BACKGROUND:It has a certain difficulty in the clinical treatment of distal humeral fractures in elderly people. According to the particularity of elderly patients, during clinical treatment of senile distal humeral fracture, conservative treatment or the metal implant internal fixation remains controversial. OBJECTIVE:To explore the feasibility and effectiveness of metal implants for the repair of senile distal humeral fractures. METHODS:A total of 35 hospitalized elderly patients with distal humeral fracture in Beijing Renhe Hospital from September 2008 to September 2013 were studied. 19 cases were given titanium implant fixation (experimental group), 16 cases were given conventional conservative treatment (control group). RESULTS AND CONCLUSION:Total y 35 patients were fol owed up. In the experimental group, elbow joint function was excel ent in eight cases and good in four cases, with total excel ent and good rate of 63%. The excel ent and good rate was significantly higher in the experimental group than in the control group (31%;P<0.05). In the experimental group, three patients suffered from infection of incisional wound, and two patients experienced sensory anesthesia of ulnar nerve innervation area. They had recovered after symptomatic treatment. No nonunion of fracture or loosening of fixator appeared. These suggest that metal implant for senile distal humeral fracture obtained good outcomes, and showed feasibility and effectiveness.

Objective To explore the effect of Laparoscopy-assisted radical pull-out operation for Hirschsprung disease.Methods The clinical data of 12 patients with Hirschsprung disease admitted to our hospital in the last 2 years were retrospectively reviewed.Results The surgical procedures of 12 cases were successfully performed by laparoscopy,including 6 cases of common segment,4 cases of short segment,and 2 cases of long segment type.All the operations were completed with laparoscopy in 80-130 min(mean 100 min).There was very little bleeding during the procedure and no obvious scar.There were no complications.Conclusions Laparoscopy-assisted radical pull-out operation for Hirschsprung disease is feasible and effective.

Objective To analyze the treatment of chemotherapy?failed advanced lung adenocarcinoma cases and the adverse reactions with apatinib. Method Twenty?two patients received treatment of apatinib at a dose of 425 mg/day for two weeks,then at a dose of 675 mg/day for two weeks if could be tolerated. The efficacy was evaluated by the imaging,CEA and NSE. Results The clinical evaluation of patients were complete remis?sion( CR) 0 case,partial remission( PR) 5 cases,steady( SD) 13 cases,progress( PD) 3 cases,1 case termina?ted the treatment due to adverse reactions,and the objective response rate was 23. 8%(5/21),disease control rate was 85. 7%(18/21). After 4 weeks treatment,CEA and NSE were significantly reduced than the previous ((97. 45±79. 05) mg/L vs. (47. 05±31. 89) mg/L,(20. 27±6. 88) mg/L vs. (11. 09±8. 92) mg/L;t=2. 45, 3. 56;P<0. 05) . The impacts on prognosis of different metastatic sites were no statistical significant difference( P>0. 05) . The main side effects were hypertension and proteinuria( 72. 7%,59. 0%) . Conclusion The treatment of chemotherapy?failed advanced lung adenocarcinoma with apatinib has better exact effect,and toxicity could be controlled,so it was worthy of clinical treatment and evaluation of long?term efficacy.

Objective To study the methods for diagnosis and treatment of insulinoma.Methods The clinical data of 120 patients with insulinoma who had been admitted to our hospital in the last 40 years were retrospectively reviewed.Results Fasting blood glucose values were less than 2.75 mmol/L in all the patients.Fasting serum insulin values in 75 patients were higher than 25 ?U/mL,and the average was (65 ?6.0)?U/mL.Before operation,tumor was detected in 2 of 60 patients by ultrasound scan,and in 10 of 50 by CT. Among 18 patients who had intra-operative B-ultrasound examination, 16 positive cases were verified by intraoperative exploration; and one case the tumor was not palpable but was found by intraoperative B-ultrasound examination.The operations included enucleation of insulinoma(70 patients),insulinoma resection and distal resection of the pancreas(44),distal resection of the pancreas(4),and biopsy(2).The low blood glucose symptoms disappeared after the first operation in 111 of the 112 patients who had benign tumor.One case with benign tumor was cured by a second operation.Twenty patients developed pancreatic fistula after tumor enacleation, of them,14 healed uneventfully after drainage,5 were cured by operation,and 1 died of peritoneal infection.Conclusions Preoperative localization of insulinomas is difficult. Intraoperative exploration and ultrasound scan are the chief methods for the localization of insulinoma.Enucleation of insulinoma should be selected for benign tumor. Resections of the pancreatic body and tail is required for large,deep or multiple tumors.

