[Objective]To evaluate the clinical result of surgical treatment of coronal shear fracture of the capitellum humeri of adults.[Method]From January 2001 to July 2005,6 cases of 2 males and 4 females with coronal fractures capitulum humeri were chosen open reduction and internal fixation utilizing screws.The fractures were terated under direct vision and were fixed with screws.The left arms in 4,right in 2,the age of the group were from 27 to 48 years old,with the average of 38 years.The operative time was from 3 days to 9 days after injury.All cases were fresh and close fractures.[Result]All operations were successful,no nerves and blood vessels injury was found,the incisions were all healed by first intention.The X-ray films showed that the fractures were anatomic reduction.The healing time was 7 weeks in average with 6 to 9 weeks range.All cases were followed up from 12 to 52 months with an average of 32 months,no postoperative complications such as myositis ossificans or avascular necrosis of capitulum humeri was found.According to BrobergMorrey Scale,there were 5 caese of excellent,1case of good.[Conclusion]The coronal shear fracture of the capitellum humeri of adults are suitable for opening reduced direct vision and fixing with screws,prompt treatment with anatomic reduction and internal fixation and early rehabilitation could lead to excellent or good outcomes.

Objective To study the CT diagnosis and differential diagnsis of hypoxic ischemic encephalopathy (HIE)in neonates.Methods 55 cases who had clear history of asphyxia in perinatal period and had clinical symptoms were scanned with CT.The complete clinical materials and CT data were analyzed.Results The clinical and CT grades were conducted according to references.The results showed that there was difference between CT grades and clinical manifestation.Subarachnoid hemorrhage was the most common complication.The density of the lesions was significantly different from that in normal sites.Conclusion In the CT diagnosis of HIE,clinical data and anatomical structure of neonates are both critical for the correct diagnosis.

Objective To study the correlation between prognosis and vertigo and status of the vestibule functions with the patients of the sudden deafness (SD).Methods For 161 patients of the SD, the parameters of the hearing before treatment, vertigo and vestibule functions, were analyzed to establish a statistic model by means of Logistic regression with single factor analysis of variance, Logistic regression analysis and Chi square test.Results The single factor analysis of variance and Chi square revealed statistical differences between prognosis of the SD and hearing before treatment(P0.05).Conclusion If the patients with SD had more severe hearing loss, the prognosis would be less successful. The normal or abnormal caloric tests had influence for the prognosis of the SD, but vertigo showed influence on prognosis only when caloric test was abnormal. The degree of hearing loss was not related to that of vertigo or vestibule functions while the sudden deafness accompanied with vertigo was not due to the damage of vestibular functions.

Objective To investigate the clinical characters of posturographic test in patients with sudden hearing loss.Methods The postural map and correlative parameters value were examined by dynamic posturography in 100 cases of normal subjects and 120 cases of sudden hearing loss.According to state of the vestibule function,120 patients were divided into normal(67 cases) and abnormal(53cases) groups.The parameters of the length,velocity and Romberg of postural sway were compared between two groups.Results The postural map was most prominent centre patten(51%) in normal subjects,the patient's map was most prominent diffuse patten(60.83%).Length,velocity and Romberg of postural sway of the patients were significantly increased in comparison with normal subjects(P0.05).Conclusion The results of posturographic test indicate that the vestibular system in patients with sudden deafness is damaged.

