Objective To evaluate the biomechanism of three kinds of internal fixations in treatment of complex tibial plateau fractures. Methods Eighteen human antiseptic cadaver tibial plateau specimens were used to make models of complex tibial plateau fracture (type Ⅵ fractures of Schatzker classification). The models were fixated with a lateral Golf-buttress plate (GP), modified dual plate (a lateral Golf-buttress plate plus a medial five-hole one-third tubular antiglide plate) (DP) or a lateral locking compression plate (LCP) respectively to compare strength, rigidity and stability of different fixation methods. Results The biomechanical strength, rigidity and stability in DP group and LCP group were better than those in GP group (P<0.05), while there was no statistical difference between LCP group and DP group (P>0.05). Conclusions Locking compression plate and modified dual plate are fairly ideal internal fixators for treatment of complex tibial plateau fractures. In the meantime, locking compression plate emphasizes conservation of soft tissues and blood supply, can better meet the requirement of the biological fixation of fracture and is the most ideal internal fixator at present.

Objective To investigate the influence of work-family support,self-efficacy and psychological safety climate on nurses' career growth,and to establish a model of this influence.Methods Totally 382 registered nurses were recruited from four third level and grade A hospitals in Tianjin.They were investigated with Career Growth Scale (CGS),Work-Family Support Scale (WFSS),General Self-Efficacy Scale (GSES) and Psychological Safety Climate (PSC).Results The total effect of work-family support on nurses career growth was 0.562 with the 95％ confidence interval at 0.502-0.641;Indirect effect was 0.121 with the 95％ confidence interval at 0.065-0.207,both of the effects were statistically significant.The effect of work-family support-psychological security atmosphere-self-efficacy and career growth path accounted for 45.1％ of the total indirect effect with 95％ confidence interval at 0.197-0.201;the effect of work-family support-self-efficacy and career growth path accounted for 54.9％ of the total indirect effect with 95％ confidence interval at 0.066-0.068,the intermediary effect were established.Conclusions This study established a structural equation model connecting work-family support,self-efficacy,psychological security atmosphere,career growth and enucleate their internal connection.The administrators of nurses should provide nurses with support on both work and life,and help nurse with their career growth through increases of self-efficacy and psychological safety climate.

Objective To investigate and analyze the clinical learning environment and professional identity among undergraduate nursing students, and discuss the relationship between two variable, so as to provide basis for ensuring the stability of the nursing staff. Methods 288 undergraduate nursing students who were practicing in Tianjin 3A grade hospital were evaluated using questionnaires about clinical learning environment and professional identity. The correlation analysis was performed between two variable. Besides, multiple regression analysis was used to identify factors that affect the nursing students′ professional identity. Results The total score of 288 nursing students′clinical learning environment and their professional identity was (3.44±0.66) points and (3.65±0.55) points respectively, which were at the middle level. The score of clinical learning environmental was positively correlated with professional identity score (P<0.01). The result of multiple regression analysis showed that professional selectivity had influence on nursing students′ professional identity. With controlling the demographic variables, undergraduate nursing students′ clinical learning environment could explain 58.2% of professional identity. Conclusions Undergraduate nursing students′ clinical learning environment and professional identity are at the middle level. Hospitals should pay more attention to the relationship that clinical learning environment have influence on undergraduate nursing students′professional identity.Measures should be taken to ensure the stability of the high-quality nursing personnel.

Objective To explore the related mechanism of clinical nurses′career growth from three aspects such as organization, family and oneself. Methods Totally 480 clinical registered nurses from eight tertiary first- class hospitals of Tianjin City were investigated with the Proactive Personality Scale, Psychological Safety Climate Scale, Work- Family Support Scale,Career Growth Scale by convenient sampling method. Results Latent interaction structural equation modeling (SEM) showed that family support and work support both had a positive effect on career growth, whose path coefficient were 0.42 and 0.26 respectively, P<0.01, but the interaction was inapparent, P>0.05. Hierarchical regression analyses showed that proactive personality had a negative effect on the relationship of work support and career growth whose regression coefficient was -0.148, P<0.01, and psychological safety climate had a positive effect on the relationship of work support and career growth whose regression coefficient was 0.178, P<0.05. Conclusions In order to promote clinical nurses′career growth, the construction of nurse team and improve quality of nursing, hospital and nurse managers should construct a favorable work atmosphere, provide more support, attach importance to the effect of individual personality on career growth and help nurse deal with work and family well.

