Objective To conduct a hiomechanical comparison of the four common internal fixation methods for the anterior eruciate ligament(ACL)avulsion fractures of displaced tibial eminence.Methods Sixteen fresh cadaver knee joints were used and randomized into four equal groups of four fixation methods:antegrade wiring group, retrograde wiring group,suturation group,and intramedullary screw group.The knee joint specimens were fixed at flexion of 30?and subject to continuous stretch stresses of 30 N,60 N and 90 N respectively on a material testing machine(MTS 858 Bionix test system,USA)which conducted a simulated Lachman test.The specimens were scanned at different angles by a three dimensional laser scanner.Data were recorded and processed by image software to es- tablish three-dimensional structure models of femur,tibia and knee joint.The test results were analyzed statistically on a computer.Results There were no obvious differences between each fixation group in the length change of ACL when the stresses were 30 N and 60 N(P＞0.05).Under 90 N stress,however,the mean length change between the femoral and tibial attachments of ACL was the smallest(4.8?1.7)mm(2.5 to 6.2 mm)in the suturation group(P＜0.05). There were no distinct differences between the intramedullary screw group and the retrograde wiring group in the changes of A CL shift(P=0.214).The average front shift in the retrograde wiring group was(6.2?1.2)mm(4.8 to 8.2 mm) and significantly smaller than that in the antegrade wiring group(P＜0.05).The antegrade wiring group made the largest average front shift under different stresses and its average front shift was(7.2?1.3)mm(5.6 to 8.7 mm). Conclusions The knee joint stability provided by the suturation fixation is distinctly better than that by the other three fixation methods.The antegrade wire fixation provides the poorest knee joint stability.There is hardly any difference between intramedullary screw fixation and retrograde wiring fixation.

Objective To evaluate the diagnostic value of cardiac magnetic resonance (CMR) in suspected coronary heart disease patients with electrocardiogram abnormalities but normal coronary angiography. Methods The data of 25 suspected coronary heart disease patients with electrocardiogram abnormalities but normal coronary angiography were collected from Taiyuan central hospital between October 2010 and April 2012. Comparison was done in terms of anterior interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end diastolic dimension, left ventricular end systolic dimension, left atrial diameterand ejection fraction measured by CMR and by UCG. Correlation of the aboved paremeters between the 2 imaging exams. Results 40%of patients had their diagnosis changed after CMR exam, 32%of the patients with adjusted assessment. The differences in anterior interventricular septal thickness, left ventricular posterior wall thickness, left ventricular enddiastolic dimension, left ventricular end systolic dimension, left atrial diameter, ejection fraction by CMR and by UCG were similar (P>0.05) with positive correlation (P<0.01). Conclusions CMR can provide diagnosis and evaluation information to chest pain patients with ECG abnormalities but normal CAG, and it is a good supplement for routine examination.

OBJECTIVETo explore the intranasal surface localization of the lacrimal sac in endoscopic dacryocystorhinostomy.

METHODSFifteen adult cadavers (30 sides) were studied, the data of projection position of the lacrimal sac on the lateral wall of nasal cavity were measured.

RESULTSIn 2/3 cadavers, the lacrimal sac is located above the axilla of the middle turbinate, and 1/3 lies below it. A majority of the lacrimal sac (2/3) are located below the entry point of the common lacrimal canaliculus, about 1/3 lies above it. Inner canthal ligament projects on the middle of the lacrimal sac, almost equal to the level of common lacrimal canaliculus. Thirty-two cases (thirty-nine sides) of chronic dacryocystitis were followed-up > 6 months after operation. Thirty-five sides were cured, 2 sides improved and 2 sides ineffective. The cure rate was 89.8%, improve rate 5.1% and ineffective rate 5.1%, respectively, and the total effective rate was 94.9%.

CONCLUSIONSThe central position of dacryocystorhinostomy should be 0.2 cm above the front of the axilla of the middle turbinate, to make an curved mucous membrane incision 0.8 cm above and 0. 4 cm below the front of the axilla of the middle turbinate and bone ostium about 1.2 cm x 1.0 cm. It is the best position in endoscopic dacryocystorhinostomy. Locating the inner canthal ligament with a bayonet type forceps to find the projection of lacrimal sac is also a simple and easy method.

Adult ; Aged ; Anatomy, Regional ; Chronic Disease ; Dacryocystitis ; surgery ; Dacryocystorhinostomy ; methods ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasolacrimal Duct ; anatomy & histology ; surgery ; Young Adult

PURPOSE: This study was done to analyze how a death preparation education program have the effects on awareness of hospice palliative care and withdrawing life sustaining treatment in older adults. METHODS: This study employed a non-equivalent control group design among quasi-experimental designs. The experimental group was comprised with 35 adults and the control group with 40 adults. The death preparation program consisted of five two-hour sessions and was administered once a week for five straight weeks. Data were analyzed by descriptive statistics, t-test, chi2 test, Fisher's exact test, and ANCOVA using SPSS version 18.0. RESULTS: The mean age of the participants was 66.2 years. A significant difference between the experimental and control groups was observed in withdrawing life sustaining treatment (F=3.380, P=0.040). However, no significant difference was found in awareness of hospice palliative care (F=0.163, P=0.850). CONCLUSION: The study results indicate that death preparation training could positively affect people's awareness of withdrawing life sustaining treatment. More studies should be conducted to explore effects of death preparation education for all ages and help people better understand hospice palliative care.
Adult ; Education* ; Hospices* ; Humans ; Life Support Care ; Palliative Care*

