Objective To observe arthroscopic manifestations of necrosis of the femoral head and to evaluate the results. Methods Arthroscopic operations were performed in 38 hips in 27 patients (19 male and 8 female) with necrosis of the femoral head. There were 8 hips of Ficat stage Ⅰ, 21 hips of stage Ⅱ, 7 hips of stage Ⅲ, and 2 hips of stage Ⅳ, respectively. The arthroscopic operation included an assessment of the appearance and texture of the femoral head, the acetabulum, and the synovium, debridement of the joint, and femoral head decompression by drilling small holes. Results Arthroscopically, the Ficat stage I hips were considered to have a intact articular surface, with normal appearance and instrument compression, displaying a hyperaemia and swelling of the synovial tissue. The stage Ⅱ hips presented a major portion of the normal articular surface, chondromalacia of the weight bearing portion of the femoral head, fissures on the articular surface, and sinking with instrument compression. A cleavage plane was formed between the fractured and collapsed necrotic subchondral bone, but the cartilage still communicated with the calcificated layer. The surface of necrotic bone was sclerosesed and rough like sandstones. Hyperplasia of the synovial tissue was seen. The stage Ⅲ hips manifested a massive disassociation of the articular surface from the underlying subchondral bone and the delamination of the femoral head. The subchondral bone was collapsed and disintegrated, with ineffective repaired granulation tissue in it. The stage Ⅳ hips displayed narrowing of the joint space, extensive chondral lesions of the femoral head, collapse of necrotic subchondral bone exposed, and degenerative changes on the acetabulum side, all of which were consistent with the end-stage of osteoarthritis. Conclusions Articular cartilage impairment plays an important role in the process of the necrosis of the femoral head. The value of hip arthroscopic examinations lies in accurate evaluation of the extent of the chondral impairment and important reference for the choice of procedures.

BAcKGROUND:In recent years,the pedicle screws fixation technique,which is used in fixation for atlantoaxial instability associated with trauma,severe degeneration and tumorectomy,has been developed.However,this kind of technique easily causes several complications,including malpositional screws,vascular injuries,and even vertebral artery injury.Based on the biomechanical characteristics of memory alloy and determination of atlantoaxial data,a neotype shape memory alloy cervical hook was designed to treat atlantoaxial instability.OBJECTIVE:To investigate the biomechanieal characteristics of the neotype shape memory alloy cervical hook for atlantoaxial instability.DESIGN,TIME AND SETTING:Repeated measurement analysis of variance test was performed in the Laboratory of Clinical Anatomy and Medical Biomechanics,Southern Medical University between March and April 2008.MATERIALS:Eight fresh adult craniocervical specimens(C0-C4)were provided by Department of Clinical Anatomy,Southern Medical University.Atlantoaxial neotype shape memory alloy cervical hook(50.8%-51.8%nickel and the remaining part was titanium)was fabricated by Shanghai Xinchang Memory Alloy Co.,Ltd.METHODS:The included eight C0-C4 specimens were used to test three-dimension ranges of motion(ROM)by fixation and neotype shape memory alloy cervical hook fixation.Then,the positions of spine varying from no loading to the maximum loading status were scanned and analyzed using image processing software to determine the three-dimensional ROM under different statuses.MAIN OUTCOME MEASURES:Three-dimensional ROM of tested specimens.RESULTS:Neotype shape memory alloy cervical hook fixation and Germany AESCULAP SSE hanger fixation had similar flexion-extension range of motion(P=0.595).Lateral bending three-dimensional ROM was greater in the neotype shape memory alloy cervical hook fixation group than in the Germany AESCULAP AAE hanger fixation(P< 0.05).The rotatory three-dimensional ROM was smaller in the neotype shape memory alloy cervical hook fixation group than in the Germany AESCULAP AAE hanger fixation(P<0.05).CONCLUSION:Neotype shape memory alloy cervical hook fixation had comparative post-surgery immediate stability with the Germany AESCULAP AAE hanger fixation.Neotype shape memory alloy cervical hook fixation produced a little worse biomechanical lateral bending stability and a little better biomechanical rotatory stability than Germany AESCULAP AAE hanger fixation.

