BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.

Objective To investigate the significance of early blood lactic acid and lactic acid clearance in patients with post-cardiac arrest syndrome(PCAS).Methods 87 cases were divided into the survival group(26 cases) and the death group(61 cases).The clinical data of two groups were analyzed statistically.Results The 6h blood lactate (8.46 ± 2.37) mmoL/L,6h blood lactate clearance rate (34.53 ± 14.75) ％,the residual alkali (-3.08 ± 3.68) mmol/L,6h SevO2 (68.35 ± 6.33) ％,APACHE Ⅲ score (19.64 ± 2.48) points in the survival group were significantly better than those of the death group [blood lactic acid value (12.32 ± 3.56) mmol/L,6h blood lactate clearance rate (27.71 ± 11.38) ％,the residual alkali (-5.61 ± 4.14) mmol/L,6h SevO2 (63.22 ± 5.94) ％,APACHE Ⅲ score (24.32 ± 5.33) points],with significant differences between two groups (t =5.99,2.36,2.73,3.66,5.62,all P ＜ 0.05).The 6h blood lactate clearance rate,6h SevO2 and APACHE Ⅲ score were independent risk factors for the prognosis of PCAS (OR =1.23,1.64,1.28,all P ＜ 0.05).Conclusion The early blood lactate clearance rate can be used as a sensitive indicator for evaluating the prognosis of PCAS.

Objective: To evaluate therapeutic effect of aortic endovascular stent-graft exclusion (EVGE) combined percutaneous coronary intervention (PCI) on patients with descending thoracic aortic dissection (DTAD) complicated coronary heart disease (CHD).Methods: A total of 58 DTAD + CHD patients undergoing aortic EVGE combined PCI were regarded as EVGE group (received aortic EVGE at first, then PCI on 3d after operation).Another 60 DTAD+CHD patients undergoing open surgery combined PCI in our hospital were selected as open surgery group.Both groups were observed and followed up, and their therapeutic effects were compared.Results: Compared with open surgery group, there was significant rise in complete cut closure rate (78.33% vs.91.38%), and significant reductions in bleeding volume during operation [(919.83±242.12) ml vs.(58.17±9.53) ml], postoperative infection rate (15.0% vs.3.4%) and hospital stay [(16.40±0.96)d vs.(9.10±0.83)d] in EVGE group, P<0.05 or <0.01.Success rate of PCI was 100% in EVGE group, and there was no PCI-related severe complications.During follow-up, coronary restenosis rate within 12 months in EVGE group was significantly lower than that of open surgery group (5.20% vs.15.30%, P=0.04).Conclusion:It is safe and possesses significant effective to treat descending thoracic aortic dissection complicated coronary heart disease using aortic endovascular stent-graft exclusion combined percutaneous coronary intervention, which is worth extending.

Radiotherapy and interventional thearapy are the main means for unresectable advanced primary hepatic carcinoma.However,the efficacies are restricted by their respective adaptability.The development of radiotherapy,especially the application of radiotherapy combined with transcatheter hepatic artery chemoembolization provide more suitable treatment means for patients.

Objective To investigate the relationship between serum surfactant protein-A (SP-A) and -D (SP-D) in patients with systemic lupus erythematosus (SLE) complicated with interstitial lung disease.(SLE-ILD) and its clinical significance.Methods Serum SP-A and SP-D levels of SLE patients and controis were assessed using a sensitive enzyme-linked immunosorbent assay (ELISA).The relationship between SP-A and SP-D and SLE-ILD,the correlation between SP-A and SP-D with age,disease activity index,pulmonary function test and high-resolution computed tomography (HRCT) score were analyzed.Results The level of serum SP-A and SP-D in patients with SLE is higher than that in healthy controls(P＜0.05).The level of serum SP-A and SP-D in patients with SLE complicated with ILD was higher than that in patients without ILD and healthy controls (P＜0.05).The level of serum SP-D in patients with SLE-ILD was correlated positively with HRCT score (r=0.508,P=0.004) and interstitial score (r=0.468,P=0.009),and it correlated inversely with vital capacity (%VC) (r=-0.590,P=0.001 ) and diffusing capacity of carbon monoxide (%DLCO)(r=-0.588,P=0.001 ).There was no correlation between the level of serum SP-A with SLE-ILD and HRCT score,%VC and %DLCO.The level of serum SP-D in patients with SLE-ILD correlated positively with serum IgG (r=0.376,P=0.040),and the level of serum SP-A in patients with SLE-ILD correlated positively with serum C reactive protein (CRP)(r=0.403,P=0.027).There was a positive correlation between the level of serum SP-D in patients with SLE and age (r=0.352,P=O.001 ).Conclusion The levels of serum SP-A and SP-D may be useful markers for ILD in patients with SLE.There is correlation between the level of serum SPD and HRCT score,pulmonary function test,and it is positively correlated with age and disease activity index.

