BACKGROUND: Most of the displaced fractures of calcaneus reed operation treatment. Because early postoperative dirigation is sometimes ignored,most patients receive only good anatomic reduction but less pleased functional reduction.OBJECTIVE: To compare the effect of different starting time of the postoperative dirigation on the functional recovery of the joint of the foot after the operation of the fracture of calcaneus with joint surface displacement.DESIGN: Non-randomized and concurrently controlled retrospective analysis with blind evaluation.SETTING: Orthopedic Department of Renji Hospital of Shanghai Second Medical University.PARTICIPANTS: Cases with the fracture of the calcaneus with joint surface displacement, in the Orthopedic Department of Renji Hospital of Shanghai Second Medical University were chosen from October 2000 to June 2003. There were totally 64 cases(72 sides), male 40 sides and female 32sides, whose ages varied from 22 to 68 years old. According to the starting time of the postoperative dirigation, the cases were divided into two groups,the 1-week dirigation group with 34 cases(38 sides), male 20 sides and female 18 sides, and the 6-week dirigation group with 30 cases(34 sides), male 20 sides and female 14 sides.METHODS: Totally 64 cases were involved in the result analysis. In the two groups, the same operative therapeutic methods and postoperative dirigation were taken except the starting time of the dirigation. The dirigation was started respectively 1 or 6 weeks after the operation and lasted for 6weeks. Six months later, follow-ups were done according to the Maryland Grade(excellent 90-100, good 75 -89, moderate 50 -74, poor ＜ 50) to evaluate the activity of the talocrural joint and the stability of the anterior half of the foot and the gait as well.MAIN OUTCOME MEASURES: Primary results: the postoperative function of the injured foot of the two groups. Secondary results: the adverse events and side effect.Maryland Grade: In the 34 cases(38 sides) of the 1-week dirigation group,the average mark was 87. 8, and in the 30 cases(34 sides) of the 6-week dirigation group, the average mark was 73.2, and the difference had signifigroup, 3 cases had poor healing of the incision, and achieved the healing after 2-week medication. And 2 cases had injury of the lateral dorsal cutaneous nerve of the foot. In the 6-week dirigation group 2 cases had poor healing of the incision and achieved the healing after 2-week medication, and 1 case had injury of the lateral dorsal cutaneous nerve of the foot. There was no significant difference between the two groups.CONCLUSION: After the operation of the fracture of calcaneus with joint surface displacement, early application of dirigation is beneficial to the functional recovery of the foot and talocrural joint without unsafety.

[Objective]To discuss the difference of mechanical stability in using different fixation methods in treating radius and ulna fracture,in order to provide a theoretical basis for clinical applications.[Method]In the experiment,15 pieces of fresh radius and ulna were used to produce middle-part transverse fracture models(A3.2)which were fixed by three different methods(double plate fixation group,double-intramedullary nail fixation group,ulnar intramedullary nailing + radial plate group).Through biomechanical tests,axial stiffness,bending stiffness,torsional stiffness and the equivalent stiffness were compared.[Result]There were no difference between double-plate group and ulnar intramedullary nailing + radial plate group,the stability in these two groups were higher than that in double-intramedullary nail fixation group.[Conclusion]Ulnar intramedullary nailing + radial plate has a good biomechanical property,it can provide firm fixation and with less trauma.So it is a good fixation.

Objective To study which is more advantage between comfortable care and functional care.Methods There are 49 case.We divided them into two groups,countrast group (function mode) and experimental group (comfortable mode) according to the preoperation case and postopreation case.Count the operative complication rate of two groups.Results Satitical analysis was performed using χ2,P<0.05.Conclusions Comfortable care mode was significantly advantage than functional care mode.

