AIM: To observe the curative effect of reconstruction of extensor tendon by transplanting heterologous tendon in the treatment of mallet finger deformity. METHODS: Fifteen cases of mallet finger deformity treated by reconstruction insertion of extensor tendon were enrolled at Department of Orthopedics, Xuzhou Hospital Affiliated to Medical College, Southeast University from January 2003 to March 2006. They all participated the observation voluntarily. Two open injury patients were treated with operation in the first emergency phase. The 13 closed injury patients were treated with operation in the first week phase. ①operation method: After brachial plexus anesthesia, an incision was conducted on the back of distal interdigital joint. A bone tunnel was made at 4 mm distance from the digital interphalangeal joint and deviation to the back of distal phalanx. A suit heterologous tendon was passed through the bone tunnel and was sutured with the lateral tendon after crossing on the back of the digital interphalangeal joint (the distal interphalangeal joint in 10?-15? extension by 1.0 mm diameter keith needle). Fixation with plaster splint, function practice of the distal phalanx could be performed when the plaster splint and the keith needle were removed after 6 weeks. Follow-up was done regularly after operation. ②function assessment: The total extension lag angle of metacarpophalangeal joint, proximal articulations interphalangeae, distal articulations interphalangeae at maximal extension position and the distance between finger tip and transverse striation at finger flexion position were measured. 0?indicated excellent flexion and finger tip was over transverse striation at finger flexion; at most -15? indicated good flexion and finger tip touched transverse striation at finger flexion. RESULTS: Totally 15 patients were involved in the result analysis, no drop-out. Postoperative follow up ranged from 2 months to 3 years, with an average of 19.5 months. The wound of all patients was good and no reject reaction. According to Dargan criteria, the overall effective rate was 93.3%. Excellent result was obtained in 12 cases (80%) and good in 2 cases (13.3%). One case was distal interphalangeal joint stiffness and flexion function was not free. CONCLUSION: Reconstruction of extensor tendon is an effective method for mallet finger deformity.

Objective To explore the training demand among clinical medical postgraduate students.Methods Focus Group Discussions and a research interview,two of the qualitative study methods were applied among medical students of a hospital.Results Different clinical medical postgraduate students need different levels training.The demand status related to the students' training styles.Students had desire to receive kinds of help of hospital administrative authority.Conclusion Training guide is importance during the growth of clinical medical postgraduate students.Hospital administrative authority should afford manifold ways to satisfy the demand of students for their training.

Objective To investigate the effect of dexmedetomidine on the intubation reaction during intratracheal intubation in the patients in the emergency department .Methods Fifty adult patients needing emergent tracheal intubation in the emergency de-partment of this hospital were divided into the dexmedetomidine group and the middazolam group ,25 cases in each group .The dexmedetomidine group was given dexmedetomidine(1 μg/kg) before tracheal intubation and the midazolam group was given mid-azolam(0 .1 mg/kg) before tracheal intubation .Results BP and HR during tracheal intubation ,at 1 ,3 min after tracheal intubation in the dexmedetomidine group were significantly decreased compared with the midazolam group (P<0 .05);SpO2 at 1 min before tracheal intubation and during tracheal intubation in the dexmedetomidine group had no statistical difference compared with before drug administration(P>0 .05);SpO2 at 1 min before tracheal intubation and during tracheal intubation in the middazolam group was decreased ,which showed the statistical difference compared with before drug administration (P<0 .05) .Conclusion Dexme-detomidine is more effective than midazolam in alleviating cardiovascular responses during intratracheal intubation ,moreover has no influence on the patient′s respiratory function .

To explore the clinical characteristics, diagnosis, and management of pancreatic glucagonoma, a retrospective analysis of the clinical data and diagnostic algorithm of a patient with pancreatic glucagonoma was conducted, along with literature review. Pancreatic glucagonoma is a rare neuroendocrine tumor that originates from the pancreatic alpha cells. The main manifestations of glucagonoma syndrome(GS) include necrolytic migratory erythema, diabetes, anemia, and other systemic involvement. Early diagnosis of GS is challenging and crucial. Early identification and recognition of skin lesions contribute to timely diagnosis and treatment of the disease. Surgical resection is an effective treatment modality for glucagonoma.

OBJECTIVETo explore the clinical features and mutations of MYO5B gene in a family affected with microvillus inclusion disease.

