Objective Measure the epicondyles of the distal femur on magnetic resonance image(MRI), in order to locate presicely the surgical transepicondylar axis(STEA) in total knee arthroplasty(TKA) and to provide theoretical basis for the designing of the size of the femoral component. Methods Totally 78 normal knees of Chinese individuals were studied. The images of coronal, sagittal and traverse sections of the knee were obtained by magnetic resonance image. Measurement included the width of the STEA, distance between the epicondyles and the joint line, anterior posterior width of the medial and lateral epicondyles, posterior condyle angle. Results The width of the STEA averaged(79.55±4.90)mm in males, and femles(71.18±4.22)mm. The distance from the epicondyles to the joint line was correlated with the width of the STEA, so was the anterior posterior width of epicondyles. PCA averaged(4.22±2.07)°. Conclusion The size of the epicondyles in Chinese is significantly smaller than that of the Westerns. The ratio between anterior posterior width of the medial epicondyle and the width of the STEA is 0.84, and is 0.87 between anterior posterior width of the lateral epicondyle and the width of the STEA. The distance from the epicondyles to the joint line is helpful to locate the STEA. The reliability is poor to locate the STEA by touch or PCL.

Objective To observe the effects and safety of recruitment maneuver(RM)and open-lung approach(OLA)in mechanical ventilated patients with pulmonary acute respiratory distress syndrome(ARDS).Methods 6 cases of pulmonary ARDS were treated with RM(30～35 cm H2O,30～40s)and OLA(PEEP=12.1±2.0 cm H2O).SO2 and artery blood gas were recorded.Results SO2 began to rise in(3.7±2.0)min after RM,reaching plateau at(86.1±89.0)min,which was maintained longer than 5 hours by moderate level of PEEP.The RM and OLA significantly improved SO2[(88±5)%vs(97±2)%,P=0.000].Conclusion Single RM and OLA can rapidly improve SO2 and maintained it at a higher level in pulmonary ARDS patients with basic pulmonary disease(severe emphysema and bulla are excluded).

Objective To investigate the therapeutic effect of continuous intravenous pralidoxime chloride infusion in acute organophosphorus pesticide poisoning(AOPP).Methods The patients with severe AOPP were randomly divided into 3 groups:(1)group 1(n =51)received a bolus injection of pralidoxime chloride 2.Og followed by continuous intravenous infusion at 0.25 g/h.(2)group 2(n = 51)received a bolus injection of pralidoxime 2.Og followed by continuous intravenous infusion at 0.5g/h.(3)group 3(n = 50)received intravenous drip of pralidoxime 2.Og for 3 times a day.Efficacy was compared among 3 groups on the basis of time to reach atropinization,recovery of cholinesterase activity .cumulative amount of atropine,incidence of recurrence of pesticide poisoning,intermediate syndrome,and hospitalization days,etc.Results Efficacy in patients receiving continuous intravenous therapy was significantly different from the third group.But there was no significant difference in efficacy between the first and second groups.Conclusion The patients with AOPP can be effectively treated by a loading dose followed with continous intravenous pralidoxime chloride infusion.

Newborn screening of inherited metabolic diseases by tandem mass spectrometry is flourishing in our country.With expansion of the coverage and spectrum of diseases, it is important to strengthen the quality management, optimize the performance and reduce the false rate currently, such as quality assurance of the specimens, quality control of the process, quality verification of the test procedure, quality evaluation of the laboratory and quality optimization of the interpretation method. Along with development of the equipment, software and project, promotion of regional collaboration by data and experience sharing will be more critical in the future, and national neonatal screening by tandem mass spectrometry will step into a new stage.

To explore the effect of Problem-based learning (PBL)in the clinical clerk-ship of internal medicine,we applied PBL method and traditional method from 2006. Compared with the traditional method,PBL method and traditional method is a better way to enhance students'ability of analyzing and solving problems.But there are some problems related to the PBL in pretent stage of medical education in our country.

