Objective To explore an effective prevention and management of nonunion and malunion due to insidious infection after fracture internal fixation. Methods From January 2001 to January 2006,we treated 26 patients with nonunion and malunion due to insidious infection after fracture internal fixation.They were 15 cases of femoral fractures, 2 cases of ulna fractures, 3 cases of radial fracturos, 3 cases of humerus fractures, and 3 cases of tibial fractures. The patients were treated with irrigation after debridement.In 23 fractures, the internal fixation was dislodged and changed into external fixation. In the 3 cases whose internal fixation remained, instillation and drainage were conducted after debridement. Bone grafting was performed for 20 cases after replacement of internal fixation, and for 3 cases after removal of external fixation.Three patients received no bone graft. Results The preoperative X-ray findings confirmed the diagnosis of insidious infection in 21 cases, while the other 5 cases were diagnosed by bacterial culture or pathological examination of the pus and inflammatory granulation tissue found during surgery. The bacterial culture was positive in 17 cases, including 6 cases of Staphylococcus epidermidis, 8 cases of Staphylococcus aureus, and 3 cases of Escherichia coli. All the patients were followed up for 8 to 48 months, with an average of 23.5 months. Of the 26 cases, 22 obtained bony union, 2 partial union and 2 nonunion. Complications included fistula in 2 patients and infection relapse in 3 patients. Conclusions Insidious infection may be related to the bacterial toxicity, anatomical sites and surgical methods. X-ray changes may help the diagnosis of insidious infection. Surgery is necessary for management of nonunion and malunion due to insidious infection after fracture internal fixation.

In order to further promote teaching effect of clinical practice in higher medical college & university,we should focus on the following main points:renovating teaching ideal and educational thought;reinforcing the cultivation of diagnosis and treatment technique and diagnosis thoughts;reforming teaching method and strategy;strengthening the teaching management;combining scientific research with training practice;infiltrating humanities-social sciences thoughts.

Objective To investigate the application value of transcystic choledochoscopy combined with holmium laser for common bile duct stones . Methods Clinical data of 16 patients with common bile duct stones who underwent transcystic choledochoscopy and holmium laser cholelithotripsy between March 2012 and December 2013 in this hospital were retrospectively analyzed.During holmium laser cholelithotripsy (1.0 J/10 Hz, 400 μm fiber), the stones were fragmented under direct vision of choledochoscopy and were extracted by using water flushing or a stone basket . Results The stones were successfully removed in 15 patients, including 6 cases of laparoscopic operation and 9 cases of open operation .The operation time was (132 ±27) min for open surgery and (156 ±33) min for laparoscopic surgery .The stone fragment and removal time was (30.2 ±8.5) min for open surgery and (45.6 ±10.4) min for laparoscopic surgery .The hospital stay was (9.7 ±1.4) d.There was 1 case of failed cholelithotripsy due to obstructed water flow and blurry vision .Follow-up examinations in 14 cases for 2-24 months found no recurrence of stones or biliary strictures. Conclusion Transcystic choledochoscopy and holmium laser cholelithotripsy is intuitive , accurate, and effective, being a safe and reliable alternative for choledocholithiasis .

The use of adjuvant extemal-beam RT is well established in the postoperative treatment of glioblastoma multiforme (CBM).It is consensus that target volume should be determined based on the fusion images of MRI and CT,but the inclusion of peritumoural edematous is controversial.The vast majority of recurrences occur within 2 cm of the original tumor site orin radiation field.There is no inevitable relation between the degree of peritumoral edema and recurrence model.The clinical and pathological characteristics may be as predictive and prognostic factors for the treatment of GBM.Target volume delineation for CBM tend to individual,which can maintain known outcomes and reduce treatment toxicity.

Objective To investigate the recognition of cyclomastopathy in female college students in Guangzhou.Method 300 female college students(90 medical students and 210 non-medical students)from 10 colleges in Guangzhou were involved in the survey using the self-designed questionnaire.Results Medical students had significantly higher recognition about cyclomastopathy than non-medical students(all P<0.05).The college students lacked of awareness of self breast care.Only 15.56%of the medical students and 11.43% of the non-medical students regularly took breast self-care.Conclusion To improve the social,school and students pay more attention to the breast diseases,strengthen the female university students about breast health education,has improtant significance for improving college students' knowledge of disease of mammary gland hyperplasia.

