Objective To evaluate the preliminary clinical outcome of the screw fixation of minimally displaced scaphoid fracture assisted by computerized imaging reconstruction and preoperative planning system.Methods From March 2013 to Feburary 2014,Five screws on five patients were treated.We calculated and designed the position of scaphoid screw guide wire and ensured the guide wire centrally placed in the scaphoid by using the computerized imaging reconstruction and preoperative planning system software.The appropriate length of the screw was measured too in the software.We also identified the entry and exit points of the guide wire on the custom orthoses splinting the wrist joint.Five patients with scaphoid fractures were treated with percutaneous screw fixation under the guidance of a C-arm fluoroscopy and a guide wire were inserted based on the entry and exit points calculated preoperatively.All of the scaphoid fracture was nondisplaced or less than 1 mm.The modified MAYO wrist scoring system was used to evaluate the pain,function and range of motion for the wrist joint during follow up.Results Total surgical time was 28.8 min (25-39 min)and Fluoroscopy time was 18.4 s (11-23 s).The fracture healing was observed at routine 8 weeks follow up.No complication such as infection or fixation failure was reported.Modified MAYO wrist score was 83.8 (81-88)at average followup at 15 months (6-12 months).Conclusion Computer assisted percutaneous screw fixation is an effective method for the treatment of nondisplaced scaphoid fractures.It leads to significantly reduced guidewire placement time and radiological exposure time while provides accurate placement of the screw.

Objective To summarize the methods of diagnosis and results of surgical treatment of pancreatic insulinoma. Methods The clinical data of 137 patients with insulinoma treated in our hospital during the past twenty-six years were reviewed retrospectively.Results There were 77 males and 60 females. All of them were characterized by the Whipple′s triad. The sensitivity of ultrasonography, CT and MRI for localization was 35.1%, 67.9% and 58.1% respectively. One hundred and tweenty-six patients underwent operation. Of them, 102 cases had tumor enucleation, 4 cases had pancreaticoduodenectomy, 16 cases had distal panreatectomy, and the other 4 cases had only laparotomy. Of the 122 patients, who underwent resection, the tumor was benign in 118(96.7%) and malignant in 4(3.3%). The diameter of the tumor was less than 2cm in 86.9% of cases. In 98.4% of cases the tumors were single and in 1.6% of cases were multiple. 13.1% of the tumors located in the head, 46.7% in the body, and 40.2% in the tail.Conclusions Whipple′s triad and the measurement of fasting glucose, IRI, IGR, C-peptide, and proinsulin levels contribute to the diagnosis of insulinoma. However, the preoperative tumor localization is still difficult. Tumor enucleation is the technique of choice when feasible. Patients in whom tumor localization is unsuccessful at operation should be carefully evaluated to be certain of the diagnosis, and in general should not undergo blind resection.

Objective The purpose of this study is to study the clinical and pathological features of neurilemoma .Methods We observed the clinicopathologic features and immunohistochemical staining from eight patients with orbital neurilemoma between 2010.1~2012.12.Results Eight patients with classic neurilemoma were included in the study ,in which there were five males and three females ,aged between 21 and 63,mean age 35.The main symptom of the patients was exophthalmos ,including five cases of right eyes and three left eyes;2 cases of orbital floor and six above orbit ,lasting for one to ten years .The tumor diameter ranged between 1cm and 5 cm,an average of 3 cm,being pale and light yellow color .There were five cases of type Antoni A and one case of type was Antoni B among the six classic type neurilemoma .Two cases of ancient were neurilemoma ,in which one case was the histological structure of the classic type neurilemoma ,but there were more hypertrophy tumor cells , chromatin was coarse block atypia cells .The other one case with cells arranged disorderly ,which was mainly fine striated cells with scattered deeply stained atypia cells ,stromal transparent degeneration ,cystic degeneration .Im-munohistochemistry results showed that S -100(+),vimentin(+),ki67(-).Conclusion Antoni type B and ancient schwannoma are rare ,with complicated histologic characteristics .Combined with clinical features and im-munohistochemistry staining ,it can be diagnosed .

Amblyopia greatly affects the physical and mental development of children. Acupuncture is effective for amblyopia, though its mechanism remains unclear. This article summarized the mechanism of acupuncture treatment of amblyopia from the perspectives of morphology of neurons in visual cortex, visual electrophysiology, and molecular biology, etc. It was found that acupuncture may treat amblyopia through repairing the morphological and ultrastructural damages of neurons in visual cortex, promoting the electrical activities in visual pathway and visual cortical neurons, and modulating the synthesis and expression levels of factors involved in visual system. Nevertheless, further studies are required to unveil the mechanism of acupuncture treatment of amblyopia.

