Objective To investigate simple manual humeroulnar distraction for alleviating elbow stiffness due to upper limb fracture. Methods Twenty-seven patients with elbow stiffness due to upper limb fracture were divided into control and experimental groups. Before treatment there was no significant difference in stiffness between the groups. The controls were treated with the combined mobilizations and passive stretching. The experimental group was treated with manual humeroulnar distraction alone. Both groups were treated for four weeks. Range of motion ( ROM) and the Mayo elbow function scale (MEFS) were used to evaluate elbow function before and after 4 weeks of treatment. Results After 4 weeks, there was a significant difference between the groups. In the experimental group average ROM reached (110±20) °,an average of 29.6°better than the controls (80.4±23.6) °. MEFS scores also showed significant differences between the experimental group (93. 85±7. 95) and the control group (83.93±9. 24). Conclusions Humeroulnar joint distraction might increase ROM and improve the functioning of stiff elbow joints. This finding may help rehabilitation professionals choose more effective manual mobilization techniques for treating elbow stiffness after upper limb fracture.

Objective To study the influence of aging and chemotherapeutic drugs of breast cancer patients on chemotherapy-induced amenorrhea (CIA) and to guide the further selection of drugs for chemotherapy.Methods We prospectively studied the CIA of the premenopausal breast cancer patients and compared the difference in CIA between the patients who were at different aging periods or received different chemotherapeutics. Results 137 patients were followed up.The occurrence rate of CIA and long-term chemotherapy-induced amenorrhea(LCIA)were 73.72%(101/137)and 43.80%(60/137)respectively.The rate of CIA and LCIA was significandy higher in older women(＞40 years)than young women(≤40 years,X2=25.32,18.42,P＜0.05).The recovery rate of CIA in young women was 61.90%(13/21)which was significantly higher than the older women[35.00%(28/80);X2=4.99,P=0.025].The difference in the rate of LCIA was statistically significant between the older women (＞40 years)who received different anthracyclinebased chemotherapy(X2=6.92,P=0.031).Conclusion Age is an important factor for the CIA.Chemotherapy has less influence on the menstruation of younger women(≤40) and most amenorrhea is reversible.For older women,the rate of LCIA is different in patients who receive imported epirubicin,domestic epirubicin or pirarubicin.

The majority of women diagnosed with early-stage breast-cancer have an excellent long-term prognosis, but many still suffer from worsened life quality and infertility caused by chemotherapy-induced amenorrhea(CIA). The risk of CIA varies by patient age, but is not significantly influenced by chemotherapeutic regimens. CIA will improve disease-free survival and overall survival for patients with hormonal receptor positive tumors. For low-risk patients and patients with the intention of maintaining fertility, proper treatments need to be chosen to preserve their reproductive function.

Objective To explore the relationship between Lp (a)level and age,gender in Nanjing area.Methods 8 442 ser-um specimens from examination individuals were collected in the First Affiliated Hospital of Nanjing Medical University in 2014.Lp (a)was measured by immune turbidimetry method.All the subjects were divided into six groups:15~29,30~44, 45~59,60~69,70~79 and ≥80 years old.SPSS21.0 software was used to carry out statistics.Results The Lp(a)level in female [134±197 mg/L (M±QR,the same below)]was higher than that in male significantly (U =8 355 137,P <0.001). LP (a)levels from people of different sex correlated with the age weakly (r =0.154,P <0.001),and increased with age groups.Lp(a)of six groups in male were 106.5± 151.0,119.0± 170.0,128.0± 179.0,159.0±206.0,145.0±200.0 and 162.0± 190.0 mg/L respectively.The difference was statistically significant between between 1 and 2 groups,2 and 3 groups,3 and 4 groups,theU value were 645 152.5,1 006 572.0,197 595.0 respectively;P all<0.05.The difference was not statistically significant between 4 and 5 groups,5 and 6 groups,3 and 4 groups,theU value were 59 127.0 and 15 959.5 respectively,P >0.05.Lp(a)of six groups in female were 128.0 ± 194.0,128.0 ± 187.0,139.0 ± 207.0,157.0 ± 228.0, 173.5±227.0 and 150.0±201.0 mg/L.The difference was statistically significant between 2 and 3 groups,theU value was 641 147,P =0.006,respectively.The difference was not statistically significant between 1 and 2 groups,3 and 4 groups,4 and 5 groups,5 and 6 groups,theU value were 783 676,92 442.5,16 069.5 and 3 038,respectively;P all>0.05.Conclusion Lp (a)level in healthy population in Nanjing area is related to gender and age groups,it is necessary to establish different reference ranges.

