We retrospectively analyzed 23 cases of histiocytic necrotizing lymphadenitis (HNL) admitted to our hospital as fever of unknown origin (FUO).Fever,lymphadenopathy and skin rash were the most common clinical manifestation.The major laboratory features included cytopenia,abnormal liver enzyme and elevated inflammatory markers.Three of the 23 cases were finally diagnosed as infectious disease,5 as autoimmune disease,while the left 15 remained as HNL during the follow-up.Four of the 15 HNL patients resolved spontaneously,while the other 11 relieved by steroid use.Two patients relapsed during the follow-up.HNL was one of the rare causes of FUO.Since it would be accompanied with infectious,autoimmune or malignant diseases,long follow-up is necessary.

The clinical medical work is accompanied with high risk .The medical treatment risk exists everywhere at anytime, but the graduate students of the Medical colleges lack the understanding of the hygiene laws. Therefore it is necessary for them to accept the education of hygiene law.

ObjectiveTo explore the application of peripherally inserted central venous catheter (PICC)and central venous catheter (CVC) in the surgical parenteral nutrition.MethodThe operation time,success rate,indwelling duration,abnormal biopsy,and adverse reactions of PICC and CVC were retrospectively compared.ResultsCVC had significantly shorter operation time than PICC groups [ (28.67 ±5.13) min vs.(45.20 ±6.89)min,P =0.035 ).The mean indwelling duration was significantly longer in PICC group than in CVC group [ ( 114.85 ± 10.29) d vs.(24.78 ± 8.42) d,P =0.033 ].PICC group was superior to CVC group in terms of five complication items,while only phlebitis was more frequent/severe in CVC group.ConclusionsPICC may be more suitable for long-term ( ＞4 weeks) catheter-based nutrition.CVC has short operation time and fast flow rate,and therefore is most suitable for rescue treatment for critically ill patients.

Objective To study the efficacy and repeatability of the Limb X Film Measuring Plate (LXMP)in clinical x film measurement of lengths and angles of limbs.Methods The LXMP was de- signed and manufactured for testing.Three known points in 9 templates were taken as golden standards.which were to be compared with measuring results of these projected points on the X film for testing efficacy of LXMP.Twenty-one patients with knees osteoarthritis were selected.The lengths and angles of their lower limbs were measured twice with the help of LXMP by an observer at different time intervals for testing in. Tra-observer repeatability.Two observers measured once on films at the same time for testing inter-observer repeatability.The correlation coefficients,mean absolute difierences between the repeated measurements,and error rate were calculated. Results The points on LXMP could be seen clearly on X film.Validation tests showed the differences in angle measurement between golden standards and measuring results for those pro- jeted points on the X film were insignificant.with mean absolute difference being O.10.-0.21,error rate being 0.12%-3.15%and r being close to 1.The differences in length measurement were insignificant ei- ther,with mean absolute differenee being 0.05 cm-0.16 cm.error rate being 0.12%-o.28%and r being close to 1.The intra-observer repeatability test for beth angles and lengths showed that r was close to I.mean absolute diffefences 0.55.and 0.1-0.37cm and error rate 0.3l%-O.97%.while the inter-observer re- peatability test showed that r was close to 1.mean absolute difierences o.39.and0.05-0.13cm and error rate O.16%-O.35%. Conclusion The Limb X Film Measuring Plate Can be used for accurately mcasuring limb lengths and angles with good efficacy and repeatability.

Objective To compare operative and non-operative treatments for intraarticular fractures of distal radius by meta-analysis. Methods The literature which had been published in English or Chinese from 1988 to 2008 on comparison between operative and non-operative treatments of intraartieular fractures of distal radius were searched for on line.Three Chinese papers and 2 English ones were eligibly included in this meta-analysis.The clinical data of the 5 papers were collected for comparing wrist function,reduction on X-rays,complications and patient's satisfaction. Results Operative treatment resulted in better reduction on X-rays,better wrist function and fewer complications but lower patient's satisfaetion than non-operative treatment. Conclusion The operative treatment should be recommended for intraarticular fractures of distal radius,but meanwhile the needs and expectations of the patient should be also addressed.

