Objective To analyze the clinical effectiveness,safety and significance of treatment with external circular fixator,through the relationship of inducible nitric oxide synthase (iNOS) and bone regeneration to further explore the mechanism of the molecular biology of bone lengthening at the same time.Methods Collected bone defect after tibial shaft fractures secondary infection who were treated with external circular fixator as study group (28 cases),all the cases fixed by external circular fixator,20 healthy volunteers as control group.Study group in different time point measured the levels of serum iNOS content,were compared with the control group.Results All patients were scheduled to reach the extremity lengthening and the bone defect were repaired and healed in study group.The bacterial culture results showed that 18 cases (64.29％,18/28) of resistant Staphylococcus aureus,5 cases (17.86％,5/28) of Hemolytic streptocaccus,2 cases (7.14％,2/28) ofP.aeruginosa,one case (3.57％,1/28) of drug-resistant Enterobacter cloacae,one case(3.57％,1/28) of Staphylococcus epidermidis,one case(3.57％,1/28) of Onion-like aeromonas,the proportion of the former two was significantly higher than other bacteria (P ＜ 0.05).The levels of serum iNOS content 1 d after surgery in study group were increased,compared with control group,difference was no significant (P ＞ 0.05).The levels of serum iNOS content 14 d after surgery,stoped extend,1 d stoped extend,3 d stoped extend in study group were significantly higher than those in control group [(118.8 ± 6.6) U/L vs.(86.4 ± 5.4) U/L,(136.2 ± 8.4) U/L vs.(88.2 ± 3.6) U/L,(132.6 ± 9.0) U/L vs.(87.6 ± 4.8) U/L,(103.8 ± 5.4) U/L vs.(86.4 ± 4.2) U/L] (P ＜ 0.05),there was no significant difference between two groups in other times (P ＞ 0.05).Conclusions External circular fixator for the repair and reconstruction effects in patients with bone defect can achieve the desired therapeutic goal,the higher expression of iNOS may be one of the molecular biological mechanisms of bone lengthening.

Objective To investigate the etiology, clinical features, diagnosis and treatment of regional portal hypertension (RPH).Methods The clinical data of 26 patients with RPH treated in Beijing Chaoyang Hospital Affiliated to Capital Medical University between January 2005 and June 2010 were analyzed with retrospective analysis.The first symptom, routine analysis of blood, liver function test, hepatitis B and C markers, tumor markers, abdominal ultrasound, abdominal enhanced CT, endoscopy findings of 26 patients and the results of abdominal CT angiography (CTA) of 16cases were analyzed.Results Pancreatic disease (18 cases) was the leading cause of RPH.The main clinical manifestations of splenomegaly in 26 cases, irregularly abdominal pain in 14 cases, and upper gastrointestinal bleeding in 10 cases.Isolated gastric varices were revealed by endoscopy in 25 cases,complicated with lower esophageal varices in 1 case.4 cases with endoscopic tissue glue injection in gastric variceal bleeding, splenectomy in 4 cases, 2 cases with splenectomy and pericardialdevascularization, 2 cases with splenectomy, pancreatic tail resection and spleno-renal shunt, 3 cases with splenic embolization treatment.Conclusions RPH often accompanied by pancreatic disease,manifested as splenomegaly, hypersplenism, but normal liver function, absence of liver cirrhosis.Isolated gastric varices is the characteristic features of RPH.RPH caused by benign diseases is curable.Splenectomy is more effective than simple endoscopic hemostasis in RPH associated with gastrointestinal bleeding.

Because of the particularity of the interventional therapy,that is,the interventional management covers a large scope in clinical application and involves the diagnosis and treatment of various diseases of multiple systems and organs,the clinical interventional practice has really brought an unprecedented challenge for the administration of the nursing care in the intervention ward.In our hospital,independent nursing group for the intervention ward was established two years ago.For the past two years,we have constantly groped and summarized the reasonable and effect administration of interventional nursing care.Pertinent administrative measures,such as nurse training,strengthening of communication with physicians and focusing on key links in nursing care and promptly finding out the weak points in clinical work,have effectively improved the quality of clinical nursing,in this way the clinical nursing practice has been integrated into the interventional therapy and the safe and high-quality nursing service has been provided to the patients.

