AIM:To explore the roles of brain-stem auditory evoked potential(BAEP) in early monitoring the hearing loss and brain damages in hyperbilirubinemia and nitric oxide(NO) in the pathogenesis of bilirubin-induced hearing loss and brain damages.METHODS:Different doses of bilirubin solution(30 mg/kg,60 mg/kg,90 mg/kg,120 mg/kg and 150 mg/kg) were injected into the abdominal cavity of 15-day old SD rats to make the animal model of hyperbilirubinemia.The serum concentrations of bilirubin were detected by a micro-gauge.The bilirubin concentrations in the brain tissues were examined via a diazo method.The Na+-K+ATPase activities in the brain tissues were analyzed by rooting phosphorus.The NO contents in the brain tissues were assayed via the method of nitrate reductase.BAEP were recorded with an evoked potential recorder.RESULTS:After making the ejection,parts of the rats in the high dosage groups(120 mg/kg and 150 mg/kg) showed the abnormal neuro-behaviors.After 6 hours of the ejection,the bilirubin concentrations in serum and in brain tissues,and NO contents in the brain tissues were increased significantly.The Na+-K+ATPase activities in the brain tissues were decreased obviously,and the PL and IPL of BAEP were prolonged significantly in all the experimental rats except the ones in low dosage group(30 mg/kg).The changes of them were closely related to the dose of injected bilirubin.CONCLUSION:The PL and IPL of BAEP are the objective and sensitive indexes for early monitoring the hearing loss and brain damages in hyperbilirubinemia.NO may plays a certain role in the pathogenesis of bilirubin induced hearing loss and brain damages.

Objective To evaluate the effects of femoral offset (FO) on the stress level of bone cement total hip arthroplasty (THA) in the elder patients by the three-dimensional finite element analysis. Methods The normal bilateral hip joints in two cases was determined with CT imaging,with parameters including FO,neck shaft angle and neck length.The three-dimensional finite element model of THA was built so as to make Von Mises stress analysis of the changes of different neck lengths,neck shaft angles and FO. Results Stress levels in the prosthesis and bone cement reduced monotonically with the increase of neck shaft angles.In the meantime,the stress levels were lowered when neck length was in a range of 35-44 mm,but beyond the range they showed monotonous increase. Conclusions The reduction of stress levels of prosthesis and bone cement,promotion of femur stress and extension of range of motion of hip joints are closely related to FO.FO reconstruction benefits the restoration of abductor force arm and biomechanical function of normal hip joints.

Objective To compare the short-term efficacy of AC TightRope plate and clavicular hook plate in the treatment of acromioclavicular joint dislocation.Methods A retrospective case control study was conducted to analyze the clinical data of 32 patients with acromioclavicular joint dislocation admitted to Yifu Hospital Affiliated to Nanjing Medical University from April 2016 to December 2017.There were 23 males and 9 females,aged 26-61 years [(43.5 ±9.5)years].According to Rockwood classification,there were 23 patients with type Ⅲ and 9 patients with type Ⅴ.The patients were divided into AC TightRope group and clavicular hook plate group according to different treatment methods.There were 17 patients in AC TightRope group,including 12 males and 5 females,aged (42.6 ± 10.3)years.There were 15 patients in clavicular hook plate group,including 11 males and 4 females,aged (44.5 ± 8.9)years.The incision length,operation time,intraoperative blood loss,hospitalization time,postoperative visual analogue scale (VAS) of the affected shoulder,functional recovery of shoulder joint and complications were compared between the two groups.Results All patients were followed up for 6-26 months,with an average of 15 months.There was no significant difference between the two groups in hospitalization time (P ＞ 0.05).In the AC TightRope group and clavicular hook plate group,the operation time was (41.5 ±4.2)minutes and (60.1 ± 4.2) minutes,respectively (P ＜ 0.01);the incision length was (3.6 ± 0.3) cm and (10.1 ± 0.6) cm,respectively (P ＜ 0.01);the intraoperative blood loss was (45.3 ± 11.1) ml and (78.3 ± 16.0) ml,respectively (P ＜ 0.01);the postoperative VAS of the shoulder was (1.9 ± 0.5) points and (3.1 ± 0.7) points,respectively (P ＜ 0.05);the excellent and good rate of postoperative recovery of shoulder joint function was 100％ (17/17) and 67％ (10/15),respectively (P ＜0.01).There were no complications such as surgical incision infection,intraoperative neurovascular injury or condylar fracture during the perioperative period.No serious postoperative complications such as internal fixation loosening,loss of reduction or recurrence of dislocation were found in both groups.Conclusion For acromioclavicular joint dislocation,AC TightRope can obtain good clinical effect and has obvious advantages in operation time,incision length and blood loss,with lower incidence of shoulder pain and better functional recovery compared with clavicular hook plate.

