BACKGROUND:Cannulated screw tension band combined with wire fixation is most commonly used for treatment of patel a fractures.
OBJECTIVE:To evaluate the clinical outcomes of combination of cannulated screw tension band and wire fixation in the treatment of patel a fractures.
METHODS:A literature search method was employed to retrieve relevant articles addressing cannulated screw tension band and wire fixation of patel a fractures. In-depth analysis of literatures meeting the study criteria was carried out. Patients with patel a fractures who received cannulated screw tension band and wire fixation were fol owed up to evaluate the postoperative fracture healing, complications and functional recovery of the knee joint at the injury side. Then, the clinical efficacy of cannulated screw tension band combined with wire fixation was analyzed.
RESULTS AND CONCLUSION:After treatment with cannulated screw tension band and wire fixation, patients with patel a fractures exhibited good fracture healing and low probability of complications, including screw or wire loosening, broken, and shedding. Functional recovery of the affected knee was up to 90%. Clinical case analysis showed that cannulated screw tension band combined with wire fixation achieved good outcomes in the treatment of patel a fracture, with over 90%functional recovery of the affected knee, which is consistent with the reported results. It indicates that the cannulated screw tension band combined with wire fixation is one of the ideal and reliable methods in use for internal fixation of patel a fractures.

Objective To explore the efficacy and side effect of CAG (G-CSF, aclarubicin and cytarabine) priming chemotherapy for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Methods 54 patients with AML at diagnosis and relapse or MDS were'enrolled for the initial treatment with CAG regimen. Patients who have achieved complete remission (CR) were treated with various regimens. Results The total effective rate was 72.2 %, complete remission rate was 48.1% and partial remission rate was 24.1%. The incidence of granulocyte deficiency was 40.7 %(22/54). The severe infection rate was 24.1%(13/54). One case died of function damage in liver. The study includes 36 patients below 60 years, 18 patients above 60 years, and overall effective cases are 28 (77.8 %), 11 (61.1%),respectively. There was significant difference (P ＜0.05). Conclusion CAG regimen is effective and well tolerated in remission for AML and MDS-RAEB.

After investigating conditions of 210 seven-year system medical students' extracurricular reading,we discovered that most medical students were rather interested in extracurricular reading,but there existed certain problems in the aspects of the arrangement of time and choice of books etc,which not only lowered the quantity of the student' extracurricular reading,but was disadvantageous to the effective display of the humanities education.Therefore,it was necessary to enhance the seven-year system medical students' extracurricular reading.

Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.

Chronic insomnia is a severe disease that seriously influence the human health,and about 10%-15% of the adults suffer from it.No definite conclusion has been made about its etiology up to now,possibly associated with heredity,hormone secretion and living habits.Insomnia not only decreases the patients' quality of life,but also adds burden to society,families and individuals.The diagnosis of chronic insomnia should be based on the patients' sleep history,medication history,psychiatric history and necessary examinations.International diagnosis criteria should be combined if possible.Presently the treatments for chronic insomnia mainly include the OTC medicine,prescription drugs,self-medication with alcoholic beverage,cognitive behavior therapy,melatonin and some traditional herbal therapies.Limited information is available presently about insomnia and a large amount of laboratory and clinical research need to be done to further understand and solve this public problem.

Objective To study the expression of tight junction factors in human placental tissues derived from assisted reproductive technology (ART) and natural pregnancy and its role in placental barrier.Methods Ten placental samples were collected from the women who had undergone ART treatment and 11 placenta were collected from control group.Transmission electron microscope (TEM) examination was utilized to detect the morphology of placental tight junctions.The mRNA of claudin (CLDN) 1,CLDN4,CLDN5,CLDN8,zonula occudens (ZO) 1 was detected by real-time PCR and the protein of CLDN4,CLDN8 and occludin (OCLN) were measured by western blot.Results TEM microscopy results showed that placenta samples derived both ART and control placenta had normal microscopic histological features of tight junctions,localized in the apical part of the syncytium and also between the cell-cell contacts of fetal blood vessel endothelial.The expression level of CLDN4 mRNA were 0.87 ±0.17 in ART group and 1.18 ± 0.30 in control group,respectively.The expression level of CLDN8 mRNA were 3.25 ± 2.32 in ART group and 1.08±0.41 in control group,respectively.The mRNA level of CLDN4 and CLDN8 were significantly differentially expressed in ART derived placenta when compared with control groups.The expression level of CLDN1,CLDN5,OCLN and ZO1 mRNA were 0.49 ± 0.44,0.80 ± 0.20,0.92 ± 0.18 in ART group and 1.09±0.82,1.21 ±0.78,0.80± 0.27 in control group,respectively,in which there were no significant differences between two groups.Western Blot analysis showed the protein levels of tight junctions CLDN4,CLDN8 and OCLN did not differ between groups.Conclusions Tight junction factors were expressed in human placental tissues.Tight junction derived from ATR platenta might have mild dysfunction.

