OBJECTIVETo compare clinical outcomes of locking plate for proximal humeral fracture whether application of inferomedial screws.

METHODSFrom January 2012 to July 2013, 46 patients with proximal humeral fracture underwent locking plates were retrospectively analyzed. There were 25 males and 21 females aged from 29 to 80 years old with an average of 55.1 years old. Among them, 25 patients were treated with inferomedial screws (support group), including 13 males and 12 females aged from 38 to 80 years old with an average of (55.8 ± 11.8) years old; 8 cases were part two fracture,10 cases were part three fracture and 7 cases were part four fracture according to Neer classification. Twenty-one patients were treated without inferomedial screws (non-support group), including 12 males and 9 females aged from 29 to 79 years old with an average of (54.2 ± 14.8)years old; 6 cases were part two fracture, 9 cases were part three fracture and 6 cases were part four fracture according to Neer classification. Operative time, fracture healing time and complications were observed and compared, Neer scoring of shoulder joint were used to evaluate clinical effect.

RESULTSAll patients were followed up from 12 to 41 months with an average of 15.6 months. Operative time and fracture healing time in support group was (1.6 ± 0.4) h and (3.0 ± 0.6) months, and (1.5 ± 0.4) h and (3.1 ± 0.6) months in non-support group, while there was no statistical difference in operative time and fracture healing time between two groups. There was significant differences in Neer score between support group (89.7± 4.9) and non-support group (83.1 ± 7.1). No complication occurred in support group,while 4 cases occurred complications in non-support group.

CONCLUSIONLocking plate with inferomedial screws for proximal humeral fracture has advantages of stable fixation, less complications, quick recovery of function and satisfied clinical effect.

Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Male ; Middle Aged ; Shoulder Fractures ; physiopathology ; surgery ; Shoulder Joint ; physiopathology ; surgery ; Treatment Outcome

Adult medical education has its own particularity.Its quality is affected by students' work units,families,schools,their own and other factors.Changing concepts,optimizing management,promoting personal quality education,setting up early warning mechanism,and doing full co-ordination are effective ways to improve the quality of adult medical education.

Objective To compare the outcomes of off-pump versus on-pump CABG.Methods From 2002 to 2008,CABG was performed in 105 patients aged 80 years and over,including 45 without cardiopulmonary bypass (CPB) or off-pump (OP) CABG (OPCAB) and 60 with CPB (onpump CABG).The outcomes were compared between two groups.Results The mean ICU stay was (37.1±30.3) h in OPCAB group and (60.6±58.2) h in on-pump CABG group (P＜0.01).Average ventilator-assisted time was (10.8±9.7) h for OPCAB group versus (22.3±35.7) h for onpump CABG group (P＜0.01).Postoperative atrial fibrillation occurred in 31.1％ of OPCABG patients and 41.7 ％ of on-pump CABG patients (P＜0.01).The mortality rate was 5.0％ in OPCABG group versus 8.3％ in on-pump CABG group (P＜0.05).Conclusions OPCABG is a safe and efficient method of myocardial revascularization in the elderly patients with lower morbidity and complications.

