Objective To study and analyze the related factors of neonatal dopamine leakage in NICU and psychological intervention. Methods 100 cases of neonatal NICU patients who received intravenous infusion of dopamine in our hospital from February 2015 to October 2017 were selected and randomly divided into two groups,the control group and the experimental group,with 10 patients in each group.The patients in the control group were given routine nursing care,the patients in the experimental group were given comprehensive care and psychological intervention,and they paid attention to the psychological status of the patients,and carried out a comprehensive evaluation,and given positive care.The clinical indexes of the experimental group and the control group were compared and analyzed. Results After the corresponding nursing mode,10 cases in the control group were transfused 100 times,and 30 cases of secondary leakage occurred,accounting for 30.0%.In the experimental group,10 cases were transfused 100 times,and 16 cases of secondary leakage occurred,accounting for 16.0%.The probability of dopamine leakage in the control group was significantly higher than that in the experimental group,with statistical difference.In the experimental group,9 parents were satisfied with the nursing work,and the satisfaction rate was 90.0%.In contrast,42 parents were satisfied with the nursing work,and the satisfaction rate was 80.0%. The satisfaction degree of nursing in the experimental group was significantly higher than that in the control group,and the difference was statistically significant.Conclusion The application of psychological intervention in neonatal NICU intravenous infusion of dopamine and comprehensive care,can reduce the occurrence probability of leakage of dopamine in a large extent,improve nursing satisfaction,to build a harmonious doctor-patient relationship is further applied in clinical significance.

Objective To investigate the clinical characteristics and treatment of external auditory canal chol‐esteatoma (EACC) .Methods The clinical data of 38 cases(39 ears)with external auditory canal cholesteatoma from August 2006 to December 2014 were retrospectively analyzed .Results All the cases of EACC in this study had the external ear canal full of impacted squamous material or granulation tissue .The Holt and CT imaging examinations disclosed that 10 ears were phase I ,lesions were confined to the external auditory with no bone destruction .There were 23 ears were phase II ,the lesions were located in external auditory meatus with destruction of bone ,but with no involvement of the middle ear .There were 6 ears were phase III ,showing the lesions with disrupt external audi‐tory meatus and involvement of the middle ear ( mastoid and/or tympanic sinus) .Hearing impairment and aural fullness were the most common symptoms .The phase I cases were treated by removing cholesteatomas from the ex‐ternal auditory canal .Canaloplasty and/or tympanoplasty were performed in phase II cases .The phase III cases were successfully managed by modified radical mastoidectomy and/or tympanoplasty .There were 30 ears of tympan‐ic membrane were perfect and invaginate .There were 4 ears of ossicular chain were disrupted with one ear of facial nerve exposed .All surgeries were performed at once .No recurrence except in one patient was found during the fol‐low -up period .Conclusion The clinical stages can help identify the primary lesions and determine the choice of the best surgical approach .

Objective To establish a way to measure the injury severity of articular surface due to posterior malleolus fracture and investigate its clinical significance based on three-dimensional reconstruction technique.Methods Between May 2009 and March 2014,138 cases of peri-ankle injury combined with posterior malleolus fracture were treated.Lateral radiographs were reviewed to measure the ratio of posterior fragment area to distal tibial plafond area using the common method.Three-dimensional CT images were examined to measure ratio of the area of injury using the three-dimensional measuring method.Statistical comparison was made using the t-test and intraclass correlation coefficient (ICC).Results Measurement failed on 33 lateral radiographs and 13 three-dimensional CT images.Six cases cannot be measured by both imaging technology,so results of 98 cases were compared.Ratio of posterior fragment area to tibial plafond area was (16.2 ± 7.2) ％ measured by radiographs and was (29.6 ±10.1) ％ by three-dimensional CT scans (P ＜ 0.05).Three-dimensional CT measurements showed higher intra and inter-observer agreement (ICC of 0.973 to 0.942) than that in radiographic measurements (ICC of 0.875 to 0.860).Conclusion Three-dimension CT assessment of the extent of injury to articular surface because of posterior malleolus fracture is reliable and reproducible,but radiographic assessment may underestimate the injury and influence the choice of surgical indications.

