OBJECTIVETo discuss the effect of surgical staging and using craft bone with vancomycin for the treatment of calcaneal fractures.

METHODSFrom January 2006 to December 2012,13 patients with open calcaneal fractures were treated including 9 males and 4 females with an average of 35.2 years old ranging from 23 to 66. All cases were emergency cases. According to Sanders classification of calcaneal fractures, 2 cases were type II, 7 cases were type III, 4 cases were type IV. According to Gustilo-Anderson soft tissue injury classification, 8 cases were type II, 2 cases were type III A, 2 cases were type III B, 1 case were type III C. Firstly a thorough debridement or VSD procedures were applied,secondly calcaneal fracture were treated with open reduction, plate fixation and bone graft complex with antibiotics. Based on clinical examination, radiographic evaluation, and American Foot and Ankle Surgery Society (AOFAS), ankle function were evaluated after operation.

RESULTSOpen wounds were headed after dressing and repairing,, lateral calcaneal wound were healed during the first period. All patients were followed up for 6 to 36 months (means 14.5 months). Fracture healing time was 14 to 20 weeks (means 16.2 weeks). Last follow-up AOFAS ankle-hindfoot score was (80.0 +/- 7.4) ranging from 55 to 95.

CONCLUSIONFor patients with open fractures, through reasonable clinical evaluation, staging operation, using bone graft with antibiotics can reduce the incidence of postoperative wound infection and promote fracture healing.

Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; Bone Transplantation ; methods ; Calcaneus ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged

Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.

Background and purpose:The application of intensity-modulated radiotherapy (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly, which changed the predictive value of T classiifca-tions of TNM staging system. This study aimed to validate the predictive effect of T classiifcations in the 7th Union for International Cancer Control (UICC) staging system and discuss the simpliifcation of T classiifcations.Methods:We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classiifcations by Kaplan-Meier method and Cox regression model.Results:The 5-year overall survival (OS), local relapse-free survival (LRFS), progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%, 88.5%, 78% and 87.1%, respectively. The 5-year OS of T1, T2, T3 and T4 categories were 91.6%, 85.3%, 90.1% and 76.5%, respectively; LRFS were 93%, 85.3%, 91.5% and 84.4%; PFS were 88.2%, 77.3%, 80.8% and 70.9%; DMFS were 95.1%, 88.9%, 88.2% and 81.3%, respectively. The difference in survival curves between T1, T2 and T3 were not signiifcant (P>0.05). However, several prognostic indexes were signiifcantly different between T4 and T1, T2, T3. We merged the T1, T2 and T3 classiifcations as new T1, and the T4 classiifcation as new T2. The 5-year OS of new T1 and T2 were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simpliifed T classiifcations had obvious advantages when separately analyzed in different N stages.Conclusion:In the era of IMRT, the predictive effect of T classiifcations of the 7th UICC staging system has diminished. The simpliifcation of T classiifcations can ift with the new treatment and provide a better surviv-al prediction.

OBJECTIVETo investigate clinical and molecule genetics features of four Ph-positive leukemia patients characterized by pericentric inv(9)(p22q34) with the der(9)t(9;22)(q34;q11).

METHODSCytogenetic analysis was carried out on bone marrow directly or after short-period culture. R banding was used for karyotype analysis. BCR/ABL fusion gene was detected with interphase fluorescence in situ hybridization (FISH), and chromosome painting was carried out using specific probes. RT-PCR was used to detect BCR/ABL chimeric transcripts.

RESULTSOne patient with acute myeloid leukemia (AML) presented three clones, which included one with a normal karyotype, one with t(9;22)(q34;q11), and one with inv(9)(p22q34) involving the der(9)t(9;22) and additional t(8;12)(q12;p11). The inv(9)(p22q34) has always co-occurred with der(9)t(9;22)(q34;q11) accompanied by der(22)t(9;22)(q34;q11) in all metaphases from the three patients with chronic myeloid leukemia (CML). B3a2 transcript was detected in all patients by RT-PCR. Inv(9)(p22q34) was found in both CML and AML, and was associated with poor prognosis.

