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 study pharmacodynamic changes of combined anesthesia with remifentanil at different target plasma concentrations and isoflurane at different minimal alveolar concentrations(MAC) in laparoscopic operations. Methods Forty-five patients with ASA status Ⅰ~Ⅱ,receiving selective laparoscopic cholecystectomy or laparoscopic oophorocystectomy,were included.The patients were randomly divided into three groups with 15 patients in each group.In the Group A,anesthesia was maintained with isoflurane inhalation at the MAC of 1.3;in the Group B,anesthesia was maintained with both isoflurane inhalation at the MAC of 0.6 and remifentanil target-controlled infusion at 4 ng/L;and in the Group C,anesthesia was maintained with both isoflurane inhalation at the MAC of 0.4 and remifentanil target-controlled infusion at 6 ng/L.Pharmacodynamic parameters and recovery characteristics,including bispectral index(BIS),heart rate variability(HRV),mean arterial pressure(MAP),heart rate(HR),time to additional administration of muscle relaxants,time to the recovery of spontaneous breathing,time to eye opening,time to endotracheal extubation,time to the recovery of orientation,and follow-up survey of "awareness during operation",were compared among the 3 groups.Results ①The BIS value was lower in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladder or the ovarian cyst.The measures of HRV were higher in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladder or the ovarian cyst.The measures of MAP and HR in the Group A were higher than those in the Group C at the time of pneumoperitoneum for 2 min,and were lower than those in the Group C at the time of the endotracheal extubation and the recovery of consciousness.②Either isoflurane inhalation at the MAC of 0.6 combined with remifentanil target-controlled infusion at 4 ng/L or isoflurane inhalation at the MAC of 0.4 combined with remifentanil target-controlled infusion at 6 ng/L provided satisfactory anesthetic maintenance.③Significantly shorter time to endotracheal extubation,to eye opening,and to the recovery of orientation were recorded in the Group B and C than in the Group A.Conclusions Anesthesia with target-controlled infusion of remifentanil combined with inhalation of isoflurane can be used for laparoscopic surgery.Pharmarcodynamic parameters and recovery characteristics show that combined use of remifentanil infusion at 4 ng/L and isoflurane inhalation at the MAC of 0.6 provides optimal anesthetic maintenance.

In order to study the effects of biliary high pressure on splanchnic major nerve and the its significance during sever type acute cholangitis(ACST), using a self-made catheter with a blind cyst at the biliary tract, an observation was completed on biliary compression of 150mmHg (20kPa) in big ear white rabbits, nervous impulse frequercy of splanchnie major nerve and blood pressure was measured at the same time. The results showed that a significant decrease in blood pressure(P0.05), the authors believe that activity of splanchnic major nerve is related to the decrease of blood pressure in earlier stage of ACST.

In order to study the effect of acute biliary hypertension on cardiovascu-lar activity, an experiment has been done on Japanese big ear white rabbits, using a self-made catheter with an inflatable rubber bag fixed to its anterior end. It was insertedinto the extrahepatic biliary tract via the duodenum, biliary high pressure of 8-20 kPawas created and maintained for 2 h by inflating the bag with water. A significant decreaseof cardiac output (CO) and fall of the arterial blood pressure were found during theexperiment (P0.05). These results indicated that the increase ofthe biliary pressure without infection could also make CO decrease, so it was a direct rea-son for falling of blood pressure, it was also an important factor causing the decline ofblood pressure in the ealier stage of severe acute cholangitis (ACST).

Objective To compare the peri-operative anaesthetic management between emergent and selective operations of(off-pump) coronary artery bypass grafting(OPCAB).Methods A retrospective review was conducted on clinical data of 50 cases of OPCAB from January 2001 to December 2004 in this hospital,including 30 emergent operations(Emergent Group) and 20 elective operations(Selective Group).The preoperative assessment and preparation,hemodynamic changes,vasoactive agent usage,hemostatic functions,and postoperative outcomes were compared between the two groups.Results ①The risk assessment score was greater in the Emergent Group(18.56?5.12) than in the Selective Group(8.98?3.12)(t=-7.479,P=0.000),and the application rate of(intra-aortic) balloon pump assist device(IABP) before the operation was higher in the Emergent Group(93%) than in the Selective Group(50%)(?~2=12.354,P

ObjectiveTo determine the principle and method of surgical management of acute colon obstruction caused by carcinoma in the elder patients. MethodsClinical data of 98 patients with acute colon obstruction caused by carcinoma were analyzed retrospectively. ResultsOf 98 patients undergoing operation,complications occurred in 8 cases,and 3 ( 3.1%)died postoperatively.The other patients were healed. ConclusionsThe management of acute colon obstruction caused by carcinoma in the elder patients depends on the patients,general condition and local condition of the carcinoma.If it is an indication, one-stage resection of the cancer and anastomosis of the colon may be safe and suitable .