Objective To investigate the relatonahip between TNF-α and ventricular arrhythmias after acute myocardial infarction(AMI)and its mechanism.Method Both the clinical and animal experiments were done.(1)Clinical experiment:Eighty patients with AMI were included in Union Hospital,Tongji Medical College,Huazhong University of Science and Techology,from May 2005 to November 2006 according to the WHO diagnostic criteria.Co-infection of diseases such as severe upper respiratory infection,lung infection,high fever,cancer,et al were excluded.The relationship between the levels of TNF-α and arrhythmias were observed at different times after AMI.A straight line correlation,analysis Was done.(2)Animal experiment:Different concentrations of TNF-αwere added to isohted rat hearts for observing the arrhythrnia effects.The effect of TNF-α on intracellular Ca2+ concentration was detected by laser confocal technique.All data were analyzed by SNK-q test using SPSS 13.0 sofeware prograrn.Results(1)The plasma levels of TNF-α were significantly associated with the Lown class of PVC after AMI and they were higher in AMI of anterior wall[(46.41±10.34)pg/ml]than other positions [(28.25±6.35)pg/ml,P<0.05].2)The frequency of ventricular arrhythmias was interrelated with the concentralions of TNF-α.Using etanercept beforehand,TNF-α induced a slight increase of intracellular Ca2+ intensity (P<0.05).Conclusions There was a relationship between TNF-αlevels and ventricular arrhythmisa in patients with AMI.Animal experiments confirmed the isolated heart perfusion with TNF-α induced ventricular arrhytrnias.Expression of TNF-α after AMI was related with the occurrence of ventricular arrhythrnias.The effect might be associated with the increased inuaeellular Ca2+ intensity caused by TNF-α.

Objective To evaluate brush cytology under endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures, and to analyze the factors influencing the diagnosis yield.Methods Brush cytology was applied in 144 patients with suspected malignant biliary strictures at ERCP.Brushing in bile duct was performed for 10 times from 2004 to 2006, while at least 20 times of brushing and repeated manipulation were performed at biliary strictures from 2007 to 2009. Cytological samples were processed immediately after brushing and analyzed by the same pathologist. Efficacy of brush diagnosis was evaluated based on reference to histopathology after surgery and/or clinical diagnostic criteria. Results Malignant stricture was finally diagnosed in 96 patients, and benign diseases in other 48. Brush cytology was positive in 78 of 96 patients with malignant stricture ( sensitivity 81.3% ), and negative in all patients without malignancy ( specificity 100. 0% ). Overall accuracy of diagnosis was 87.5%. Positive rate of malignancy by brush between 2007 and 2009 was 87.7% (50/57), while that between 2004 and 2006 was 71.8%, which were significantly different ( P ＜ 0. 05 ). The positive rate was not correlated with stricture location or tumor type. No major complications occurred, except for 4 moderate acute pancreatitis, 3 cholangiolitis and 2 biliary bleeding. Conclusion Brush cytology is of high sensitivity and specificity for malignant biliary stricture.Repeated brushing and manipulation can facilitate diagnosis yield.

Objective To observe the expression of heparanase(HPA)in kidney of diabetic nephropathy(DN)rats and to investigate the role of HPA in the pathogenesis of proteinuria in DN rals. Methods DM rat models induced by intraperitoneal injection with streptozotocin were constnmted.Twenty-six rats were randomly divided into heahhy control group(n=6),DM6-week group(n=10)and DM 12-week group(n=10).Relative kidney weight(RKW),blood glucose,BUN,Scr,24-hour urine volume and(t 24-hour proteinuria quantilation were measured,and renal morphology was observed after 6 and 12 weeks.The expression of HPA was examined by immunohistochemistry and reverse transcription PCR. Results (1)Conq)ared with the control group,RKW,blood glucose,BUN,24-hour urine volume and 24-hour proteinuria quantitation of DM groups increased markedly(P＜0.05 orP＜0.01).(2)Compared to the control group,the expression of HPA mRNA and protein in DM groups increused significantly(P＜0.01).(3)HPA protein and mRNA were positively correlated with the quantification of urinary prolein (r=0.783,P＜0.01;r=0.793,P＜0.01). Conclusion The increased expression of HPA maybe parlicipate in the pathogenesis of proteinuria in DN.

In handling crises in hospitals caused by natural disasters like earthquake, systemati cpractical measures of crisis management are needed, which include: early contact with top managements for support in counter disaster supplies, immediate organization of temporary first aid stations by hospital staff, logistic support by full time personnel to solve problems such as drugs and medical equipments as well as food and drinking water, and psychological consultation to patients and staff members.

