Objective:For further exploring the feasibility,we have treated the middle and infe- rior femoral bone fracture nonunion by the transplantation of bone flap with ascending and transvers branch of the lateral femoral circumflex vessels.Method:The technique,on the basis of anatomical study have been designed to treat the femoral bone fracture nonunion by the transplantation of bone flap with ascending and transvers branch which pedicle was descendant branch of the lateral femoral circumflex vessel.Results:8 cases of middle and inferior femoral fracture nonunion had been treated by this method.At follow-up of 1 year 5 months to 4 years 6 months,the results have been satisfacto- ry.Conclusions:The method of the transplantation of the bone flap with ascending and transvers branch of the lateral femoral circumflex vessel for the treatment of middle and inferior femoral fracture nonunion has the adventages of simplicity,easiness,reliability.

BACKGROUND:Natural biologic bone-derived products have been prepared by raw ox bone but not by swine vertebra. Previous research has indicated that biphasic ceramic-like biologic active bone made by swine vertebra has osteoinductive ability. OBJECTIVE:To investigate the feasibility of biphasic ceramic-like biologic active bone and biphasic ceramic-like biologic bone (BCBB) to repair the segmental defect in radius of rabbits. DESIGN,TIME AND SETTING:A randomized controlled animal experiment was performed at Institute of Orthopedics,the Fourth Military Medical University of Chinese PLA and Central Laboratory of Qingdao Medical College from October 2004 to October 2005. MATERIALS:Biphasic ceramic biologic bone was made of swine vertebra and sodium pyrophosphate after two calcinations at low temperature. The mixture which consisted of hydroxyapatite and tricalcium phosphate,sizing 0.3 cm ? 0.3 cm ? 1.5 cm was combined with type I collagen to make BCBB. Bone morphogenetic protein was mixed with type I collagen,and then the mixture was combined with biphasic ceramic biologic bone to make biphasic ceramic-like biologic active bone. METHODS:A total of 48 healthy Japanese rabbits were randomly divided into biologic active bone group,biologic bone group,and blank control group,with 16 rabbits per group. A segmental defect which was 15 mm along bilateral radius was established. Biphasic ceramic-like biologic active bone and BCBB were implanted into defect region,respectively,but implantation was not treated in the blank control group. MAIN OUTCOME MEASURES:Materials were harvested at weeks 2,4,8,12 for the gross observation under microscope. Tissue sections were selected for hematoxylin-eosin (HE) staining and Masson staining. RESULTS:① Gross observation:At 2 weeks,there were no differences between the two groups,and the materials were connected to bone bed with fibrous tissues. At 4 and 8 weeks,there was more new callus in biologic active bone group than in biologic bone group. At 12 weeks,some bionic biphasic ceramic-like biologic active bone were absorbed and new bone regenerated in biologic active bone group,being similar to appearance of host bone,but there were few callus in biologic bone group. In blank control group,bone defect could not be repaired and there were fibrous tissue in bone defect. ② Staining results:At 2 weeks after operation,there were no differences between the two groups,and the materials were connected to bone bed with fibrous tissues. At 4 and 8 weeks,more vessels and fibrous tissues grew into BCBB,new bone was formed,and bone connect was found between BCBB and bone bed in the biologic active bone group. At 12 weeks,in the biologic active bone group,more materials degraded,new bone was integrated with bone bed,and bone marrow-like structure was formed. At 12 weeks,the broken ends were sclerosis and blocked in the blank control group. CONCLUSION:Bionic biphasic ceramic-like biologic active bone characterizing by good bone induction and biocompatibility can remarkably repair the segmental defect in radius of rabbits. BCBB is perspective for repairing the segmental bone defect.

Objective:To investigate the infusion methods of postoperative enteral nutrition in patients with gastric cancer.Methods:86 patients with gastric cancer received radical operationin our hospital from January 2014 and December 2015 were enrolled for the study and randomly divided into continuous infusion group and periodic infusion group,each group with 43 cases.Patients in continuous infusion group were given postoperative continuous enteral nutrition for 24 h in one day,while cases in periodic infusion group were given postoperative continuous enteral nutrition for 15-17 h in one day.Results of enteral nutrition,physical indicators including upper arm skinfold,diameter of midpoint of upper arm and grip strength,nutritional indexes including total protein (TP),hemoglobin (Hb),albumin (AIb),prealbumin (PA) and transferrin(TF),immune indicators including immunoglobulin G(IgG),immunoglobulin M (IgM),immunoglobulin A (IgA),CD4+,CD8+ and CD4+/CD8+were compared between two groups before and after operation.Results:Intolerance of enteral nutrition occurred in 1 case(2.3％) of continuous infusion group and 3 cases(7.0％) of periodic infusiongroup,and there was no significant difference between them (P＞0.05).Time of transition to full enteral nutrition and taking off the tube to self-feeding incontinuous infusion group were significantly smaller than that in periodic infusion group (P＜0.05).There were no significant difference in baseline data,physical indicators,nutritional indexes and immune indicators between them before operation (P＞0.05).PA level at 5 d,10 d after operation in continuous infusion group were significantly higher than that in periodic infusion group (P＜0.05),and there were no significant difference in physical indicators,other nutritional indexes and immune indicators between them after operation(P＞0.05).Conclusion:Compared with periodic infusion,continuous infusion method could shorten the time of transition to full enteral nutrition and taking off the tube to self-feeding in patients after radical operation of gastric cancer,and had more significant effect of improvement of nutritional status,worthy of clinical popularization and application.

