Objective:In order to provide a new area of bone flap were supplied for non-unions, osseous defect of upper limbs and chondral defect of elbow joint.Methods:The origin,course,distribu- tion and anastomosis of inferior ulnal collateral artery and ulnal recurrent artery were observed on 40 adult cadaver upper limbs.Based on the results,transposition of pedicled medial lower part of humerus bone flap with vessels was designed.Results:Satisfactary results were achieved in 9 case of patients (non-unions of 3 case and osseous defect of 2 case on medial part of humerus bone;non-unions of 3 case on medial upper part of ulna and radius;chondral defect of 1 case on elbow joint.)Conclusion:This pe- riosteal flap that there are constant vessels and abundant anastomosis with inferior ulnar collateral artery form many area of bone flap were supplied with blood supply for repairing the non-unions,os- seous defect of humerus,ulna,radius and chondral defect of elbow joint.

Objective To test the expression of HGF and its receptor c-met and to evaluate their relationship to lymphangiogenesis in NSCLC. Methods Immunohistochemical study was used to determine the lymphatic microvessel density (LMVD) and the expression of HGF and its receptor c-met in 113 patients with NSCLC and 20 normal lung tissue samples.Results The levels of expression of HGF (67.3 %) and c-met (74.3 %) in NSCLC tissues were significantly higher than that in normal lung tissues (20.0 %, 25.0 %respectively), (u=4.008, 4.342; both P ＜0.05).The expressions of HGF and c-met in NSCLC tissues had no correlation to age, gender, tumor size and differentiation grade.However, the expression of HGF and c-met was positively correlated to TNM stage and lymph node metastasis.In NSCLC samples, HGF and c-met were significantly associated with LMVD contrast to normal sample (HGF: 16.3051±5.3753 vs 10.9934±4.9668,t =4.58; c-met: 15.6692±5.5386 vs 11.3700±5.3875, t =3.97, both P ＜ 0.05).Conclusion The high expression of HGF and its receptor c-met is closely correlated with LMVD and metastasis of lymph nodes, which indicates that HGF and c-met may play an important role in lymphangiogenesis and lymphatic metastasis in NSCLC.

Objective To research the incidence and etiological factors of intraocular pressure(IOP)elevation in patients in early and late postop?erative stages after vitrectomy. Methods The clinical data of 235 cases(306 eyes)who underwent vitrectomy in our hospital were respectively ana?lyzed. IOP was measured before operation,in the early postoperative stage(within 2 weeks)and in the late postoperative stage(6 months after opera?tion or longer)by non?contact tonometer. Risk factors related with ocular hypertension happened in the early and late postoperative stages were statis?tically analyzed. Results The mean average IOP before operation was 15.3 ± 4.1 mmHg for the 306 eyes. Within the follow?up period of 6?20 months(mean,14.3 months),ocular hypertension occurred in 42 eyes[incidence,13.7%;mean,31.9 ± 6.0 mmHg]in the early postoperative stage and in 12 eyes[incidence,3.9%;mean,32.1 ± 5.7 mmHg]in the late postoperative stage. Logistic regression analysis revealed that lensecto?my,scleral buckling,cyclophotocoagulation,inert gas filling,silicone oil tamponade and diabetic retinopathy were the independent risk factors of oc?ular hypertension in early postoperative stage after vitrectomy,while lensectomy,scleral buckling,pan retinal photocoagulation,silicone oil tampon?ade,diabetic retinopathy and carotid artery stenosis were the independent risk factors of ocular hypertension in late postoperative stage after vitrecto?my. In addition,cyclophotocoagulation was a protective factor of IOP in the late postoperative stage. Conclusion The risk factors of ocular hyperten?sion after vitrectomy include the intraocular gapfiller,the mode of combined operation,disease type and carotid artery stenosis. IOP elevation that happens in the late postoperative stage is more harmful. Ocular hypertension in the late postoperative stage is not associated with that in the early stage.

