Objective To evaluate the therapeutic effect of implanted drug delivery system (DDS) in patients with inoperable pancreatic carcinoma.Methods During 1998 to 2004,145 patients with no indication for operation were randomly divided into two groups.In 73 patients with regional interventional chemotherapy group (group A),percutaneous left subclavain artery port-catheter DDS implantation with the tip in common hepatic artery was performed, and regional chemotherapy infusion were done in every 1 to 2 month. In 72 patients with systemic chemotherapy group (group B), the chemotherapy were given via peripheral vein in every 1 to 2 month. The FAM(adriamycin 40 mg/m2+mitomycin 6 mg/m2+fluorouracil 375 mg/m2) were selected in two groups. Results In group A, after 2-10 (average 7.6) cycles of chemotherapy, 4 patients reached complete release (CR) and 49 patients reached partial release (PR). In group B, after 1-7 (average 3.8) cycles of chemotherapy, no patient reached CR and 25 patients reached PR. The effective ratio was 60.2% and 34.7% in group A and B, respectively. The survival time ranged from 3 to 34 months (median 13.5 months) in group A and 1 to 13 months (median 6.2 months) in group B. Among the 56 patients with obstinate pain in group A, 27 patients were free of pain and 22 patients got partially alleviation 2-3 weeks after chemotherapy. Among the 54 patients with obstinate pain in group B, 11 patients were free of pain and 14 patients got partially alleviation 2-3 weeks after chemotherapy. The pain-releasing ratio in group A and group B was 87.5% and 46.3%. There were no severe damage of liver, kidney, heart and bone marrow in group A. Twenty five patients in group A experienced mild digestive side-effect and decrease of white blood cells, all of them completed the chemotherapy. In group B, 3 patients experienced bone marrow arrest, one died of severe damage of liver and kidney, and 67 patients displayed digestive side-effect and decrease of white blood cells. The ratio of side-effect in group B was 90.3%. The differences of effective ratio, survival time and side-effect ratio between group A and B were statistically significant (P

Objective To evaluate the effect of hepatic vein occlusion and stent replacement in treatment for Budd-Chiari syndrome(BCS).Methods Forty three patients with BCS were underwent percutanous puncture,radiography,transjugular angioplasty,balloon dilation and stent placement for hepatic vein under Doppller ultrasounographic guidance from July 2001 to September 2006. Results Technical success was 100%with no complications.The medium vein pressure was reduced from 32.5 tO 20 cm H2O(1 cm H2O-0.098 kPa)after stents replacement(P＜0.01).The hepatic vein angioplasty revealed that all stents were patent and branches were disappeared.The symptoms in 38 patients were disappeared immediately,and improved in 5 patients.All patients were followed up of 32 months(ranged 1-62).Except one patient died of severe gastric bleeding,the 42 patients were survived with symptoms free.Conclusion Hepatic vein occlusion and stent replacement are safe and effective in treatment of BCS.

Among ankle injuries, the injury to the distal tibiofibular syndesmosis is common and likely neglected. The stability of the distal tibiofibular syndesmosis is related to the depth of the fibular notch. In imaging diagnosis, X-ray examination cannot be used for a definite diagnosis of the injury to the distal tibiofibular syndesmosis. For diagnosis of the distal tibiofibular separation>3 mm, CT scan can be accurate but is not sensitive enough for a separation<1 mm while MRI is more sensitive in diagnosis of the injury. Arthroscopy has gradually been used as the "gold standard" in diagnosis of the injury to the distal tibiofibular syndesmosis due to its advantage of direct vision. The distal tibiofibular separation occurs in the injuries of pronation external rotation Ⅳ°, supination external rotation Ⅲ° and Ⅳ°, and pronation abduction Ⅱ° and Ⅲ° by the Lange-Hansen classification. Most patients with simple stable injury to the distal tibiofibular syndesmosis may have a good prognosis after nonoperative treatment. Surgical anatomic reduction and maintenance of stability of the distal tibiofibular syndesmosis are the basic management principles for unstable distal tibiofibular syndesmosis or the injury to the distal tibiofibular syndesmosis combined with ankle fracture. Screw fixation is the most commonly used in the surgical treatment of the injury. Elastic fixation has the advantages of maintaining the biological characteristics of the distal tibiofibular syndesmosis fretting joint, better reduction fault tolerance, and lower rates of complications and long-term reduction loss. The angle of nail placement is the key to maintaining good reduction of the distal tibiofibular syndesmosis, but there has been little description of the specific methods to ensure the theoretical angle of nail placement in practice. This article also reviews the prospects of the future treatment of the injury to the distal tibiofibular syndesmosis.

The Ehlers-Danlos syndromes(EDS)are a group of rare hereditary connective tissue disorders characterized by joint hypermobility,skin hyperextensibility,and tissue fragility.The clinical and genetic hetero-geneity of EDS frequently leads to underdiagnosis and misdiagnosis.Genetic testing is an essential approach to clarify the underlying diagnosis.Recent research has preliminarily established genotype-phenotype correlations and introduced the novel concept of"disease spectrum"in some subtypes.These studies deepen our under-standing of EDS etiology and provide important insights into clinical management.Published in 2023,the Chinese Guidelines for Diagnosis and Treatment of the Ehlers-Danlos Syndromes(the Guidelines)recommend performing genetic testing with deep phenotyping for patients who meet the clinical diagnostic criteria or are sus-pected of having EDS.However,it should be noted that the clinical diagnosis might differ from the molecular diagnosis.Furthermore,cutting-edge approaches such as periodic data reanalysis,integration of RNA sequen-cing into family-based whole-genome sequencing,and third-generation sequencing may facilitate the reclassifi-cation of variants of uncertain significance or resolve undiagnosed cases.This article summarizes recent progress in the genetics research of EDS,with the hope of offering a valuable resource for clinical diagnosis,treatment and scientific research to optimize the quality of life of patients with EDS.