BACKGROUND:Fracture must be properly reset, cannot present angle, rotation and overlapping shift. Kirschner wire fixation is fit for transverse fracture of first metacarpal bone of proximal phalanx and middle phalanx. Mini-plate fixation is fit for disfigurement or short bevel fracture of metacarpal bone and proximal finger backbone. Which is fit for cmplicated fracture of metacarpal bone? OBJECTIVE:To analyze the clinical effective and safety of complicated metacarpal fractures after fixed with mini-plates and Kirschner wires. METHODS:A total of 68 cases of complicated metacarpal fractures (72 sites) were chosen from Sanshui Hospital of Foshan Municipal Hospital of Traditional Chinese Medicine as the research subjects. They received open reduction and internal fixation, and were divided into two groups. Mini-plate group contained 36 cases (39 sites). Kirschner wire group contained 32 cases (33 sites). Healing time of metacarpal and phalangeal fractures, functional recovery and wound infection were observed. Clinical effects and complications were compared between the two groups. Bone healing was observed using X-ray. The recovery of hand function was evaluated using total action flexion score of American Society for Surgery of the Hand. RESULTS AND CONCLUSION:Patients in the mini-plate group were fol owed up for 3-12 months, and patients in the Kirschner wire group were fol owed up for 3-10 months. In the mini-plate group, the excel ent and good rate of total action flexion score was 92%. X-ray films revealed that healing time was 4-6 weeks, averagely 4.7 weeks. Complications:no bone nonunion occurred. Moreover, patients with closed fracture did not suffer from postoperative infection. Patients with open fracture suffered from infection to different degrees at three fracture sites. In the Kirschner wire group, the excel ent and good rate of total action flexion score was 76%. X-ray films demonstrated that healing time was 6-9 weeks, averagely 7.7 weeks. Complications:bone nonunion was observed at three fracture sites. After bone grafting, postoperative infection was found in 4 sites of 28 sites of open fracture. Statistical analysis showed that significant differences in total action flexion score were detectable between the two groups at 3 months of fol ow-up (P<0.05). These results suggest that the clinical effect of mini-plate fixation for complicated metacarpal fracture was apparently better than that of Kirschner wire, so mini-plate fixation can be used as an effective repair method for complicated metacarpal fracture.

BACKGROUND:Hematopoietic stem cel transplantation is a promising treatment for a variety of malignant and nonmalignant disorders. But noninfectious pulmonary complications folowing hematopoietic stem cel transplantation are a major cause of morbidity and mortality in these patients. And the diagnosis and treatment are difficult. OBJECTIVE: To review the noninfectious pulmonary complications after hematopoietic stem cel transplantation in terms of onset time, risk factors, clinical manifestations, characteristics of the high-resolution CT, histopathological measurement, related genes and treatment options. METHODS: A computer-based search of VIP, PubMed and Sciencedirect databases was performed for articles related to noninfectious pulmonary compli cations after hematopoietic stem cel transplantation published from January 2005 to October 2014. The key words were “HSCT, pulmonary complications, non-infectious, pirfenidone” in Chinese and English in the title and abstract. Finaly, 31 articles were included in result analysis. RESULTS AND CONCLUSION: The incidence of noninfectious pulmonary complications after hematopoietic stem cel transplantation has become more and more, with atypical clinical manifestations and limited diagnosis and treatments. According to the different clinical onset time, diagnostic criteria, clinical manifestations and the appropriate laboratory tests, clinicians can make early diagnosis and early intervention. Especialy, the usage of high-resolution chest CT and bronchofiberscope for bronchoalveolar lavage as wel as the timely drug administration can improve the survival rate of patients with noninfectious pulmonary complications after hematopoietic stem cel transplantation.

Objective To investigate the histopathological characteristics of choroidal melanoma. Methods The histopathological data from 64 patients with choroidal melanoma were analyzed retrospectively. The tumor size and the cytological types were observed and detected. The locations of the tumor were classified according to the involved part invaded by the anterior margine of the tumor, and the degrees of the development of the tumor were graded according to the extent of the outward infiltration of the tumor cells. Results In 64 patients with choroidal melanoma, There were large, medium, and small tumors in 25(39.1%), 31(48.4%), and 8(12.5%) respectively. The spindle cell type was found in 42 patients (65.6%) including spindle cell A and B type in 15(23.4%) and 27(42.3%) respectively; epithelioid and mixed cell type was found in 7(10.9%) and 10(15.6%) respectively; the other types were found in 5(7.8%). Twenty-five cases(39.1%)had no invasion with sclera, 22(34.4%)had but limited to sclera, 12(18.8%)penetrated through sclera and 5(7.8%)had intra-orbit infiltration. Conclusion The histopathological characteristics of choroidal melanoma are multiple, and spindle cell type is the most common one. The choroidal melanoma can easily invade the sclera.

