Objective To evaluate the functional recovery of unstable ankle fractures prospectively after early weight-bearing and cast immobilization. Methods From October 2003 to October 2007, 100 patients who had sought medical management in our department for unstable ankle fractures were enrolled in this prospective study. All patients were treated with open reduction and internal fixation (ORIF), according to the AO/ASIF principles. They were randomized into 2 even groups, one receiving early weight-bearing and the other cast immobilization. The functional recovery was evaluated in terms of Olernd score, Tegner score, pain intensity[merical rating scale (NRS)], full weight-bearing time, return-to-work time, and hospital stay time. Results Forty-six patients in early weight-bearing group and 45 patients in immobilization group finished follow-ups. There was no difference in Olernd score, Tegner score or NRS between the 2 groups, and all pa-tients got a good Olerud score and returned to work. Total weight-beating time in early weight-beating group was 4 weeks less than in immobilization group. Conclusion Early weight-bearing may be recommended for patients who have got a stable osteosynthesis of their fractured ankles as judged by their responsible surgeons, fine compliance, and a high motivation.

Objective To observe the immunologic function of critically ill newborn and the relative function of nuclear factor kappa B(NF-?B).Methods The critically ill group contained 50 cases,and 25 cases from healthy newborns were used as control group.Blood samples were collected in each case,levels of cytokine interleukin(IL)-4,interferon(IFN)-?,tumor necrosis factor(TNF)-? and NF-?B were detected.Result Compared with control group,NF-?B of the critically ill newborn activated and the cytokine were disorder,and IL-4 and TNF-? increased,but IFN-? decreased.Conclusions Critically ill newborn exist immune functional disorder.Furthermore,NF-?B activation may be involved in the process in infants with critically illness.

DNA methylation is one of the most important epigenetic mechanism and molecular biological basis in tumor suppressor gene silencing.It is now well recognized that solid malignant tumors can release a significant amount of genomic DNA into systemic circulation,and with more than 90％ of this total circulating cell-free DNA derived from tumor tissue,which can reflect the overall cell heterogeneity of the tumor itself.In breast cancer,the presence of abnormally high DNA concentrations in plasma has been reported,and changes in the levels of these circulating DNA associated with tumor burden and progression have been confirmed repeatedly.Accumulating data strongly suggested that DNA methylation patterns found in circulating cell free DNA were similarly with the primary tumor,and could be a useful biomarker in early diagnosis,prognosis assessment,and recurrence monitoring for breast cancer patients.Here,we summarize the latest advances in this research field.

Objective To investigate the effects of different types of anesthesia on the incidence rates of low-er respiratory tract infections of elderly patients in orthopedic department.Methods Clinical data from 445 elderly patients in orthopedic department were collected and retrospectively analyzed.We also investigated the relationship be-tween the types of anesthesia and the lower respiratory tract infections.Results The incidence rates of lower respira-tory tract infections were 23.08%in 169 cases,12.14%in 173 cases,and 4.85%in 103 cases after general anesthe-sia with tracheal intubation,intraspinal anesthesia,and nerve blocking anesthesia,respectively.There was statistically significant difference in the infection rates among the three groups (χ2 =13.784,P=0.001).Conclusion Different ways of anesthesia is critically correlated with the incidence of the lower respiratory tract infections in elderly patients.

AIM: To optimize the extraction process of the total flavonoids of Pollen typhae. METHODS: The optimum extraction process was selected with the orthogonal design (L 27 (3 13 )), using the contents of typhaneoside and isorhamnetin 3 O neohesperidoside as the evaluating criteria. RESULTS: The significant effects of alcohol concentration, extraction time and extraction times on the extraction of the total flavonoids of Pollen typhae were discovered. CONCLUSION: The optimum extraction process was as follows: Pollen typhae was extracted with 40% alcohol for two times, each with the solvent volume 14 times of the weight of the raw materials and extraction time for 3 h.

