Objective To investigate the application of delayed sternal closure in the process of open heart surgery.Methods Delayed sternal closure was performed from Mar.2000 to Jun.2005 in 11 patients(4 males and 7 females,aged 16-67 years with an average of 42 years) after cardiac surgery.The indication included: cardiac dilatation(4 cases),intractable arrhythmia(4 cases),continuous bleeding(2 cases) and severe pulmonary edema(1 case).During the open chest period,the wound was covered with 3-layers of latex temporarily,and the delayed sternal closure was performed when bleeding was controlled,heart size reduced,and hemodynamic condition became stable.Results Except two patients died of acute kidney failure during open chest period,delayed sternal closure was successfully carried out in 9 patients 8-43 hours(23.7?11.0) after cardiac surgery.Except one patient died of cardiac arrest 21 days after operation,the 8 others survived and were discharged from ICU 1-8 days(3.9?2.4) after sternal closure,and the wounds healed well.Follow-up for the 8 survivors revealed an improvement of NYHA class(class Ⅰfor 4 cases,class Ⅱfor 2 cases,and class Ⅲ for 2 cases).Conclusion The delayed sternal closure is an effective method in the treatment of postoperative cardiac compression,severe bleeding and arrhythmia,and it does not increase the incidence of complications such as sternal infection.

Objective To investigate the effect of cardiac resynchronization therapy on improving heart function and reversing left ventricular remodeling in chronic heart failure patients. Methods Eleven patients with NYHA class Ⅲ to Ⅳ heart failure, ejection fraction ≤35% and QRS duration ≥130 ms were implanted synchronous biventricular pacemaker. Serial assessment was performed before and up to 1-36 months after pacing. Results There were significant improvement of LVEF、 LVFS; and decrease in MR、 LVED and QRS duration. The NYHA class of heart function was improved from Ⅲ-Ⅳ to Ⅰ-Ⅱ. Six-minute hall walk distances were also improved. Conclusion For patients with NYHA class Ⅲ to Ⅳ heart failure and ventricular conduction delay, cardiac resynchronization therapy could reverse left ventricular remodeling and improve heart function.

OBJECTIVETo investigate the exerted force in different phases of the female menstrual cycle, as well as the changes in estrogen (E2), osteocalcin (OCN), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin (OPG) levels in the gingival crevicular fluid (GCF) during orthodontic tooth movement, to provide a theoretical basis for the selection of the best opportunity for efficient tooth movement.

METHODSTwelve women (aged 18 years to 28 years) with extracted first premolars had been selected. Six women in the group were randomly selected as the menstrual period group, whereas the remaining six were assigned to the ovulation period group. Right canines were retracted with 1.5 N NiTi close coil spring. GCF samples were collected prior to the force exertion experiments at 0 (T0), 15 (T1), 30 (T2), and 45 d (T3). The levels of E2, OCN, OPG and RANKL in GCF were measured by chemiluminescence and enzymelinked immunosorbent assay.

RESULTSThe E2 and OCN levels were significantly higher in the ovulation period group than in the menstrual period group (P < 0.05). No significant differences were found in RANKL and OPG levels between the two groups (P > 0.05). Finally, no significant difference was found in RANKL/OPG ratio between the two groups (P > 0.05).

CONCLUSIONExerted force on teeth during the menstrual period may promote rapid tooth movement.

Objective: To explore the characteristics of sensory behavior of autism children. Methods: 93 autism children between age 2 to 12, including 87 boys and 6 girls, were investigated based on Harrison's Sensory Behavior Scale. Results: Abnormal visual and auditory responses are quite common among autism children. Hyposensitivity to pain and overusing of smelling are less common. Significant differences were detected in auditory filtering, unusual visual response, hyposensitivity to pain and smell sensitivity between mild and severe groups. Conclusion: Autism children present varied sensory abnormalities. Severe autism children had significantly more sensory symptoms than the mild autism. The mechanisms for this deserves further exploring.

Objective To evaluate the clinical diagnosis and management of solid-pseudopapillary tumors of the pancreas.Methods A retrospective clinical analysis was made on 21 cases of solid-pseudopapillary tumors of the pancreas admitted from June 1994 to June 2003.Results Abdominal pain was the major complains in 13 cases , 7 cases had palpable abdominal mass.Imaging examination can show the abdominal mass clearly, but diagnosis can not be defined.There were 12 cases whose tumors were located in pancreatic head (4 underwent Whipple procedures and 8 tumor enucleations) and 9 cases with tumors in pancreatic tail (all underwent body and tail resection plus splenectomy).The average diameter of tumor was 9.5 cm (3-20).One case had liver metastasis.Diagnosis was proved by frozen pathology during operation in 14 cases, and other 3 cases initially diagnosed as insulinomas and other malignant tunors, had definite diagnosis by postoperative paraffin section and enzyme labeling.Enzyme labeling examinations showed that there were 14 cases of NSE positive in 15 cases, 8 cases of Vimentin positive in 10 cases and 7 cases of PAS positive in 8 cases.CK, EMA and CHG A were negative.Eighteen cases were followed up (85.7%) with a median period of 24 months(1～60) without tumor recurrence.Conclusion Huge pancreatic masses of pancreas in young females should suggest the diagnosis of solid-pseudopapillary tumors.Aggressive surgical therapy can result in good prognosis in these patients.

