The treatment of avascular necrosis of the femoral head whose pathological procedure is femoral head avascularity and osteocyte necrosis induced by many etiological factors is one of the difficult subjects in orthopaedics. As a newly-developed technology, cytokines and gene therapy have been widely used in the research of avascular necrosis of the femoral head. Many cytokines and transduced genes have the effects of promoting vascular reconstruction and bone repairment so that it could recover the blood supply and repair the osteonecrosis of femoral heads. Most current researches remain in the experimental phase. Therefore, the research focus in the future comes down to the lengthening of gene transfection expression as well as the selection of vectors and tissue engineering bones that have low immunereaction and low toxicity.

Background and purpose:ERp29 belongs to endoplasmic reticulum stress proteins and might play roles in neoplasm metastasis. This study aimed to investigate the expression of ERp29 in Hca-F and Hca-P cells and to elucidate its role in lymphatic metastasis.Methods:Immunohistochemistry, Western blot and lfow cytometry analysis were used to detect the expression of ERp29 in Hca-F and Hca-P.Results:The results of immunohistochemistry suggested that ERp29 protein was located at cytoplasm of hepatic cells and some were also detected in the nucleus. The results of western blot suggested that ERp29 had positive expression in Hca-F and Hca-P cells. Its expression in Hca-F cells was apparently lower than that in Hca-P cells. And there was statically different between Hca-F and Hca-P cells (P<0.01). The relative lfuorescence intensity of ERp29 protein was signiifcantly lower in Hca-F cells (375.27±47.33) than that in Hca-F cells (623.91±46.80) by lfow cytometry (P<0.01).Conclusion:The different expression of ERp29 may be related to the potential ability of tumor lymphatic metastasis in Hca-F and Hca-P cells.

Objective To investigate the effects of astragalus injection auxiliary on the levels of serum troponin I ( cTn I ) , creatine kinase isoenzyme(CK-MB), creatine kinase(CK), interleukin 4(IL-4), interleukin 6(IL-6) and interleukin 23(IL-23) in patients with infantile viral myocarditis.Methods 70 patients with infantile viral myocarditis who were treated in Zhejiang Quzhou Hospital were selected and randomly divided into control group andexperiment group,with35 cases in each group.Patients in control group were treated with 1, 6 -two-diphosphate fructose, a lot of vitamin C and polarized liquid conventional treatments, patients in experiment group were treated withastragalus injectionon the base of control group.After treatment with two weeks, the serum cTn I, CK-MB, CK,IL-4,IL-6 andIL-23 levels of two groups were compared, and the clinical total effective rate were observed.Results Compared with pre-treatment, the serum cTn I, CK-MB, CK, IL-6 and IL-23 levels of the two groups were decreased, the IL-4 level increased(P<0.05).ompared with the control group, the serum cTn I, CK-MB, CK, IL-6and IL-23 levels of experiment group were lower, theIL-4 levelwashigher ( P <0.05 ) . The clinical total effective rate of experiment group was higher than control group ( P <0.05 ) . Conclusion Astragalus injectioncombined with conventional therapy aremore effective in treatment with infantile viral myocarditis .

Objective To establish an accuracy test method for MDCT dose assessment based on information in DICOM images.Methods The type of MDCT studied in this paper was widely used in clinical practice.A software package developed by java language was used to automatically read doserelated information from DICOM files of MDCT.The CTDIvol and DLP of each pectoral or abdominal scan was calculated based on these information and the basic scan parameters such as collimation,mAs and pitch.The calculated values were compared with the displayed values.Results For pectoral scans,the difference between the calculated and displayed values was between-2％-8％ for CTDIvol,and-2％-5％ for DLP.For abdominal scan,the difference between the calculated and displayed values was 0-2％ for CTDIvol,and-2％-3％ for DLP.Conclusions This method is useful for MDCT dose assessment and is worth disseminating its application for general use.

Objective To evaluate the clinical efficacy and safety of combination treatment with clofazimine ( Cfz ) and other antituberculosis drugs for patients with multidrug-resistant tuberculosis(MDR-TB).Methods 32 cases of MDR-TB patients were treated with combination regimens that included clofaziminefrom October 2011 to September 2016 in our hospitol,according to the history of drug use and drug susceptibility test results using individualized chemotherapy,the starting dose of clofazimine was 0.1 g/day,oral,some patients with adverse reactions and tolerance adjusted to 0.05 g/day,treatment for the last 12 months for three consecutive sputum mycobacterium tuberculosis culture and sputum smear acid-fast bacilli were cured,observe the clinical efficacy and safety.Results After treatment with the combined regimen,56.2%(18/32) of patients were cured,43.8%(14/32) of patients failed treatment, there was no statistically significant difference in the number of drug-resistant patients before and after CFZ treatment,there was no statistically significant difference between the time of failure and the time of CFZ treatment,after taking CFZ combined with anti-tuberculosis program,the number of drug users was statistically significant of patients cured and failed (P<0.05).The average time of sputum culture inversion was 16w.90.6% (29/32) of patients with adverse reactions,mainly including skin color change,ichthyosis and gastrointestinal tract and other adverse reactions, through dose adjustment and symptomatic treatment to continue treatment.The average duration of treatment with clofazimine was about 13 months.ConclusionClofazimine was welltolerated,combination treatment with Clofazimine and others for patients with MDR-TBhave better efficacy .

