Objective The purpose of this study is to evaluate the safety and operation of a modified coaxial portals for posterior ankle arthroscopy. Methods 20 anticeptic-frozen ankle specimens were divided into 2 teams at random equally. In the first team, the original coaxial portals designed by Acevedo were established with K-wires first, then followed by modified coaxial portals. In the second team, modified coaxial portals were created at two levels, one at 1.5 cm proximal to the tip of lateral malleolus and the other at 2.5 cm to the tip. K-wires were left in place for distance measurement between them and the posterior important anatomic structures. Mimic ankle arthroscopy operation was performed on 5 fresh ankle amputations, using 2.7 mm, 30? arthroscopy with the modified coaxial portals technique. Results Results of the anatomic study show that the average distince was (22.07+2.82) mm to the small saphenous vein, (5.39+1.47) mm to flexor hallucis longus tendon, (6.27+1.84) mm to the tibial nerve in modified coaxial portals and (8.54+2.76) mm to the small saphenous, (3.62+1.37) mm to flexor hallucis longus, (4.40+1.40) mm to the tibial nerve in the original one. Only the difference of the average distance to the tibial nerve in the No.2 team has statistic significance. Flexor hallucis longus and flexor digitorum tendon were identified as the inner-safety landmarks. Neither penetration nor contact of nerve or vessel was observed. Conclusion Compared with original ankle posterior coaxial portals, the modified coaxial portals may be superior safety, easier-operated and reproducible.

Objective To explore the characteristics of narcissism in a sample of violent criminal and analyze the relationship between narcissism and impulsive-premeditated violent aggression.Methods A total of 88 violent criminal were administered by means of cluster random sampling with the Chinese version of the Impulsivepremeditated Aggression Scale and the Narcissistic Personality Questionnaire.Results (1) Comparing with the impulsive violent criminal,premeditated violent criminal had higher level of Overt narcissism,and the difference was statistically significant(59.77±10.89,54.67±10.15; P＜0.05).(2) Overt narcissism had significantly positive correlation with premeditated aggression(r=0.560; P＜0.01) ;and covert narcissism had significantly positive correlation with impulsive aggression(r=0.440; P＜0.01).(3)The authority and self-admiration traits of overt narcissism had significantly positive prediction to premeditated aggression(β=0.442,P＜0.01;β=0.297,P＜0.05);The vulnerability trait of covert narcissism has significantly positive prediction to impulsive aggression(β=0.526,P＜0.01).Conclusion Overt narcissism can result in premeditated aggression;Covert narcissism can result in impulsive aggression.

Objective To evaluate the effectiveness of color doppler ultrasound(CDU)in combination of computed tomographie angiography(CTA)in diagnosis of the arteriosclerosis occlusion.Methods:43 patients with arteriosclerosis occlusion were assessed by color doppler ultrasound,CTA and digital subtraction angiography(DSA).By using DSA as the reference standard,the results were compared.Results The sensitivity.specificity,positive and negative predictive values for CDU were 82.96%,95.2%,94.92%,83.8% respectively.Those for CTA were 88.89%,96.75%,96.77%,88.81% respectively,and for the two combination,were 94.81%,99.17%,99.22%,94.44% respectively.Conclusion The color doppler ultrasound combined with CTA is an effective way in diagnosing arteriosclerosis occlusion.

