Objective To observe the effect and its factors of open reduction and internal fixation of calcaneal fractures,and the influencing factors.Methods A retrospective analysis of 116 cases of calcaneal fracture were made.All patients were treated with open reduction and internal fixation,the effect was evaluated by Maryland foot score.The relation of the data before surgery (sex,age,cause of injury,associated injuries,injury and surgery,frac-tures sanders classification,opening and closing,diabetes,smoking history)and the effect,the surgical data (graft case,fixation,fractures,postoperative Bohler angle)and the effect were analyzed.The independent factors of the effect were analyzed by Logistic regression analysis.Results 116 patients with calcaneal fracture had been followed up for 6 -12 months,the excellent -good rate of Maryland foot score was 74.14%.Univariate analysis showed that different types of fractures,open and closed,with or without diabetes,with or without a history of smoking,different fixation methods,different fractures,patients with different postoperative Bohler angle foot function excellent rate differences were statistically significant (χ2 =17.194,4.077,6.766,9.116,5.136,6.919,4.458,all P <0.05).Logistic regres-sion analysis showed that the type of fracture,fixation,fractures,postoperative Bohler angle were independent risk factors for foot function excellent rate(OR =0.052,0.048,0.056,0.386,all P <0.05).Conclusion It has exact efficacy for open reduction and internal fixation with calcaneal fractures,the fracture type,fixation,fractures,postoper-ative Bohler angle are independent risk factors for affecting the calcaneal fractures patients.Perioperative treatment should take appropriate measures to avoid adverse factors affecting the efficacy of improved clinical efficacy.

[Objective] To investigate the surgical method of transforminal lumbar interbody fusion(TLIF)technique in treatment of upper lumbar intervertebral disc herniation.[Methods]From January 2002 to December 2006,a retrospective analysis on TLIF surgery treatment of 45 patients with upper lumbar intervertebral disc herniation were carried out and they acquired 12~24 months(mean,15 months)follow up.There were 29 males,and 16 females aging from 30~55 years(mean,39.2 years).Eleven intervertebral spaces were T12-L1 hernination,25 intervertebral spaces were L1、2 hernination,and 18 intervertebral spaces were L2、3 hernination of the space.Nine were double disc herniation.All cases were treated with TLIF technique.A retrospective analysis on surgical therapeutic effect was made.[Results]Five patients developed complications after operation and recovered by symptomatic treatment.Patients moved around in 2~3 d after surgery.Oswestry score improved from(52.32 ?9.17)to(20.33 ?5.72)in an average 15-months follow-up.X-ray showed that all cases had bone graft fusion and no adjacent segment degeneration occurred.[Conclusion]TLIF technique is an effective method in treatment of upper lumbar intervertebral disc herniation.It can offer satisfactory clinical effects.

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function (RRF) in patients on continuous ambulatory peritoneal dialysis (CAPD).Methods Fifty patients on CAPD from our department were enrolled in the study.Eight patients with residual urine volume ≤ 100 ml/d and 42 patients with residual urine volume ＞ 100 ml/d were enrolled into anuria group and non-anuric group respectively.The clinical and laboratory status of each group were compared and equations (Hoek' s,Yang' s and abbreviated MDRD equations) were validated in the non -anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF.Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46± 1.15) mg/L,t =2.39,P =0.02)].(2) RRF estimated by each equation was correlated well with measured RRF (r =0.56,0.56 and 0.39,all P ＜ 0.05).(3) Yang' s equation [0.10 ml· min1· (1.73 m2)-1]was least biased,followed by Hoek' s equation [-0.73 ml· min-1 · (1.73 m2) 1] and abbreviated MDRD equation [3.15 ml· min-1 · (1.73 m2)-1].(4) The precision of Yang' s equation was equivalent to that of Hoek' s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml· min-1 · (1.73 m2)-1].(5) 50％ accuracy according to Yang' s equation and Hoek' s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5％ and 54.8％ vs 23.8％,respectively,all P ＜ 0.01).Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias,precision and 50％ accuracy.For patients undergoing CAPD,the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.