Objective To explore the mechanism of SH?SY5Y mitochondrial dysfunction treated by manganese to find a new potential therapeutic target. Methods Transmission Electron Microscopy(TEM)to observe the morphology of mitochondria. Cell treated with 250μmol/L for periods of time(2 h, 4 h, 6 h)while mitochondrial membrane potential(MMP)and ROS can be detected by FCM and fluorescence microplate reader. Results After treating with MnCl2 in 6 h, TEM images showed early vacuoles, lamellar structures of SH?SY5Y cells. Then test the mitochondrial membrane potential and showed that MMP would be decreased gradually. Meanwhile, analysis showed that in comparison with control, treatment group had a higher ROS level respectively (P < 0.05). Conclusion MnCl2 can cause mitochondrial damage through a mechanism closely related to disrupt the MMP or generate abundant ROS.

Objective To evaluate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram(ECG)to predict severe arrithmia in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to emergency department from July 2003 to April 2008 were enrolled.A total of 223 patients met the criteria(ischemic chest pain ≥ 30 min,2 or more adjacent leads of ST segment elevation and onset time within 12 h).Exclusion criteria were bundle branch block and left ventricular hypertrophy.All enrolled patients were divided into two groups based on the enrollment electrocardiogram:grade 2 ischemia(ST elevation without terminal QRS distortion; n =134)and grade 3 ischemia(ST elevation with terminal QRS distortion; n =89).Patients of the two groups had comparable genderproportion,average age and coronary heart disease risk factors etc.All patients received thrombolytic therapy.The incidence rate of ST segment resolution(STR)and severe arrithmia in hospital stay were observed.Numerical variables were expressed mean ± standard deviation and compared by unpaired Student't test,Categorical variables were expressed percentage and compared by chi square test.Multiple logistic regression analysis was used to determine independent predictors of severe arrithmia.Results Patients with grade 3 ischemia had greater Σ ST on admission and 2 h after thrombolysis ECGs(P ＜ 0.01),the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia(P ＜0.01).The peak creatine kinase MB fraction was higher in patients with grade 3 ischemia than that in patients with grade 2 ischemia(P ＜ 0.01).There was no significant difference of the incidence of severe arrithmia,such as ventricular premature beat,ventricular tachycardia or fibrillation,second-degree or third-degree atrioventricular block,and sinus arrest between the two groups(P ＞ 0.05),but there was a trend of higher incidence of severe arrithmia in patients with grade 3 ischemia compared with that in patients with grade 2 ischemia.Multiple logistic regression analysis demonstrated that the independent predictors of severe arrithmia were duration from symptom to thrombolysis and initial.Σ ST,whereas grade 3 ischemia remained a strong predictor of severe arrithmia.Conclusions Grade 3 ischemia on admission is associated with lower incidence of STR in patients with ST-segment elevation myocardial infarction(STEMI)after thrombolysis and a strong predictor of severe arrithmia.

Objective To investigate the infection following the lymphocytes deleted agent (ATG) and IL-2 receptor antagonists (Basilixinab and Daclizumab)-based induction therapy after renal trausplantation.Methods A retrospective analysis was carried out on 701 kidney transplant recipients between Jan. 1,2005 to Dec.31,2010.According to exclusive and inclusive criteria,finally 549 patients were evaluated,including 429 patients treated with ATG (ATG group) and 120 patients with anti-CD25 monoclonal antibodies (monoclonal antibodies group; 86 patients with Basiliximab,and 34 patients with Daclizumab).The incidence of acute rejection,infection rate,infection time,hospital stay,severe infection rate and mortality were analyzed.After operation,the patients received an immunosuppression therapy including Tacrolimus (cyclosporine A),Mycophenolate-Mofetil and prednisone to present rejection. Part of the patients were treated with ganciclovir and sulfamethoxazole sulfadiazine and trimethoprim for infection prevention.Results The acute rejection rate in ATG group and monoclonal antibodies group was 15.9％ (68/429) and 10.0％ (12/120),and there was no statistically significant difference (P＞0.05).The infection rate in ATG group was 11.9％ (51/429),including 13.7％ (7/51) with severe infection,and mortality was 7.8％(4/51).The infection rate was 15.0％ (18/120) in monoclonal antibodies group,including 11.1％ (2/18) with severe infection,and mortality was 5.6％ (1/18).There was no statistically significnat difference in infection rate,severe infection rate and mortality between two groups (P＞0.05).The hospital stay in ATG group and monoclonal antibodies group was 25.8 days and 19.1 days respectively (P＜0.05).Dead cases had not received regular anti-infection treatment,and the patients age was over 50 years.Conclusion The infection risk and mortality between these two induction therapies are identical,but hn comparison to the patients using ATG,the infection of patients using anti-CD25 monoclonal antibodies is easier to control.Anti-infection prophylaxis is important to reduce infection rate and decrease infectious mortality.