METHODSClinical data of an infant affected with microvillus inclusion disease was collected. Genomic DNA was extracted from peripheral blood samples from the patient and her parents. PCR amplification and Sanger sequencing were performed to analyze all the exons and their flanking sequences of the MYO5B gene.

RESULTSThe patient presented with complicated manifestations including respiratory distress syndrome, dehydration, acidosis, bowel dilatation, liver and kidney dysfunction, and severe and intractable diarrhea. A compound mutation of the MYO5B gene, i.e., IVS37-1G>C/c.2729_2731delC (p.R911Afs916X), was discovered in the patient. The former was a splice-site mutation inherited from the mother, while the latter was a frameshift mutation inherited from the father. Both were not reported previously.

CONCLUSIONBased on the clinical and molecular evidence, the patient was diagnosed with microvillus inclusion disease. Above finding has expanded the mutation spectrum of the MYO5B gene, which can provide valuable information for genetic counseling for the family.

Family ; Female ; Genetic Testing ; methods ; Genotype ; Humans ; Infant ; Malabsorption Syndromes ; genetics ; Male ; Microvilli ; genetics ; pathology ; Mucolipidoses ; genetics ; Mutation ; genetics ; Myosin Heavy Chains ; genetics ; Myosin Type V ; genetics ; Phenotype

Objective:To investigate the clinical characteristics of acute myeloid leukemia with BCR-ABL p210 fusion gene-positive.Methods:The clinical characteristics of a patient diagnosed in the Second Hospital of Jiaxing were analyzed and the related literature was reviewed.Results:BCR-ABL p210 fusion gene and Philadelphia chromosome (Ph) were detected by reverse transcription-polymerase chain reaction (RT-PCR) and fluorescence in situ hybridization (FISH). Imatinib associated with multi-drug intravenous chemotherapy resulted in poor efficacy.Conclusions:Patient with Ph +/BCR-ABL + acute myeloid leukemia is rare with a very poor prognosis. There is no unified standard treatment and the efficacy of tyrosine kinase inhibitors is unclear. Intravenous chemotherapy combined with hematopoietic stem cell transplantation is expected to change the prognosis.

Objective: To evaluate the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in prophylaxis neutropenia after chemotherapy in patients with lymphoma. Methods: This was a multicenter, single arm, open, phase Ⅳ clinical trial. Included 410 patients with lymphoma received multiple cycles of chemotherapy and PEG-rhG-CSF was administrated as prophylactic. The primary endpoint was the incidence of Ⅲ/Ⅳ grade neutropenia and febrile neutropenia (FN) after each chemotherapy cycle. Meanwhile the rate of antibiotics application during the whole period of chemotherapy was observed. Results: ①Among the 410 patients, 8 cases (1.95%) were contrary to the selected criteria, 35 cases (8.54%) lost, 19 cases (4.63%) experienced adverse events, 12 cases (2.93%) were eligible for the termination criteria, 15 cases (3.66%) develpoed disease progression or recurrence, thus the rest 321 cases (78.29%) were into the Per Protocol Set. ②During the first to fourth treatment cycles, the incidences of grade Ⅳ neutropenia after prophylactic use of PEG-rhG-CSF were 19.14% (49/256) , 12.5% (32/256) , 12.18% (24/197) , 13.61% (20/147) , respectively. The incidences of FN were 3.52% (9/256) , 0.39% (1/256) , 2.54% (5/197) , 2.04% (3/147) , respectively. After secondary prophylactic use of PEG-rhG-CSF, the incidences of Ⅳ grade neutropenia decreased from 61.54% (40/65) in the screening cycle to 16.92% (11/65) , 18.46% (12/65) and 20.75% (11/53) in 1-3 cycles, respectively. The incidences of FN decreased from 16.92% (11/65) in the screening cycle to 1.54% (1/65) , 4.62% (3/65) , 3.77% (2/53) in 1-3 cycles, respectively. ③The proportion of patients who received antibiotic therapy during the whole period of chemotherapy was 34.39% (141/410) . ④The incidence of adverse events associated with PEG-rhG-CSF was 4.63% (19/410) . The most common adverse events were bone pain[3.90% (16/410) ], fatigue (0.49%) and fever (0.24%) . Conclusion During the chemotherapy in patients with lymphoma, the prophylactic use of PEG-rhG-CSF could effectively reduce the incidences of grade Ⅲ/Ⅳ neutropenia and FN, which ensures that patients with lymphoma receive standard-dose chemotherapy to improve its cure rate.