Objective To study the application of open reduction and plasticity titanium plate in the treatment of calcaneal fracture.Methods 29 patients with sanders Ⅱ、Ⅲ、V calcaneal fracture were treated by surgery with open reduction and titanium plate fixation.The clinical effects were observed.Results All patients were followed by Maryland Foot score postoperative functional evaluation system,the group of 29 cases of fracture,excellent 21 cases,good 9 cases,acceptable 2 cases,excellent rate was 93.7％.Condtusion The open reduction and internat fixation with plastic titanic plate was reliable to treat displaced intra-articular fracture of calcaneus.

Objective To discuss the clinical effects of anal cushion suspensory and external hemorrhoid airfoil-shaped suture in treatment of ring-ship mixed hemorrhoid,improve the level of the surgical treatment of ring-ship mixed hemorrhoid.Methods One hundred and twenty patients with ring-ship mixed hemorrhoid were divided into treatment group (60 cases treated by anal cushion suspensory and external hemorrhoid airfoil-shaped suture) and control group (60 cases treated by Milligan-Morgan operation) according to the operation method.The postoperative pain,hospitalization time,wound healing time,postoperative complications,etc were observed and compared.Results The cure rate was 100.0％ (60/60) in treatment group and 70.0％ (42/60) in control group,and there was significant difference between two groups (P ＜ 0.05).The hospitalization time,wound healing time was (8.58 ± 0.89),(14.00 ± 0.72) d in treatment group,(10.20 ± 0.30),(19.00 ± 0.21) d in control group,and there was significant difference between two groups (P ＜ 0.05).The incidence of postoperative complications and the degree of postoperative pain in treatment group was lower than that in control group,and there was significant difference between two groups (P ＜ 0.05).Conclusion Anal cushion suspensory and external hemorrhoid airfoil-shaped suture in treatment of ring-ship mixed hemorrhoid has advantage of shorter wound healing time,less postoperative pain,less postoperative complications.

Objective To study the application efficacy of ultrasound-guided catheter lavage in patients with severe pancreatitis surgery. Methods 60 patients with severe pancreatitis from January 2009 to March 2013 in our hospital were randomly and equally divided into the experimental group and the control group. Patients of the control group were merely treated with comprehensive treatment after severe acute pancreatitis operation,and Patients of the experimental group were given ultrasound-guided catheter lavage treatment additionally. Hospital stays,clinical examination indicators and clinical effects of the two groups were analyzed. Results Hospital stay of experimental group was significantly shorter than the control group (P<0. 05);the temperature and heart rate of experimental group was significantly lower than con-trol group (P<0. 05);leukocyte,serum amylase and urine amylase of the experimental group were significantly lower than the control group (P<0. 01). The total effective rate of experimental group (93. 3%) was significantly higher than the control group (66. 7%),which means a statistically difference (P<0. 01). Conclusion Ultrasound-guided catheter lavage has good results for patients with severe pancreatitis surgery,and it is worthy of clinical application.

Objective To investigate the efficacy and safety of long guidewire exchange technique in performing cerebral angiography via radial artery approach.Methods The clinical data of 257 patients,who received cerebral angiography during the period from June 2014 to May 2016 at Daxing Hospital of Capital Medical University,Beijing,China,were retrospectively analyzed.Among the 257 patients,186 had type Ⅱ or type Ⅲ aortic arch.According to the different looping technologies for Simmons-2 catheter used in the performance of cerebral angiography,these 186 patients were divided into the study group (n=90) and the routine group (n=96).The success rate of radial artery puncturing,the success rate of Simmons-2 catheter looping formation,the success rate of supra-arch arterial catheterization,the time spent for angiography,the radiation exposure time,complications,etc.were recorded.Results The success rate of radial artery puncturing was 100％ in both groups.The success rate of Simmons-2 catheter looping formation in the study group was 97.8％,which was significantly higher than 72.9％ in the routine group (P＜0.05).The success rates of catheterization for the left subclavian artery,left common carotid artery and right carotid artery in the study group were 97.8％,97.8％ and 97.8％ respectively,which were remarkably higher than 72.9％,72.9％ and 72.9％ respectively in the routine group (P＜0.05).No statistically significant difference in the success rates of catheterization for right subclavian artery and for right vertebral artery existed between the two groups (P＞ 0.05).The time spent for angiography in the study group and the routine group was (22.5±9.4) min and (28.3±8.3) min respectively.The radiation exposure time in the study group was (8.9±4.5) min,which was obviously lower than (12.6±6.5) min in the routine group (P=0.017 and P=0.035,respectively).The incidences of complications in the study group and the routine group were 4.4％ and 5.2％ respectively,the difference was not statistically significant (P＞0.05).No severe complications,such as intracranial arterial embolie events,puncture bleeding,arterial occlusion,etc.,occurred in all patients of both groups.Conclusion The use of long guidewire exchange technology can improve the success rate of Simmon-2 catheter looping formation and the success rate of supra-arch arterial catheterization,it can also shorten the time for angiography procedure and reduce the radiation exposure time.This technique is very effective with higher safety.Therefore,this long guidewire exchange technique should be used as a common method for cerebral angiopraphy via radial artery approach in patients with type Ⅱ or type Ⅲ aortic arch.

