Open calcaneal fractures are relatively rare, but most of them are potentially devastating with severe injury of soft tissue and comminuted bone. Its management is still challenging and controversial. Improper treatment will l ead to wound infection, osteomyelitis and even amputation. Preservation or repai r of soft-tissue to partly cover the hindfoot is the most important factor for the treatment. Another important factor is to restore the alignment and function of the hindfoot. Variables in determining outcomes of different cases include s everity and type of injury, wound location and treatment options. It is suggeste d that different measures should be taken according to different types of injury . This article reviews the current development and progress in the diagnosis and treatment of open calcaneal fractures.

Objective To comparison of the safety of two treatment methods of cesarean scar pregnancy (CSP) of typeⅡ and Ⅲ in menopause within 7 weeks. Methods Totally 70 cases of CSP of typeⅡ and Ⅲ within 7 weeks of the last menstrual period, hospitalized within Peking University First Hospital from January 2009 to May 2016, had been retrospectively studied in two groups of different treatments. The methotrexate (MTX) treatment group included 37 cases receiving ultrasound-guided complete curettage of uterine cavity combined with MTX therapy, while the uterine artery embolization (UAE) group had 33 cases treated with UAE combined with MTX therapy and subsequent ultrasound-guided complete curettage of uterine cavity. The bleeding measurements during operation had been documented and compared for the study. Results The comparative difference of bleeding measurements between the MTX treatment group and the UAE group was insignificant from the statistical perspective (median: 5.0 vs 5.0 ml, P=0.716).The comparative difference of the duration (median: 2.0 vs 6.0 days, P<0.01) and expenses (median: 2832.1 vs 10147.1 yuan, P<0.01) for hospitalization between the MTX treatment group and the UAE group were significant from the statistical perspective. Conclusions The bleeding risks may not increase during the treatment of ultrasound-guided complete curettage of uterine cavity combined with MTX therapy for CSP patients of type Ⅱ and Ⅲwithin 7 weeks of the last menstrual period. Meanwhile, the UAE adverse effects and complications will be avoided, and the duration and expenses for hospitalization will be reduced.

ObjectiveTo investigate the high risk factors,etiology,diagnosis,treatment and precaution of venous thromboembolism (VTE) in pregnancy and puerperium. MethodsData of 16 cases of VTE admitted in Department of Obstetrics and Gynecology,Peking Union Medical College Hospital from January 1992 to April 2011 were analyzed retrospectively.The differences of blood routine test and coagulation function between VTE patients (study group) and normal pregnant women (control group) were compared by paired t test in this case-control study.Results All patients were diagnosed by color Doppler ultrasound or CT pulmonary artery angiography.Five cases (31.2 ％) occurred before delivery and 11 (68.8 ％) occurred during postpartum.Two cases (12.5 ％)complicated by pulmonary thromboembolism,and one of them died.Six cases (37.5％) were older than or equal to 35 years old,and 12 cases (75.0％) had gestational complications.The hematocrit in study group were lower than that in control group (0.29±0.06 vs 0.39±0.02,t=4.56,P=0.01).There was no statistical difference between the coagulation function of the two groups.After anticoagulant therapy or surgery,15 cases recovered.One pulmonary thromboembolism patients complicated with rheumatic cardiac disease remained shock after anti-coagulants was administered,then died of hemorrhage of respiratory tract after inferior vena cava filter placement. Conclusions VTE is likcly to happen in puerperium than in pregnancy.There are no good screening indicators for thromboembolism during pregnancy and puerperium.Anticoagulation is recommended to be the first line therapy.For women with high risk of thromboembolism,it is suggested to prevent actively and treat early to decrease the complications and long-term sequelea.

Objective To evaluate the life quality of patients with nasopharyngeal carcinoma after intensity modulated radiotherapy and chemotherapy. Method Using phenomenological research method, we interviewed 10 patients repeatedly to explore their somatization, psychological changes as well as the effect on quality of life. Result The life quality of patients with nasopharyngeal carcinoma after intensity modulated radiotherapy and chemotherapy were affected tremendously , characterized by intense psychological stress, side effects from radiochemotherapy, hunger for emotional support, heavy burden of medical expenses, and the change of family and work roles. Conclusion Nursing staff should understand the mental feelings of patients, and provide supports for the patients psychologically, physically, from the economic, family and social points of view, so as to improve the life quality and physical and mental health of patients.

Purpose:Occult carcinoma of thyroid ( OCT) is difficult to differentiate from benign thyroid nodules because it is small ( < 1 cm),often asymptomatic,shares similar ultrasonographic characteristics.The aim of this study was to retrospectively review the ultrasound diagnosis and pitfalls of ultrasound in OCT.Materials and Methods: The ultrasonography in 37 cases suspected of OCT were reviewed,analyzed and compared with histopathology.Results: 30/37 (81.1% ) cases (38 nodules) confirmed of OCT were found solid,hypoechogenic nodules in 97.4%,with irregular margins ( 33/38,86.8% ),longitudinal-to-transverse ratio = 1 ( 17/38,44.4% ),minute calcification (19/38,50.0%),decreased flow (36/38,94.7%),and resistance index < 0.7( 30/37,81.1%).7/37 (19.0%) cases of misdiag-nosis included 3 chronic lymphocytic thyroiditis with nodules,2 nodular goiter and 2 collagen nodules.They all had overlapping ultrasonographic features.Conclusion: Those ultrasonographic features were of certain value in OCT.

