Objective To investigate the causes of non-union and delayed union of fractures and to report the surgical techniques and outcomes of the treatments. Methods 107 cases of non-union, 54 cases of delayed union and 2 cases of congenital non-union of tibia were treated between July 1990 and December 2004 in our hospital. The treatments were evaluated retrospectively to analyze the causes of the disorder and the treatment outcomes at the follow-up. 18 cases of delayed union were treated conservatively while the other 145 cases in this series underwent surgery. Results Except in the 2 cases of congenital non-union of tibia, iatrogenic factors were found to be responsible for nonunion or delayed union in all the other 161 cases. 153 cases were followed up for an average of 17 (6 to 28) months only to reveal bone union in all the cases with a mean healing time of 10 (6 to 14) months. All the limbs regained good function. Conclusion Since development of non-union and delayed union of fractures chiefly result from iatrogenic technical defects, satisfactory results can be achieved as long as appropriate treatments are performed according to different etiological factors.

In order to optimize acupuncture protocol for stephenipodia after stroke, related papers of the recent 20 years are retrieved. Interrelated factors which may influence the therapeutic effect of acupuncture are analyzed through the aspects such as acupoints, needling methods and opportunities of acupuncture. It is held that importance should be attached on relation between acupoints and anatomy during acupoint selection. Different acupuncture protocol can be adopted in different phases of stephenipodia according to its time of occurrence. And it is found that the combination of acupuncture and rehabilitation can reinforce the therapeutic effect. Relationship between effect of acupuncture and patient's condition, acupoint selection and prescription, acupuncture manipulations (including directions, angles, reinforcing and reducing, quantity of stimulus) are worth to be further studied. On the base of the above all mentioned studies, optimization can be carried out on selection of acupoints and acupuncture manipulations. And therapeutic effect can be enhanced when the optimized acupuncture protocol is combined with rehabilitation therapies.
Acupuncture Points ; Acupuncture Therapy ; Foot Diseases ; etiology ; therapy ; Humans ; Stroke ; complications

Objective To study imageology anatomy concerned of sellar turica and explore its potential role on growth of pituitary adenomas. Methods According to classification of sinus sphenoidalis,103 normal imageology data of sellar turica region were analyzed, including 83 cases with entire saddle type sinus sphenoidalis and 20 cases anti-saddle type sinus sphenoidalis. Furthermore, the clinical data of 45 cases of pituitary adenomas with extension into sinus sphenoidalis were retrospectively studied. Results The relationship between sellar floor's shapes and sinus sphenoidals'types was that the larger the sinus sphenoidalis was, the deeper the floor was(98.8%). The relationship between sellar floor's shapes and the superior surface of hypophysis was that most of depressed sellar floors were companied with depressed superior surfaces of hypophysises(93.8%). The anteroposterior shapes of sellar turica in midsagittal can be divided into 4 types such as bag-type, kettle-type, tube-type, and sifter-type. 45 patients suffering from pituitary adenoms with extension into sinus sphenoidalis all had entire saddle type sinus sphenoidalis. Conclusions The imageology anatomy concerned of sellar turica could explain the phenomena of pituitary adenomas with extension toward sellar floor and sinus sphenoidalis. Referring to the literatures concerned, it indicated that the imageology anatomy was the key factor of affecting the growth of pituitary adenomas.

Objective To investigate four methods for establishing animal models of human breast cancer bone metastasis. Methods Thirty-two female nude mice aged 4-6 weeks were divided randomly into four groups (n=8 in each group). 5×105 MDA-MB-231 cells were injected into the body via the left second mammary fat pads (group A), the tail veins (group B), the left heart ventricles (group C) and the left tibia marrow cavities (group D), respectively. Tumor formations in situ were recorded in group A. Deaths after the injection were recorded. The surviving nude mice 49 days after the injection were subjected to pathological examination to determine bone metastasis. Results The rate of tumor formation in situ of group A was87.5 %(7/8). One mouse in group C died after the injection of MDA-MB-231 cells. The bone metastasis rate in groups A, B, C and D was zero (0/8), 12.5 % (1/8), 71.4 % (5/7) and 100 % (8/8), respectively. There was statistically significant difference in the bone metastasis rate between group A and group C, group A and group D, group B and group C; and group B and group D. Conclusion Injections of tumor cells via the breast fat pads and tail veins were not suitablemethods to establish animal models of human breast cancer bone metastasis. The bone metastasis model could be established efficiently by injecting tumor cells into the left heart ventricles or the bone marrow cavity of nude mice.

