Objective To investigate the clinical characteristics of clavicular defect and nonunion after operation and evaluate the clinical effects of vascularized pedicled pectoralis major clavicular periosteal flap and locking plate fixation plus bone morphogenetic protein (BMP) implantation. Methods From January 2004 to April 2008, 12 patients (mean age, 42.8 years old) with clavicular defect and nonunion were treated in Zhongshan Hospital. The internal fixators were removed, and then fibrous scars and sclerotic bones were cleared. The clavicular detects were fixed with locking plate, with implantation of the BMP. The wound was covered with vascularized pedicled pectoralis major clavicular periosteal flap. Postoperative functional rehabilitation exercises were performed. Results All patients were followed up for 8-24 months (mean 1.2 years). The clinical results were evaluated by Constant-Murley scoring system. The clavicular defects were healed in all patients within 4-7 months, and the internal fixators were successfully removed from some of the patients. Conclusions Vascularized pedicled pectoralis major clavicular periosteal flap combined with locking plate fixation plus BMP implantation is effective in the treatment of clavicular defect and nonunion.

Heart ; physiopathology ; Humans ; Infant, Newborn ; Long QT Syndrome ; complications ; Male ; Tachycardia, Ventricular ; complications ; Torsades de Pointes ; complications

Objective To study the biomechanics of simple locking proximal femoral plate (LPFP),LPFP combined with calcium phosphate cement (CPC) and proximal femoral nail antirotation (PFNA) in treatment of unstable intertrochanteric fractures.Methods Thirty-six femurs from 18 specimens with no pathological defects,fractures,malformations or neoplasms were enrolled in the study and were divided into three groups (Groups A,B and C),with 12 femurs per group.Intertrochanteric fractures were duplicated in accordance with Evans classification of type Ⅲ A.The fractures in Group A were treated by LPFP combined with CPC fixation,that in Group B treated with only LPFP fixation,while that in Group C fixed with PFNA.A comparative mechanical test of femoral specimens was performed in a special clamp.Results Axial compression test showed linear change of the load-displacement of three surgical fixations for intertrochanteric fractures under biological load.The measurement of torque-torsion angle of three fixations for intertrochateric fractures showed that the torque was enlarged with increase of torsion angle till the failure of internal fixation.Conclusion LPFP combined with CPC or PFNA can attain solid fixation of unstable intertrochanteric fractures.

Objective To study the pathologenesis and to evaluate an operative method of blepharochalasis. Methods A double eyelid-fold incision was made. The lacrimal glands were found and repositioned into lacrimal glands fossa behind superolateral orbital rim. Then redundant skin and muscles as well as hernia septal fat were removed. Results Twenty-three patients were successfully treated by the mentioned methods from 1998 to 2002. A good clinical results in both function and appearance were achieved. Conclusion It is convenient and effective to treat blepharochalasis through a double eyelid fold incision.

In addition to the common complications involving hepatic artery, hepatic vein and biliary tract, which have already been mentioned and discussed in the preceding parts of this article, there are some uncommon complications which have been reported in the medical literature as the case report or as the case- series analysis. This paper sums up these uncommon complications. Part of these uncommon complications can be treated with interventional therapy. It is very important for interventional radiologists to make a further understanding of the different etiology of these uncommon complications occurred after liver transplantation so as to get a comprehensive knowledge about the complications after liver transplantation.

Objective To evaluate the inhibitory effect of rofecoxib in human gastric carcinoma tissues established in nude mice by orthotopic transplantation through the expressions of vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS). Methods After the models of human gastric carcinoma in nude mice by orthotopic transplantation were established, rofecoxib was administered intragastrically. The expressions of VEGF and iNOS were evaluated in the local tumors by Envision immunohistochemical method. Results The expression of VEGF protein in isotonic saline group, rofecoxib group and combination group were 81.25%, 61.25%, and 35.00% respectively.There was significant difference between rofecoxib group and isotonic saline group, and so was rofecoxib group and combination group (P

Objective To investigate the effect of estrogen receptor ?(ER-?)on the formation of mice endometriosis.Methods Endometriosis animal model was established with 30 ER-? knockout(?ERKO)mice and 22 ER-? non-knockout(?ER)mice.All the mice were divided into three groups:intact group(?ERKO 10 and ?ER 8),ovariectomy group(?ERKO 10 and ?ER 7)and ovariectomy + estradiol treatment group(?ERKO 10 and ?ER 7).The endometriotic grafts were taken out from all the mice 2 weeks after operation,and the weight,histological structure and the expression of MMP-9 in the grafts were analyzed and compared between ?ERKO and ?ER mice.Results The endometriotic grafts were significantly heavier 2 weeks after transplantation than that before transplantation in intact group(P0.05).In addition,no significant differences were found between the ?ERKO and the ?ER mice in endometriotic grafts' weight,the histopathologic structure and the expression of MMP-9.Conclusion ER-? may throw few influence on the formation of endometriosis.

