Objective To study the clinical effect of large dose ulinastatin on patients combined SIRS and MODS.Methods 120 patients in ICU were randomly divided into two groups,each 60 cases,the control group using conventional standard treatment,the observation group in the control group on the basis of the 12h after the operation started on intravenous injection of large dose ulinastatin,observe two groups of patients after treatment with cytokine content and duration of hospital stay,mortality rate and APACHE Ⅱ score after treatment.Results The two groups before treatment TNFα,IL-6,IL-8 and APACHE Ⅱ score difference is not big,after treatment,48 h,72 h,two groups of patients with TNFα,IL-6,IL-8 were decreased,and the observation group decreased greater than the control group (t =8.46,8.72,8.68,10.38,7.83,9.26,all P ＜ 0.05),after treatment the observation group APACHE Ⅱ score,mortality,average time of hospitalization were significantly lower than those of the control group,there was statistical significance(t =9.58,x2 =10.28,t =9.17,all P ＜ 0.05).Conclusion High dose ulinastatin on inflammatory cytokines have obvious inhibition effect,can reduce the surgical risk in patients with APACHE Ⅱ score and mortality,shorten the treatment time of patients.

The arterial supply of the human metatarsals in 90 lower limbs,ranging in age from newborn to87 years,was studied by perfusion method. The blood supply of the metatarsals is derived from the nutrient artery,the periosteal arteries,the epiphyseo-metaphyseal arteries and the pseudoepiphyseal arteries. The proximal and distal branches of the nutrient artery supply the inner two-thirds or three-fourths of the cortex. The periosteal arteries give off a few twigs penetrating into the cortex and supplying the outer one-third or one-fourth of the cortex. The radiate form epiphyseo-metaphyseal arteries derived from superficial plexuses in continuity with the periosteal networks on the shafts, supply the base of the first metatarsal, and the heads of the other four. The pseudoepiphyseal arteries, penetrating the non-articular areas of the bones, supply the bases of the second, third, fourth and fifth metatarsals and the head of the first. The sources of the nutrient arteries to the metatarsal vary with the different bone . The nutrient arteries to first metatarsal bone usually originate from the ramus plantaris profundus and the first plantar metatarsal artery, while the nutrient arteries to the other metatarsal bones mainly derive from the plantar metatarsal arteries, the plantar arch and its perforating branches. The clinical significance of the arterial distribution to the metatarsals is discussed.

Plasma VEGF level of T2DM was higher than that of normal control （NC, n=30） and progressively increases from normal albuminuria （NA, n=26） to microalbuminuria （MA,n=26） and to macroalbu-minuria （ODN, n=24） groups, The VEGF level was positively correlated with the levels of creatinine, HbA1c and UAER and, decreases after losartan treatment in groups of MA and ODN.

Objective To provide an anatomic data of the lumbar isthmus, and to increase the fusion rate of the graft bone for spondylolisthesis treated with posterolateral spinal fusion and Steffee plate fixation. Methods The area and volume of the bone graft bed for posterolateral spinal fusion in the lumbar isthmus were studied on 30 dried specimens of adult lumbar spines from L 1 to L 5(a total of 150 lumbar vertebrae) with a vernier calipers, a goniometer and a graduate. Results The length of the superior edge of the isthmus gradually increased from L 1[(7.34? 1.15) mm] to L 5[(10.31? 1.89) mm], and that of its inferior edge progressively decreased from L 1[(6.63? 1.24) mm] to L 5 [( 4.73? 1.21) mm]. The superior edge of the isthmus was the thinnest at L 1[(1.85? 0.64)mm], and the thickness increased inferiorly from L 1[(6.57? 1.24) mm] to L 5[(7.57? 1.16) mm]. The medial and caudal inclination of the isthmus with respect to the pedicle gradually increased from L 1 (113.9?? 13.3? ) to L 5(119.1?? 13.5? ) medial inclination and from (101.2?? 9.5? ) at L 1 to (117.6?? 13.4? ) at L 5 caudal inclination, respectively. The length of the superior edge of the isthmus and the transverse diameter of the pedicle were positively correlated to the vertebral levels. The length of the inferior edge of the isthmus were negatively correlated to the vertebral levels. The dimensions of the graft bed area were postively correlated to dimensions of the graft bone volume. Conclusion The application of firm spinal internal fixation system with adequate graft bed area and adequate graft volume, the maintenance of close contact between the graft bed and the graft bone, and adequate period of postoperative stable contact of the graft in bed were the keys to enable reduction of the spondylolisthesis and to increase the fusion rate of posterolateral bone graft.

