Atlanto-Axial Joint ; injuries ; Child ; Humans ; Joint Dislocations ; etiology ; Male ; Tympanoplasty ; adverse effects

Objective To introduce a simple and reliable way for atrial septal puncture. Methods Atrial septal puncture had been carried out in 627 patients with various underlying heart diseases, and the patients aged between 4-78 years old. Three protocols for precise location of atrial septal puncture points were recommended, 1) Site of atrial septal puncture point in cranial-caudal direction was determined under posterior-anterior projection, which was confined to the cranial side of the inferior margin of left atrium silhouette at a distance of 1 cone body height along the midline of spine. If the inferior margin of left atrium silhouette was unclear, angiogram of pulmonary artery to display left atrium and placement of coronary sinus electrodes could be done to verify it. 2) Under right anterior oblique 45 degree view, the puncture point was located between one cone body height anterior to posterior margin of left atrium silhouette and the isometric line between the posterior margin of left atrium silhouette and atria-ventricular suculus. 3) The arch feature of puncture needle and distal part of sheath turned into a straight line under 45 degree of right anterior oblique view. Results The success rate of atrial septal puncture was 99.8% (626/627), and that with only one try was 71.93% (451/627), the rate of tamponade was 0.32% (2/627). No death occurred. Conclusion Simple, reliable and safe, atrial septal puncture under 45 degree of right anterior oblique view is an easily-mastered approach.

Objective To assess the effect of dilute pituitrin solution (0.05 U/ml) on blood loss and distention fluid intravasation during hysteroscopy. Methods From January 2003 to June 2004, 68 women with abnormal uterine hemorrhage undergoing hysteroscopic endometrial resection were randomly divided into treatment and control groups (34 cases in each). In the treatment group, dilute pituitrin solution (0.05 U/ml) was injected into the cervix before dilation of the cervix in preparation for hysteroscopy, while the patients in the control received no pituitrin injection. Results The mean operation time in the treatment group was significantly shorter than that in the control [(32.2?6.0) min vs (35.9?6.8) min; t=-2.379, P=0.020]. The amount of distention fluid infusion in the treatment group was significantly less than that of the control [(2982.1?880.5) ml vs (3461.2?795.8) ml; t=-2.354, P=0.022]. The volume of distention fluid intravasation in the treatment group was significantly less than that of the control [(225.3?81.1) ml vs (319.4?89.2) ml; t=-4.551, P=0.000]. The rate of fluid intravasation was (7.5?1.1)% in the treatment group that was significantly lower than that in the control [(9.2?1.1)%, t=-6.372, P=0.000]. The mean blood loss in the treatment group was significantly less than that of the control [(15.1?4.1) ml vs (24.7?6.6) ml; t=-7.204, P=0.000]. Conclusions Intraoperative administration of dilute pituitrin solution can reduce blood loss, operation time, and the amount of distention fluid infusion and intravasation. As a result, it is useful to avoid post-hysteroscopy complications including TURP syndrome.

Objective To evaluate the outcome of posterolateral approach to the fibula for trimalleolar fractures,especially the fracture in posterior malleolus.Methods Thirty-two patients with trimalleolar fractures treated via posterolateral transmalleolar approach from July 2006 to July 2011 were analyzed retrospectively.All underwent open reduction and internal fixation,including 22 Lauge-Hansen grade Ⅳ supination-external rotation ankle fractures and 10 Lauge-Hansen grade Ⅳ pronation-extemal rotation ankle fractures.Results All fractures had bone union after the follow-up of average 15.5 months (range,12-18 months).Average American Orthopedic Foot & Ankle Society (AOFAS) score was 90.75points,suggesting an excellent result.Kellgren grading system for posttraumatic arthritis severity was grade 0 in eight patients,grade Ⅰ in 18,grade Ⅱ in five,and grade Ⅲ in one,which turned out to be satisfactory.Conclusions Posterolateral approach to the fibula for trimalleolar fractures allows direct reduction and fixation of posterior malleolus fragment in treatment of trimalleolar factures and the clinical outcome is satisfactory.Moreover,the approach deserves clinical practice.

