Objective To assess the renal safety of adefovir dipivoxil (ADV) in Chinese patients with chronic hepatitis B (CHB).Methods A retrospective study was performed on 1 013 CHB patients from Chinese ADV multicenter clinical trials (ADF30001 and ADF106632).All patients were administrated with ADV 10 mg daily.The serum creatinine and phosphorus levels were measured in different time pointsduring 104-week treatment.Nephrotoxicity was defined as an increase ≥44.2 μ mol/L from baseline in serum creatinine or a serum phosphorus value of ＜ 0.4845 mmol/L on two consecutive occasions.Paired t test was used to analyze serum creatinine and phosphorous data before treatment and at different time points during treatment.Results At week 28,week 52,week 80 and week 104,the median levels of serum creatinine were 74.963,76.996,76.820 and 77.969 μmol/L,respectively,and there were no significant differences from baseline (t =0.91,0.23,0.59 and 0.97,P ＞ 0.05).No patient experienced a ≥ 44.2 μmol/L increase from baseline.For serum phosphorus,the median levels at week 28,week 80 and week 104 were 1.098,1.088 and 1.048 mmol/L,and there were significant decreases from baseline (t =2.34,3.06 and 4.94,P ＜0.05 or ＜ 0.01).The cumulative incidence of serum phosphorus abnormality was 0.8％ (8/104).There were no confirmed serum phosphorous decreases to ＜ 0.4845 mmol/L.Conclusion Two years treatment with ADV (10 mg/d) does not result in marked nephrotoxicity,indicating that ADV 10 mg daily is well tolerated by Chinese patients.

Objective To report the anatomical study and clinical application of the medial sural artery pertorator flaps. Methods The anatomical study involved 12 fresh adult cadaver lower legs, the arteries of which were perfused with suspensions of lead oxide and gelatine. The bifurcation, location, length, diameter and blood territories of the medial sural artery and its perforating vessels were recorded by dissection, angiography and photography. The integument of the leg was dissected and ridiographed. The tendency of the vessels was analyzed, the surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. With the aid of anatomic study, a series of five clinical cases was reported, including five free medial sural flaps for ipsilateral hand reconstruction. Results There was at least one perforating vessel in the medial sural areas of the specimen. A mean of 2.1 perforators was noted over the medial gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease, 1 to 5 cm from the posterior medial line. Their diameter was (1.03±0.22)mm at the deep fascial level. The average vascular territory on the sural area was (107.5±23.9)cm2, and the average supplying area of single perforator was (58.3±17.0)cm2. All the transferred free flaps taken in the 5 clinical cases survived uneventfully. All the patients were followed-up from 6 months to 12 months. The appearance of flaps and the function of the limbs were satisfied. Conclusion The standard method for the study of perforator flap is the lead oxide-gelatin technique. It is the anatomic basis that there are perforating musculocutaneous vessels on the medial gastrocnemius muscles constantly. The free medial sural perforator flap has the advantage of good appearance. It is the safe and suitable choice in the cases when a medium or small-sized flap is required for resurfacing hand injuries.

BACKGROUND: Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE: To investigate the outcome of autologous iliac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN, TIME AND SETTING: The own control study was performed at the Department of Orthopaedics, Sixth People’s Hospital, Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS: Of 21 cases of the ununited distal ulnar fracture with osseous defects, 13 cases were induced by ulnar and radial fracture, and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fractureof first onset. Bone defects were 1.5 cm-5.0 cm, averagely 3.1 cm. METHODS: Bone defects were filled with intercalary iliac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate, reconstruction plate or locking compression plate. At least two screws were used at the distaend, and 3 or 4 screws were fixed in the proximal end. Follow-up was conducted once per month to observe clinical appearanceand radiograph in each patient. MAIN OUTCOME MEASURES: Fracture nonunion, dorsal extension and palmer flexion of wrist joint, pronation and supination othe forearm were measured. RESULTS: All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union, and a mean timof 4.6 months (ranged 3 to 7 months). The distal ulnar healed with

Objective To investigate the curative effect of tube placement and drug irrigation in the auditory tube under nasoscope in the treatment of secretory otitis media(SOM). Methods Under the visualization of a 30? nasoscope,an epidural guiding tube was placed through the pharyngeal opening of the auditory tube into the tympanic cavity for drug irrigation in 50 cases of secretory otitis media(50 ears).Results Follow-up observations for 6~24 months showed 26 cases of cure(52%),19 cases of improvement(38%),and 5 cases of no effect(10%),the total effective rate being 90%. Conclusions This procedure has advantages of simplicity of performance,unaffected drum membrane,high safety,no pain,and satisfactory outcomes,being an effective treatment option for improving the function of the auditory tube and hearing ability in patients with secretory otitis media.