Objective: To evaluate the effect of concomitant chemoradiotherapy for the prevention of recurrence and metastasis of postoperative salivary adenoid cystic carcinoma(SACC).Methods: 14 cases of salivary adenoid cystic carcinoma after operation were treated with concomitant chemoradiotherapy. Regular radiotherapy of 60 Gy and chemotherapy with hydroxycamptothecin (HCPT) at 10 mg/m 2 , 3 times a week, were administered. HCPT was given in 1st, 2nd, 4th and 5th week. Recurrence and metastasis of SACC after operation were observed using CT, MRI, ultrasonography and X ray. Results: After 3～17 months' follow up, relapse free survival was 100%. No recurrence and metastasis of SACC after operation were found. Adverse reactions of the chemotherapy were nausea, vomiting and leukopenia. After suspended in a short time and using ondansetron and /or G CSF the chemotherapy of HCPT was continued and completed. Conclusion: concomitant chemoradiotherapy of HCPT and radiotherapy can prevent recurrence and metastasis of SACC after operation. The efficacy of long term needs further observation.

Objective To evaluate the effect of preoperative intramuscular injection of of dextromethorphan in three dosages on fentanyl consumption in postoperative PCA in order to optimize its pre-emptive analgesia dose. Methods 80 ASA Ⅰ-Ⅱ patients underwent spine operations under general anesthesia were randomly divided into four groups, who respectively received intramuscular dextromethorphan 10mg (DM10 group), 20mg (DM20 group), 40mg (DM40 group), or normal saline (CON group) respectively. The PCA fentanyl consumption as well as VAS pain scores were observed 4h, 24h, and 48h after the operation. Results Although there was no significant differences in pain VAS score between the four groups, the fentanyl consumption was significantly lower in groups DM20 and DM40 compared with group CON and DM10. However, there was no significant difference between group DM20 and group DM40. Conclusion Preoperative IM dextromethorphan shows a dose-dependant fentanyl spare effect on postoperative PCA, and a dose of 20mg seems to be optimal for preoperative use.

Objective To evaluate the efficacy of quadriceps femoris fasciculation induced by lowcurrent nerve stimulation when used to assist ultrasound-guided lumbar plexus block.Methods One hundred patients of both sexes,aged 18-45 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 50-85 kg,scheduled for elective unilateral knee arthroscopy,were selected and randomly divided into 2 groups (n =50 each) using a random number table:ultrasound assisted by nerve stimulator group (group SU) and ultrasound group (group U).The shamrock method was used to perform the ultrasound-guided lumbar plexus block in two groups.In group SU,the nerve stimulator with current 0.35 mA and frequency 1 Hz was used in the process of puncture,and 0.5％ ropivacaine 0.4 ml/kg was administrated when quadriceps femoris fasciculation was induced.In group U,when the tip of the nerve stimulating needle was located around the lumbar plexus,which was confirmed by ultrasound,0.5％ ropivacaine 0.4 ml/kg was administrated.The time of puncture,depth of needle insertion,onset time of block and effective block were recorded.Motor block was assessed using the modified knee score,and the development of complications was recorded within 24 h after block.Results Compared with group U,the onset time of block was significantly shortened,the rate of effective block was increased,the degree of motor block was aggravated (P＜0.05),and no significant change was found in the time of puncture or depth of needle insertion in group SU (P＞0.05).No complications were observed in two groups.Conclusion Low-current (0.35 mA) nerve stimulation-induced quadriceps femoris fasciculation when used to assist location can improve the efficacy of ultrasound-guided lumbar plexus block.

Objective To investigate the changes and significance of plasma interleukin (IL)-6,IL-8,tumor necrosis factor-alpha (TNF-α) and nitric oxide synthase (NOS) in acute blood loss patients.Methods The levels of plasma IL-6,IL-8,TNF-α and NOS were determined in 25 patients with acute blood loss(blood loss group) and 25 healthy controls(control group) by enzyme linked immunosorbent assay.Result The levels of plasma IL-6,IL-8,TNF-α and NOS in blood loss group were higher than those in control group (0.284 ± 0.027 vs.0.204 ± 0.016,0.059 ± 0.079 vs.0.037 ± 0.039,0.460 ± 0.024 vs.0.372 ±0.018,0.637 ±0.054 vs.0.443 ±0.040,P＜0.05 or ＜0.01).Conclusions First,the expressions of IL-6,IL-8,TNF-α and NOS are strongly induced at the circumstances of acute early stage blood loss which can cause inflammatory reaction,aggravate the damage of soft tissues and organs,and easy to lead the blood loss to uncontrolled hemorrhagic shock.Second,the expression of NOS is strongly induced at the circumstances of acute blood loss which should reduce the damage of soft tissue,and alleviate the hemorrhagic shock.Therefore,the levels of plasma IL-6,IL-8,TNF-α and NOS can estimate the illness prognosis and curative effect,which have important clinical instruction value for effective treatment of hemorrhagic shock.

