Objective To study the treatment of the chronic calcaneus osteomyelitis combined with skin ulcers or defects of the posterior heel following internal fixation for calcaneal fractures.Methods From February 1999 to June 2005,17 cases of calcaneus osteomyelitis combined with skin ulcers or defects following internal fix- ation for their calcaneal fractures were treated with elimination of infection focuses and dead spaces,tissue trans- plants and continuous irrigation.Skin flaps or myocutaneous flaps were used to repair heel ulcers or defects and to fill the dead spaces.Drainage and irrigation tubes were placed into the flap covered areas to carry out the continuous irrigation.Results All the cases were followed up for 3 to 36 months(mean,25 months).All the grafts survived without recurrence of calcaneus osteomyelitis.Their posterior heels regained fair appearance.Thirteen cases obtained fine sensory recovery and friction tolerance and could walk with weight-bearing.Conclusion Calcaneus os- teomyelitis can be cured by simply and effectively tissue transplants and continuous irrigation,which can provide adequate anti-infection and improve blood circulation.

Objective:The hemolytic prediction model of the axial flow impeller blood pump is carried out by using a computational fluid dynamics(CFD) multiphase flow model.Methods:The hydrodynamic performance of the pump and the flow field in the pump, and the shear stress distribution are analyzed. A hemolytic prediction model based on the shear stress is built based on the calculation results. Hemolysis tests in vitro were performed 6 times with fresh bovine blood. At each time, the flow of the ventricular assist device(VAD) is 5 L/min and the outflow tract pressure is 100 mmHg(13.3kPa). According to the tests, the plasma free hemoglobin(FHB) content and the hematocrit(HCT) are measured every half hour. At the end of each experiment Normal Index of Hemolysis(NIH) is calculated.Results:The average of NIH is 0.0055 g/100L, almost identical with that obtained from the hemolytic prediction model.Conclusion:Multiphase flow model can be used for quantitative predictions of the hemolytic behavior of a VAD. This method can be applied in the selection stage of a blood pump.

Objective To explore the feasibility of contrast-enhanced ultrasonograhy (CEUS) in preoperative classification of hepatocellular carcinoma (HCC) microvascular morphology.Methods Totally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline Time-intensity curve (TIC) were drawn using SonoTumor. The tumor size, alpha fetoprotein (AFP), cirrhosis, Child-Pugh classifi cation, tumor differentiation and TNM stage were statistically analyzed. The intratumoralmicrovessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed.Results CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC: 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength (PE), rise time (RT), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-in area under the curve (WiAUC) and mean transit time (MTT) in 28 cases of capillary-like type were (4350.7±2566.0) a.u, (10.7±3.2) s, (717.0±489.9) a.u, (12820.3±8331.6 )a.u, (128 240.8±74 487.1) a.u, (71.9±33.1)s. Those parameters in 14 cases of sinusoid-like type were (2471.6±1107.1) a.u, (16.2±4.2)s, (321.9±171) a.u, (5 561.4±2 938.0) a.u, (86 780.1±47 563.7) a.u, (117.8±69.6)s. And in 52 cases of mixed type they were (3563.2±2343.1) a.u, (14.1±4.8)s, (519.4±403.2) a.u, (9 015.3±6 884.7)a.u, (128 240.8±74 487.1) a.u, (71.9±33.1) s respectively. The CEUS parameters of WiR, WiPI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were signifi cant (WiR: t=3.87, 3.3, bothP=0.05; WiPI: t=2.96, 2.06, bothP=0.05; RT: t=3.19, 2.34, bothP=0.05). The parameter of PE in capillary-like type HCC patients were signifi cantly higher than that in sinusoid-like type HCC patients (t=2.51,P=0.05). And the parameter of PE in capillary-like type HCC patients was higher than mixed HCC patients, but there was no signifi cant difference. The parameters of PE, WiR and WiPI in mixed type HCC patients were higher than that in sinusoid-like type HCC patients, while RT in mixed type HCC patients were lower than that in sinusoid-like type HCC patients, but there were no signifi cant differences. No signifi cant differences of WiAUC and MTT were observed in HCC patients with different microvascular morphology.Conclusions There were signifi cant differences of CEUS parameters in different microvascular morphology types. And CEUS, as a non-invasive method, can be used for preliminary preoperative prediction of microvascular morphology in HCC patients.

