The management of periprosthetic fracture following total knee arthroplasty (TKA) remains a challenging problem. Periprosthetic fractures are increased with increasing TKA times,aging,and increased activity after TKA. Periprosthetic fractures after TKA involves the femur,tibia,or patella,in particular at the supracondylar region of the femur. In addition,periprosthetic fractures can also occur in operation. According to fracture morphology,various cause factors,and the timing of fracture,a number of treatment options are available to treat this complex problem. Appropriate fracture classification would assist clinical physicians to evaluate fracture site,type,bone loss and prosthesis fixation. Because of the complexity,periprosthetic fractures often require tailored treatment to attain a more individualized treatment strategy to promote fracture healing,reconstruct bone mass and maintain joint function. Recently,with improving internal fixation materials and surgical techniques,the methods of surgical treatment of periprosthetic fracture have made great progress.

The relative content of DNA-RNA and the nuclear area/nucleolar area ratio of the hyperplastic tissue,glottic polypus,dysplastic tissue of grade I to I laryngeal squamous cell carcinoma were measured in 33 cases with image analysis technique.It was found that the changes of DNA-RNA content and the ratio of nuclear/nucleolar area were parallel to those of the severity of the carcinoma,and RNA was markedly increased in grade 11 and I dysplastic tissue.On the basis of the current grading of laryngeal pathology,the combined determination of DNA-RNA can provide more sensitive indicators to the stages of malignant degeneration of the laryngeal squamous cell carcinoma.

OBJECTIVE: Polyurethane (PU) and silicon rubber have good biocompatibility, excellent mechanical properties, easy processing and controlled properties, etc. Therefore, their researches exhibit an important significance in the designs of the medical appliance and body apparatus.DATA SOURCES: The computer respectively indexed the database articles of abroad El, SCI, CA, Science Direct (Elsevier) and Chinese periodical full text from January 1995 to May 2006, the indexed words were "Silicon rubber, polyurethane, medical materials", the article language category was limited respectively in English and Chinese.STUDY SELECTION: The relevant articles (full text) that meet the study were selected by the first trial. Inclusion criteria: ① Related to silicon rubber and polyurethane. ② The medical rubber apparatus and body organ design. Exclusion criteria: The repetitive studies.DATA EXTRACTION: Collect totally 122 relevant articles that use the medicinal rubber materials, and expel the repetitive or similar research,therefore 16 articles meeting the request.DATA SYNTHESIS: ① Medicinal gum, hose and other products: The medical stopper used for sealing is requested to have the flexibility,resistant to cold, water, oil and disinfectant, and pinprick can still keep the original closeness and gastightness, etc. ② The abroad body organs: The material of repairing fracture, skull, meninges, bridge, auricle, mandible,windpipe, tear bolt, lung membrane, heart valve, stomach, intestine,peritoneum, penis, knuckle, muscle, knee membrane, skin and breast. ③ The research and expectation of the medicinal silicon rubber and polyurethane offer more medicinal apparatus and body organ.CONCLUSION: The study of the medicinal silicon rubber and polyurethane make people design and produce more cheap artificial organ and medicinal apparatus. More materials were applied to the clinic, so that satisfy the demand of many patients.

Objective To compare the efficacy, tolerance and cost of interferon (IFN) α-2b and adefovir (ADV) in patients with chronic hepatitis B (CHB) for two years. Methods The treatmentnaive outpatients with CHB were treated with IFN α-2b or ADV according to intention to treat.Among 77 patients, 34 were treated with recombinant IFN α-2b 5 MU once every other day subcutaneously (IFN group), 43 were treated with ADV 10 mg/day orally (ADV group). The medications were stopped or the regimens were changed due to intolerant adverse reactions or without effects according to intention to treat. The patients were followed up for 24 months. The therapeutic effects, adverse reactions, compliance and cost of two initial treatments were compared. The data were analyzed by Fisher exact probability test. Results The complete virological response (HBV DNA＜500 copy/mL) rates after 12 months of therapy in IFN group and ADV group were 41.2% (14/34)and 67. 4 % (29/43), respectively, while the alanine aminotransferase (ALT) normalization rates were41.2% (14/34) and 93. 0% (40/43), respectively. The rates in ADV group were both significantly greater than those in IFN group (both P＜0.01). There were no statistically significant differences of HBeAg negative rate and HBeAg seroconversion rate between the two groups. In IFN group, the expulsion rate was 23. 5% (8/34), the therapy was discontinued in 8. 8% (3/34) of patients due to adverse reactions and the medication was changed in 47.1% (16/34) of patients. In ADV group, there were no adverse reactions associated with medication during 2-year therapy and patients were well tolerant, the expulsion rate was 7.0% (3/43) and the regimen in 9.3% (4/43) of patients was changed (P＜0.01). The comparison of therapeutic cost between the two groups showed that the cost of anti-viral therapy, management with adverse reactions and laboratory examinations in IFN group were all higher than those in ADV group. The average cost per person of two years was increased with RMB 4855 yuan in IFN group. Conclusion In HBeAg-positive CHB patients, ADV is cost-effective and suitable choice for initial antiviral treatment.