Objective To investigate the efficacy and safety of anti CD25 Ab (Zenapax;Daclizumab) induction therapy in 62 patients following renal transplantation. Methods Sixty-two renal transplant recipients treated with Daclizumab induction therapy were analyzed retrospectively from Sep. 1999 to May 2004. Main immunosuppressive therapy regimen consisted of steroids cyclosporine and mycophenolate mofetil in all recipients after operation. According to Daclizumab dosage, these recipients were divided into 1-dose group, 2-dose group and over 2-dose group. All patients received Daclizumab 1 h before operation.Results The patients subject to Daclizumab were followed up from 3 months to 57 months. Seven of them had acute rejection ( 11.3 %) at intervals for 10.3 months, from 2 months to 14 months. Patient who had acute rejection at 10th month after operation lost his graft at 13th month after transplantation for graft dysfunction. The incidence of acute rejection was 15.6 % among 45 patients followed up over 12 months. Conclusions Induction therapy of Daclizumab could decrease the incidence of acure rejection, delay the time of acute rejection and relieve the severity of rejection. More graft can be long-survival. We can lower the dosage of CsA effectively and safely after induction of Daclizumab.

Objective To find out the risk factors of early pulmonary infections after renal transplantatioa Methods The data were collected from 96 patients receiving renal transplantation between Oct. 2006 and Oct 2010, including 48 cases of early lung infection after renal transplantation as infection group, and 48 patients receiving immunosuppressive regimen at the same period as-control group. Taking the factors of lung infecition as variables, t test or chi-square test was used in univariate analyses whereas logistic regression was used in multivariate analyses. Results Single factor analysis showed that induction therapy, albumin levels, dose of steroid in 1 month after operation,family income and prophylactic SMZ treatment were related to lung infectioa Analysis of multiple variables logistic regression revealed that induction therapy, albumin levels, dose of steroid in 1 month after operation and prophylactic SMZ treatment were related to lung infection. Conclusion The correlation analysis indicated that induction therapy and dose of steroid in 1 month after operation have positive correlations with pulmonary infection, while albumin levels and prophylactic SMZ treatment have negative correlations with pulmonary infection.

Purpose To evaluate parameter changes of pelvic floor muscles in patients with female pelvic organ prolapse (POP) through diffusion tensor imaging (DTI).Materials and Methods Fifty female patients with POP at Ⅲ or ⅣV degree (research group) and fifty healthy women volunteers (control group) were collected to make prospective research.The axial DTI sequence was performed in subjects,with b=500 s/mm2,at 15 directions.DTI original images were imported into the post-processing software,and the corresponding DTI mappings were formed.In the original images,pelvic floor muscles were sketched out layer by layer,and various DTI parameters,including fractional anisotrophy (FA),mean diffusivity (MD),λl,λ2,λ3,linear anisotropy (CL),planar anisotropy (CP) and spherical anisotropy (CS),were calculated.Six kinds of pelvic floor muscles,including anal sphincter,superficial transverse perineal muscle,pubic visceral muscle,puborectal muscle and iliococcygeal muscle were measured,and five of them were measured on both sides.The difference of DTI parameters between right and left side of each muscle,and the difference of DTI parameters between research and control group were compared.Results Between the right and left side of five kinds of pelvic floor muscles in control group,significant difference was only found in FA,λ3,CP,CS value of internal obturator muscle (P＜0.01,P＜0.001).There were significant differences in FA,λ3,CL,CP and CS values of the left and right muscles in the study group (P＜0.05,P＜0.001).Compared with control group,FA value and CS value of superficial transverse perineal muscle,CL value of left pubic visceral muscle,FA,λ3,CL,CS and CP value of right pubic visceral muscle,λ1 and λ3 value of left iliococcygeal muscle of research group were significantly different (P＜0.01,P＜0.05).Conclusion DTI for observation of female pelvic floor muscle is technically feasible,and it can detect the injury of pelvic floor muscle in POP patients,and may be helpful to reveal the pathogenesis of POP.

Objective To analyze the characteristic of trauma in 246 fatal falls. Methods We collect 246 cases of fatal falls from Pudong district of Shanghai from 2005 to 2014, and then analyze the characteristics of trauma by using different parameters. Results The height in suicides by fall is higher than accidents by fall (25.7m:13.98m). In all fatal falls, head has a higher possibility in suffering trauma than other body regions (75.2%), while neck has a lower possibility (6.5%). The possibility of head trauma in accidents by fall is higher than suicides by fall (89.4%:75.2%). Conclusion Comparing with suicides by fall, victims in accidents by fall have lack of protection from limbs. Besides, the low rate of ifnding neck trauma suggests legal physicians should be more careful in examining this area.