Objective To investigate the expression of proinsulin, insulin, C-peptide in insulinoma and normal pancreas and their roles. Methods Thirty-eight cases of insulinoma and 20 cases of normal pancreas from Sep. 2006 to Dec. 2009 in our hospital were selected. Immunohistochemistry was used to determine the expression of proinsulin, insulin, C-peptide. Results Proinsulin, insulin, C-peptide was expressed in insulinoma and normal pancreas. Proinsulin, C-peptide were strongly expressed in 100%insulinoma, while they were weekly expressed in 55% ～60% normal pancreas; insulin was expressed as + + +in 79% insulinoma, while it was expressed as + + + + in 85% normal pancreas. Proinsulin, C-peptide positive cell accounted for 80% ～ 100% of 38 insulinoma, and insulin positive cell accounted for 50% ～ 70%,the proinsulin/insulin ratio ＞ 1 accounted for 78.9%; while the corresponding values were 20% ～ 80%, 60% ～90%, 10.0% in normal pancreas, and the difference was statistically significant ( P ＜ 0.05 ). Conclusions The proinsulin/insulin ratio ＞ 1 is 78.9% in insulinoma, and detection of proinsulin may help to diagnose insulinoma.

Objective To observe the effect of elbow support on muscle activity and subjective feelings of comfort during typing.Methods Ten college students voluntarily participated in this experiment.They typed the same text using elbow supports of five different heights.The distance between their elbows and the desk was supported at 3 cm below,0 cm,and-3 cm and-6 cm above the desk.There was also an unsupported condition.Myoelectric readings were recorded from the right splenius,trapezius,biceps,extensor carpi radialis,flexor digitorum superficialis,flexor carpi radialis,and extensor digitorum muscles.Perceptions of comfort of the neck,shoulder,hand and forearm,and hand using the different supports were surveyed using a questionnaire.Results One way ANOVA shows that the height of the elbow significantly affects the activity of the trapezius,the extensor carpi radialis and the extensor digitorum muscles.Trapezius muscle activity was higher with 3 cm high elbow support than without support,and the value was smaller when using-6 cm elbow support.The activity of the carpi radialis longus extensor was least when using-6 cm and-3 cm elbow support,and greatest with 3 cm support.Extensor digitorum activity was least when using-3 cm high elbow support and again greatest with 3 cm support.The different elbow support heights had no significant relationship with comfort perceptions for any body part.Conclusion The height of elbow support can change the average myoelectric signals from muscles during typing,but there is no significant difference in the typist's perception of comfort.This could be due to a change of typing position and neuromuscular motion control mode in response to the height of elbow support.