Portal vein tumor thrombus (PVTT) influence the prognosis of hepatocellular carcinoma.The development of PVTT is a multi-factor,multi-part process.According to anatomic features of the portal vein in the liver and tumor thrombus of HCC developing modes,a uniform tumor thrombus types system (typesⅠ -Ⅳ) is recommended.Multi-modal therapy based on surgery,interventional therapy and radiotherapy can improve the curative effect enormously.

Shortages in the fostering of medical humanistic spirits for students majoring medical science of law in medical colleges and universities were discussed from the perspectives of concept establishment,curriculum,clinical teaching and teaching staff.The fostering of medical humanistic spirits for students should be enhanced to achieve the balance between medical humanity and legal professionalism.

Objective To explore clinical effect of self-made traditional Chinese medicine for hand-foot-mouth disease.Methods 118 cases with hand-foot-mouth disease were randomly divided into two groups.The control group(n=59)were treated by regular western medicines.On that basis,the study group(n=59)were treated bys elf-made traditional Chinese medicine.And the curative effects of two groups were observed.Results Fever subsidise time of the study group after treatment was(2.0±0.7)d,which was significantly shorter than that of the control group,with P＜0.05.Rash subsidise time of the study group after treatment was(3.9±0.9)d,was significantly shorter than that of the control group,with P＜0.05.Length of hospital stay of the study group after treatment was(3.5±1.3)d,was significantly shorter than that of the control group,with P＜0.05.Total effective rate of the study group after treatment was 94.9％,which was significantly higher than that of the control group(81.4％),with P＜0.05.Conclusion Self-made traditional Chinese medicine for hand-foot-mouth disease has good clinical curative effect,has high security and reliability.

Objective To analyse the treatment,clinical features and prognosis of chronic lymphocytic thyroiditis combined with thyroid cancer.Methods Retrospectively analysed 40 cases with chronic lymphocytic thyroiditis combined with thyroid cancer,admitted to the Department of General Surgery of the First Affiliated Hospital of Dalian Medical University from November 2002 to April 2011.All the 40 patients were female.Results Ultrasound diagnosis or suspected diagnosis of chronic lymphocytic thyroiditis was made in 2 patients.Eleven patients underwent CT examination,and 2 patients were found with thyroid adenoma,1 patient found with thyroid cancer and lymph node metastasis,3 patients with chronic lymphocytic thyroiditis.Forty patients underwent surgical treatment,pathological results of 39 patients showed chronic lymphocytic thyroiditis with thyroid papillary carcinoma,1 patient was medullary thyroid carcinoma combined with chronic lymphocytic thyroiditis.Forty patients were administrated levothyroxine tablets.Thirty-six patients were followed up,4 patients were lost,1 relapsed,the others were in stable condition.Conclusions Preoperative diagnosis is difficult for chronic lymphocytic thyoiditis combined with thyroid cancer,which needs through the thyroid antibody tests,imaging examinations and intraoperative,postoperative pathologic examination and other means of comprehensive application.The method of definitive diagnosis for CLT combined with TC is intraoperative,postoperative pathologic diagnosis.The main pathological type is papillary thyroid carcinoma,which small papillary carcinoma occupies a large proportion.Surgery is the main treatment for CLT combined with TC.

Autonomic nerve dysfunction is common after onset of ischemic stroke.Heart rate variability (HRV) has been used widely because of the regulation effect of heart rate by the quantitative analysis of the autonomic nervous system.This article reviews the evaluation method of HRV and its clinical significance in ischemic stroke.