Objective To explore the prognostic value of serum C-reactive protein/albumin (CRP/ALB) ratio in the adult patients with sepsis.Methods A retrospective study was conducted.Clinical data were collected from septic patients who were at least 18 years old and whose intensive care unit (ICU) lengths of stay were at least 3 days,and who were admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University in Henan Province from September 2013 to September 2015.These patients were divided into survival group and death group according to 28-day outcome.The serum CRP,ALB,and CRP/ALB ratio levels at the start of treatment (0 hour),24 hours and 72 hours after treatment in ICU were analyzed.And the receiver-operating characteristic (ROC) curve was plotted to assess the value of CRP,ALB and CRP/ALB ratio at different time points for predicting the outcome.Results Sixty-nine patients with sepsis were selected,among whom 28 cases were in the death group and the mortality was 40.6％.The characteristic of the baseline data in the two groups was balanced.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score at the first 24 hours of ICU admission in the death group were significantly higher than those in the survival group (APACHE Ⅱ score:25.18 ± 3.18 vs.17.88±3.20,SOFA score:11.71± 1.78 vs.9.17 ± 2.38,both P ＜ 0.05).And the ICU length of stay in the death group was significantly longer than that in the survival group [days:9.0 (2.5) vs.8.0 (3.0),P ＜ 0.05].The ALB level increased gradually as the treatment was extended in both groups while the levels of CRP and CRP/ALB declined gradually.The ALB levels at 0,24,72 hours after treatment in the death group were significantly lower,and the CRP and CRP/ALB levels were significantly higher than those in survival group [ALB (g/L):23.40 (4.20) vs.25.20 (8.20) at 0 hour,24.18±4.33 vs.28.54±4.88 at 24 hours,25.50±4.88 vs.34.88±7.23 at 72 hours;CRP (mg/L):179.32±34.04 vs.159.55±36.82 at 0 hour,160.08±22.91 vs.146.23±30.31 at 24 hours,159.36±25.81vs.142.53±36.30 at 72 hours;CRP/ALB:7.52±1.32 vs.6.04±1.46 at 0 hour,6.77±1.42 vs.5.23±1.24 at 24 hours,6.40± 1.34 vs.4.19± 1.21 at 72 hours;all P ＜ 0.05].ROC curves analysis showed that the area under ROC curves (AUC) of CRP/ALB at all time points were larger than those of CRP and ALB,with higher sensitivity and specificity;the AUC of ARP/ALB at 0,24,72 hours were 0.767,0.807,0.895,respectively;the cut-off values were 6.96,5.44,4.91,the sensitivity were 71.4％,85.7％ and 89.3％,and the specificity were 73.2％,63.4％ and 82.9％,respectively.Conclusions High serum CRP,CRP/ALB and low ALB in adult patients with sepsis indicate a poor prognosis,while the prognostic value of CRP/ALB is obviously better than the single value of CRP or ALB.CRP/ALB at 72 hours may be one of the best indicators for the assessment of clinical therapy and prognosis of patients with sepsis.