ObjectiveTo evaluate the intermediate term efficacy of posterior stabilized (PS) total knee arthroplasty(TKA) and posterior cruciate-retaining(CR) TKA and explore the clinical related problem.MethodsThe clinical data of 84 patients (87 knees) who treated with primary TKA from May 1992 to May 2006 were analyzed retrospectively.The intermediate term efficacy was compared between PS TKA (PS group,41 cases with 43 knees) and CR TKA (CR group,43 cases with 44 knees).ResultsAll the patients were followed up for 5-10(7.6 ± 1.5 ) years,no infection,dislocation or neurovascular injury occurred in both groups.But 1 knee occurred intraoperative posterolateral femoral condyle fracture in PS group.The lateral retinacular release rate was 2.3％ ( 1/43 ) and 2.3％ (1/44) in PS group and CR group,respectively.The incidence of anterior knee pain was 4.7％(2/43 ) and 4.5％(2/44) after 6 months surgery in PS group and CR group.The incidence of anterior knee pain was 0 at the end of follow-up in both groups.There was no significant difference in the lateral retinacular release rate and the incidence of anterior knee pain between two groups (P ＞0.05).The range of motion and American knee society score(KSS) was similar and no statistical difference was found between two groups(P ＞ 0.05 ).The incidence of patellar tilt or subluxation in X-ray was 2.3％ (1/43) and 2.3％ (1/44) at the end of follow-up in PS group and CR group.There was no significant difference between two groups (P ＞ 0.05 ).At the end of follow-up,no osteolysis,X-ray radiolucent zone and prosthesis loosening were found in both groups.There was no revision owing to loosening or other reasons.ConclusionsThe intermediate term efficacy of PS TKA and CR TKA is near a tie.However,the future efficacy still need further follow-up.

Objective To explore the differential diagnostic significance of clone analysis for multicentric occurrence (MO) and intrahepatic metastasis (IM) in hepatocellular carcinomas (HCCs).Methods Loss of heterozygosity (LOH) and microsatellite instability (MSI) were analyzed by microsatellite polymorphism test and the integration sites of HBV were assessed by Southern blot in each nodule of the HCCs. The clonalities were then compared between each nodule of the same patient and the diagnosis of MO or IM was concluded. Finally, the results based on clonality analysis were compared with those according to clinicopathological and imaging data. Results According to the results of LOH and MSI in 79 nodules and nontumorous tissue from 35 cases of mutiple HCCs, 5 (14.3%)and 29 cases (82.9 %) were divided into MO and IM, respectively. Both MO and IM presented simultaneously in 1 patient (2.9%). The integration sites of HBV could be analyzed in 77 nodules from 34 multiple HCCs. Among them, 6 (17. 6%) and 27 cases (79.4%) were divided into MO and IM, respectively. Both MO and IM presented simultaneously in 1 patient (2.9%). The classification results of microsatellite polymorphism test and HBV integration sites analysis demonstrated a significant positive correlation (rs = 0.909, P＜0.001). Nevertheless, neither the classification of microsatellite polymorphism test nor that of HBV integrate sites analysis was correlated with the discrimination according to clinicopathologic and imaging data (rs=0. 133, P=0. 468, rs =0. 262, P=0. 155, respectively). Recurrence in patients in the MO group occurred significantly later than that in IM cases who were diagnosed by clonality analyses (P=0. 001). Conclusion The clonality analysis based on the results of LOH and MSI or assessments of HBV integrate sites is useful for the differential diagnosis of MO and IM and their treatment and prognosis.

Objective:This article aimed to discusse the feasibility and effects of humanistic service using Kano model in outpatients .Methods:Using a self-designed Kano model outpatient humanistic service demand question-naire investigated clinic patients by using the Kano model analysis method , implementing humanistic service in the outpatient on the base of analyzing the starting point , and compare the satisfaction situation before and after the im-plementation .Results:There are service items including necessary quality , expected quality , attractive quality in Kano model analysis , 9, 8, 2 items respectively.After the implementation of humanistic service , patient's satisfac-tion increased significantly .Conclusion:The Kano model can be used in the outpatient services .The outpatient hu-manistic service could get the approvals from most outpatient patients .Outpatient humanistic service can improve the satisfaction of patients , so as to reduce medical disputes , alleviate conflicts between the doctors and patients , and improve the hospital popularity .