Objective To establish an animal model of high-iodine and low-protein in Wistar rats,and to observe the effect of combined excess-iodine and low-protein diet on growth,metabolism and morphological changes in thyroid.Methods According to body weight[(110 ± 10)g] and sex(half male and half female),one hundred and ninety-two Wistar rats,1 month after weaning,were randomly divided into ① normal iodine control group (NI),② 10-fold excess-iodine group (10HI),③ 50-fold excess-iodine group (50HI),④ 100-fold excess-iodine group (100HI),⑤ low-protein control group (LC),⑥ low-protein and l 0-fold excess-iodine group (L10HI),⑦low-protein and 50-fold excess-iodine group (L50HI),⑧ low-protein and 100-fold excess-iodine group(L100HI).Twenty-four rats were in each group,with the experimental period of 6 months.The iodine content of NI and LC groups was 4.65 μg/d; 10HI,50HI and 100HI groups were 46.50,232.50 and 465.00 μg/d,respectively.The animal's body weight,water and feed consumption were recorded weekly.At the end of 60,120,180 days,urine and blood samples were collected from eight rats in each group.Urinary iodine was tested by arseni cerium catalytic spectrophotometry; serum iodine was tested by the method of chloric acid.Histological change of the thyroid gland was observed by transmission electron microscopy and hematoxylin-eosin (HE) staining at the end of 6 months; apoptosis of thyroid was tested by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) method.Results At the end of 4,8,16,18,22 and 24 weeks,the differences of body mass of rats among groups were statistically significant(F =4.26,3.75,4.98,4.09,3.28,3.95,all P ＜ 0.05).At the end of 60,120,180 days,the differences of iodine concentration in urine and blood among groups were statistically significantly (H =5.37,6.03,all P ＜ 0.05).Light microscopy showed that thyroid follicular epithelial cells became flattened,and follicles became distended with colloid following increasing of iodine concentration.Electron microscopy showed increased glial vesicles,condensation of nuclear chromatin,karyopyknosis,and karyolysis with increasing of iodine concentration.The differences of apoptotic indexes among groups were statistically significant (F =4.59,P ＜ 0.01).The apoptotic indexes of L50HI and L100HI groups [(21.50 ± 5.20)‰,(26.70 ± 6.40)‰] were higher than those of 50HI and 100HI groups [(11.20 ± 4.30)‰,(19.40 ± 4.80)‰,P ＜ 0.01 or ＜ 0.05].Conclusion Excessiodine and low-protein can cause growth retardation,abnormal iodine metabolism,and thyroid follicular epithelium damage in Wistar rats.

Objective To evaluate the inverse distance weighted(IDW) in revealing the characteristics of spatial distribution of water fluoride in Heze City,Shandong Province.Methods A geographic information system (GIS) database of water fluoride was established in Heze City of Shandong Province using the data of endemic fluorosis surveys collected by Endemic Disease Prevention Institute in Shandong Province during 2005-2007.IDW spatial interpolation was applied to predict the distribution of fluoride in drinking water in 139 towns of Heze City.Sensitivity and specificity were calculated.Results Mean water fluoride levels in 10 counties of Heze City were all higher than 1.0 mg,/L,and the water fluoride in Cao County,Juye,Mudan District and Juancheng were higher than 2.0 mg/L.Of all 139 townships of Heze City,129 were higher fluoride townships where fluoride was ＞ 1.0 mg/L,10 were lower fluoride townships(≤ 1.0 mg/L).IDW spatial interpolation showed that the water fluoride of most areas in Heze City were ＞ 1.0-2.0 mg/L.The areas with water fluoride of ＞ 2.0-3.0 mg/L were mainly located in eastern Juancheng,northern Mudan District,north-central Chengwu,central and southern Juye,southeastern part of Caoxian and eastern part of Shan Town.Regions of water fluoride ＞ 3.0 mg/L were mainly distributed in Xieji and Wanfeng towns of Juye County,Jishan town of Juancheng County,Sunlaojia town of Caoxian and Dusi town of Mudan County.The internal verification results showed that the sensitivity,specificity and overall accuracy rate of IDW used for predicting water fluoride content was 100.00％ (129/129),10.00％ (1/10) and 93.53％ (130/139),respectively.While the external verification results showed that the sensitivity,specificity and overall accuracy rate of IDW for predicting water fluoride content was 100.00％(31/31),11.11％(1/9) and 80.00％(32/40),respectively.Conclusion With the application of IDW interpolation,it is feasible to infer the overall spatial distribution based on the monitoring data,and to reveal the spatial characteristics of water fluoride in Heze City,Shandong Province.

