Objective Examinating the efficacy and safety on prophylaxis of deep venous thrombosis(DVT) following arthroplasty using low-molecular-weight heparin (LMWH) in combination with intermittent pneumatic compression(IPC) starting with different time. Methods 156 patients undergoing primary arthroplasty from July 2003 to June 2005 were divided into four groups randomly. In the first group, 38 patients used LMWH preoperatively and IPC starting since anesthesia. In the second group, 42 patients did LMWH postoperatively and IPC starting since anesthesia. In the third group, 36 patients did preoperative LMWH and post-operative IPC. In the fourth group, 40 patients did post-operative LMWH and IPC. All patients were examined by colour duplex ultrasonography, valued the clinical symptom of DVT, recorded the volume of blood loss in perioperation and observed complication of hemorrhage. Results In the first group, two cases of DVT (5.26%) were found and the average perioperative volume of blood loss was (1030.8?282.0) ml. In the second group, two cases of DVT (4.76%) were found and the average volume of blood loss was (900.7?246.9) ml. In the third group, one case (2.78%) of DVT was found and the average volume of blood loss was (1040.3?288.5) ml. In the fourth group, nine cases of DVT (22.5%) were found and the average volume of blood loss was (852.2?295.4) ml. Comparing the incidence of DVT between each group, group 1, 2, 3 were lower than group 4(P﹤0.05). Comparing the volume of blood loss in perioperation, group 2 , 4 were less than group 1,3(P﹤0.05). Conclusion On the basis of this study, it is more effective and safer using LMWH staring with post-operative 10 h in combination with IPC starting with anesthesia on prophylaxis of DVT following arthroplasty.

Objective To evaluate the effect of a nurse-led case management intervention on arm function and uncertainty for women with breast cancer.Methods 90 women with breast cancer were divided into the intervention group and the control group according to their nurses,with 45 patients in each group.All participants were followed six months after surgery.The intervention group attended a 6-month nurse-led case management program,while the control group received the routine care and follow-up only.Questionnaires on arm function and uncertainty were administered 1 month,3 months and 6months after the surgery respectively.Score changes were compared by repeated-measure ANOVA and MANOVA.Results The arm function of the intervention group was better than the control group,except for the 10th day after the operation,there were significant differences at other three time points.The disease uncertainty level of the intervention group was better than that of the control group,except for the dimension of unpredictability,there were evident differences in other dimensions at other three time points.Conclusions The nurse-led case management intervention could improve arm function recovery and decrease the uncertainty to disease of breast cancer survivors.

OBJECTIVE:To evaluate therapeutic efficacy of strontium dichloride (89SrCl2 ) combined with local radiotherapy for pain caused by malignant tumor bone metastasis. METHODS:115 patients with malignant tumor complicated with bone metasta-sis were analyzed retrospectively,and they received therapy regimen of 89SrCl2 combined with local radiotherapy. The amount of 89SrCl2 was calculated according to body weight of patients,and given by intravenous injection manner at the beginning of treat-ment,and then radiotherapy target section was confirmed according to iconography for irradiation. Effect of bone pain control,side effects (myelosuppression) and the effect of treatment on quality of life were evaluated at the end of treatment. RESULTS:After one month of treatment,there were 32 cases of complete remission(CR)and 62 cases of partial remission(PR),and total effec-tive rate was 81.7%;after one month of treatment,6 cases(5.1%)suffered from Ⅲ-Ⅳ degree myelosuppression;but there was none of Ⅲ-Ⅳdegree myelosuppression case after 2 months of treatment. The improvement of overall quality of life was not signifi-cant after treatment. Pain symptoms,general situation and sleep quality all improved significantly. CONCLUSIONS:89SrCl2 com-bined with local radiotherapy can control pain caused by malignant tumor bone metastasis and induce side effect,and improve quali-ty of life to certain extent.

Objective To discuss perioperative features, operative approach and surgical effects of spinal tuberculosis in older patients. Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal tuberculosis ranging in age from 61 to 78 years (average, 67 years). The lesion was located in thoracic vertebrae in 9 patients, thoracolumbar vertebrae in 14, lumbar in 16, and lumbosacral in 6. Preoperative Frankel grades were B in 7 cases, C in 21, D in 11 and E in 6. Among them, 21 had cardio-cerebrovascular disease, 10 had diabetes mellitus. With preoperative medicine and chemotherapy for 2-3 weeks, all patients were treated surgically. The surgical procedures included: 1) Posterior focus debridement, bone grafting and one-stage posterior transpedicular screw system fixation in thoracic vertebrae (T2-T7). 2) Anterior debridement, bone grafting and one-stage posterior transpedicular instrumental fixation in lumbosacral vertebrae (L5-S1). 3) Anterior focus elimination, bone grafting and one-stage anterior plate fixation in the other vertebrae. Results Forty-five patients were followed up for 24 to 40 months, with the average of 28.5 months. No severe complication occurred during and after operation. Forty-four cases had recovered and 1 recurred. Spinal fusion occurred 12-18 months after operation. Frankel neurological grades improved significantly. Conclusion With the effective management of comorbidities in perioperative period,the elderly could tolerate surgical treatment. The appropriate approaches, thorough debridement and reasonable bone grafting with internal fixation are key to therapeutic success.

