Objective To investigate effects of ACUMED self-orientated elbow plate system in treatment of comminuted distal humeral fractures (type C) in adults.Methods Thirty-two adult cases of comminuted distal humeral fractures treated by open reduction and internal fixation with parallel dual plates from May 2009 to October 2010 were enrolled in the study.There were 17 males and 15 females,at average age of 60 years (range,21-85 years).All cases were subjected to closed fractures,involving left side in 15 cases and right side in 17.Besides,two cases had associated ulnar nerve injury.According to AO classification,there were 12 cases of type C1,12 of type C2 and eight of type C3 fractures.The time from injury to operation averaged 5.6 days.Distal humeri were exposed through posterior median incision of elbow and V shape osteotomy of olecroanon.Muscular contractile and relaxant functional exercise was taken within 24 hours postoperatively.Clinical results were assessed based on Mayo elbow performance score (MEPS) and X-ray films.Results X-ray films showed that all cases obtained primary bone healing in the follow-up (mean 12 months).Three cases of type C3 fractures had heterotopic ossification.All cases had no complications like infections or implant loosening postoperatively.Range of motion in elbow flexion and extension averaged 85° (range,8°-140°).MEPS was average 90 points (range,60-100 points),including excellent outcomes in 13 cases,good in 15,fair in one and poor in three,with excellence rate of 88％.Conclusion ACUMED parallel dual plate fixation technique based on stability theory of arch structure achieves solid fixation of adult comminuted distal humeral fractures,successfully reconstructs bone structure of distal humeri,and effectively restores elbow joint function in response to early rehabilitation exercise.

It remains a common problem that the evaluation model of course learning for stu-dents is so simple in the higher education of China. Moreover, the teachers are usually used to evalu-ating student's course learning by summative appraisal and ignore process appraisal, so that the stu-dents are usually lack of learning enthusiasm for self study. Besides, the course learning evaluation of students generally lacks the uniform and detail standard in the country. To resolve these problems, a comprehensive evaluation model of course learning based on the principle of talent evaluation has been practiced and improved since 2007 in some basic medical courses at our university. This model is composed of four parts:the evaluation of mastering basic knowledge, the evaluation of the ability to resolve problems through applied knowledge, the evaluation of practical study and the evaluation of learning initiatives. The model has showed in the practice the characteristics of powerful operability, pluralistic evaluating indicators, combining summative appraisal and process one, reflecting objectively the mastering degree of expertise of students and promoting the self-study of students.

Wave intensity (WI) is a newly proposed hemodynamic index that assesses the working condition of cardiovascular system. The purpose of this study is to investigate the clinical value of WI in assessing the function of cardiovascular system in patients with chronic heart failure (CHF). We used a combined Doppler and echo-tracking system to calculate the carotid artery WI in 16 patients with CHF and 35 normal subjects, and examined the characteristics of WI. The main WI indices included W1, W2, NA, R-W1 and W1-W2. Compared with those in the control group, W1 and W2 were significantly decreased in CHF group (5.44 +/- 3.24 vs. 10.05 +/- 46.33, P < 0.01, 0.83 +/- 0.42 vs. 1.50 +/- 0.95, P < 0.01, respectively), the temporal indices R-W1 shortened (141.06 +/- 41.14 vs. 109.77 +/- 22.50, P < 0.05) and W1-W2 prolonged (214.63 +/- 39.93 vs. 260.51 +/- 20.58, P < 0.01), and the (R-W1)/(W1-W2) ratio was significantly larger in CHF group (0.69 +/- 0.26 vs. 0.43 +/- 0.10, P < 0.01). WI provides a great deal of information about the dynamic behavior of the interaction between the heart and vascular system, so it is a new quantitative approach for analysis of CHF.
Adult ; Aged ; Blood Flow Velocity ; Blood Pressure ; Carotid Arteries ; diagnostic imaging ; physiopathology ; Chronic Disease ; Echocardiography, Doppler, Color ; Female ; Heart Failure ; diagnostic imaging ; physiopathology ; Hemodynamics ; physiology ; Humans ; Male ; Middle Aged

OBJECTIVETo compare design-based and model-based methods in descriptive analysis of complex sample.

