Objective To analyze the effects of vascularized fibular flap combined with vacuum sealing drainage (VSD) in the repair of tibia defect.Methods Clinical data of 24 patients with chronic osteomyelitis of the tibia who accepted the operation of vascularized fibular flap combined with VSD were collected in the study.In the first operation, the lesions were completely debrided and the dead bone was removed, then the vascularized fibular was replaced from the other limb to repair the tibia defect.Later, vacuum-assisted closure was applied to cover the wound.Results All patients enrolled in the study were followed up for 13 to 50 months, with an average of 32.3 months.The sinus of 22 cases healed in 4 weeks and the healing rate was 91.7%.The other two patients received additional debridement for the sinus and they also healed soon after that.All flaps survived and the survival rate was 100%.The X-ray showed that the transplanted fibula was healed in all cases, with a healing rate of 100%.The healing time ranged from 4 to 7 months, with an average of 4.9 months.Based on the Enneking scoring system, the patients achieved an average score of 26 points out of 30 points, and the recovery rate of limb function was evaluated as 86.7%.Conclusion For patients with chronic osteomyelitis of the tibia, vascularized fibular flap combined with VSD can not only effectively repair bone defect, but also restore the continuity of limbs.The application of VSD can effectively control infection, shorten treatment course, and restore limb function.

Objective To observe the effectiveness of Lugol's chromoendoscopy of the entire e-sophagus on the diagnosis of advanced esophageal carcinoma. Methods Four-hundred and forty patients with advanced esophageal carcinoma were examined with lugols chromoendoscopy preoperatively. Biopsy was taken from non-stained area. The specimen obtained after esophagectomy were sectioned in sub-series. Results Abnormal stains were observed in 55 cases( 12. 5% )including 48 with multifocus,4 with extended lesions and 3 with both. The patterns of esophagectomy were changed in 51 cases due to abnormal finding of stains. Compared with the pathology specimen, the sensitivity and specificity of the stain for multifocus were 97. 9% and 85. 2% respectively. Conclusion It is useful in the patients with advanced esophageal carcinoma to perform a Lugol' s chromoendoscopy . More detailed information might obtain from the examination , particularly in finding out the multifocus lesions and outlining the extent of lesion.

Objective To explore the application of thinprep cytology test thinprep cytologic test ( TCT) and the serum squa-mous cell carcinoma antigen ( SCC-Ag) measurement in the cervical lesions screening .Methods TCT and serum SCC-Ag measure-ment were performed in 58 patients with cervical lesions .Based on pathology diagnosis , specificity and sensitivity of these two screen-ing methods were calculated .Results Sensitivity and specificity of TCT detection were 75%and 65.8%, the sensitivity and specific-ity of SCC-Ag detection was 60%and 86.9%, respectively, and specificity of combined detection were 55%and 89.4%, respective-ly.There was statistical significance in TCT test and SCC-Ag test ( P <0.05 ) , the difference had statistical significance of combined detection of both with a single TCT to detect differences ( P <0.05 ) .Conclusions The combination of TCT and SCC-Ag detection can improve specificity and there was a certain clinical application value in the screening of cervical lesions .

Doctor-patient communication is the very important part of the relationship between patients and doctors.It builds the trust from patients and protects the interests of doctors and patients.The communication is the useful way to reduce the medical dispute.This paper discusses the importance of communication and gives advices on how to communicate between patients and doctors.

0.05). However, the reduction of intracranial pressure were gender and age dependent (P

Objective:To study the effect of simvastatin therapy on bone density and metabolism in rats with osteoporosis. Methods:Forty female Wistar rats were randomly divided into four group: control group-A (sham operation group), ovariectomized group-B(OVX), OVX with oestrogen treatment group-C and OVX with simvastatin treatment group-D. Thirty days after surgery, oestrogen replacement therapy(nilestriol 1 mg/(kg?d), ig once a week for 12 weeks) in group-C and simvastatin therapy(with simvastatin 5 mg/(kg?d), ig once a day for a week, paused for two weeks,and given for another one week,until 12 weeks)in group-D.After 12 weeks, all rats were sacrificed. On the 12th day and the 4th day before sacrifice,all rats received subcutaneous injections of tetracycline as in vivo label. The proximal tibiae of rats were processed to undecalcified sections and stained with HE or Von Kossa.The microarchitecture was studied by bone histomorphometry. Results:Osteoporotic changes in proximal tibiae were observed in all ovariectomized rats and not in sham-operated rats. There was significant difference in static parameters (%Tb.Ar, Tb.N,Tb.Sp) comparing group C or D with group B respectively(P

A large number of health information management persons are needed in regional health information construction and the characteristics of medical institutions needing for health information management persons in re-gional health information construction are different.Analysis of their common and specific needs for health informa-tion management persons can show the training target of information management , establish the scientific and rational training mechanisms, optimize the course system, enforce the practical education in colleges and universities, and increase the employment of their graduate , thus meeting the crying need of health information management persons in our country .