Objective To investigate the expression and significance of S100A4 protein and Ecadherin in coloreetal carcinoma. Methods S-P immunohistochemical method was used to detect the expression of S100A4 and E-cadherin in 87cases with colorectal carcinoma and 87 cases with adjacent colorectal tissue, and the expression of S100A4 and E--cadherin were analyzed with relation to clinicopathologic factors and post-operative five-year survival. Results There was no expression for S100A4 protein in glandular epithelium of adjacent colorectal tissues. The positive expression rate of S100A4 was 64.4 %(56/87) in colorectal carcinoma. There was a significant difference between eolorectal carcinoma and adjacent group(P ＜0.01). The expression of S100A4 was positively correlated with the clinical stages, lymph node metastasis and five-year survival (P ＜0.05), but not with other clinicopathalagic factors (P ＞0.05). There was 100 % expression for E-cadherin in adjacent colorectal tissues. The positive expression rate of Ecadherin was 62.1%(54187) in colorectal carcinoma. There was a significant difference between colorectal carcinoma and adjacent group (P ＜0.01). The expression of E-cadherin was positively correlated with the clinical stages, lymph node metastasis, tumor site and five-year survival (P ＜0.05), hut not with other clinicopathologic factors (P ＞0.05). The expression of S100A4 was negatively correlated to E-cadherin in colorectal carcinoma without statistical meaning(r =-0.087, P ＞0.05). Conclusion S100A4 and E-cadherin are closely related with colorectal cancer invasion, metastasis and prognosis; S100A4 might be an important predictor of the clinicopathologic features and prognosis of eolorectal carcinoma.

Objective To investigate the correlation between functional lung dose-volume histogram (f-DVH) parameters and radiation-induced lung toxicity (RILT) in patients of locally advanced non-small cell lung cancer (NSCLC) treated with late-course accelerated hyperfractionated radiotherapy and chemotherapy,and to identify the excellent predictors of f-DVH and their reference thresholds.Methods A total of 51 patients of NSCLC at stage Ⅲ underwent PET/CT/SPECT coregistered image guided radiotherapy.Philips Pinnacle3 planning system was used for delineation of the target volume and organs at risk so as to establish the three dimensional conformal radiotherapy or intensity-modulated radiotherapy treatment plans.The version 3.0 of the NCI Common Terminology Criteria for Adverse Events was used to evaluate the grade of RILT,and analyze the correlation of the DVH parameters of the total lung (TL),ipsilateral lung (IL),and functional lung (FL) and RILT,and to identify the excellent predictors.The median follow-up was 15 months.Results During the follow-up,10 cases of RILT (19.6%) ≥grade 2 were observed.Single factor analysis showed that the V5-V40 of TL,V5-V/20 of IL,and V5-V50 of FL were all related to the occurrence of RILT,and multiple factor analysis showed that TL-V15 and FL-V20remained associated with RILT (P = 0.005 and P = 0.016).According to ROC analysis,the V10 (45.38%) of FL was the most sensitive predictor with a sensitivity rate of 90.0% and 1/25 (27.78%) of FL was the most specific predictor with a specificity rate of 90.24%.The sensitivity,specificity and accuracy of V20 of FL were 70.00%,73.17%,and 74.90%,respectively.Conclusions The occurrence of RILT is closely associated with multiple f-DVH parameters of FL,and f-DVH has good sensitivity and specificity for prediction.

BACKGROUND: Repair of segmental bone defects is one of the difficult problems in orthopaedics. Although the therapeutic effect on bone autograft is the best, the source is limited and there is lack of suitable substitutive materials for autologous bone.OBJECTIVE: To probe into the therapeutic effects of surface-decalcified bone matrix gelation(SDBMG) and the substitutive possibility of autologous bone on repair of segmental bone defects.DESIGN: The research was designed as completely randomized controlled experiment. The clinical research was designed as pre- and post-controlled study on the basis of diagnosis.SEETING: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command.MATERLALS and PARTICIPANTS: The experiment was accomplished in Laboratory of Wuhan General Hospital of Guangzhou Military Area Command, and Testing Center of Wuhan University of Technology. Thirty-two local healthy adult male rabbits were employed as the materials in the experiment, 2.5 kg in body mass, bought from Hubei Academy of Medical Sciences. The clinical subjects were 31 patients(male 25 and female 6, a meanage of 9 years old) with segmental bone defects hospitalized in the Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command during January 1991 to May 2001.METHODS: The 32 rabbits were randomized into group A and group B. The bilateral radial bones were prepared into 1-cm bone defect in both groups. In both groups, SDBMG was grafted on the left side; in Group A, wholly-decalcffied bone matrix gelatin(WDBMG) was grafted on the right side;and in Group B, the autologous bone was grafted on the right side. Human SDBMG was provided to treat 31 cases of segmental bone defects.MAIN OUTCOME MEASURES: ① Regular X-ray and histological examinations after operation in animals(Group A) and biomechanical deterruination (Group B ). ② Regular X-ray examinations after operation.RESULTS: SDBMG induced osteogenesis process "gradually" from exterior to interior. The bone repair with SDBMG was similar to that with autologous bone, and there was no significant difference in compressive strength compared with autologous bone. After clinical follow-up, except failure in 1 case due to improper selection of indication, the other 30 cases were all cured.CONCLUSION: SDBMG provides satisfactory osteogenesis and reliable mechanical property. It can be taken as the suitable substitutive material for autologons bone in the repair of segmental bone defects. But it is cautious for the application of SDBMG to infective bone defect in the active phase.