After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later.
Aged ; Amebiasis/*diagnosis/parasitology/*pathology ; Central Nervous System Protozoal Infections/*diagnosis/parasitology/*pathology ; Cerebrospinal Fluid/parasitology ; DNA, Protozoan/chemistry/genetics ; Fatal Outcome ; Humans ; Male ; Microscopy ; Naegleria fowleri/classification/genetics/*isolation & purification ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Taiwan

OBJECTIVETo investigate the clinical efficacy of the pith decompression of the femoral head and fibular allograft transplantation in the treatment of early stage avascular necrosis.

METHODSFrom January 2004 to November 2008, 32 hips of 25 patients with avascular necrosis of femoral head of Ia-IIIb period were treated by the pith decompression of the femoral head and fibular allograft transplantation, hollow lag screw fixation, included 17 males and 8 females, aged from 20 to 55 years old (39.1 years on average). Preoperative pain was from 2 to 14 months (means 5.5 months). All patients were applied on conventional X-ray films, MRI examination, Harris score.

RESULTSThe patients were followed up for 12 to 48 months (means 36.4 months). X-ray film showed 21 hips of 18 cases improved,6 hips of 4 cases unchanged, no collapse of articular surface, 3 hips of 2 cases deterioration, 2 hips of 1 case failed. Preoperative Harris score was (77.0 +/- 8.0) and postoperative (90.6 +/- 2.5), there was a significant difference (t = 1.67, P < 0.05).

CONCLUSIONPith decompression of the femoral head and fibular allograft transplantation in the treatment of early stage avascular necrosis of femoral head has advantage of joint function in bed-ridden after a short time, quick recovery,clinical symptoms improved. Its short-term efficacy is certain but long-term efficacy is still need further observation.

Adult ; Decompression, Surgical ; methods ; Female ; Femur Head Necrosis ; surgery ; Fibula ; transplantation ; Humans ; Male ; Middle Aged ; Transplantation, Homologous

OBJECTIVETo evaluate the prevalence of TET2 gene mutation in acute myeloid leukemia (AML) patients, and analyze their clinical characteristics and prognosis.

METHODSPolymerase chain reaction (PCR) and direct sequencing were used to sequence exon 3 to 11 of TET2 gene.

RESULTSAmong 96 AML patients, TET2 gene mutation was detected in 13 (13.54%) patients (95%CI 6.70% - 20.38%). The median age was 54 years in mutated group and 41 years in unmutated group (P = 0.010). Mutated and unmutated patients did not significantly differ in gender, white blood cells (WBC) count at diagnosis, platelet count, PB and BM blast percentage and chromosome karyotype, excepting for hemoglobin level 84 (70 - 108) g/L in mutated group versus 70 (55 - 87) g/L in unmutated group (P = 0.032). TET2 gene mutation had no significant correlation with C-KIT, FLT3, JAK2V617F mutations, but did with NPM1 mutation. TET2 mutated patients had lower CR1 rate and 2-year overall survival than unmutated in non-M(3) patients (P < 0.05).

CONCLUSIONSTET2 gene mutation is more prevalent in older AML patients and has a certain correlation with clinical characteristics and outcome. It may be a molecular marker for poor prognosis in AML.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; DNA Mutational Analysis ; DNA-Binding Proteins ; genetics ; Exons ; Female ; Humans ; Karyotype ; Leukemia, Myeloid, Acute ; genetics ; Male ; Middle Aged ; Proto-Oncogene Proteins ; genetics ; Young Adult

Objective To determine whether circulating level of catestatin (CST) could provide prognostic information independently of conventional risk markers for the development of in-hospital heart failure in patients with ST-segment elevation myocardial infarction (STEMI).Methods The data of 120 STEMI patients (mean age:61 years,73％ male) were collected from the Second Hospital of Shanxi Medical University and Taiyuan Central Hospital between November 2010 and September 2011.The patients were categorized into 4 groups according to CST (ng/L) quartile:≤74.72,74.73-79.67,79.68-84.21and ≥84.22 ng/L.Clinical features,therapeutic approaches were compared among groups.The patients were also grouped according to Killip class:Killip level Ⅰ (n =68),Killip level Ⅱ (n =23),Killip level Ⅲ (n =18),Killip level Ⅳ (n =11).CST,NE and NT-proBNP were compared among groups.The Spearma rank correlation and multivariate logistic regression analysis were applied to determine the association between risk factors and in-hospital heart failure.Receiver-operator characteristic (ROC) curve was performed to evaluate the power of CST and NT-proBNP on predicting in-hospital heart failure.Results Gender,hospital days,past history of smoking,hypertension,myocardial infarction,CK-MB peak level,TnI peak level,heart rate,blood pressure,blood glucose,blood lipid levels on admission and early reperfusion therapy were similar among groups.Patients with higher CST values were more likely to be older,to have lower body mass index,to have higher white blood cell count,CysC,hs-CRP,NE,NT-proBNP,past history of angina,diabetes mellitus,being diuretic users,and to have a lower ejection fraction (all P ＜0.05).Higher CST levels were also associated with increased risk of heart failure (P ＜ 0.05).In proportion with the deterioration of the cardiac function,CST,NE,NT-proBNP concentration gradually increased (all P ＜0.05).Spearman rank correlation analysis showed that the CST was negatively correlated with LVEF (rs =-0.923,P ＜ 0.001) and positivey correlated with NT-proBNP (rs =0.884,P ＜ 0.001).After multivariate adjustment,CST remained to be an independent risk factor for the development of in-hospital heart failure(OR =1.125,95％ CI:1.056-1.198 ; P ＜ 0.001).The area under the ROC curve of CST and NT-proBNP was 0.777 and 0.874.Using CST =77.29 ng/L as a cut-off value,the sensitivity was 92.8％ and specificity was 70.6％ for predicting the development of in-hospital heart failure.Conclusion The plasma CST level is an independent predictor for the development of in-hospital heart failure in patients with STEMI.