OBJECTIVE:To explore the clinical efficacy and safety of nedaplatin combined with docetaxel in the treatment of advanced cervical cancer. METHODS:A total of 53 patients with advanced cervical cancer selected from our hospital during Apr. 2014-Apr. 2016 were divided into observation group(31 cases)and control group(22 cases)according to chemotherapy plan. Con-trol group was given Docetaxel injection 60 mg/m2,ivgtt,qw. Observation group was additionally given Nedaplatin for injection 35 mg/m2+0.9% Sodium chloride injection diluted into 500 mL,ivgtt (≥60 min),qw. A chemotherapy cycle lased for 21 d,and both groups received 2 cycles of chemotherapy. Clinical efficacies of 2 groups were evaluated 2 weeks after treatment,and the level of PCNA integal was detected before and 2 weeks after treatment. The occurrence of ADR was recorded. RESULTS:The total re-sponse rate of observation group (77.42%) was significantly higher than that of control group (63.64%),with statistical signifi-cance(P<0.05). Before treatment,there was no statistical significance in PCNA integval between 2 groups(P>0.05). After treat-ment,PCNA integval of 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance(P<0.05). ADR were concentrated in grade I,and there was no statistical significance in the in-cidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Docetaxel combined with nedaplatin can significantly improve the clinical efficacy of patients with advanced cervical cancer,and does not increase the adverse reactions compared to docetaxel alone.

Objective To evaluate the clinical efficacy of a stroke unit combined with community health services for treating stroke survivors. Methods A total of 120 stroke patients were randomly divided into a " stroke unit combined with community medicine" group ( combined group) , a stroke unit group and a general treatment group. Patients in the former 2 groups were treated in a hospital stroke unit during their hospitali-zation. The general treatment group was given conventional medical treatment. After discharge, the combined group continued to receive regular rehabilitation therapy and guidance in the form of community medical services, while the stroke unit group received follow-up only. Assessment was by means of Fugl-Meyer scores, the Barthel index and self-rating on a depression scale ( SDS). The patients were assessed at admission, on discharge and 3 months after discharge. Results There were no significant differences in average limb motor function, ability in the activities of daily living ( ADL) or depressive mood among the 3 groups on admission, but at discharge, limb motor function and ADL ability in the combined group and stroke unit groups were significantly superior to those in the general therapy group. Limb motor function and ADL ability in the combined and stroke unit groups had improved further 3 months after discharge, with more significant improvements in the combined group. No significant change in depression was observed in any group at discharge, but average depression scores in the combined and stroke unit groups improved significantly in the 3 months after discharge, and there was a statistically significant difference between the combined group and the general group. Conclusion Supplementing the work of a stroke unit with community health services significantly improves stroke patients' recovery of limb motor function and ADL ability.

Antigens, CD34 ; metabolism ; Carcinoma, Signet Ring Cell ; genetics ; metabolism ; pathology ; surgery ; Codon ; Diagnosis, Differential ; Exons ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Gastrointestinal Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Gastrointestinal Stromal Tumors ; genetics ; metabolism ; pathology ; surgery ; Humans ; Melanoma ; metabolism ; pathology ; Middle Aged ; Neurilemmoma ; metabolism ; pathology ; Point Mutation ; Proto-Oncogene Proteins c-kit ; metabolism ; Receptor, Platelet-Derived Growth Factor alpha ; genetics ; metabolism

OBJECTIVETo investigate and clarify the key surgical techniques and evaluate clinical effectiveness of modular cementless femoral stems(LINK MP modular stem) in complex revision hip arthroplasty.

METHODSFrom January 2002 to December 2013, 470 patients in Chinese PLA General Hospital received revision hip arthroplasties using MP stems. Among them, 246 patients were followed for an average of 5.7 years (ranged, 0.5 to 11 years). There were 148 males and 98 females, with an average age of 62.5 years old (ranged from 26 to 83 years old). The most common reason for revision was aseptic loosening of femoral stems (107 cases, 43.5%), followed by prosthetic joint infection (104 cases, 42.3%). Other reasons included unexplained hip or thigh pain, periprosthetic femoral fracture, prosthesis wear and dislocation. According to Paprosky classification of femoral deficiency, there were 171 cases of type IIIA (69.5%), 14 cases of type I, 39 cases of type II, and 22 cases of type IIIB. The average preoperative Harris hip score (HHS) was 37.4 ± 7.5. In addition, radiographic presentation, degree of patients' subjective satisfaction, and clinical effectiveness were assessed as well.