Objective To investigate efficacy and safety of photodynamic therapy on basal cell carcinomas.Methods Twenty three cases of basal cell carcinomas were given with photosensitizer 5-amino acid (ALA) ketone spreading on skin lesions.Reddish illumination was taken at 4h later with energy density at 100 J/cm2,40 min/time,and weekly for a total of 4 weeks; and 2 year followup in the study was evaluated recurrence retrospectively.Results Among twenty three patients with basal cell carcinomas,15 were cured(65.22％),5 partially (21.74％) remitted,and 3 ineffective (13.04％),with the efficiency 86.96％.None of the resolved lesions recurred during the 6-month follow-up period,and 3 cases were recurred within 1 year (20％).Repeated ALA-photodynamic therapy (PDT) treatment,recurred lesions were completely resolved.There were no additional recurrences after 2 year.ALA-PDT was well tolerated,and adverse effects were limited to mild local pain and erythema.Only three patients were complained of erythema and edema.Complete response rate was higher in younger patients (t =-2.94,P ＜0.01) and those with smaller lesions (t =-5.92,P ＜ 0.01).Superficial type had also significant higher response rate (x2 =27.17,P ＜ 0.01).Conclusions The application of photodynamic therapy in treatment of basal cell carcinoma is effective with less painfulness,non-invasiveness,and without side effect.It demonstrated a good efficacy and satisfactory cosmetic outcomes.

Objective To explore the correlation between the dose measured in the rectum and reference dose in three?dimensional brachytherapy ( 3DBT ) for cervical cancer, and to evaluate the significance of the dose measured in the rectum. Methods Fifty patients receiving radiotherapy for cervical cancer were selected, and 3DBT was performed after pelvic external beam radiotherapy. According to the rectal monitoring method recommended in the report ICRU38, in vivo monitoring was applied to obtain the dose measured in the rectum, reference point dose ( DICRU ) , and D2 cm3 , and the planned dose was obtained from the planning system. The differences in these values were determined by the paired t?test and correlation analysis was performed with Pearson test. Results The dose measured in the rectum was higher than the planned dose (3. 48 vs. 3. 25,P=0. 000), and lower than DICRU(3. 48 vs. 3. 71,P=0. 000) and D2 cm3(3. 48 vs. 3. 87,P=0. 002). A linear relationship existed between the dose measured in the rectum and the planned dose, with a deviation percentage of-20% to 40% and an average deviation of 8. 16%;63%of the patients with cervical cancer had a deviation of<± 10%;the maximum deviation was 60%. The dose measured in the rectum had a strong correlation with DICRU(r=0. 722), but a weak correlation with D2 cm3 ( r=0. 284) . Conclusions During 3DBT for cervical cancer, the dose measured in the rectum has certain deviations, but has a linear correlation with the planned dose. Both the dose measured and the planned dose underestimate the dose at the reference point in the rectum, and in vivo rectal monitoring may be an effective method for quality control.