Autoantibodies ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Infertility, Male ; drug therapy ; etiology ; immunology ; Male ; Phytotherapy ; Spermatozoa ; drug effects ; immunology ; Treatment Outcome ; Young Adult

OBJECTIVE: This study was performed to investigate buccal facial depth (BFD) changes after extraction and nonextraction orthodontic treatments in post-adolescent and adult female patients, and to explore possible influencing factors. METHODS: Twelve and nine female patients were enrolled in the extraction and nonextraction groups, respectively. Changes in BFD in the defined buccal region and six transverse and two coronal measuring planes were measured after registering pretreatment and posttreatment three-dimensional facial scans. Changes in posterior dentoalveolar arch widths were also measured. Treatment duration, changes in body mass index (BMI), and cephalometric variables were compared between the groups. RESULTS: BFD in the buccal region decreased by approximately 1.45 mm in the extraction group, but no significant change was observed in the nonextraction group. In the extraction group, the decrease in BFD was identical between the two coronal measuring planes, whereas this differed among the six transverse measuring planes. Posterior dentoalveolar arch widths decreased in the extraction group, whereas these increased at the second premolar level in the nonextraction group. The treatment duration of the extraction group was twice that of the nonextraction group. No differences were found in BMI and Frankfort horizontal-mandibular plane angle changes between the groups. BFD changes in the buccal region moderately correlated with treatment duration and dental arch width change. CONCLUSIONS: BFD decreased in adult female patients undergoing extraction, and this may be influenced by the long treatment duration and constriction of dentoalveolar arch width. However, nonextraction treatment did not significantly alter BFD.
Adult ; Bicuspid ; Body Mass Index ; Constriction ; Dental Arch ; Female* ; Humans

BACKGROUND:With the development of tissue engineering, autologous chondrocyte implantation is often used to repair cartilage defects. And poor integration is one of the common reasons that lead to failure repairing. Many models in vitro are used for related studies.
OBJECTIVE:To develop an interface integrated model of tissue engineered cartilage repair in vitro and to evaluate the effect.
METHODS:Cartilage integration model in vitro was established in pigs. Total y 21 cartilaginous rings were obtained and divided into agarose gel group (n=18) and control group (n=3). In agarose gel group, cartilage rings were covered with agarose gel. Chondrocytes were separated and implanted into the ring. The leakage of cells around the cartilage rings was observed. The sections were stained for histological observation at 1, 2, 4 weeks. The average area of neochondrocytes was measured and compared.
RESULTS AND CONCLUSION:The results from the control group were not processed, because there was no chondrocyte aggregate formation in the center of the explant ring due to earlier chondrocyte leakage outside the explant. While no chondrocytes were found outside the explant ring in the agarose gel group. Tissue sections of the agarose gel group were stained by hematoxylin and eosin, alcian blue, Safranin-O and col agen type II immunohistochemistry at 1, 2, 4 weeks. Neochondrocytes proliferated within cartilage ring, and produced extracellular matrix. After 2 weeks of incubation, these inserted chondrocytes were significantly increased. There was no statistical y significant increment between 2 weeks and 4 weeks (P>0.05), although the area was further increased by 4 weeks. This model provides a convenient simulation of the cartilage integration process in vitro and has a potential application in studies of cartilage integration and cartilage tissue engineering.

Objective To evaluate the application of infrared fluoroscopic navigation guiding pedicle screwfixation of thoracic-lumbarspine.Methods The pedicle screw fixation of thoraic-lumbar spine was adopted in 32 patients,including 19 cases with thoracic-lumbarspine fractures,5 cases with protrusion of lumbar intervertebral disc or vertebral canal stenosis,8 cases with lumbar spine slippage.The timefor pedicle screwfixation and amount of bleeding were recorded.The pedicle screwposition was assessed with post-operative CTby using An-drewgrade.Results Totally148 screws were fixed in 32 cases successfully,including10 screws in T11,20 in T12,18 in L1,36 in L2,16 inL3,26 in L4,28 in L5,and 14 in S1.According to andrewgrade,165 screws were inⅠgrade(98%),2 inⅡgrade,and 1 inⅢ grade.Nonerve and spinal cord damage was observed after operation.The average time of per pedicle screwfixation was(10?2.4) min.The averageamount of bleeding was(400?52.3) ml in thoracic-Lumbar Spine fractures,(200?36.8) ml in protrusion of lumbar intervertebral disc orvertebral canal stenosis,and(300?44.6) ml in Lumbar Spine slippage.Conclusion Infrared fluoroscopic navigation can improve the pre-cision of pedicle screw fixation of thoraic-lumbar spine,reduce the amount of bleeding,and shorten the operative time.