[Objective]To discuss the alterations of sesamoid position before and after opertation and its relation to the function of the metatarsophalangeal joints.[Methods]Eighty feet(39 hallux valgus feet,41 normal foot) were selected.The distance from sesamoids to the second metatarsal,the relative position of sesamoid bone to the first metatarsal bone,the function of the first metatarsophalangeal joints were determined and analyzed.[Results]The distance from sesamoid to the second metatarsal had no statistical significance in normal feet compared with the hallux valgus feet(P

Objective To evaluate the dynamic MR imaging findings of peripheral cholangiocarcinoma (PCC) of the liver. Methods Seventeen patients with PCC underwent dynamic MRI during the early, middle, and delayed phase after contrast medium administration. Enhancement pattern of the tumor, the wedge-like enhancement area peripheral to the tumor, dilatation of the intrahepatic biliary ducts, vascular involvement, and extrahepatic tumor invasion were evaluated. Results Early peripheral enhancement with progressive and concentric filling by contrast medium was the most frequent enhancement pattern (9 patients). A wedge-like enhancement area was observed in 10 patients. Ductal dilatation was found in 11 patients. Vascular involvement and extrahepatic invasion were seen in 8 and 2 patients, respectively. Conclusion Enhancement pattern is relative to the character of pathology (quantity and distribution of cell and fibrosis). Early peripheral enhancement with progressive and concentric filling by contrast medium may be specific for PCC.

AIM:To observe the effect of lidocaine to the activation of NF-?B and apoptosis in human neutrophils(PMN)in vitro.METHODS:Human PMN were divided into five groups:control group(0.9% sodium chloride);TNF-?(200 ng/L);TNF-?+lidocaine(1.0 mmol/L);TNF-?+lidocaine(2.0 mmol/L),and TNF-?+ lidocaine(4.0 mmol/L).The expression of NF-?B subunit p65 mRNA in the nuclear and I-?B mRNA in the cytosol extracts were analyzed by Western blotting,after co-incubation for 3 h and the content of p65 protein were observed by RT-PCR.PMN apoptosis was detected on flow cytometry after co-incubation 12 h and 24 h.RESULTS:The expression of NF-?B mRNA was significantly decreased and the expression of I-?B mRNA was markedly increased in lidocaine groups(P

Background and purpose:Although FDG tumor imaging has been applied in clinic widely, dual-phase imaging can provide much more information about the FDG uptaking of pulmonary lesions. The purpose of the study was to evaluate the usefulness of dual-phase18F-FDG coincidence detection SPECT/CT imaging in the differential diagnosis of the pulmonary lesions.Methods:There were 28 patients with pulmonary lesions which were detected by CT. All the patients undertook the SPECT/CT imaging at 2 time-phases respectively: early imaging at 40-60 min and delayed imaging at 2-3 h after the intravenous injection of FDG. Data processing: calculating the radio of T and N in early and delayed imaging respectively; T: The radioactive count of the lesions; N: The radioactive count of the normal tissue; and the change rate:ΔT/N. ROC was used to ifnd out the threshold of T1/N1, T2/N2及ΔT/N in the differential diagnosis between benign and malignant lesions. AUC was used to evaluate the diagnosis value of the dual-phase and single-phase imaging.Results:The threshold of T1/N1 in early imaging was 2.65, whereas AUC was 0.767. The sensitivity, speciifcity and accuracy were 83.3%, 30% and 64.3%, respectively. The threshold of T2/N2 in delayed imaging was 3.14, whereas AUC was 0.847. The sensitivity, speciifcity and accuracy were 94.4%, 60.0% and 82.1%, respectively. The threshold ofΔT/N in delayed imaging was 16.9%, whereas AUC is 0.950. The sensitivity, speciifcity and accuracy were 88.5%, 71.4% and 86.2%, respectively.Conclusion:Dual-phase18F-FDG coincidence detection SPECT/CT imaging has much higher accuracy and speciifcity. However it still has false positivity, and should be analyzed with CT and clinical history.

