[Objective]To probe the probability of autologous platelet-rich glue(PRG) combined with particulate of cancellous bone in treating the aseptic tibial nonunion.[Method]Sixty patients with tibial nonunion in distal 1/3 fragment were randomly divided into 2 groups.Each group had thirty patients.PRG combined with particulate of autogenous cancellous bone was transplanted in the experimental group while particulate of cancellous bone was applied in the control group.The mean time to the operation was 10.5 months(7-36 months) and the average age were 38 years old.The postoperative systemic and local reaction,and X-ray finings of tibial nonunion were observed.The average follow-up was 22 months.According to the Johner-Wruh scoring system the results were statistically analyzed.[Result]At 8 months bony union was all achieved.There was a remarkable difference between those of experimental and control groups.[Conclusion]PRG had an important role in speeding bone healing,and the combination of PRG and particulate of autogenous cancellous bone is an ideal alternative of bone transplantation.

Objective To investigate the relationship of polymorphisms at codons 333 and 637 of TAP-1 allele gene to recurrent condyloma acuminatum (CA) in a Chinese population. Methods Amplificatory refraction mutation system-PCR (ARMS-PCR) was performed to detect TAP1 polymorphic residues at codon 333 in 88 patients with recurrent CA and 81 age- and sampling date-matched controls and at codon 637 in 60 patients with recurrent CA and 60 age- and sampling date-matched controls. Results The frequencies of AA,GG and AG genotypes at codon 333 of TAP-1 gene were 86.36%, 0, 13.64%, respectively, in patients with recurrent CA, 79.01%, 0 and 20.99%, respectively, in the controls, and no significant difference was observed between the two groups (χ2 = 1.604, P ＞ 0.05). However, a significant difference was observed in the frequencies of AA, GG and AG genotypes at codon 637 of TAP-1 gene between the patients and controls (3.33% vs 10.0%, 95.00% vs 60.00%, 1.67% vs 30.00%, χ2 = 21.551, P ＜ 0.01 ). Conclusions The recurrence of CA may be associated with the polymorphism at codon 637, but not with that at codon 333, of TAP-1 gene.

Humidificait on by artificial means must be provided when the upper airway is bypassed during mechanical ventilation.Enough humidification is very important during mechanical ventilation.Heated humidification( HH) and heta and moisture exchanger( HME) are the most commonly used types of artificial humidification in this situation.In this article, their advantages and disadvantages are itn roduced.HH na d HME are compared in humidification performance,effect no ventilator mechanics and association with venti-lation associated pneumonia.Depending on the clinical scenario, humidifier is reasonably selected, and the selection may changeo ver time according the treatment effect.

AIM: To observe the effects of norepinephrine (NE) on the cardiopulmonary and lung injury in goats with acute respiratory distress syndrome (ARDS) induced by endotoxin. METHODS: A model of septic ARDS was induced by intravenous infusion of low dose endotoxin in six goats. Then 40?10~ -6 NO inhalation was applied to the animals. After 30 min, combined intravenous infusion of NE at concentration of 0.5 mg?kg~ -1 ?min~ -1 was conducted. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan-Ganz catheter. Arterial blood gas analysis before and after the onset of ARDS, 30 min after NO inhalation and combined NE was detected. Histology of the lung was also observed. RESULTS: Inhalation of NO rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO_2, decreased P_ (A-a) O_2 and Qs/Qt in septic ARDS goats. These decrease and increase were more significant than those in NO inhaled alone when animals received NE. The combination of NO inhalation and NE injection resulted in increase in mean arterial pressure. NO inhalation did not ameliorate lung injury and combined NE intravenous injection ameliorated lung injury. CONCLUSION: Injection of low dose norepinephrine improves the beneficial effects of inhaled nitric oxide on lung gas exchange and ameliorates lung injury in goats with acute respiratory distress syndrome induced by endotoxin.

Objective To study the effects of electrical stimulation of efferent vagus nerve on the endotoxic shock in rabbits. Method Sixteen Newzealand rabbits were randomly divided into 2 groups, namely group S as the stimulation group and group C as the control group). Rabbits were subjected to bilateral cervical vagotomy and had challenge with intravenous injection of lipopolysaccharide (LPS) (E. COLI O111: B4 , DIFCO, USA) in a dose of 600 μg/kg. The distal end of the left vagus nerve trunk was connected to an electric stimulator with bipolar electrode and controlled by an acquisition system. Stimuli with stable voltage (10 V,5 Hz,5 ms) were applied twice to the nerve for 10 minutes just before and after the administration of LPS in group S. At the time before and after the infusion of LPS 30 min,60 min, 120 min, 180 min,240 min and 300 min respectively, the heart rate(HR)and the mean arterial blood pressure (MABP) in each animal were recorded, and blood samples were taken for measuring serum tumor necrosis factor-αa(TNF-α) and interleukin-10 (IL-10). Results Compared with group C,the electrical stimulation of efferent vagus nerve could significantly attenuated the LPS-induced hypotension and de-creased the contents of TNF-α[(38.12±7.85) pg/mL vs. (55.12±7.89) pg/mL, P <0.01], but increased the contents of IL-10[(55.12±9.37)pg/mL vs. (40.15±5.44) pg/mL, P <0.01]afar LPS challenge. Conclusions The stimulation of the efferent vagus nerve can down-regulate systemic TNF-α, production and attenu-ate the development of shock after LPS challenge.

