Objective To study the methods treating talar neck fractures. Methods From Oc-tober 1988 to June 2004, 66 patients with talar neck fractures were treated with different methods. Accord-ing to modified Hawkins classification, there were 14 patients with type Ⅰ fractures treated with plaster exter-nal fixation, 34 with type Ⅱ treated with manipulative reduction plus plaster external fixation, 16 with type Ⅲ treated with open reduction and internal fixation or joint fusion and 2 with type Ⅳ treated with open re-duction and internal fixation or joint fusion. There were four patients with old fractures. Results All pa-tients were followed up for mean 6.28 years and clinical outcomes evaluated according to Hawkins scoring system, which showed that 19 patients (29%) were graded excellent (including 13 type Ⅰ fractures, 5 type Ⅰ and 1 type Ⅲ), 17 good (including 1 type Ⅰ fracture, 12 type Ⅱ and 4 type Ⅲ), 18 fair (including 11 type Ⅱ fractures, 6 type Ⅲ and 1 type Ⅳ) and 12 poor (including 6 type Ⅱ, 5 type Ⅲ and 1 type Ⅳ). There occurred osteonecresis in 25 patients (38%), traumatic arthritis of ankle joint in 20 (30%) and that of subtalar joint in 26 (39%). Conclusions For type Ⅰ and Ⅱ fractures, plaster external fixation should be the choice of treatment. While open reduction and internal fixation should be done for type Ⅲ talar neck fractures and joint fusion for type Ⅳ and old fractures.

Objective To explore the short-term influences of conventional internal medical treatment combined with escitalopram on cognitive function and cardiac function in elderly patients with chronic heart failure (CHF) complicated with depression disorder.Methods A total of 97 patients with CHF complicated with depression disorder in Chongqing Ninth People's Hospital,from October 2014 to October 2015,were selected and randomly divided into the antidepressant group and control group.Both groups were undergoing conventional internal medical treatment.Additionally,patients in the antidepressant group were administrated with escitalopram,while patients in the control group were treated with placebo.The degree of depression and anxiety and cognitive function were assessed by using 24-item Hamilton depression scale (HAMD-24),14-item Hamilton anxiety scale (HAMA-14) and Montreal cognitive assessment(MoCA) scale,and the plasma level of NT-proBNP,left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were measured before and after 6-week treatment.Results After 6-week treatment,the HAMD-24 and HAMA-14 scores and plasma level of NT-proBNP in antidepressant group were lower than those in the control group,while the attention score and LVEF were greater than those in the control group,there were statistically significant differences(P＜0.05).After 6-week treatment,no statistically significant difference was found in other observed indicators between the two groups(P＞0.05).Conclnsion For elderly patients with chronic heart failure complicated with depression disorder,it is indicated that escitalopram could not only relieve their anxiety and depression,but also improve their cardiac function and attention.

Objective To investigate the dynamic characteristic of molecular epidemiology of group A Rotavirus (RV) by analyzing viral genotypes,disease seasonality,and the patients' age distribution,so that to provide theoretical basis for preyention and control of RV diarrhea in children.MethodsA total of 380 RV antigen positive samples were selected from 5176 stool specimens collected from ＜5 year-old patients with acute diarrhea who were admitted to Children's Hospital of Fudan University during January 2006 to December 2008. Multiplex nested reverse transcription polymerase chain reaction (RT-PCR) was used to analyze the RV genotypes.ResultsDuring 2006-2008,the incidence of RV related diarrhea peaked from October to December and about 96.8％ of all RV episodes occurred in patients younger than 3 years old,The predominant genotype was G3 which accounted for 58.4％ (222/380),G9 was an emerging genotype with the prevalence rate as high as 10.8％ (41/380).G1 and G2 types were rarely found during the three years.Infections with both G3 and G9 were the major mixed genotype G infection. Genotype P [8] was predominant with the prevalence rates of 64.6％ (53/82) and 46.8％ (58/124) in 2006 and 2008,respectively,whereasgenotype P[4] was predominant in 2007 (38,5％,67/174).P[6] and P[9] were found as minor types.The major mixed genotype P infection were genotype P[4] and P[8]. The proportion of undetermined genotype G and genotype P strains tended to increasing during 2006-2008.Genotype P [8]G3 was the major RV strain (20.5％) in Shanghai during 2006-2008 and the other prevalent genotypes included P[4]G3 and P[m]G3.Conclusion The infection of group A RV in Shanghai presents some new molecular epidemiology characteristics during 2006-2008,such as switch of predominant genotypes and diversification of prevalent genotypes.