BACKGROUND: Chondron is a basic microanatomical unit of articular cartilage. lncreasing evidence suggests that the pericellular matrix (PCM) is a distinct functional compartment in articular cartilage, influencing the metabolic, micromechanical environment, and degeneration of chondrocytes. But the precise functions and action mechanism need further investigation.OBJECTIVE: To review the literature pertinent to the morphology, function, isolation of the chondron in articular cartilage, and its degenerative events during the progression of osteoarthritis (OA).METHODS: This review summarized the articles published in the PubMed database before July 2009. In addition, recent data and figure of our laboratory on the morphology and biomechanics of chondron and chondrocyte were supplemented. RESULTS AND CONCLUSION: The PCM is primarily characterized by the presence of type Ⅵ collagen, and these components are widespread in the expansive extracellular matrix (ECM) in newborns, while in mature the components are mainly localized to a narrow pericellular zone. The three-dimensional morphology of chondron has been recently quantified in situ with fluorescence confocal microscopy, and the mechanical properties of the isolated individual chondrons and their PCM are measured using the micropipette technique and atomic force microscopy. More studies have shown that the presence of the PCM in chondrons has a profound influence on chondrocyte gene expression. At the same time, structural, histochemical and biomechanical studies indicate the chondron and their PCM may undergo degenerative processes with osteoarthritis, similar to those occurring in the ECM, Although the precise function of the PCM is unknown, increasing evidence in vivo or in vitro suggests that the PCM is a basic microanatomical unit in articular cartilage, influencing the metabolic and micromechanical environment of chondrocytes.Department of Orthopedics, the Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair,Taiyuan 030001,Shanxi Province,China

Though lack of definite evidences,closed suction drainage after arthroplasty is routinely employed by the majority of orthopaedic surgeons with the aim of preventing the formation of wound haematoma,reducing delayed wound healing and the risk of deep infection.But the optimal time to remove drains is controversial.The usual time to remove drains is 48~72 h after operation when the volume of drains is less than 50ml within 24 h.But some scholars find that the time of draining more than 24 h increases the risk of wound infection.This paper reviews the literature of draining time,and concludes that the optimal time to remove drains is 24 h after the primary arthroplasty.

10.3969/j.issn.2095-4344.2013.26.021

Objective To investigate the protective effect of butylphthalide for focal cerebral ischemiareperfusion injury and its possible mechanism.Methods A total of 60 healthy and clean adult Sprague-Dawley rats were randomly divided into sham operation,saline control,low-dose butylphthalide and high-dose butylphthalide groups (n =15 in each group).A focal cerebral ischemia-reperfusion model was induced by the suture method.At the beginning of reperfusion,100 rng/kg and 400 mg/kg butylphthalide injection were injected intraperitoneally in the rats of the low-dose butylphthalide and high-dose butylphthalide groups; 0.5 ml/kg saline was injected intraperitoneally in rats of the sham operation and saline control groups.All the rats were sacrificed after 24 h of ischemia-reperfusion.Results The degree of neurological deficit in the low-dose butylphthalide (t =1.488,P =0.000) and high-dose butylphthalide (t =2.362,P =0.000) groups were significantly improved compared to the saline control group,in which the high-dose butylphthalide group was improved more significantly than the low-dose butylphthalide group (t =-0.873,P =0.000).The infarct volume in the low-dose butylphthalide (t =18.589,P =0.000) and high-dose butylphthalide (t =36.963,P =0.000) groups were reduced significantly compared to the saline control group,in which the infarct volume of the high-dose butylphthalide group was reduce more significantly than that of the low-dose butylphthalide group (t =-18.374,P =0.000).HE staining showed that neurons were sparse,there were a large number of degeneration and necrosis,cell space became larger,and the intercellular substances showed vacuolar changes.In the butylphthalide group,the neuronal degeneration and necrosis reduced significantly,the survival of nerve cells increased,and the improvement of the high-dose butylphthalide group was more remarkable.SOD activity of the low-dose and high-dose butylphthalide groups were increased significantly compared to the sham operation and saline control groups (all P ＜0.05),in which the SOD activity in the high-dose butylphthalide group was significantly higher than that in the low-mall dose butylphthalide group (t =80.199,P =0.000); The MDA levels in the low-dose and high-dose butylphthalide groups were decreased significantly compared to the sham operation and saline control groups (all P ＜ 0.05),in which the MDA level in the high-dose butylphthalide group was significantly lower than that in the low-dose butylphthalide group (t =-1.308,P=0.000).Conclusions The protective effect of butylphthalide on ischemia-reperfusion injury may be associated with the increased antioxidant activity.

Objective To determine whether rabbit articular chondrocytes express growth factor genes delivered by recombined rat TGF beta 1,IGF 1 and what other influences on chondrocytes are,and to determine which gene is the best one for osteoarthritis therapy.Methods Monolayer cultures of rabbit articular chondrocytes were infected with recombinant plasmid pcDNA 3 and pAT 153 carrying genes encoding the following growth factors respectively:TGF beta 1 and IGF 1.The synthesis of TGF beta 1,IGF 1 and type Ⅱ collagen was measured by in situ hybridization,immunohistochemistry,immunofluoroscopy,flow cytometer and 3 H TdR radiolabeling.Results The expression of TGF beta1,IGF 1 and type Ⅱ collagen was high beyond control levels ( P