Objective To explore adaptability of the patellofemoral joint after combined soft-tissue surgery in treatment of habitual patellar dislocation at different age. Methods Seventy-three children with habitual patellar dislocation were retrospectively reviewed from 2000 to 2007. There were 24 males and 49 females, with a mean age of 7.1 years(ranged 3-15). The mean follow-up period was 38 months (ranged 25-98). There were 24 patients with 30 knees aged from 3 to 8 years in A group and 49 cases with 69 knees aged from 8 to 15 years in B group. The combined soft-tissue surgery procedure consists of lateral capsular release, medial retinacular tightening of the knee, vastus medialis muscle transfer to the patella, medial and distal transfer of the half patellar tendon. Patella axial and knee lateral X-ray examination were obtained.Femoral trochlear angle,patellar height changes, patellofemoral congruence angle and patellar tilt angle (Laurin angle) were measured to evaluate adaptability of the patellofemoral joint. Results The data of 73 cases were complete. At the last visit, no recurrence of patellar lateral dislocation was found and two cases had patella medial dislocation. Femoral trochlear angle improved from 150.1°±5.1° preoperatively to 144.3°±6.0° postoperatively (P ＜0.05) in A group, while similar changes had not found (P ＞ 0.05) in B group. There were no difference in A and B group in regard to patellar height, congruence angle and Laurin angle. Conclusion The combined soft-tissue surgery had effect on patellofemoral joint remodel in children with habitual patellar dislocation. These procedures can significantly promote development of the femoral condyle, decrease femoral trochlear angle and improve adaptability of the patellofemoral joint in children under the age of 8 years. But it had no obvious influence on older than 8-year-old children.

There are several special advantages of the application of standardized patients ( SPs) in the assessments of clinical skills examination of medical practitioners .However , this application in China is restricted by some limit factors, such as the shortage of SP trainers and SPs , the huge funds needed and the imbalance of regional develop-ment.The suggestion to overcome those limitation and to promote SPs be applied to the clinical skills examination of medical practitioners are as follow: the preparatory of regional university union of SPs , the introduction of social capital to participate in and the adoption of the mode of scale operation .

Objective To determine the feasibility of limb salvage with major vascular reconstruction for sarcomas of extremities, focusing on the early complications, oncological and functional outcomes.Methods Between August 2004 and June 2009, 13 patients (mean age 38 years, range 14-63 years) underwent wide resection of upper and lower extremity sarcomas to include the involved arterial and venous segments. 4 patients had bone sarcomas and 9 soft tissue sarcomas, 6 patients only had underwent artery replacement and the other 7 had underwent both artery and vein. 8 resected vessels were reconstructed with vascular graft and 5 with ipsilateral or contralateral saphenous vein. Results No patient suffered from reperfusion injury and infection. The patient with osteosarcoma in proximal humerus had suffered acute arterial graft thrombosis at first day postoperatively; however, the limb was salvaged after successful thrombectomy. 5 of 8 patients with synthetic graft developed minor delayed wound healing and hematoma, but the other 5 patients with autologous saphenous vein replacement did not. The mean follow-up was 19.4 months (7-45months). One patient died of pulmonary metastasis; the patient with osteosarcoma in proximal humerus had developed local recurrence, but refused amputation and was alive with metastasis. No arterial occlusion was observed at final follow-up or at the time of death, but the patency of artery and vein was 100% and 28.6%respectively. One patient who has pulmonary metastases before operation died of metastases 7.5 months after operation. Four patients developed pulmonary metastases, therefore, Kaplan-Meier survival analysis showed that 2-year overall and metastasis-free survival rate was 90.9% and 63.6% respectively. Functional status were judged as good or excellent (mean MSTS score 72%) in 12 of 13 patients. Conclusion The study indicate that malignant involvement of major vessels is not a contraindication for limb-salvage. Vascular reconstruction is a feasible option in limb salvage surgery. Wide resection with vascular reconstruction provide acceptable oncological and functional outcome of limb salvage.