CONCLUSIONInv(9)(p22q34) is a novel, rare, but recurrent secondary chromosomal abnormality for Ph-positive leukemia. Leukemia with der(9)t(9;22) and inv(9)(p22q34) has unique clinical and laboratory characteristics.

Adult ; Chromosome Inversion ; Chromosomes, Human, Pair 22 ; Chromosomes, Human, Pair 9 ; Female ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; genetics ; Leukemia, Myeloid, Acute ; genetics ; Male ; Middle Aged ; Translocation, Genetic

OBJECTIVETo reveal the mechanism of moxibustion preconditioning in preventive brain-protecting action.

METHODSThe rat model of global brain ischemia was made with 4-artery ligation method. 78 Wistar rats were randomly divided into 5 groups: normal control group, sham-operation group, brain ischemia group, brain ischemia preconditioning group and moxibustion preconditioning group. The brain was taken 24 h, 48 h and 72 h after operation in the all groups, respectively, for determination of SOD activities by xanthine oxidase method and MDA content by thibabituric acid method.

RESULTSThe SOD activity significantly increased, especially 24 h after the moxibustion preconditioning, and the MDA content decreased significantly with a very significant difference as compared with the ischemia group(P<0.01).

CONCLUSIONMoxibustion preconditioning exerts the protective action on the brain tissue of ischemia and anoxia through increasing the endogenous anti-oxidase activity.

Animals ; Brain ; Brain Ischemia ; Ischemia ; Moxibustion ; Rats ; Rats, Wistar

OBJECTIVETo assess the association of the A260G and A386G single nucleotide polymorphisms (SNP) of the DAZL gene with male infertility in the Chinese population of Zhejiang Province.

METHODSWe collected the peripheral blood samples from 317 idiopathic infertile males with azoospermia or oligozoospermia and 246 normal fertile men, and genotyped the polymorphic loci of the A260G and A386G polymorphisms of the DAZL gene using the SNaPshot technique.

RESULTSThe DAZL gene A260G was found genetically polymorphic in the Chinese population of Zhejiang Province, with the gene frequencies and their distribution consistent to the Hardy-Weinberg equilibrium. The frequencies of the AA, AG and GG genotypes of the A260G polymorphism were 92.3%, 7.3%, and 0.4% respectively in the normal controls and 94.3%, 5.7%, and 0% in the infertile patients, with no statistically significant differences between the two groups (P = 0.43, OR = 0.78, 95% CI 0.413-1.46). Heterozygosis (AG) of A386G was found in 1 of the control males but not in the infertile patients, while homozygosis (GG) of A386G was not observed in either group (P = 0.259, OR = 0.698, 59% CI: 0.374-1.306).

CONCLUSIONA260G and A386G SNPs of the DAZL gene are not associated with spermatogenic failure and neither represents a molecular marker for the genetic diagnosis of male infertility in the Chinese population of Zhejiang Province.

Asian Continental Ancestry Group ; Azoospermia ; genetics ; China ; Gene Frequency ; Genetic Markers ; Genotype ; Humans ; Infertility, Male ; genetics ; Male ; Oligospermia ; genetics ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; RNA-Binding Proteins ; genetics

"Treatment for before sick" is a theory of TCM, reflecting preventing thought of "prevention being better than cure" and "nipping in the bud", while "moxibustion treatment for before sick" is highly praised by doctors of past ages. Moxibustion can activate human vital-qi and increase immunologic function of the organism, playing a preventive role for before sick, which is similar to the essence of "ischemic preconditioning" raised in recent years. Because of convenient manipulation, no adverse effect, it has very important position in the field of preventive medicine.
Acupuncture Points ; Humans ; Ischemic Preconditioning ; Moxibustion ; methods ; Preventive Medicine

