[Objective]To evaluate the two plates internal fixation treating the distal humeral comminuted and complicated fracture.[Method]Twenty-eight patient with comminuted distal humeral fracture were treated with the double-plate internal fixation from April 2004 to April 2007.According to AO/ASIF classification method,all fractures were C types.There were 9 C1 types,15 C2 types,4 C3 types.All cases were taken from the middle of posterior elbow incision.The patients were treated with the open reduction and double plate internal fixation.Fifteen cases were done through the triceps tongue-shaped flap,13 cases were olecranon osteotomy (including one case with olecranon fractures with ipsilateral).Surgical steps included:the articular surface reduction of intra-articular fractures,small temporary Kirschner wire fixation,making the complete fractures into simple comminuted fractures of humerl condylar fractures,then resetting metaphysis.Internal fixation method used the restruction plate according to the size of fracture.The restruction plate was fixed in the back of the distal humeral radial column.One-third of a good-shaped tubular plate was used to fix the inner edge of humeral ulnar column,two 90 ? of each other into the plane separately fixed on the inner lateral humeral column.[Result]All cases were followed up for an average of 17 months(ranged,8-33 months).Fracture healing time ranged 8-16 weeks.Myositis ossificans was found in 1 case,joint space narrowing was found in 4 cases.No non-union and ulnar nerve injury were found.The final good-to-excellent rate was 82.1%.[Conclusion]The distal humeral comminuted fracture has complicated structure.The internal fixation with two plates and screws,and early functional exercise could improve the elbow function.It has satisfactory curative effect in clinic.

Objective To evaluate the influences of artifical plasma substitutes on blood coagulation and fibrinoglysisMethods Forty adult patients, ASA grade Ⅰ-Ⅱ, scheduled for selective surgery ,were randomly allocated to receiving intravenous infusion of hydroxyethylh starch(HES group), polygeline (Haemaccel,HAE group), succinylated gelatin (Gelofusine,GEL group), or normal saline (control group) at the rate of 20ml?kg -1?h -1in 60 min ,respectively, with 10 cases in each groupThe venous blood samples were taken before and 1h following the infusion to determine platelet count(PLC),platelet agglutgtination test(PAG), platelet factor 3 availability test(PF 3at), activated partial thromboplastin time(APTT), prothrombin time(PT), thrombin time(TT), fibrinogen(FIB), tissue plasminogen(t-PA) and plasminogen activator inhibitor(PAI:A)Results In HAE group PAG decreased significantly, and PT was prolonged markedly after the infusion(P005)In GEL group only FIB reduced obviously after the infusion ,additionally was remarkably lower than that in control group(P

Exosomes are nanosized membrane microvesicles secreted by various living cells.They contain proteins,lipids,RNA,and a variety of other biological macromolecules.Exosomes play an important role in many pathological and physiological processes,such as antigen presentation in the immune system,repair of damaged tissues,and growth and migration of tumors.Tumor-derived or tumor-associated exosomes play a vital role in regulating the occurrence and development of tumors.The analysis and detection of exosomes in tumors is helpful for the early diagnosis of tumors and provide new treatment methods.This article reviews exosomes' origin,composition,and functions in the development,migration,diagnosis,and treatment of tumors and provides new ideas for the treatment of tumors.

Given that there has been a series of problems in the teaching of diagnostics,appropriated approaches should be made and feasible actions carried out.First of all,the notion of clinical teaching should be transformed and the level of qualified teaching staffs should be further elevated.In addition,the humanity connotation should be integrated into the course of diagnostics,and quality supervision and control should be executed to ameliorate the teaching of diagnostics.

Objective: To observe the therapeutic effects of needle warming moxibustion for chronic diarrhea. Methods: Two-hundred cases with chronic diarrhea were divided randomly into a treatment group and a control group. 100 cases in the treatment group were treated with needle warming moxibustion on specific acupoints. 100 cases in the control group were treated by oral administration of Smecta. Results: The therapeutic results showed cure in 52 cases, remarkable effect in 34 cases, improvement in 14 cases and the total effective rate in 100.0% in the treatment group, and cure in 5 cases, remarkable effect in 23 cases, improvement in 33 cases, failure in 39 cases and the total effective rate in 61.0% in the control group. The comparison of the total effective rate between the two groups was statistically significant (P<0.05). Conclusion: The needle warming moxibustion on specific acupoints is better than oral administration of Smecta in the therapeutic effects.

Objective To study the factors influenceing patients' family members to make own relative fac-tors patients' families making decision on refusal of cardiopulmonary resuscitation (CPR) to the critical patients. Method Data were registered based on Utstein Style of 522 patients aged over 15 years, who subjected to in-hos-pital cardiac arrest(CA) in Department of Emergency of The First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2008. A total of 157 patients' family made refusal decision among the 522 pa-tients, who belonged to the refusal group, and others belonged to the attempt resuscitation group. The associated factors included age, sex, marriage, household register, cause of CA, underlying diseases, capability of activity before CA, life supported with mechanical ventilation, and administration of pressor agents. The refusal decisions were evaluated by using univariate Logistical regression analysis, and then the statistical significant variables were analyzed by using muhivanate Logistical regression analysis. Results Age, household register, cause of CA(car-diac or traumatic),stroke, sudden death, cancer, capability of activity before CA, life supported with mechanical ventilation,and administration of pressor agents were the important factors of making refusal decision (P < 0.01), but sexes or marriage was insignificant related to the refusal decision (P > 0. O5). The independent risk factors re-lated to refusal decision were age (P = 0.034),cancer (P = 0.006),stroke (P = 0.003), and life supported with mechanical ventilation (P = 0.000) in multivariate Logistical regression analysis, but the protective factors were sudden death (P =0.000),cardiac CA (P =0.020) and traumatic CA(P =0.000). Conclusions Age over 60 years, cancer, stroke, and life suppoted with assisted ventilation before CA were factors associated with re-fusal decision making, yet sudden death, cardiac CA and traumatic CA were factors of accepting CPR.