METHODSA total of 1 000 samples were selected and a multistage random sampling design was used in the analysis of the 2010 China chronic disease and risk factors surveillance. For each simulated sample, cases with probability proportional age were randomly deleted so that sample age structure was deviated systematically from that of the target population. Mean systolic blood pressure (SBP) and prevalence of raised blood pressure, as well as their 95% confidence intervals (95%CI) were determined using design-based and model-based methods (routine method and multi-level model). For estimators generated from those 3 methods, mean squared error(MSE) was computed to evaluate their validity. To compare performance of statistical inference of these methods, the probability of 95%CI covering the true parameter(mean SBP and raised blood pressure prevalence of the population) was used.

RESULTSMSE of mean estimator for routine method, design-based analysis and multilevel model was 6.41, 1.38, and 5.86, respectively; and the probability of 95%CI covering the true parameter was 24.7%, 97.5% and 84.3%, respectively. The routine method and multi-level model probably led to an increased probability of type I error in statistical inference. MSE of prevalence estimator was 4.80 for design-based method, which was far lower than those for routine method (20.9) and multilevel model (17.2). Probability of 95%CI covering the true prevalence for routine method was only 29.4%, and 86.4% for multilevel model, both of which were lower than that for design-based method (97.3%).

CONCLUSIONCompared to routine method and multi-level model, design-based method had the best performance both in point estimation and confidence interval construction. Design-based method should be the first choice when doing statistical description of complex samples with a systematically biased sample structure.

Objective:To study the clinical feasibility and advantages of the RapidPlan module based on Halcyon 2.0 ring medical linear accelerator in the design of volumetric modulated arc therapy (VMAT) plans after cervical cancer surgery.Methods:The data of 98 clinical cervical cancer cases were selected from the database, and VMAT artificial radiotherapy plans were designed based on Halcyon 2.0. Then, the designed plans were imported into the RapidPlan module to train the module for a prediction model with high goodness of fit. Another 20 patients after cervical cancer surgery were selected as the validation set to compare the differences in dosimetry, plan consistency, and plan execution efficiency between the manual plans and RapidPlan automatic plans.Results:The RapidPlan automatic plans could obtain dose distribution of target volume and organs at risk with the same quality as the manual plans. The RapidPlan automatic plans provided slightly inferior protection of the femoral head but superior protection of the spinal cord compared to the manual plans, and the difference was statistically significant ( t = 4.71, P<0.001). The average MU of the RapidPlan automatic plans was 687.46, which was lower than that of the manual plan (815.34), and the difference was statistically significant ( t = 6.09, P < 0.05). The portal dosimetry (PD) verification revealed that the average γ passing rate (1 mm/1%) of the RapidPlan automatic plans was 89.48%and that of the manual plans was 88.22%, and the difference was statistically significant ( t = 3.35, P < 0.05). Conclusion:RapidPlan automatic plans based on the Halcyon 2.0 platform can meet the clinical needs of the VMAT program for cervical cancer and has certain advantages.

Objective:To compare the changes of marginal bone resportion between immediate implantation and delayed implantation after 12 to 24 months of definitive prostheses finished.Methods:41 patients were recruited and divided into immediate implant placement group(n =20) and delayed implant placement group(n =21).All implants were evaluated via radiograph after surgery,6 months after implantion,1 year and 2 years after prostheses placement respectively,the height of marginal bone was measured 6 month after implation,1 year and 2 years after prostheses placement.Results:After 6 month,1 year and 2 year the mesial marginal bone attachement (MBA) of immediate implant placement group increased by (1.35 ± 1.12),(2.16 ± 1.73) and (2.53 ± 1.65) mm,the distal by (1.46 ± 1.17),(1.94 ± 1.16) and (2.32 ± 1.68) mm,respectively (among the 3 time points of examination,P ＜ 0.05).As for the delayed implantation group,in the mesial area MBA increased by (-0.52 ± 0.47),(-0.69 ± 0.58) and (-0.97 ± 0.78) mm,in the distal area by (-0.46 ± 0.44),(-0.60 ± 0.45) and (-0.72 ± 0.63) mm (among 3 time points,P ＞ 0.05).Conclusion:Immediate implantation is superior to delayed implantation for marginal bone attachement of dental implant.

