[Objective] To discuss the therapeutic effect of different methods in the treatment of intertrochanteric femur fracture. [Methods]Totally 118 middle aged or old patients with intertrochanteric femur fracture were fixed with dynamic hip screw (DHS), Gamma nail or PFNA.[Results]Totally 112 cases were followed up, and the average time was 16 months, in those 45 patients were fixed with DHS: 29 were excellent, 11 cases were good, and 5 were poor, and the excellent to good rate was 88.9%; 36 patients were treated with Gamma nail, and the excellent, good, poor results were 28, 2, 1, respectively, and the excellent to good rate was 96.8%; 36 patients were fixed with PFNA, and the excellent, good, poor results were 29, 6, 1, respectively. The differences were significant (P=0.02, analyzed by Logistic regression with SPSS software). The excellent and good superiority of Gamma nail and PFNA were 5.1552 and 2.3726 times compared to DHS, and there was significant differences between the groups.[Conclusion]Surgical treatment of intertrochanteric femur fracture can improve the functional recovery and reduce the complication incidence, and PFNA fixing method can shorten the operative time, reduce the bleeding and the therapeutic effect is reliable, and suitable for old patients combined with osteoporosis.

The humanistic thinking of life philosophy of traditional Chinese medicine (TCM) observed inlife activities is different from western theories and methods,which is more about life experience and feeling and rich in practical significance.The life philosophy of TCM is also different from traditional Chinese culture.The intuitive feeling of life is one of the main characteristics of life philosophy of TCM.Students of TCM soak in traditional Chinese medicine culture and are influenced by the thinking of real life caused by the care of realbody in TCM.Chinese medicine education should fully mobilize the tacit knowledge of life education in TCM,play excellent tradition of Chinese traditional life philosophy,and cultivate the life moral quality in students of TCM.

Objective To conduct the performance verification of the Stago STA-R automatic blood coagulation analysis system once every year to evaluate the analysis system for ensuring its accuracy and reliability .Methods According to the related docu-ments of the Clinical and Laboratory Standards Institute (CLSI) ,5 items of prothrombin time (PT ) ,activated partial clotting en-zyme live time (APTT) ,thrombin time (TT) ,fibrinogen (Fib) and antithrombin Ⅲ (ATⅢ) were selected to conduct the verifica-tion and preliminary evaluation on the accuracy ,imprecision ,carry-over rate ,linearity range and reference interval of the instrument analysis system .Results The relative bias(SE% ) of accuracy in each item was less than 5% .The intra-batch and inter-batch im-precisions (CV) were less than 3% and 5% respectively .The carry-over rates were within 4% .The linearity of Fib and AT Ⅲ was very well ,r2 were 0 .9980 and 0 .9979 respectively .Validated reference interval was consistent with quotative reference range . Conclusion The Stago STA-R automatic blood coagulation analysis system has good analytical performance ,can provide accurate and reliable test results for clinical doctors .

Objective It has been shown that ketamine and magnesium used in combination provide more effective analgesia than either drug alone. The purpose of this study was to investigate the effects and interaction of the two drugs on recombinantly expressed NMDA receptors. Methods Xenopus oocytes expressing NR1/NR2A or NR1/NR2B glutamate receptors were stimulated with glutamate/glycine and studied at a holding potential of -70mV using two electrode voltage clamp. The effects of magnesium and s ( + )-ketamine alone or in combination on NMDA signaling were determined. Results Magnesium and s( + )-ketamine alone inhibited NMDA receptors non-competitively. IC50s of magnesium were (4.2 ± 1.2)×10-4mol/L and (6.3 ± 2.4) × 10-4 mol/L on NR1/NR2A and NR1/NR2B, while IC50s of s( + )-ketamine on NR1/NR2A and NR1/NR2B were (4.1 ± 2.5) × 10-6 mol/L and (3.0 ± 0.3 ) × 10-6 mol/Lrespectively. Magnesium and s( + )-ketamine used in combination decreased IC50s more than 90% at both receptors. Isobolographic analysis demonstrated superadditive interactions. Conclusions s( + )-ketarnine and magnesium inhibit responses of recombinantly expressed NMDA recptors non-competitively, and the combinations of the two drugs produces a synergistic effect.