Objective To understand the attitude and current situation of medical English stud y as well as its relevant factors among long schooling medical students so as to provide first hand information for constructing students-centered medical English teaching model. Methods A self-de-signed questionnaire including basic information of students, attitude and current situation of medical English students was given to 134 seven or eight year program clinical medical graduates from grade 2006 to grade 2008 in Tongji University. Questionnaires were collected timely and an-alyzed with SPSS 19.0 and results were described by percentage. Results Totally 132 copies of questionnaire were recovered with an recovering rate of 98.51%. 56.82%(75/132) students had interest in medical English study and 71.97%(95/132)students had a will to go abroad for learning exchange. Main pur-poses for students to learn medical English were ‘professional literature reading’(68.94%,91/132),‘SCI papers writing’(59.09%,78/132)and ‘international communication’(58.33%, 77/132). Main influencing factors of medical English study were ‘boring teaching methods ’ ( 45 . 45%, 60/132 ) ,‘difficult medical English’(41.67%,55/132) and ‘insufficient teaching time’(40.91%,54/132).Conclusions Medical students with long schooling have demand for medical English study;however, most of them have some difficulties in practical application. Measures should be taken from three as-pects including students, teachers and curriculum setting to improve students' medical English.

Objective To investigate the effect of sustentaculum tali screw placement on outcomes following open reduction and internal fixation (ORIF) of intraarticular calcaneal fractures.Methods A retrospective analysis was made on 139 patients with intraarticular calcaneal fractures treated by ORIF from April 2008 to January 2012.According to Sanders classification,there were 9 patients with type Ⅱ fractures,87 with type Ⅲ fractures and 43 with type Ⅳ fractures.Fracture reduction followed by placement of calcaneal anatomic plate or anatomic locking plate was performed via calcaneal lateral L-shape incision.All the patients received X-rays and CT scans within postoperative 2 weeks.Placement of screws in sustentaculum tail was detected by CT volume rendering to visualize implants combined with multiplanar reconstruction imaging (MPR).Patients were divided into accurate fixation group (Group A,n =28),marginal fixation group (Group B,n =58),and non-fixation group (Group C,n =53) based on radiological results.Intra-and peri-operative parameters,time to partial weight-bearing,time to full weight-bearing,fracture healing time,and clinical outcome were compared among groups.Functional outcome was assessed using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale.Results Postoperative X-rays indicated accurate fixation of sustentaculum tail in 64 patients,marginal fixation in 22,and non-fixation in 53,but CT images manifested accurate fixation in 28 patients,marginal fixation in 58,and non-fixation in 53.Group A had operation duration of (93 ±11) min and intraoperative blood loss of (252 ± 27) ml,longer or higher than those in Group B [(85 ±8) min,(194±16) ml] and Group C [(57±6) min,(136 ±13) ml] (P＜O.05).There was no significant difference in mean hospital stay among the three groups (P ＞ 0.05).Ninety-two patients were followed-up for 12-38 months (mean 18.5 months) and 85 patients completed foot and ankle exercise as planned.Moreover,no significant differences were observed among groups concerning time to partial and full weight-bearing,fracture healing time and AOFAS score at the final follow-up (P ＞ 0.05).Conclusion Sustentaculum tali screw placement has no apparent effect on the short-term outcome of surgical treatment for calcaneal fractures.