Objective To investigate advantages of sep to plasty under nasal endoscope. Methods Septoplasty was carried out under nasal endoscope in 50 cases, including 6 cases of upper or posterior n asal septum deviation. Results The operation was completed on one session in all the 50 cases, with the deviated nasal septum being entirely c orrected. The operation time was 30~72 min (mean, 48 min). Follow-up surveys for 6~9 months (mean, 7.1 months) indicated a complete cure in 45 cases (90%) and a n improvement in 5 cases (10%). No septal hematoma, abscess, perforation, nasal cavity adhesion, or bridge collapse were encountered. Conclusions Nasal endoscopic septoplasty has advantages of short operation time, few bl ood loss, mild pain, little complications, and the possibility of nasal sinus co -operation. This technique may fully replace the traditional submucous resection .

Objective To explore the curative effect of endoscopic simple maxillary ostium enlargement in the treatment of non-invasive mycosis of maxillary sinus. Methods Clinical data of 16 cases of noninvasive mycosis of maxillary sinus were analyzed retrospectively. Results The operation time was 30～120 minutes, with a mean of 60 minutes. No operative complications occurred. The hospital stay was 5～7 days, with a mean of 6 days. Histopathological examination found hyphae and spores in 16 cases, and a positive culture of Aspergillus was observed in 9 cases. Postoperative follow-up for 3～24 months (mean, 18 months) in 16 cases revealed free of symptoms in 14 cases, in which the endoscopic examination showed unobstructed ostium and normal sinusal mucosa, and recurrence in 2 cases, who underwent repeated enlargement of ostium and were re-followed for 6 and 13 months, respectively, without recurrence. Conclusions Nasal endoscopic simple maxillary ostium enlargement in the treatment of non-invasive mycosis of maxillary sinus is a radical and minimally invasive technique, but particular attention must be directed to managing the maxillary ostium.

BACKGROUND:Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE:To investigate the outcome of autologous lilac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN,TIME AND SETTING:The own control study was performed at the Department of Orthopaedics,Sixth People's Hospital,Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS:Of 21 cases of the ununited distal ulnar fracture with osseous defects,13 cases were induced by ulnar and radial fracture,and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fracture of first onset. Bone defects were 1.5 cm-5.0 cm,averagely 3.1 cm. METHODS:Bone defects were filled with intercalary lilac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate,reconstruction plate or locking compression plate. At least two screws were used at the distal end,and 3 or 4 screws were fixed in the proximal end,FoUow-up was conducted once per month to observe clinical appearances and radiograph in each patient. MAIN OUTCOME MEASURES:Fracture nonunion,dorsal extension and palmer flexion of wrist joint,pronation and supination of the forearm were measured. RESULTS:All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union,and a mean time of 4.6 months (ranged 3 to 7 months). The distal ulnar healed with < 10° of angular deformity in a coronal plane in one patient and with 15° of angulation in a sagittal plane in another one,while others (19 patients) obtained satisfactory alignment. The excellent and good rate was 90.5％. CONCLUSION:Intercalary bone-grafting with autologous lilac and secure fixation for treating the ununited distal ulnar fracture with osseous defects can reconstruct ulnar length,correct deformities,and obtain good bone healing and functional recovery.

