Objective To investigate the effect through clinical practice on the treatment of clavicular fractures.Methods 89 patients with a aeries of strict clinical examination were provided to determine the diagnosis,treatment design.Results After anatomic reduction,if the end of fracture became stability,joint pain disappeared even with oppression and the activities of the shoulder became normal,the healing effect is excellent.There were 48 cases of this kind and it was 54%of the whole;after anatomic reduction,if the end of fracture becatne stability,surrounding local joint pain disappeared with oppression and the activities of the shoulder nearly became normal,the healing effect belongs to the good.There were 25 cascs of this kind and it was 28% of the whole;if patients only achieved a reduetion of 1/2,they would suffer various degrees of pain after lifting heavy objects or moving and their joint activities would be restricted.The healing effect is also OK and there were 11 cases of this kind and it Wsa 12% of the whole;besides,poor treatment outcome for five cases,accounting for 6%.Excellent rate is 94% altogether.Conclusion The treatment of clavicular fractures to open reduction and internsl surgery is better than the traditional solid eight characrers bandage external fixation approach reduction.The use of reconstruction plate and collarbone hook plate is a well-established method of selection,by which bones can be fixed solidly and patients can move their shoulders earlier.What's more,joint function can restore quickly,the results are satisfactory.

Objective To investigate the pathogenesis of chronic gluteal pain.Methods 79 cases with chronic gluteal pain were provided in series of strict clinical examination to make sure their final diagnosis.Results 67 cases were identified with lumbar disc herniation,7 cases were of sacroiliac joint disease,2 cases of L5 isthmic spondyloisthesis,2 eases of avaseular necrosis of the femoral head,1 case of compressive fracture of thoracolumbar re- gion.Meantime 2 other concealed factors ought to be noted:ankylosing spondylitis and 12th intercostals neuritis. Conclusion Most cases of chronic gluteal pain were resulted from lumbar disc herniation,next from sacroiliac joint disturbances and probably a few cases from hip ioint disease.

Objective To investigate the serial clinical course about osteoporosis and spinal fracture,so as to promote knowledge of diagnosis and treatment. Methods 53 cases with whole clinical stuff were provided for analysis and study,especially on the diagnosis and medical treatment,it helps us to draw a conclusion from experience and lessons. Results After a series of proper treatments, the patients became healthy and sound earlier on,and the rate of good-results is 92 % . Conclusion Normally, the cause of the death is not just because of the fracture itself, but the complication which results from bed rest. In order to get the best result of treatment,solve the ambivalence synthetically and relatively.

Postprandial hyperglycemia is a risk factor for atherosclerosis and cerebro-vascular diseases. This article reviews the mechanisms of cerebrovascular diseases caused by postprandial hyperglycemia from aspects of postprandial hyperglycemia participating in the pathophysiological mechanisms of atherosclerosis, and the relations between postprandial hyperglycemia and cerebrovascular diseases.

Objective To improve the ingestion protocol of esophageal capsule endoscopy in right lateral supine (RLS) position. Methods A total of 53 patients were randomized into RLS group and improvement group. The time of passing the esophagus, visual range and clarity of esophagus and z-line, and comfort of the procedure were compared between the two groups. Results The time of capsule passing the esophagus in improvement group was significantly longer than that in RLS group [ 202 (20-480) s vs.63 (8-210) s, P ＜ 0. 001 ) ]. The range of visualization in esophagus (2. 69 ± 0. 21 ) and Z-line (2. 54 ±0. 22) in improvement group was significantly larger than that in RLS group (2. 55 ± 0. 23 and 2. 40 ± 0. 24,respectively, P =0. 019 and P =0. 037, respectively). No significant difference was detected in clarity of esophagus or Z-line between 2 groups (P ＞0. 05). Two patients (7.7%) in RLS group had transient cough due to frequent water drinking, while no cough was observed in improvement group. Conclusion Compared with the ingestion protocol of esophageal capsule endoscopy in right lateral supine position, the improved ingestion protocol shows larger range of visualization, better safety and the same definition.

Objective To investigate the effects of acupuncture on astrocyte proliferation in hippocampus of rats after cerebral ischemia-reperfusion. Methods Ischemia-reperfusion injury was induced by temporary middle cerebral artery occlusion(MCAO)in 36 Sprague-Dawley rats,who were divided randomly into a control group,a model group and an acupuncture group.The expression level of Cyclin D 1 and glial fibrillary acidic protein(GFAP) was analyzed by immunoreactivity and Western blot. Results It was shown that the expression of Cyclin D1 and GFAP increased significantly(P＜0.01)at 2 and 7 days after cerebral ischemia-reperfusion,respectively.It was also shown that application of acupuncture could inhibit Cyclin D1 and GFAP(P＜0.01). Conclusion Acupuncture may inhibit glial proliferation by regulating cell cycle factor.

Objective To analyze hospitalization expenses and influential factors of elderly inpatients with medical insurance,and to provide scientific evidences for curbing hospitalization expenses and adjusting medical insurance policy.Methods Based on hospitalization data derived from Beijing town during 2007-2011 from 65082 elderly urban inpatients under medical insurance,descriptive analysis and multiple stepwise linear regression methods were used to analyze the hospitalization expense and its influential factors.Results The last 5 year witnessed rising hospitalization expense and average hospitalization expense per admission of elderly patients with medical insurance; among the components of hospitalization expense,cardiovascular/cerebrovascular/tumor/respiratory system diseases cause the heaviest medical burden; days of stay,hospital level,out-of-pocket proportion are the most important influential factors on their hospitalization expense per time.Conclusion The hospitalization expense of elderly patients with medical insurance keeps growing.Therefore,shorter days of stay,rational referral of patients to appropriate hospitals,adjusting out-of-pocket proportion would be effective measures of curbing hospitalization expense.