Objective To study the risk factors of MRI for the prediction of collapse in patients with avascular necrosis of the femoral head.Methods Twenty-two patients (39 hips) diagnosed avascular necrosis of femoral head by MR were enrolled in our study.The following MR appearances were evaluated:bone marrow edema,joint fluids,signal intensity and location of the lesion.The volume and surface area of the necrosis zone were calculated.The time of follow-up was 18-84 months (median,25 months).Logistic regression analysis was used to predict the risk factors by SPSS 13.0.The maximum value of Youden index was selected as the critical point to predict the collapse of femoral head and to define the sensitivity,specificity and accuracy.Results In the 39 hips with femoral head necrosis,21 hips had collapse.Bilateral collapse occurred in 5 cases.In 25 hips with the necrosis surface larger than 25％,collapse occurred in 21 (84％); In 8 hips with the volume of femoral head necrosis larger than 30％,collapse occurred in all cases; 1n 33 hips with the necrosis locating at the superolateral quadrant,collapse occurred in 21 (63.6％); In 22 hips with necrotic areas showing heterogeneous signal intensity,collapse occurred in 18(81.8％) ;In 25 hips with large amount of joint effusion,collapse occurred in 16 (64％) ;in 18 hips with bone marrow edema,collapse occurred in 13 (65％).Joint fluid,heterogeneous signal intensity and lesions in the superolateral quadrant,volume ratio,and area ratio were the high risk factors,while bone marrow edema was a relatively low risk factor.The area under ROC curves for area ratio of NASA was greater than that for volume ratio (0.987 vs 0.902).When the critical value for area ratio was 26.7％,the true positive rate was 95.2％,true negative rate was 94.4％,and Youden's index was 0.896.Conclusions The collapse of necrosis of femoral head may result from many factors.The femoral head was easy to collapse when it had large enough area of necrosis and mixed signal intensity,a large amount of joint effusion,bone marrow edema,and superolateral quadrant location.The critical value for area ratio to predict the collapse of femoral head was about 26.7％.The area ratio is more accurate than volume ratio in predicting the collapse of necrosis of femoral head.

Objective To systematically review the safety and effectiveness of 6% hydroxyethyl starch (HES) 130/0.4 and crystalloid solution for the patients undergoing elective surgery .Methods We searched the Medline , EMBASE , CENTRAL , CNKI and Wanfang databases for randomized controlled trials involving comparison of the safety and effectiveness of 6% HES 130/0.4 and crystalloid solution for the patients undergoing elective surgery . The major evaluation indexes included intraoperative blood loss , postoperative incidence of dialysis and intraoperative incidence of hypotension . The secondary evaluation indexes included mortality , perioperative incidence of nausea and vomiting , coagulation function , renal function and incidence of adverse events .The two reviewers independently screened ,evaluated and extracted the data .Meta-analysis was performed using the Cochrane Collaboration’s RevMan 5.2 software .Results Ten trials involving 693 patients were included in our meta-analysis .Eight trials were in English and 2 trials were in Chinese .Comparison of the safety and effectiveness of 6% HES 130/0.4 and balanced solution was conducted in 7 trials (498 patients in total) ,and the results showed that 6% HES 130/0.4 reduced the intraoperative incidence of hypotension (OR 0.31 ,95% CI 0.13-0.75 ) and perioperative incidence of nausea and vomiting , (OR 0.08 , 95% CI 0.01 to 0.67 ) in the patients undergoing spinal anesthesia ( P< 0.05 );there was no significant difference in the intraoperative incidence of hypotension ,perioperative incidence of nausea and vomiting ,mortality ,and intraoperative blood loss under general anesthesia or combined spinal-epidural anesthesia between the two solution groups ( P> 0.05 );heterogeneity was found in the urine output under general anesthesia ( P<0.000 01 ,I2 =93% ) .The safety and effectiveness were compared between 6% HES 130/0.4 and normal saline in 3 trials (195 patients in total) and the results showed that there was no significant difference in the intraoperative blood loss ,intraoperative incidence of hypotension ,perioperative incidence of nausea and vomiting ,coagulation function ,renal function ,and incidence of adverse events between the two solution groups ( P> 0.05 ) .Conclusion 6% HES 130/0.4 is safe and effective when applied for the patients undergoing elective surgery .