Objective To evaluate the efficacy of ultrasound?guided transversus abdominis plane ( TAP) block with different concentrations of ropivacaine for analgesia after cesarean section. Methods A total of 120 parturients, aged 24-31 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, weighing 64-73 kg, at 35 to 41 week gestation, scheduled for elective cesarean section, were randomly di?vided into 3 groups ( n= 40 each) using a random number table: 0?25% ropivacaine group ( group Ⅰ) , 0?20% ropivacaine group ( groupⅡ) , and 0?15% ropivacaine group ( groupⅢ) . A patient?controlled an?algesia pump was connected at the end of surgery, and the corresponding concentration of ropivacaine 1?5 mg∕kg was injected into the bilateral TAP under the guidance of ultrasound in each group. Visual analogue scale score was maintained ≤3. The number of attempt and the number of patients requiring rescue analge?sic were recorded at 48 h after surgery. The occurrence of TAP block?related complications was observed and recorded. Results Compared with groupⅢ, the number of attempt and the number of patients requi?ring rescue analgesic were significantly decreased in Ⅰ and Ⅱ groups ( P<0?05 ) . Compared with groupⅡ, the number of attempt and the number of patients requiring rescue analgesic were significantly de?creased in group Ⅰ (P<0?05). No TAP block?related complications were detected in the three groups. Conclusion Ultrasound?guided TAP block with 0?25% ropivacaine is helpful in improving the analgesic efficacy after cesarean section without serious complications.

Objective To investigate the effects of emulsified isoflurane preconditioning on lung ischemia-reperfusion (Ⅰ/R) injury in rats.Methods Thirty-two male Sprague-Dawley rats,weighing 250-320 g,were randomly divided into 4 groups (n =8 each) using a random number table:sham operation group (group S),group Ⅰ/R,intralipid group (group IL),and emulsified isoflurane preconditioning group (group EI).Lung Ⅰ/R was produced by clamping the left hilum of lungs for 1 h followed by 2 h of reperfusion in anesthetized rats.In group S,intraperitoneal normal saline 10.5 ml/kg was injected,but the hilum was only exposed 24 h later.In groups Ⅰ/R,IL and EI,intraperitoneal normal saline 10.5 ml/kg,30％ intralipid 10.5 ml/kg and 8％ emulsified isoflurane 10.5 ml/kg were injected intraperitoneally,respectively,and then the model was established 24 h later.At the end of reperfusion,blood samples were collected from the left ventricle for measurement of PaO2,PaCO2,plasma malondialdehyde (MDA) concentration (by ELISA).The rats were then sacrificed,and left lungs were removed immediately for microscopic examination and for determination of myleoperoxidase (MPO) activity (using colorimetric method) in pulmonary specimens.Wet/dry lung weight ratio (W/D ratio) was calculated.Results Compared with group S,W/D ratio,MPO activity,plasma MDA concentration and PaCO2 were significantly increased,and PaO2 was decreased in the other three groups.Compared with group Ⅰ/R,W/D ratio,MPO activity,plasma MDA concentration and PaCO2 were significantly decreased,and PaO2 was increased in IL and EI groups.W/D ratio,MPO activity,plasma MDA concentration and PaCO2 were significantly lower,and PaO2 was higher in group EI than in group IL.The pathological changes of the lung were significantly attenuated in group EI compared with group Ⅰ/R.Conclusion Emulsified isoflurane preconditioning can reduce lung Ⅰ/R injury in rats,and inhibition of pulmonary inflammatory responses and of production of oxygen free radicals are involved in the mechanism.

Objective To evaluate the role of spinal nicotinamide-adenine dinucletide phosphate (NADPH) oxidase in the development and maintenance of neuropathic pain (NP) in rats.Methods Twenty-four pathogen-free healthy male Sprague-Dawley rats,aged 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (S group),NP group and NADPH oxidase inhibitor group (NI group).The left sciatic nerve was exposed but not ligated in group S.The left sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 silk thread to establish the NP model in group NP.In group NI,the NP model was established at 3 days after intrathecal catheterization,and NADPH oxidase inhibitor 5 μg/10 μ1 was injected intrathecally once a day for 7 consecutive days starting from 30 min before operation.The mechanical paw withdraw threshold (MWT) was measured at 1 day before operation and 1,3,5 and 7 days after operation.The rats were sacrificed at 8 days after operation,and the spinal cord was removed for determination of NeuN positive cells (by immuno-histochemistry) and expression of NADPH oxidase (by Western blot).Results Compared with group S,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly decreased in NP and NI groups,the expression of NADPH oxidase was upregulated in group NP,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Compared with group NP,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly increased,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Conclusion Up-regulated expression of spinal NADPH oxidase is involved in the development and maintenance of NP in rats.