Objective To analyze the present situation of the dental instrument cleaning and disinfection in Hainan province and to explore the management mode of dental instrument cleaning and disinfection which is suitable for the provincial situation .Meth-ods By adopting the stratified random sampling method according to the hospital grades ,24 hospitals in Hainan province were per-formed the questionnaire survey on the cleaning mode of oral instruments ,layout of cleaning and disinfection room ,cleaning method and facilities ,protection measures and training of cleaning staff .Results 14 hospitals (58 .33% ) had the sterilization and supply center for conducting the centralized processing on the dental instruments .The tertiary hospitals and the second-grade hospitals had the independent cleaning and disinfection rooms with the rational layout and professional cleaning staff ;the safeguard facilities had the application in place ,the training of the related cleaning and disinfection work and the cleaning process conformed the require-ment of the standards .Among 10 first-grade and below hospitals ,only 1 hospital(10 .00% ) had the rational layout of cleaning and disinfection rooms ;3 hospitals(30 .00% ) had the professional cleaning staff ;the related training of the cleaning staff was not basi-cally carried out and the safeguard was not in place ,most of the cleaning and disinfection instruments and the cleaning process were not in accordance with the requirements .The qualification rates of instruments cleaning and disinfection in different grades of hospi-tals by the ATP bioluminescence assay were 100 .00% ,90 .00% and 80 .00% .Conclusion The existing problems are general and prominent in the hospitals of the first-grade and below .It is suggested that the regionalized disinfection and supply management mode is implemented for maximally realizing the optimized resource configuration in the disinfection and supply center .

Objective To evaluate the tolerance and safety of sorafenib for elderly patients with advanced renal cell carcinoma.Methods Forty cases with advanced renal cell carcinoma were enrolled,26 were males and 14 were females,the average age was 70 years.Recurrence or metastasis was found in 32 patients who had received nephrectomy,22 of the 32 cases had received cytokine therapy before recurrence or metastasis.Primary renal lesions of 8 cases could not be resected,so patients get renal tumor biopsy.Pathological type of all patients was clear cell carcinoma.KPS of all the patients were ≥70 points.Sorafenib was used as first-line treatment,with 400 mg twice per day,until intolerance or disease progression occurred.Results The average treatment time was 7.5 months (3-18 months),CR 0 case,PR 6 cases,SD 29 cases,PD 5 cases.The overall objective response rate and disease control rate were 15.0% (6/40)and 87.5%(35/40),respectively.The median follow-up period was 11 months.The adverse reaction included hand-foot skin reaction(70.0%),alopecia (62.5%),rash(52.5%),diarrhea(37.5%),loss of appetite(32.5%),fatigue(27.5%).Most adverse reactions occurred around the second week after drug therapy initiation,their duration did not equal.And most of these adverse reactions could be released by symptomatic treatment,they did not affect the treatment.Conclusions The types of adverse reactions of sorafenib for elderly patients with advanced renal cell carcinoma are similar to those reported in the literature.Generally the degree of adverse reactions is minor,with good tolerance and safety.

The effect of globular adiponectiin (gAd)on the function of NIT-1 cells under high glucose medium was investigated. The results showed that gad could completely block the increase of NADPH oxidase components p47phox expression and recover mRNA expression of pancreatic duodenal homeobox-I ,paired box gene 6,glucose transpoter 2,and glucokinase except neurogenic differentiation factor 1 (P<0.05 or P<0.01). Whereas,impaired insulin secretion and mRNA expression at high glucose concentration were not significantly improved by gAd.

Objective To investigate the clinical features of gynecological malignant tumor related multiple primary malignant neoplasms (MPMN).Methods Apply retrospective and comprehensive analysis to the clinical data of 30 patients with gynecological malignant tumor related MPMN.Results Synchronous MPMN were found in 9 patients.Their average age was 50.2 years old and their median age was 49 years old.The neoplasms were located at ovary,uterus,cervix,breast and intestine.Metachronous MPMN were found in 21 patients.Their average age was 57.7 and their median age was 57 years old.The median interval between the first and the second primary malignant neoplasm was 4.0 years.The neoplasms were located at breast,ovary,uterus,gastrointestinal tract,uterine cervix,lung etc.In 30 cases,26 of them were treated by surgical operation and further adjunctive treatment of chemotherapy and (or) radiotherapy was conducted as per the neoplasm staging and its pathological results.The rest 4 patients (first primary malignant neoplasms were excised from 3 of them and another one was not treated by surgical operation) received adjunctive treatment of chemotherapy and (or) radiotherapy.Followed ups,which varied from 6 to 60 months,were made to 29 patients and 20 out of the 29 were alive.5-year survival rate of patients with gynecological malignant tumor related MPMN was 47.8％,2-year survival rate was 73.9％,and 1-year survival rate was 88.6％.Conclusion Pay more attention to the patients with gynecological malignant tumor related MPMN,examine the high-risk patients with malignant tumor comprehensively,identify whether it is recurrence,metastasis or new growth of malignant neoplasm,and further ensure early diagnosis and proper treatment,avoiding misdiagnosis and missed diagnosis.

0.05).Concusions There exsits the disequilibrium of Th1/Th2 in asthmatic children,but SIT can recovery the balance of Th1/Th2.We find excllent effects of SIT on immune and pulmonery function of asthmatic infants.