Objective To explore the relationship of plasma level of B-type natriuretic peptide (BNP) with cardiovascular risk,the severity of coronary heart disease(CHD),and the short-term prognosis in patients with type 2 diabetes. Methods 154 patients with type 2 diabetes,of them 95 cases complicated with CHD and 65 with hyper-tension were selected in this study. The CHD patients were diveded into 3 groups: AMI(n=32), UAP(n=33) and SAP(n=30). The relationship of the plasma BNP levels with cardiovascular risks, with each coronary heart disea-ses,were observed. The patients were followed up for 6 months to study the predicting role of BNP on the death in pa-tients accompanied with CHD. Results The plasma BNP level was (397.34±217.79) ng/L, which was correlated with age, CRP, hypertension and CHD (r=0.631,0.672, 0.762,0.857, P<0.05 for each);the plasma BNP levels increased with age(r=0.896,P<0.01):(57.6±12.3) ng/L in patients <50 years old,(146.2±53.4)ng/L in patients 50≤and < 59 years old, (388.4±67.5) ng/in patients 60≤and < 69 years old, and (423.8±132.6) ng/L in patients≥70 years old (P<0.01 or P<0.05). The plasma BNP levels, was higher in patients with hyper-tension than that in patients without hypertension [(314.7±125.3) ng/L vs (136.8±98.7) ng/L, P<0.01];Higher in patients with CHD than that in patients without CHD [(425.03±200.80)ng/L vs (37.64±21.57) ng/L,P<0.01)]. The short-term prognosis of patients with CHD was correlated with the levels of BNP, and BNP levels≥485 ng/L may be an independent predicting factor for cardiac death within one month. Conclusions Plas-ma levels of BNP were associated with some cardiovascular risks,which may be one of biomarkers for cardiovascular risks in patient complicated with CHD.

Objective To better understand students' professional perception,humanistic education status quo and their preference to different humanistic education methods.Methods Questionnaire was conducted for 990 undergraduate students (2006 grade- 2010 grade) at medical school of Shanghai Jiao Tong university.SPSS 17.0 statistical software was used to analyze results of the questionnaire.Results Nearly 45％ students chose to major in clinical medicine out of personal interest.The identification of students for humanistic quality was lower than that for clinical knowledge and skills.More than 50％ students believed doctors were with high humanistic quality and there was a gap between students′ action and their understanding of the medical career identity and medical humanistic cultivation.More than 50％ students preferred activities that train medical and auxiliary skills.Nearly 67％ students also showed a shallow reading habit from regular internet surfing.Conclusion The professional perception of medical students are influenced by both social and historical factors influence.The gap between understanding and action is a consequence of current humanistic educational system.The humanistic educational methodology should conform to the psychological and s~ial characteristics of contemporary students.

10.3969/j.issn.2095-4344.2013.26.004

Objective:To study the distribution of flurbiprofen axetil ( FA) microemulsion in rats and evaluate the targeting prop-erty to traumatic inflammation tissue. Methods:Traumatic injury model rats were established by hip surgery on the rat right thigh mus-cle and randomly divided into 2 groups:microemulsion group and solution group. Serums and tissues of rats were collected at 15, 30, 60, 120 and 240min after administration (iv. 5 mg·kg-1). A high performance liquid chromatography (HPLC) with UV detection was developed to study the concentration of flurbiprofen in biological samples. Results: The elimination of flurbiprofen axetil microe-mulsion from blood and tissues was slower than flurbiprofen solution. At each 5 time points, drug concentrations of microemulsion group in injury muscle were higher than in normal muscle (P<0. 05), while solution group had no significant difference(P>0. 05). Micro-emulsion group injury muscle Te(targeting efficiency) =12. 21%, and the solution group Te =3. 97%. The Re (relative uptake rate) of injury muscle was 4. 15. Conclusion:The flurbiprofen axetil microemulsion has the targeting property to traumatic injury tissues.