Objective To investigate the diagnostic value of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy and small bowel follow through (SBFT) for small bowel Crohn's disease (CD). Methods Fifty-seven consecutive patients with CD underwent ileocolonoscopy, CTE, CE, and SBFT. It included the presence of the following symptoms and signs: abdominal pain, weight loss,diarrhea, fever and positive fecal occult blood test. The location and the characteristics of intestinal and extra-intestinal lesions detected by four techniquks were compared. The proportions of patients with positive findings using each examination were compared. Results Of the 57 patients, 50 underwent ileocolonoscopy, terminal ileum lesion was found in 33 patients (66. 00% ), the remaining 17 (34.0%)were normal; among 34 patients who had CTE, 29 of small bowel lesion were found (85. 29% ); CE were performed in 27 patients, due to prolonged gastric transit one time, the capsule did not reach the cecum in one patient during battery lifetime. CE showed small bowel lesion in 26 patients (96.30% ); SBF was performed in 39 patients and 26 of small bowel lesion were detected (66. 67% ). CE had the highest diagnostic yield for CD and ileocolonoscopy had the lowest, and there were statistically significant difference among the 4 examinations (P = 0. 006 ). The combinded positive rates of two methods were: CE + CTE 92. 86% (13/14), SBFT + CTE 90. 91% (20/22), CE + ileocolonoscopy 95. 65% (22/23), CE + SBFT100% (17/17), ileocolonoscopy + CTE 89. 66% ( 26/29 ), ileocolonoscopy + SBFT 77.78% ( 28/36 ), but there were no significant differences between each two examinations. Conclusion CE, CTE have a higher yield in depicting mild to moderate finding of CD than SBFT. CE is better for assessing early mucosal disease,whereas CTE is better for detecting transmural and extraluminal abnormalities. Most important, CE plus CTE may depict nonobstructive CD of the small bowel when conventional techniques such as ileocolonoscopy or SBFF have negative or inconclusive finding. CE provides us explanations for the symptoms of patients, decision to follow up or therapy.

As a heteronomy,the code of medical ethics plays an important role in sustaining the trust between physicians and patients.Based on a comparative analysis of the domestic and foreign codes of medical ethics,and field survey on such trust at tertiary hospitals in Beijing,as well as medical providers’moral characteristics,this article analyzed the causes that “goodwill”is insufficient in the trust in terms of internal and external factors;and then,in respect of heteronomy as a basis,it put forward suggestions to improve code of medical ethics in order to rebuild such trust.

Physician-patient trust is the basis of informed consent,and the informed consent institution is supposed to strengthen the trust.However,it affects trust in an opposite way in practice. This research aimed to analyze the relationship between informed consent and physician-patient trust,and provide with the advice,recommending on such rebuilding.

The study found that the physician-patient trust crisis results from overreliance on technology trust instead of interpersonal trust and institutional trust. The alleged “Paternalistic government innovation”in healthcare service has caused wastes of healthcare resources and gap below public expectancy due to its incompetence in resolving social problems,further eroding institutional legality and intensifying such crisis.This research aimed to identify government accountabilities in building such trust from three aspects.

Objective To investigate the expression of inducible co-stimulator (ICOS) and inducible co-stimulator ligand (ICOSL) on PBMCs,and the plasma concentrations of soluble forms of ICOSL and their clinical relationship with systemic lupus erythematosus (SLE) patients.Methods Peripheral blood samples were collected from 45 SLE patients and 39 healthy subjects (HC).The expressions of ICOS and ICOSL on peripheral blood mononuclear cells (PBMCs) were detected by flow cytometry.The concentrations of soluble ICOSL were assessed by measured by enzyme linked immunosorbent assay (ELISA).And the relationship between their expression levels and patients' clinical manifestations were analyzed.Levene F test was used for statistical analysis,the comparison between groups was conducted using t test,and the correlation between two variables were tested by Pearson correlation analysis.Results The expression of ICOS on CD4+ and CD8+ T cells were significantly higher than that of the HC [(19.1±1.7)％ vs (14.0±1.5)％,t=2.156,P=0.035],[(10.0± 1.0)％ vs (6.4±1.0)％,t=2.587,P=0.012].The expression of ICOSL on CD14+ mononuclear cells in SLE patients was significantly higher than that in the HC group [(2.94±0.88)％ vs (0.89 ±0.21)％,t=2.152,P=0.04].Plasma ICOSL concentrations in patients with active SLE were significantly higher than those of patients with inactive SLE [(362±25) ng/ml vs (278±15) ng/ml,t=2.356,P=0.025].We also found a significant negative correlation between the soluble ICOSL expression and the surface ICOSL expression on both mononuclear cells and B cells (r=-0.4243,P=0.022;r=-0.4099,P=0.025).MMPI induced an evident reduction in sICOSL levels released from the cells,which was statistically significant in comparison with untreated cells (P＜0.05).Conclusion The up-regulated expressions of ICOS and ICOSL on peripheral lymphocytes and the high levels of plasma concentration of soluble ICOSL are closely correlated with the severity of the disease,suggesting that ICOS/ICOSL pathway may play a critical role in the pathogenesis of SLE.