OBJECTIVE: To establish a staging standard for a transplanted hepatoma model in rats, which may be equivalent to the human primary liver cancer. METHODS: A transplanted hepatoma model was made in SD rats by implantation of histologically intact Walker-256 tumor fragment into the left lateral lobe of the liver. The body weight, tumor volume and serum albumin level of the rats were measured and assayed in different periods. Pathological sections were also fabricated to detect the invasion and metastasis of the neighboring tissues. RESULTS: The body weight loss and ascites occurred at the 12th and 18th day separately. The serum albumin level was (35.32+/-2.45) g/L at the 11th day, which showed no statistical difference as compared with the healthy rats (P>0.05), and the albumin level at the 18th day was significantly lower than that at the 11th day (P<0.05). At the 23rd day, 56.25% of the rats developed bloody ascites. CONCLUSION: The period between 5-11 days in the model rats may be correspondent to the early stage of human primary liver cancer, and the biological behavior of the model rats at the18th day may be correspondent to the late stage of human primary liver cancer. This staging standard might be the guideline for model selection in experimental study of primary liver cancer.

The Chinese Traditional Clinical Treatment for Gout Emulational Training System applies the technologies of AI,multimedia,database and so on to automatically create cases which accord with the learners’ needs,and realize teaching in accordance of students’ aptitude and virtual. It has resolved the problem in the actual instruction of Chinese traditional medicine for gout’s clinical treatment.

Objective To investigate the Correlation between Plasma Total Homocysteine and Copper in Patients with coronary artery disease complicated with diabetes mellitus. Methods 31 pateints with coronary artery disease complicated with diabetes mellitus were studied. 36 age-matched and gender-matched patients with coronary artery disease not complicated with diabetes mellitus and 30 normal subjects were served as control groups. The concentrations of copper and total homocysteine was determined and compared. Results The concentration of copper and total homocysteine was significantly highter in the patients with coronary artery disease complicated with diabetes mellitus (18.8?3.5 ?mol/L、21.1?3.8 ?mol/L, respectively) than in the patients with coronary artery disease not complicated with diabetes mellitus (15.6?1.9、14.8?2.2 ?mol/L, respectively) (P

Objective To investigate the association of Lipoprotein(a) concentrations and patients with aortic dissection.Methods 27 pateints with aortic dissection were studied. Sixty age-matched and gender-matched patients with acute myocardial infarction and fifty normal subjects were served as control groups. The levels of Serum lipoprotein(a), plasm C-reactive protein, white blood cell count were compared between the three groups. Observed the changes of the levels of lipoprotein(a), C-reactive protein, white blood cell count 24 hours, 72 hours and 5 days after the initial of disease in eight of the patients with aortic dissection. Results 1. Median serum lipoprotein(a) levels of patients with aortic dissection, acute myocardial infarction and normal subjects were 327.35?89.23, 261.35?77.54, 79.69?21.63 mg/L respectively (P

Objective To evaluate effects of ropivacaine combined with different concentrations of fentanyl for epidural labor analgesia. Methods In this multicenter double-blinded randomized study 128 parturients at full term and 2-3 cm of cervical dilatation who requested epidural analgesia were randomly allocated to one of 4 groups: group F0 received epidural ropivacaine alone (n = 33); group F1 received epidural ropivacaine with fentanyl 1 ?g?ml-1 (n = 30) ; group F2 epidural ropivacaine + fentanyl 2?g?ml-1(n = 33) and group F3 epidural ropivacaine + fentanyl 3 ?g?ml-1(n = 32). Epidural catheter was placed at L2,3 and advanced 4 cm into the epidural space in cephalad direction. A bolus of 15 ml of ropivacaine alone or with fentanyl was given after correct epidural placement was confirmed. EC50 of epidural ropivacaine was determined by up-and-down sequential experiment. The initial concentration of epidural ropivacaine was 0. 12% . If effective the next parturient received ropivacaine of lower concentration; if ineffective the ropivacaine concentration was increased. Each time the concentration of epidural ropivacaine increased/decreased by 0.01% . The analgesia was assessed using VAS score (0-10 0 = no pain, 10 = worst pain) . If VAS score was less than 3 within 30 min of ropivacaine administration, analgesia was defined as effective. EC50 of ropivacaine was calculated according to Dixon and Massey. Results Four of the 128 parturients enrolled were excluded because of uncertain results of interrupted observation. The EC50 of epidural ropivacaine for labor analgesia and the 95% confidence interval (95% CI) of EC50 were 0.110% (95% CI 0.109 0%-0.111 6%) in group F0; 0.089% (95% CI 0.087 7%-0.091 1%) in group F1; 0.073% (95% CI 0. 071 7%-0.0744%) in group F2 and 0.060% (95% CI 0.056 0%-0.634%) in group F3 respectively. The EC50 was significantly higher in group F0 than in group F1, F2 and F3 (P0.05) . The incidence of side-effect was significantly higher in group F3 than in group F0(P

