A total of 1273 elders above 65 years old received health check-up in our community.Among them,63.3％ ( 806/1273 ) had a history of hypertension and 64.9％ ( 523/806 ) showed abnormal blood pressure.And 43.2％ (202/467) of those without a history of hypertension were firstly found to have abnormal blood pressure.Among 674 blood testers,19.6％ had an elevated level of fasting blood glucose.And 11.4％ of those without a history of diabetes had an elevated level of fasting blood glucose.Hyperuricemia (21.8％,n =147),hypercholesteremia ( 11.1％,n =75),hypertriglyceridemia (35.5％,n =239) and increased low density lipoprotein-cholesterol (LDL-C) (46.3％,n =312) were noted.The levels of total cholesterol and LDL-C were higher in females than those in males ( both P ＞ 0.05 ).The results suggested that general practitioners should pay more attention to the management of chronic diseases and the health education and screening of high-risk populations.

Objective To analyze the repair methods of bone defects caused by the harmful removal of lower extremity long bone segmental bone fibrous structure,and to provide reference for clinical treatment.Methods Six cases of patient with adverse fibrous structure,3 cases with the jnjury of backbone of the tibia and 3 cases of femoralshaft damage were conducted as the research objects.Bone defect length after tumor resection was (17.3 ±4.2)cm,inorder to coinside with the peroneal vessels in the other side,fibulas with peroneal vessels from both sides should be cutdown.Dual fibula medial periosteal was stripped from the central longitudinal incision to the bone crest,folding fibulatwo -stage to make the front sides face to face,and then fixed the ends.The peroneal vascular was looped on one sideof graft to form a U shape.The vessels out of damage region was dissected,and was inserted fibula between the ends offracture,as the case wire or screws may be used.The peroneal vessels had to coinside with those in damage region,andimaging assessment should be taken to evaluate the healing of bone joints after surgery,at the same time,assessingpostoperative function by functional scores of Bone Cancer Society of the United States was also neccessary,finallyvascular anastomosis through the bleeding condition of the grafts were detected.Results All patients were followedup for 5 -8 years,the bone healed 1 year later,and the transplanted bone marrow cavity got recanalization 5 years later,at the same time,there was no tumorigenesis in the double fibula,and x -ray showed the good healing.All bonesturned to be normal ones without nonunion,infection and other complications.Final follow -up score of lower limbswas 91.2%.Conclusion It is effective and feasible to use a combination of double fibula to repair lower extremitylong bone defects caused by large bone fibrous dysplasia in the periosteum.

Hypoxic preconditioning improves organism in stress response such as operation.This dissertation expound the effects of hypoxic preconditioning on hepatic carcinoma after hepatic resection.Hypoxic preconditioning protect remainder hepatocyte from ischemia reperfusion injury in the remaining liver by regulating HIF-1,nuclear factor-kappa B and being kind to our mitochondria; remote-ectopic hypoxic preconditioning and cross-pluripotential hypoxic preconditioning preserve residual liver.Hypoxic preconditioning can relieve liver from ischemia reperfusion injury after hepatocellular carcinoma hepatectomy,but no clear evidence demonstrate it improve residual liver regeneration.This need further experimental study.

[Objective]To evaluate the effect of bone cement oscillator on increasing bone cement-bone interface binding intensity.[Method]Sixty fresh femoral bones of adult pig were randomly divided into experiment group and control group under the 30%,50%,70% ultimate shear strengh of the cement/bone.There were 10 samples in each subgroup.Mechanics test was performed by MTS-810 material testing machine,and the binding intensity of bone cement-bone interface in oscillating cement-bone interface binding intensity in experiment group was compared with control group.[Result]Mechanics test showed bone cement group were significantly stronger than control group under the 30%,50% ultimate shear strengh of the cement-bone(P 0.05).[Conclusion]Bone cement oscillator can increase binding intensity of bone-cement interface,and effectively reduce long-term aseptic loosening of artificial prostheses.

Objective Explore the value of video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis.Methods This is a prospective randomized control study.Fifty-four patients who were confirmed to be MG preoperatively from 2005 to 2008 were divided into VATS group(27 cases)and thoracotomy group(27cases).Thymectomy and dissection of all faity tissue anterior to pericardium were performed in both groups.Results When compared with thoacotomy group,VATS group had less blood loss,shorter postoperative hospital stay and time of postoperative chest drainge tube left.One patient was converted to open surgery because of the injury to the brachiocephalic vein.During a period of followed-up 624 months,symptom was improved in 81% of the patients in VATS group and 85% in thoractomy group(P>0.05).Conclusion Extened thymectomy with VATS is safe and feasible with the advantage of less invasion,less surgical trauma and pain,lower rate of complication and good curative effect.

Objective To study the application of VATS and gasless laparoscopy to the treatment of portal hepertension Methods 12 operations of the splenectomy combined with ligation of pericardial vein and lower part of lung covered by omentum majus were performed throngh the thoracoscopy and laparascopy Results All of the 12 operations were successful. The procedures lasted (2.5～5.2) hours with mean time being 3.3 hours. Gastrointestinal function recovered in (48-72) hours after operation. The duration of hospitalization was (9～11)days. No postoperative thoracic and abdominal cavity complications were found. The average duration of hospitalization after operation was 10.3 days.12 cases were followed up for 2 month to 4 years and no rebleeding was found. Conclusions The procedures including ligation of pericardial vein under VATS combined with gasless laparoscopy assisted splenectomy and lower part of lung covered by omentum majus for the treatment of portal hypertension is passable.