Background Thyroid-associated ophthalmopathy (TAO) is a kind of clinically common and incurable ocular disease,and its incidence is at top place.The etiology and pathologic mechanism of TAO are still unknown because of shortness of replicative animal models and difficulty to acquire the ocular tissues in the early stage of the disease.To better understand the pathogenesis of TAO and investigate effective treatable measures, an appropriate animal model should be developed.Objective This study was to immunize female BALB/c mice with the recombinant plasmid of human thyroid-stimulating hormone receptor (TSHR) extracellular domain in cationic liposomes for the establishement of TAO models.Methods Thirty-two 6-to 8-week-old female BALB/c mice were randomly assigned to four groups according to computer random allocation.pcDNA3.1 +/hTSHR289 of 100 μg in an adjuvant cationic liposomes was injected via anterior tibialis muscle and peritoneal cavity separately in the recombinant plasmid injection group in 0, 3,6 weeks, and pcDNA3.1 or cationic liposomes was injected in the liposomes injection group or the blank plasmid group in the same way, respectively, and normal saline solution was injected in the blank control group.Body weight of the mice was measued before and 1 month,2,3 and 4 months after initial injection.The manifestations were observed after modeling.The mice were sacrificed 17 weeks after initial injection,and the histopathology examination was carried out on the thyroid gland and orbital tissue.The heart blood was collected from the mice,and serum contents of total thyroxin 4 (TT4) and thyroid-stimulating hormone (TSH)were assayed by ELISA.Results Protrusion, eyelid swell and keratitis occurred in 12 eyes of 6 mice in the recombinant plasmid injection group after immunization.A significant difference in the body weight of the mice was found among the blank control group, blank plasmid group, liposomes injection group and recombinant plasmid injection group (Fgroup =3.425, P =0.028), and the body weight was considerably reduced in the recombinant plasmid injection group in comparison with the blank control group, blank plasmid group,liposomes injection group (Ftime =0.838 ,P=0.023).The serum levels of TT4 were (7.75±1.00), (7.96±0.76), (6.76±1.10) and (4.43±2.88) μg/dlin the blank control group, liposomes injection group, blank plasmid group, and recombinant plasmid injection group, and those of TSH were (6.36±2.58),(4.83±3.96),(6.63±1.71) and (1.60 ±1.76) ng/ml, showing significant differences among the groups (F =7.150, P＜0.001;F =5.521, P＜0.01) , and the serum levels of TT4 and TSH were remarkably lower in the recombinant plasmid injection group than those of the blank control group,liposomes injection group and blank plasmid group (all at P ＜ 0.05).Histopathology revealed the lymphocyte infiltration of thyroid gland in 6 mice and proliferation of orbital adipose tissue, infiltration of lymphocytes and mastocytes,deposition of hyaluronic acid as well as swell, breakage and inflammatory cell infiltration of extraocular muscle in 15 eyes of the recombinant plasmid injection group.Conclusions A murine model of TAO can be successfully induced by immunization with recombination plasmid pcDNA3.1 +/hTSHR289 and cationic liposomes.The histopathology characteristics and ocular findings of the animal models are similar to human TAO.

Objective To explore the technique and clinical outcome of the atlantoaxial pedicle screw system in the treatment of the unstable atlantoaxial dislocation post traction.Methods The study involved 32 patients with atlantoaxial dislocation(type T2 of TOI classification)admitted from March 2005 to September 2009.There were 17 patients with fresh odontoid fracture and two with old odontoid fracture,five with traumatic disruption of the transverse atlantal ligament and eight with congenital odontoid dysplasia.JOA scores of neurological function before operation was at a range of 5-13(average 8.38).The average of space available for the cord(SAC)was 9.15 mm.Before the atlantoaxial pedicle screw system was carried out,the skull traction was performed in all the patients preoperatively.Results A total of 128 pedicle screws were inserted safely,with mean operation time and perioperative blood loss for 1.5 hours and 300 ml,respectively.No injury to the vertebral artery or spinal cord was observed.All the patients were followed up for 12-24 months,which showed that JOA scores one year after operation was increased to 10-17(average 14.56),with the improvement rate of 71.70%,and that the SAC was average 14.86 mm.The X-ray and SCT scans verified the proper position of the screws,with no internal fixation failure or atlantoaxial redislocation.After 3-6 months,all the patients except for one patient achieved a solid bone fusion.One year after operation,the one patient with no bone graft fusion was removed of the internal fixation system and obtained satisfactory restoration of the rotational function.Conclusions Atlantoaxial pedicle screw system is an effective method for the treatment of the unstable atlantoaxial dislocation post traction,for it has the advantages of stable three-dimension fixation,direct screw placement,intraoperative reduction and high fusion rate.

