Objective To explore diagnosis of nonunion following intramedullary nailing of femoral and tibial fractures and the treatment of nonunion of femoral and tibial fractures with Less Invasive Stabilization System (LISS) or locking compression plate (LCP). Methods From February 2003 to December 2004, 7 cases of nonunion after intramedullary nailing of femoral and tibial fractures were diagnosed by X-ray or CT scanning or CT-3D. LISS or LCP fixation and bone grafting were employed to treat the 7 cases of nonunion in the femur and tibia. Their case histories ranged from 10 to 49 (mean 23.3) months. Results All the 7 patients were followed up for a mean of 9.1 (4 to 16) months. The bone union time for all the fractures averaged 4.7 months (ranging from 4 to 6 months). No loosening or breakage of the implants occurred in this series. Conclusions The operation should be done for the patients who feel pain in the lower extremities or the fracture line still exists at the fracture ends long time after intramedullary nailing. In order to improve the healing of bone fractures, micromovement and bone defects at the fracture site should be eliminated. Because of its merits in design, the LISS can be used to effectively treat nonunion at the distal femur or the proximal tibia.

Objective To explore the application of plastic pancreatic stents and/or nasal biliary drainage for choledocholithiasis patients having DSBC during Endoscopic Retrograde Cholangiopancreatography (ERCP).Methods Retrospective analysis on clinical data of 57 ERCP cases aiming at choledocholithiasis patients having DSBC from January 2010 to December 2015 has been carried out. According to the guide wire cannulation in an operation, patients are divided into three groups, i.e. plastic pancreatic stents group, nasal biliary drainage group, and plastic pancreatic stents + nasal biliary drainage group, so as to observe the success rate of operation and the occurrence rate of postoperative complications, such as pancreatitis or hyperamylasemia, as well as to compare the differences between the three groups.Results Out of the 57 patients receiving ERCP, 13 patients are in the plastic pancreatic stents group, with two successful operations (15.4%), one case of hyperamylasemia (7.7%), two cases of postoperative pancreatitis (15.4%), one case of fever (7.7%) and one case of hemorrhage (7.7%); 20 patients are in the nasal biliary drainage group, with 20 successful operations (100.0%), no occurrence of hyperamylasemia or postoperative pancreatitis or other complications including hemorrhage and fever; 24 patients are in the plastic pancreatic stents + nasal biliary drainage group, with 19 ERCP operations succeeded at the first attempt (79.2%) and 5 ERCP operations succeeded at the second try (20.8%), as well as 4 cases of hyperamylasemia (16.7%), 2 cases of hemorrhage (8.3%) , no occurrence of fever cases and postoperative pancreatitis. In comparison between the three groups, the occurrence of postoperative pancreatitis and successful rate of operation show a significant difference.Conclusion By adopting plastic pancreatic stents and/or nasal biliary drainage for patients having a dififcult selective biliary cannulation during ERCP, the success rate of operation can be improved, and the occurrence of pancreatitis can also be reduced.

Objective To explore the effectiveness of using middle-latency somatosensory evoked potentials (MLSEP) to predict the prognosis in patients with acute severe stroke. Methods MLSEP, shortlatency somatosensory evoked potentials (SLSEP), and Glasgow Coma Scale (GCS) were recorded in 70 acute severe supratentorial stroke patients within 1 week after onset. All patients were evaluated with modified Rankin Scale (mRS) and follow-up in 6 months after onset. SLSEP and MLSEP were recorded in 20 normal controls. The consistency between MLSEP, SLSEP, GCS and prognosis, as well as the prognostic authenticity of MLSEP, SLSEP, and GCS were analyzed. Results Bilateral N20, N35, and N60 exited in all normal controls. Some waves of MLSEP were absent in stroke patients, and the proportion of absent waves in ipsilateral MLSEP was higher than in contralateral MLSEP. The consistency between bilateral absence of N60 and unfavorable outcome ( Kappa = 0.828, P ＜ 0.01 ), and between bilateral absence of N60 and death ( Kappa = 0.686, P ＜ 0.01 ) was satisfactory. By using the prognostic authenticity analysis of predictors, the ipsilateral absence of N60 showed the highest sensitivity ( 100% ) for unfavorable outcome and death, which added 14.3% compared with the sensitivity of ipsilateral absence of N20 ( 85.7% ). Bilateral absence of N60 showed a high specificity of 100% for unfavorable outcome, which equaled bilateral absence of N20.However, it showed a lower specificity ( 82.9% ) for death, than bilateral absence of N20 (97.1% ).Conclusions MLSEP was able to reflect the degree of brain injury and showed higher sensitivity than SLSEP for predicting unfavorable outcomes. Therefore combined use of MLSEP and SLSEP in evaluating and predicting the outcomes in brain injuries is suggested.