Objective To compare the molecular epidemic characteristics of human astrovirus (HAstV) between outpatient and hospitalized children with acute diarrhea,and to investigate the relationship between HAstY infection and diarrhea in children.Methods A total of 298 cases were randomly collected from hospitalized children from January 2008 to December 2010 in Children's Hospital of Fudan University,and 360 specimens were collected from outpatients with acute diarrhea from August 2010 to July 2011.Reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect rotavirus (RV),human calicivirus (HuCV),HAstV and human adenovirus (HAdV).H AstV genotype was determined by gene sequencing and phylogenetic analysis.Results Epidemiology of HAstV in hospitalized children was as follows:among the included 298 samples,HAstV was detected in 27.2％ (81/298) of the patients,compared with 33.9％ (42/124),33.8％ (25/74) and 14.0％ (14/100),respectively from 2008 to 2010.HAstV diarrhea occurred throughout the year and peaked in January,March,and April.95.1％ (77/81) of the infected children were 0-35 months old.All the episodes of HAstV were mixed with other diarrhea virus infection.Molecular epidemiology of HAstV in outpatient children with diarrhea was as follows:the overall incidence of HAstV was 1.9 ％ among the 360 cases (7/360).The seasonal distribution of HAstV's gastroenteritis showed a peak in November.All the outpatient children were 0-35 months old.Three cases were single infection with HAstV and the others were coinfection with RV (3 cases) or HAdV (1 case).All of the detected HAstV,either in inpatients or outpatients,belonged to HAstV-1.Conclusions The detection rate of HAstV in hospitalized children is significantly higher than that in outpatients.Most HAstV infections in hospitalized children are ascribed to nosocomial infections.Most episodes of HAstV infection were accompanied with other diarrhea viruses infection.HAstY single infection is seen in outpatient children while the detection rate is very low,implying that HAstV co-infection with other viruses plays a main role in diarrhea in most instances.

Objective To explore the clinicopathological characteristics of lupus nephritis (LN) with antinucleosome antibody (AnuA).Methods Data of 481 patients with biopsy-proven LN in the First Affiliated Hospital of Zhengzhou University from 2004 to 2011 were analyzed retrospectively.The patients were divided into two groups:AnuA-positive group (76 patients) and AnuA-negative group (405 patients).The clinical manifestations,laboratory examinations,histopathologic classes of LN,disease activity measured by SLE disease activity index (SLEDAI) of two groups were investigated and compared.Results There were 15 male patients in positive group (15/76,19.74％) with mean age of (27.99±10.88) years and 45 patients in negative group (45/405,11.11％) with mean age of (31.15±12.15) years respectively,which showed that male patients were more common in positive group (P＜0.05).Incidences of oral ulcer,fever,anemia,low complement and positive anti-dsDNA antibody were higher in positive group (P＜0.05).Percentage of diffuse proliferative lupus nephritis (class Ⅳ ) and pathological activity index (AI) in positive group were higher compared to negative group (all P＜0.05),while no significant differences of other pathological types,chronic index (CI) and SLEDAI were found between two groups.Conclusion LN patients with positive AnuA have special clinicopathological characteristics and AnuA may be used as a promising biomarker for the proliferative LN.