[Objective]To evaluate our protocol with the extensile lateral approach to open reduction and internal fixation in the treatment of displaced intra-articular calcaneus fractures.[Method]From 2001 to 2005,35 patients(41 feets)were treated with open reduction and internal fixation using extensile lateral approach,with 25 right feet and 16 left feet and with plate fixation using in 40 cases,single screw fixation using in 1 case.[Result]Evaluated with postoperative plain radiographs,90%(37/41) fracture had anatomic or near anatomic reduction of posterior facet.73%(30/41) Bhler angle above than 20? in 28 cases,32 feets among the patients were followed up at a mean of 14 months(ranged,9 to 24 mouths) and evaluated according to hind foot and ankle score system of AOFAS,average score was 87.The function were satisfactory.It took average 4 month to come back normal action,none of nerves injury,4 patients had wound hematoma.Two cases developed surgical wound edge necrosis and dehiscence among them,who were treated in initial phase in the treat group,the 2 cases were managed with dressing changes and healed in 1 month,whitout skin flaps and grafts.[Conclusion]Open reduction and internal fixation using lateral approach is a better choice to treat intra-articular calcaneal fractures,because it can correct directly the pathology of calcaneal fractures.Anatomical reduction of joint congruity and the shape of the calcaneus are important prognostic factors.

[Objective]To explore the cause and treatment of refractory nonunion of patella combined with handicapped joint function.[Method]Retrospective analysis was given to twenty-four patients diagnosed as patellar nonunion that had been admitted to our hospital from Jan 1992 to Jan 2006.The series included fifteen males and nine females with an average age of 36(range 12-71) years.Initial treatment of the original fractures was nonoperative in 3,cerclage with wiring or suture silk in 11,tension band wiring in 6 and modified tension band wiring in 4.All fractures progressed to symptomatic nonunion at an average of 18 months from original injury(range 5-32).All patients were given open reduction and internal fixation,which consisted of Nickel-Titanium patella concentrator(NT-PC) in 9,NT-PC combined with cannulated compression screws in 6,combined with Kirschner wire in 5 and tension band wiring in 4.[Result]Twenty-four patients were followed up with an average of 35(range 6-168) months.The time of bone union averaged 4.2(range 3-6) months.No bone block displacement,loosening or breakage of internal fixation happened.According to Xu Shaoting' s knee function scores,the results were excellent in 14 cases,good in 6 cases,fair in 3 cases and poor in 1 cases.The excellent and good rate was 83.3%.[Conclusion]Operative reconstruction of smooth joint surface,rigid internal fixation and early functional exercise are effective remedies to refractory nonunion of patella combined with handicapped joint function.

Objective To compare the effect of establishment of Coronary angiography model in minipigs with right femoral Judkins catheter and 5F universal catheter .Methods Ninteen minipigs were randomized into two groups with right femoral Judkins catheter (ten minipigs)and 5F universal catheter(nine minipigs). Success rate,operation time,X-ray irradiation time were observed .Results The success rate, operation time ,X-ray irradiation time after Coronary angiography in right femoral Judkins catheter group was 100%,(5.68 ±3.53 ) min,(20.84 ±2.45 ) min,in 5F universal catheter group was 88.8%,(6.98 ± 4.13 )min,(26.23 ±8.45 )min.This difference was signifficant( P <0.01).Conclusion Coronary an-giography in minipigs with right femoral Judkins catheter has the advantage of high success rate , less opera-tion time, X-ray irradiation time , is more suit to coronay anatomy of the minipig .

Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disease due to glucocorticoid biosynthesis enzyme deficiency,in addition to the common types such as 21-hydroxylase,11 β-hydroxylase deficiency,also include rare types such as 3 β-hydroxysteroid dehydrogenase deficiency,17α-hydroxylase deficiency and congenital lipoid adrenal hyperplasia (CLAH).These rare types of CAH have multiple clinical manifestations,which are easily missed or misdiagnosed.This article focus on molecular genetics,pathophysiology,clinical manifestations and treatment principles of above 3 rare types of CAH.

