Objective To discuss the efficacy of micro-diameter and multiple-drilling core decompression in treatment of early femur head necrosis. Methods Sixty-eight patients with early femur head necrosis were selected, and they were divided into 2 groups by random digits table method. The experiment group (35 cases) underwent the micro-diameter and multiple-drilling core decompression (3.0-4.0 mm Kirschner wire or drill), and the control group (33 cases) underwent traditional instruments surgery. Results The operative time, hospital stay and pain score of postoperative hip joint Harris score in experiment group were better than those in control group:(41.2±7.4) min vs. (74.3±10.2) min, (9.7±2.3) d vs. (14.3±4.2) d and (43.56±2.12) scores vs. (37.21±1.19) scores, and there were statistical differences (P<0.01 or<0.05). There were no statistical differences in blood loss and overall hospital costs between 2 groups (P>0.05). There were no statistical differences in the total score of hip joint Harris score at 3 and 6 months after surgery (P>0.05). The total scores of hip joint Harris score at 12 and 24 month after surgery in experiment group were significantly higher than those in control group:(93.11± 2.43) scores vs. (91.23±2.89) scores and (85.23±2.43) scores vs. (73.54±2.89) scores, and there were statistical differences (P<0.05). Conclusions The micro-diameter and multiple-drilling core decompression is applied to the early femur head necrosis with less trauma, shorter operative time, higher clearance rate of necrotic bone and slower disease progression compared with traditional instruments. The micro-diameter and multiple-drilling core decompression makes patients' hip function get a satisfactory recovery with certain clinical applications.

Objective To investigate the therapeutic effect of tripterygium wilfordii and prednisone in old patients with primary nephrotic syndrome. Methods 78 elderly primary nephrotic syndrome patients were randomly divided into two groups. 42 patients in treated-group were treated with tripterygium wilfordii and prednisone while 36 patients in control-group were treated with prednisone only. The curative effect,24 hours urinary protein, serum albumin,plasma lipid and renal function were detemined after six months. The responses of the patients were classified as complete remission(CR) ,partial remission(PR) and NO-response. Results After six months treatment, there were 24 patients got to CR,12 patients to PR,and 6 patients remained refractory to treatment group. While there were 13 patients got to CR,10 to PR,and 13 as refractory in the control group. The general effective rate in the treatment group was 85.7% ,which was markedly higher than that of the control group,which is 66. 67% (P＜0. 05). The recurrence rate in the treatment group and control group were 14. 3% and 36. 1% respectively (P＜0. 05 ). Conclusion The curative effect of tripterygium wilfordii and prednison on elderly primary nephrotic syndrome is markedly better than prednisone only.

Objective To explore the clinical value of renal biopsy in the diagnosis of atypical lupus nephri-tis(LN). Methods The clinical and renal pathological data of 28 cases with atypical LN were analyzed retrospective-ly. Results All 28 patients could not fulfill the ACR diagnostic criterion,misdiagnosed as primary nephritic syndrome 21 eases,chronic glomerulone-phritis syndrome 4 cases ,asymptomatic hematuria 2 cases and asymptomatic proteinuria 2 cases,all renal biopsy showed changes consistent to lupus nephritis,pathological types:3 cases were class Ⅱ,4 cases were class Ⅲ,21 cases were class Ⅳ ,7 cases were class Ⅴ,2 cases was class Ⅳ+ Ⅴlupus nephritis,the clinical manifestations of nephritic syndrome were mostly pathological type Ⅳ and Ⅴ, the chronic glomerulonephritis syndrome showed diversification of pathological type, asymptomatic hematuria and/or proteinuria were mostly pathological type Ⅱ and Ⅲ. Conclusion clinical manifestations of atypical LN is no specific and easy to be misdiagnosed. Renal bi-opsy has great value in the diagnosis of atypical LN.

Objective To compare the placement of peripherally inserted central catheters(PICC)by using vascular ultrasound guidance system and traditional method.Methods Totally 938 patients undergoing PICC were divided into the traditional method group and the vascular ultrasound system and microintroducer techniques group according to the puncture time.The differences in the one-attempt success rate and the overall success rate of the placement and the incidences of complications were compared between the two groups.Results The one-attempt success rate was 93.01％ in the traditional method group and 98.76％ in the vascular ultrasound system and microintroducer techniques group(P =0.005).The successful rate of PICC placement was 100％.The incidence of complication was 11.29％ in the traditional method group and 2.47％ in the vascular ultrasound system and microintroducer technique group(P =0.000).Conclusion The PICC placement using vascular ultrasound guidance system and microintroducer techniques can increase one-attempt success rate and decrease complications.