Objective To study the anatomic landmarks of recurrent laryngeal nerve (RLN) in minimally invasive video-assisted thyroidectomy (MIVAT), and to evaluate the operative skills to avoid nerve injury. Methods 106 patients were enrolled in the study dated between August 2008 and August 2010, in which 8 patients were converted to the conventional thyroidectomy. Intraoperative anatomic landmarks for location of RLN were the gap between trachea and carotid artery (GTC), as well as the middle and posterior portion of tracheal wall. Results 98 RLN were at risk, and 97 (98.98 %) nerves were recognized by means of two landmarks. 1 nerve failed to locate which was non-recurrent laryngeal nerve. Temporary RLN paralysis happened to 1 nerve(1.02 %), and no permanent RLN paralysis appeared. Conclusion GTC combined with middle and posterior portion of tracheal wall are safe and effective anatomic landmarks to locate RLN in MIVAT.

Objective To analyze the clinical efficacy of endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity and summarize the experiencein order to achieve better results.Methods From January 2014 to June 2015,45 patients (52 limbs,including 17 males and 28 females,aged 36 to 68 years) diagnosed as great saphenous varicosity received endovenous laser treatment combined with transilluminated powered phlebectomy.Thirty-eight cases was unilateral great saphenous vafcose veins,7 cases was bilateral large saphenous varicose veins.The clinical efficacy was analyzed.Results All cases were performed successfully.The mean operation time was (68.4 ± 15.1) minutes,the average bleeding volume was (23.5 ± 10.7) ml,the number of mean operative incision quantity was (5.8 ± 1.9) and the average hospitalization time was (5.9 ± 1.6) days.All patients had no serious complications.During a mean follow-up time of 22 months (12 to 30 months),only one patient recurred.Conclusions Endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity is effective and safe.It also has the advantages of shorter operation time,less bleeding,shorter hospitalization time,small trauma and better cosmetic results.

Objective To study the relationship between cognitive dysfunction and location of lesion and prognosis in patients with cerebral infarction.Methods 120 patients with cerebral infarction in the Second People's Hospital of Yueqing were selected.According the results of the cerebral CT or MRI,the patients were divided into primary group(58 cases)and recurrence group (62 cases).3 -10days after admission,the cognitive impairment was evaluated with the method of simple mental state examination (MMSE)scale.The stroke score of the National Institutes of health(NIHSS)in the United States and ability of daily life activity Barthel index score before the admission and after the discharge were conducted on the patients.And the relationship between different lesion location of primary or recurrent infarction,cognitive disability and prognosis were observed.Results The incidence of cognitive impairment in the ecurrence group was 90.32%,which was obviously higher than 72.41% in the primary group(χ2 =6.419,P =0.011);In the two groups,the proportion of thalamic cortex was the highest,but there was no significant difference between the two groups (χ2 =0.000,P =1.000).The NIHSS and Barthel scores of patients with thalamic infarction were (11.4 ±1.6)points and (27.5 ±3.7)points respectively,both of which were the highest(FNIHSS =47.22, PNIHSS =0.000;FBarthel index =17.77,PBarthel index =0.000);the NIHSS and Barthel indexes in each part of the two groups at discharge were lower than those before the admission (all P <0.01),and the differences at admission was not statistically significant(P >0.05);the NIHSS scores of the primary group and the recurrent group at discharge were (6.3 ±0.5)points and (7.8 ±0.7)points respectively;the Barthel scores were (24.3 ±7.3)points and (30.8 ± 6.8)points respectively.And all of them were lower than those at admission and the improvement degree of the primary group were more significant than those of the recurrence group(tNIHSS =13.43,PNIHSS =0.000;tBarthel index =5.05, PBarthel index =0.000).Conclusion Cognitive impairment after cerebral infarction is associated with lesion,and thalamic infarction is the most prone to perform cognitive disfunction with poor prognosis,and the frontal and temporal lobe are also common parts where targeted prevention is needed.

Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma( cN0-PTMC) and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients(34.8%)had cervical lymph node metastasis (30.0%in central region and 9.9%in lateral region). For patients with tumor diameter ( D)≤5 mm and D>5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%(χ2 =6.199,P<0.05) and it was 4.9% and 13.7% respectively in lateral region (χ2 =5.035,P<0.05).For male and female patients, lymph node metastasis rate in central region was 42.1% and 26.1%respectively(χ2 =5.224,P<0.05), and it was 21.1% and 6.3% respectively in lateral region (χ2 =10.604,P<0.01).Lymph node metastasis rate in patients≤45 years old and >45 years old was 37.9% and 21.1% respectively (χ2 =7.792, P <0.01 ) .The lateral region lymph node metastasis rate was 17.1% and 6.7%when the central region lymph node was infringed or not (χ2 =5.947, P<0.05).Conclusions All cN0-PTMC patients should have a normative central neck dissection .Male patients with PTMC and tumor diameter >5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.

Objective To investigate the therapeutic effect of the ultra-early stent-assisted coil embolization of the ruptured intracranial aneurysms. Methods The clinical data of 13 patients with ruptured intracranial aneurysm treated by ultra-early stent-assisted coil embolization were analyzed retrospectively. The preoperative Hunt-Hess gradeⅠ-Ⅱ was in 7 cases,gradeⅢ was in 4 cases,and grade Ⅳ was in 2 cases. The patients were treated with stent-assisted coil embolization under the general anesthesia with endotracheal intubation within 24 h of aneurysm rupture. The postoperative embolization was assessed according to the Raymond grading standard. The postoperative complications and the assessment of the follow-up results from 1 to 6 months after procedure according to the modified Rankin scale (mRS ) scores were observed. Results All 11 patients recovered well,1 case had postoperative hemiplegia,1 case had postoperative bleeding,and none of them died. During the follow-up period,no patients had rebleeding, 1 had recurrence,and DSA revealed that the patient was embolized completely at 2 months after reembolization. Conclusion The method of ultra-early stent-assisted coil embolization of ruptured intracranial aneurysms is feasible. It may improve the cure rate of the ruptured aneurysms and improve the prognosis of patients.