ObjectiveTo investigate the clinical value of routine para - aortic lymphadenectomy in patients with stage Ⅰ B1 and Ⅱ A2 cervical cancers treated by surgical intent.Methods240 patients with stage Ⅰ B1 and Ⅱ A2 squamous cervical cancer were randomly divided into tow groups( group A and B).120 patients (group A) underwent radical hysterectomy with systematic pelvic lymphadenectomy and paraaortic lymphadenectomy.Other 120 patients (group B) underwent radical hysterectomy with systematic pelvic lymphadenectomy,additional para-aortic lymphadenectomy were carried out when para-aortic lymph nodes were identified as suspicious by visualization and palpation.The operation time,amount of surgical bleeding,length of stay,complications,and metastasis rates of pelvic lymph node,metastasis rates of common iliac lymph node and metastasis rates of para-aortic lymph node were analyzed between two groups.ResultsThe clinical characteristics of the patients had no statistically significant difference between the two groups.The length of stay and the complications of group A were significantly higher than group B ( P ＜0.05 ).During the 240 patients,the metastasis rates of pelvic lymph node,common iliac lymph node and para-aortic lymph node were 27.9％,10.8％ and 5.4％.The metastasis rate of para-aortic lymph node in group A was statistically higher than that in group B( 8.3％ vs 2.5％,P ＜0.05),whereas there had no significant difference of the metastasis rates of pelvic lymph node and common iliac lymph node between the two groups.ConclusionsRoutine para-aortic lymphadenectomy can be helpful to accurately predict the status of the para-aortic lymph node in patients with stage Ⅰ B1 and Ⅱ A2 cervical cancer,but the length of stay and the complications of operation will increase.

Objectives To understand the vaccination situation of left-behind children in rural areas,provide the evidence for developing vaccination strategies for left-behind children.Methods The counties with population over 1,000,000 were selected from Anhui and Sichuan provinces respectively to conduct survery to the children who were born between the year 2003 and 2006,and had registration on vaccination book(card).Results The proportion of left-behind and outflow children are 17.94% and 6.05% respectively.The information about the children’s parents going out most came from village doctors. The proportion of the parents going out after children born was 51.60%,staying outside for more than 10 months was 78.50%. 67.97% pareets came back home during the spring festival,35.43% left-behind children went out with their parents.Conclusion Although the number of outflow children was smaller than the left-behind children,it was easy to develop immunization gap. It is the difficult part of management on EPI to migraut children. The information aboat the children’s parents going out mostly came from village doctors. It is impotant to mobilize the enthusiasm of doctors.It is especially essential that we should propagandize to the people with vaccination knowledge to the pareets came back home during spring festival.

Objective To determine the safety location of the bony tunnel in reconstruction of the coracoclavicular ligaments on the basis of digital characterization of the anatomy of the clavicle and coracoid process.Methods Unilateral shoulder spiral CT scan was conducted in 30 patients without injury to the clavicle or coracoid process.They were 15 men and 15 women,aged from 20 to 71 years old (average,49.3 years).Thirty 3D digital models of the clavicle and coracoid process were constructed using the CT scan data by Mimics13.0.Half of the models were of the left shoulder and half of the right.Anatomic measurements of the clavicle and coracoid process were carried out on these models.Virtual transclavicular-transcoracoid bony tunnels were established according to the anatomy of the conoid ligament.Parameters of these bony tunnels were measured before the safety location was calculated.Results The mean clavicular length was 147.70 ± 5.34 mm in males and 133.09 ± 6.61 mm in females; the distance between the lateral edge of the clavicle and the center of the conoid tuberosity (CCD) was 35.90 ± 3.16 mm in males and 30.48 ± 0.54 mm in females; the distance between the lateral edge of the clavicle and the center of the trapezoid tuberosity (CTD) was 22.68 ± 1.23 mm in males and 18.69 ± 1.65 mm in females,with significant differences between genders (P ＜ 0.05).There were no significant differences between male and female regarding the ratio of the CCD to the clavicular length,the ratio of CTD to the clavicular length,or the mean internal rotational angle of the coracoid process (P ＞ 0.05).According the attachments of the conoid ligament on the clavicle and coracoid,from the superior-posterior edge of the clavicle to the anterior midpoint of the coracoid basement,the bony tunnels were established.These tunnels nearly bisected the cross section of the clavicle and coracoid basement,35.23° ± 2.36° medially inclined to the sagittal section and 5.91° ± 2.14° posteriorly inclined to the coronal section of the body.Conclusions To ensure that the bony tunnel should pass through the center of the clavicle and coracoid,it should be drilled from the superior-posterior edge of the clavicle and located at the clavicular attachment of the conoid ligament,tilting about 35° medially and 6° posteriorly to aim at the anterior midpoint of the coracoid basement.