Objectlve To investigate the value of basic and contrast-enhanced ultrasound in the diagnosis of superficial cervical lymph nodes.Methods Five hundred and forty-five cases of superficial cervical lymph nodes were sacned by basic ultrasound,in which 52 cases were also scaned by contrast-enhanced ultrasound.All cases were performed ultrasound-guided biopsy.Lymph nodes were divided into benign group and malignant group according to pathology reports.The differences of the two groups were analysed,and statistical analysis was performed.Results Two hundred and thirty cases were benign,315 cases were malignant.S/L(P＜0.01),RI(P＜0.01),vascular pattern(P＜0.01)and contrast enhancement pattern(P＜0.01)between benign and malignant group showed statistical significant differences,while no statistical difference in coefficient correlation of the time-intensity curve between the two groups was found.Conclusions A combination of basic and contrastenhanced ultrasound can significantly enhance the ability to identify malignant lymph nodes from benign lymph nodes.

Objective To analyze the risk factors for failures of intramedullary and extramedullary internal fixation in surgery of femoral intertrochanteric fractures in elderly patients.Methods A retrospective study was conducted of the 205 elderly patients with osteoporotic femoral intertrochanteric fracture who had accepted closed reduction together with intramedullary and extramedullary internal fixation between September 2005 and August 2014.They were 89 men and 116 women,from 65 to 98 year of age (average,78.8 years).By AO classification,137 cases were of types AI.1-A2.1 (stable fractures),and 68 of type A2.2-A3.3(unstable fractures).The incidence of internal fixation failure and Harris scores at the last follow-up were recorded.The factors possibly contributing to the failure were analyzed using the univariate analysis and multivariate logistic regression analysis.Results Of the patients,192 obtained a mean follow-up of 39 months (from 14 to 60 months),but 13 were lost after a 10-month follow-up.Of the 205 patients,internal fixation failure occurred in 12 (incidence of 5.9％).Five failed cases received DHS fixation and 7 accepted PENA fixation.At the last follow-up when the 13 cases were lost after 10-month follow-up,the mean Harris hip score was 81.6 (from 57 to 92),and the excellent to good rate was 84.9％ (29 excellent cases,145 good ones,10 fair ones and 21 poor ones).The multivariate regression analysis revealed that tip-apex distance (TAD) ＞ 25 mm(OR ＝ 333.33),severe osteoporosis (OR =267.44),AO types A2.2-A3.3 (OR ＝ 22.24),functional reduction of fracture (OR =20.79),and concomitant medical diseases (OR =4.59) were independent risk factors for failures of internal fixation.Conclusions DHS and PFNA fixations are effective treatments for elderly patients with femoral intertrochanteric fractures.TAD＞ 25 mm,severe osteoporosis,unstable factures,functional reduction of fracture,and concomitant medical diseases may lead to internal fixation failure in surgery of femoral intertrochanteric fractures in elderly patients.

Objective To investigate the type,clinical and imaging features of iatrogenic bile duct injury and the efficacy and safety of endoscopic and interventional radiology therapy.Methods A total of 48 patients with iatrogenic bile duct injury who have undergone endoscopic and/or interventional therapy from January 1st 2013 to June 30th 2016 were enrolled.Patients' general information,causes of injury,clinical manifestations,treatment methods,efficacy and complications were retrospectively analyzed.Results The causes of iatrogenic bile duct injury were cholecystectomy(45.8％,22/48),liver transplantation (35.4％,17/48),transjugular intrahepatic portosystemic shunt (8.3％,4/48),Roux-en-Y anastomosis (6.3％,3/48) and endoscopic retrograde cholangiopancreatography (4.2％,2/48).The most common type of iatrogenic bile duct injury was stenosis of intra/extra bile ducts (66.7％,32/48).Other types included biliary fistula(18.8％,9/48),hemobilia (10.4％,5/48) and stenosis of anastomotic stoma (4.2％,2/48).The most common clinical manifestations were jaundice (37.5％,18/48) and abdominal pain (29.2％,14/48).Other clinical manifestations were fever (14.6％,7/48),hematemesis or melena (8.3％,4/48) and abnormal drainage fluid (8.3％,4/48).Diagnosis was confirmed by angiography,cholangiography or endoscopy.The overall effective rate of minimally invasive therapy was 91.7％ (44/48) and the most common complications were fever (16.7％,8/48) and pancreatitis (10.4％,5/48).Other complications were hemobilia (2.1％,1/48),cardia dilaceration (2.1％,1/48) and biliary fistula caused by catheter shedding(2.1％,1/48).Conclusion Iatrogenic bile duct injury could occur after upper abdominal surgeries,endoscopic or interventional procedures.Early diagnosis and treatment with endoscopic or vascular interventional methods can achieve satisfying efficacy and safety.

