Objective To study the results of treatment of open fracture of tibia and fibula by external fixation with unilateral multifunction external fixation apparatus(UMEFA) and plaster in different period. Methods 89 cases with open fracture of tibia and fibula had got reduction and external fixation with UMEFA and then divided into two groups, group A of 53 cases followed by external fixation with UMEFA, 8 cases of them were forced to remove UMEFA because of complications, the other 45 cases followed by external fixation with UMEFA till bone union, group B of 36 cases were removed UMEFA and changed with plaster when the skin was healed, the sweal was eliminated and the bone was steady. Compared and analyzed the results by complication, healing time and quality.Results In group B, there was less complications(P

Objective:To investigate the balance of Th1/Th2 and Tc1/Tc2 in peripheral whole blood from SLE patients and find out the relationship between disease activity and the balance of type 1 and type 2 cytokines.Methods:Peripheral blood cells from SLE patients(active,n=15,inactive,n=20) were stimulated and normal subjects(n=20) with phorbol myristate acetate and ionomycin(PMA/I) for 4 h,then IFN-? and IL-4 in CD3~+CD8~-T cells(Th) and CD3~+CD8~+T cells(Tc) were detected by recently developed intracytoplasmic cytokine-staining techniques,anti-dsDNA antibodies in serum was detected with enzyme linked immunosorbant assay(ELISA) and immunoglobulin in serum and protein in urine were analyzed with rate nephelometry.Results:In SLE patients with active disease,the percent of IFN-?-secreting Th cells significantly increased compared with SLE patients with inactive disease and normal after in vitro PMA/I stimulation,the percent of IFN-?-secreting Tc cels significantly increased compared with normal,but IL-4-secreting Th cells and Tc cells did not vary significantly.In SLE patients with inactive diseases,only the percent of IFN-?-secreting Tc cells significantly increased compared with control.The percent of IFN-?-secreting Th and Tc cells in patients with anti-dsDNA antibody(+) in serum decreased significantly compared with patients with anti-dsDNA antibody(-).Although the percent of IL-4-secreting Th and Tc cells in patients with aberrantly high level of immunoglobulin had no change,but the mean fluorescent intensify(MIF) of IL-4-secreting Th and Tc cells increased significantly compared with patients with normal level of immunoglobulin.There was no correlation between the percent of IFN-? or IL-4 in Th or Tc cells and the content of protein in patients' urine.Conclusion:The balance between type 1 and type 2 cytokine-secreting T cells is disrupted in SLE patients,especially IFN-?-secreting T cells,which is significantly in favour of Th2 cells.The level of IFN-? or IL-4 in Th or Tc cells varied partly with disease activity,which deserved further study.

Objective To analyze the data of Human Immunodeficiency Virus (HIV ) screening in Qinnan District of Qinzhou from 2013 to 2015 ,and to provide scientific evidences for the prevention and control of Acquired Immune Deficiency Syndrome (AIDS) .Methods HIV antibody data which was collected from the AIDS laboratory between 2013 and 2015 in Qinnan District of Qinzhou were analyzed .Results Of 3 955 cases of the HIV antibody detecting in the AIDS laboratory from 2013 to 2015 ,200 cases were HIV antibody positive ,and the positive rate was 5 .06% which was decreased compared with previously .The HIV antibody positive rate of man was 9 .26% ,which was higher than women .Among the HIV positive people ,the rate of the ages older than 50 was 25 .36% which was the highest compared to the other age groups .The positive rate of farmers was 30 .83% and the rate of di‐vorced or widowed was 30 .86% and the rate of the illiterate was 16 .08% .Conclusion Man ,farmers ,the age older than 50 years old ,the divorced or widowed and the low degree of education groups are the focus groups of health education and prevention of AIDS .If we can find HIV infectors earlier ,we can control the epidemic of AIDS and formulate the prevention and control strategies better .

Over the last decade, chronic critically ill (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of care bundles has significantly decreased early deaths of critically ill patients, and have allowed them to survive previously lethal multiple organ failure (MOF). However, more and more survivors leave persistent low grade organ dysfunctions, depend on continues organ support, need to stay in ICU, and become CCI patients. These patients experience a persistent immune dysregulation with persistent inflammation, immunosuppression, and catabolic syndrome. Therefore, malnutrition is an important feature of patients with CCI, and nutritional support is a crucial part of their treatment. The main strategies of nutritional support are as follows: providing sufficient calories and proteins with appropriate anabolic agents to promote anabolic metabolism, using immunomodulators to improve immune suppression and inflammatory responses, and supplementing micronutrients to enhance metabolic support. In this review, the nutritional assessment, calorie assessment, protein assessment and other nutrient supplementation (such as β blocker, testosterone and oxandrolone, immunonutrition, vitamins) of CCI patients were reviewed, so as to provide reference for the treatment of CCI.

Public health education is the core and foundation of the development of public health.Therefore,it is an urgent problem to explore the effective ways to improve public health education and to enhance the service abilities of public health,which meets the needs of development of modern public health.On the basis of analyzing the present situation of public health education in our country,this paper discusses the necessity of introducing the concept of integrated medicine in public health education,and then puts forward the corresponding settlement measures to solve the specific problems by utilizing the concept,thinking and method of integrated medicine,which aim to provide a certain theoretical basis for cultivating high-quality public health talents and accelerating the development of public health disciplines in China.