Objective A phase Ⅱ study was conducted to test the efficacy and toxicity of the combination of cisplatin,5-Fu and nimotuzumab,as induction treatment of resectable head and neck squamous cell carcinoma (HNSCC).Methods Forty cases of resectable HNSCC were treated with nimotuzumab (400 mg on day 1 ) combined with PF regimens ( cisplatin 75 mg/m2 on days 1 and 5-Fu 750 mg/m2 on days 1 -5 q3wks ). After 2 cycles,an organ-preservation local therapy (surgery or radiotherapy) was recommended.The primary endpoints of this study were overall response rate,pathologic complete response and safety of the induction treatment.Mean age of 40 patients was 54 years old,of them 9 patients with oropharyngeal cancer (22.5％ ),16 hypopharyngeal cancer (40.0％ ),10 laryngeal cancer (25.0％),and 5 oral cancer (12.5％ ).Results With a 2-cycle induction treatment,34 (85.0％)patients achieved complete or partial response. Twenty-four patients (60.0％) got downstage,with T downstage in 21 (52.5％ ) patients and N downstage in 8(20.0％) patients.Totally 27 patients got surgery after the induction treatment,of them 20 patients (74.1％ ) preserved organ functions. Four patients' primary tumors ( 10.0％ in all 40 patients and 14.8％ in operated 27 patients) showed pathologically complete responses.The toxicity was mild and manageable.The most common grade 3/4 toxicities were neutropenia ( 5.0％ ),nausea/vomiting ( 2.5％ ),stomatitis ( 2.5％ ) and thrombocytopenia ( 2.5％ ).One patient got grade 2 renal insufficiency and one patient got grade 1 skin rash. Conclusion For resectable HNSCC,nimotuzumab plus PF regimen as induction treatment is highly effective for preserving the organ function and the toxicities are well tolerable.

OBJECTIVETo investigate the efficacy and safety of sirolimus in management of chronic allograft nephropathy (CAN).

METHODSA retrospective study was conducted involving 31 CAN patients followed up since March 2002, who experienced a change from a calcineurin inhibitor (CNI)-based regimen to a SRL-based regimen. Serum creatinine (Cr) in these patients was compared before and after the regimen change, and the adverse events associated with SRL were analyzed.

RESULTSTill March 2007 when the study closed, 15 patients reached the primary endpoint for resuming dialysis, 8 had improved and 8 had stable renal function. In patients with high Cr(0)(> or =3 mg/L, n=12), 9 resumed dialysis and 2 had improved renal function, but one of the patients with renal improvement eventually died due to infection; in the patients with low Cr(0)(<3 mg/L, n=19), 5 resumed dialysis, 8 had stable renal function and 6 had improved renal function, showing significant difference between the 2 groups (P=0.003). Altogether 14 patients reached the secondary endpoint for ceasing SRL for severe infection (5 patients, of whom 4 resumed dialysis and 1 died of infection) or adverse events associated with SRL (9 patients, of whom 4 resumed dialysis, 2 had stable and 3 had improved renal function). Hyperlipidemia (51.6%), leukocytopenia (41.9%), mouth ulcer (29.0%) and liver function lesion (16.1%) were the commonest adverse events in these patients, and totalling 13 severe adverse events were recorded, including 2 fatal cerebral hemorrhage, 3 fatal infection episodes, and 8 pulmonary and urinary infections that require hospitalization.

CONCLUSIONConversion from a CNI-based to SRL-based regimen can be effective for some CAN cases, especially for those with Cr(0) below 3 mg/L. Attention must be given to adverse events like hyperlipidemia and leukocytopenia, as well as the related cerebral vascular accidents and infections.

Adult ; Aged ; Chronic Disease ; Creatinine ; blood ; Female ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Kidney Function Tests ; Kidney Transplantation ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Sirolimus ; adverse effects ; therapeutic use ; Transplantation, Homologous ; Treatment Outcome ; Young Adult