Objectives:In order to prevent and control hospital infection efficiently, comprehensive management is put into effect on the quality of disinfectant and sterilization. Methods:The management model which spot-supervision, bacteria monitor and scientific modification are integrated has been applied in hospital. Results and Conclusions:The sterilization mind of staffs has been steadily strengthened and the qualified ratios of various monitor items has increased annually.

【Objective】To investigate the molecular mechanism of dopamine (DA)-induced apoptosis in cultured cerebellar granule neurons (CGNs) and the effect of muscarinic cholinergic receptor (mAChR) agonist carbachol on it.【Methods】The apoptosis of neurons was measured by phase-contrast microscopy,Hoechst 33258 nucleus staining and DNA fragmentation agarose gel electrophoresis.The neuronal viability was measured by fluorescein diacetate (FDA) staining.The activation of extracellular signal-regulated protein kinase (ERK) was determined by Western blot.【Results】Dopamine increases the phosphorylation of ERK and induces apoptosis in CGNs,which is blocked by both carbachol and PD 98059.The protective effect and the inhibiting ERK phosphorylation of carbachol were blocked by atropine.【Conclusion】DA-induced apoptosis in CGNs may be mediated by activation of ERK.Carbachol protects CGNs from DA-induced apoptosis by activating mAChR and subsequent inhibition of activation of ERK.

According to the three-parameter expression of blood , the dual-frequency complex impedance information is selected as the known quantity. In this paper , the particular solution process of three-parameter is introduced. A calculational method to obtain basic quantity and pulsatile quantity of three-parameter of blood electrical impedance is established.

Objective: To discuss the action mechanisms of Takayasus arteritis (brachiocephalic artery type) of acupuncture. Methods: We applied acupuncture therapy with the principle of warming Yang and supplementing Qi, removing obstruction in the meridians and recovering pulse, to treat patients with takayasus arteritis (brachiocephalic artery type). Before and after treatment, we detected the TCD (Transcranial Doppler) changes of the average velocity of blood flow (AVBF) and arterial pulsatility index (PI) of related arteris. Results: After treatment,acupuncture and moxibustion can regulate the abnormal blood flow rate in endocranial correlated arteries by two sides, in the AVBF while, elevate the elasticity of endocranial vessels.Conclusion: Acupuncture and moxibustion can regulate cerebrovascular function of patients with takayasus arteritis (brachiocephalic artery type), increase the perfusion of cerebral blood flow, and adjust abnormal state of endocranial hemodynamics. This is possibly the important action mechanisms acupuncture in treating this disorder.

OBJECTIVETo study the absorption mechanism of tanshinones in the roots of Salvia miltiorrhiza as well as the interaction between the components in the effective fraction.

METHODThe model of intestinal absorption in vivo was used and the concentrations of the tanshinones were determined by HPLC, the apparent absorption constant (K(a)) and half life of absorption (t1/2) were obtained, the other components in the extract on the absorption of the there components were also studied.

RESULTWith the increase of dosage of tanshinone II A or cryptotanshinone, K(a) decreased and absorption half life t1/2 increased, the drug absorption rate constant (K(a)) had little significant effect on duodenum, Jejunum and ileum. Tanshinone I has a good absorbing in the rat small intestine. The absorption of tanshinone II A and cryptotanshinone was promoted by the other components in tanshinones extract while tanshinone I' was decreased.

CONCLUSIONWhen the concentration increases to a certain level, the uptake of tanshinone II A and cryptotanshinone do not increase. The transport mechanism of tanshinone II A and cryptotanshinone in vivo is similar to active transport or facilitated diffusion. They could be well absorbed in general intestinal tract without specific absorption site, and the complex constituents in extract could significant effect the absorption of the pharmaceutical effective constituents.

