Objective To study the clinical effects of delayed surgery for Maisonneuve fractures.Methods Between January 2006 to June 2011,we treated 21 patients with Maisonneuve fracture by delayed surgery.They were 18 men and 3 women,aged from 17 to 63 years (average,36.8 years).Rupture of inferior tibiofibular ligaments was complicated in all,lateral malleolus fracture in 17 cases,medial malleolus fracture in 14 cases,rupture of deltoid ligament in 7 cases,and posterior malleolus fracture in 15 cases.None of them got timely surgery due to complicated injuries,poor skin condition or missed diagnosis.Six patients had surgery after 2 weeks,11 after 3 weeks and 4 after 4 weeks.The interval from injury to surgery ranged from 14 to 32 days,averaging 21.3 days.Fractures of lateral,medial and posterior malleolus were treated with open reduction and internal fixation.Ruptures of deltoid ligament and anterior ligament of inferior tibiofibula were repaired and reconstructed.Functional recovery of the ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.Results The patients were followed up for 10 to 18 months (average,12.3 months).All the fractures healed after an average time of 12.4 weeks (from 10 to 22 weeks).No infection or implant failure was observed in this group.The affected ankle restored inflexion basically to the range of the contralateral 6 months post-surgery,but was limited in the ranges of varus and valgus.Pain was extensively experienced.At the last follow-up,10 patients (47.6％) showed obvious disparity between the 2 sides,and 5 ones had lateral displacement of the talus and widened ankle mortise.AOFAS results were excellent in 5 cases,good in 9,fair in 4 and poor in 3,yielding a good to excellent rate of 66.7％.Conclusion Because delayed surgery increases the difficulties in surgery and functional recovery,early diagnosis and early surgery are crucial for treatment of Maisonneuve fractures to achieve satisfactory outcomes.

The objective of study was to investigate the influence of alcohol concentration and amount,soaking time on extraction rate from Rhizoma Atractylodis Macroephalae with the method of uniform design. We concluded that this method has potential as a good method for experiment design with many factors during the screening of optimum extraction process of Chinese medicine preparations.

Objective To compare the effect of different analgesia methods on the treatment of pain after total knee arthroplasty (TKA),and find the ideal analgesia way for peri operation period of TKA.Methods A total of 79 patients was randomly divided into three groups:cocktail,spinal,and multimodal analgesia groups.A comparative study among three groups was conducted on the postoperative visual analogue scale (VAS) of pain score,range of motion,and adverse reaction.Results The motion pain score of using multimodal analgesia patients 24 hours after operation and the resting pain scores 48 hours after operation were less than the other two groups.The postoperative joint range of motion in 1 ～ 2 weeks of multimodal analgesia group was significantly better than the other two groups.Conclusions Multimodal analgesia was an effective way to treat pain after knee arthroplasty.

Objective To discuss the clinical therapeutic effect of tibia fracture treated by intramedullary nail using limited incision or close reduction.Methods We treated 54 tibia transverse fracture cases,93 oblique fracture cases, 7 1 fragmental fracture cases by intramedullary nail using open with limited incision or close reduction.We then compared operation time,X-ray time,hospital stay duration,infection rate,nonunion rate, and postoperative function restoration between patients with different fractures.Results There was no different operation time in transverse fracture group,but longer for close reduction in oblique fracture group and for open reduction in fragmental fracture group.X-ray time did not differ for open or close reduction in transverse fracture group.Long X-ray time was used in close reduction in oblique and fragmental fracture groups.There was no significant difference in nonunion rate for open and close reduction in both transverse and fragmental fracture groups.The oblique fracture nonuinon rate was higher in close reduction group than in open reduction group.No difference was found in infection rate or function recovery whether for open or close reduction in all types of fractures.Conclusion Different therapy methods should be determined by different fracture types.Open reduction with minimal incision should be used for oblique fracture cases and fragmental fracture cases with reduction difficulty.

Objective To observe how different measuring methods of corneal curvature produce affect postoperative corneal a-stigmatism correction after implantation of TORIC artificial lens .Methods To measure 4 teams of age-related cataract patients complicated with regular astigmatism of more than 1 .0D by the procedure of manual keratometer ,IOL Master ,auto keratometer and Pentacam respectively .The Toric artificial lenses were precisely placed in appropriate position in phacoemulsification surgery .We observed the uncorrected visual acuity (UCVA) ,best corrected visual acuity (BCVA) in 1D ,1W ,1M ,3M before and after the sur-gery ,corneal astigmatism after the surgery ,as well as anticipated and consequent residual astigmatism .Results The variance analy-sis of absolute-value deviation between anticipated residual astigmatism (ARA) and best corrected visual acuity (BCVA) is P<0 .0001 ,the above difference was statistically significant ;we consider that the astigmatic deviation measured by the four methods is different ;besides the deviation of paired comparison results between Master-team (0 .322) and auto-team (0 .242) ,auto-team and manual-team (0 .218) ,manual-team and Pentacam-team(0 .107) is more than 0 .05 and not statistically significant ,all the remaining paired comparison results are statistically significant ,(P<0 .05) ,the Pentacam-team (0 .082) is the minimum deviation ,while the IOL Master-team (0 .422) is the maximum one .Conclusion The measuring result to estimate the exact value of Acrysof Toric IOL by Pentacam is more accurate than by other methods .

