[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.

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.

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.

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.

Adult ; Aged ; Amides ; administration & dosage ; Analgesia, Patient-Controlled ; methods ; Humans ; Middle Aged ; Pain, Postoperative ; prevention & control ; Young Adult

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 assess the radiographic and clinical outcomes of opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach in the treatment of unstable thoracolumbar fractures. MethodsFrom January 2008 through March 2010,a consecutive series of 13 thoracolumbar fractures were managed with opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach.They were 8 males and 5 females,aged from 20 to 58 years(median age,37.2 years).The fractures happened at T11 in 2 cases,at T12 in 3 cases,at L1 in 6 cases and at L2 in 2 cases.The autologous ilium was used for all the anterior strut grafts.The time from injury to surgery ranged from 21 days to 2 years (average,8 months).The mean heights of anterior and posterior borders of the vertebral body,the cobb angles and treatment-related complications were compared between preoperation and postoperation and the patients' satisfaction was assessed with the visual analogue scale(VAS).Statistical analyses were performed with the paried-sample t test. Results The patients were followed for 12 to 36 months (average,17 months).The latest follow-up radiographs were available for all patients.The mean heights of anterior and posterior borders of the vertebral body restored respectively from preoperative 21.02 ± 3.02 cm and 31.34 ± 5.18 cm to postoperative 31.88 ±3.46 cm and 33.75 ± 3.66 cm.The mean cobb angle was corrected from preoperative 28.46° ± 5.81° to postoperative 4.62° ± 3.48°.The mean VAS score decreased from preoperative 7.63 ± 0.72 to 1.39 ± 1.02 at the final follow-up.There were significant differences between preoperation and postoperation in the radiographic and clinical outcomes ( P ＜ 0.05).No mortality or major complications occurred involving large blood vessels or abdominal viscera or internal organs. Conclusion The opening osteotomy supplemented with autologous anterior strut grafting and internal fixation through posterior-lateral approach is safe and effective for old unstable thoracolumbar fractures.

Objective To evaluate the efficacy of Ambu AuraOnce laryngeal mask airway (LMA) in Chinese patients undergoing general anesthesia.Methods Fifty-six female patients, aged 20-64 yr, weighing 45-75 kg, of American Society of Anesthesiology physical status Ⅰ or Ⅱ (Mallampati Ⅰ-Ⅲ), scheduled for elective breast surgery under general anesthesia, were equally and randomly divided into either Ambu AuraOnce LMA group (group A) or LMA Supreme group (group S) using a random number table.After induction of anesthesia, Ambu AuraOnce LMA was inserted in group A, and LMA Supreme was placed in group S.After successful placement of LMA, correct position was confirmed by fiberoptic laryngoscopy.Intermittent positive pressure ventilation was performed during surgery to maintain pulse oxygen saturation ＞ 95％ and partial pressure of end-tidal CO2 at 30-45 mmHg.The success rate, insertion time, extubation time, airway sealing pressure, peak airway pressure and occurrence of air leakage of LMA were recorded.After removal of the LMA, the blood stains on the LMA were checked, and the occurrence of hypoxemia, regurgitation, nausea, vomiting and bucking was recorded.The occurrence of sore throat, hoarseness and dysphagia was also recorded within 24 h after surgery.Results There were no significant differences in terms of insertion time, overall success rate, success rate at first attempt, removal of LMA time, airway sealing pressure, and incidence of air leakage of LMA, hypoxemia, blood stains on the LMA, sore throat, hoarseness and dysphagia between the two groups.The rate for correct position of LMA confirmed by fiberoptic laryngoscopy was significantly higher in group A than in group S.Conclusion Ambu AuraOnce LMA can safely and effectively be applied for airway management in Chinese patients undergoing general anesthesia.