Objective To compare the clinical effects of closed reduction and intramedullary nailing versus open reduction and plate fixation in the treatment of displaced midshaft clavicular fractures.Methods A prospective,randomized,controlled trial was performed between July 2012 and May 2014 in 194 patients with acute displaced midshaft clavicular fracture.They were 136 males and 58 females,from 16 to 65 years of age.They were randomly divided into 2 groups to received either closed reduction and intramedullary nailing (n =98) or open reduction and plate fixation (n =96).We recorded operation time,intraoperative blood loss,hospitalization expenses,fracture healing time and complication rate.Functional assessments were conducted at 3,6 and 12 months using the Disabilities of the Arm,Shoulder and Hand (DASH) and Constant-Murley scores.The preoperative general data showed no statistical significance between the 2 groups (P ＞ O.05).Results All the 194 patients were followed up for 12 to 27 months (average,15.6 ±3.1 months).The operation time (27.7 ± 16.3 min),intraoperative blood loss (18.6 ± 14.4 mL),hospitalization expenses (12,462.0 ±3,263.4 yuan),and fracture healing time (12.1 ± 3.0 weeks) in the intramedullary nailing group were significantly better than those(62.3 ± 19.4 min,40.3 ± 17.4 mL,24,760.0 ± 3,320.4 yuan,and 16.9 ± 2.8 weeks) in the plate fixation group (P ＜ 0.05).At 3 months after surgery,the DASH (13.4 ± 3.5) and Constant-Murley (88.5 ±5.9) scores in the plate fixation group were significantly better than those (24.8 ± 6.7 and 69.1 ± 6.2,respectively) in the intramedullary nailing group (P ＜ 0.05).At 6 and 12 months after surgery,there were no significant differences in the Constant-Murley scores or DASH scores between the 2 groups (P ＞ 0.05).The complication rate in the intramedullary nailing group (25.5％,25/98) was significantly higher than in the plate fixation group (9.4％,9/96) (P ＜ 0.05).Conclusions In the treatment of displaced midshaft clavicular fractures,compared with open reduction and plate fixation,closed reduction and intramedullary nailing has advantages of less invasion,lower cost and faster fracture healing,but a disadvantage of higher complication rate.The 2 treatments may lead to similar functional recovery of the shoulder.

Objective To investigate the existence of genetic divergence of sympatric populations of Anopheles sinensis of different feeding preferences based on the rDNA-ITS2 sequence differences. Methods A large number of wild anopheles popu-lations were trapped all night by man-baited net and calf-baited net that had been set up between high-density natural villages of An. sinensis populations and vector-breeding sites,from which two groups of An. sinensis were separated by morphological iden-tification and brought back to the lab for conventional breeding. A large closed greenhouse which temperature and humidity was appropriate was selected as research settings of mark-release-recapture methods by female mosquitoes ,in the center of which above An. sinensis populations baited by man and calf and respectively correspondingly marked by red and yellow phosphors were released in together,in each side of which An. sinensis were recaptured simultaneously by man-baited net and calf-baited net. An. sinensis populations trapped by man twice were brought back to the lab and bred with man-blood,correspondingly ones trapped by calf with calf-blood. Man-preferring and calf-preferring strains were screened respectively from An. sinensis which had been baited by man and calf by the mark-release-recapture methods after parent and F1 mosquitoes,and sequencing and aligning of both rDNA-ITS2 were conducted via PCR amplification. Results The recapture ratios of wild parental mosquitoes An. sinensis of man-preferring group by man-baited net and calf-baited net were 54.07%(339/627)and 45.93%(288/627)re-spectively,and ones of calf-preferring group by man-baited net and calf-baited net were 58.01%(409/705)and 41.99%(296/705)respectively. Two groups of parental mosquitoes trended towards selecting the original blood hosts in host-seeking prefer-ence(χ2=19.42,P<0.01). The recapture ratios of F1 mosquitoes An. sinensis of man-preferring group by man-baited net and calf-baited net were 63.43%(765/1 206)and 36.57%(441/1 206),and ones of calf-preferring group by man-baited net and calf-baited net were 68.22%(1 039/1 523)and 31.78%(484/1 523). Two groups of F1 mosquitoes had more significant characteris-tics of selecting the original blood hosts in host-seeking preference(χ2=271.69,P<0.01)and showed the genetic differentia-tion phenomenon,but the results of sequencing and aligning of the rDNA-ITS2 via PCR amplification showed no difference in base sequence between the two strains and both were 469 bp. Conclusions The genetic divergence based on the rDNA-ITS2 se-quence does not happen in An. sinensis sympatric populations of different feeding preferences.

This is a work aimed to investigate the efficacy and safety of the combination of metformin with glargine or with neutral protamine Hagedorn in treatment of type 2 diabetes mellitus. Sixty such patients with poor glycemic control by oral antidiabetic drugs were included and divided into group A and group B. Thirty patients in group A were treated with glargine and metformin, and the other 30 patients in group B were treated with neutral protamine Hagedorn and metformin for 12 weeks. Fasting plasma glucose (FPG), postprandial glucose(PPG) and HbA1c were measured before and after the treatment. Hypoglycemia was also noted. At the end of the study, the levels of FPG, PPG and HbAlc were significantly lower than the baseline levels in the two groups (P < 0.05). At the 12th week, the percentage of HbAlc < 7% in group A was 53.3% and that in group B was 40.0%; statistically, there was no significant difference (P > 0.05). After the end of the treatment, there was no significant difference in that the percentage of HbA1c < 7% was 70.6% in group A and 62.5% in group B; the two groups' HbA1c levels were > or = 7%-9% at the baseline (P > 0.05). No sigificant difference in respect to the incidence rate of hypoglycemia in the two groups was noted (P > 0.05). In the cases of type 2 diabetes mellitus with poor glycaemic control by oral antidiabetic drug, glucose and HbA1c can be lowered further by the combination of metformin with glargine or with neutral protamine Hagedorn, the incidence rate of hypoglycemia is low. Metformin plus glargine or plus neutral protamine Hagedorn is a safe and effective therapeutic choice for type 2 diabetes mellitus cases with poor glycaemic control; moreover, metformin plus neutral protamine is a cheaper and effective choice.
Aged ; Diabetes Mellitus, Type 2 ; drug therapy ; Drug Therapy, Combination ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; adverse effects ; Insulin Glargine ; Insulin, Isophane ; administration & dosage ; adverse effects ; Insulin, Long-Acting ; administration & dosage ; adverse effects ; Male ; Metformin ; administration & dosage ; adverse effects ; Middle Aged