BACKGROUND: Hand metacarpophalangeal and interphalangeal joint defects caused by trauma, infection, tumor excision or congenital disease seriously affect hand function and contour. At present, there are many methods for the repair of hand bone or joint damage, but none of them can effectively reconstruct the joint anatomic structure and function to restore the normal activity function of joints. OBJECTIVE: To summarize the domestic and foreign researches on the reconstruction of injured hand bone or joint, and to explore the research status and progress of each method in recent years. RETRIEVAL STRATEGY: A computer-based online search of PubMed was undertaken to identify the English articles dated from January 1980 to August 2007 with the keywords "hand, bone and joint injury". In addition, we searched China Periodical Full-text Database, Wanfang Database, and VIP database for the related articles published in Chinese between January 1997 and August 2007-08 with the keywords "hand, bone and joint damage, treatment" in Chinese. We also manually searched the related books. Finally, 62 articles were collected. After the first trial, only articles closely correlated with treatment of hand joint damage, and published in the near future or in the authoritative journals were selected. Duplicated researches were excluded. LITERATURE EVALUATION: The articles mainly discussed the research progress in joint damage treatment. Of the 30 selected articles, 5 were review articles, and the others were clinical or basic experimental studies. DATA SYNTHESIS: Now, there are many methods for treating hand joint damage such as fusion of joint, arthroplasty, prosthetic replacement, joint transplantation, cartilage transplantation, cell transplantation, and tissue engineering technique. How to integrate the advantages of each therapy to explore more fast, effective, and low damage treatment methods has become the hot spot in present studies. CONCLUSION: Although the joint reconstruction in hand with bone or joint defects has made a great progress, it still needs further improvement in clinic. To explore fast, highly effective, and low damage treatment method is a hot spot in recent researches.

The pharmacokinetics of alprazolam in 18 rats was studied by using reversed-phase HPLC. The pharmacokinetic characteristics were fit to one compartment opened model after intragastric administration of alprazolam at doses of 50,20 and 2 mg ? kg-1, respectively. The absorbing and eliminating parameters between the three groups were no significant difference. Mean of Ka was 3. 3454 h-1,Ke 0. 3873h-1,T1/2Ka 0. 29 h, T1/2Ke 2.61 h, and Tmax 1.04 h. There was a positiverelationship between the serum concentration and dosage (r = 0. 6096, P

To summarize the clinical data of two cases with severe hyponatremia diagnosed as adrenal insuffiency combined with syndrome of inappropriate secret on of antidiuretic hormone(SIADH),and to review related literatures.Case 1 diagnosed as Addison's disease for 27 years and developed severe hyponatremia again but did not response well to sufficient glucocorticoid.Further examination showed SIADH caused by lung cancer and tolvaptan worked well.Case 2 was diagnosed as SIADH caused by lung cancer and responsed well to tolvaptan.However,hyponatremia reoccurred with the decreasing level of ACTH and cortisol during the chemotherapy.It was thought that hyponatremia was caused by drug-related adrenal insuffiency and glucocorticoid replacement therapy achieved good response.Both primary/secondary adrenal insuffiency and SIADH can lead to severe hyponatremia,but it is rare that the two situations exist in one patient and occur in different time.We should consider the possibility of the situations when we make differential diagnosis of refractory hyponatremia,monitoring the curative effects carefully,then correct the diagnosis timely,and reduce missed diagnosis and misdiagnosis.

Diabetes insipidus ( DI) could lead to urinary tract dilatation, even renal dysfunction. This study compared clinical features of DI with or without urinary tract dilatation. The results showed that the former had earlier onset age, more male patients, longer duration, and higher serum creatinine, as well as lower urine osmotic pressure and urine specific gravity after injection of vasopressin. But only disease duration was the independent risk factor (OR=1. 248). More nephrogenic DI and more hereditary DI were with urinary tract dilatation compared with central DI or acquired DI.

The pharmacokinetics and absolute bioavailability of 1-hexyl-carbamoyl-5-fluorouracil ( HCFU ) (10 mg/kg ) after oral and intravenous administration were studied in 5 dogs with cross-over design. The concentration of HCFU in serum was determined by reversed-phase high performanee liquid chromatography. After intravenous administration, the curve of serum HCFU concentration vs time was fit to a two-compartment opened model and the phar-macokinetic parameters were. T1/2?=1 .67 min, T1/2? = 34.55 min, Vc= 0.2525L/kg,C1 = 0.3205 L/kg?h~-1 & AUCiv =1.9375 mmol/min?L~-1. When HCFU tablets were tiken orally, the curve of concentration vs time was fit to an one-compartment opened model and its pharmacokinetie parameters were: T1/2ke=12.13 min, T1/2ke=38.51 min, Tmax=23.46 min,Cmax=8.140?10~-3mmol/L & AUCpo=1.5856 mmol/min?L~-1 . The absolute bioavailability calculated from AUCpo and AUCiv was 0.8214.

