Objective To establish the finite element (FE) model of the anterior tibiofibular ligament injury by ankle fracture fixation, so as to compare the stress and deformation of the finite element model by using anchor-reinforced repair combined with screw fixation. Methods CT images of the ankle joint from a normal young male volunteer was selected to establish the FE model of the anterior tibiofibular joint injury by ankle fracture fixation. The injury models were divided into experimental group and control group, which were fixed by anchors or screws, respectively. The maximum stress distributions and the maximum deformation of the two models under various load conditions were observed through the FE analysis and calculation. Results Under the vertical load, the deformation of the experimental group was 6.8% higher than that of the control group. The deformation increased by 22.6% under external rotation load, while the deformation decreased by 5.1% under internal rotation load. Under the same load, differences in the maximum peak stress on the model between the control group and the experimental group was not significant. Due to the anchor fixation, the maximum stress of the experimental group were borne by the screw that fixed the distal tibial fracture, while the maximum stress of the control group was borne by strong fixation of the steel plate and the inferior tibiofibular screw. The maximum stresses on the anchor were distributed on the screw, and the suture mainly played the role of fixing. Conclusions The lower tibiofibular screw and anchor fixation could effectively treat the tibiofibular instability left by ankle fracture fixation. The anchor fixation dispersed the stress on the steel plate, and it showed greater ankle joint deformation ability while fixing the lower tibiofibula, so as to avoid the risk of broken nails.

Based upon the measure of depression as defined by Hamilton depression scale (HAMD)scores ＞ 17,120 patients with chronic obstructive pulmonary disease (COPD) were classified into 2 groups:COPD patients with or without depression.According to the mini-mental state examination (MMSE),the cognitive functions of all patients were evaluated.Meanwhile,oxygen saturation and pulmonary function were measured by blood gas analyzer and spirometer respectively.Fifty-four COPD patients were complicated with depression.HAMD scores were significantly negatively correlated with oxygen saturation and pulmonary function (P ＜0.05).Multiple regression analysis revealed that gender,oxygen saturation and MMSE scores were risk factors of depression (P ＜ 0.05).MMSE scores decreased more obviously in the COPD patients with depression and were positively correlated with oxygen saturation (P ＜ 0.01).A negative correlation existed between MMSE scores and HAMD scores (r =-0.549,P ＜ 0.05).

Objective To investigate the influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in 6-minute walk test (6MWT).Methods One hundred and twenty COPD patients,whose acute exacerbation was controlled,were enrolled in the study from September 2009 to April 2011.According to Hamilton depression scale (HAMD) scores,48 patients with HAMD scores ＜ 7 were classified as non-depression group (control),60 patients with HAMD scores ≥17 were classified as depression group,patients with 7 ≤ HAMD scores ＜ 17 were classified as uncertain depression and not included in the experiment.Six-minute walk testing was performed in patients.Blood pressure,heart rates,respiratory rates,Borg scores were measured before and after 6MWT; body mass index and lung function were also measured in all patients.Results The distances of walk in the depression group and control group were (259 ±91) and (312 ±71) meters,respectively (P ＜0.05).Heart rates,svstolic blood pressure,respiratory rates and Borg index in depression group after testing were (108± 11)/min,(148.7 ± 15.4) mm Hg(1 mm Hg =0.133 kPa),(23.3 ±3.9) /min and (4.65 ± 1.67),respectively;those for control group were (95 ±9) /min,(141.8±8.9) mm Hg,(20.2 ±3.7) /min and (2.59±1.52),respectively.There were significant differences between two groups (all P ＜ 0.05).Conclusions Depression may affect the exercise capacity of COPD patients,the psychological status of the patients should be under consideration when conventional treatment is taken.

Objective To investigate the effects of salmeterol/fluticasone (seretide) combined with community intervention on lung function and quality of life of chronic obstruetive pulmonary disease (COPD) patients in the stable period.Methods 96 cases with COPD in the stable period were divided into two groups randomly:Group A was treated only by seretide for six months,group B was treated by seretide combined with community intervention (health education,psychological intervention,exercise training,and nutritional guidance).6 months later,the lung function was determined and the quality of life was assessed by SGRQ.Results The lung function and the score of the quality of life in two groups after treatment [Group A:(1.78 ±0.16)L,(65 ±9)％ and 40 ± 18,36 ± 16,125 ±40;group B:(2.05 ±0.28)L,(73 ±9)％ and 21 ± 10,20 ± 11,58 ± 28,respectively] were improved than those before treatment [Group A:(1.59 ±0.15),(58 ±7) and 63 ±22,50 ±24,167 ±68;group B:(1.61 ±0.14)L,(58 ± 8)％ and 62 ±22,48 ± 22,163 ± 67,respectively] (P ＜ 0.05 );The lung function and the score of the quality of life in B group were improved than those in A group after treatment ( P ＜ 0.05 ).Conclusions Using community intervention combined with seretide in treatment of COPD patients has better effect than the single use of seretide therapy,it improves lung function and quality of life.It is a safe treatment method and worthy to spread widely.