Objective To evaluate the surgical treatment of the acute posterolateral complex(PLC)injuries of knee joint and then observe the clinical outcome.Methods Twelve cases(12 knees)of acute PLC injuries were treated from May 2006 to October 2008.Patients' age ranged from 23 to 47 years old,average 31 years.There were 9 males and 3 females.Rebuild the anterior cruciate ligament(ACL)and posterior cruciate ligament(PCL)under arthroscope and then,locally suture the PLC injuries sites on those patients with PLC avulsion fraction.If there is PLC rupture,then locally suture the injury sites plus PLC reconstruction.Knee functions were evaluated by IKDC and Lysholm score.Results All patients were followed up for 12-18 months(mean,13.3 months).The preoperative range of motion was 118.00°±6.77°,which was 130.75°±3.05° after surgery.KT-1000 arthrometer measurement showed that the average posterior translation improved from(14.85+1.83)mm preoperatively to(4.18±1.88)mm postoperatively.Seven cases were normal(A grade),3 cases were nearly normal(B grade),1 abnormal(C grade),and 1 severely abnormal(D grade)according to IKDC standard.The preoperative Lysholm joint function score was 35-44,average 38.83 ±3.16,which was 79-91,average 84.92±3.73 after surgery.Conclusion To those acute PLC injuries with avulsion at the ligament extremities,locally suture should be taken.But for those with PLC rupture at the mid part of ligament,locally suture the injury sites plus PLC reconstruction helps get satisfactory outcome.

Objective To explore the relationship between case mix index ( CMI ) and the bed allocation in clinical departments, and to evaluate the performance of bed scale of departments at tertiary hospitals based on CMI. Methods Based on the HIS system of a tertiary hospital, the authors collected the disease treatment information and bed allocation information of each clinical department in 2015. The CMI value was calculated by means of diagnosis-related group( DRG) , while the proportion of cases and average daily beds occupancy corresponding to the quartile of the CMI value of each department was also counted. Then the bed occupancy and distribution of various patients were analyzed. Results The hospital′s overall CMI value, DRG groups, DRG cases at the departments, days of stay, DRGs, CMI values and its quartiles were calculated. It was found that the medical and surgical CMIs had a linear relationship with the critical proportion (r=0. 998, 0. 996, P<0. 001). The main influencing factors of average daily bed occupancy were ranged from high to low as followed: the number of cases that were allocated in the group, employee numbers and CMI (F=87. 656, P<0. 001). Conclusions CMI is an ideal indicator for the difficulty of medical services at different departments and for evaluating the bed scale performance. Hence it can be used as an important reference for bed number adjustment in hospitals.

Objective To explore the influences of selenium,age,sex,education level,occupation and other factors on cognitive function in elderly of rural areas in Shandong Province.Methods Rural Chinese aged 65 years or older were sampled from Gaomi County and Zichuan County from 2006 to 2007 in Shandong,Province by cluster sampling method.Demographic characteristics were collected,and cognitive functions were surveyed using dementia community survey(CSID),including dementia test,CERAD word list learning,recall test,Indiana University (IU) story recall test and impact test on animals.The nail samples were collected and the selenium content was tested using 2,3-diamino-naphthalene fluorescence assay.The relationship between selenium and other related factors(age,sex,education level,occupation,et al) With cognitive function was analyzed.Results A total of 1 000 people aged 65 years or older were investigated.In which,457 were males,and 543 were females.Most elderly were farmers and illiteracy.The differences of CSID total scores and IU story recall scores between different selenium groups were statistically significant(F =2.56,9.18,P ＜ 0.05 or ＜ 0.01).Multiple linear regression model analysis showed,age,sex,education level,occupation,hypertension and nail selenium content had significant impact on CSID scores(t =-9.942,-6.848,5.391,2.276,-2.863,2.309,all P ＜ 0.05).Age,sex,education level,occupation and nail selenium content had significant impact on IU story recall test (t =-4.252,-2.021,8.203,2.528,4.490,all P ＜ 0.05).While age,sex,education level,occupation were main influence factors to animal fluency test(t =-7.951,-6.166,7.544,2.824,all P＜ 0.05).Conclusions Selenium is a protective factor for cognitive function of elderly in Shandong Province.Besides,age,sex and education level also have impact on cognitive ability of rural elderly.