Objective To carry on statistical analysis of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease, find out the significative indices for syndrome diagnosis, and establish the diagnostic criteria of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease. Methods Cases of angina pectoris of coronary heart disease were selected according to modern medical diagnostic criteria. Clinical observations were carried on and clinical information was filled in the forms of the clinical cases. Each case was differentiated and made corresponding diagnosis of syndrome according to tradtional mongolian medicine. Clinical cases were grouped according to syndrome of tradtional mongolian medicine and decided the significative indices by statistical analysis. Results Four hundred and ten cases were differentiated which contain tradtional mongolian medicine information about angina pectoris of coronary heart disease, including 358 cases of Chu Si syndrome, 23 cases of Nian Xie syndrome, and 29 cases of Wei Sha syndrome. Through statistical analysis of the various syndromes and the objective indices, diagnostic criteria of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease was established. Conclusion Diagnostic criteria of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease was summarized by combination of disease and syndrome, and provides a theoretical basis for the resonable application of mongolian herb.

Objective To study the effect of poly- DL- lactic acid (PDLLA) absorbable membrane on preventing adhesion after repair of peripheral nerve injury. Methods 60 SD rats were divided into 2 groups randomly: the suturing+ PDLLA group (experimental group) and the purely suturing group (contrast group), with 30 rats in each group. Their sciatic nerves were cut off and then sutured microsurgically. In the experimental group, the anastomotic stoma was encapsulated with PDLLA membrane; in the contrast group, there was no such a treatment. We conducted gross observations and histological examinations at 2, 4, 8, 12, and 16 weeks after operation, neural electrophysiological examinations at 12 and 16 weeks after operation, and image analysis by computer at 16 weeks after operation. Results The scar proliferation and adhesion near the anastomotic stoma in the experimental group were less extensive than those in the contrast group; regenerative nerve fibers grew more straight and orderly manner. Electrophysiological examinations and image analyses by computer also showed that the experimental group achieved better results than the contrast group. Conclusion Poly- DL- lactic acid (PDLLA) absorbable membrane can prevent scar proliferation and adhesion after repair of peripheral nerve and promote nerve functional recovery effectively.

Background It has been proved that as an important adhesion protein of extracellular matrix,osteopontion (OPN) can affect tumor neovascularization.Some new researches showed that anti-OPN antibody plays a role in regulating the neovascular vessel formation.Choroidal neovascularization (CNV) has the same structure with tumor neovascularization,but whether anti-OPN antibody restricts new vessel formation is unclear.Objective This study was to investigate the inhibitory effect of anti-OPN antibody on CNV.Methods Laser-induced CNV models were created in 40 eyes of 40 male SPF C57BL/6J mice by Argon laser photocoagulation of retinas,with the wavelength 514 nm.Thirty-six successful models were randomly divided into anti-OPN antibody group,mouse-IgG group and PBS group by the randomized number table.On the second day after photocoagulation,anti-OPN antibody of 400 μg was intraperitoneally injected in the anti-OPN antibody group,and the equivalent amount of mouse IgG and PBS were used in the same way in the mouse IgG group and PBS group.The CNV was evaluated by fundus fluorescein angiography (FFA) on the seventh days after photocoagulation.The mice were immediately sacrificed and the eyeballs were enucleated on the fourteenth day after photocoagulation,and 4 eyeballs in each group were used to observe the areas of CNV on the retinal pigmental epithelium-choroid-sclera fiat mounts,and the other 8 eyeballs of each groups were used to analyze the expression levels of OPN mRNA and vascular endothelial growth factor(VEGF) mRNA using quantitative fluorescence-PCR (QF-PCR).Results FFA showed fluorescein leakage areas around laser spots 7 days after photocoagulation,indicating that CNV appeared.The CNV areas were ([16.98±0.70] × 103) μm2,([27.13 ± 0.81] × 103) μm2 and ([35.39±2.14] ×103) μm2 respectively in the anti-OPN antibody group,mouse IgG group and PBS group,with a significant difference among the 3 groups (F =533.76,P =0.00),and the CNV area was significantly smaller in the anti-OPN antibody group compared with those of the mouse IgG group and PBS group (q =-3.95,-4.40,both at P＜0.05).No significant difference was found in the OPN mRNA expression between the antiOPN antibody group and mouse IgG group (t =-5.26,P =0.66).However,the expression of VEGF mRNA in choroidal tissue was significantly declined in the anti-OPN antibody group than that in the mouse IgG group (t =-6.74,P＜0.01).Conclusions Anti-OPN antibody suppresses the formation of CNV in laser-induced mouse model by down-regulating VEGF.