Objective To investigate the values and characteristics of 75 g oral glucose tolerance test (OGTT) in pregnant women.Methods A total of 6 103 singleton pregnant women aged (30.4±3.8) years (18-49 years) who delivered in Peking University First Hospital between May 1,2011 and December 31,2012 underwent the 75 g OGTT at gestational age of 24-28 weeks.They were divided into five groups based on maternal age:＜25 years (n=222,3.6％),25-years (n=2 485,40.7％),30-years (n=2 573,42.2％),35-years (n=683,11.2％),and ≥ 40 years (n=140,2.3％).The normal values of the fasting,1 h and 2 h blood glucose were lower than 5.1,10.0 and 8.5 mmol/L.Gestational diabetes mellitus (GDM) was diagnosed when blood glucose of any point was higher than or equal to normal value.Comparison between groups was tested by analysis of variance and LSD test.Logistic regression was used to calculate the risk for GDM in different age groups.Results (1) The fasting,1 h and 2 h blood glucose levels were in Gaussian distribution.The （-x）+2s were 5.51,11.12 and 9.49 mmol/L.The 97.5 percentile were 5.63,11.32 and 9.95 mmol/L.Fasting plasma glucose of ＜ 25,25-,30-,35-,and ≥ 40 years were (4.53±0.40),(4.60±0.40),(4.67±0.43),(4.74±0.46) and (4.82±0.49) mmol/L.The 1 h blood glucose were (6.98± 1.70),(7.55± 1.60),(7.92± 1.63),(8.30± 1.71) and (8.76± 1.86) mmol/L.The 2 h blood glucose were (6.11±1.33),(6.53±1.27),(6.89±1.33),(7.23±1.50) and (7.57±1.60) mmol/L.Therewas statistical difference in the blood glucose levels at a same time-point test among different age groups (F=29.61,60.17 and 72.29,all P＜0.01).(3) The total prevalence rate of GDM was 21.1％ (1 290/6 103) ; and the prevalence rates were 9.9％ (22/222),16.7％ (414/2 485),22.7％ (583/2 573),32.1％ (219/683) and 37.1％ (52/140) among the five age groups,respectively,with significant differences (x2=120.68,P=0.00).Compared with the group aged ＜25 years,the OR (95％CI) of the prevalence among 25-,30-,35-,and ≥40 years group were 1.82 (1.16-2.86),2.66 (1.70-4.18),4.29 (2.69-6.86) and 5.37 (3.08-9.39),respectively.Conclusions Advanced age is a risk factor for GDM.The risk of GDM increases significantly after 35 years old and pregnancy in women aged ＜ 35 years can reduce the risk of GDM.

OBJECTIVE To investigate the risk factors of nosocomial infection in patients with advanced nasopharyngeal cancer during radiotherapy with concomitant weekly paclitaxel treatment. METHODS Twenty six cases of advanced nasopharyngeal cancer patients in our hospital were analyzed retrospectively. RESULTS There were 20 cases of nosocomial infection from inpatients.The infection rate was 76.9 % and isolates of bacteria were found,of which Candida albicans accounted for 46.2%,Gram-negatives were 38.5%,Gram-positives were 11.5%.The main risk factors were long time hospitalization,oral mucosal lesion,leukocytopenia,improper application of antibiotic and glucocorticoids. CONCLUSIONS To prevent and control nosocomial infection in advanced nasopharyngeal cancer during radiotherapy and concomitant chemotherapy,measures such as shortening hospitalization days,reinforcing oral nursing,preventing the leukocytopenia,reasonable using of antibiotics and glucocorticoids should be adopted.

Objective To investigate the expression of pro-inflammatory cytokines in lumbar dorsal root ganglions (DRG) of rats model of high-dose fentanyl induced hyperalgesia. Methods 64 male SD rats were divided into 2 groups (n = 32), fentanyl group and normal saline (NS) group. The rats were injected with fentanyl (60 μg/kg) or NS 4 times in total subcutaneously with a 15-minute interval. Mechanical and thermal nociception were measured via the tail pressure test (tail flick thresholds, TFT) and paw withdrawal test (paw withdrawal latency, PWL) at 1 day before, at 1, 2, 3 and 4 hour and on 1 ~ 7 day after administration. 4 rats were sacrificed and the lumbar DRG were harvested to analyze the expression of PGE2 , IL-1β, IL-6 and TNF-αvia ELISA. Results There were no significant changes of TFT, PWL and the expression of pro-inflammatory cytokines in DRG compared to baseline of rats in NS group. The value of TFT , PWL in fentanyl group were above the baseline at the 1 ~ 4 hour and below the baseline at 1~3 day after fentanyl injections. PGE2 , IL-1β, TNF-α and IL-6 increased on 1,3,5,7 day after fentanyl injections significantly. Conclusions High-dose fentanyl induced significant hyperalgesia and up-regulation of pro-inflammatory cytokines in DRG. The expression pro-inflammatory cytokines peaked later and were more protracted than the change of behavior test and show no direct relationship between the two.

Objective To explore the clinical feature and diagnosis of the X linked adrenal hypoplasia congenital (X-AHC). Methods The clinical data and gene detection results of one case of AHC were retrospectively analyzed. The related literatures were reviewed. Results Two-month-old male infant was suffered with slow weight gain, vomiting, and salt craving of adrenal insufifciency after birth. Gene detection found a new missense mutation on NROB 1 gene. The diagnosis of X-AHC was conifrmed. Conclusions X-AHC is a kind of rare disease and is diagnosed by clinical manifestation, laboratory testing, and NROB 1 gene detection.