Objective:To explore the indication and operative procedures with different operation styles of the surgical treatment of condylar fractures. Methods:The results of the surgery styles to condylar fractures were reviewed with the clinical data of 112 condylar fracture cases,by clinical condition,radiodiagnosis,fracture region,degree of displacement and time of trauma,that included 53 cases of anatomical reduction in subcondylar oblique ramus osteotomy without detaching condyle,38 cases of traditional open reduction,18 cases of arthroplasty in oblique ramus osteotomy with detaching condyle upside-down,3 cases of arthroplasty in oblique ramus osteotomy with detaching condyle. Results:The anatomical reduction in subcondylar oblique ramus osteotomy without detaching condyle was an effective treatment of condylar fractures on long term results. Conclusion:Majority condylar fractures may apply the anatomical reduction in subcondylar oblique ramus osteotomy without detaching condyle. Smashed fractures and old fractures of condyle may apply the arthroplasty in oblique ramus osteotomy with detaching condyle upside-down. The high condylar fractures may use the arthroplasty in oblique ramus osteotomy with detaching condyle.

Objective: To explore the value of implanted intensity-modulated bmchytherapy for recurred cervical carcinoma. Metheds: A total of 25 cases of recurred cervical carcinoma were enrolled into the trial group which were treated with pelvic implanted aftedoading intensity-modulated brachytherapy. The other 25 patients with recurred cervical carcinoma treated with routine brachytherapy during the same pedod were en-rolled into the control group. Results: There were 20 cases with CR and 5 cases with PR in the trial group, and 10 cases with CR, 7 cases with PR, 4 cases with SD and 4 cases with PD in the control group, with a signifi-cant difference between the two groups (P<0.05). In the trial group, there were 5 cases with vaginal-rectal fis-tula and 1 case with grade 3 enteritis. In the control group, there were 3 cases with vaginal-rectal fistula. Con-dusion: Pelvic implanted intensity-modulated brachytherapy for recurred cervical carcinoma is satisfactory with better short-term efficacy than that of the routine brachytherapy and tolerable side effects.

Objective To study the clinical value of nipple discharge detection in the early diagnosis of breast cancer,CA153 ,CEA levels were measured both in nipple discharge and serum. Methods 153 consecutive patients with nipple discharge in Rizhao hospital were studied,among them there were 91 cases with breast cancer and 62 cases with benign disease. The nipple discharged and serum from the 153 cases with nipple discharged were collected and CA153, CEA levels were measured with electrochemiluminescence method. Results The CA153, CEA levels of nipple discharge in breast cancer were significantly higher than the control group(CA153:t =28.949,33.844;CEA:t = 19.773,16.623, all P ＜ 0.01). The positive rate of CA153, CEA in nipple discharge were significantly higher than in the serum (P ＜ 0.05). Conclusion The positive rate of CA153, CEA in nipple discharge were significantly higher than in the serum. The detection of CA153 ,CEA had important value in the early diagnosis of breast cancer.

BACKGROUND: How to establish a stable in vitro culture system, including location of corneal limbal epithelial stem cells, in vitro sample harvest, in vitro culture, vector selection, as well as identification methods, play a key role in corneal limbal epithelial stem cells culture. OBJECTIVE: To culture the isolated rabbit corneal limbal epithelial stem cells and to identify the biological properties of cultured cells. METHODS: The primary rabbit cornel limbal epithelial stem cells were isolated and cultured with tissue inoculation using human amniotic membrane as vector. The growth features of cells were observed under an inverted microscope. The morphology of cells was observed by hematoxylin-eosin staining and a scanning electron microscope. Furthermore, the monoclonal antibody AE5 and P63 two-step immunohistochemical staining were used to identify limbal epithelial stem cell protein expression. RESULTS AND CONCLUSION: The rabbit corneal limbal epithelial stem cells could be successfully cultured and maintained a relatively high value-added potential in vitro. Rabbit corneal limbal epithelial stem cells cultured on the amniotic membrane pull netted cellular layer. The AE5 monoclonal antibody positive rate of primary cultured cells was about 5% and P63 monoclonal antibody positive up to 90%. AE5-positive rate increased and P63-positive rate decreased with the increase in the number of subculture. The rabbit limbal epithelial stem cells can be successful culture and amplified on human amniotic membrane in vitro by limbal tissue culture method. The cultured cells maintain the characteristics of corneal epithelial cells. The rabbit corneal limbal epithelial stem cells can form grafts on the amniotic membrane.