Objective To understand the morbidity of schistosomiasis japonica and health status of the liver and spleen of residents in a village and to evaluate the application of ultrasound on schistosomiasis epidemiology. Methods A total of 454 residents aged 5-65 years were examined by methods of Kato-Katz and ultrasound as well as disease history inquiry. Results The positive rate was 9.38% by stool examination, with no significant difference between males and females. The intensity of the infection among population was 5.70 eggs per gram of stool (EPG), with significant difference between males and females. The stool positive rate and EPG in farmers and students were the highest. Among 10.66% of the males and 8.10% of the females, as well as in 23.81% of the stool positive and 8.31% of the stool negative, the parenchyma of the liver was abnormal(≥GradeⅡ),with significant difference between males and females and between the stool positive and the stool negative. The abnormal rate of liver parenchyma went up with the age. Conclusion Ultrasound can evaluate the health status of inhabitants with schistosomiasis japonica and improve the compliance rate of residents to praziquantel chemotherapy.

By complexation reaction with water-soluble carboxymethyl chitosan and Ca 2+ ?Fe 2+ ?Zn 2+ in solution,the metal complexes of Ca 2+ ?Fe 2+ ?Zn 2+ were preparated.The effects of various factors:reaction time,etmperature,substitution degree of carboxymethyl group,ionic strength and pH value on the reaction were investigated.The results showed that the optimum reaction condition was pH 5~7,time 10 min,the complex capacity of CMCS for metal ions increasing with the substitution degree of carboxymethyl group,decreasing with the ionic strength of solution.

Objective:To discuss the curative effect of bifid triple viable capsules in the patients after laparoscopic cholecystecto-my ( LC) . Methods:Totally 100 cases of patients with LC were selected and divided into the observation group and the control group at random. The patients in the two groups underwent LC under the general anesthesia, and were given routine medical treatment after the operation. The patients in the observation group were additionally given bifid triple viable capsules, 630mg per time, twice a day for 1 week as the treatment course. The changes in the occurrence of diarrhea, alteration of intestinal flora and plasma D-lactic acid of the patients and drug adverse reactions in the two groups were observed and compared after the medical treatment. Results:One week after the operation, the occurrence of diarrhea and alteration of intestinal flora of the patients in the observation group were lower than those in the control group (P<0. 05), and compared with those before the treatment, the plasma D-lactic acid levels of the patients in the two groups were declined (P<0. 05 or P<0. 01), and the declining rate in the observation group was much higher than that in the control group (P<0. 05). Totally 3 and 5 cases of drug adverse reactions were appeared in the observation group and the control group, respectively with no significant difference (P>0. 05). Conclusion: The application of bifid triple viable capsules in the pa-tients after LC can effectively reduce the plasma D-lactic acid levels, occurrence of diarrhea and alteration of intestinal flora with prom-ising security, which is good for the postoperative recovery of the patients.

Single-supervisor system is the widespread practice for graduates of clinical medicine at present. But in terms of education to clinical medical graduate students, students rotate in the departments of various disciplines for a long time, and there are more rotary department, resulting in some students' unbalanced learning development. Combined with the charac-teristics of the department of hematology, multi-supervisors training model was carried out to the rotating masters of other disciplines when they rotated in hematology department. With supervisor equipment and teaching implementation, we applied the principle of integrating theory with practice and trained students' innovation ability and doctor-patient communication ability. Compared with traditional single supervisor training pattern, multi-supervisors system can effec-tively improve the students' theoretical level, practical skills and comprehensive ability when the clinical medical graduate students rotate in the department of hematology.

ObjectiveTo investigate the modification method of Cervical Spine Injury Severity Score System and discuss diagnosis and treatment strategy of lower cervical spine injuries.Methods Treatments of lower cervical spine injuries were selected according to the injury severity graded by the modified Moore' s classification system.Conservative therapy could be adopted for the patients with stability quantification rating ＜ 3 points or for the those with stability quantification rating =3 points but without spinal cord or nerve root compression.Surgical treatment was recommendable for the patients with stability quantification rating =3 points and with spinal cord or nerve root compression.Surgical therapy could be required for the patients with stability quantification rating ≥4 points and with risk of lower cervical instability.The higher the stability quantification score implied the stronger the surgical indications.Lower cervical spine injury combined with spine cord or nerve root compression had absolute surgical indications.At the same time,therapies were selected based on patients' other factors.ResultsBased on basic principles of the modified Moore' s classification system together with opinions of the patients and their relatives,14 patients were managed with surgical treatment and 16 with conservative treatment.Among the patients with complete spinal cord injury (Grade A),two patients treated surgically showed no obvious signs of spinal function recovery,but their nerve root irritation symptoms disappeared; the other one patient who needed surgery but received conservative treatment had no change of the spinal cord function and nerve root irritation.The patients with incomplete spinal cord injury (Grades B,C and D) treated surgically obtained certain degree of spine cord function recovery,with their American Spinal Injury Association (ASIA) score raised by 0.5 grade on average.However,the patients who needed surgery but received conservative treatment gained average increase of ASIA score for 0.5 grade.Imaging examination showed that patients without combined spinal injuries obtained interbody fusion after surgery,with normal alignment and height of the cervical vertebra but without presence of vertebral shift or instability. ConclusionsThe modified Moore' s classification system takes patients' spiaal injury condition and other factors into consideration in selection of conservative or surgical treatment,which improves the Cervical Spine Injury Severity Score System to some extent and has prospect of clinical application.