Objective To investigate the oropharyngeal microbial colonization in elderly patients.Methods Totally 618 elderly cases and 96 young and middle-aged cases were involved in this investigation.The colonization of bacteria and fungi on the oropharyngeal mucosa were obtained by throat swab cultures.Results There were 85.4％ of cases (82 cases) with Streptococcus viridans and Neisseria gonorrheae on the oropharynx mucosa in young and middle-aged group and the pattern of constitute was simple.3 to 5 bacterial species were isolated from the oropharyngeal mucosa in elderly group.There were only 25.7％ of cases (159 cases)with Streptococcus viridans and Neisseria gonorrheae on the oropharyngeal mucosa in elderly group.Biodiversity of the constitution pattern in the bacterial colonization was exhibited in the elderly.The colonization rate of Gramnegative bacilli was higher in elderly group than in young and middle-aged group [53.1％ (328/618)vs.6.3％ (6/96)].Staphylococcus aureus and Streptococcus pneumonia were the common Grampositive bacteria colonization in the elderly.The colonization rate of Candida fungus was 9.1 ％ (56/618) in the elderly.Conclusions The reduction of commensal bacteria,especially Streptococcus viridans may be the pathological basis of mode changes in bacteria colonization and opportunistic bacteria colonization on oropharyngeal mucosa in the elderly.The colonization rate of oropharyngeal Gram-negative bacili is obviously increased and Klebsiella Pneumoniae is the common bacteria on oropharyngeal mucosa in the elderly.Enterobacteriaceae,Pseudomonas aeruginosa and Acinetobacter baumannii are sensitive to common antibiotics.

Objective Using twins methods to explore the influence of genetic and environmental factor on Intelligence develop-ment of children and adolescent twins .Methods It was 190 pair of twins aged 6 to 18 who lived in Chongqing were recruited ,DNA were extracted from buccal mucosa and venous blood samples to identify zygosity .The intelligence was investigated by using the Wechsler Intelligence Scale for Children(C-WISC) ,the intrapair correlation coefficients of twins were compared and calculate the genetic degrees .Results The total IQ of children aged 6 to 18 heritability were 0 .63 ,Verbal IQ were 0 .44 ,Performance IQ were 0 .57 .The total IQ heritability of children aged 10 to 14 and 15 to 18 years(0 .78 ,0 .79) were higher than that of those aged from 6 to 9 years(0 .018) .Conclusion This study suggested the intelligence of children aged 6 to 18 affected by genetic and environment , and the older ,the more influence of genetic on intelligence development .