Objective To summarize the clinical effect of Doty procedure on surgical treatment for patients with congenital supravalvular aortic stenosis (SVAS).Methods Between Jan.2009 and Jun.2013,12 cases of consecutive patients underwent surgical corrections of SVAS using Doty procedure.Among them,Williams' syndrome were present in 5 patients.Nine cases were male,and 3 cases were female.Mean age was(5.3 ±4.2) years(9 months to 12 years) and mean weight was (11.5 ± 5.3) kg (7.5-32.0 kg).Echocardiography and Computed Tomography confirmed the diagnosis.SVAS was discrete in 9 patients and diffuse in 3 patients.Mean peak preoperative gradient was 6.86-16.23 (11.07± 3.68) kPa,with 3 patients above 13.33 kPa.Bicuspid aortic valve was present in 2 patients,mild aortic valve stenosis in 1 patient,mild aortic regurgitation in 2 patients,1 patient with subaortic membrane,3 patients with stenosis of the left or the right pulmonary artery,1 patient with pulmonary valve stenosis,2 patients with PDA,moderate to severe mitral insufficiency in 1 patients.Surgery was performed using Doty procedure through median sternotomy with cardiopulmonary bypass.Results Mean time of cardiopulmonary bypass was (85 ± 26)min (68-129 min).Mean time of aortic clamp was (51 ± 16) min(43-68 min).There was no early death and low cardiac output syndrome.Mild ST segment change was present in 5 patients and occasional premature beat was in 3 patients.Ventilator was applied for 7 to 38 h and Cardiac Intensive Care Unit treatment was done for 1 to 4 d.The mean peak supravalvular gradient measured postoperatively was (2.18 ± 1.09) kPa.Follow-up data were available for 11 patients,ranged from 6 months to 3 years.The gradients across supravalvular were lower than 3.33 kPa,except for 2 patients with severe SVAS preoperatively.There was no late death,dizzy or palpitation during follow-up.Conclusion Doty produce for SVAS can get satisfactory clinical results.

Objective:To investigate whether transplantation of mesenchymal stem cells(MSCs)through renal arteries can protect kidney from acute tubular necrosis(ATN),so as to lay a foundation for MSC transplantation in treatment of ATN.Methods:Five-week-old nude mice were randomly divided into three groups:normal control group(n=10),acute tubular necrosis(ATN)model group without(n=10)and with MSCs treatment group(n=11).ATN nude mice were induced with 50% glycerin.MSCs labeled with enhanced green fluorescent proteins(EGFP)were injected into kidney through renal arteries.Serum creatinine was determined in all groups and pathological changes of renal tissues were detected using H-E staining.The amount and distribution of the EGFP-marked MSCs in renal tissues were determined with fluorescence microscope.Results:Degeneration and exfoliation of renal tubular epithelial cells,and even renal tubular tamponade with cast-off cells were observed in the ATN group;these pathological changes were mainly located at renal cortex and juncture of renal cortex and medulla.The damages were greatly alleviated in the ATN+MSCs transplantation group,with no swelling of epithelial cells,nuclear condensation or edema.Fourteen days after MSCs transplantation,EGFP positive cells were increased in renal tubules of recipient mice.Conclusion:The MSCs transplantation via renal artery can locate in renal tubular epithelium,and promote the repair of injured renal tubular epithelial cells.

The medium and process parameters were optimized in batchaminoglycoside antibiotic JI-20A fennentation. The optimal medium consists mainly of comstarch 60g/L, peanut meal 30g/L, com slurry 8g/L, maltose 10g/L, inorganic compound and amylase moderate , methionin 1g/L and cobalt chloride 6?g/mL. It was significant to adjust medium pH after autoclaving and oxygenate the fennentation medium for the cell growth and JI-20A product.

Objective To evaluate the b value of diffusion-weighted(DW)MRI in distinguishing between benign and malignant breast lesions.Methods Three diffusion-weighted sequences were implemented with 500,1000 and 2000 s/mm~2 b values respectively on 95 breast lesions in 83 patients.All lesions were confirmed by pathology.The apparent diffusion coefficient(ADC)values and signal intensity (SI)were recorded and compared in different lesions(breast cancer,benign lesion,cyst and normal beast tissue)with the same b value and the same lesions with the different b values.Results(1)The mean ADC value and SI of breast cancer were 1.375?0.378 and 839.713?360.493 respectively with b= 500 s/mm~2,1.176?0.311 and 459.314?229.609 with b=1000 s/mm~2,0.824?0.198 and 243.825? 110.616 with b=2000 s/mm~2.The differences in the mean ADC value were significant between two type lesions(cancer and benign lesion,cancer and cyst,cancer and normal breast tissue)with b values of 500 s/mm~2 and 1000 s/mm~2.But the significant differenee was only seen between cancer and benign lesions when b value was 2000 s/mm~2.(2)The one-side upper limits of 95% confidence interval of mean ADCs were adopted as the point to separate the malignant from the benign lesions,the sensitivity was 70.92%, 70.73% and 69.77%,the specificity was 77.19%,75.70% and 54.76%,the accuracy was 77.12%, 74.32% and 62.35% respectively with b values of 500 s/mm~2,1000 s/mm~2 and 2000 s/mm~2.The areas under ROC eurves were Az_(500)=0.775?0.046(P0.05).Conclusion DWI MRI is useful for the differential diagnosis of breast lesions with b values of 500 s/mm~2 and 1000 s/mm~2.