Objective To quantify Contribution to LE at Birth from Mortality Variation for Some Diseases in Shanghai.Methods Health problem for population was classified into 5 group: infectious group,tumor,cerebrovascular group,injury and others.Cause elimination life table methods was employed to analyze the mortality registry data for Shanghai residents during 1953 to 1999.Chisquare for trend was used to analyze the variation for ASMR and Pearson correlation was used to describe the relationship between the variation of LE at birth and social economic factors.Results During 1953 to 1999,crude mortality rate(CMR),mortality rate by area,age-specific mortality rate(ASMR) from infectious group diseases showed obvious trends of descending.Also CMR and ASMR from injury for urban residents showed obvious trends of ascending.However,for suburb residents,CMR from injury had a trend of decline but ASMR had no significant trend.CMR from tumor and cerebrovascular group for Shanghai residents showed a rising trend but mortality rate by area and ASMR not.After 1979,the proportion of contribution for the rise of LE at birth for Shanghai urban residents from infectious group was about 33%,which was much higher than that of other 3 groups.The proportions of contribution in suburb male group from injury and cerebrovascular were 40.26% and 25.18%,respectively.The variation of mortality risk from tumor for urban male residents gave a negative contribution to respondent rise of LE at birth.Besides,the proportions of contribution in suburb female group from infectious disease(21.60%) and injury(12.55%) were largest.Compared to the mortality in 1996,among infectious group,injuries,tumor and cerebrovascular group,potential decline of mortality from tumor contribute the most to the rise of LE at birth,cerebrovascular group has the second,injury had the third and infectious group has the least.Development of Shanghai medical service resource showed a significant correlation with the rise of LE at birth.Conclusion Shanghai has successfully prevented and controlled the infectious disease group.The future strategy for disease prevention and control ought to focus on tumor,cerebrovascular diseases and injury.Based on the theory of risk competing,cause elimination life table method help greatly to set proper LE aims for public health plan.

Objective To study the clinical characteristics and therapeutic effect of the combination of intensive immunosuppression therapy with umbilical cord blood infusion in severe aplastic anemia (SAA) patients with infections.Methods A retrospective analysis of bacterial spectrum and treatment effect was performed for infections occurred in 27 SAA-Ⅰ patients who received antithymocyte globulin (ATG),cyclophosphamide (Cy) and cyclosporine A (CsA) followed by umbilical cord blood infusion.Results The prevalence of infections in 27 SAA-Ⅰ patients was 48.1％,among which 70 ％ were infected with bacteria (mostly gram-negative bacilli) and 30 ％ with fungal infection.Upper respiratory tract was the most common site,followed by the blood and lungs.The primary infections occurred at the median time of 9.5 d (-2-10 d)after the immunosuppressive therapy,and the initial infections of ANC were ＜ 0.2 ×109/L.Conclusion Combination of intensive immunosuppression and umbilical cord blood infusion is proven effective in treating SAA-Ⅰ.As a result,infection rate is low and can be controlled with sensitive antibiotics.

BACKGROUND:The quantity and function reduction of circulating endothelial progenitor cells(CEPCs)indicate that vascular endothelial repair capacity reduces in hypertension patients,but the impact of statins on the CEPCs is still not very clear.OBJECTIVE:To investigate the effects of atorvastatin calcium on endothelial cells and CEPCs in renovascular hypertensive rats.DESIGN,TIME AND SETTING:Randomized controlled animal experiment was performed in Chongqing Key Laboratory ofNeurology from June 2008 to Febmary 2009.MATERIALS:Totally 24 SD male rats of SPF grade,and atorvastatin calcium was produced by Lipitor,Pfizer Inc.with batch number of 65837003.METHODS:The renovascular hypertension was induced with 2-kindey and 1-clip method in 16 SD rats,which were then randomly divided into two groups:hypertensive group(n=8)and statins group(n=8).control group(n=8)underwent the same operation,without silver slip.At 4 weeks after model construction,statins group was treated with atorvastatin calcium MAIN OUTCOME MEASURES:At 4 and 12 weeks of the experiment.three groups of rats were measured blood pressure and blood lipids;at 12 weeks,the thoracic aortic endothelial cells continuity was investigated through hematoxylin-eosin stain;the quantity,proliferation,adhesion and migration capacity of CEPCs were determined.RESULTS:At 4 and 12 weeks of the experiment,there was no significant differences in the systolic pressure between statins RESULTS:At 4 and 12 weeks of the experiment,there was no significant differences in the systolic pressure between statins group group and model group,which were dramatically high than control group(P＞0.01):the blood lipids in the statins group was not changed.In the model group,rat aortic endothelial cells were greatly damaged;the injury of CEPCs was dramatically relieved in the model group.Compared with statins group and control group,the number of CEPCs was significantly decreased,the capacities of proliferation,adhesion and migration were also significantly reduced in the model group(P＜0.01);moreover,statins group was inferior to control group in terms of these capacities.with significant differences among three groups(P＜0.01).CONCLUSION:Renovascular hypertensive rats thoracic aortic endothelial calls are severely damaged,CEPCs decline in the humber and function;atorvastatin calcium can increase the number of CEPCs and improve the function of CEPCs.