Objective To design and testify a novel strategy for acquiring mimetic epitope mapping by screening for a phage random peptide library using polyclonal anti keratin autoantibodies (AK auto Ab). Methods AK auto Ab were isolated and purified from pooled human sera by keratin affinity column in which keratin had been linked with CNBr Sepharose 4B,then biotinylated by the biotin ester. A 15 mer phage random peptide library was biopanned for 3 cycles and positive clones were identified by ELISA,competition assay and DNA sequencing. ResultsBy sequence comparison 23 positive clones were selected randomly and three epitopes were confirmed. Among the three epitopes SLSPMPTTNRR was the dominant epitope. The phages carrying positive clones reacted with AK auto Ab specifically and keratin could prevent interaction between AK auto Ab and positive phages. Conclusion The designed strategy is successfully applied in acquiring epitopes of polyclonal autoantibodies to keratin, which could provide a new approach for the discovery of epitope mapping which binds to natural autoantibodies.

Objective To observe the clinical efficacy of ulinastatin(UT) conjoined to high flow continuous blood purification( CBP) in the critical patients with multiple organ dysfunction syndrome(MODS). To evaluate the therapeutic potential of UT and CBP in systemic inflammatory response syndrome (SIRS) , severe sepsis( SS) , acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Method A total of 122 cases of emergency and critical patients with a score of more than 15 counted up from APACHE H (acute physiology and chronic health evaluation 11 ) were randomly divided into Ulinastatin treatment group (UT group, n = 35) .continuous blood pu-rification(CBP group, n = 31),UT plus CBP (combine group, n = 30) and routine treatment group (control group, n =26). Routine treatment was given to patients of all groups, and patients of UT group had Ulinastatin 0.4 MIU given intravenously every 8 hours for 7 days in addition. Patients of CBP group were managed with continuous blood purification round the clock for 7 days and those of combine group were treated with UT plus CBP for 7 days.The efficacy of the treatment in four groups was assessed,and serum high sensivity reactive protein(hs-CRP) and IL-6 levels were measured on admission and comparison was made between values of biomarkers taken before and 1 d,3 d,and 7 d after treatment in four groups. The changes in WBCs,arterial gas analysis and the oxygena-tion index PaO2/FiO2 were checked, and at the same time, the APACHE II values and the incidence of MODS were compared within four groups. Results (1)One, three and seven days after treatment the plasma hs-CRP and IL-6 levels in UT and CBP groups were reduced significantly more than those in control group ( P < 0. 05), and in combine groups those were more dramatically lowered ( P < 0.05, P < 0.01). Before treatment there was no significance diffience in those values between groups, and there was on diffience in those values between 3 rd day and 7 th day after treatment ( P > 0.05). (2) The 1 st,3 rd and 7 th day after treatment the arterial gas PaO2/FiO2 index in UT and CBP groups was improved more than that in control group ( P < 0.05) , and it in combine group was most significant improved (P < 0.05,P < 0.01). The ALT and creatinine were lower than those in control group ( P < 0.05), and there were no significant differences in ALT and creatinine between groups before treatment (P > 0.05). (3) The 1 st,3 rd and 7th day afer treatment,the APACHE II values in UT and CBP groups were decreased more than those in control group ( P < 0. 05) , and therefore, the incidence of MODS was lower ( P < 0.05). Conclusions Ulinastatin could significantly inhibit the production of inflammatory cytokines and CBP could effectively eliminate inflammatory factors from blood, and the combination of these two approaches produce a more effective therapeutic potential for preventing MODS development.

Objective To evaluate the effects of fluid resuscitation and large-volume hemofiltration (HVHF) on the Alveolar-arterial oxygen exchange in patients with refractory septic shock. Method A total of 89 intensive care patients with refractory septic shock treated with fluid resuscitation and/or HVHF were enrolled between August 2006 and December 2009. All the patients were randomly divided into two groups. In group A, patients were treated with fluid resuscitation, n = 41 cases) and in group B, patients were treated with large-volume hemofiltration and fluid resuscitation, n =48). The O2 content of central venous blood(CcvO2), arterial oxygen content (CaO2), Alveolar-arterial oxygen pressure difference (P(A-a)DO2), the ratio of arterial oxygen pressure/alveolar oxygen pressure (PaO2/PAO2), respiratory index (RI) and oxygenation index (OI) were checked. The levels of oxygen exchange in two groups were detected by arterial blood gas analysis before treatnent, 24 hour, 72 hour and 7 days after treatment. The APACHE Ⅱ scores in patients with refractory septic shock were measured before and the 7th day after treatment with HVHF and/or fluid resuscitation respectively. Data were analyzed by using t -test and chi-square test to compare the differences and ratio between two groups and were expressed in mean ± standard deviation, and the analysis of variance was done with SPSS version 12.0 software. Results ① The differences in CcvO2 and CaO2 between two groups were[(0.60±0.24) vs. (0.72±-0.28), P ＜0.05 and (0.84±0.43) vs. (0.94±0.46), P ＜0.05]; and the oxygen extraction rates (O2ER) were significantly different between two groups [(28.7±2.4) vs. (21.7±3.4), P<0.01];② The levels of P(A-a)DO2、ratio of PaO2/PAO2、RI and OI in group B were reduced more significantly than in group A (P<0.05 or P<0.01);③The APACHE Ⅱ scores in both groups were gradually reduced after treatment for 7 days, and the APACHE Ⅱscore in group B on the 7th day of treatment were lower than that in group A[(17.2 ± 6.8) vs. (8.2 ± 3.8), P ＜ 0.01]. Conclusions Fluid resuscitation and HVHF could improve alveolar-arterial-oxygen exchange in patients with refractory septic shock, and at the same time decreased the APACHE Ⅱ scores, improving the survival rate of patients.