Objective To introduce the method of arthroscopically assisted closed reduction and percutaneous screw fixation for intra-articular calcaneal fractures and to discuss its clinical indications, advantages and disadvantages. Methods From February 2003 to December 2004, 12 unilateral intra-articular calcaneal fractures were treated with the method of arthroscopically assisted closed reduction and percutaneous screw fixation. 7 cases were males and 5 cases were females. The average age was 36.8 years (range, 23-61 years). 8 feet were on right side and 4 feet were on left side. The mechanism of injury was fall from a height in 11 cases and vehicle accident in 1 case. According to Sanders classification, 8 cases were type Ⅱ fractures(1 type ⅡA, 5 type ⅡB, 2 type ⅡC) and 4 cases were type Ⅲ fractures(2 type ⅢAB,1 type ⅢAC,1 type ⅢBC). Results Arthroscopy in the operation showed the fracture space and step were less than 1 mm. The preoperative X-ray film showed that B?觟hler angle was 18.4??5.8?, Gissane angle was 109.1??10.2?, calcaneal width was (35.9?2.2) mm. The postoperative X-ray film demonstrated that B?觟hler angle was 25.4??3.5?, Gissane angle was 118.1??6.4?, calcaneal width was (32.3?1.1) mm. The average follow-up of nine patients was 17.4 months (range, 10-25 months). According to Maryland foot score, all patients had satisfactory results with the mean score of 92.5 score (range, 82-100 score), 6 were excellent and 3 were good. None of the patients had re-displacement of fracture, significant lame or other late complications. They regained normal shape of foot and wore normal footwear. Conclusion Arthroscopically assisted closed reduction and percutaneous screw fixation is an effective and applicable minimal-invasive treatment for Sanders type Ⅱ and selected type Ⅲ intra-articular calcaneus fractures. It can significantly reduce the risk of soft tissue injury and other complications while ensuring satisfactory reduction of the posterior calcaneal facet of the subtalar joint and reliable fixation.

Objective: To study the effect of different dissolution media on the dissolution curve of risperidone oral soluble films to provide reference for the quality evaluation of the preparation.

Objective To observe the changes of body weight,fat mass and skeletal muscle mass of rats after 4 weeks of intermittent fasting,and explore relationship with autophagy in skeletal muscle,so as to provide theoretical basis for intermittent fasting.Method Twenty male Sprague Dawley rats were randomly divided into a control group (Con) and an intermittent fasting group (IF),each of 10.The rats of IF group were forbidden to eat food every Wednesday and Friday,and the body weight of both groups was recorded weekly.After 4 weeks,Dual-Energy X-Ray Absorption (DEXA) was used to analyze the body fat mass,then the bilateral soleus was separated to record the wet weight and measure the cross-sectional area of the soleus fibers by testing laminin with immunofluorescence confocal laser scanning microscope.The form of autophagic vacuole of soleus was observed using a transmission electron microscopy.The expression of autophagy-related protein LC3,p62 and regulating protein AMPK,pAMPK and ULK1 were measured using Western blotting.Result After 4 weeks of intermittent fasting,the weight and fat mass of IF were significantly lower than those of Con (P＜0.01),but there were no significant differences between them in wet weight and cross-sectional area of soleus (P＞0.05).The expressions of AMPK,p-AMPK,ULK1 in IF were significantly higher than those in Con (P＜0.01).Compared with Con,the expression of LC3-Ⅱ/LC3-Ⅰ of IF increased significantly,while the expression of p62 decreased significantly (P＜0.01).Conclusion Four weeks of intermittent fasting decreases the fat mass significantly,and control the weight efficiently.Intermittent fasting can maintain the skeletal muscle mass by promoting moderate autophagy through the AMPK-ULK1 pathway.It should be a potential lose weight method for further research.

Objective To study the feasibility, efficacy and safety of laryngeal mask airway (LMA) in neonatal resuscitation. Methods Totally, 369 neonates requiring positive pressure ventilation at birth were randomized into two groups by offering either LMA resuscitation (205 cases) or bag-mask ventilation (BMV) resuscitation (164 cases). The effect in the two groups were observed. Results (1) No significant difference was observed in Apgar scores at 1 min between LMA group and BMV group, but the neonates having higher Apgar scores at 5 min in LMA group were more than in BMV group (x2 =-3. 39,P=0. 001). The successful resuscitation rate of LMA group was higher than that of BMV group (99.02%vs 84. 15% ,x2 =28. 76, P＜0. 01), the total ventilation time of LMA group was shorter than that of BMV group [(36.4±23.7) s vs (66.2±35.4) s] (t=-8.66, P＜0. 01). Among severe asphyxia neonates,seven of nine were successfully resuscitated by LMA, while in BMV group six neonates with severe asphyxia were all switched to endotracheal intubation ventilation. In neonates with Apgar score of 4 to 5 at 1 min after birth, the successful resuscitation rate of LMA group was higher than that of BMV group (100% vs 42. 86%, x2 =23.04, P＜0.01), the ventilation time of LMA group was shorter than that of BMV group [(54.6±33.6) s vs (136.4±42.0) s] (t= -4. 45, P＜0.01). In neonates with Apgar score of 6 to 7 at 1 min after birth, there was no significant difference in the successful resuscitation rate between LMA and BMV group. (2) The successful rate of LMA insertion at first attempt was 98.54% (202/205) and the average insertion time was (7.8 ± 2. 2) s. The adverse effects included vomiting(4 cases)and regurgitation (3 cases). Conclusions In neonatal resuscitation, LMA can be easily inserted. Compared to BMV, LMA is a better choice in resuscitation for neonates with moderate or severe asphyxia and preferable for those medical staffs who are unfamiliar with endotracheal intubation, or even as a substitute of endotracheal intubation ventilation.