Objective To study the relationship between essential hypertension(EH)with serum homocysteine(HCY),uroten-sinⅡ(UⅡ),angiotensin converting enzyme(ACE)and N-terminal pro-brain natriuretic peptide(NT-proBNP).Methods By collec-ting the clinical cases,UⅡwas determined by ELISA and HCY,ACE and NT-proBNP were simultaneously detected by ELISA.The detection results were analyzed and compared between the patients with essential hypertension(EH group)and the healthy con-trols.Results The levels of serum HCY,UⅡ,ACE and NT-proBNP in the EH group were significantly increased compared with the healthy control group;the area under curve (AUC)of serum HCY,UⅡ,ACE and NT-proBNP in the ROC curve in the EH group were 0.93,0.765,0.792 and 0.972 respectively,which showed clinical diagnostic significance.Conclusion The levels of HCY,UⅡ,ACE and NT-proBNP are highly expressed in EH and have significant differences compared with the healthy popula-tion,which has the diagnostic value to EH.

Objective To find out more optimal surgical approach for glioblastoma located in sensofimotor cortex and language area. Methods A respective review of 27 cases of glioblastomas located in sensorimotor and language area were operated, via the transsylvian-opercular approach, ineluding outcomes of microneurosurgery between January 2005 to December 2007. Results Among of 27 cases, tumors in 21 cases were covered by opereular cotex and were totally resected, tumors protruded into sylvian and wrapped around middle cerebral artery in 6 cases. 3 of them were totally removed, others were subtotally. Neurofunction of 26 cases were preserved of one were injuried. Conclusion Transsylvian-opercnlar approach for resection of glioblastomas located in subcortex of sensorimotor and language area is more optimal surgical approach, which not only ensure tumor resection with great degree, but preserve neurofunction well.

Objective To investigate the effect of BRAFV600E mutation on the invasion capacity of a human melanoma cell line, A375. Methods Plasmids containing short hairpin RNAs (shRNA) specific for BRAF gene were prepared in previous study, and used to transfect A375 cells. Those cells transfected with negative plasmid and untransfected cells served as the controls. Transwell chambers were used to examine the invasion ability of melanoma cells in vitro. RT-PCR and Western blotting were performed to detect the mRNA and protein expressions of matrix metalloproteinase 2 (MMP-2) and vascular endothelial growth factor (VEGF), respectively, before and after the transfection. The activity of MMP-2 was also studied with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Results Compared with the negative control, the specific shRNA decreased the mRNA and protein expressions of MMP-2 by 35% and 85%, respectively, and those of VEGF by 45% and 14%, respectively. Additionally, the number of cells invading through Matrigel chambers reduced by 69% in those cells transfected with the positive plasmid. Conclusions The mutant BRAFV600E has the potential to enhance the invasion capacity of melanoma cells, whereas specific shRNA could suppress the increase in metastasis capacity likely by inhibiting the production of VEGF and MMP.

Objective To study a noninvasive method in evaluating the bladder outlet obstruc-tion (BOO) and bladder function in patients with benign prostatic hyperplasia (BPH) based on the transabdominal ultrasonic measurement of intravesical prostatic protrusion (IPP). Methods The da-ta of 206 first visit BPH patients with lower urinary tract symptoms (LUTS) were retrospectively re-viewed. Patients were divided into 2 groups based on the degree of IPP: the research group with IPP greater than 10 mm(n=78) and control group with IPP 10 mm or less(n=128). Clinical data and uro-dynamic findings of the 2 groups were analyzed to find the clinical significance of IPP. Resells In-creased prostate volume(73.7±35.9 ml vs 62.8±36.5 ml), serum prostate specific antigen(1.81± 0.67 ng/ml vs 1. 64±0.36 ng/ml), post-voiding residual urine volume (PVR)(290.2±217.2 ml vs 228.2±167.9 ml), incidence of acute urine retention(33.3% vs 18.0%)and bladder trabeculation (23.1% vs 11.7%)had signicant differences between the 2 groups (P<0.05). Positive correlation was found between IPP and prostate volume as well as PVR (r=0.401 and 0.342, respectively). In the urodynamic study, significantly lower peak flow rate (Qmax) (7.6±4.1 ml/s vs 9.1±3.6 ml/s), higher incidence of detrusor overactivity (82.1% vs 17.2%) and low bladder compliance (35.9% vs 12.5%)were found in research group (P<0.01). In addition, maximum detrusor pressure(109.8± 84.9 cm H2O vs 84.9±44.1 cm H2O) and BOO index (BOOI) (75.2±27.1 vs 65.9±34.6) were significantly higher in the research group (p<0.05). The correlation study showed that r between IPP and Qmax, Pdet. max and BOOI was-0.284, 0.252 and 0.456, respectively. The incidence of acute urinary intention recurrence was higher in research group than in control group (64.3% vs 23.5%) (P<0.05). Conclusions IPP is a useful predictor in evaluating BOO and detrusor function. BOO and impaired detrusor function in obvious IPP patients are more severe. The obvious IPP pa-tients, especially those presenting with acute urine retention, may benefit more from early surgical in-tervention.

ObjectiveTo compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. MethodsFrom April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. ResultsAn unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group(t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). ConclusionEN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.

Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.