Objective To evaluate the efficacy of prevention of recurrent femur fracture in children with osteogenesis imperfecta.Methods Data of 35 patients (19 boys,16 girls) who were treated for femur deformity due to osteogenesis imperfecta at our hospital from Jun 2009 to Jun 2013 were retrospectively analyzed.The average age of the patients was 9 years 3 months,ranging from 3 years 6 months to 13 years 1 month.All the patients had suffered from recurrent femur fractures before which led to femoral deformity.The mean angulation angle was 55° (range,10°-90°).10 patients were operated at one side;the other 25 patients were treated bilaterally.None of them received operation before for fractures.The average incidence of femur fracture before operation was 2.4/year (range,2-4).According to the modified Sillence classification system,9 were type Ⅲ OI,14 type Ⅳ,and 12 type I.The curved deformity of the femurs were corrected by osteotomy and stabilized by telescopic intramedullary rods in 35 patients.Results All the 35 patients were followed up for a mean period of 62 months (range,36-72).The average healing time of the osteotomy site of the femur was 8.5 weeks (range,7-12).The patient was encouraged to begin weightbearing and walking when the Xray film showed healing of the osteotomy site.By the latest follow up,80％ of the patients could stand and walk independently.The incidence of femur fracture decreased significantly to the level of 0.3±0.1/year,compared with the level of 2.4± 1.3/year before operation.All the parents of the children were satisfied with the result of deformity correction.At the latest follow up,the Barthel index score increased from 71.82 (range,51-92) before operation to 92.32 (range,82-100) postoperatively,while the WeeFIM score increased from 53.32 (range,42-72) before operation to 78 (range,70-86) postoperatively.The difference of Barthel index score and WeeFIM score between that before and post operation was significant.The children's selfcare and motion ability improved obviously after operation.During follow up,22 patients suffered from recurrent fracture of the femur by various degree,7 of them were treated by open reduction and telescopic rodding surgery,while the other 15 patients were treated conservatively because the fracture displaced or angulated minimally and the fracture healed uneventfully.Conclusion The telescopic intramedullary rod can maintain the correction of the femur deformity and improve the quality of the bone,thus prevent the recurrent fracture of the femur in children with osteogenesis imperfecta effectively.

Objective To investigate the accuracy of image registration with computed tomograpby (CT) and magnetic resonance imaging(MRI) and to determine gross tumor volume(GTV) of hepatocellular carcinoma(HCC).Methods Thirteen patients were enrolled in this study.CT image was taken in inhala tion phase,and MRIT2 image at the time of peak exhalation.Additional MRIT2 image was taken by fast scanning(MRIT2F) in peak inhalation phase in 6 patients.After mutual information method to CT/MRI im age registration,manual adjustment was made to optimize the accuracy of image fusion.The GTV and liver of each patient was independently contoured by two observers on CT,MRIT2 and MRIT2F images.The accura oy of image fusion was assessed by the ratio of liver overlap(P-LIVERCT-MRIAT2 ,P-LIVERCT-MRIT2F) ,and the dis tance between bone markers(DCT-MRIT2,DCT-MRIT2F) of CT and MRI on the fused image.The volumes of GTV contoured on CT (V-GTVCT),MRIT2 (V-GTVMRIT2),MRIT2F (V-GTVMRIT2F) and their overlap (V GTVCT-MRIT2,V-GTVCT-MRIT2F) and composite volumes (V-GTVCT+MRIT2,V-GTVCT+MRIT2F)were measured.The percentage of V-GTVCT and V-GTVMRIT2 on V-GTVCT+MRIT2,V-GTVCT and V-GTVMRIT2F on V-GTVCT+MRIT2F,V GTVCTMRIT2 and V-GTVCT-MRIT2F on V-GTVCT was also calculated,respectively.Results The mean DCT-MRIT2 and DCT-MRIT2F were 2.7±0.8 mm and 2.1Q±0.9mm.The mean P-LIVERCT-MRIT2 and P-LIVERCT-MRIT2F were 85.9% ± 4.1% and 92.7%± 1.5%.Interobserver difference was significant for GIN defined by CT,but not by MRIT2.V-GTVCT,V-GTVMRIT2 and V-GTVMRIT2F were 387±396 cm3 ,488 ±461 cm3 and 597 ±541 cm3 ,respectively.The percentage of V-GTVCT and V-GTVMRIT2 on V-GTVCT+MRIT2 was 66.2%±13.5% and 88.7% ± 10.2% ,while V-GTVCT and V-GTVMRIT2F on V-GTVCT-MRIT2F was 71.3%±12.7% and 93.5%± 4.8%,respectively.Conclusions CT and MRI for image fusion should be obtained in the same respirato ry phase and in the same treatment position.Automatic registration using mutual information method by auto matic registration software is useful.CT and MRI image should be integrated for HCC GTV delineation.GTV used for planning should be the sum of CT-defined GTV and MRl-defined GTV.