Objective To compare the effect of spinal anesthesia by using 0.75% ropivacaine or 0.5% bupivacaine in a simulated state of rocking naval vessels, in order to choose an optimal anesthetic agent in a rocking naval vessels at sea. Methods Eighty patients undergoing elective surgery of abdomen or lower limb were randomly divided into 4 groups (n=20). Namely, horizontal level with 0.75% ropivacaine control group (R1), horizontal level with 0.5% bupivacaine control group (B1), simulated rocking with 0.75% ropivacaine group (R2), simulated rocking with 0.5% bupivacaine group (B2). The effect of anesthesia, the changes in hemodynamics and the incidence of relevant side-effects were determined and compared among the four groups. Results The anesthetic level (analgesic level) of group B2 was 2.7 segments higher than that in group B1, and the durations for fixed level was longer than group B1 (P

BACKGROUND: The problem to be solved firstly in adipocyte implantatior after its in vitro adherent ulture f preadipocyte with scaffold using tissue-engineered technique is the biocompatibility of scaffold and dipocyte.OBJECTIVE: To investigate the feasibility of poly-β-hydroxybutyric acid (PHB) used for readipocyte implantation.DESIGN: Randomized controlled trial.SETTING: Medical College of Wuhan University.MATERIALS: This trial was carried out in Medical College, Wuhan University during October 2003 o June 2005. Twelve male SD rats(Experimental Animal Center, Medical College, Wuhan University), weighing rom 200 to 250 g, were involved.PHB scaffold was provided by Institute of Polymer Materials, Department f hemical Engineering, Tsinghua University.METHODS: The preadipocytes of rats were isolated, purified and ultured in vitro for use. PHB scaffold was made into 0.75 cm×0.75 cm ×0.2 cm lamellar cell biological caffold, then which were soaked by DMEM/F12 culture medium containing 150 g/L fetal bovine serum and laced in culture plate, one piece each well, 12 wells totally. 1.0 mL cultured cell suspension was added n each well to prepare cell scaffold complex. Eight rats were selected. The prepared complexes were implanted into right-side back tissue of a rat and fixed with 5-0 silk, serving as adipocyte scaffold roup; the biological scaffolds without adipocyte adherence were implanted into left-side back tissue of he same rat with the same method, serving as blank scaffold group. One lamellar biological scaffold was mplanted into each side. Eight weeks later, the appearance and structural change of grafts were observed, nd the grafts were weighted and their volumes were measured. Four lamellar biological scaffolds were mplanted into the other 4 rats separately and taken out after 3 weeks, then they were fixed by 100 g/L eutral formalin, sliced, and stained by haematoxylin and eosin (HE). Their histological changes were observed.MAIN OUTCOME MEASURES: ① Gross and histological observation of grafts in adipocyte scaffold roup and blank scaffold group. ② Comparison of volume and mass of grafts in two groups.RESULTS: Twelve ets were involved in the result analysis ,without deletion. ①Gross observation: In the adipocyte scaffold group, grafts presented flesh-color appearance and peplos in the peripheral region, and newly ormed minute blood vessels ingrowing into the scaffold. In the blank scaffold group, grafts presented rey ppearance, which was coated by peplos. ② HE staining: Three weeks later, a few scattered adipocytes were ound in the peripheral region of the grafts,there were very few vessels. Eight weeks later, lamellar ibrous peplos was found around the complex. Adipocytes ingrew from the peripheral region of scaffold into caffold, partial scaffold was nearly full of adipocytes and many vessels formed;In the blank scaffold roup, only peplos and vessels were found, scaffold was full of fibrous connective tissue and adipocytes ere not found. ③ Comparison of volume and mass: adipocyte scaffold group was superior to blank group in scaffold volume and mass [(257.5±70.2)vs.(144.6±62.6)mm3,(245.6±58.2) vs.(148.7±60.3)mg, both P＜0.01].CONCLUSION: Preadipocyte can adhere to PHB scaffold, proliferate and differentiate into mature dipocytes. It is feasible for PHB material to serve as a carrier for preadipocyte.