Objecfive To explore pathological mechanism and treatment of central hyponatrem-ia. Methods Synchronous assay was made to detect changes of atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),endogenous digitalis-like substance(EDLS),antideuretic hormone (ADH),Na+ concentrations in blood and urine as well as osmotic pressure of plasma and urine in 68 pa-tients with traumatic brain injury(TBI). Results Of all,there were 27 patients with hyponatremia,mostly in patients with severe or critical TBI.There found syndrome of inappropriate secretion of antidi-uretic hormone(SIADH)in 7 patients and cerebral salt wasting syndrome(CSWS)in 20. Conclu-sions The central hyponatremia in patients with TBI may be related to the increased secretion of EDLS and ADH.The decrease of ANP and BNP in blood has no direct effect on Na+ concentration in blood.In-travenous injection of extrinsic thyrotropin releasing hormone(TRH)may inhibit dilutional hyponatremia resulted from increased secretion of ADH in TBI patients.

Objective To investigate the influence of family support and personality characteristics on quality of patients' life who underwent total laryngectomy. Methods Patients (68 eases)who underwent total laryngectomy were surveyed with Su life of quality scale,Hu family support scale, Gong personality test and the results were sent for statistical analysis. Results Scores of two family groups in family support and quality of life underwent t test, physical function and psychological state were statistically different (P<0.05), living ability,social relations, tracheal stoma were statistically different(P<0.01). Persona lity and quality of life were subjected to single-factor analysis, psychological states were obviously related with four dimensions.Family support and personality characteristics score of two family groups underwent t test, E(internal and external quality),P(spiritual quality),N(nerval quality)were statistically significant (P <0.01 ). Condusions Family support and personality characteristics as the internal and external environmental factors directly affected patients who underwent total laryngectomy. Three-openfour-guiding-five-integrated-care-intervention measures can overall improve their quality of life.

Objective To build learning evaluation system and indicators connotation of problem-based in small-group teaching model.Methods Delphi technique was used to build learning evaluation system of problem-based for course of nursing education through a two-round expert consultation among 30 experts in Zhejiang province.Results The experts' authority coefficient was 0.89,determination coefficient was 0.90,and familiar confficient was 0.88.The finally learning evaluation system of problem-based for course of nursing education consisted of 3 first-level indicators,14t second-level indicators and 41 third-level indicators.The coordination coefficients of first-level indicators and second-level indicators were 0.37 and 0.31,respectively,there was significant difference,P＜0.01.Conclusion This project has a rigorous and reliable construction process with strong theoretical and practical significance,and could be used as a guidance and reference for problem-based in small-group teaching for course of nursing education.

