[Objective]To explore the technique and results of reverse less invasive stabilization system(LISS) plating for subtrochanteric femur fractures.[Method]From October 2007 to May 2009,31 cases of fresh subtrochanteric femur fractures were treated with reverse LISS. There were 23 males and 8 females,with an average age of 48.6 years (range 27 to 83 years). Twelve injuries were the result of a traffic accident,six,a fall from a greater height,four,a crush injury and nine,a fall from a standing height. According to Seinsheimer classification,four fractures were type ⅡC,twelve ⅢA,six ⅢB,six Ⅳ and three Ⅴ. After anesthesia was effectively administered,subtrochanteric fracture was reduced indirectly with patient on a fracture table. Then,the reverse LISS plate was inserted through a lateral incision of the greater trochanter between the lateral vastus muscle and the periosteum. Guided by the aiming arm,4 to 5 screws were inserted through stab incisions into the proximal and distal fragments,respectively. [Result]Operative time averaged 50 minutes (range,35-80 minutes) and estimated blood loss averaged 90 ml(range,60-150 ml). Thirty-one patients were available for evaluation with an average follow-up of 15.6 months. All fractures healed at a mean of 18.2 weeks (range 13 to 32 weeks). There was no failed fixation,or deep infection. Average range of motion of the hip joint was recorded as follows:flexion 115?,external rotation 35?,internal rotation 15?,adduction 15?,and abduction 36?. According to the modified Harris hip score,scores ranged from 82 to 100 (average,92.6),and there were 24 excellent and 7 good results.[Conclusion]Reverse LISS plating yields good results in subtrochanteric femur fractures,with stable fixation and minimal invasive procedure.

Objective To explore the efficacy of closed reduction and inter na l fixation of cannulated screws by minimally invasive procedure in management of tibial plateau fractures. Methods From October 1999 to January 2002, 42 patient s with tibial plateau fractures, which were 29 males and 13 females with an aver age age of 41 years ranging from 26 to 67 years, were treated surgically in our hospital. According to Schatzker system, the fractures were diagnosed as type Ⅰ in 9, type Ⅱ in 5, type Ⅲ in 13, type Ⅳ in 3, type Ⅴ in 6 and type Ⅵ in 6. There was open fracture in 5, and closed fracture in 37. The fracture fragments of tibial plateau were reduced with closed manipulation or reduced assisted by minimally invasive procedure. The later by minimally invasive procedure included two kinds of reductions, one of which was reduction assisted by Kirschner pin t hat was introduced percutaneously into the larger fragment; the other was reduct ion assisted by a bone tamper that was introduced through a small incision into the cortical window beneath the depressed articular surface. Fixation was achiev ed using percutaneous 6.5 mm cannulated screws or combination of the cannulated screws and Bastiani external frame in unstable fractures. Results Of 42 patients , 37 were followed up from 6 to 30 months (average, 15 months). All 37 fractures were united within 12 weeks postoperatively. The mechanical axis of affected li mb and the stability of affected knee joint were restored in the patients. Accor ding to Sanders score for functional results of knee joint, 13 patients were rat ed as excellent, 20 good, and 4 fair. Anatomical reduction was identified while the stepping of articular surface after reduction was less than 2 mm. In 21 pati ents with anatomical reduction, the functional results were excellent in 8, good in 11, and fair in 2. However, in 16 patients without anatomical reduction, the functional results were excellent in 5, good in 9, and fair in 2. There was sig nificant difference between the two groups on functional results. There were no postoperative complications such as infections and neurovascular bundle. Conclus ion Closed reduction and fixation through minimally invasive procedure has provi ded satisfied results in tibial plateau fractures such as less complications, ex cellent mechanical axis restoration, and ideal functional recovery.

There are such problems as the contents of education lag , overemphasising cognition and intellectu-alization, despising practice and system supporting in current medical humanities education practice .We think that the medical humanistic education should adhere to the concept of student -oriented, medical education and human-ities education fusion , the idea of ideological education as the leading factor , the psychological compatibility as the base ,the system strengthening as the security .The medical humanities education mode is not only the response of the main current medical education mode of social alienation and human alienation , but also the surpassing of the object of humane education mode .It fully reflects the personality characteristics of the contemporary medical students , embodies the regularities of nurturing and development of human behavior in medical students .

