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.

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.

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.

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 introduce the technique and report our initial experience of Retziussparing robotic-assisted laparoscopic radical prostatectomy (RALP) and compare perioperative outcomes with the standard veil of Aphrodite technique (Veil technique).Methods nineteen Retzius-sparing RALP and 20 Veil nerve sparing RALP with posterior reconstruction for T1c to T2c prostate cancer performed by a single surgical team between 2015 January and 2016 December were retrospectively reviewed.Preoperative data of patients in Retzius-sparing group [patient age (66.3 ± 5.9) years,BMI (25.5 ± 3.1) kg/m2,tPSA (16.4 ± 5.0) ng/ml,biopsy Gleason score 6 (5-7),prostate volume (32.7 ± 7.4) ml and IIEF-5 score 14(5-18)] and Veil group[patient age (64.6 ±7.3) years,BMI (25.5 ±2.0) kg/m2,tPSA (18.5 ± 11.0) ng/ml,biopsy Gleason score 7(5-8),prostate volume (31.4± 10.8)ml and IIEF-5 score 15(6-19)].No significant difference was found between the two group in the above parameters (all P ＞ 0.05).All patients were continent preoperatively.Retzius-sparing RALP and Veil nerve sparing RALP were performed via transperitoneal RALP.Operative time,estimated blood loss,postoperative hospital stay,postoperative staging,postoperative Gleason score,return of urinary continence and postoperative IIEF-5 score of the two groups were statistically analyzed.Results All 39 cases were successfully performed robotically without conversion,transfusion or other major intraoperative and postoperative complications.Postoperative pathology confirmed pT2a 5 cases,pT2b 8 cases and pT2c 6 cases in Retzius-sparing group and pT2a 7 cases,pT2b 5 cases and pT2c 8 cases in Veil group (all P ＞ 0.05).For Retzius group,operative time was (106.5 ± 26.4) min and estimated blood loss was (48.9 ± 20.2) ml;for Veil group,operative time was (93.2± 20.8) min and estimated blood loss was (42.5 ± 16.8) ml.No significant difference was found in the above parameters (all P ＞ 0.05).Urethral catheter was removed at postoperative 7-day (Retzius-sparing group) and 21-day (Veil group),respectively.18 patients in Retzius-sparing group achieved urinary continence (0 pads) immediately after the removal of urinary catheter,while 1 patient returned to full continence in 2 weeks postoperatively.Patients in Veil group returned to continence (6.8 ± 3.6) weeks postoperatively (P ＜ 0.001).At 3-month follow up,IIEF-5 score was 14 (4-16) in Retziussparing group and 14 (4-18) in Veil group;no significant changes was noted in preoperative and postoperative IIEF-5 score in both groups,or in postoperative IIEF-5 scores in the two groups (P ＞ 0.05).No sign of tumor recurrence was appreciated for all cases (tPSA ＜ 0.2 ng/ml) during follow-up of 6 months (3 to 12 months).Conclusions Retzius-sparing RALP and the Veil nerve sparing RALP were both effective for the surgical treatment of localized prostate cancer.Our data revealed no statistical difference in perioperative outcomes between the two approaches,however,the Retzius-sparing technique seemed to yield a better outcome regarding early return to urinary continence postoperatively.

Objective To predict the disease progression risks of healthy rhesus ( normal) and rhesus infected with simian immunodeficiency virus ( SIV) in the stages of long-term nonprogressor ( LTNP) , normal progressor ( NP) , rapid progressor ( RP) by discriminant analysis. Methods Five-year observation was carried out in SIV infected rhesus model without any intervention. The SIV infected rhesus model at the stages of LTNP, NP, RP were selected, 10 in each group, and T lymphocyte subsets and serum parameters for spleen-deficiency syndrome and kidney-deficiency syndrome in SIV infected rhesus were compared with 5 healthy monkey having the same survival time. The influence factors of different types of disease progression were screened from T cell subsets and Chinese medical syndrome indexes, and then the discriminant equation was established to predict the risks. Results White blood cell ( WBC) count and lymphocyte ( LYM) ratio were enrolled into the discriminant equation before infection, and T4 level and Log10RNA of set point were enrolled into the discriminant equation in the platform period. The test results for the uniform rate of the established discriminant function showed that the total coincidence rate of theoretic distinguish to the actual data was 57.1% , 91.2%respectively before infection and in the platform period. Conclusion The pre-infection WBC count and LYM ratio can be used as a reference for the evaluation of different types of disease progresson, and Log10RNA and T4 level at platform phase can be used as the predicting factors of different types of disease progression risk prediction.

Objective:To explore the clients' assessment for the ethical behavior of the counselors and psychotherapists.Methods:The main method used in this evaluation was questionnaire,and the self-made questionnaire of the ethical problems in psychotherapy and counseling(for the clients)were used as evaluation tools.Totally 1100 clients,from 12 cities in China,were investigated with 807 questionnaires returned.Results:84.5% of the clients were confident in the treatments,and 89.2% of them gave positive assessment for the ability of their counselors and psychotherapists.15.9% of clients said the counselors and psychotherapists showed impatience or talked to them about their stress sometimes.Besides,59.1% knew about the characters,names and charge of the psychotherapies and counseling,and 53.4% knew the background of the counselors and psychotherapists.91.3% of clients thought the privacy and treatment could be kept secret.7% of clients had intimate relationship with their counselors or psychotherapists,1.5% had sexual relations,and 18.3% made friends in lives.79% of clients could receive timely psychotherapies and counseling.Conclusion:From the assessment of the clients,the vast majorities of the counselors and psychotherapists do well in work ability,confidentiality and time-setting,but not so well in informed-consent and dual relations,which need to be paid attention to and improved.

Objective To compare the efficacy of MRI and DSA in assessment of carotid artery stenosis and atherosclerotic plaque.Methods Forty-six patients with carotid plaque detected by ultrasound were enrolled in this study,and 89 carotid arteries were evaluated by MRI and DSA.MRI examination was acquired with 3.0 T MR scanner and 8 channel phase-array surface coil.The MRI sequences consisted of pre-and post-contrast T1WI,T2WI,PDWI,TOF.Anterior-posterior and lateral views of carotid artery were performed on DSA.The degree of carotid artery stenosis was evaluated by the NASCET standard.Fibrous cap rupture,intraplaque hemorrhage,and calcification were also evaluated on MRI and DSA.Statistical comparison was performed with the Kappa value and paired Chi-square test.Results The degree of carotid artery stenosis was 50％ (16％-78％) on MRI and 47％ (7％-73％) on DSA.Two imaging modalities were in good consistency in evaluation of the degree of stenosis ( Kappa =0.882,P ＜ 0.01 ).There was statistical difference in detecting fibrous cap rupture by MRI and DSA (34 vessels vs 10 vessels,respectively,x2 =20.346,P ＜ 0.01 ).Furthermore,thirty-seven vessels with intraplaque hemorrhage and 71 vessels with calcification in the plaque were found on MRI but none on DSA.Conclusion MRI is a reliable tool in assessment of the degree of the carotid stenosis and it is superior to DSA in detecting fibrous cap rupture,intraplaque hemorrhage,and calcification.