Absorption ; Animals ; Diterpenes, Abietane ; Drugs, Chinese Herbal ; analysis ; pharmacokinetics ; Intestine, Small ; drug effects ; physiology ; Male ; Phenanthrenes ; analysis ; pharmacokinetics ; Rats ; Rats, Sprague-Dawley ; Salvia miltiorrhiza ; chemistry

Objective:To explore the putative role of CD40 and COX-2 expression in human esophageal squamous cell carcinoma(ESCC)and to analyze their possible relationship with angiogenesis in ESCC.Methods:The expression of CD40 and COX-2 was detected in 79 ESCC and 28 normal esophageal epithelial tissue samples with immunohistochemical staining.The microvessel density by CD34 was determined and the clinicopathological significance of CD40 and COX-2 expression in ESCC was analyzed.In addition,the expression of CD40 and COX-2 in esophageal squamous cell carcinoma cell line Eca109 and primary cultured normal esophageal epithelial cells in vivo was comparatively studied with immunocytochemical staining andWestern blot.Results:Compared with that in normal epithelial tissues,the expression of CD40 and COX-2 in ESCC was significantly higher(54.43%vs 10.71%:69.62%vs 17.86%:respectively,P<0.05).The positive expression rate of CD40 in ESCC cases with lymph node metastasis was significantly higher than that in those without lymph node metastasis(70.37%vs 46.1 5%.P<0.05).No correlation was found between CD40 expression and patient age,sex,tumor location,size and differentiation of tumors.No clinicopathological significanca of COX-2 expression in ESCC was found.There was a positive correlation between CD40 expression and COX-2 expression in esophageal squamous cell carcinoma(P<0.05,φ=0.446).The mean MVD value in ESCC was significantly higher than that in normal esophageal tissue(25.02±5.52 vs 12.09±4.55,P<0.05).MVD value in ESCC was closely correlated with lymph node metastasis.The mean MVD value in ESCC cases with positive CD40 and COX-2 expression was higher than that in those with negative CD40 and COX-2expression(26.37±6.02 vs 22.58±5.25.P<0.05).Western blot results showed that CD40 and COX-2 expression in Eca109 was higher than that in cultured normal esophageal epithelial cells (P<0.05).Conclusion:The expression of CD40 is involved in the carcinogenesis and progression of esophageal squamous cell carcinoma.CD40 may play an important role in the angiogenesis of ESCC through promoting COX-2 expression.

Surgical treatment for bone and soft tumors of pelvis and sacrum presents a big challenge, because of the complex anatomy of sacropelvic region, large tumor volume at presentation, rich blood supply to the tumor and visceral involvemen, et al. Therefore, surgical excision and reconstruction are technically difficult for sacropelvic tumors. Extensive intraoperative haemorrhage could be life-threatening, and this issue remains a major concern. How to effectively control bleeding during surgery is critical for successful operation and patient's favorable prognosis. Some previous attempts, such as interventional selective internal iliac artery embolization or manual ligation through an additional anterior approach, were tested to be ineffective. Inspired by the success of resuscitative endovascular balloon occlusion of the aorta (REBOA) which resemble an endovascular tourniquet for traumatic hemorrhagic shock, some researchers have applied this techinique to control surgical bleeding during pelvic or sacral tumor resection.The authors have performed REBOA for more than 1 500 sacropelvic tumr surgeries since 2003 in Peking University People's Hospital. The patient age, the diameter of femoral artery and aorta, atherosclerosis, as well as tumor location, volume and expansion and blood suppy, have to be thoroughly evaluated prior to REBOA administration. Admittedly, the application of REBOA do reduce intraoperative bleeding, shorten the operation duration, improve the safety of surgery, yet some complications were observed including local hematoma at the puncture site, acute arterial thrombosis, femoral artery pseudoaneurysm or occlusio, et al. The purpose of this study is to review the literature on REBOA administration in pelvic and sacral tumors excision, with the focus on its indications, performing procedure, the safety and efficacy, and complications. Moreover, in order to popularize the clinical application of aortic balloon occlusion in the future, we summarize our experience of abdominal aortic balloon occlusion over 10 years.