Objective To investigate the effects of acitretin on T helper cell (Th) 1/Th2 balance and Th17 cells in psoriasis vulgaris (PV) patients. Methods A total of 13 men and 17 women with PV were investigated. 10 mg of acitretin was administered twice a day for 8 weeks for intervention therapy. Serum levels of interferon-gamma (IFN-γ), interleukin (IL)-4 and IL-17 were measured by enzyme-linked immunosorbent assay. T, Th1, Th2 and Th17 cells in skin biopsies were counted with double-labeled immunofluorescence. Psoriasis Area and Severity Index (PASI) score was calculated before and 8 weeks after treatment. Results Before treatment PV patients had higher serum levels of IFN-γ and IL-17, and increased T, Th1 and Th17 cells in skin biopsies. After treatment, both serum levels of IFN-γ and IL-17, and T, Th1 and Th17 cells infiltrating in PV skin decreased significantly. Th1/Th2 balance was restored to normal. However, their IL-4 and Th2 cells showed no significant change throughout the therapy. Conclusion Acitretin exerts influence on dermal Th1/Th2 balance and Th17 cell infiltration, so does it on production of systematic inflammatory cytokines IFN-γ and IL-17 in PV patients. However, Th2 cells and its derivative cytokine-IL-4 are not affected.

Objective To investigate the factors affecting health-related quality of life (HRQOL) in patients with chronic liver disease (CLD).Methods HRQOL was measured with SF-36v2 Chinese version.All patients with CLD diagnosed between December 2009 and May 2011 in Liver Research Center,Beijing Friendship Hospital and Digestive Department,Beijing Chaoyang Hospital were enrolled in this study.Patients with CLD were divided into 4 groups according to their Child-Turcotte-Pugh scores:no cirrhosis,Child's classes A,B,and C.Demographic and clinical data were collected in each group.Results A total of 392 patients with CLD and 91 healthy controls were included.HRQOL in patients with CLD was lower than that in healthy controls.Physical component score (PCS) in healthy controls was 54.6 ± 5.5,and in CLD was 47.8 ± 8.8 (t =9.343,P ＜ 0.01).Mental component score (MCS) in healthy controls was 56.4 ± 8.1,and in CLD was 51.7 ± 7.4 (t =5.302,P ＜ 0.01).Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on HRQOL,PCS scores were 53.1 ± 5.9,48.7 ± 6.6,42.4 ± 7.1 and 37.2 ± 8.9 (F =93.353,P ＜ 0.01) ; MCS scores were 53.2 ± 4.8,52.7 ±6.5,51.8 ±7.5,and 46.8 ± 7.5 (F =11.325,P ＜0.01),for no patients with cirrhosis,Child's classes A,B and C respectively.Stepwise linear regression analysis showed that severity of disease,age,present ascites,present varices,and prothrombin time had significant effects on physical health area (F =100.893,P ＜ 0.010).Severity of disease,female gender,present varices,total bilirubin,prothrombin time and hemoglobin had significant effects on mental health area (F =19.237,P ＜ 0.010).Conclusions Patients with CLD have reduced HRQOL.Increasing severity of CLD is associated with a decreasing HRQOL.Old age,female gender,advanced stage of CLD,present ascites,hyperbilirubinemia and prolonging prothrombin time are risk factors for reducing HRQOL.

Objective To investigate the diagnostic value of dynamic MRI with coupling agent filled vaginal and rectumin the display of vaginal vault prolapse and rectocele. Methods Thirty three female patients, who were diagnosed with pelvic organ prolapse with Ⅲ degrees and above by gynecologic outpatient clinic and prepared to be treated with surgery were prospectively collected. All of them underwent two types of dynamic MRI, one was routine dynamic MRI (Group A) and the other was dynamic MRI with vaginal and rectum filled with coupling agent (Group B). Two radiologists evaluated and scored the display of vaginal vault and rectocele on these two groups of dynamic MRI images. According to the joint result of two radiologists, two gynecologists made surgical planning. Kappa test was used to compare the consistency of scores performedby two radiologists, and Fisher exact test was used to compare the differentiation fromboth groups, as well as the differentiation of probability of high uterosacral ligament suspension.Results The Kappa value of both groups was 0.65 and 1.00 respectively, where the consistency of Group B was superior than Group A. There were significant differences between the two groups(P<0.01), where Group B was better than Group A. Based on the imaging results of Group A, 7 patients (21.2%, 7/33) were decided to make high uterosacral ligament suspension. Based on the imaging results of Group B, 20 patients (60.6%, 20/33) were decided to make high uterosacral ligament suspension, and differences were statistical significance between the two groups(P<0.05). Conclusions Fo purpose of the displaying vaginal vault and rectocele, the dynamic MR imaging with vaginal and rectum filled with coupling agent was better than routine method. The proposed method can provide important information and reference for the establishment of surgical planning.