Objective To study the prevalence of drinking water type of endemic fluorosis in Shandong Province,and to provide a scientific basis in making strategies for prevention and control of the disease.Methods Ten counties (cities,districts) were selected by random number table method to carry out the epidemiological study,and to study the progress and effect of water-improving and defluoridation projects.Three villages in each county (city,district) were chosen to determine fluoride content of drinking water and to check the prevalence of dental fluorosis of children 8 to 12 years old.Water fluoride content was determined with fluoride ion-selective electrode,and dental fluorosis was diagnosed by the Deans method.Results In the 10 counties (cities,districts),a total of 515 water-improving and defluoridation projects were built covering 3 207 fluorosis villages,and the waterimproving rate was 81.71％ (3 207/3 925).A total of 85 water-improving and defluoridation projects were investigated in the 10 counties (cities,districts),and all of the projects were operating normally.The number of projects that water fluoride concentration ≤ 1.20 mg/L was 51; the qualified rate of water fluoride concentration was 60.00％ (51/85),and the maximum value of water fluoride was 4.38 mg/L.A total of 29 villages that had waterimproving and defluoridation projects were investigated in the 10 counties (cities,districts),and the number of villages that mean of water fluoride ≤ 1.20 mg/L was 21,accounting for 72.41％ (21/29); ＞ 1.20 mg/L was 8,accounting for 27.59％ (8/29),and the maximum value of water fluoride was 4.02 mg/L.In the 21 qualified villages of water fluoride concentration,a total of 1 023 children aged 8 to 12 were examined; the positive rate of dental fluorosis was 38.12％ (390/1 023); dental fluorosis index was 0.67,and the prevalence of dental fluorosis was extremely low.In the 8 exceeding-standard villages of water fluoride content,a total of 449 children aged 8 to 12 were examined; the positive rate of dental fluorosis was 54.79％ (246/449); dental fluorosis index was 1.18,and the prevalence of dental fluorosis was mild.Conclusion In Shandong Province,the water fluoride content of waterimproving and defluoridation projects exceeds the national standard seriously,and the condition of children's dental fluorosis is still serious,and the measures of water-defluoridation should be further strengthened.

Objective To understand the status of endemic fluorosis in Shandong Province.Methods In accordance with the requirements of the National Surveillance Scheme of Drinking-Water-Type Endemic Fluorosis (Trial) and Shandong Provincial Surveillance Scheme of Drinking-Water-Type Endemic Fluorosis (Trial),ten counties (cities,districts) were chosen in the province,and ten water-improvement projects were selected in each county (city,district).The operating effect of water-improvement projects was investigated; one peripheral water sample of each project was collected,and water fluoride content was tested.Three epidemic villages were chosen as fixed monitoring villages in each county (city,district).In the villages that had changed water source,one peripheral water sample was collected; in unchanged water source villages,one water sample was collected following five different directions of the east,the west,the south,the north and the center of the water source location; and the water fluoride content was tested.All students aged 8 to 12 were checked for dental fluorosis in the monitoring villages.The fluoride content in drinking water was detected by fluoride ion selective electrode method,and dental fluorosis was diagnosed by Dean's method.Results ① In the 10 counties (cities,districts),a total of 85 water-improving projects were monitored,and all the projects were in normal operation; the water fluoride contents of 47 projects were qualified,and the qualified rate of water fluoride content was 55.29％(47/85),with the maximum of water fluoride content was 4.74 mg/L.② In the 30 fixed monitoring villages,27 monitored villages had water-improving projects; water fluoride contents of 19 villages were qualified,the qualified rate of water fluoride content was 70.37％ (19/27),with the maximum of water fluoride content was 4.77 mg/L.In the 3 monitored villages without water-improving projects,villages of mean water fluoride contents ≤ 1.20 mg/L and ＞ 1.20 mg/L were two and one,respectively,with the maximum of water fluoride content was 1.55 mg/L.③ In the 19 monitored villages with water-improving projects that in normal operating condition with qualified water fluoride content,the detected rates of dental fluorosis and the defect type of dental fluorosis among children aged 8 to 12 years old were 52.37％(508/970) and 6.39％(62/970),respectively,and the index of dental fluorosis was 1.02.In the 8 monitored villages with water-improving projects that in normal operating condition with water fluoride content that exceeded the national standard,the detected rates of dental fluorosis and the defect type of dental fluorosis were 62.39％ (297/476) and 8.82％ (42/476),respectively,and the index of dental fluorosis was 1.67.In the 3 monitored villages without water-improving projects,the detected rates of dental fluorosis and the defect type of dental fluorosis were 49.45％ (90/182) and 7.14％ (13/182),respectively,and the index of dental fluorosis was 1.25.Conclusions In Shandong Province,the water fluoride content of water-improving defluoridation projects exceeds the national standard seriously,and water quality of the projects still need to be further improved.The projects of water-improving defluoridation play a certain role in control of dental fluorosis condition,but the condition of children' s dental fluorosis is still very serious.So preventive and control measures for endemic fluorosis should be further strengthened.