BACKGROUND:Anterior cervical discectomy and fusion surgery is a good choice for repair of degenerative cervical disc herniation, but it is reported that fusion can affect the exercise of cervical neighboring stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration.
These two methods which applied in cervical degenerative intervertebral disc herniation stil remain controversial. OBJECTIVE:To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS:Total y 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month fol ow-up were included and retrospectively analyzed. These patients were divided into replacement group (n=21) and fusion group (n=27) according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or al ogeneic fibularing. They were fol owed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the fol ow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association (JOA) score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION:During the final fol ow-up, the fusion rate in fusion group was 93%(25/27). Comparisons between groups:at the 1 week and final fol ow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were al lower than those before treatment;the Japanese Orthopaedic Association scores were higher than those before treatment (P<0.05). In the final fol ow-up, the visual analog scale scores of neck and upper limbs and cervical dysfunction index were al lower than those after one week of treatment, and the Japanese Orthopaedic Association scores were higher than those after one week of treatment (P<0.05). There were no significant differences in the above indicators at each time point between these two groups (P>0.05). The cervical activity and surgical segmental motion after cervical disc replacement were significantly higher than those in the fusion group;the difference was statistical y significant (P<0.05). There were no serious complications in these two groups. There was no significant difference in the incidence of complications between these two groups (P>0.05). These results suggest that the artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single cervical disc herniation have the same effect in terms of patients’ symptoms mitigation. With respect to fusion technique, artificial disc replacement surgery has the advantage of maintaining cervical stability and activities of replacement segments.

Objective To analyze the space-time characteristics of hand-foot-mouth disease (HFMD) in Shijiazhuang by using geographic information system (GIS).Methods The data of HFMD during 2009 to 2011 in Shijiazhuang were collected and GIS database was created.Special map was drawn by PHGIS software to analyze the space-time characteristics of HFMD in Shijiazhuang.Results The epidemic situation of HFMD in Shijiazhuang appeared sporadic with local centralization.The attack ranked alternately rise year after year and high epidemic areas were geographically complimentary.Overall epidemic levels tend dropping from 2009 to 2011 and there were differences among areas.The high-attack areas of HFMD changed over time.Conclusions GIS can provide direct-viewing of the space-time characteristics of HFMD and further understand the prevalence of HFMD,which could help to provide the scientific basis of HFMD control in Shijiazhuang.

External quality assessments play important roles in quality improvement in clinical laboratories, but most laboratories focused on the unsatisfied data only.With appropriate quality controls, laboratories can detect not only the error sourses of unsatisfied data but the potential error sourse of satisfied data as well.

Objective To investigate the feasibility and therapeutic effect of stenting therapy by using modified Y-shaped self-expandable metal stent for the stenosis of gastroenteric stoma. Methods According to the particular anatomic structures and the pathological features of the narrowed gastroenteric stoma,the authors designed a modified Y-shaped self-expandable metal stent. Under the fluoroscopic guidance,implantation of modified Y-shaped self-expandable metal stent was performed in 5 patients with narrowed gastroenteric stoma. The technical safety and the clinical results were evaluated. Results The modified Y-shaped self-expandable metal stent was successfully implanted with one procedure in all five patients. After the implantation the symptoms such as nausea,vomiting,abdominal distension were promptly relieved,and the patients' living quality was markedly improved. Conclusion The stenting therapy with modified Y-shaped self-expandable metal stent can rapidly relieve the stenosis of gastroenteric stoma once for all. The technique is feasible and the short-term effect is reliable,therefore,it is worth popularizing this therapy in clinical practice.

Objective To investigate the optimal window width and window level for measuring the airway dimensions with spiral CT scan in Japanese white big-ear rabbits so as to lay the foundation for airway stenting in animal experiments. Methods Multi-slice spiral CT scanning of cervico-thoracic region was performed in 30 healthy adult Japanese white big-ear rabbits, the anteroposterior and transversal diameter of the thoracic trachea, the anteroposterior diameter of the right and left bronchus were measured with lung window, mediastinum window and special fat window separately. The revealing rate of the tracheal wall and the measuring results in different windows and levels were recorded and compared with the anatomical data. The differences of the relevant data were statistically analyzed. Results With lung window, the tracheal wall was well demonstrated, but the relevant data were smaller than that with mediastinum window. With mediastinum window, the data were bigger and the tracheal wall border appeared blurred. The results obtained with fat window were close to the actual anatomical data. Conclusion For accurately measuring the anteroposterior and transversal diameter of the thoracic trachea in Japanese white big-ear rabbits with multi-slice spiral CT scan, fat window should be adopted, which is helpful for the preparation of tracheal and bronchial stents.