Objective:To study the attachment and collagen deposition of human gingival firbroblasts (HGFs) on titanium surface with different topography.Methods:Titanium surfaces created by machining(group M),electrolytic etching(group ECE) and electrolytic etching and acid etching(group ECA) were observed by SEM.HGFs cultured on the titanium surfaces were observed by laser scanning confocal microscope.Attachment of the cells was examined by comparing the numbers of attached to detached cells,respectively.Collagen production and deposition were examined via a Sirius red-based stain assay and confocal laser scaning microscopy.Results:The surface rouphness (μm) of group M,ECE and ECA was 0.867 5 ± 0.136 8,1.749 8 ± 0.355 1 and 1.671 4 ± 0.297 0 (P＜ 0.05) respectively,Cell attachment was significantly weaker on machined surface than on ECE and ECA surfaces,while which was weaker on ECE surface than on ECA surface.Collagen production was the highest on the machined surface,followed by that on ECE and ECA surface,Collagen deposition displayed a parallel pattern on the machined surface,while it was multidirectional on the ECE and ECA surfaces.Conclusion:The ECA surface of titanium may be beneficial to HGFs attachment,the machined surface may promote collagen deposition.

Objective To analyze the mortality of cervical cancer and its temporal trend in women in China between 2006 and 2012.Methods The cause-of-death data about cervical cancer,which was abstracted from National Disease Surveillance Points and adjusted by special survey for underreporting,was used to analyze the age and area specific crude mortality rates of cervical cancer in China during 2006-2012.The age-standardized mortality rate was calculated by using world standardized population (Segi's).The Joinpoint regression model was used to obtain annual percentage change and 95％CI for assessing the time trend of mortality rate of cervical cancer from 2006 to 2012.Results In 2012,the crude mortality rate of cervical cancer was 3.15 per 100 000 in women in China.The mortality rate in rural area (3.45/100 000) was higher than that in urban area (2.76/100 000),while the central area had the highest mortality rate of cervical cancer (3.77/100 000) compared with western area (3.23/100 000) and eastern area (2.54/100 000).The Segi's age-standardized mortality rate in eastern area increased by 2.9％ (95％CI:0.8％-5.0％) annually,an increase of 6.0％ was observed in age group 30-59 years (95％CI:1.6％-10.5％).However,the Segi's age-standardized mortality rate in central area declined by 4.6％ (95％CI:-5.9％--3.3％),where the declines of 3.2％ and 5.7％ were observed in age groups 30-59 years and ≥60 years (95％ CI:-5.0％--1.4％ and 95％ CI:-9.3％--2.0％) and respectively.There was no significant change in cervical cancer mortality in western area.The similar trends were observed in the age-standardized mortality rate calculated according to the population of China.Conclusions The decline of overall mortality rate of cervical cancer tended to stop in China and significant differences still exist among different areas.Our results suggest that the central/western areas and rural areas are still key areas for cervical cancer prevention and control and close attention should be paid to the increase of cervical cancer mortality in women aged 35-59 years in eastern area.It is essential to establish a systematic cervical cancer prevention network with larger population coverage to reduce the deaths caused by cervical cancer.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective     To investigate the current status of constipation during postoperative hospitalization and the factors associated with moderate to severe constipation at discharge in lung cancer patients. Methods     Lung cancer patients who underwent surgery in 6 tertiary hospitals in Sichuan Province from November 2017 to January 2020 were enrolled. The MD Anderson Symptom Scale-Lung Cancer Module was used to collect postoperative constipation scores. Unconditional logistic stepwise regression was used to analyze the related influencing factors for moderate to severe constipation on the day of discharge. Results     Finally 337 patients were collected. There were 171 males and 166 females, with an average age of 55.0±10.3 years. Constipation scores of lung cancer patients increased from postoperative day 1 to day 3, and showed a decreasing trend from day 3 to day 7. Moderate to severe constipation was present in 68 (20.2%) patients at discharge. The postoperative hospital stay (OR=0.743, P<0.001) and the dose of morphine used during postoperative hospitalization (OR=1.002, P=0.015) were influencing factors for moderate to severe constipation at discharge in lung cancer patients. Conclusion    Lung cancer patients have the most severe constipation on postoperative day 3. Moderate to severe constipation at discharge is associated with the postoperative hospital stay and the dose of morphine used during postoperative hospitalization.