Objective: To investigate the effects of miR-124a on proliferation, migration and invasion in rheumatoid arthritis synovial fibroblasts (RASFs) and the underlying mechanisms. Methods: RASFs were isolated and cultured from synovial tissue, then qRT-PCR was used to detect the levels of AKT2 mRNA and miR-124a in RASFs. Western blot was applied to determin the expression level of AKT2 protein. RASFs were transfected with miR-124a, anti-miR-124a, si-AKT2 or pcDNA-AKT2 to up-regulate or down-regulate the expression level of miR-124a or AKT2 protein. The cells were divided into normal group of normal synovial tissue, control NC group, miR-con group, miR-124a group, si-con group, si-AKT2 group, miR-124a+pcDNA group and miR-124a+pcDNA-AKT2 group. MTT assay was carried out to measure the proliferation of RASFs. Transwell assay was carried out to detect the migration and invasion cell number of RASFs. Dual-luciferase reporter assay system was implemented to verify the relationship between miR-124a and AKT2. Independent sample t-test and one way analysis of variance (ANOVA) test (square deviation) were used for statistical analysis. Results: ① Compared with normal group, the expression of miR-124a (0.92±0.19) decreased significantly (t=5.788, P<0.01), AKT2 mRNA (3.15±0.63) increased significantly (t=-3.486, P=0.025), AKT2 protein (2.09±0.64) increased significantly (t=-2.959, P=0.042). ② Ccompared with NC group and miR-con group, miR-124a expression (4.17±0.46) increased significantly (F=131.830, P<0.01), migration cell number (34±6) decreased significantly, invasion cell number (14.5±3.1) decreased significantly (F₁=35.788, F₂=27.211, P<0.01). ③ Compared with mir-con group (1.02±0.18), WT-AKT2 in miR-124a group showed a significant decrease in its relative activity (0.31±0.11) (t=5.830, P<0.01). ④ Compared with NC group and si-con group, the expression of AKT2 protein (0.97±0.03) in si-AKT2 group decreased significantly (F=128.056, P<0.01), the number of migrating cells (32±4), and the number of invasive cells (18.6±2.2) (F₁=-70.082, F₂=36.524, P<0.01) were decreased significantly. ⑤ Compared with miR-con group, AKT2 protein expression in miR-124a group decreased significantly (0.21±0.03); compared with miR-124a+pcDNA group, AKT2 protein expression in miR-124a+pcDNA-AKT2 group was increased significantly (F=52.487, P<0.01). ⑥ Compared with miR-con group, the number of RASFs migrating cells (30±5) and invasive cells (12.5±1.8) in miR-124a group were significantly decreased; compared with miR-124a+pcDNA group, the number of RASFs migrating cells (71±4) and invasive cells (26.4±4.5) in miR-124a+pcDNA-AKT2 group were significantly increased (F₁=30.957, F₂=49.960, P<0.01). Conclusion MiR-124a can inhibite the proliferation, migration and invasion of RASFs by targeting AKT2 gene. MiR-124a is expected as a molecular target for diagnosis and treatment of rheumatoid arthritis.

Objective To study the clinical features of neonates with enteroviral infection.Method We collected all neonates with enteroviral infection confirmed pathologically in the Department of Neonatology in the Children's Hospital of Fudan University from March 2009 to July 2016 retrospectively.The clinical data of the patients (clinical manifestation,first laboratory examinations,imaging findings,treatment procedures and outcomes) were retrieved to summarize the clinical features of neonatal enterovirus infection and to analyze the factors affecting the prognosis of neonatal enterovirus infection.Result A total of 81 neonates with enterovirus infection were included in the study.Among them,55 were full-term infants and 26 were premature infants,and the birth weight was (3 029±728)g.The median age of hospital admission was 5 (1,16) d,and multiple systemic manifestations were common in the course of the disease.Among them,19.8％(16/81)died.The factors for death are preterm birth,decreased hemoglobin,platelet count or serum albumin levels,abnormal coagulation,elevated blood lactate levels and acidosis.A scoring system was established based on high-risk factors.A score of ≥ 4 could reliably predict adverse outcomes,with a specificity of 92.3％ and a sensitivity of 93.8％.Conclusion Enteroviral infection in neonates can be highlt critical multiple system involvement.Neonates enterovirus infections with high risk factors(premature delivery,hemoglobin/ platelet/ albumin hypoplasia,coagulation dysfunction,lactic acid increase and acidosis) had higher mortality rate.There is a need to identify these neonates for intensive care and better treatment is warranted to improve the prognosis of these patients early.

Nanocrystals are nanoscale (1-1000 nm) dispersion systems in which small numbers of surfactants or polymers are used as stabilizers to disperse insoluble drug particles in water or oil. Nanocrystals enjoy not only high drug content, but also a simple and mature preparation process. At present, 24 nanocrystals products that have been marketed mainly focus on enhancing the solubility and bioavailability of poorly soluble drugs. And recent years have witnessed an increasing number of research reports on target drug delivery of nanocrystals through particle size control and surface modification. This paper mainly introduces three targeting strategies for prolonging the in vivo circulation time of nanocrystals, increasing the affinity for tumor cells and achieving the response to internal and external stimuli, and discusses the current challenges in the application of nanocrystal technology to targeted anti-tumor drugs.