Objective To study the application of accreditation standards for trainers of general practitioners (GPs) in community health centers.Methods The questionnaire was designed according to the accreditation standards for GP trainers in community health centers,which involved professional quality,clinical competence in primary care and teaching abilities.According to typical sampling,583 trainers from 56 community teaching bases in Shanghai were selected for the survey.Results Among 583 participants,the effective respondents were 505 with a response rate of 86.6％.The professional quality was highly recognized by the participants,and more than 80％ of trainers met the requirement.For the ability of primary care,81.4％ (411/505),79.8 ％ (403/505) and 69.5 ％ (351/505) of participants were well qualified with the abilities of management for hypertension,type 2 diabetes and coronary heart disease,respectively,while only about 40％ had abilities of management for epilepsy,hypothyroidism and chronic mental diseases.75.4％ (381/505) participants fully mastered the principle of first aid skills and CPR,while only 24.8％ (125/505) had abilities of management for conjunctival foreign body and nasal foreign body,34.5％ (174/505) had the abilities of debridement and gastrolavage.For the index of teaching abilities,most trainers had insufficient teaching capacity and experience in the community.Only 48.5％ (245/505) and 40.2％ (203/505) of trainers were familiar with the teaching methods of cased-based learning and problem-based learning,respectively.Significant difference was found in the scores of teaching abilities among trainers from community health centers in different locations (P ＜ 0.05),such as using appropriate teaching methods (F =3.45,P =0.033),monthly assessment and feedback to students (F =5.14,P =0.006) and ensure at least 4 hours of teaching time every week(F =4.96,P =0.007).No significant differences were found in the scores of professional quality and clinical competences in primary care (P ＞ 0.5).Conclusion The trainers of general practitioners in community health centers meet the requirement of accreditation standards in the aspects of professional quality and clinical competences in primary care,while the teaching abilities remained to be improved and should be strengthened in the future.

Objective To investigate the influence of nasal continuous positive airway pressure (nCPAP) treatment on cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea Syndrome (OSAHS). Methods Thirty-one patients with newly diagnosed OSAHS were divided into 3 groups based on the status of nC-PAP treatment: group 1,10 patients with nCPAP > 4 hrs/night;group 2:9 patients with nCPAP < 4 hrs/night;group 3:12 patients without nCPAP treatment. Serum cardiovascular risk factors (i. e. ,C-reactive protein(CRP), total cholesterol, triglycerides, highdensity lipaprntein cholesterol (HDL-C), low-density lipoprotein cholesterol, apo-lipoprotein A-I (ApoA-1), and apolipoprotein B (ApoB) ) were measured at baseline and 6 months after nCPAP treatment. Results ① There was no significant difference on age,body mass index,blcod pressure,Epworth sleepi-ness scale (ESS) and saturation of blood oxygen (SPO_2) between the 3 groups (P>0.05). ②In group 1, ESS, SPO_2 minimum SPO_2 were significantly improved (3.20±2.80,93.80±2.01 and 84.10±6.17, respectively) compared to baseline (13.30±5.20,88.60±4.14 and 69.60±11.80, respectively) (P<0.01). Moreover, in group 2, there were significant improvement on ESS, SPO_2 and minimum SPO2 (4.95±2.67,94.20±1.46 and 85.20±4.97, respectively) compared to baseline (12.80±5.50,89.10±5.11 and 73.70±12.50, respectively) (P<0.01). ③In group 1 ,significant decreases in the levels of CRP,total cholesterol was observed (P=0.021 and 0.038). ④In group 2, group 3 there were slightly decrease of CRP after treatment, but the difference did not reach statistieal significance. Conclusions Good compliance to nCPAP treatment decreases the serum levels of cardiovas-cular risk factors, indicating a beneficial effect on the overall cardiovascular disease prevention and control.