Objective To discuss the diagnosis and treatment of intraductal papillomatosis. Methods Fifteen cases of intraductal papillomatosis were analyzed retrospectively. Results Of the 15 cases,preoperative diagnosis of intraductal papillomatosis was made in 8 cases who had received fiberoptic ductoscopy,while the rest of 7 cases who had not undergone ductoscopy were wrongly diagnosed.Postoperative pathological findings revealed 2 cases of partial malignant change and 1 case of contralateral infiltrating lobular carcinoma.Reoperation was required in 3 cases because of relapse,the relapse rate being 20%. Conclusions Intraductal papillomatosis is absolutely different from intraductal papilloma.It presents the potentiality of malignancy,and is subject to relapse after local resection.Fiberoptic ductoscopy may improve the diagnosis rate for this disease.

Objective: To explore the problem behaviors of high school students and its distribution among them. Methods: 1 739 middle school students in Beijing were collected as our sample (N=1739). Anonymous questionnaire of problem behavior of adolescents were used in this investigation. Results:1) the problem behaviors (general delinquency, cigarette smoking, and problem drinking) were significantly correlated with each other (r=0.28, 0.37, 0.39,P

Objective To investigate the oligodendroglial cytoplasmic inclusion (OCI) in the central nervous system of multiple system atrophy (MSA) and to evaluate its roles in pathologic diagnosis of MSA.Methods Modified Gallyas Braak staining was used to investigate tissue samples of the brain and the spinal cord of 4 cases with MSA, which were previously diagnosed by clinical and routine pathologic methods. Eight cases with motor neuron disease and 6 cases without nervous system disease were used for control study.Results OCIs were demonstrated by Gallyas barrak method in the white matter of the brain and the spinal cord of 3 cases with MSA. They look like sickle , semilunar , and flame shaped. Their main distributions were transverse fibers of the basis pontine, the white matter of the cerebellum, striatopallidal fibers and lateral column of the spinal cord. While OCIs were not found in the brain and the spinal cord of one case without typical clinical features and pathologic findings. Nor did all of the control cases.Conclusions OCIs may be regarded as pathologic marker of the sporadic forms of MSA. It also suggests that OCIs are related to degenerative process of myelinated fibers in MSA.

Anterior shoulder instability is a very difficult issue to treat,especially with glenoid bone defect.When the defect is small,there is little influence on shoulder instability.The larger the defect is,the more influence there will be.Most authors agree that glenoid bone reconstruction should be considered when glenoid bone defect is more than 20％-25％.In this condition soft tissue procedures alone are not enough to provide stability to the shoulder.To date,there is still not an ideal typing of glenoid bone defect.There are many methods of assessing the size of bone defect.Pico system is one of the most common methods,as it is easier and more precise.Numerous surgical procedures have been described to address the bone defect.The Bristow procedure,the Latarjet procedure and the Eden-hybinette procedure are effective and most popular around the world.The Latarjet procedure can provide more bone blocking than the Bristow procedure,and is more popular.The Eden-hybinette procedure dose not need coracoid transfer and then has no damage of normal anatomical structure.But it also lack the hanging effect of the conjoint tendon.After all,each procedure has its advantage and disadvantage in treating anterior shoulder instability associated with glenoid bone defect and should be chosen depending on the characteristics of each patient and the preference of each surgeon.Furthermore,more new and effective treatments are still needed.