Objective To explore clinical and radiological outcomes of treating displaced fractures of proximal clavicle by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle.Methods From August 2013 to August 2015,12 patients with displaced fracture of proximal clavicle were treated in our hospital by open reduction and internal fixation with an inverted anatomic locking plate for distal clavicle.They were 11 men and one woman,with an average age of 43.5 years (range,25 to 62 years).There were 9 fresh and 2 old fractures.According to the Edinburgh classification,10 fractures were classified as type 1B1 and 2 as type 1B2.After fixation,the 180° inverted plate on the ipsilateral side was placed on the superior aspect of proximal clavicle.The medial fragment was fixed with 2 to 4 pieces of 2.7 mm multidirectional locking screw and the lateral fragment with 2 to 3 pieces of 3.5 mm locking screw.X-ray and CT were performed to assess union,delayed union,nonunion,and hardware failure.Functional outcomes were assessed by Constant-Murley scores and Disabilities of the Arm,Shoulder and Hand (DASH) scores at final follow-ups.Results There were no significant neurovascular injuries intraoperatively.All patients were followed up for an average of 15.6 months (range,12 to 24 months).All fractures healed after an average of 14.3 weeks (range,8 to 24 weeks).At final follow-ups,the mean Constant-Murley score was 96.0 points (range,84 to 100 points) and the mean DASH score 1.9 points (range,0 to 14.8 points).There were no such significant complications as infection,reduction loss or implant failure.Conclusion Displaced fractures of proximal clavicle may be treated with an inverted anatomic locking plate for distal clavicle on the ipsilateral side because of rigid fixation,fine stability and good chance for early rehabilitation.

Purpose To investigate the clinicopathological features,immunophenotype,diagnosis and differential diagnosis of superficial CD34-positive fibroblast tumor.Methods Retro-spective analysis was performed in 6 cases of superficial CD34 positive fibroblastic tumors.Routine HE staining was performed under light microscopy,immunohistochemical Eli Vision staining was performed,and FISH was used to detect the PRDM10 gene.Literature review was also conducted.Results Among the 6 SCPFT patients,there were 2 males and 4 females.Four masses were located subcutaneous in the lower limbs,one in the lower abdomen,and one in the vulva.Microscopically,the tumor cells were arranged in bundles or solid patches,with obvious pleomor-phism or deformity of the nucleus and nucleoli.Pseudoinclusion bodies were visible in the nucleus,and the cytoplasm was eosin-ophilic.Some areas of the cells were epithelioid,with no mitotic figures observed.A small amount of inflammatory cells were scattered in the stroma.Immunophenotypically,diffuse and strong expression of CD34 and INI1 was observed in the tumor cells,some cells expressed CK(AE1/AE3),but did not ex-press SMA,CD68,desmin,S-100,CD31,ERG.Ki67 had a value-added index below 3％.FISH detection of PRDM10 gene was performed on 4 cases of SCPFT,and 3 cases were positive.Conclusion Superficial CD34-positive fibroblast tumor is a newly reported soft tissue tumor with borderline or low-grade ma-lignant biological behavior.Diagnosis needs to be differentiated from multiple CD34 positive soft tissue tumors to avoid over diag-nosis and over treatment.

Erythropoietic protoporphyria （EPP） is a rare inherited metabolic disease that often involves skin， blood， and nervous systems， and EPP with the main manifestations of severe liver damage and acute abdominal pain is extremely rare. By reviewing the clinical data and genetic testing results of a patient with EPP， this article discusses the clinical features and pathogenic genes of this disease， in order to improve the understanding of the disease among hepatologists and achieve early diagnosis and treatment.