OBJECTIVE:To observe the effects of different regimens of tranexamic acid on perioperative bleeding and postoper-ative compliance of simultaneous bilateral total knee arthroplasty(TKA). METHODS:A total of 70 patients undergoing simultane-ous bilateral TKA in our hospital were randomly divided into control group and observation group,with 35 cases in each group. Control group was given Tranexamic acid injection 15 mg/kg 30 min before surgery. Observation group was given Tranexamic acid injection 15 mg/kg,30 min before surgery and 30 min before suturing incision. The operation duration,total blood loss,intraopera-tive blood loss,postoperative drainage as well as the levels of FIB,PT,APTT before trectment and 3 d after surgery,the occur-rence of postoperative compliance and ADR were observed and compared between 2 groups. RESULTS:There was no statistical significance in operation duration,intraoperative blood loss and rate of ADR between 2 groups (P>0.05). The total blood loss, postoperative drainage and the incidence of complications of observation group were significantly lower than those of control group,with statistical significance(P<0.05). There was no statistical significance in coagulation indexes(FIB,PT and APTT)be-tween 2 groups before treatment and 3 d after surgery,with statistical significance(P>0.05). CONCLUSIONS:The application of tranexamic acid 30 min before simultaneous bilateral TKA and 30 min before the end of surgery can reduce perioperative bleeding and postoperative venous thromboembolism with good safety.

Nowadays more and more medical study fields need mathematics knowledge.The mathematics abilities of medical students include the ability of basic logic thought,changing medical problems into mathematics ones,understanding and applying mathematics knowledge as well as solving mathematics problems with computers.

Objective To investigate the microRNAs(miRNAs)expression profiles in the bowels of patients with Hirschsprung disease(HSCR),and to explore the role of differentially expressed miRNAs in the pathogenesis of HSCR. Methods Twenty - seven HSCR tissues,including spastic segments and distending segments,were obtained from patients with HSCR during operation. Then miRNA microarrays were used to investigate the miRNA expression profiles in 6 HSCR specimens. Bioinformatics software was used to predict target genes of miRNA. Three miRNAs (miR - 145 - 3p,miR - 4505 and miR - 1260a)were chosen and quantificational real - time(qRT)- PCR was per-formed to verify the different expression of those three miRNAs in 27 HSCR tissues. Results The expression of 26 miRNAs in an aganglionic colon segment was found to be more than two fold greater than that in ganglionic segment tis-sues,including 19 up - regulated miRNAs and 7 down - regulated miRNAs in patients with HSCR(all P ﹤ 0. 05). Tar-get genes of miRNAs were found,such as SOX10,RET,L1CAM. qRT - PCR showed the expression of miR - 145 - 3p (1. 42 ± 0. 42,aganglionic segment vs 0. 90 ± 0. 31,ganglionic segment)and miR - 4505(1. 30 ± 0. 30,aganglionic segment vs 0. 76 ± 0. 22,ganglionic segment)displayed a statistical difference between groups(all P ﹤ 0. 001). Be-sides,the expressions of miR - 145 - 3p(1. 53 ± 0. 46,long - segment type vs 1. 16 ± 0. 12,short - segment type)and miR - 4505(1. 42 ± 0. 26,long - segment type vs 1. 00 ± 0. 16,short - segment type)showed a statistical difference be-tween different types(all P ﹤ 0. 001),but miR - 1260a(1. 11 ± 0. 25,aganglionic segment vs 0. 99 ± 0. 21,ganglionic segment)did not show differential expression between different groups(P = 0. 064). Conclusions Abnormal expression of miRNAs was found in HSCR spastic segments,suggesting that miRNAs may be involved in the pathogenesis of HSCR.

Objective To systematically evaluate the effectiveness of diabetes self-management education through telemedicine on glycosylated hemoglobin (HbA1c). Methods Randomized clinical trials (RCTs) that assessed the effectiveness of remote diabetes self-management education in patients with diabetes were systematically reviewed using multiple electronic databases. The searching time was from database establishment to May 2015. These articles were analyzed after evaluation of their quality. Results Eight RCTs were included involving 2 047 patients.The results of Meta-analysis showed the effectiveness of remote DMSE on reduction of HbA1c of patients with type 2 diabetes was more significant than that of the control group [WMD=-0.50,95%CI (-0.88,-0.12),P < 0.05],while failing to support the effectiveness of remote DMSE on patients with type 1 diabetes [WMD=0.62, 95%CI(-0.19,1.43), P>0.05]. Conclusions Remote DMSE is effective to improve the glycemic control in patients with type 2 diabetes,while the effect on patients with type 1 diabetes is still not certain. Large-scale and multi-centered RCTs are needed to confirm its effectiveness.