Objective To eveluate the pancreatic injury induced by smoking alone or combined with alcohol consumption,and its possible mechanism.Methods The Wistar rats were divided into control group (n=10),smoking group (n=30),drinking group (n=42) and smoking combined with drinking group (combination group,n=48).Serum levels of interleukin (IL)-6,superoxide dismutase (SOD) activities,monocyte chemoattractant protein-1 (MCP-1) and hydroxyproline were determined at 4th-,8th- and 12th- week.The pathohistological changes of the pancreas were examined using HE staining and the expression of α-smooth muscle actin (α-SMA) were measured by immunohistochemistry.ResultsIn contrast to control group,pancreatic changes including cytoplasmic vacuolation and increased levels of α-SMA and hydroxyproline were found in both smoking and drinking groups at the 8th-week (P<0.01).Whereas these changes were aggravated in combination group (P<0.05).Serum level of IL-6 and MCP-1 expression in pancreatic tissue were significantly increased in smoking group when compared with control group.But MCP-1 expression was lower in drinking group than control group.Moreover,the SOD activity in pancreatic tissue decreased in smoking and drinking groups,especially in combination group.Conclusions Long-term smoking can induce cytoplasmic vacuolation in pancreatic acinar cells,enhance inflammatory factors and chemokine expression and aggravate oxidative stress response in pancreas.These changes are aggravated when smoking and drinking coexisted.The mechanism behind it may be associated with increased oxidative stress response in pancreas.

Objective To compare the efficacies of medicated thread moxibustion plus needle picking therapy versus medication for sciatica.Method Seventy sciatica patients were randomly allocated to a treatment group of 35 cases and a control group of 35 cases. The treatment group received medicated thread moxibustion on Zusanli (ST36), three cones once daily and needle picking at Yanglingquan (GB34) and Huantiao (GB30), once daily. The control group took quick-acting sciatica pills, two pills twice daily. One course of treatment consisted of 10 days in both groups. The therapeutic effects were compared between the two groups of patients after two consecutive courses of treatment.Result Posttreatment pain score decreased more markedly in the treatment group (P<0.01). The total efficacy rate was 88.6% in the treatment group and 57.1% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Medicated thread moxibustion plus needle picking therapy for sciatica is more effective in relieving pain and raising the total efficacy rate.

ObjectiveTo detect the fiber structure and volume differences in frontal lobe between patients with amnestic mild cognitive impairment (aMCI) and normal control.MethodsT1 -weighted magnetic resonance imaging and diffusion tensor imaging were obtained in 28 aMCI patients and 25 normal controls.Volumes,fiber fractional anisotropy (FA),fiber apparent diffusion coefficient (ADC),fiber number,and average fiber length of frontal lobe in the two groups were measured.ResultsVolumes of left frontal lobe ( ( 337.35 ± 20.45 ) cm3 ) in aMCI group were smaller than control ( (358.54 ± 27.26) cm3 ) ( t =- 3.223,P =0.002 ).Numbers of short range fiber in left frontal lobe ( 16985 ± 892) were significantly increased relative to control ( 16387 ±752) ; while numbers of long range fiber (3214 ± 185 ) were reduced compared with control (3425 ± 277 ),and ADC values increased ( t =2.621,P =0.012; t =-3.714,P =0.001 ; t =17.595,P=0.000).In aM CI group,numbers of long range fiber in right frontal lobe were reduced (2895 ± 343 vs.3451 -± 230,t =- 7.011,P =0.000),and ADC values were increased ( t =4.443,P =0.000).In aMCI group,numbers of long range fiber in left frontal lobe were positively correlated with scores of mini-mental state examination ( MMSE ) ( r =0.457,P =0.015 ),while ADC values of long range fiber in left frontal lobe were negatively correlated with scores of MMSE ( r=-0.415,P=0.028).ConclusionThe structure and fiber connectivity are affected in aMCI patients and the lesion of connectivity in left frontal lobe are related to the severity of symptom.

Primary testicular lymphoma comprises 1% to 9% of testicular neoplasms and represents 1% to 2% of all non-Hodg-kin lymphomas. Histologically, the majority of the tumor consists of diffuse large B-cell non-Hodgkin lymphomas that are of intermedi-ate- or high-grade neoplasm. Clinically, the disease typically presents as a painless testicular swelling that develops over a span of weeks to months. B symptoms such as fever, weight loss, and anorexia are present in 25% to 41% of the patients. This tumor is an ag-gressive type, with frequent invasion of the epididymis, spermatic cord, and scrotum, as well as a marked tendency to relapse, especial-ly in the CNS. The treatment is mainly based on orchiectomy (mostly in stages ⅠE and ⅡE) regardless of its association with prophy-lactic irradiation of the scrotum and administration of intrathecal chemotherapy, cyclophosphamide, doxorubicin, vincristine, and pred-nisone regimen chemotherapy plus rituximab (R-CHOP) (stages ⅢE and ⅣE) and radiotherapy. The multi-modality treatment marked-ly improved progression-free and overall survival. We introduce as reference one case that received a multidisciplinary comprehensive discussion in the Department Lymphoma, Tianjin Medical University Cancer Hospital.