Objective To provide references for anatomical reduction and correct implantation in treatment of distal fibular fracture by analyzing morphological characteristics of distal fibula on three-dimensional (3D) modes.Methods 16-row spiral CT scans of 126 normal ankle structures from May 2009 to June 2014 were collected.Surface shaded display technique was used to reconstruct 3-D images of bones around the ankle.The distal fibula was extracted using 3D segmentation technique.The parameters of distal fibula were measured by selecting points,lines and surfaces on the 3D models.Results The morphological characteristics of distal fibula were complicated.Significant differences were observed between males and females in most parameters (P ＜ 0.05),but not in the length between the plane of the most lateral point of the tibial anterior node and the most distal point of the fibula,the length between the midpoint of lateral border of the fibula and its opposite cortex on the plane of the most proximal border of the fibular fossa or the mean angle of posterior crest of the fibula (P ＞ 0.05).The intra and interclass correlation coefficients (ICC) were excellent.Conclusions When a lateral plate is used for internal fixation of distal fibula,the plate should be placed as proximally as possible.When a posterior-lateral plate is used,the screws to be inserted on the plane proximal to the initial point of anterior node of the tibia can be fixed bi-cortically.When a posterior plate is used,pre-contour of the plate before insertion is required.

Objective To investigate the impact of pair box 3 (PAX3) gene mutations on transcriptional ac‐tivity of target gene microphthalmia -associated transcription factor (MITF) and the role it plays in the pathogene‐sis of Waardenburg syndrome type I .Methods The 293T cells were transient transfected with wild type (WT ) PAX3 and mutant type (M T ) H80D ,H186fsX5 plasmids .We observed and analysed the regulation effects of WT/MT PAX3 on the transcriptional activities of MITF and the influence of the two mutants on WT PAX3 function u‐sing luciferase activity assays ,detect DNA binding capacity of WT/MT PAX3 to MITF gene promoter using a bioti‐nylated double - stranded oligonucleotide probe containing PAX3 binding motif ATTAAT to precipitate PAX3 , H80D and H186fsX5 respectively .Results H80D mutant was partially functional and was able to transactivate the MITF promoter in part ,but it was dramatically reduced as compared with WT PAX 3(P<0 .01) .H186fsX5 mu‐tant was loss -of -function and failed to transactivate the MITF promoter as compared with WT PAX 3 (P<0 .01) . None of them showed dominant -negative effect on WT PAX3(P>0 .05) .WT PAX3 and H80D mutant were able to bind specifically to the ATTAAT motif on the MITF promoter ,whereas H186fsX5 PAX3 lost the DNA -binding ability .Conclusion The mutations H80D and H186fsX5 made down-regulation of MITF transcription and decrease syn‐thesis of melanin ,which resulted in haploinsufficiency of PAX3 protein and caused mild phenotypes of WS1 .

Objective To discuss the curative effect of computer assisted pre-operation plan (CAPP) in treating the geriatric intertrochanteric femoral fracture.Methods The data of intertrochanteric fractures treated with PFNA-Ⅱ between March 2012 and June 2015 were retrospectively analyzed.They were divided into two groups by preoperative design.One group was the CAPP group consisting of 53 patients with a mean age of 75.3 years (range,60-92 years).According to the Evans Classification,there were 12 Evans type Ⅰb,9 Evans type Ⅰc,15 Evans type Ⅰd and 17 Evans type Ⅱ fractures.The other group was the non-CAPP group consisting of 74 patients with a mean age of 76.6 years (range,62-95 years).There were 18 Evans type Ⅰb,15 Evans type Ⅰc,20 Evans type Ⅰd and 21 Evans type Ⅱ fractures.Operation time,intraoperative blood loss,times of fluoroscopy during operation and days of hospital stay were compared.The hip joint function was evaluated by Harris score at the final follow-up.Results The CAPP meanly cost 24.7 min.The consistency of the surgery and CAPP was up to 100％.In the CAPP group,the average operation time was 46.8±6.5 min;the average times of fluoroscopy during operation were 12.0±2.3 times;and the average blood loss was 154.4±27.6 ml.In the non-CAPP group,the average operation time was 57.8±10.3 min;the average times of fluoroscopy during operation was 20.9±3.2;and the average blood loss was 235.0±65.8 ml.All above data in the CAPP group were significantly lower than those in the non-CAPP group.The mean days of hospital stay were 13.9±1.3 days in the CAPP group and 14.3±1.4 days in non-CAPP group.The days of hospital stay had no significant difference between the two groups.Forty-five patients with an average follow-up period of 18.3 months were reviewed in the CAPP group.Fifty patients were followed up with an average period of 19.2 months in the non-CAPP group.At the final follow-up,the average Harris score was 88.6±2.8 points (range,84-96 points) in the CAPP group and 87.5±3.2 points (range,80-95 points) in the non-CAPP group.Conclusion CAPP system is convenient and efficient.It can facilitate the treatment of intertrochanteric fracture effectively.