RESULTSThe average Harris score was im- proved to 87.8 ± 4.2 after operation,with significant statistical difference when compared to preoperative score (t = 92.13,P = 0.00). Analysis of patients' subjective satisfaction for leg length discrepancy, stability and overall degree of satisfaction showed that the number of patients with great satisfaction were 27, 60, 61 respectively. The most common complication was the periprosthetic fracture (intraoperatively 21 cases and postoperatively 8 cases). Other complications included infection (7 cases), dislocation (5 cases), numbness possibly caused by incomplete sciatic nerve injury (6 cases) and thigh swelling (3 cases). The X-ray taken at the final follow-up revealed that prosthesis subsidence occurred in 4 cases, 2 of which needed a second revision.

CONCLUSIONThe application of modular cementless femoral stems (LINK MP modular stem) in complex revision hip arthroplasty (especially in cases with the serious defect of proximal femoral bone) shows good results at both the short-term and long-term follow-up, especially in the revision for prosthetic infection with the high success rate. In order to avoid complications and improve clinical outcomes,the surgeons should carefully select proper surgery candidates,perform the procedure with care, and master the key surgical techniques.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Postoperative Complications ; therapy

Objective: To explore the turnover and treament of postoperative remainder of giant nonfunctioning pituitary adenoma with suprasellar extension(SSE). Methods: The clinical data of 68 cases suffering from giant nonfunctioning pituitary adenoma with suprasellar extension(SSE)admitted into our department were retrospectively analyzed.These patients underwent primary transsphenoidal surgery. Results: Twenty cases had SSE adenomas totally removed(20.6%).In other 48 cases(79.34%)，SSE residues were shown in MRI recheck at one day after surgery.After 3 months，the 3rd MRI scanning was performed only to find that tumor residues descended to sellar floor in 21 cases,into intrasella in 8 cases，and down to the level of stalk hypophysial and the entrance to the sella in 3 cases.All of Patients with residual tumors received retranssphenoidal resection(the total removal rate of desending SSE residues was 96.9%).There were 2 cases with adenoma residues with slight descending.Obvious SSE adenomas were treated with transtranial approach.The twelve cases with small SSE residues were consecutively observed and two of them received gamma knife treatment because of unobvious postoperative visual improvement.The surgical mortality was 0%.There was no death during follow up in all of these patients.There were no cases with rhinorrhea.meningitis or visual deterioration.Two patients had supradiaphragmatic bleeding detected by routine postoperative CT. Conclusion: Staged surgery with two or multiple transsphenoidal resections is an appropriate treatment for giant nonfunctioning pituitary adenoma with supresellar extension(SSE)，with few complications.Futher study is warranted to investigate the growth pattern of pituitary adenoma.

Objective The radiotherapy is one of main treatments for patients with malignant tumor and leads to ovarian func-tion decreasing in young women .It is very important to protect ovarian function during the process of radiotherapy .The aim of this study is to investigate the effect of melatonin ( MT) agonist on radiotherapy-induced ovarian function damage in female rats . Methods Thirty SD rats were divided into five groups randomly , which received normal saline, 200 cGy radiotherapy+normal saline, 200 cGy radiotherapy+MT(25 mg/kg), 200 cGy radiotherapy+MT(50 mg/kg), and 200 cGy radiotherapy +MT(100 mg/kg), respectively.All rats were de-capitated two weeks after radiotherapy .Levels of serum follicle-stimulating hormone (FSH) and estradiol (E2) were measured by en-zyme-linked immune sorbent assay method;the number of the primordial follicles , the growth follicles and the mature follicle were ob-served;Caspase3 activity was assayed by spectrophotometry . Results In accordance with the normal control group , RT+MT (100 mg/kg) group, RT+MT (50 mg/kg) group,RT group , serum E2 levels decreased, respectively (6.68 ±0.48, 5.73 ±1.36, 4.26 ±0.44, 2.83 ±0.51)pmol/L;FSH levels increased, respectively (0.340 ±0.011, 0.431 ±0.053, 0.479 ±0.023, 0.604 ± 0.028)ng/mL ;the total number of follicles decreased ,respectively (21.67 ±1.97, 18.00 ±2.28, 15.50 ±1.05, 11.50 ±2.43);Caspase3 activity increased,respectively (0.14 ±0.03, 0.26 ±0.06, 0.36 ±0.05, 0.50 ±0.05).Except FSH had no significant difference between RT +MT(50 mg/kg)group and RT+MT(100 mg/kg) group(P>0.05), the rest indexes had significant difference between the two groups(P<0.05). Conclusion MT can diminish radiotherapy-induced ovarian damage in female rats, it may be related to the mechanism that MT inhibits the radiotherapy-induced activation of Caspase 3.