Objective To explore the role of VEGF positive expression in tumor tissue in the prognosis of liver transplantation for hepatocellular carcinoma (HCC).Method Fifty cases of liver transplant recipients with HCC confirmed immunohistochemically were enrolled in this study.The MaxVisionTM two-step method was applied to detect the expression of vascular endothelial growth factor(VEGF),and the microvessel density (MVD) was measured in para-cancerous tissues by using DAB staining.The correlation of the VEGF tumor tissue in tumor tissue with Child-Pugh,MELD,tumor diameter and number,differentiation,MVD,Milan criteria and UCSF criteria for HCC liver transplantation was analyzed.Result In the HCC tissue,the VEGF positive expression rate was 52％(26/50).The one-year survival of recipients positive and negative for VEGF was 78％ and 100％,respectively,and one-year recurrence rate was 32％ and 12％,respectively,with the difference being significant (P =0.043 and P =0.048 respectively).The expression of VEGF was associated with Child-Pugh,tumor diameter,MVD,Milan criteria and UCSF criteria (P＜0.05 for all).Logistic regression analysis showed that low differentiation and VEGF positive expression were independent prognostic factors for HCC recurrence after liver transplantation.Conclusion VEGF has a certain reference value to judge HCC invasiveness and prognosis of liver transplantation.

Objective To investigate the effects of N - acetylcysteine (NAC) on apoptosis and the expressions of Fas/FasL mRNA in lung tissue of rats with paraquat - induced acute lung injury.Methods Forty five male SD rats were randomly (random number) divided into normal control group,paraquat (PQ) group,and NAC treatment group.The rat model of acute lung injury was made with 2％ PQ induction in dose of 25 mg/kg injected,and NAC was injected into the PQ poisoning rats (200 mg/kg) 30 minutes after PQ administration in NAC treatment group.In the control group,equal amount of saline instead was injected into the rats.Apoptosis was detected by using TUNEL method and the expressions of Fas/FasL mRNA were evaluated by using reverse transcription polymerase chain reaction (RT- PCR),and the levels of Fas/FasL protein were detected by using western blot analysis.Results Compared with control group,cell apoptosis and expressions Fas/FasL mRNA in PQ group were significantly different ( P ＜ 0.05 ).Compared with PQ group,cell apoptosis and expressions Fas/FasL mRNA in NAC group were significantly decreased,were significant lower (P ＜ 0.05).Conclusions NAC inhibited apoptosis in lung tissue of rats with paraquat induction by regulating the activation of Fas/FasL systems.

It is kno wn that 8-Br-cAMP is one of selective bi nding site analogues for cAMP RIIα to af fect cell growth through regulation of g ene expression.The p16,p21wafl,p53 a nd Rb are antioncogenes which affect cel l growth through control of cell cycle.T he aim of this study is to investigate t he 8-Br-cAMP effect on the expression of antioncogenes in human HXO-Rb44 cells. Methods Cultured HXO-Rb44 cells in RPMI -1 640 medium were divided into two aliquot s.8-Br-cAMP (2×10-5mol/L) was added i nto one aliquot for 24h as the experime ntal group(EG),the another aliquot witho ut 8-Br-cAMP as the control group(CG).Af ter 24h,the cell suspension was dropped onto the nitrocellulose membrane.The mR NA of p16,p21wafl,wild type(w)p53,mut ant type(m) p53 and Rb were used respec tively with biotin-labeled cDNA probes b y intact cell RNA dot blot.The immunorea ctivity(IR) of P16,P21wafl,PRb,PCN A,cdk2 and cdk4 were detected respecti vely with specific monoclonal antibodies on dot blot.ResultsThe mRNA dot blot s ignals of mp53 and protein dot blot of cdk2-IR,cdk4-IR and PCNA-IR in EG were weaker than those in CG(P＜0.05～0.01). W hile,the mRNA signals of p16,p21wafl,wp53 and Rb in EG were stronger than tho se in CG(P＜0.05～0.01).The intensity of ea ch protein dot blot was consistent with that of their RNA dot blot (except for w P53-IR and mP53-IR not to be done).Conc lusions(1)8-Br-cAMP could up-regul ate expression of antioncogenes includin g p16,p21wafl,wp53,Rb,and protein exp ression of P16,P21wafl and PRb.(2) 8-Br-cAMP could down-regulate mp53 gene expression and protein expression of cd k2,cdk4 and PCNA.The results suggest t hat 8-Br-cAMP could inhibit human HXO-Rb 44 cell growth through interfering rela ted gene expression of cell cycle.