BACKGROUND:Although bone marrow mesenchymal stem cels from multiple myeloma patients present a variety of abnormalities, it is unclear how these abnormal mesenchymal stem cels influence the chemotactic function of myeloma cel lines.
OBJECTIVE:To investigate thein vitro effects of bone marrow mesenchymal stem cels from normal donors versus multiple myeloma patients on the chemotactic capacity of myeloma cel lines.
METHODS:In vitro cultured bone marrow mesenchymal stem cels derived from either normal donors (N-MSCs group) or newly-diagnosed multiple myeloma patients (MN-MSCs group) were directly co-cultured with U266 cels, in the presence or absence of bortezomib; and then harvested U266 cels were assayed for Transwel migration and mRAN expression of chemotaxis-related genes. U266 Transwel migration to conditioned medium derived from either N-MSCs or MN-MSCs was also tested.
RESULTS AND CONCLUSION:After co-cultured with N-MSCs or MN-MSCs, U266 cels harvested from MN-MSCs group showed increased spontaneous Transwel migration and up-regulated CCR1 mRNA level than those from N-MSCs group (P < 0.05), whatever bortezomib was present or not. However, there was no evident difference between U266 cel Transwel migration to conditioned medium derived from either MM-MSCs group or N-MSCs group. Our study implies that there may be some intrinsic aberrance in bone marrow mesenchymal stem cels derived from multiple myeloma patients, which can modulate the chemotactic migration of myeloma cel lines when they directly interact with each other.

BACKGROUND:Coracoclavicular ligament reconstruction with transclavicular-transcoracoid driling is an effective surgical technique to treat acromioclavicular dislocation. A good driling in the clavicle leads to a perfect bony tunnel and a good surgery. OBJECTIVE: To observe the effects of different driling positions of the clavicle on the location of bony tunnels in coracoclavicular ligament reconstruction. METHODS:Sixty three-dimensional digital models of the clavicle and coracoid process were constructed by Mimics13.0. Virtual transclavicular-transcoracoid bony tunnels were established according to different surgical planes with different driling positions in the clavicle. Parameters of these bony tunnels were measured, and the safety was evaluated. Option 1: The driling was made 30 mm distal to the clavicle, located in the center of the front and rear edges of the clavicle surface. Option 2: The driling was made 40 mm distal to the clavicle, located in the center of the front and rear edges of the clavicle surface. Option 3: The driling was made at the straight line of tapered nodule tip and the midpoint of the base of the coracoid process, located at the rear edge of the clavicle upper surface. RESULTS AND CONCLUSION: Bony tunnels in option 1 were extremely on the inside of the coracoid. Bony tunnels in options 1 and 2 were not in the center of clavicle. Bony tunnels in option 3 were in the center of both clavicle and coracoid. The method of locating the driling position with a certain distance to the distal clavicle leads to different results in man’s and woman’s models. To ensure that the bony tunnel can pass through the center of clavicle and coracoid, it is suggested to dril at the straight line of tapered nodule tip and the midpoint of the base of the coracoid process and nearby the rear edge of the clavicle upper surface.

Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.

10.3969/j.issn.2095-4344.2013.25.024

Objective To investigate the distribution of 16S rRNA methylase genes in Klebsiella pneumoniae strains producing Klebsiella pneumoniae ealbapenenase type 2(KPC-2).Methods A total of 37 Klebsiella pneumoniae isolates producing KPC-2 were collected.The minimal inhibitory concentrations (MICs)of these strains to amikacin,gentamyein and netilmicin were determinated by agal dilution method.Six 16S rRNA methylase genes(armA,rmtA,rmtB,rmtC,rmtD and npmA)were detected by PCR.Results The resistant rates to amikacin,gentamycin and netilmicin were 97.3%(MIC50≥1024μg/mL).Among those resistant strains,8 were armr/A positive,25 were rmtB positive,4 were both armA and rmtB positive.and no other 16S rRNA methylase genes were found.The total positive rate of 16S rRNA methylase genes was 78.4%(29/37).Conclusion 16S rRNA methylase genes armA and rmtB ale prevalent in Klebsiella pneumoniae strains producing KPC-2.

Objective:To observe the clinical effect of tuina plus foot bath with Chinese medicine for patients with diabetic foot (DF) in early stage.Methods:A total of 70 patients with early-stage DF were randomly allocated by the random number table into two groups,with 35 cases in each group.Patients in the control group received conventional medication,while patients in the observation group received tuina plus foot bath with Chinese medicine on the basis of conventional medication.The clinical efficacy was compared after 2 courses of treatment.Results:After treatment,intra-group comparisons of ankle-brachial index (ABI) showed statistical significance in both groups (both P＜0.05).The curative rate was 83.3％ in the observation group,with the total effective rate of 96.7％,versus 29.4％ and 76.5％ in the control group,respectively,and the between-group comparisons showed statistical significance (both P＜0.05),indicating a better effect in the observation group.Conclusion:Tuina plus foot bath with Chinese medicine has a good therapeutic effect for DF patients in early stage.

Objective To evaluate the effects on trabeculectomy combined with implantation of anterior lens capsule.Design Radomized,controlled experimental study.Participants 36 experimental albino rabbits.Methods 36 albino rabbits were divided into 3 groups randomly.The rabbit and human anterior lens capsules were implanted under the scleral flap in trabeculectomy in group A and group B respectively,while only trabeculectomy in control group.The average follow-up period was 12 months.Main Outcome Mea- sures Intraocular pressures(IOP),filtering bleb,complications.Results The postoperative IOP of the experimental groups decreased sig- nificantly as compared with preoperative IOP at 12 week postoperatively.Retention of reflective filtering bleb in experimental groups was longer than that in contral group(5.12?0.43week,5.05?0.59week,2.74?0.32week,P＜0.05).The passage of humor outflow kept open in ex- perimental groups and became closed in control group at 12 week postoperatively.Anterior lens capsule wasn't attacked by T or B lym- phocyte seen with electron microscope.Conclusions Implantation of anterior lens capsule may help to postpone filtering bleb scarring in the trabeculectomy.This study provides experimental basis for the clinical practice.