Objective To investigate the mercury exposure level in cord blood of neonatal in Zhoushan Islands and to analyze the related factors,in order to provide scientific basis for relevant prevention and control measures.Methods From June 201 2 to July 201 3,peripheral blood and umbilical cord blood samples were collected in local women who delivered their babies in Zhoushan Islands.Questionnaire survey and mercury exposure test were performed.Results 3 052 maternal blood and neonatal umbilical cord blood samples were tested,and the mean,median,P25 and P75 of the maternal blood mercury were 5.33 ±3.69,4.63,2.8 and 8.2 μg/kg respectively.And the mean,median,P25 and P75 of the cord blood mercury were 7.72 ±4.87,7.31 ,4.7 and 1 1 .2 μg/kg.Single factor analysis showed that the neonatal umbilical cord blood mercury levels were associated the intake of pan -fried mackerel during pregnancy (OR =1 .79,P <0.01 ).No association was found with the sex of newborn,the intake of iron,calcium,and vitamin during pregnancy,the number of mending tooth,the use of whitening cosmetics,the intake of fish and seafood,father's smoking,the average family income and residence time.Multivariate Logistic regression analysis showed that the neonatal umbilical cord blood mercury levels were associated the intake of pan -fried mackerel during pregnancy (OR =1 .96,P <0.01 ).Conclusion Mercury levels in cord blood in Zhoushan area are detected at a high level;the intake of pan -fried mackerel could be one of the major sources of mercury accumulation in neonates.There is an association between the mercury levels of maternal blood and neonatal umbilical cord blood.

This study is to report the effect of OATP1B1 gene mutation in the 521T --> C in Chinese human on the pharmacokinetics of rosuvastatin and guide the reasonable clinical application of rosuvastatin by the feature of genetic polymorphism of OATP1B1. Plasma samples were determined with LC-MS: the analyte and internal standard pitavastatin were both analyzed by MS in the ESI, m/z was 480.0 for rosuvastatin and 420.0 for the IS, separately. Genotyping of OATP1B1 was determined with the method of polymerase chain reaction--amplification refractory mutation system targeted at 40 healthy volunteers and showed that there were 7 subjects with 521T --> C mutant, accounting to 17.5% of total and wild type homozygote accounted to 82.5%. It was found that there were significant differences between OATP1B1 mutation in the 521T --> C and wild type homozygote for rosuvastatin pharmacokinetic process in Chinese human. In contrast to OATP1B1 wild type group, OATP1B1 mutation group's absorption degree increased, elimination process decreased. The OATP1B1 mutation should be noted for guiding the reasonable application of rosuvastatin during its clinical use.
Asian Continental Ancestry Group ; genetics ; Exons ; Fluorobenzenes ; blood ; pharmacokinetics ; Genotype ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; blood ; pharmacokinetics ; Male ; Organic Anion Transporters ; genetics ; Point Mutation ; Polymorphism, Single Nucleotide ; Pyrimidines ; blood ; pharmacokinetics ; Rosuvastatin Calcium ; Solute Carrier Organic Anion Transporter Family Member 1b1 ; Sulfonamides ; blood ; pharmacokinetics

OBJECTIVETo explore therapeutic effects of emergency medial malleolus osteotomy for the treatment of fractures of talar neck and dislocation of talar body.

METHODSFrom 1995. 6 to 2007. 10, among 24 patients with fractures of talar neck and dislocation of talar body, 18 patients were male and 6 patients were female, ranging in age from 28 to 58 years (mean 35.4 years). The duration from injury to the emergency ward ranged from 0.5 to 12 h. All the patients were treated in 5 hours after hospitalization with emergency medial malleolus osteotomy and internal fixation. Firstly, osteotomy was made above the medial malleolus tip; Secondly, the medial malleolus was turned over downward to uncover the talus; Then, the fracture of talus can be reduced in direct visidn.

RESULTSAll the patients were followed up ranged from 6 to 60 months. According to Kenwright evaluation standards, 18 patients obtained an excellent results, 4 good and 2 fair.

CONCLUSIONIt is easy and clearly to perform medial malleolus osteotomy. The blood circulation of talus is preserved. So it is an effective method to treat the fractures of talar neck and dislocation of talar body.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Osteotomy ; methods ; Talus ; injuries ; surgery ; Treatment Outcome