Objective To investigate the clinical effect of lumbar catheter drainage combined with intrathecal injection on patients with cerebrospinal fluid leakage and intracranial infection.Methods A retrospective study was conducted.One hundred and fifty-two cases with cerebrospinal fluid leakage and intracranial infection were selected as our subjects who were hospitalized in the First Hospital of Yuncheng from 2006 to 2014.The patients were divided into lumbar puncture + intrathecal group (A),lumbar (group B) and lumbar intrathecal large pool + group (group C) based on post-processing methods.A experimental data were recorded and compared in terms of the total efficiency of treatment,the therapeutically effective time,bacterial clearance and security differences.Results After treatment,the levels of white blood cells,protein,glucose and intracranial pressure were changed compared with that of before treatment in three group(P ＜ 0.01),but there was no significant difference among the three groups(P ＞ 0.05).The therapy periods in group A,group B and group C were (12.80 ± 2.25) d,(12.64 ± 2.00) d and (9.44 ± 1.50) d respectively and the difference was significant(F =25.94,P ＜ 0.05).Compared with Group C,the therapy periods in group A and B were significant different(t =2.769,2.854;P ＜ 0.05),but there was no significant difference between group A and B (t =0.119,P =0.908).The cases with success.effect was 45 (89.1％) in group A,53 (94.6％) in group B,46 (95.8％) in group C,and there was no significant difference among three groups (P ＞ 0.05).In terms of bacterial clearance rate,33 cases(68.75％) was in group A,35 cases(72.91％) in group C and 23 cases (41.07％) in group B and the effective rate in group A or C were higher than that in group B (x2 =9.478,10.63 ; P ＜ 0.05).Conclusion The methods of lumbar catheter drainage combinedwith intrathecal injection is proved with a high clinical value of therapy,effective treatment can effectively shorten the time and improve the overall treatment effect.

Objective To investigate the specific activity of 24Na per unit neutron fluence,AB/Φ,in blood produced for Chinese reference man irratiaded by 252Cf neutron source,and to analyze the effects of scattering neutrons from ground,wall,and ceiling in irradiation site on it.MethodsA 252Cf neutron source of 3 × 108 n/s and the anthropomorphic phantom were used for experiments.The phantom was made from 4 mm thick of outer covering by perspex and the liquid tissue-equivalent substitute in it.The data of phantom dimensions fit into Chinese reference man.The weight ratios of H,N,O and C in substitute equal from source to long axis of phantom were 1.1,2.1,3.1 and 4.1 m,respectively.Both the neutron source and the position of xiphisternum of the phantom were 1.6 m above the floor.ResultsThe average specific activity of 24Na per unit neutron fluence was related to the irradiation-distances,d,and its The AB/ΦM corresponds to that of phantom irradiated by plane-parallel beams,and the value is about more 3% than that by BOMAB phantom reported in literature.It has shown that floor-( wall-)scattered neutrons in irradiation site have significant contribution to the specific activity of 24Na ,but they contributed relatively little to the induced neutron doses.Consequently,using the specific activity of 24 Na for assessing accidental neutron doses received by an individual,the contribution of scattered neutrons in accident site will lead dose to be overestimated,and need to be correct.

Objective To evaluate the clinical outcomes and correction accuracy of posttraumatic varus and valgus knee deformities using the Taylor Spatial Frame (TSF).Methods From June 2006 to December 2010,26 patients with posttraumatic varus and valgus knee deformities who had been treated with the TSF combined with less invasive high tibial osteotomy (HTO) or supracondylar femur osteotomy (SFO) were retrospectively analyzed,including 19 males and 7 females with an average age of 39 years.There were 20 cases of posttraumatic varus knees and 6 valgus knees.Twenty one patients were treated with HTO and 3 with SFO,2 with HTO and SFO simultaneously.During the operation,the TSF was firstly assembled and then the parameters of the frame were measured followed by less invasive percutaneous osteotomy.Correction was started seven to ten days after the operation following the time schedule provided by the computer program.Correction of the struts were performed 3 times per day,with a total movement of 0-3 mm.Results Through 7-35 days frame adjustments,20 cases of deformities were fully corrected.X-ray showed that the mechanical axis deviations of the tibia and femur all were recovered to normal range,and the deformity of rotation,angulation and crispation were fully corrected.Six cases had residual slight angulation or crispation deformity ( ＜ 4° or ＜ 10 mm).Through the second 4-10 days frame adjustments,these 6 cases of deformities were fully corrected finally.New bone formation and consolidation on the osteotomy site were good.The fixators were removed from 2.5-6.0 months after surgery and the appearance of the limbs and the patients' gait recovered to normal and the keen pain disappeared.All patients were followed up for 12-60 months and without the recurrence of the deformity.Eleven cases occured pin site infection and were controlled by use of the sensitive antibiotics.One case occured refracture of the distal femur osteotomy site 1.5 months after frame removal.Through conservative treatment,the fracture finally healed.Conclusion Posttraumatic varus and valgus knee deformities can be effectively corrected by using TSF and with a high accuracy.