Objective To investigate the effects of source to image receptor distance (SID) on the image quality and entrance surface dose (ESD) in the chest digital radiography (DR) for infants.Methods Anthropomorphic chest phantoms were exposed to 60 kVp and different values of SID ( 150 -80 cm with the interval of 10 cm,totally 8 groups) so as to record the values of mAs and ESD.The SID values of 110 cm and 90 cm with the moderate and low ESD values were selected for clinical test.Forty-two hospitalized infants,aged 12 months (8 months to 2 years) underwent chest DR with the SID of 110 cm before admission and 90 cm before discharge respectively.The values of ESD were recorded and compared.Three experienced experts assessed the quality of 84 pieces of images.Results The values of mAs and ESD decreased gradually along with the decrease of the SID from 150 cm to 80 cm.All the 84 images from the 42 infants met the demands for diagnosis.There was no significant difference in the score of image quality of the group with the SID of 110 cm (4.4±0.3) and 90 cm(4.2±0.4) (t=0.453,P＞0.05).The value of ESD of the group with the SID of 90 cm was significantly lower than that of the group of SID of 110 cm by 0.003 4 mGy ( t =12.001,P ＜ 0.05 ).Conclusions The image quality of chest DR could meet the demands for diagnosis in spite of the value of SID,however,the SID value in chest DR significantly might influence the ESD.The SID value of 90 cm shoud be recommended in chest DR for infants.

Objective:To summarize the curative effect, safety and experience of non-thoracoscopic modiifed Nuss procedure for correction of pectus excavatum (PE).
Methods:From January 2007 to December 2011, 267 cases of PE patients were selected in our hospital. Among them 85 were treated by thoracoscopic minimally invasive modified Nuss Procedure and 182 by non-thoracoscopic procedure. The operation time, blood loss during operation, length of postoperative hospital stay and effect of treatment were compared retrospectively.
Results:All the 267 patients finished the repair procedure smoothly. The non-thoracoscopic group had advantage in terms of operative time (22.5 min vs 35.1 min, P<0.05). As for the blood loss during operation, length of postoperative hospital stay and effect of treatment, there was no signiifcant difference among the 2 groups (P>0.05). hTere were no deaths.
Conclusion:Non-thoracoscopic minimally invasive modified Nuss procedure is as safe and effective as thoracoscopic Nuss procedure. With advantages of simpliifed operation procedure and shorter operation time, it is easier in practice.

AIM:To explore the effect of recombined sICAM-1 on the adhesion of leukocyte to pulmonary microvascular endothelial cell. METHODS:Primary cultured rat pulmonary microvascular endothelial cells were used in this experiment. Leukocyte was labeled with 99　Tm-HMPAO.The effects of different dose of sICAM-1, CA7 and dimeric form of sICAM-1 (sICAM-1*CA7)were tested separately in cell adhesion .RESULTS:sICAM-1 and CA7 could not inhibit cell adhesion even at the concentration of 100 mg/L,while sICAM-1*CA7 at concentrations of 20 mg/L and 40 mg/L could inhibit 42% and 50% of cell adhesion respectively (P＜0.05). CONCLUSION:sICAM-1 has poor inhibitory effect on cell adhesion, probably due to monomeric form.

Objective To observe the morphological damages of hyperbilirubinemia on rat central nervous system, and evaluate the therapeutic effects of different routes of basic fibroblast growth factor (bFGF) administration. Methods Totally 90 Wistar rats were inflicted to hyperbilirubinemia models and then divided randomly into 3 groups:untreated group (BG),treated-1 group (T_ 1 G), treated-2 group (T_ 2 G), and another 30 rats served as control group (CG). bFGF injection were given at 30 min, 1, 3, 5 and 7 d by abdominal cavity (T_ 1 G,) and cranial cavity (T_ 2 G). GAP-43 expression levels and the micro-morphological features were observed with immunohistochemical assay and transmission electron microscopy respectively at 2 nd, 8 st, 28 st and 60 st day. Results ①Hyperbilirubinemia rat model was verified by gross and microscopic observation, bilirubin concentrations in the plasma and brain.②Compared to CG, the expression level of GAP-43 was significantly up-regulated in BG, T_ 1 G and T_ 2 G, especially in the later 2 groups (P

AlM: To compare the effects of external approach microsurgery and conventional external approach surgery for retinal detachment ( RD) .METHODS: From January 2010 to January 2013, 60 patients (60 eyes) in our hospital were randomly divided into experimental group (29 cases, 29 eyes) and control group ( 31 cases, 31 eyes ) , the external approach microsurgery and conventional external approach surgery were performed respectively ( by the same skilled doctor ) . Retinal reattachment rate, visual acuity improvement rate and operative time were compared between two groups.RESULTS:lt cost shorter time for the external approach microsurgery than that of conventional external approach surgery ( P = 0. 0087 ). The once successful retinal reattachment rate in experimental group was 93% ( 27 cases ) , which was higher than that in control group (90%, 28 cases), there was no statistical difference. The vision improvement rate in control group was 86% ( 25 cases ) , compare to 90% ( 28 cases ) in experimental group, there was no statistical differences. CONCLUSlON: No statistical differences showed in visual acuity improvement and the once retinal reattachment rate between the two groups for rhegmatogenous retinal detachment. However, it is believed that external approach microsurgery could be faster, easier to learn with satisfactory effect.