Doctor-patient trust plays an important role in doctor-patient knowledge transfer.Investigating the basic features and trust performance of the patients, the authors classified by means of a cluster analysis, the patients into four groups with such criteria as the trust on hospital, trust on doctors, patient's awareness of the knowledge, and patient's compliance to the doctor's advice. The four groups are rational and suspicious, passive compliance, high self-confidence, and blind trust groups. In view of behavioral characteristics of the patients, different doctor-patient knowledge transfer strategies are suggested, in an effort to perform effective doctor-patient communication and to gain patient's trust.

Prognosis and treatment of primary Sj?gren′s syndrome with renal tubular acidosis

BACKGROUND: The total knee replacement is considered as one of the most effective and successful operations to cure terminal or severe gonarthritis. How to lower the revision rate as well as increace the effect of prostheses after the knee replacement should be solved urgently.OBJECTIVE: To retrospectively analyse the clinical applications and curative effects of different knee prostheses.DESIGN: Based on patients who accepted knee replacement, preoperative and postoperative condition was observed and compared so as to compare the postoperative effect of different types of knee prostheses replacements.SETTING: Department of Orthopedics, General Hospital of Chinese PLA.PARTICIPANTS: A total of 398 patients (523 knees) were selected from the Department of Orthopedics, General Hospital of Chinese PLA from January 2002 to January 2005, including 276 unilateral knee replacements (276 knees) and 122 bilateral knee replacements (244 knees). Patients were respectively diagnosed as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), pigmented villonodular synovitis (PVNS), etc.METHODS: According to the pathogenetic condition, patients received total knee replacements with different knee prostheses. Types of knee prostheses: ① According to the replacing range, it could be divided into unicondylar prostheses and total condylar prostheses; total condylar prostheses could be subdivided into posterior cruciate ligament (PCL)-retaining and PCL-substituting prostheses. ②According to the degree of mechanical constraint, it could be divided into unconstrained, semiconstrained or fully constrained prostheses. ③ According to whether imitating meniscus-function, it could be divided into tibial plateau rotatable sliding type and fixed type. Follow-up was conducted on patients that mentioned above after half a year. Knee joints were scored by using knee joint scoring system of American special surgical hospital (HSS scoring with the total score of 100 points, those above 85 were considered as excellent; 70-84 as good;60-69 as fair; below 60 as poor). Feller scoring (total score of 30 points; the higher the points were, the better the symptom was) criteria was used in patellar scoring. Investigation and comparison on pain-degree of anterior region of knee,range of motion of knee joint and the stabilization were done during the follow-up, ap and lateral views of patella from 30 degrees and 90 degrees were taken in radiography.MAIN OUTCOME MEASURES: Preoperative and postoperative scores of HSS, patella, anterior pain of knee, function of patella, the maximum flexion and tibiofemoral angle.RESULTS: Follow-up was conducted in 372 patients (490 knees) with the follow-up rate of 93.4%. ①Therapeutic effect:Excellent and good rate of the operation was 89%. Pain and function of patients after operation were obviously ameliorated, effect on pain-amelioration and range of motion of knee joint activation were significant. ② Score of HSS, patellar,anterior pain of knee, function of patellar and the maximum flexion were markedly increased than those before operation (P ＜ 0.01). ③ There were no marked significances in comparison of score of HSS, patellar, anterior pain of knee, function of patellar, the maximum flexion and tibiofemoral angle on different knee prostheses replacements (P ＞ 0.05).CONCLUTION: Prostheses should be chosen carefully and appropriately according to the indications, contraindications,anticipated attainable functions, service life as well as pathogenetic conditions, and then satisfactory curative effect will accordingly be achieved.