Objective To identify the incidence and risk factors of gastrointestinal bleeding in patients supported with mechanical ventilation over 48 hours. Method A total of 127 ICU patients supported with mechanical ventilation for over 48 hours were enrolled from January 1, 2007 to December 31, 2008 for the retrospective study. Exclusion criteria included the history of gastrointestinal bleeding and ulcer, recent gastrointestinal surgery, brain death and active bleeding from nose or throat. Demographics of patients including age, diagnosis at admission, duration of ICU stay, duration of mechanical ventilation, pattern and parameters of ventilation, ICU mortality, A-PACHE II score, multiple organ dysfunction score, and the results of biochemical assays including renal, hepatic and coagulation functions were recorded. Risk factors of gastrointestinal bleeding were analyzed by using univariate analysis And multiple logistic-regression analysis. Results Of the 127 patients, the incidence of gastrointestinal bleeding was 41.7% . and among them 3.9% patients suffered from clinically significant bleeding. However, the independent risk factors of gastrointestinal bleeding were the peak inspiratory pressure > 30 cmH20 (RR = 3.73, 95% CI = 1.59-9.46), renal failure (RR = 1.16,95% CI = 1.02 - 2.32), PLT count <50× 109 L-1(RR = 2.67, 95% CI = 1.32 - 15.78) and prolonged APTT (RR = 4.58, 95%CI = 2.32 - 12.96). The good entetal nutrition had a beneficial effect to the avoidance of gastrointestinal bleeding ( RR = 0.30, 95% CI = 0. 13 - 0.67). Conclusions The incidence of gastrointestinal bleeding is high in patients supported with mechanical ventilation, and the bleeding usually occurs within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT are significant risk factors of gastrointestinal bleeding. However, the good enteral nutrition is the independent protective factors.

Objective To evaluate the effect ofJiawei-Danggui-Buxue decoction in the treatment for the patients with hemorrhagic anemia after total knee arthroplasty (TKA).Methods A total of 63 TKA patients with hemorrhagic anemia were included, and were divided into the treatment group (31 patients) and the control group (32 patients). All patients started to take medicine the second day after surgery. The control group took the Ferrous Succinate Tablets and the treatment group took Jiawei-Danggui-Buxue decoction in the following 4 weeks. The Hb and Hct were detected,and the changes of TCM syndrome scores and the total effect rates of anemiawere observed.Results The total effect rate of TCM syndrome scores in the treatment group was 93.54%, which was significantly higher than control group 83.87% (P<0.05); The total effect rate of anemia in the treatment group was 90.32%, which is significantly higher than control group 75.00% (P<0.05). At the fifteenth day after operation,. And at the postoperative 29th day, the levels of Hemoglobin (129.61 ± 13.02 g/Lvs. 113.35 ± 15.46 g/L,t=6.245) and Hematocrit (0.45% ± 0.03 %vs. 0.41% ± 0.04%,t=5.962) in the treatment group were significantly higher than those in the control group (P<0.05).Conclusions TheJiawei-Danggui-Buxue decoctionimprovethe Hb, HCT and the clinical effect rates of anemia and TCM syndromes for the patients with hemorrhagic anemia after TKA.

Objective To investigate the characteristics of the depression during emotional processing.Methods 24 participants with first episode of depression and healthy controls were assessed with HAMD scale,using DTI to dectect values of white matter FA,and using fMRI with pictures of emotional stimuli;thus results related with imagings were produced.The results were statistically analyzed.Results The brain areas indicating FA values deference with statistial significance in depression patients compared with the control ones included:left and right frontal lobe (left frontal lobe depression group 0.324 ± 0.090,control group 0.467 ± 0.072,P ＜ 0.01),corpus callosum knee (depression group 0.614 ±0.146,control group 0.734 ±0.063,P＜0.01),anterior cingulate gyrus (depression group 0.222 ±0.035,control group 0.343 ±0.021,P＜0.01) ;the fronal FA values in depression grop were negatively correlated with the duration of bilateral frontal white matter (r =-0.555,P ＜ 0.01).The activation of emotional brain regions stimulated by pictures includes frontal cortex-subcortical reticular system,and the hypothalamus and limbic system.There was a significant difference between two groups.Conclusion There may be abnormal emotional processing dystunction in patients with depression.It may be the pathological basis to have frontal white matter fiber tracts broken.