Objective To compare the effect of high negative pressure drainage system and the traditional suction drainage system applied in thyroid surgery.Methods Eligible patients were selected randomly and divided into high negative pressure drainage group(30 cases) and traditional suction drainage group(30 cases).The draining rate within 24 hours after operation,delayed extubation rate,postoperative bleeding,rates of recurrent laryngeal nerve Injury,postoperative infection rate,degree of extubation pain and the incidence of severe pain of both groups were observed and difference of incidence of incision adhesions 1 month after operation were observed.Results The average drainage within 24 hours after operation in experimental group was (19.00 ± 6.79) ml,while (28.53 ± 14.74) ml in control group (P ＜ 0.05).Delayed extubation rate in experimental group was 3.33 ％,while 26.67％ in control group (x2 =4.71,P ＜ 0.05).Incidence of hematoma and bleeding after operation in experimental group was 0％,while 10％ in control group(x2 =1.40,P ＞ 0.05).No recurrent laryngeal nerve injury was found in either group,Incidence was 0％.The incidence of infection in experimental group was 0％,while 10％ in control group (x2 =1.40,P ＞0.05).The incidence of severe pain when extubation in experimental group was 0％,while 100％ in control group (x2 =60.00,P ＜ 0.05).Incidence of incision adhesions in experimental group was 0.33 ％,while 30％ in control group (x2 =6.14,P ＜ 0.05).Conclusion Draining rate,delayed extubation rate and incidence of incision adhesions could be reduced with high negative pressure drainage system applied in thyroid surgery,which is worthy of clinical.

Objective To study the genetic diversity of Fritillaria thunbergii,a traditional Chinese herb in Zhejiang Province in China.Methods The genetic diversity of six representational populations of F.thunbergii including 32 individuals was investigated by amplified fragment length polymorphism(AFLP) maker technique.Results The genetic diversity was revealed as follow: the Nei′s genetic diversity index(He) 0.169 0?0.175 7,Shannon′s information index(I) 0.269 8?0.245 3,percentage of polymorphic loci(PPB) was 76.85% at the species level;Ht 0.169 0?0.030 9,and Hs 0.150 8?0.024 0,I 0.233 3?0.261 9, PPB was 50.38% at population level.The genetic differentiation index(Gst) was 0.107 6,Nm 4.147 0.The result of dendrogram of six populations indicated that Dongyang and Yongkang populations shared the minimum genetic distance(0.015 0),they were classified into a group,and Xiangshan and Jinyun populations shared the maximum genetic distance(0.032 4).Conclusion The genetic diversity of F.thunbergii cultivated in Zhejiang Province is very rich,which could ensure the long-term survival of F.thunbergii.But the genetic diversity of F.thunbergii is relatively higher in population levels while lower at the species levels and the degree of genetic differentiation occured among the populations is not significant.The germplasm resources are relatively stable among these six populations.These populations could be used to breed the fine strains of F.thunbergii as the bases.

Objective To observe the expression of cysteine rich-protein 61 (Cyr61) on renal tubular cells,to explore its effects against hypoxic induced kidney injury and the underlying mechanisms.Methods A stably Cyr61 expressed tubular cell line Cyr61-HK2 was established based on HK2 cells and recombinant Cyr61-lentivirus.BrdU incorporation assay was used for cell proliferation.The apoptosis of cells was analyzed by flow cytometry with Annexin V and propidiumiodide staining.Western bloting was used to detect the protein expression of BAD,Akt and ERK.Results (1) Cyr61-HK2 cells displayed more proliferation ability than HK2 cells.(2) Under hypoxia condition,the apoptosis of both HK2 and Cyr61-HK2 cells increased,but the apoptosis of Cyr61-HK2 cells was lesser than HK2 cells.(3) The expression of Cyr61 led to the phosphorylation of BAD,Akt and ERK on 0 h,0.5 h,1 h (all P ＜ 0.05).Conclusion The expression of Cyr61 can promote cell proliferation and dampen cell apoptosis induced by hypoxia,which may be involved in the Akt/ERK signal pathway.