Objective To investigate the relationship between serum lipid and bone mineral density in post-menopausal women.Methods Bone mineral density(BDM)was measured at a variety of skeletal sites,including lumbar spine 2(L2),3(L3),4(L4)2~4(L2~L4),femoral neck(Neck),trochanter(Troch),Ward's triangle,using the Norland XR-36 dual-energy X-ray absorptiometer in northern Chinese healthy population-based sample of 60 post-menopausal women from 2002 to 2006 in our hospital.Serum lipid profiles of total cholesterol(TC),low-density lipoprotein(LDL),Triglyceride(TG)and high-density lipoprotein(HDL)were examined.Results HDL-C correlated inversely with BMD in both lumbar spine(P

Objective To compare in-vitro percutaneous absorption and pharmacodynamic actions of anti-inflammation and inhibiting delayed-type hypersensitivity of Chinese herbal compound cremor for eczema (CHCCE) with different mass concentrations of synthetic borneol. Methods By adopting modified Franz diffusion device add with isolated BALB/cnude mice skin as a barrier, in vitro percutaneous absorption effectiveness of CHCCE with different mass concentrations of borneol was compared by in vitro percutaneous test after the content of matrine was determined with high performance liquid chromatography(HPLC). Meanwhile, the effects of CHCCE with different mass concentrations of synthetic borneol on reducing dimethylbenzene-induced auricular edema and suppressing delayed-type hypersensitivity induced by 2,4-dinitrochlorobenzene(DNCB) in mice were compared. Results Cumulative permeation amount of matrine in CHCCE with synthetic borneol was higher than that in CHCCE without synthetic borneol 2～ 48 h after administration (P < 0.05). There was no significant difference of cumulative permeation amount (P>0.05) among CHCCE groups with different mass concentrations of synthetic borneol after 48 h. In vitro percutaneous absorption behavior of matrine arrived to the steady state and the cumulative permeation amount of matrine presented a decreasing trend in all medication groups 12 h after administration. Within 12 h of the medication, the permeation rate of CHCCE with different mass concentrations of borneol was in the sequence of 3％ borneol > 1％ borneol > 2％ borneol > 0.5％ borneol > no borneol. The content of matrine was decreased with the increase of mass concentration of synthetic borneol after 12 h. The results of pharmacodynamic actions of CHCCE showed that compared with the blank control group, CHCCE with 1％, 3％ synthetic borneol could significantly suppress the acute inflammation induced by dimethylbenzene and inhibit contact dermatitis induced by dinitrochlorobenzene (DNCB) in mice(P < 0.05). Compared with Triamcinolone Acetonide Acetate and Miconazole Nitrate and Neomycin Sulfate Cream, CHCCE with 1％, 3％synthetic borneol could decrease the serum level of IL-4, but the difference was insignificant(P>0.05). Conclusion CHCCE with 1％ synthetic borneol has good effects on in vitro transdermal absorption, and can suppress inflammation and delayed-type hypersensitivity effectively.