Aim To investigate the myocardial hypertrophy,the expression of transforming growth factor ?1(TGF-?1),Smad3 and Smad7 proteins in spontaneous hypertensive rats(SHR)and the effects of benazepril and candesartan.Methods SHRs of 12 weeks old were given benazepril and candesartan for 12 weeks.The tail arterial pressure was measured every two weeks.At 12 th weekend,cardiac configuration,heart mass index,area of cadiocytes,concertrations of AngⅡin plasma and myocardium,expressions of TGF-?1、Smad3 and Smad7 proteins were measured respectively.Results The arterial pressure,wall thickness,heart mass index,area of cardiocytes and the expressions of TGF-?1,Smad3 proteins increased in SHRs but were attenuated after the treatment of benazepril or candesartan.After the combined treatment,the synergistic effect could be observed.The levels of cardiac tissue and plasma AngⅡwere reduced.The expressions of Smad 7 were up-regulated after the treatment of benazepril or candesartan,while they were stable after the combined use.Conclusion There is a synergistic effect of attenuating myocardial hypertrophy in SHRs by combined use of benazepril and candesartan.It may be related to the regulation of Ang Ⅱ,decreasing the expressions of TGF-?1 and Smad3.

Microvascular architecture of the oviduct was observed by SEM in 20 adult female Wistar rats which were not pregnant. The oviduct was supplied by 2-4 tubal branches (0.2-0.3mm in diameter) which were derived from the ovarian artery. The tubal branches entered the wall of oviduct and divided into numerous meandering arterioles (0.02-0.07mm in diameter). Intrinsic microvasculature of the oviduct might be divided into three layers: (1) the subserosal vascular plexus which appeared tortuous and formed reticulate anastomosis, (2) a parallel branching vasculature in the muscle coat, and (3) the subepithelial capillary network. The latter arised from the arterioles which ramified terminally near the apex of mucosal folds and broke up into very dense capillaries. Subepithelial capillary density in the fimbriae was markedly higher than that in the isthmus and uterine part. Intrinsic venules of oviduct were less tortuous and less closely accompanied with the arterioles. In mesoviduct, veins were in closely accompanied with the corresponding arteries. In the wall of oviduct, some capillaries and venules drained to the small veins directly and vertically.

Objective To prove with mathematical formula that the patient's blood electrolyte concentration shows a tendency to approach that of replacement-fluid after continuous renal replacement therapy (CRRT).Methods Electrolyte concentration of plasma,replacement-fluid and returning fluid were compared,and they were labeled as Cblood,Cnom,and Creturn respectively.The Creturn was calculated,and the relationship among them was demonstrated with comparison by mathematical formula.At last,according to their relationship,plasma change towards to the replacement fluid was analyzed.Results It was showed that Cblood＜Creturn＜Cnom or Cblood＞Creturn＞ Cnom,and according the relationship,it was derive that the trend of change in Cblood after circulation for m unit time was Cblood1 ＞Cblood2 ＞Cblood3 ＞ … ＞Cbloodm ＞Cblood or Cblood1 ＜ Cblood2 ＜Cblood3 ＜ … ＜Cbloodm ＜Cnom.The plasma electrolyte concentration would close to that of replacement fluid infinitely with the continue of CRRT.Conclusions With mathematical model,it is proved that the replacement fluid electrolyte concentration is the final target of the plasma.We must make up the replacement fluid correctly.And this results provide the basis for CRRT treatment of electrolyte disorder.

Objective To detect the expression and correlated significance of inducible nitric oxide synthase and p53,Bax in benign and malignant diseases of gallbladder. Methods In 16 cases of chronic cholecystitis,11cases of chronic cholecystitis with adenomyoma and 24 cases of gallbladder adenocarcinoma,the expression of iNOS,p53 and Bax in gallbladder's wall was detected by SP immunohistochemistry. Results 1^Inducible NOS and Bax expressed in both benign and maligmant diseased gallbladders' wall,compared with benign diseased gallbladders,the expression of iNOS and Bax in adenocarcinoma was decreased(P