Objective To explore the optimum sentinel lymph node (SLN) mapping method in gastric cancer. Methods The clinical data of 59 patients who were confirmed with gastric cancer at Guangzhou General Hospital of Guangzhou Military Command from January 2004 to August 2008 were retrospectively analysed. Patent blue V dye was used in 20 patients (group A), technetium-99m sulfur colloid was used in 20 patients (group B),and a combination of patent blue V dye and technetium-99m sulfur colloid were used in 19 patients (group C).The number of SLNs detected, and accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were analysed by t test and chi-square test. Results The numbers of SLNs detected in groups A, B and C were 38 (1.9 per case), 31 (1.6 per case) and 56 (2.9 per case), respectively. In group C, 46 SLNs were screened out by patent blue V dye and technetium-99m sulfur colloid simultaneously, six SLNs were only detected by patent blue V dye and four only by technetium-99m sulfur colloid. There was a significant difference in the number of SLNs detected among the three groups (t = 4.35, P ＜ 0. 05 ). The number of SLNs detected in group C was significantly greater than that in groups A and B (t = 4. 21, 3. 54, P ＜ 0.05 ). The accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were 95% (19/20) and 5% (1/20) in group A, 90% (18/20) and 10% (2/20) in group B, and 100% (19/19) and 0 in group C. The accuracy was significantly higher (x2 = 163.01, P ＜ 0.05) and the false-negative rate was significantly lower in group C compared with those in groups A and B (x2 = 170. 14, P ＜ 0. 05). Conclusion A combination of dye and radioactive tracer is a favorable method for detecting SLNs in gastric cancer.

A total of 185 hospitalized patients with chronic obstructive pulmonary disease (COPD) were recruited.And the questionnaire of COPD Assessment Test (CAT) was used to evaluate the CAT scores and Hamihon Depression Scale to evaluate HAMD scores.Lung function,body mass index,smoking and medication were measured and recorded in details.According to the HAMD scores,65 cases had depression and 120 cases no depression.Comparing with the no-depression group,the results show that HAMD and CAT scores were higher significantly in the depression group and there was a lower proportion of long-term domiciliary oxygen therapy.According to the logistic regression analysis,the CAT scores were associated with global initiative for chronic obstructive lung disease (GOLD) stages Ⅳ and HAMD scores.These results suggest that poor lung function and depression affect greatly the quality of life for stable COPD patients.

From August, 1984 to February, 1985, We kept a synchronous observation of 92mothers and their babies on the relationship of iron status between them. The 92 pregnantwomen, of whom the gestational periods were not longer than 36 weeks, were divided rando-mly into wo groups: a medication group and a control group. For all, Hb, Hct, FEPand SF were tested. In the 4th week after labor, Hb, Hct and SF of the mothers ofthe medication group were higher than that of the control group (P

Objective To investigate the clinical characteristics of bloodstream infections in obstetric patients and analyze the distribution and antimicrobial susceptibility of the pathogenic organisms. Methods The clinical data of bloodstream infections in obstetric patients treated in the Third Affiliated Hospital of Guangzhou Medical University from December 2014 to December 2017 were studied retrospectively. Results A total of 111 cases were identified, including 31(27.9％)during pregnancy and 80(72.1％)after delivery. Most(79.3％, 88/111)of these patients had obstetric disease or complication, and urinary, abdominal or intrauterine infection was found in 15(13.5％)cases. All patients had fever, and 7 cases showed septic shock. After treatment, 109(98.2％)patients were cured, despite infectious abortions in 6 cases. A total of 118 isolates were collected, including 31(26.3％)from pregnant women and 87(73.7％)isolates from puerperants. Gram-negative organisms, gram-positive organisms and Candia accounted for 58.5％, 39.0％, and 2.5％, respectively. The most common pathogens identified were Escherichia coli(44.1％), Enterococcus spp.(22.0％), and Staphylococcus spp.(5.1％). The prevalence of ESBLs-producing strains was 62.5％ in E. coli. All the E. coli strains were susceptible to piperacillin-tazobactam, imipenem, and tigecycline. No Enterococcus isolates were resistant to vancomycin or tigecycline. About 88.5％ of the Enterococcus strains were susceptible to ampicillin. Conclusions Bloodstream infection in obstetric patients usually occurs after delivery, probably resulting in septic shock or infectious abortion. The main pathogens are gram-negative bacteria and Enterococcus spp. The prevalence of ESBLs-producing strains was high in E. coli. Most of the Enterococcus strains were susceptible to ampicillin.