Objective To investigate the clinical characteristics,treatment methods,and clinical outcomes of open injury of foot and ankle in children.Methods From February 2004 to June 2010,35 children with open injury of foot and ankle were treated,including 22 males and 13 females,aged from 3 years to 14 years (average,8.4 years).Twenty-eight cases resulted from traffic accidents; 7 cases occurred from sharp instruments and machine-related crush injuries.Thirty cases were associated with bone fractures,and according to the Gustilo classification of open fractures,five cases were Type Ⅰ injuries,eight cases were Type Ⅱ injuries and 22 cases were Type Ⅲ.Twenty three cases (type Ⅰ,type Ⅱ and type Ⅲ) underwent surgical debridement and/or internal fixation with skin flap grafting.Twelve type Ⅲ cases underwent debridement,temporary Kirschner wire or plaster fixation and VSD in the first stage of treatment.In the second stage of treatment,fracture reduction and internal fixation (with or without bone graft) + skin flap grafting was performed in all 12 cases.Results Thirty patients (85.7％) were followed-up for an average of 38.7months (range,6-89 months).Skin grafting was performed in two Type Ⅱ cases that developed necrosis in parts of the wound.Wound healing time was an average of 8.3 weeks (range,3-15 weeks).One Type Ⅲ case suffered chronic osteomyelitis with the formation of a sinus tract.Two cases suffered from club foot ab normalities 3 years postoperatively.All three patients above mentioned healed after treatment.In 12 type Ⅲpatients with staged treatment,the flap survived,and its color and elasticity were good.Healing time ranged from 3 to 8 weeks (average,6.8 weeks).According to the Maryland standard,17 cases were excellent,9good,3 fair,and 1 bad; the excellent and good rate was 86.7％.Conclusion Traffic accidents are the major causes of open foot and ankle trauma in children.A good surgical outcome can be achieved when patients receive staged treatment that is appropriate to injury severity.

Objective To summarize the curative effect of repairing large area soft tissue defects in heel and crus by flaps with double blood-supply of posterior tibial artery perforators and saphenous nerve nutrient vessels.Methods From January 2006 to February 2012,twenty cases took operation under the guide of Continuous Wave Doppler and design of tibial artery perforator as rotation point.And in all cases,island flaps with the blood supply from saphenous nerve nutrient vessels and tibial artery perforator were retained to repair large area soft tissue defects in heel and crus.In operations,the range of flap area were ranged from 19 cm × 11 cm to 11 cm × 8 cm.Skin flaps incision was up to the patella margin level,low to medial malleolus on edge,former to crus former median line,rear to after crus median line and farthest to the surface of wound on the metatarsophalangeal joint.Results Nineteen cases survived,and 1 case of skin flap mild necrosis at the farthest side took a second-phase line skin flap to repair.Followed-up from 6 months to 24 months was taken in all cases at the mean time of 10 months,with a result of good recovery and no ulceration for the flaps.To varying degree,all flaps recover sense of pain and deep touch.Conclusion There is no wound to posterior main tibial artery in repairing large area soft tissue defects in heel and crus by flaps with double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels,meanwhile to maintain double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels and expand the range of blood supply of posterior tibial artery perforators.In this operation,a blood circulation for the flap can be guaranteed so as for a large wound in heel and crus.

Objective To summarize the clinical characteristics of adrenal tumors combined with renal carcinoma and to extend the clinical understanding of the situation.Methods To analyze the data of 1 100 patients with adrenal tumors hospitalized in Peking University First Hospital from Jan.1994 to Mar.2012 retrospectively,in the series there were 42 combined with renal carcinoma.Results There were 27 males,15 females,aged 29 to 83 years,mean 60.5 years old.In 42 renal carcinomas,there were 29 (69.0％) clear cell carcinomas,5 (11.9 ％) cystic renal carcinomas,2 (4.8％)clear cell with granulosa cell hybrid carcinomas,1 renal lymphoma,1 (2.4％) spindle cell tumor,1 acidophilic cell adenoma,and 1 undifferentiated type of renal cell carcinoma and pathologically not clear in 2 cases (4.8％).Clinical manifestations were not specific.In 42 adrenal tumors,20 situated in the left,and 17 right,and 5 were bilateral.35 cases were considered primary adrenal tumors,in which 3 were diagnosed primary hyperaldosteronism,32 were non-functional tumors.Other 7 were non-functional matastatic carcinomas.25 patients underwent resection of adrenal tumors,and pathology revealed 22 (88.0％) were primary,in which 12 (54.6％) were cortical adenomas,7 (31.9％) hyperplasia,1 (4.5 ％) pheochromocytoma,1 (4.5 ％) ganglioneuroma,1 (4.5 ％)adenoma with hyperplasia;2 (8.0％)metastatic tumors,and 1 (4.0％) non-Hodgkin' s lymphoma.The mean diameter of primary adrenal tumors was 1.9 cm,while that of metastatic carcinoma was 3.84 cm.25 underwent abdominal ultrasonography,40 underwent computed tomography (CT) scan,6 underwent magnetic resonance imaging (MRI) scan,positive rate was 72.0％,97.5％,and 100.0％ respectively.25 patients who underwent surgery were followed up,17 survived for 8 months-6 years,4 died,in which 1 metastatic carcinoma died of intraoperative bleeding,1 died of adrenal lymphoma,2 died because of other disease,4 were lost to follow-up.Conclusions The most common type of renal carcinoma combined with adrenal tumors was clear cell carcinoma,while majority of the adrenal tumors were primary with non-specific clinical manifestations and function.The adrenal tumors might be located in the same or the opposite side of renal carcinoma,also might be bilateral which were more common in metastatic carcinomas and always bigger than primary ones.CT/MRI scans were important in judging the nature of the tumors and pathology was the gold standard.The non-functioning primary adrenal tumors could be safely followed up,and the isolated metastatic carcinoma should be resected.Prognosis depends mainly on that of renal carcinoma.