Objective To investigate the value of functional MRI in the diagnosis and differential diagnosis of breast diseases.Methods Sixty-five patients with 68 lesions were enrolled in this study. Conventional T_1 WI and T_2 WI scan,dynamic contrast enhanced MRI,diffusion weighted imaging and ~1H single voxel MR spectroscopy were performed consequently.All lesions were verified by pathology,including 4 cases of breast adenosis,22 fibroadenomas,2 chronic inflammations,3 cysts,33 infitrating ductal carcinomas,1 intraductal carcinoma and 3 cystosarcoma phyllodes tumors.Morphological features,maximum enhancement ratio,time-intensity curve,apparent diffusion coefficient and Choline peak were analyzed. Results The detection rates of T_1 WI and T_2 WI were 14.7%(n=10)and 51.5%(n=35).The sensitivity,specificity,accuracy of dynamic contrast.enhanced MRI for the malignant tumor were 94.6%, 71.4% and 76.5% respectively.Retrospective study showed that diffusion weighted imaging,with the b value from 800 s/mm~2 to 1000 s/mm~2,could be used to differentiate various types of breast lesions.~1H signal voxel spectroscopy had a sensitivity of 51.4%,specificity of 82.6%,and accuracy of 67.6% for the malignent.The sensitivity,specificity and accuracy could reach 97.3%,90.0% and 92.6% respectively by combining conventional scan,dynamic contrast enhanced MRI and MR spectroscopy.Conclusion Functional MRI,with high sensitivity,specificity and accuracy,can be used widely in the diagnosis of malignant breast lesions.

OBJECTIVETo investigate the effect of Kangquan Recipe (KQR) on apoptosis regulatory genes bax and bcl-2 mRNA in prostate of rats.

METHODSBenign prostatic hyperplasia model rat was established by injecting testosterone after castration. The model rats were killed and prostate glands were removed for examination after being treated with administration of KQR by gastrogavage for 30 days. The wet weight of prostate was measured and the mRNA expressions of bax and bcl-2 in rats' tissue of abdominal lobe of prostate were determined by RT-PCR.

RESULTSCompared with the model group, wet weight of prostate was lower significantly in the groups treated with different dosages of KQR (P < 0.05 or P < 0.01), and that in the high dose KQR treated group was similar to that in the normal group (P > 0.05). Compared with the model group, the expressions of bax mRNA and ratios of bax/bcl-2 were significantly higher and the expressions of bcl-2 mRNA significantly lower in the KQR treated groups (P < 0.01), and these indexes in the high dose KQR treated group were insignificantly different from those in the normal group (P > 0.05).

CONCLUSIONKQR shows an obvious treatment effect on rats with benign prostatic hyperplasia, the mechanism might be through effectively regulating the expressions of bax mRNA and bcl-2 mRNA in prostatic tissue to accelerate the cell apoptosis of prostate in obvious dose-effect manner.

Animals ; Apoptosis ; drug effects ; Drugs, Chinese Herbal ; therapeutic use ; Gene Expression ; drug effects ; Male ; Phytotherapy ; Prostate ; drug effects ; metabolism ; pathology ; Prostatic Hyperplasia ; chemically induced ; drug therapy ; genetics ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Testosterone ; bcl-2-Associated X Protein ; genetics