Objective To explore the anti-sliding plating for Hoffa fractures by comparing the me-chanical properties of anti-sliding plates and cancellous bone screws. Methods Twenty cases of the same type of Hoffa fracture in the model femur were randomly divided into 4 even groups. Group A used 2 antegrade cancellous bone screws; Group B used 2 retrograde cancellous bone screws forwards; Group C used anti-sliding plate and locking screw fixation; Group D used anti-sliding plate and cancellous bone screw fixation. All the samples were subjected to the cycle fatigue and the maximum failure load tests. Results The fatigue test revealed no significant difference in the mean maximum displacements at the 10, 100, 1000, 10 000 cycles between the 4 groups. In the maximum failure load test, there were significant differences between Group A [(1224±72) N] and Groups C and D [(2183±227) N and (2124±235) N], as well as between Groups B [(1405±235) N] and Groups C and D; there was no significant difference between Group A and Group B, neither between Group C and Group D, Conclusions In the initial period after secure fixation for Hoffa fractures, anti-sliding plates and cancellous bone screws can all provide satisfactory mechanical stability and strength. But anti-sliding plating is recommended for cases of long healing expected, patients with great body mass index, and patients with poor compliance.

Objective To investigate the application effect of flexible management in nursing of general surgery department. Methods 21 nursing staff and 836 patients from January to October, 2007 were selected as research object, and were given flexible management. 21 nursing staff and 797 patients from January to December were selected as the control. The influence of flexible management on nurses and patients and satisfaction degree with nursing work before and after application of flexible management were compared. Results Working and learning enthusiasm greatly improved,educational background and professional titles of nurses increased after application of flexible management. The average hospitalization time was 28 days,the per capita cost was 12 131 yuan,satisfaction degree with nursing was 87.0% before application of flexible management, but the average hospital stay of patients decreased to 20 days, the per capita cost decreased to 8764 yuan and satisfaction degree with nursing increased to 97.0% after application of flexible management. Conclusions Application of flexible management in nursing care of general surgery department showed significant effect,it is suitable for more application in practice.

Objective To observe the dyskinesias and motor fluctuation in patients with Parkin-son’s disease, and investigate their influential factors. Methods The detail information of dyskinesias and motor fluctuation of 63 patients with Parkinson’s disease were recorded and followed up when the of L-Dopa therapy was carried out, and all patients were assessed by using UPDRS at “on” and “off” stage, Hoehn and Yahr scale, Schwab and England living scale.The data were calculated with SPSS 10.0 statistic software. Results All patients received alone or combined L-Dopa therapy.Among the 63 patients, 11 (17.5%) were experienced dyskinesias, in which 10 show dystonia; and 36 were (57.1%) experienced motor fluctuation, in which 28 developed wearing-off.The mean daily dose of L-dopa and score of UPDRS in “off” stage were positively correlated with dyskinesias.The duration of therapy with L-dopa was positively correlated with motor fluctuation.The controlled release cabidopa/levodopa was in negative correlation. Conclusions The rate of motor fluctuation was approximately equal to the results reported in other countries.The dyskinesias was lower in occurrence and the mean daily dose of L-dopa and the disease severity should be the main influencing factors to the dyskinesias.The duration of therapy with L-dopa should be influencing factor to motor fluctuation.The main subtype of motor complications should be dystonia and wearing-off.