Objective To elaborate the clinical characteristics of adrenal non-Hodgkin's lymphoma and to expand the clinical thinking of adrenal tumors.Methods Subjects with adrenal tumors and nonHodgkin's lymphomas between January.1994 and December.2012 in Peking University First Hospital retrospectively were included and these with adrenal lymphoma patients were analyzed in the present study.Results Among 1100 adrenal tumors and 1 002 non-hodgkin's lymphomas,21 patients (aged 35 to 80 years,mean 56 years) were diagnosed as having adrenal non-Hodgkin's lymphoma with 14 males and 7 females.Among the 21 patients,15 were with pain on the waist and the back,3 with fever,1 had weight loss.Two patients were diagnosed by regular health examination.Only 2 subjects accompanied by superficial lymph node enlargement,while 10 by abdominal cavity lymph node enlargement.Eleven subjects were with extranodal involvement.Bilateral adrenal were involved in 8 patients with 9 on the left and 4 the right.The average diameter of the masses was 7.2 cm.There were no specific features in conventional imaging such as CT and MRI scan.All of the 21 cases were found normal adrenal function by endocrinological examinations.Pathology reviewed that 18 of 21 were diffuse large B cell non-Hodgkin's lymphoma,2 were T cell lymphoma,1 were anaplastic large cell lymphoma.Only 7 of 21 cases were diagnosed with adrenal lymphoma pre-operation.Seventeen patients were followed up by telephone in September 2014,in which 14 died and the average survival time was 5.5 months,2 were tumor-free survival for 4 and 10 months respectively,1 were currently undergoing chemotherapy.Conclusions Adrenal lymphoma is rare with less superficial lymph node,more bilateral adrenal involved with high malignant degree.It progressed quickly with poor prognosis.Clinical and imaging features were not specific,so misdiagnosis was very common.Pathology is the diagnostic gold standard.The most common type was diffuse large B cell type.

AIM: To observe the different changes of neuroendocrine systems between the state of sport fatigue and poverty of movement. METHODS: 60 male Wistar rats were randomly divided into three groups: normal control group, sport fatigue model group and poverty of movement model group (20 rats in each group). The sport fatigue model was established by the method of combining basal diet and loaded swimming during 2 weeks, whereas the method of restricted activities was used to establish the poverty of movement model with total experimental time of 10 weeks. By the end of experiment, the climbing pole time was determined. The contents of hypothalamus thyrotropin releasing hormone (TRH), and serum norepinephrine (NE) and epinephrine (E) in rats with different treatments were determined by ELISA. In addition, the changes of hypothalamus corticotropin release hormone (CRH), pituitary adrenocorticotropic hormone (ACTH) and thyroid stimulating hormone (TSH), and serum corticosterone (CORT), triiodothyronine (T_3), tetraiodothyronine (T_4) were determined by radioimmunoassay to evaluate the functions of adrenergic nerve-adrenomedullin system, hypothalamo-pituitary-adrenal (HPA) axis and hypothalamo-pituitary-thyroid (HPT) axis. RESULTS: Compared to control group, the climbing pole time of the animals was obviously decreased in two model group. The adrenergic nerve-adrenomedullin system and HPA axis were inhibited in sport fatigue model rats, but HPT axis was unchanged. Interestingly, the HPA axis was hyperfunctional and HPT axis was inhibited in poverty of movement model rats. However, no change in the adrenergic nerve-adrenomedullin system was observed. CONCLUSION: Sport fatigue and poverty of movement all affect neuroendocrine system and lead to the adjustment mechanism imbalance, but the target and tendency are different.