Objective To explore the endoscopic features and careinoembryonic antigen (CEA) ex-pressions of colorectal serrated adenomas (SA). Methods From June 2005 to July 2008, 27 patients with colorectal polyps and 26 cases of advanced colorectal cancer (ACC) were enrolled in the study. The pit pat-tern of the suspected lesions were observed with 0. 4% indigo carmine sodium stain and classified according to Kudo classification. The polyps were removed by biopsy, high-frequency electrical excision or endoscopic mucosa resection and the samples of ACC were collected with biopsy forceps. All specimens underwent rou-tine pathological examination and CEA expression was detected by immunohistochemistry. Results There were 47 SAs and 27 other types of polyps in polyp group. Most SAs located in left-side colon and were char-acterized by the bulge semipedunculation. The diameters of 45 serrated adenomas ranged from 3 to 8ram, and the maximal diameter of other 2 were more than 10ram. The most common type of pit pattern in SA was mixed type Ⅱ and ⅢL, with type Ⅱ predominant in a certain percentage. Expression of CEA in SA glands was significantly higher than that in proliferative polyps (P < 0. O1). Candnsion SA is an unique type of colorectal adenoma, which is capable of expressing CEA, and displays malignant potential and deserves great attention.

Objective:To compare the clinical effects of direct anterior approach (DAA) and posterolateral piriformis-sparing approach (Mis-PLA) for minimally invasive surgery of total hip arthroplasty.Methods: The patients who had total hip arthroplasty from March 2015 to February 2016 were randomly divided into 2 groups: DAA group and Mis-PLA group.In the study,43 patients (45 hips) were performed with total hip replacement via the direct anterior approach (DAA group).As comparison,39 patients (42 hips) were performed with total hip replacement via the posterolateral piriformis-sparing approach (Mis-PLAgroup) at the same period.DAA group:27 male patients (27 hips),and 16 female patients (18 hips),with an average age of (57.4±7.3) years,preoperative Harris score (41.4±8.7),body mass index(BMI)(24.3±2.2) kg/m2;Mis-PLA group: 25 male patients (26 hips),14 female patients (16 hips),with an average age of (59.2±7.3) years,preoperative Harris score (39.6±8.4),BMI (24.7±2.5) kg/m2.The length of incision,operation time,blood loss,postoperative Harris score were observed and specially the hip functional recovery was fully assessed.Results: (1) All the incisions healed by first intention.No complications were found in both groups.The length of incision:DAA group:(9.2±0.7) cm and Mis-PLA group:(9.5±0.6) cm.No statistical significant differences were found (P=0.053).The operation time:DAA group (74.3±10.1) min and Mis-PLA group(37.5±4.3) min,which showed statistically significant differences(P<0.01).Blood loss:DAA group(229.6±79.2) mL and Mis-PLA group (215.7±56.0) mL.Nostatistical significant differences were found (P=0.366).(2) The patients in both groups were followed up for 6-12 months.The Harris hip scores for 6 weeks' follow-up:(85.5±4.1) in DAA group and (79.0±4.4) in Mis-PLA group,which indicated statistically significant differences (P<0.01).The Harris scores for the 6-month follow-up:(94.3±2.7) in DAA group and (95.2±1.9) in Mis-PLA group.No statistically significant differences were found (P=0.125).The basic daily hip function analysis for the 6-week follow-up:walking speed: no statistically significant differences were found between the two groups(P=0.298);Climbing stairs: Mis-PLA group' outcome was better than DAA group's with statistical differences (P=0.047);Circling,sitting and wearing shoes and socks: outcomes in DAA group exceeded Mis-PLA group's with statistically significant differences (P<0.01,P=0.016,P<0.01).Conclusion: Total hip arthroplasty through either DAA or Mis-PLA approaches could result in very satisfactory clinical effect.Comparing with DAA,Mis-PLA requires less operation time,shorter learning curve,which indicates that it is a re-latively safer approach.The advantages of total hip arthroplasty through direct anterior approach lie in less positional limitation in the early stage of postoperative period,as well as a faster recovery of hip function.