Objective To evaluate the childhood asthma control test(C-ACT) on the assessment of asthma by exploring the correlations among C-ACT,disease severity,the control level of pediatric asthma,disease partition and the changes in the pulmonary function as well as the score range,and to evaluate the feasibility and effectiveness of C-ACT's application to guide children's asthma control.Methods Two hundred and five children with asthma in the Pediatric Asthma Outpatient of Xiamen Hospital of Fujian University of Traditional Chinese Medicine from October 2011 to October 2015 were enrolled and randomly divided into control group and experimental group by random number table.The patients in the experimental group were monitored by the C-ACT with corresponding guidance,while patients in control group were treated without the monthly guidance of C-ACT after C-ACT involvement at the first time.C-ACT questionnaire score surveys were completed by all patients and their parents under the guidance of asthmatic specialists or nurses.Pulmonary function,disease severity and disease partition and the control level of pediatric asthma were detected and evaluated by doctors before and after treatment.The correlation between the results of C-ACT and the changes in the clinical indicators was assessed,and the improvement of lung function and the control rate of asthma were evaluated in 2 groups after 1 year.Results (1) There was no significant difference in gender,age and disease severity distribution based on the results of pulmonary function assessment between the control group and the experimental group (all P ＞ 0.05).(2) The C-ACT scores in normal,slight abnormal,moderately abnormal and severely abnormal pulmonary function were (24.79-± 2.20) scores,(21.67 ± 1.93) scores,(17.07-± 2.01) scores and (12.67 ± 1.81)scores,respectively,which showed the pulmonary function had a positive correlation with C-ACT scores (F =314.0,P ＜ 0.000 1).(3)Assessment of the reliability of C-ACT:the α value of Cronbach's coefficient for the scale was 0.867,which showed the high reliability.The correlation coefficients between the C-ACT score and the percentage of predicted value of forced expiratory volume in one second(FEV1％),the percentage of peak expiratory flow in the predicted value (PEF％) were 0.683 and 0.712,respectively,which also showed the strong reliability.(4) C-ACT scores in intermittent attacks of asthma,slight persistent asthma,moderate persistent asthma,severe persistent asthma were (24.47 ± 2.26) scores,(22.17 ± 1.86) scores,(17.42 ± 2.52) scores and (13.27 ± 2.11) scores,respectively,which showed the severity of asthma was positively associated with C-ACT scores (F =244.0,P ＜ 0.000 1).(5) C-ACT scores in controlled,partly controlled and uncontrolled asthma were (24.32 ± 2.34) scores,(18.87 ± 1.95)scores and (14.03 ± 1.32) scores,which showed the control levels of asthma had a positive association with C-ACT scores(F =394.0,P ＜ 0.000 1).(6)C-ACT scores in different disease partitions of green,yellow and red area were (24.72 ± 2.04) scores,(18.17 ± 2.03) scores and (15.06 ± 1.93) scores,which showed the diseases partition had an association with C-ACT scores (F =367.2,P ＜ 0.000 1).(7) After treatment of 3 months,6 months and 12 months,the control rates in the control group were 28.71％,67.33％,81.19％,but they were 44.23％,79.81％,95.19％ in the experimental group respectively.The control rates were higher in the experimental group than those in the control group,and the differences were significant (x2 =5.318,4.114,9.722,all P ＜ 0.05).Conclusion The C-ACT is highly correlated with pulmonary function,and our study show the C-ACT score range can help to make a quick assessment of disease severity,disease partition and the control level of children asthma.The application of C-ACT for the treatment of asthma has a good effect and it can be recommended and applied to childhood suitable for the promotion and application of children asthma clinics and community medical institutions at all levels of hospitals.

Objective Estimating clinical effects of the Therapy of Potassium L-aspartate Injection on Hypokalemia.Methods These hypolalemia patients from the Renji hospital of Shanghai Jiaotong University and Other Two Hospitals,and from March 2007 to May 2008,which were caused from various kinds of reasons.The test group (42 patients) were intravenous dripped by using three rami potassium L-aspartate injection added in 5% Glucose (or saline) 750 mL,the control group (44 patients) were gived two rami chloratum Kalium injection added in 5% Glucose (or saline) 750 mL,the Kalium were 1.10 g/d in both groups,once per day,time of therapy was 7 day.Results The test and control groups effective power after therapy were 86.67% and 91.11%,respectively,there was no significant difference (P=0.3998).The Kalium dose of test group was advanced from (3.18?0.23) mmol/L before testing to (3.73?0.37) mmol/L after therapy,the elevated average was (0.61?0.46)mmol/L,and there was no significant difference (P=0.4722).The accumulation power of Kalium recovery were (51.11?7.45)%,(77.78?6.20)%,(86.67?5.07)%,at the second,the fored and the sevened day,respectively.There was no significant difference between the two groups (P=0.1430).Conclusion The clinical effect was correspond between three rami potassium L-aspartate injection added in 5% Glucose (or saline) 750 ml and the Isodose chloratum Kalium injection,by once per day,and seven days of therapy,which can treat hypokalimeia caused from various kinds of reasons.

Objective To reports to anatomy and clinical application of the medialis pedis perforator flap. Methods The origin, course, distribution and out diameter of medial plantar perforators, which were located at the septums between the abductor hallucis muscle and the flexor digitorum brevis, and between the abductor hallucis muscle and the skeleton, were observed on 10 sides adult feet specimens perfused with red latex. 11 free medialis pedis perforator flaps were transferred for soft-tissue defect in hand. The areas of tissue defect ranged from 2 cm x 2 cm - 9 cmx 4 cm. Results The medial plantar artery sends 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and the flexor digitomm bre-vis, and 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and nav-icluar bone and the medial cuneiform bone. These perforators supply the medial plantar flap and medialis pedis flap respectively. All of the 11 cases of free medialis pedis perforator flap survived uneventfully. The flap areas ranged from 2 cm × 3 cm - 11 cm× 5 cm. The appearance and functional results were satisfactory with following up for 6 to 24 months. Conclusion The free medialis pedis perforator flap is a good method in repairing soft-tissue defect in hand.