[Objective] To investigate the clinical characteristics and blood transfusion status of patients of liver cirrhosis and analyze its rationality.[Methods] We designed questionnaires to collect the data of patients admitted with liver cirrhosis including clinical features,blood transfusion,smoking,drinking and other living habits.We follow up the patients and analyze the blood transfusion rationality.[Results] Data on 198 patients was collected.34.8％ (69/198) of all patients were transfused at least one blood component.Total blood transfusion was 371 times,of which 52.2％ of the blood transfusion cases (36/69) were transfused with two or more blood during hospitalization.Among the 69 cases of blood transfusion,11 cases were treated with the first blood transfusion for the purpose of treatment and 58 cases for prevention.18 of those cases were infused with red blood cells of 90.5 units.54.55 ％ (60/110) and 60.91％ (67/110) of patients who had a pre-transfusion INR＞1.3 did not receive plasma.2.27％ (2/88) of patients who had a pre-transfusion INR≤1.3 received plasma.29.41％ (5/17)who had a pre-transfusion fib≤1.0 received cryoprecipitate.3.87％(7/181) who had a pre-transfusion fib＞1.0 received cryoprecipitate.[Conclusions] Blood transfusion is common in patients with liver cirrhosis.Empirical and preventive blood transfusion is common also.We should take a more scientific restrictive blood transfusion strategy.

Objective To explore how to control schistosomiasis at the presence of snails in lake marshland. Methods From March 1st to October 31st every year, 2000-2002- the measure of "marshland isolation and farming prohibition" was carried out. Local residents and cattle were examined and treated for schistosomiasis. Results The infections rate of schistosomiasis in surveillance spots decreased from 2.66% (1999) to 1.66% (2002). The infections rate was 0.57% (5/ 871 ) in the township. There were no acute schislosomiasis cases and new patients. The rate of schistosomiasis of cattle decreased from 4. 90% (1999) to 0. 14% . and there was no new calf under two years of age infected. The rale of infected snails decreased from 1. 450% to 0. 005% , and the density of positive snails from 0. 014 8 snail /0. 1 m2 to 0. 000 11 snail/0. 1 m2. Conclusion The measure, mainly including "marshland isolation and farming prohibition", can control schistosomiasis prevalence even at the presence of snails in lake marshland.

BACKGROUND:Stroke is the leading cause of death and long-term disability. This study was undertaken to investigate the factors influencing daily activities of patients with cerebral infarction so as to take interventional measures earlier to improve their daily activities. METHODS:A total of 149 patients with first-episode cerebral infarction were recruited into this prospective study. They were admitted to the Encephalopathy Center, Department of Neurology, the First Affiliated Hospital of Wenzhou Medical College in Zhejiang Province from August 2008 to December 2008. The baseline characteristics of the patients and cerebral infarction risk factors on the first day of admission were recorded. White blood cell (WBC) count, plasma glucose (PG), and many others of laboratory targets were col ected in the next morning. Barthel index (BI) was calculated at 2 weeks and 3 months respectively after onset of the disease at the outpatient clinic or by telephone cal . Lung infection, urinary tract infection and atrial fibrillation if any were recorded on admission. The National Institute of Health Stroke Scale (NIHSS) scores and the GCS scores were recorded within 24 hours on and after admission, at the second week, and at the third month after the onset of cerebral infarction respectively. RESULTS:The factors of BI at 2 weeks and 3 months after onset were the initial PG level, WBC count and initial NIHSS scores. Besides, urinary tract infection on admission was also the factor for BI at 3 months. CONCLUSION:Active measures should be taken to control these factors to improve the daily activities of patients with cerebral infarction.

We have developed a rapid and high throughput lipase-ANS (8-Anilino-l-naphthalenesulfonic acid) assay to evaluate the thermo-stability of lipases based on the ANS fluorescence signal's increasing and shifting when this small fluorescence probes binds to lipase. The testing lipase samples were incubated at a temperature range of 25 degrees C to 65 degrees C for 30 min before mixed with ANS solution (0.20 mg/mL lipase and 0.05 mmol/L ANS in the buffer of 20 mmol/L Tris-HCl, 100 mmol/L NaCl, pH 7.2) in a cuvette or microplate. Fluorescence signals of the samples were measured at EX 378 nm, EM 465 nm with a fluorescence photometer or a plate reader, and Tm was calculated with the software of GraphPad Prism5.0. The Tm values of several mutants of Penicillium expansum lipase (PEL) were measured with this ANS assay and conventional method simultaneously and the results show that Tm values are comparative and consistent between these methods, suggesting that the lipase-ANS assay is a reliable, rapid and high throughput method for lipase thermo-stability measurement.
Anilino Naphthalenesulfonates ; chemistry ; Enzyme Stability ; High-Throughput Screening Assays ; methods ; Hot Temperature ; Lipase ; metabolism ; Spectrometry, Fluorescence