Objective To study the signs and the value of CT enhanced scanning in diagnosing the liver cancer combined arteriovenous fistulae(AVF).Methods 50 cases of the liver cancer combined AVF had plain and enhanced scanning by spiral CT,then proved by hepatic arteriography.The signs of CT and hepatic arteriography were contrast analyzed.Results CT scan showed 17 cases of artery-portal vein fistulae (centre),10 cases of artery-the small branch of portal vein fistulae(periphery),3 cases of artery-liver vein fistulae,5 cases combined the signs aforementioned,2 cases combined the artery-portal vein fistulae and the artery-liver vein fistulae,and the 13 cases no the characteristic signs of CT,37 cases of the signs of AVF were found by CT,sensitivity 74%.26 cases were diagnosed as AVF,postitive rate 52%.Conclusion The development of portal vein and/or the inferior caval vein ahead in artery phase,especially the parenchyma of the lobes,segments and subsegments of liver,may be a foundation of the diagnosis of AVF.And we discussed the limitation of the CT examination in diagnosing this complication.

To analyze the epidemiological characteristics of human infection with avian influenza A(H7N9) virus from 2013 to 2016 in Xiaoshan,China,we collected the epidemiological data of human A(H7N9) cases as well as the results of environmental monitoring and analyzed it by case study,descriptive epidemiological method,and statistical analysis.Results showed that a total of 22 cases were confirmed,including 12 deaths.All the cases occurred in winter and spring,and most of them had been exposed to live poultry,and with the underlying condition of chronic diseases.Chi-square test showed that the ratio of cases with chronic diseases in death group was higher (P=0.01).The environmental monitoring result showed there were distinctive seasonal differences of positive rate with peaks in winter and spring and nadirs in autumn and summer.Positive rates for the samples from external environmental monitoring were consistent with the distribution of the case onset.Due to rise of environmental monitoring positive rate,we should be alert to the occurrence of new cases,especially in rural areas where live poultry fairs still exist and among people with occupational exposure.We should further improve ability to prevent and control this disease.

Objective To evaluated diagnosis yield of cytological and histological analysis of endoscopic ultrasound guided fine needle aspiration (EUS-FNA).Methods A total of 43 patients who were clinically diagnosed as having mediastinal lesions,retroperitoneal lesions or pancreatic lesions by CT were recruited to the study.EUS-FNA was performed with standard 22G needle.Specimens were placed in formalin for histological analysis,and residual materials were prepared for cytologic analysis.Results Lesions were located in the mediastinum (n =9),the retroperitoneum (n =1),and pancreas (n =33).Cytologic diagnoses included malignancy (n =22),suspicious malignancy (n =2),atypical cell (n =3),absence of malignancy (n =16).Histologic diagnoses included malignancy (n =30),suspicious malignancy (n =1),sarcoidosis (n =2),chronic inflammation (n =10).The positive rates,sensitivities and accuracies of cytology and histology were 51％,59％,65％ and 74％,81％,84％,respectively.Conclusion The positive rate,sensitivity and accuracy of histology of EUS-FNA is superior to cytology.

AIM:To develop a method for determining cholic acid by HPLC-ELSD and GC was applied to determing muscone;in Jawei Xihuang Soft Capsule(Calculus Bovis,Moschus,Venenum Bufonis,Olibanum,Myrrha).METHODS:AC_(18) column(Kromasil C_(18),5 μm,4.6 mm×250 mm)was used as stationary phase,the mobile phase was methanol-0.01% glacial acetic acid(73:21)at a flow rate of 1.0 mL/min.The parameters of ELSD were set as follows:evaporation temperature was 40℃,carrier gas(N_2)pressure was 200 kPa.The GC system consisted of DB-1 capillary column(30 m×0.32 mm×0.25 μm)and FID as the detector.The programmed temperature-GC and internal standard method were employed to determine the content of muscone.RESULTS:The linear ranges of cholic acid and muscone were in the range of 45.2 ng-904 ng and 0.05 mg/mL-0.5 mg/mL respectively.The average recoveries were 99.06% and 99.40% with RSD of 1.56% and 0.95% respectively.CONCLUSION:The method is convenient and accurate,and it can be used for the quality evaluation of Jawei Xihuang Soft Capsule.