The pattern of incidence and clin ic al presentation of primary hyperparathyroidism (PHPT) collected during the past 45 years were analysed. It showed that most of PHPT patients were young or mid- aged, and female patients were somewhat more than male patients. The duration of illness was longer and symptoms were more severe. The number of post-menopausa l female patients was increased in recent ten years.

2.65 mmol/L with co-elevated PTH. For locating the adenoma, the specificity of B-Us was 95% and the sensitivity of MIBI was 100%. Our standard surgical procedure were bilateral exploration. We found much more tumors in inferior glands than that in superior glands. The success rate in a single exploration in benign cases was 99%. Conclusions PHPT could be diagnosed by co-elevated calcemia and PTH. B-US with 99m Tc-MIBI was the first choice for localization. Bilateral exploration is safe and effective.

Objective To discuss the diagnosis and surgical treatment of multiple endocrine neoplasia 1 (MEN1). Methods The clinical data of MEN1 from 1974 to 2005 were retrospectively analyzed. Results There were 17 cases of MEN1 in our group. Among them, 11 cases were from 4 families. MEN1 gene mutation was detected in 14 cases admitted after 1997. There were 11 cases of pHPT, 6 cases of insulinoma, 8 cases of pituitary adenoma, 6 cases of adrenal adenoma, 2 cases of thymic carcinoid and 2 cases of collagenoma. Two patients had respectively 4 glands involved, 3 patients had 3, 7 patients had 2 kinds of gland involved respectively. Four patients had only one kind of gland involved. A 12 year old girl had no clinical symptom and biochemical change. Six patients presented with nephrolithasis, 6 patients had impaired pancreatic endocrine function. Subtotal parathyroidectomy was performed in 4 patients of pHPT, and one patient received parathyroid adenoma enucleation. Insulinomas were enucleated in 4 patients. Two patients underwent thymus tumor extirpation. Conclusions MEN1 varies in symptoms, even those from the same family. Cermline mutation test helps establish diagnosis. Operations should be aiming at tumor resection as well as the improvement of life quality.

Objective To discuss the diagnosis and surgical treatment of multiple endocrine neoplasia 2 (MEN2). Methods The clinical data of 28 MEN2 cases from Jun 1997 to Jun 2006 were retrospectively analyzed. Results There were 25 cases of MEN2a and 3 cases of MEN2b. Among the patients of MEN2a, 23 patients were from 7 families with mutation of codon 634, exon 11 of RET, 3 patients of MEN2b had mutation of codon 918, exon 16 of RET and no family history. Twenty-two cases of MEN2a had thyroid masses with elevated calcitonin level, in which 17 were pathologically diagnosed as medullary thyroid carcinoma (MTC) ,12 patients had pheochromocytomas. Among them, 5 were of multiple foci and 2 were malignant. Five patients presented hyperparathyroidism and 3 patients were asymptomatic without biochemical alterations. Three MEN2b patients had MTC and mucosal ganglioneuromatosis with Marfanoid, one patient had bilateral pheochromocytoma. Total thyroidectomy with bilateral dissection of regional lymph nodes was performed in 12 patients of MEN2a, and nodule enucleations was done in other 5 patients followed by persistent elevated calcitonin level. Nine MEN2a patients underwent pheochromocytoma enucleation including bilateral adrenal resection in 3 cases. Three MEN2b patients underwent total thyroidectomy with bilateral lymph node dissection. Conclusions MTC is the most often complications of MEN2. Germline mutation test helps to make early diagnosis. Radical total thyroidectomy in young patients may prevent MTC.

Objective To study the clinical characteristics of thyroid carcinoma in young females,in order to improve the diagnosis and treatment of this disease.Methods The clinical data of 74 consecutive young female patients with thyroid carcinoma treated in our hospital in the recent ten years were analysed.In most of the cases,there was no firm texture or fixation of the thyroid nodules to surrounding structures on physical examination before operation.Ultrasonography was performed in all patients and multiple thyroid nodules were found in 61 cases(82.43%).Thyroid scintiscans were performed in 43 cases,and thyroid nodules were found in 41 cases.The cold,cool and warm nodules were found in 14,18 and 9 cases,respectively,by scintiscans.Fine needle aspiration biopsy(FNAB) was performed in 11 cases,and in 2 cases were negative,1 case showed abnormal cell,3 cases were suspicious of carcinoma,and 5 cases were confirmed papillary carcinoma.Results Papillary carcinoma was found in 70 cases,follicular carcinoma in 3 cases and medullary carcinoma in 1 case by histological examination,and benign disease was also accompanied in most cases.Lymph node metastases was found in 28 cases(37.84%),and the rate of metastases was significantly different than that of older female patients(16.46%) at the same time.There were 2 cases who died 3 years after operation because of metastases.Conclusions The lymph node metastases were prevalent in young female patients with thyroid carcinoma.The texture and mobility of the nodules cannot be used to differentiate benign from malignant nodules.We should carefully analyze every nodule found on ultrasonography.For the solid nodules with diameter larger than 1.0cm,we suggest operation;for the non-solid nodules with diameter larger than 2.0cm,we prefer scintiscans and FNAB for diagnosis.