Objective To investigate the three-dimensional morphological characteristics of tibial plateau based on CT image post-processing technique and analyze its significance in preoperative planning of tibial plateau fractures.Methods Multi-slice spiral CT data of 98 humans (56 males and 42 females) with normal tibial plateau and 30 patients (15 males and 15 females) with tibial plateau fractures were extracted.Morphological measurements of the tibial plateau were achieved by means of a three-dimensional measurement method based on points,lines and surfaces.Differences in threedimensional parameters between genders in normal tibial plateau and differences between normal tibial plateau and tibial plateau fractures were analyzed.Results Differences of males and females were significant in width of tibial plateau [(73.2 ± 3.7) mm,(65.5 ± 3.7) mm],anteroposterior dimension of medial tibial plateau [(39.8 ± 3.5) mm,(34.8 ± 2.6) mm] and anteroposterior dimension of lateral tibial plateau [(34.0 ± 3.3) mm,(29.8 ± 3 5) mm] (P ＜ 0.05),but not in varus inclination of tibial plateau [(3.19 ± 1.98) °,(3.16 ± 1.89) °],medial plateau posterior slope [(7.31 ± 3.04) °,(8.16 ± 2.46)°] and lateral plateau posterior slope [(5.23 ±2.35)°,(5.60 ±2.55)°] (P ＞0.05).Above parameters in three-dimensional morphological measurements of tibibial plateau fractures varied compared to the normal reference value (P ＜ 0.05).Intraclass correlation coefficient (ICC) for intra-observe and inter-observer agreement in normal tibial plateau measurement was excellent.Conclusions Present research provides a series of scientific and objective data for preoperative planning of tibial plateau fractures.Measurements of tibial plateau can assist the evaluation of reduction of tibial plateau fractures.

Objective To evaluate the clinical effect of the intertrochanteric fractures with or without lateral femoral wall fractures using proximal femoral nail antirotation (PFNA).Methods From May 2008 to June 2011,102 patients with intertrochanteric fractures were treated with PFNA.In accordance with the preoperative three dimensional CT reconstruction(3D CT) images,the group A included 41 cases with lateral femoral wall fractures,and the other 61 cases with an intact lateral wall were in group B.According to the AO/OTA classification,there were 5 cases in 31-A2,36 in 31-A3 in group A,and 61 in 31-A2 in group B.The operative time,operative blood loss,average length of stay,postoperative X-ray images,and 3D CT images were collected for each patient.Time of partial weight-bearing,full weight-bearing and fracture healing were also recorded.Clinical evaluation was made using the functional recovery scale (FRS) of hip fractures.Results The mean operation time was 56±8 min in group A vs 45±6 min in group B; the mean blood loss was 238±21 ml vs 175±11 ml; the average length of stay was 17±3 days vs 15±3 days.On the postoperative radiography,the blowout of lateral trochanteric wall only occurred in 8 (19.5％,8/41) cases in group A and 3 (4.9％,3/61) in group B.According to the postoperative 3D CT,the similar findings were seen in 36 (87.8％.36/41) cases in group A and 45 (73.8％,45/61) in group B.Eighty-two cases were followed up for 6 to 35 months (mean.19.5 months).The mean FRS score was 64.2±4.8 points in group A and 76.5±7.9 points in group B.Conclusion When treating unstable intertrochanteric fractures,iatrogenic fractures in lateral trochanteric wall could be easily caused with using PFNA.3D CT could effectively evaluate iatrogenic trauma in the intertrochanteric fractures.