Objective The purpose of this study was to investigate the occupation stress and quality of life among teachers in medical university,and analyze the correlation between the occupational stress and the quality of them.Methods Totally 249 teachers in medical university of Anhui province were investigated with the instruments of the occupational stress scale and the Chinese version of World Health Organization Quality of Life Brief(WHOQOL-BREF).Results The findings showed that:The coefficient of correlation was-0.374 between occupational stress and quality of life in teachers in medical university(r =-0.374,P ＜0.001).Conclusion The score of social relations dimension,the environment dimension and utilization of support have statistical significance with different sex and age of teachers in medical university.There was negative correlation between the occupational stress and the quality of life in teachers in medical university.

Objective To evaluate the effect of individualized diet nursing on nasogastric gavage-indueced complications after operations on laryngeal cancer? Methods Sixty patients having undergone surgical operation on laryngeal cancer were randomly divided into experiment group and control group in equal number? The control group received nutritional support by conventional enteral nutrition and the experiment group was managed by individualized diet nursing with nasogastric feeding? On days 3 and 10 after operation,the two groups were compared in terms of body constitution,results of experimental tests and complications?Result Compared to the control group,the experiment group showed no significant difference in terms of body constitution and results of experimental tests(P > 0?05)but significantly lower rate of complications on days 3 and 10(P < 0?05)? Conclusion The individualized diet nursing for laryngeal cancer patients may ensure their needs for nutrition,meanwhile reduce the incidences of complications from enteral nutrition,and thus promote their recovery?

Anhedonia is the loss of pleasure or lack of reaction to pleasurable stimuli, which is a promising phenotype of depression. In order to explore the potential biological mechanism, the recent ad?vances were summarized from researches focused on depression with anhedonia from neuroanatomy,inflamma?tion and immunology,and molecular genetics. The structural and functional brain imaging showed that the ac?tivity in reward?related brain regions of the depressive disorder with an anhedonia was changed during re?ward?related tasks.In addition,some other genetic studies based on the related neurotransmitter,such as do?pamine, together with the findings from the researches on immunological inflammation, may shed light on finding the potential targets for novel antidepressants,besides the 5?HT.

Biliary atresia is the most common obstructive cholangiopathy in infants.Its etiology and pathogenesis still remains unclear.Hypothetical mechanisms include genetic predisposition,viral infection,chronic inflammation or autoimmune-mediated bile duct injury,and congenital malformations of vessels or biliary tracts.The key pathogenesis is related to viral infection and immunoreaction.This review overviewed the research progress in the pathogenesis of biliary atresia in the past few years.

Objective To explore the feasibility and t he efficacy of laparoscopic splenectomy of massive splenomegaly in the treatment o f hereditary spherocytosis in children. Methods Seven children with massive splenomegaly underwent laparoscopic splenectomy. Their age ranged 1~14 years (mean, 8.8 years), and their body weight was 10~57 kg (mean, 33.8 kg) . Three children had an accompanying cholelithiasis: 2 of them received a concom itant cholecystectomy and 1 of them, cholecystotomy. Results A ll the operations were successfully performed under laparoscope, and hand-assist ed splenectomy through a small incision was applied in 1 child because of bleedi ng of the splenic vein. The duration of operation was 50~150 min (mean, 90 min), the intraoperative blood loss was 30~500 ml (mean, 117 ml), and the length of h ospitalization, 4~10 d (mean, 5.5 d). The red blood cell counts had significantl y increased 3 days following the operation (t=2.652, P

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.