Objective To explore the feasibility and effects of one stage vascular free fibular transplantation or combination of bone transport two-stage technique for reconstruction of adversity congenital pseudarthrosis of the tibia. Methods Vascularised free fibular reconstruction operations for adversity congenital pseudarthrosis of tibia were performed in 16 cases, including male in 9 and female in 7,age ranged from 6 to 14 years with the mean in 8.5 years. 2 to 6 operations history were documented in all cases with the mean in 3.2 before went to our hospital, with 3 to 12 cm and mean 5.8 em short of the tibia. Mean9.2 cm (from 6.0 to 16.0 cm) vascular free fibular were harvested and transplanted to reconstruct the bone frame in 16 cases, bone transport operation were performed in 4 cases 1 year later. Results Fourteen cases were followed up for mean 4.5 years, bone union could be found by radiology examination, mean 7.8cm (from 4.0 to 11.5 cm) elongation of the low limb were obtained in 4 cases. Basic walking function was obtained in all cases. Conclusion It is an effective method to treat adversity congenital psuedarthrosis of the tibia by thoroughly resection of the focus and enough length of vascular fibular transplantation, deficiency of low limb can be ameliorated by bone transportation technique in those patients.

Objective To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients.Methods After breaking thrombus through indwelling catheter,both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula.The necessary nursing measures were carried out to assist the whole therapeutic procedure.Results All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion.The reopening rate of the obstructed fistula was 100%.Conclusion Indwelling catheter thrombolysis with urokinase infusion is a simple,effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients.In order to obtain optimal results,necessary nursing measures must be carried out.

Objective To explore the possibility of treating tibial osteomyelitis with transfer of a compound flap composed of the sural nerve fasciocutaneous flap and the lateral gastroenemius muscle.Methods We observed in cadaver specimens the anatomical structure of the sural nerve fasciocutaneous flap and the lateral gastrocnemius muscle to design a compound flap. Fifteen cases of tibia] osteomyelitis were treated with sinus excision and thorough debridement before the skin defect area was covered with a sural nerve compound flap whose muscle was stuffed into the tibia] channel. Plates were replaced with unilateral fixators in 3 cases of tibial nonunion. Results We observed 5 to 6 perforating branches of blood vessels between the sural nerve fascioeutaneous flap and the lateral gastroenemius muscle, indicating that the two can be harvested simultaneously in one compound flap. The transferred compound flaps survived in 15 cases. Tibial os-teomyelitis was completely cured in 14 cases, 1 case healed after second debridement, and 3 cases of tibial nonunion healed 6 months later after a second stage iliac bone graft. No recurrence was found after a mean follow-up of 18 (10 to 26) months. Conclusion A compound flap composed of the sural nerve fascio-cutaneous flap and the lateral gastrocnemius muscle can be used to treat tibia] osteomyelitis effectively.

Objective To explore the physical development and immune function of infants without human immunodeficiency virus(HIV)infection who were delivered by HIV_infected mothers. Methods Two hundred and ninety_seven infants delivered HIV_infected mothers in Guangxi province from January 2008 to November 2011 were selected as observation group. According to whether infants had HIV infection or not,the children were further divided into the HIV_infection group and the infants in the non_HIV infection group according to the presence or absence of HIV infection,and the infants in the non_HIV infection group were divided into the antiretroviral drug(ART)treatment group and the non_ART treatment group according to whether the mother had used ART during pregnancy. Ninety_one healthy children born at the same time were selected as the healthy control group. The physical examination,T lympho_cyte subgroup analysis and humoral immunity test were performed on all infants. Results The weight and body length at birth of infants born from HIV_infected mothers were all significantly lower than those in the healthy control group [(2. 86 ± 0. 49)kg vs.(3. 15 ± 0. 52)kg;(47. 05 ± 2. 20)cm vs.(50. 01 ± 2. 58)cm],and the differences were sta_tistically significant(t﹦2. 652,2. 247,all P〈0. 05). The CD8 level and CD4∕CD8 ratio of infants delivered by HIV_infected mothers had no significant differences statistically compared with those in the healthy control group[(21. 31 ± 6. 49)% vs.(22. 01 ± 5. 43)%;1. 82 ± 0. 79 vs. 1. 82 ± 0. 67,t﹦0. 933,0. 033,all P〉0. 05];the CD3 and CD4 levels were lower than those in the healthy control group[(62. 36 ± 7. 94)% vs.(65. 70 ± 6. 32)%;(4. 83 ± 7. 62)% vs.(37. 02 ± 5. 69)%],and the differences were statistically significant(t﹦3. 66,2. 946,all P〈0. 01). The immunoglobulin(Ig)M,IgG and IgA levels of children born to HIV_infected mothers had no statistically significant differences compared with those in the healthy control group[(1. 79 ± 0. 66)g∕L vs.(1. 76 ± 0. 66)g∕L;(8. 96 ± 2. 74)g∕L vs.(8. 80 ± 1. 97)g∕L;(0. 85 ± 0. 57)g∕L vs.(0. 86 ± 0. 41)g∕L,t﹦0. 341,0. 619,0. 173,all P〉0. 05). The weight and body length at birth of non_HIV infected children born from HIV_infected mothers were all significantly lower than those in healthy control group[(2. 92 ± 0. 43)kg vs.(3. 15 ± 0. 52)kg;(49. 03 ± 2. 22)cm vs.(50. 01 ± 2. 58)cm],and the differences were statistically significant( F﹦4. 163,2. 87,all P〈0. 05). The birth weight,birth length and head circumference of the ART group were all significant lower than those in the healthy control group[(2. 90 ± 0. 43)kg vs.(3. 15 ± 0. 52)kg;(48. 27 ± 1. 89)cm vs.(50. 01 ± 2. 58)cm;(31. 80 ± 1. 47)cm vs. (34. 88 ± 3. 21)cm],and the differences were statistically significant( F﹦3. 711,2. 970,3. 689,all P〈0. 05). The CD8 level and CD4∕CD8 ratio of non _ HIV infected children born to HIV _ infected mothers had no significant differences statistically compared with those in the healthy control group[(20. 77 ± 5. 60)% vs.(22. 01 ± 5. 43)%, 1. 85 ± 0. 76 vs. 1. 82 ± 0. 67,F﹦43. 568,11. 705,all P〉0. 05];the CD3 and CD4 levels were lower than those in the healthy control group[(62. 27 ± 7. 94)% vs.(65. 70 ± 6. 32)%;(35. 30 ± 6. 86)% vs.(37. 02 ± 5. 69)%],and the differences were statistically significant(F﹦7. 083,28. 06,all P〈0. 05). Conclusions The humoral immune func_tion of the non_HIV infected infants delivered by HIV_infected mothers is not significantly affected,but the physical development at birth and cellular immune function are significantly affected. ART during pregnancy is not a major factor in the limitation of physical development at birth. Therefore,the nutrition support for the infants delivered by HIV_in_fected mothers and prevention of infection are especially necessary clinically.