Objective To study the influence on allograft function of HLA antibody in patients who received pairs of allograft from the same donor.Methods In Beijing Friendship Hospital.HLA antibodies were tested from October,2008 to April 2009 in patients.Recently (October,2013-February,2014),renal functions(serum creatinine/urea nitrogen)were studied in 226 patients who received transplant from 113 donors.LATM10x5,One Lambdas used for Panel reactive antibody screen-ing.Results 41 pairs of renal for male,21 pairs of renal for female and 51 pairs of renal for both male and female.PRA posi-tive in 26 patients (only 4 pairs of renal for patients were positive),11 recipients (HLA II antibody positive in only 1 pair of renal for patients)and 36 recipients (only 5 patients produced antibody)in 226 patients,HLA antibody positive in 73 pa-tients,in which renal function lost or decreased in 64 patients.HLA antibody negative in 153 recipients,in which renal func-tion lost or decreased in 4 patients.There was significant difference between the two group (χ2=160.70,P<0.001).Con-clusion HLA antibody is a important factor influence renal function and long term survival.

Objective To investigate the influences of HLA mismatching on renal function in the kidney transplant patients re-ceiving pairs of allograft from the same donor.Methods 171 pairs of renal transplant patients receiving the kidneys from the same donors were investigated.They were admitted in our hospital before 2008.Their human leukocyte antigens (HLA)were typed with the commercial polymerase chain reaction (PCR)-sequence-specific primers (SSP)HLA typing kit (One Lambda,Inc.,USA;and GTI Diagnostics,USA).The serum creatinine (SCr)and blood urea nitrogen(BUN)were measured in the clinical laboratory of our hospital.Results Among 171 pairs of renal transplant patients,there were 162 recipients with HLA mismatch≤4,in which the re-nal function was remained stable in 107 recipients and lost or decreased in 55 patients.There were 180 recipients with HLA mis-match >4,in which the renal function was stayed normal in 84 recipients and lost or decreased in 96 patients.The difference in in-fluencing the renal function between the HLA mismatch≤4 and HLA mismatch>4 had statistical significance (χ2 =12.22,P <0.05).Conclusion Excellent HLA typing match has important significance for renal long term survival.

Objective To investigate the effect of PBL combined with EBM applied in the teaching of fever of unknown origin. Methods PBL combined with EBM teaching was applied in fever of unknown origin course for 30 clinical medicine specialty(eight years) students of Tongji class of grade 2009(experiment group), while PBL teaching was applied in fever of unknown origin course for 30 clinical medicine specialty (eight years) students of Tongji class of grade 2008 (control group). After teaching, the theory examination for both basic knowledge and case analysis was organized for all students of both groups. At the same time the questionnaire survey was conducted to 30 students of grade 2009 to evaluate the teaching effect. The results were assessed by using SPSS 18.0 statistical software for the T-test of the experimental group and the control group.Inspection level was α=0.05. Results The theory test score of students in the experimental group was (93.5±3.2) point, signifi-cantly higher than that of the students in the control group(84.7±2.8). There was statistically signifi-cant difference between the scores of the two groups of students (P=0.00). Survey results showed 19 students ( 63 . 33%) thought that the development of PBL teaching combined with evidence-based medicine teaching had its necessity, and 16 students(53.33%) thought that the teaching method im-proved their clinical thinking ability of logical reasoning. Conclusion The concept of PBL combined with EBM has achieved significant resultsinthe teaching offever of unknown origin, and it is necessary to carry out this teaching mode in medical colleges with certain teaching strength.