ObjectiveTo investigate the variation of peripheral blood CD34+ cells during the hematopoietic stem cell mobilization,and its influence on the collecting timing and results.Methods Twenty-seven cases of peripheral blood hematopoietic stem cell mobilization and collection from April 2010 to December 2011 were analyzed,including 13 autologous cases mobilized with chemotherapy combined with granulocyte colony-stimulating factor (G-CSF,10 μg· kg-1 · d-1) and 14 cases of healthy donors mobilized with only G-SCF (7.5 μg · kg- 1 · d- 1 ).The number of peripheral blood CD34+ cells was counted,and its correlation with the yield of mononuclear cells (MNCs) and CD34+cells was analyzed.ResultsMNCs (5.84 ± 1.48) × 108/kg and CD34+ cells (3.93 ± 2.16) × 106/kg were obtained in healthy donors,and (6.58 ± 3.72) × 108/kg MNCs and (3.98 ± 3.06) × 106/kg CD34+ cells were obtained in autologous cases,respectively.There was only 1 failure in autologous cases.The peak of peripheral blood CD34+ cells in autologous cases appeared at day 4 after the treatment of G-CSF,and in healthy donors the number of peripheral blood CD34+ cells at day 5 was still in ascendant phase.The CD34+ cells/kg in the collection products were positively correlated with the percentage and absolute value of peripheral blood CD34+ cells.The cases ratio of CD34+ cells≥2× 106/kg in the products of single collection was up to 76.2％ (16/21) in the cases with peripheral blood CD34+ cells absolute value greater than 20/μl.ConclusionThe number of peripheral blood CD34+ cells was an important monitoring indicator in hematopoietic stem cell mobilization and collection,CD34+ cell absolute value ≥20/μl could be used as collection threshold.

Objective: To investigate the clinicopathologic features, molecular characteristics and prognosis of spread through air space (STAS) in patients with adenocarcinoma of the lung. Methods: Two hundred and eighty-eight lung adenocarcinoma patients with complete clinicopathologic and follow-up data were included. The patients were divided into STAS positive (178 cases) and negative (110 cases) groups.EGFR and KRAS gene mutations were detected by amplification refractory mutation system (ARMS), and ALK and ROS1 gene fusion were detected by fluorescence in situ hybridization method. The relationship between STAS and clinicopathologic, molecular features, and patient outcome was analyzed. Results: STAS was present in 61.8%(178/288) of lung adenocarcinomas. The positive rate of STAS in tumors >3 cm was significantly higher than that in tumors ≤3 cm (P=0.009), and was significantly higher in tumors with pleural invasion (P<0.01), venous invasion (P<0.01), lymphatic invasion (P<0.01), perineural invasion (P=0.029) and tumors with necrosis (P<0.01). STAS was also correlated with tumor recurrence (P<0.01) and advanced pathologic TNM stage (P=0.002). There was no significant correlation with patients′ gender, age and smoking history. Histologically, STAS was present in 58.0%(91/157), 67.6%(50/74), 2/6, 64.3%(27/42) and 8/9 of acinar, papillary, lepidic, solid and micropapillary adenocarcinomas, respectively. In addition, the positive rates of STAS in tumor with micropapillary (>5%) and without micropapillary pattern were 80.9%(55/68) and 55.9%(123/220), respectively (P<0.01). STAS was significantly higher in EGFR negative group (P=0.034), ALK gene rearrangement group (P=0.003) and ROS1 gene rearrangement group (P=0.012), but there was no significant correlation with KRAS mutation. Univariate survival analysis showed that patients with STAS had a shorter progression-free survival (PFS, P<0.01) and overall survival (P=0.013). Multivariate analysis confirmed that STAS was an independent predictor of PFS in lung adenocarcinoma patients (HR: 2.749, 95%CI: 1.550-4.876, P=0.001). Conclusions The presence of STAS in lung adenocarcinoma suggests high risk of recurrence and invasion and is thus an important prognostic factor. In addition, STAS is associated with EGFR mutation, ALK and ROS1 gene rearrangement.