p53 (encoded by TP53) is undoubtedly one of the most extensively studied genes and proteins. It is a highly potent transcription factor which, under normal circumstances, is maintained at low level. Both genotoxic and non-genotoxic stresses can induce p53 stabilized leading to changes in the expression of p53-responsive genes. The biological outcome inducing this pathway can be either growth arrest and apoptosis or senescence to maintain the integrity of the genome or to delete the damaged cells. The biochemical activity of p53 itself and the cellular environment govern the choice between these outcomes in a cell type- and stress-specific manner. So, p53 is a pivotal tumour suppressor and a mainstay of our body's natural anticancer defence. This review could provide some useful information for further study on the mechanisms of tumorigenesis and its progression, and also could contribute to the discovery of antitumor agents.

Objective To evaluate the role of SPECT cerebral perfusion imaging in assessing the stent implantation for cerebral artery stenosis.Methods A total of 35 patients (31 males,4 females,average age (63.9±10.8)years) with cerebral artery stenosis confirmed by DSA for cerebral artery stent implantation were retrospectively analyzed.99Tcm-ECD cerebral perfusion imaging was performed for all patients before and after stent implantation.The images were realigned and normalized by SPM 2.0 and then analyzed by Brain Search software for quantitative analysis.The brain was automatically separated to 210 functional areas according to Talarich map.The normalized averaged counts (NAC) of each area were calculated and compared with the data of 28 health controls (8 males,20 females,average age (35.8± 9.4) years).Less than 1.96s was defined as low perfusion lesions.The NAC values before and after stent implantation were compared for classifying improved from non-improved group.The mean number of lesions and Essen stroke risk score (ESRS) were analyzed between the two groups.The mean number of lesions and postoperative improvement rate of the internal carotid artery (ICA) occlusion and stenosis were compared.Paired rank sum test,two-sample t test,two-sample rank sum test and x2 test were used for statistical analysis.Results In 35 patients with low perfusion areas,20 were significantly improved after stent implantation.The mean number of lesions in the improved group (34.05± 14.41)was significantly higher than that in the non-improved group (22.93±17.24; t=2.067,P＜0.05).The mean ESRS of the improved patients (14.8)was significantly lower than that of the non-improved patients (22.3,Z=2.24,P＜0.05).The improvement rate of 28 cases with ICA stent implantation was (60.7％,17/28)higher than that of 7 cases with middle cerebral artery (MCA) stent implantation (3/7; P＞0.05).The mean number of the ICA occlusion lesions (34.36± 14.31)was higher than that of the ICA stenosis lesions(31.35± 16.37),but the difference was not statistically significant(t=0.498,P＞0.05).The improvement rate of the ICA occlusion was higher than that of the ICA stenosis (7/11 vs 10/17),but the difference was not statistically significant (P＞0.05).Conclusion SPECT cerebral perfusion imaging and its quantitative analysis can evaluate the low perfusion lesions before stent implantation and predict the perfusion improvement after stent implantation.

Objective To observe clinical efficacy of warm-promotion needling for the treatment of cold coagulation and blood stasis of primary dysmenorrhea.Methods Totally 120 patients with cold coagulation and blood stasis of primary dysmenorrhea were randomly divided into warm-promotion needling group (60 cases) and control group (60 cases). Warm-promotion needling group was treated with warm-promotion needling at Guanyuan (RN4), Sanyinjiao (SP6), Shiqizhui (EX-B8), and Diji (SP8), and cooperated with Ciliao (BL32), Hegu (LI4), and Taichong (LR3). Control group took same acupoints and applied uniform reforcing-reducing method. The two groups began treatment 5-7 d before menstruation, 1 times a day, for 7 times. The treatment was given 3 menstrual cycles. The visual analogue scale (VAS) and COX menstrual symptom scale (CMSS) were used to observe the pain degree at the end of 1, 2, 3 menstrual cycles. The clinical efficacy was evaluated 3 months after treatment.Results The scores of VAS and CMSS was obviously reduced in the two groups after the treatment compared with those before treatment (P<0.01). The synperiodic scores of VAS and CMSS in warm-promotion needling group was obviously lower than those in the control group (P<0.05). The total effective rate of warm-promotion needling group was 96.67% (58/60), and the control group was 73.33% (44/60), the difference was significant (P<0.05).Conclusion Warm- promotion needling can obviously relieve dysmenorrhea symptoms and shorten the time of pain of patients with cold coagulation and blood stasis of primary dysmenorrhea, which has affirmative clinical efficacy.