Objective To assess the efficacy of subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) in the treatment of hepatolithiasis. Methods A retrospective analysis was done on 43 patients with hepatolithiasis who underwent STHG between June 2001 and May 2008. The strictured bile duct at the hilus was opened after removing the stones or cutting the damaged liver segments. The gallbladder was anastomosed to the widely opened bile duct in the hilus to form a widened pass way through the intrahepatic to the extrahepatic ducts. And the fundus of the gallbladder was mobilized and pulled to the abdominal wall to form a subcutaneous tunnel as a re-entry to the biliary tree. Results Totally 18 patients (41.9%) underwent resection of the liver,17 patients (39.5%) had residual stones. The rate of residual stone was 27.8% (5/18) in those treated by STHG combined with hepatectomy,and 48.0% (12/25) in those received STHG only. One patient developed biliary leakage and 1 patient had fungous infection after the operation. The 43 patients were followed up for a mean of 27.6 months (range,1-83). During the period,3 patients had recurrence of cholangitis and hepatolithiasis,1 showed cholangitis,and 1 had recurrent stones. The recurrent cases were cured by drainage or removing the stones through the subcutaneous tunnel. Conclusion STHG is safe,effective,minimally invasive and easy to manipulate for the treatment of hepatolithiasis.

Objective To study the clinical effects of YangGanYiShui granule(YGYSG) on treating early renal damage induced by essential hypertension(EH)and observe the corresponding changes of total cholesterol(TC)、low-density lipoprotein cholesterol(LDL-C)、 C-reactive protein(CRP) and serum uric acid(UA).Methods Eighty EH patients with early renal damage were randomly divided into 2 groups: treatment group(n=40) and control group(n=40).Both two groups were treated with conventionally therapeutic methods of antihypertensive for four weeks.Besides,the YGYSG was added Simultaneously into the treatment group.The levels of TC、LDL-C、UA、CRP in 80 cases were measured and compared.Results After the therapy with YGYSG,the levels of TC、LDL-C、UA、CRP were significantly decreased.The difference between two groups was prominent(P

Objective:TO investigate the effects of the different factors on the quality control of PCI. Methods: Elucidating the correlation of PCI with the different personnel. Results: Success or failure of PCI is related to quality of subsystems in which the most importance is to manage and control concerning personnel including operating staff,nurses and patients. Conclusion:The organic coordination and total quality management of all parts are the safeguard of successful PCI.

Objective To establish a matrine delivery system in vitreous is very important for the dynamic treatment of proliferative vitreoretinopathy(PVR) . Present study was to evaluate the efficacy of matrine polyactic acid microsphere(MAT-PLA-MS) in prevention of PVR. Methods The suspension of cultured fibroblasts was injected into vitreous cavity of 30 healthy adult New Zealand albino rabbits to induce PVR. Then the experimental rabbits were divided into 3 groups and 10 rabbits for each. The animals received intravitreal injection of 0.3 mL MAT-PLA-MS(4 mg) matrine in MAT-PLA-MS group. Free matrine normal sodium solution 0.3 mL(containing 2mg matrine) was injected in vitreous cavity in free matrine group. 0. 3 mL normal saline solution was injected into the vitreous of the left eyes and the equivalent volume of blank polyaetic acid microsphere(blank-PLA-MS) into the right eyes in control group. The changes of cornea, aqueous humor, lens, vitreous and fundus were examined and recorded by slit lamp biomicroscope, indirect ophthalmoscope, fundus color camera and B ultrasonogram on the 1st, 3rd, 7th, 14th, 21st, 28th and 35th day following injection of drug. The inhibition effect of matrine on PVR was evaluated according to Ryan' s grading criteria of PVR. Results On the 14th days after implantation of MAT-PLA-MS, the rate of retinal detachment was 60%, 10%, 5% and 60% in normal saline group, free matrine group, MAT-PLA-MS group and blank-PLA-MS group respectively. Statistically significant difference was found among normal saline group, blank-PLA-MS group, MAT-PLA-MS group and free matrine group(P ＜0. 05). On the 21st day after injection of fibroblasts, the morbidity of retinal detachment was 80%, 30%, 10% and 80% in normal saline group, free matrine group, MAT-PLA-MS group and blank-PLA-MS group respectively, showing a significant difference among different groups. On the 28th day, the incidence rate of retinal detachment was 90%, 50%, 15% and 90% respectively, presenting statistical difference among various groups (P ＜ 0. 05) as well as between free matrine group and MAT-PLA-MS group (P＜0. 05). On the 35th day, considerably difference also was seen in the morbidity of retinal detachment among various groups (90%, 60%, 15% and 90% respectively) (P＜0.05). Conclusion Implantation of MAT-PLA-M S into vitreous cavity can effectively inhibit the development of PVR induced by fibroblasts in rabbit model.

Firstly effect of opposing needling was underlying acupoints of uninjured side facilitate injured side, similar as the nature of association reaction. That hinted association reaction may be the mechanism of opposing needling. Then opposing needling about its clinical application indication, therapeutic effect, stimulus intensity and strategy was discussed and interpreted on the basis of apprehension association reaction conception, essential characteristic and its role in hemiplegia rehabilitation.