Objective To explore the efficacy of breast-conserving therapy of ductal carcinoma in situ (DCIS),and to evaluate its safety.Methods 54 patients with DCIS receiving breast-conserving therapy(the experimental group) and 49 patients with DCIS treated with mastectomy(the control group) in the First Affiliated Hospital of Wenzhou Medical College from Mar.2010 to Mar.2013 were retrospectively analyzed.The follow-up results of the 2 groups were analyzed in terms of the local recurrence,distant metastasis and the 3-year diseasefree survival(DFS).The efficacy and safety of breast-conserving treatment were evaluated.Results All patients were followed up for 5 months to 39 months,with the average of(22.3 ± 8.5) months.No local recurrence happened in the experimental group.There was 1 case of chest wall recurrence in the control group.One case in the experimental group and 2 cases in the control group had distant metastasis.DFS rate in the 2 groups was 100％ and 95.9％ relatively.No statistically significant difference was found between the 2 group in terms of the above items (P ＞ 0.05).Conclusion For DCIS patients,the difference between breast-conserving therapy and mastectomy surgery in the rate of local recurrence and distant metastasis was not significant.Breast-conserving therapy is safe for DCIS patients and should be further promoted.

Objective To study the mechanics situation of proximal femoral locking plate internal fixation after dynamic hip fixation in-tertrochanteric fracture. Methods Totally 10 couple of elderly proximal femur specimens were collected and intertrochanteric fracture model were prepared. Fixation material was removed after dynamic hip screw fixation. The left sides were collected as control group and given anti-rotation intramedullary nail internal fixation, while the right side were collected as observation group and given proximal femoral locking plate internal fixation. Then vertical displacement, axial stiffness and rotational stiffness under different loads were compared. Results Under dif-ferent loads, femoral bone vertical displacement and femur tuberosity vertical displacement in the observation group were both significantly shorter than those in the control group (P<0. 05), and femoral bone and femur tuberosity axial stiffness and rotational stiffness in the observation group were significantly higher than those of the control group (P<0. 05). Conclusion Proximal femoral locking plate internal fixation can improve stress load and enhance axial stiffness and rotational stiffness, and it's an ideal material for refracture fixation model after dynamic hip fixation intertrochanteric fracture.

Objective To investigate the clinical features,diagnosis and treatment of appendix tumor.Methods The clinical data of 58 cases with primary appendiceal tumor were analyzed retrospectively.Results In the 58 cases clinical presentation mimicked acute appendicitis in 22 cases,chronic appendicitis in 15 cases,appendiceal abscess in 12 cases,intra-abdominal mass in 7 cases,and gastrointestinal perforation in 2 cases.Primary appendiceal tumor was diagnosed intraoperatively by intraoperative frozen histopathological examination in 10 cases,and the diagnosis was made by postoperative histopathological examination in the other 48 cases.There was appendiceal carcinoid in 40 cases,adenocarcinoma in 6 cases,mucocele in 2 cases,mucous adenocystoadenoma in 5 cases,pseudomyxoma peritonei in 2 cases,malignant neurilemmoma in 1 case,and malignant lymphoma in 2 cases.Surgical procedures included appendectomy in 6 cases,ileocecal resection in 8 cases,and right hemicolectomy in 44 cases (including right hemicolectomy and intraperitoneal chemotherapy with 5-FU 1 000 mg for pseudomyxoma peritonei in 2 cases).Radical resection was achieved in 55 cases and palliative resection in 3 cases.The 2 cases with pseudomyxoma peritonei died of tumor recurrence at 36 months and 54 months after operation respectively.All the 5 cases of adenocystoadenoma and 2 cases of appendix cyst survived without an evidence of recurrence.7 of 49 cases of malignant appendiceal tumor suffered recurrence postoperatively,the recurrence rate was 14％,which included liver metastasis in 4 cases and intraperitoneal recurrence in 3 cases.The 1,3,5-year survival rates of malignant appendiceal tumors were 100％ (49/49),92％ (35/49) and 80％ (39/49),respectively,which were 100％,98％ and 92％ for carcinoid,and 100％,67％ and 33％ for adenocarcinoma,respectively.Conclusions The preoperative diagnosis of primary appendiceal tumor is very difficult,the intraoperative frozen histopathological examination is helpful for diagnosis,the prognosis of appendiceal carcinoid is fair after resection.

Objective To investigate the dosimetric comparison of target volumes and organs at risk (OAR) between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for esophageal cancer by a meta-analysis.Methods A literature search was performed to collect the clinical studies on dosimetric comparison between VMAT and IMRT.The primary endpoints of interest were dosimetric parameters of target volumes and OAR, number of monitor units (MUs), and treatment time (TT).Results A total of 17 studies involving 323 patients were included in this meta-analysis.When the total dose was>50.4 Gy, VMAT showed significantly lower mean dose (Dmean) of gross tumor volume (GTV) and maximum dose (Dmax) of planning target volume (PTV) than IMRT (P=0.009;P=0.039).There were no significant differences in Dmean, V30, and V40 of the heart, Dmax of the spinal cord, and V5, V10, and Dmean of the lung between VMAT and IMRT (P>0.05).VMAT showed significantly lower V15, V20, and V30 of the lung than IMRT (P=0.001;P=0.000;P=0.023).When the single dose was 1.8 Gy and 2.0 Gy, VMAT showed significantly lower TT (reduced by 323.5 s and 193.7 s) and number of MUs (reduced by 275.4 MU and 134.2 MU) than IMRT (P=0.000 and 0.009;P=0.000 and 0.022).Conclusions VMAT can significantly reduce TT, MUs, irradiation dose to the lung, and the risk of radiation pneumonitis, and improve the utilization rate of equipment.Compared with IMRT, VMAT has no significant advantages in protection of the spinal cord and the heart and dosimetric parameters of target volumes except Dmean of PTV and Dmean and Dmax of GTV when the total dose was ≤50.4 Gy.