Objective To detect Mycobacterium tuberculosis (MTB)and its resistance against rifampin (RIF ) by applying Xpert MTB/RIF assay in the clinical samples from patients with extrapulmonary tuberculosis,and to discuss the value of this assay in extrapulmonary tuberculosis. Methods Totally 300 clinical samples from the patients who were highly suspected with extrapulmonary tuberculosis and hospitalized in Department of Tuberculosis Section,Shanghai Public Health Clinical Center of Fudan University from May 2014 to May 2015 were collected.Smear and fluorescence staining microscopy,MGIT 960 BACTEC liquid culture,Xpert MTB/RIF assay were applied to detect MTB in these samples.Meanwhile,all the patients received the peripheral blood T-cell spot of tuberculosis test (T-SPOT.TB).The sensitivity and specificity of Xpert MTB/RIF assay for MTB and its resistance against rifampin (RIF)in extrapulmonary tuberculosis samples were evaluated.The measurement data of two independent samples were analyzed by using t test and enumeration data were analyzed by usingχ2 test.Results Totally 282 out of 300 clinical samples from patients with extrapulmonary tuberculosis were included in this study,and 62.7% were male with average age of (32.1 ±24.6 )years and 37.3%were female with average age of (37.8 ±21 .0)years.When MGIT 960 BACTEC liquid culture results were considered as standard diagnosis,the sensitivity,specificity,positive predictive value and negative predictive value of Xpert MTB/RIF assay were 53.8% (95 %CI :37.4%—69.6%),100.0% (95 %CI :86.3%—100.0%),100.0% (95 %CI :80.8%—100.0%)and 63.3% (95 %CI :48.3%—76.2%), respectively.The sensitivity of Xpert MTB/RIF assay in smear-positive/culture-positive samples was 92.3% (95 %CI :62.1 %— 99.6%),while that in smear-negative/culture-positive samples was only 34.6% (95 %CI :17.9%— 55 .6%).Xpert MTB/RIF assay had advantage for detecting MTB in fine needle aspirates,pus,stool and urine,but not in serous effusion and cerebrospinal fluid.However,the sensitivities of MGIT BACTEC 960 liquid culture,fluorescence smear and T-SPOT.TB were 25 .8%, 21 .8% and 70.2%,respectively,and the specificities were 95 .5 %,90.3% and 51 .6%,respectively. The diagnostic value of Xpert MTB/RIF assay was not significantly different from those of MGIT BACTEC 960 liquid culture and fluorescence smear (χ2 =0.61 and 3.45 ,respectively;both P >0.05 ), while it was significantly different from T-SPOT.TB (χ2 =50.58,P <0.05).The sensitivity of T-SPOT. TB was significantly superior to Xpert MTB/RIF assay,but the specificity was relatively low.The sensitivity and specificity of Xpert MTB/RIF assay in RIF resistance detection were 71 .4% (95 %CI :30.3%—94.9%)and 100.0% (95 %CI :86.7%—100.0%),respectively.Conclusions The sensitivity and specificity of Xpert MTB/RIF assay in detecting MTB in fine needle aspirates,pus,stool and urine are relatively high,but not in serous effusion and cerebrospinal fluid.However,the pros of rapid detection and the ability of detecting RIF resistance are useful for the diagnose of extrapulmonary tuberculosis in clinical settings.

Objective To investigate effect of sorafenib on serum hepatoma marker in patients with advanced hepatocellular carcinoma. Methods 101 patients with advanced hepatocellular carcinoma were selected, and divided into two groups.50 cases in control group were treated with routine clinical treatment, and 51 cases in experimental group were treated with sorafenib on the basis of control group.The survival time, adverse reactions, VEGF, CTGF, HIF-1 and OPN levels were compared after the treatment.Results The survival time of experimental group was higher than control group (P<0.05).Compared with control group, the serum levels of VEGF、CTGF,HIF-1, OPN,AFP, CEA, and CA199 in experiment group were lower (P<0.05,P <0.01).There were no significant differences of total adverse reactions between experimental group and control group. Conclusion Sorafenib can effectively prolong survival time of patients with advanced hepatocellular carcinoma, reduce serum VEGF, CTGF, HIF-1 alpha and OPN levels.

Aim To study the oxygen free radical scavenging activities and antilipid peroxidation of nicotinic acid. Methods High lipid models of quail were induced by high fat diet. Five groups were divided, namely control group, high lipid group, NA group(150 mg?kg-1 and 75 mg?kg-1), and Vit E group (100 mg?kg-1). The contents of TC,TG,MDA and activities of SOD were examined for 3 times in the plasma and liver after administering NA for 9 weeks. Results The results showed the increase of TC,TG and MDA contents and decrease of SOD activities in high lipid groups by 3 weeks high fat diet. After administering NA for 3 weeks, NA reduced TC,TG and MDA contents and increased SOD activities, revealing the relationship to dose-dependence. Conclusion NA is most likely to possess the capabilities of anti-oxygen free radicals and anti-lipoperoxidation to hyperlipodemia quail.