Objective To explore the effect of self-care agency on frailty syndrome in hospitalized elderly patients.Methods A total of 102 hospitalized elderly patients were recruited by convenience sampling method and investigated by cross-sectional survey. The prevalence of frailty was evaluated by frailty phenotype, and socio-demographic characteristics scale and exercise of self-care agency scale were used to evaluated these patients.Results The prevalence of frailty syndrome were 31.4%(32/102). The total score of self-care agency scale was (104.38±20.20). Univariate analysis showed that the prevalence of frailty syndrome in elderly was statistically different in the age, household income, career, the number of chronic disease, the use of medication and self-assessment of health (P<0.05). Compared with no-frailty elderly, the self-care agency, especially self-worth of frailty syndrome patients reduced significantly(P<0.05). Multiple Logistic regression indicated that self-care skills (OR=0.775, 95%CI: 0.641-0.937) and self-worth (OR=0.585,95%CI: 0.424-0.807) were significant protective factors of frailty syndrome.Conclusions The poorer self-care skills and self-worth of the elderly, the higher prevalence of frailty syndrome. Raising the level of self-care agency actively can help to prevent or improve frailty syndrome.

Objective To investigate the relationship between health literacy and cognitive function in elderly inpatients.Methods A cross-sectional survey was conducted among 216 elderly people who were admitted to a class Ⅲ grade A hospital by convenience sampling. Social demographic characteristics scale, questionnaire on Chinese citizens' health literacy and minimum mental state examination were used in this survey.Results The health literacy score of elderly inpatients was (64.33±12.79) and the cognitive function score was(26.52±2.27). The scores of health literacy and cognitive function had moderate correlation in hospitalized elderly patients (r=0.52,P<0.05). The single factor analysis showed that the health literacy of the elderly inpatients was statistical different in the education level,the average monthly family income,occupation, chronic disease and cognitive function (P<0.05). The results of multiple linear regression analysis showed that educational level,cognitive function,occupational and chronic diseases were independent factors of health literacy among the elderly inpatients.Conclusions The cognitive function of elderly inpatients varies greatly, and the higher level of cognitive function is a protective factor for the health literacy of elderly inpatients. It is an important approach to improve health literacy among elderly patients in hospital by lowering the burden of cognitive function to communicate health information.

In order to meet the urgent needs of social high-level nursing talents in the times and reality, scholars at home and abroad pay more and more attention to the development of professional spirit of nursing students. By using systematic analysis, this paper summarized five kinds of widely used professional spirit teaching methods, such as role model teaching, reflective learning teaching, PBL teaching, behavior-oriented teaching and hidden curriculum teaching so as to break the traditional teaching mode and explore scientific and effective teaching methods.

Objective To observe the changes of cell apoptosis and levels of Bcl-2 and Bax protein in myocardium after cardiopulmonary resuscitation (CPR) in rats and to study the protective effects of different doses of exogenous phosphocreatine (creatine phosphate, CP) on cell apoptosis. Methods A total of 32 male adult SD rats were randomly divided into 4 groups, namely control group ( group A), CPR group (group B), low dose CP group (group C, phosphocreatine 0. 5 g/kg given at beginning of CPR and 1.0 g/ kg 2 hour after CPR) and high dose CP group ( group D, phosphocreatine 1.0 g/kg at beginning of CPR and 2. 0 g/kg 2 hours after CPR) . Cardiac arrest was induced by asphyxiation and CPR was started 7 min after asphyxiation it groups B, C and D. Myocardium samples were taken 24 hours after CPR for detecting myocardium cell apoptosis by TUNEL method. The levels of Bcl-2 and Bax protein were measured by using immunohistochemistry. Experimental data were processed with variance analysis in SPSS package. Results Compared with group A, myocardium cell apoptosis index (AI), and the levels of Bcl-2 and Bax proteinincreased significantly in groups B, C and D (P ＜0. 01 ), and Bcl-2/Bax ratio decreased significantly (P ＜0. 01 ) . Compared with group B, myocardium cell AI and levels of Bcl-2 and Bax protein decreased significantly in groups C and D ( P ＜ 0. 01 ), and Bcl-2/Bax ratio increased significantly ( P ＜ 0. 01 ) .Compared with group C, myocardium cell AI and levels of Bcl-2 and Bax decreased significantly in group D (P ＜ 0. 05 ), and Bcl-2/Bax ratio increased significantly ( P ＜ 0. 05 ) . Conclusion Exogenous phosphocreatine, especially inlarge dose, could inhibit apoptosis of myocardium cells and alleviate myocardium injury after CPR in rats.