Objective To evaluate the effect of transverse position and numbers on the stability of the spinal pedicle screw fixation during the pedicle cortex perforation. Methods The vertebral compression fracture was performed in the L1 vertebral body using the Chiba's method from 60 fresh thoracic and lumbar vertebrae samples of sheep(T13-L3),which were randomly divided into 6 groups(A,B,C,D,E,and F)using a lottery method. Bilateral pedicles of vertebral arch of T14 and L2 were inserted pedicle screws,connecting titanium rods to fix T14-L2 segments. Then the samples of groups B,C,D,E,and F were removed a quarter of right side of lateral T14 thoracic pedicle cortical,which were considered the pedicle cortex perforation model. Finally,each group was fixed on different numbers of crosslinks:group A(0 crosslink,Intact),group B(0 crosslink,NCL),group C(1 crosslink,1/2 of the rods,MCL),group D(1 crosslink,1/3 of the rods close to T14,PCL),group E(1 crosslink,2/3 of the rods away from T14,DCL)and group F(2 crosslinks,1/3 and 2/3 of the rods respectively,TCL). After all samples were subject to 10 000 times of fatigue test with biomechanics test machines,the axial compressive stiffness,range of the motion(ROM)of the 6 directions(flexion,extension,lateral bending,and axial rotation),and the maximum pullout of the screws of the T14 pedicle cortex perforation were measured and compared among these 6 groups. Results The axial compressive stiffness in groups A,C,D,E,and F was significantly higher than that in group B(all P<0.05),and group A was significantly higher than group F(P<0.05) . The maximum pullout in groups A,C,D,E,and F were significantly higher than that in group B(all P<0.05),and group A was significantly higher than group F and groups C,D,and E were significantly lower than group F(all P<0.05). ROM of flexion,extension,lateral bending,and axial rotation in groups A,B,C,D,E,and F were significantly lower than that in group B(P=0.000),and ROM of left and right axial rotation in groups C,D,and E were significantly higher than in that group F(P=0.000). Conclusions During the pedicle cortex perforation,adding of one crosslink can improve the stability of the pedicle cortex perforation,and adding of two crosslinks can approximately achieve the same stability as the pedicle screw fixation with no pedicle cortex perforation. The location of the crosslink has no obvious effect on the short segment of spinal fixation.

Irritable bowel syndrome( IBS)is a commonly seen chronic functional bowel disease,the prevalence showed a rising trend in recent year in China. At present,the etiology and pathogenesis of IBS have not yet been fully elucidated,and may be related to intestinal gas. Intestinal gas is usually composed of 59% N2 ,21% H2 ,9% CO2 ,7%methane(CH4 )and 4% O2 ,in which H2 and CH4 are produced only by intestinal bacteria metabolism. IBS patients usually manifested as having abdominal distension and symptoms of flatulence,suggesting the occurrence of accumulation of intestinal gas. In recent years,the relationship between symptoms of IBS and intestinal gas has attracted much attention. This article reviewed the progress in study on symptoms of IBS and intestinal gas.

Objective To evaluate the therapeutic effect,as well as the safety,of on-demand sildenafil on men with idiopathic ED.Methods One hundred and four men who met the diagnosis criteria of idiopathic ED were recruited into 2 groups.Among them,46 men who refused or were reluctant to take pharmacotherapy were recruited into the clinical control group with instruction of sexual knowledge and skills.Fifty-eight men who were involved in the on-demand group,were administrated sildenafil 50 mg just 1h before the coitus at thebeginning,then,if needed adjusted the dosage according to the effect and tolerance of the first four administration.The questionnaire of IIEF-5 was completed at the baseline and the end point,and the clinic total effective rate,the fully recovery rate of ED and the adverse events were also evaluated at the end of administration.Both groups were treated for 3 months.The therapeutic effect was reevaluated 1 month and 3 months later,respectively.Results After 3 months treatment,scores of IIEF-5 at the baseline and the end point for control group and on-demand group were as follow:5.2 and 12.6,4.2 and 19.8 ;and the fully recovery rate of ED for each group were as follow:12 (26.1％),56 (96.6％) ; the total effective rate for each group were 27.7％,97.2％ ; 1 month and 3 months after the end point,the fully recovery rate of ED and the total effective rate were evaluated separately,for 1 month:8 (17.4％),56(96.6％) and 19.4％,97.1％; for 3 months:7 (15.2％),55 (94.8％) and 16.4％,96.4％.The side effects in on-demand group (16,27.6％) was little higher than the control group (5,10.9％) (P ＞0.05).Most of the side effects were not only subtle and transient but also would vanish with the time.Accordingly,no one discontinued because of side effects.Conclusions Treatment of idiopathic ED with sildenafil was effective and safe.In terms of the fully recovery rate,total effective rate and effect maintenance,the on-demand group at the end point,even 1 month and 3 months after the end point,showed a great advantage over the control group.

To investigate the differential gene expression profile in two typical traditional Chinese medicine (TCM) syndromes of patients with chronic hepatitis B (CHB), and to find the relationship between TCM syndromes and gene expressions.