AIM: To determine the antioxidant and the immunoregulatory effects of Centella asiatica extracts. METHODS: Centella asiatica was extracted with alcohol and different organic solvent. The content of polyphenol was determined by Folin-ciocalteau method. The efficacy of the extracts to scavenge the hydroxy radical (OH·), 1,1-diphenyl-2-picryl-hydrazyl radical (DPPH·) and intra-cellular reactive oxygen species (ROS) was measured. Lymphocyte proliferation was assessed to observe the influence of Centella asiatica extracts. RESULTS: (1) Centella asiatica was found to have abundant polyphenol extrated from different phases and in a descending order as follows: ethyl acetate extracts>n-butanol extracts>water extracts>ligarine extracts. (2) Extracts of Centella asiatica exhibited the scavenging efficacy of OH· and DPPH· free radicals, in which the acetic ether extracts showed the significant effect. (3) The acetic ether extracts had significant ability to inhibit the generation of ROS in stimulated lymphocytes. (4) The acetic ether extracts suppressed the lymphocyte proliferation. (5) The active ingredient was identified as flavone. CONCLUSION: Flavones in the Centella asiatica posseses antioxidant activity and effectively inhibits lymphocyte proliferation, showing ability of immunosuppre-ssion.

BACKGROUND:The existing bone grafting apparatus are al long tubular-shape, antegrade bone grafting; however, the bone grains within the tube were difficult to put through, along with large bone loss. OBJECTIVE:To design a new concept of minimaly invasive bone grafting apparatus, so as to achieve the minimaly invasive bone grafting in vertebral body and intervertebral space. METHODS: On Solidworks 2012 software platform, the 3D three-dimensional solid modeling technology was employed to design a new concept of gun-shape bone grafting device with the characteristics of headend reversely placing at the grafting position and antegrade pushout, against the problems such as antegrade bone grafting, long bone grafting path and difficulty in bone grafting existing in precious percutaneous or/and transpedicular bone graft apparatus. The virtual assembly and simulative bone grafting surgery were performed with the bone grafting apparatus for observation of the instrument matching degree and grafting surgical procedures. RESULTS AND CONCLUSION: A set of minimaly invasive gun-shape bone grafting apparatus was successfuly designed; its length was 20 cm in total; the length of the front semi-closed bone tube was 2.5 cm. There are two kinds of diameter specifications: inner diameter of 3.5 mm/outer diameter of 4 mm, and inner diameter of 5 mm/outer diameter of 6 mm. Virtual assembly revealed that the grafting apparatus were wel matched. Stimulative surgery displayed that the bone grain loading and launch were simple. The gun-shape bone grafting device is reasonable in design, avoiding pushing too long distance, bone pushing difficulties, bone loss and other problems in previous tubular bone grafting apparatus. Percutaneous, endoscopic vertebrae or intervertebral space minimaly invasive bone grafting can be performed with this apparatus.

Objective To explore the clinical efficacy and safety of microsurgery in hand retrograde skin avulsion.Methods 56 patients with hand retrograde skin avulsion were selected and randomly divided into study group(28 cases)and control group(28 cases).The study group was taken treatment of microsurgery,the control group was taken treatment of free return FLAP treatment plant.The treatment effect of the two groups was compared. Results The total effective rate of the study group was 96.4%,which was significantly higher than 78.6% of the control group(χ2 =4.082,P =0.043).The average survival skin rate of the study group was (95.62 ±4.23)%, which was significantly higher than (73.20 ±6.48)% of the control group(t =15.331,P =0.000).The skin index in the study group was significantly better than the control group (χ2 =4.909,P =0.027).Conclusion Hand retrograde skin avulsion in patients using microsurgical treatment method can maximize recovery skin vitality and improve the appearance and function of the hand of patients,and improve the therapeutic effect.

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Objective To evaluate the role of native ureter for the management of renal transplantation urological complications retrospectively.Method Twenty-six renal transplant recipients (18 males and 8 females) experienced the following urological complications:upper ureter injury,urinary leaks and moderate or severe ureteric obstructions secondary to ureterovesical anastomotic stricture.These complications have been managed with minimally invasive endourologic techniques or percutaneous nephrostomy as the first-line intervention.While endourologic treatment did not succeed,and the recipients have been treated with intraperitoneal open surgical correction.Urinary continuity was established by pyeloureterostomy or ureteroureterostomy using recipient native ureter.A pigtail ureteral stent was placed with the tip positioned in the pelvis of the graft and native bladder and removed after 4 to 6 weeks.Result The recipients were managed successfully during a follow-up period of 6 months to 6 years without occurrence of urological complications.One case underwent graft loss due to chronic rejection 5 years later postoperation,and the rest developed stable renal function with baseline serum creatinine.Conclusion Excellent outcomes have been achieved by the use of recipient native ureter for the management of urological transplant complications.This simple and efficient procedure should be considered as the superior choice for the recipients who experienced urological complications while less invasive endourologic techniques failed.

Objective: To study the feasibility of evaluating the adequacy of hemodialysis using neural calculating method. Methods: The adequacy of hemodialysis patients were evaluated using Daugirdas, TACurea and neural calculating method respectively, the results of the 3 method; were compared with the clinical assessment of the patients. Results: The coincidence rate among the 3 methods was 84.6%, coincidence rate between neural calculating method and the clinical outcome of the patients was 92.3%, which was significantly higher than that of Daugirdas method (76.9%) and of TACurea (80.8%). Conclusion: Neural calculating method has higher accuracy in assessing the adequacy of hemodialysis patients and is clinically practical.