BACKGROUND: Arterial injury surrounding the mandibular angle is very common during mandibular angle ostectomy. The retromandibular vein is susceptible to injury owing to thin vascular wall and deep location. Anatomical studies regarding the retromandibular vein are rarely reported.OBJECTIVE: To observe the construction, branches, backstreaming of the retromandibular vein and its relation to the facial nerve and mandibular angle.METHODS: Twenty formalin-fixed adult cadavers (40 samples) were randomly selected. Bilateral retromandibular veins and their branches were cleaned. The construction, branches, backstreaming of the retromandibular vein and its relation to the facial nerve and mandibular angle were anatomically observed.RESULTS AND CONCLUSION: The retromandibular vein originated constantly and provided an average length of (4.51±2.01) cm, with an average outer diameter of (0.52±0.28) cm at the origination part. A total of 34 samples showed that the retromandibular vein was formed by the union of the superficial temporal and maxillary veins, and six samples showed that the retromandibular vein originated from the superficial temporal vein. The retromandibular vein divided into two types according to the backstreaming and course: one type consisted of the anterior and posterior branches: the anterior branch mostly drained into the internal jugular vein and minorly drained into the external jugular vein; the posterior branch was joined by the posterior auricular vein and became the external jugular vein. Another type of retromandibular vein without the anterior and posterior branches directly connected with the posterior auricular vein and entered the external jugular vein. The retromandibular vein had the following branches (appearance frequency): facial transverse vein (88%), mandibular articular vein (98%), parotid veins (95%),anterior auricular veins (58%), styloid process vein (43%). 88% of the retromandibular vein was located in the superior and inferior trunks of the facial nerve and in the medial branches. The retromandibular vein connected with facial nerve trunk or major branches in a decussated fashion. 75% of the arc-shaped structures formed by the retromandibular vein and its branches coursed close to the inferior and posterior border of the mandibular angle, and 25% of the arc-shaped structures were not close to the lowest point of the mandibular angle. The thin periosteum between the venous wall and cortical bone was just the position of ostectomy line of mandibular angle. The retromandibular vein was easily injured no matter in vein dissection or ostectomy.

Objective To introduce a new CT classification system we designed for Hoffa fractures and compare the interrater reliability between the CT and X-ray classification systems.Methods A total of 20 isolated Hoffa fractures from January 2008 to December 2011 were randomly selected for the present analysis of their imaging data (anteroposterior and lateral X-ray films of the knee joint and three-dimensional CT reconstruction of the femoral condyle).At the same time,a total of 20 independent observers (clinicians with junior,intermediate and senior professional qualifications) were selected for classification of the Hoffa fractures in the same manner respectively according to the Letenneur's X-ray system and our self-designed CT system.We used Kappa statistics to evaluate the interrater reliability among the clinicians between the 2 classification systems for Hoffa fractures.Results According to the CT classification of the 20 Hoffa fractures by the 20 clinicians,type Ⅰ,Ⅱ and Ⅲ fractures accounted for 66.0％,30.5％ and 3.5％ respectively.In type Ⅰ fractures,type Ⅰb involving zone b accounted for the most (50.0％),next by type Ⅰc(31.0％) and type Ⅰa (19.0％).In type Ⅱ comminuted fractures,fracture fragments were mostly seen in zone b.The overall incidence of fractures involving zone b by CT classification was 67％.According to the X-ray classification,type Ⅰ,Ⅱ,Ⅲ and Ⅳ fractures accounted for 31.4％,14.3％,28.0％ and 26.3％,respectively.The interrater reliability for CT classification agreement (Kappa =0.681) among clinicians was higher than that for X-ray agreement (Kappa =0.261).Conclusion For Hoffa fractures,communicated ones in particular,our CT classification system may be better than the X-ray classification system.

Type 2 diabetes mellitus is a metabolic disorder characterized by hyperglycemia caused by multifactors.The incidence of type 2 diabetes is gradually increased.Its prevention and treatment are paid more and more attention.Intestinal flora is one of the hot spots in recent years.A large number of studies have shown that intestinal flora is closely related to the occurrence and treatment of type 2 diabetes mellitus.Intestinal flora is expected to be a new direction for the improvement and treatment of type 2 diabetes mellitus.In this paper,the relationship between type 2 diabetes and intestinal microflora in recent years,pathogenesis and treatment were summarized.