Objective To compare the analgesic efficacy and safety of the sole local anesthetic ropivacaine with the combination of both local anesthetic ropivacaine and opioidergic analgesic sufen-tanil given epidurally on the labor pain control.Methods After institutional review board approval and patient consent,a total of 481 nulliparas requesting epidural labor analgesia were randomized into two groups:a sole local anesthetic group (0.125% ropivacaine,group R)and a combination of local anesthetic and opioidergic analgesic group (0.125% ropivacaine+0.3 μg/ml sufentanil,group RS). Analgesic efficacy was measured using numerical rating scale (NRS)of pain and maternal visual ana-logue scale (VAS)analgesia satisfaction with regard to the first and the second stage of labor.Anal-gesic safety was measured with the Bromage scale of maternal safety and epidural labor analgesia re-lated side effects,as well as fetal safety including Apgar scoring and umbilical cord artery blood gas a-nalysis.Results A total of 346 participants completed the study,with 1 64 and 182 women in each group R and RS,respectively.The median NRS pain score during the first stage of labor was signifi-cantly lower in the combination group (2.2,IQR:1.8-2.7 )comparing to the sole local analgesic group (2.4,IQR:2-2.8)(P <0.001).No significant difference was observed in NRS pain score dur-ing the second stage of labor.Patients in both groups were rated the same VAS satisfaction of analge-sia.Patients in the sole local analgesic group experienced fewer side effects than those in the combina-tion group (37.7% versus 47.2%,P =0.082).The incidence of 1-min Apgar≤7 was lower in the sole local analgesic group 2 (1.2%) than the combination group 10 (5.5%) (P < 0.05 ). Conclusion The sole local anesthetic ropivacaine produces a comparable labor analgesic effect as the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil but the former has less maternal side effects,and less incidence of lower 1-min Apgar scoring.

Objective To compare the influence of regular intermittent bolus of different con-centrations of ropivacaine for epidural labor analgesia on maternal intrapartum fever.Methods One hundred parturients aged from 20 to 35 years,of ASA Ⅰ or Ⅱ,singleton pregnancy,head presenta-tion,were randomly divided into two groups:Group H with 0.1% ropivacaine and 0.4 μg/ml sufen-tanil,Group L with 0.08% ropivacaine and 0.4 μg/ml sufentanil,50 cases in each group.Both groups were given epidural analgesic solution of 8 ml every 60 minutes respectively.Maternal tympanic membrane temperature,pain visual analogue scale (VAS),and modified Bromage score were recorded at the beginning of analgesia,1,2,3,4,5 h post analgesia,delivery,and 1 h post de-livery.And the anesthetics consumptions,labor duration,and neonatal Apgar score of 1,and 5 min were also observed.Results Compared with the beginning of analgesia,maternal tympanic membrane temperature significantly rose at 4,5 h post analgesia,delivery,and 1 h post delivery in both groups (P <0.05).Compared with group L,maternal tympanic membrane temperature significantly rose at 4,and 5 h post analgesia in group H (P <0.05).There was no significant difference in the incidence of intrapartum fever between the two groups.Compared with the beginning of analgesia,maternal VAS significantly decreased from 1 h post analgesia to 1 h post delivery in both groups (P <0.05);but there was no statistically significant difference between the two groups.Conclusion Regular inter-mittent epidural bolus of 0.08% or 0.1% ropivacaine combined with 0.4 μg/ml sufentanil can provide satisfactory labor analgesia,and body temperature rises more dramatically in women receiving higher concentration of local anesthetic than those receiving lower concentration.