Objective To explore the relationship between acceptance of disability and hope level in patients with total laryngectomy.Methods Totally 84 patients with total laryngectomy were recruited and investigated with the general information questionnaire,Acceptance of Disability Scale (ADS)and Herth Hope Index (HHI).Results The total score of ADS was (85.82±12.64),which showed medium level acceptance of disability.The total score of Herth Hope Index (HHI) was (35.50±8.12),which showed high level HHI.Significantly positive correlation was found between acceptance of disability and HHI.Conclusions Nurses should pay more attention to the acceptance of disability in patients with total laryngectomy,and provide effective psychological intervention to improve the patients' menial health and quality of life.

Objective To discuss the concrete method and clinical effects of the wound refers to multiple fingers and fingerweb.Methods Twenty-six patients were used four different flaps to repair the wound refers to multiple fingers and fingerweb.Dorsalis pedis flap in 18 cases,2 cases were distal dorsal foot flap,anterolateral thigh flap,3 cases,toe web flap,4 cases,dorsal carpal branch of ulnar artery flap,1 case in this group.Results All of 25 flaps survived,the distal part of 1 case got necrosis and use skin grafting to treat.6 cases of dorsal foot flap and 1 case of anterolateral thigh flap use the operation of spliting fingers and finger web deepen operation.Conclusion According to the specific injury of the patients' hands refers fingerweb,using the suitable flap to repair the wound,can make a satisfactory results in the appearance and function of patients' hands.

Objective To explore the efficacy difference of biliary stent combined with 125I seed intracavity irradiation and palliative biliary drainage in the treatment of obstructive jaundice caused by pancreatic head cancer. Methods The clinic date of 95 patients with pancreatic head cancer who underwent palliative surgery from June 2010 to June 2015 were analyzed retrospectively. 46 of the cases were treated with percutaneous biliary metal stent implantation combined with 125I seed intracavity irradiation (stent group), and the other 49 cases were treated with palliative biliary enterostomy (surgery group). The levels of jaundice, liver function, tumor size, survival time and hospitalization cost were compared between the patients before and after treatment. Paired t-test was applied for statistical analysis. Results Both the two treatment coulel effectively relieve jaundice and improve liver function. The mean TBIL of surgery group and stent group was (29.4±9.6) and (21.0±8.0)μmol/L after three months treanment, (40.3±11.0) and (24.4±9.6)μmol/L after six months treatment, respectively. Tumor maximum diameter of the two groups were (37.9 ± 4.5) mm and (33.5 ± 6.0)mm after three months treatment, (45.9 ± 5.0) mm and (37.0 ± 6.5) mm after six months, respectively. Each time point between them had statistical significance (t=-4.235,-5.476,-3.654,-6.702, P<0.05). The mean survival time was (12.83 ± 0.80) months in the stent group and (9.06±0.49) months in the surgery group, the difference was statistically significant (t=-3.49, P<0.01). The mean hospitalization cost of the stent group was (38 453.0 ± 7 282.0) yuan and the surgery group was (43 057.0 ± 7 667.4) yuan, the difference was statistically significant (t= 2.759, P<0.05). Conclusion For inoperable pancreatic head cancer patients, compared with palliative biliary enteric drainage, percutaneous biliary stent placement combined with 125I seed intracavity irradiation can effectively relieve biliary obstruction, improve liver function, inhibit tumor growth and prolong survival time.

Objective To provide the utilization information of drugs in Chongqing ,which has been analyzed the statistical data from 18 Chongqing medical organizations'sales volume from 2005 to 2007. Methods We have investigated and graded the sum of the drug purchasing money,the significant medical varieties,and the pharmaceutical manufactories to analyze the latest situation during this three years. Results According to the analysis,the sales number was increasing at a rate of about 20% per year. Water,heat and balance of electrolyte were the most positive rate increased (106.85%). However,the vitamin sell was the negative one dropping down at the rate of 10.47%. In addition,there was only three pharmaceutical companies in Chongqing ranked top 100. Conclusion To predict the future of the drug purchasing money will still rise successively. Nevertheless,it is influenced by rectifying the domestic medicine market so that Chongqing pharmaceutical enterprises are developing slowly without new varieties of drugs being produced.