BACKGROUND: At present, treatment of diabetes mellitus with western medicine starts from the angle of stimulating injured β cell of islet to strength insulin secreting. Treatment with traditional Chinese medicine is very important in protecting injured β cells.OBJECTIVE: To observe the protective effect of lycium barbarum polysaccharide and nourishing yin and activating blood compound recipe on pancreatic islet function in rats with streptozotocin-induced diabetes mellitus.DESIGN: A randomized and controlled animal experiments.SETTING: First Affiliated Hospital and Medical College of Henan University of Science and Technology.MATERIALS: Totally 70 male Wistar rats, aged 6 weeks, with body mass of 200 g, were used in this experiment.METHODS: This experiment was carried out at the Animal Room of Henan University of Science and Technology from October 2001 to April 2002. Totally 70 rats were divided into two groups: normal control group (n=10) and modeling group (n=60). Totally 30 successful model rats were randomly subdivided into 3 groups: streptozotocin model group, compound recipe treated group and lycium barbarum polysaccharide-treated group,with 10 rats in each group ;Intragastric administration of 60 g/kg Chinese herb compound recipe for nourishing yin and activating blood was performed on the rats in the compound recipe treated group at 9:00 every day (huangqi, shanyao, gegen respectively 30 g, gouqizi, danshen, huafen,digupi respectively 15 g, danggui, zhimu respectively 12 g, danpi, wuweizi respectively 10 g, shuizhi 5 g, shanyurou 20 g, etc, provided by drug store of First Hospital Affiliated to Henan University of Science and Technology,were decocted and condensed to be equivalent crude drug 3.0 kg/L with routine method). Intragastric administration of 0.5 g/kg lycium barbarum polysaccharide was given in the lyciun barbarum polysaccharide treated group (lycium barbarum polysaccharide was isolated and purified from ningxia barbary wolfberry fruit). Intragastric administration of comparative volume of normal saline was performed in the streptozotocin model group and normal control group, totally 3 weeks. The levels of fasting blood glucose (FBG) and insulin were measured at 3 weeks before and after experiment, and function index of β cell of islet was calculated; Pancreas was taken out to detect SOD activity, NOS activity and concentrations of NO and MDA were also detected.RESULTS: Ten rats in normal control group and 30 successful model rats in model group entered the stage of result analysis. ① In the initial stage of experiment, FBG level in each modeling group was significantly increased (t=16.51 to 10.07,P ＜ 0.01), while fasting insulin level and function index of β cell were significantly decreased (t=13.64 to 100.99 ,P ＜ 0.01 ) in comparison with normal control group. ② At 3 weeks after experiment, levels of FBG, NO , MDA , NOS activity were significantly decreased in the compound recipe treated group and lycium barbarum polysaccharide group compared with streptozotocin model group (t=8.08 to 72.68 ,P ＜ 0.01 ), while level of fasting insulin and function index of β cell, SOD activity were significantly increased in the compound recipe treated group and lycium barbarum polysaccharide group compared with streptozotocin model group (t=4.39 to 17.87,P ＜ 0.05-0.01 ). ③ Levels of FBG and MDA , NOS activity and concentration of NO were significantly decreased in the compound recipe treated group, and fasting insulin and function index of βcells were significantly increased in comparison with lycium barbarum polysaccharide group(P ＜ 0.01 ).CONCLUSION: Lycium barbarum polysaccharide and nourishing yin and activating blood compound recipe increase the level of fasting insulin and function index of βcell of rats with streptozotocin induced diabetes mellitus, decrease the level of blood glucose, improve the function of βcell of islet, which might be related to the increase of pancreatic islet SOD activity and decrease NOS activity.

Objective To compare the estimated CFR (eCFR) values using the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation with those from the abbreviated MDRD equation in a Chinese cohort with chronic kidney disease (CKD) and to analyze the impact of the new CKD-EPI equation on the staging of CKD. Methods A total of 450 Chinese patients (239 female and 211 male) with CKD were enrolled. eCFRs obtained by the CKD-EPI equation and the abbreviated MDRD equation were compared with the Bland and Altaian method. The agreement between two equations in CKD staging was assessed by Kappa test. Results Mean eGFR was 2.4 ml ·(min)-1 ·( 1.73 m2)-1 higher with the CKD-EPI equation as compared to the abbreviated MDRD equation. The percentage of CKD staging concordance between equations for stage 1, 2, 3A, 3B, 4, and 5 was 97.10% (n=67), 80.77% (n=105), 6 0.86% (n= 48), 87.69%(n=57), 90.38% (n=47) and 98.18% (n=54) respectively. Kappa index was 0.913 (95%C/: 0.881-0.945). The CKD-EPI equation reclassified 19.23% (n=25) and 39.24% (n=31) of patients with CKD stage 2 and 3A,upward to a higher eCFR category. Conclusions The new CKD-EPI equation reclassifies a number of patients to higher CKD stages, especially those classified as CKD stage 2 or 3A by the abbreviated MDRD equation.