Objective To investigate the risk factors of severe intrahepatic cholestasis during early period after liver transplantation.Methods The clinical data of 225 patients who received orthotopic liver transplantation at the Nanfang Hospital of Southern Medical University from August 2004 to February 2011 were retrospectively analyzed.All patients were divided into positive group (60 patients with intrahepatic cholestasis) and negative group (165 patients without intrahepatic cholestasis).Preoperative,intraoperative and postoperative factors of the 2 groups were compared via t test,chi-square test,Wilcoxon test or Logistic regression analysis.Results The proportion of patients with hepatic cirrhosis,hepatic encephalopathy integral,ascites integral,international normalized ratio,and the levels of prothrombin time (PT),total bilirubin (TBil),aspartate aminotransferase of the positive group before operation were significantly higher than those in the negative group (x2 =6.09,Z =2.22,2.60,2.46,2.84,4.81,3.42,P ＜ 0.05),while the levels of albumin,Na +,K +,hemoglobin,platelet (PLT) of the positive group in the operation were significantly higher than those in the negative group (t =2.10,4.97,Z =2.49,t =3.51,Z =3.66,P ＜ 0.05).The ratio of compatible blood type of the donors and recipients,ratio of fatty liver graft,cold ischemia time,relative warm ischemia time,intraoperative blood loss,intraoperative transfusion of red blood cells,PLT,and cryoprecipitate of the positive group after the operation were significantly higher than those in the negative group (x2 =4.29,13.11,Z =2.45,2.61,3.75,3.20,2.89,3.95,P ＜0.05).The incidences of acute rejection,hepatic artery embolism,pulmonary infection,bacteraemia,fungal infection and cytomegalovirus (CMV) infection were significantly higher than those in the negative group (x2 =9.87,4.91,8.21,6.29,3.92,9.26,P ＜0.05).The results of multivariate analysis revealed that preoperative level of TBil ＞ 51.3 μmol/L,fatty of the liver graft,intraoperative transfusion of cryoprecipitate,postoperative acute rejection,hepatic artery embolism,postoperative pulmonary infection,bacteraemia,CMV infection were independent risk factors of severe inrahepatic cholestasis (OR =15.82,7.99,2.88,3.03,53.20,3.34,4.11,3.22,P ＜ 0.05).The incidence of severe intrahepatic cholestasis was significantly lower in patients with higher level of PLT and longer PT (OR =0.33,0.25,P ＜ 0.05).The mortality rates of the positive group and negative group at 6 months after the operation were 41.7％ (25/60) and 19.4％ (32/165),and the mortality rate of the positive group was significantly higher (x2 =11.54,P ＜ 0.05).Conclusion Correction of poor clinical status before liver transplantation,reinforcement of infection control and anti-rejection may reduce the incidences of complications and decrease the associated early mortality.

Objective To study the relationship between uric acid and various cognitive functions in Alzheimer's disease (AD).Methods A total of 46 patients with AD and 50 people without cognitive disorder were selected.Plasma uric acid,MOCA,and ADL were measured.Results The mean level of plasma uric acid was (217.93 ± 67.91 )μmol/L in ADs,and (337.02 ± 59.70) μmol/L in controls.The mean level of uric acid was significantly lower in the blood of patients with AD than control with a statistically significant difference ( t =9.142,P ＜0.01 ).Multiple regression analysis revealed that low uric acid,age,educated years,and hypertension were related to cognitive function( P ＜0.01,P ＜0.05 ).Partial correlation analysis revealed uric acid was significantly related to memory ( r =0.457,P =0.002),and attention ( r =0.398,P =0.008).Conclusions Low levels of uric acid may have influence on the occurrence and development of cognitive function impairment in AD.Uric acid may have more influence on the memory and attention in patients with AD.

Objective　To investigate exogenous ceramide-induced apoptosis in colon carcinoma LoVo cells.Methods　LoVo cells were pretreated for 3 h with or without the presence of phorbol 12-myristate 13-acetate (PMA), a potent protein kinase C (PKC) stimulator, later treated with C2-, C6-ceramide or C2-dihydroceramide, and then passed through gel electrophoresis, Heochest 33342 fluorescence staining and flow cytometry with Annexin V/PI staining. The treated LoVo cells were observed for biochemical and morphologic changes. Results　Treatment with C2- or C6-ceramide in the range of indicated concentrations (10～25 μmol/L) for 12 to 24 hours resulted in apoptosis in LoVo cells, whereas C2-dihydroceramide, which is similar to C2-ceramide in configuration but lacks the trans double bond at C4-C5 of the sphingoid base backbone, did not induce the apoptosis at the same or even higher concentrations, indicating that the ceramide-induced apoptosis was stereospecific. Moreover, the exogenous ceramide-induced apoptosis in LoVo cells was inhibited in part by PMA. Conclusion　Ceramide takes part in the process of apoptotic signal transduction in LoVo cells. PKC may be one of downstream target molecules acted by ceramide.