Objective:To establish a 180-day mortality predictive score based on frailty syndrome in elderly sepsis patients [elderly sepsis score (ESS)].Methods:A prospective study for sepsis patients aged 60 years and above who were admitted to a medical intensive care unit of the General Hospital of Southern Theatre Command from January 1st, 2018 to December 31st, 2018 was conducted. Univariate analysis was performed on 19 independent variables including gender, age, body mass index (BMI), tumor, charlson comorbidity index (CCI), activity of daily living (ADL), instrumental activity of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), clinical frail scale (CFS), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHEⅡ, APACHEⅣ), modified NUTRIC score (MNS), multiple drug resistance (MDR), mechanical ventilation (MV), continuous renal replacement therapy (CRRT) and palliative care. Continuous independent variables were converted into classified variables. Multivariate binary regression analysis of risk factors was conducted to screen independent risk factors which affecting 180-day mortality in elderly sepsis patients. Then a 180-day mortality predictive score was established, and the discrimination of the mortality of patients using CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS scores were compared.Results:A total of 257 patients were enrolled, with a 180-day mortality of 60.7%. Univariate analysis showed that age, tumor, CCI, ADL, IADL, MMSE, CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS, MDR, MV, CRRT, palliative care were risk factors of 180-day mortality in elderly sepsis patients [age: odds ratio ( OR) = 1.027, 95% confidence interval (95% CI) was 1.005-1.050, P = 0.018; tumor: OR =2.001, 95% CI was 1.022-3.920, P = 0.043; CCI: OR = 1.193, 95% CI was 1.064-1.339, P = 0.003; ADL: OR = 0.851, 95% CI was 0.772-0.940, P = 0.001; IADL: OR = 0.894, 95% CI was 0.826-0.967, P = 0.005; MMSE: OR = 0.962, 95% CI was 0.937-0.988, P = 0.004; CFS: OR = 1.303, 95% CI was 1.089-1.558, P = 0.004; SOFA: OR = 1.112, 95% CI was 1.038-1.191, P = 0.003; GCS: OR = 0.918, 95% CI was 0.863-0.977, P = 0.007; APACHEⅡ: OR = 1.098, 95% CI was 1.053-1.145, P < 0.001; APACHEⅣ: OR = 1.032, 95% CI was 1.020-1.044, P < 0.001; MNS: OR = 1.315, 95% CI was 1.159-1.493, P < 0.001; MDR: OR = 2.029, 95% CI was 1.197-3.437, P = 0.009; MV: OR = 6.408, 95% CI was 3.480-11.798, P < 0.001, CRRT: OR = 2.744, 95% CI was 1.529-4.923, P = 0.001, palliative care: OR = 5.760, 95% CI was 2.177-15.245, P < 0.001]. By binary regression analysis, CFS stratification ( OR = 1.934, 95% CI was 1.267-2.953, P = 0.002), MV ( OR = 4.531, 95% CI was 2.376-8.644, P < 0.001), CRRT ( OR = 2.471, 95% CI was 1.285-4.752, P = 0.007), palliative care ( OR = 6.169, 95% CI was 2.173-17.515, P = 0.001) were independent risk factors of 180-day mortality in elderly patients with sepsis. The model of "ESS = 0.660×CFS stratification+1.511×MV+0.905×CRRT+1.820×palliative care" was established. Receiver operating characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) for predicting 180-day mortality by ESS was 0.785 (95% CI was 0.730-0.834, P < 0.001). When the best cut-off value was 2.2 points, its sensitivity was 78.9%, specificity was 70.3%, the positive predictive value was 80.4%, and the negative predictive value was 68.3%. Simplified ESS was defined as "0.5×CFS stratification+1.5×MV+1×CRRT+2×palliative care". ROC curve analysis showed that AUC for predicting 180-day mortality by simplified ESS was 0.784 (95% CI was 0.729-0.833, P < 0.001). When the best cut-off value was 2.0 points, sensitivity was 76.9%, specificity was 70.3%, the positive predictive value was 80.0%, and the negative predictive value was 66.4%. Compared with CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ and MNS, ESS had a significant difference in discriminating 180-day mortality in elderly patients with sepsis (AUC was 0.785 vs. 0.607, 0.607, 0.600, 0.664, 0.702, 0.657, 95% CI: 0.730-0.734 vs. 0.537-0.678, 0.537-0.677, 0.529-0.671, 0.598-0.730, 0.638-0.766, 0.590-0.725, all P < 0.05). Conclusions:CFS, MV, CRRT, and palliative care are independent risk factors of 180-day mortality in elderly patients with sepsis. We established ESS based on these risk factors. The ESS model has good discrimination and can be used as a reference and assessment tool for prediction and treatment guidance in elderly patients with sepsis.

Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.

Objective To investigate the effect of capsaicin on cognitive function and the expression of TRPV1 protein in hippocampus of rats with chronic cerebral hypoperfusion (CCH).Methods 60 SD rats were randomly divided into control group (SHAM group),chronic cerebral hypoperfusion group (CCH group),placebo control group(PC group) and capsaicin group(CAP group) with 15 in each group.The chronic cerebral hypoperfusion rat model was established by permanent bilateral common carotid artery occlusion.The rats in CAP group and PC group were given capsaicin and saline respectively by intraperitoneal injection,twice a week.The spatial learning and memory ability and emotion of rats were observed by Morris water maze test and open field test,and the expression of TRPV1 in the hippocampus of rats was detected by Western blot.Results (1) In the open field experiment,compared with the SHAM group (22.60±4.60),the standing times of the CCH group(12.10±2.80) decreased (P＜0.01),but the standing times of CAP group (19.30± 4.16) increased compared with that of h PC group(12.50 ±2.68) (P＜0.01).(2) In Morris water maze test,positioning navigation experiment showed that compared with the SHAM group,the escape latency of the CCH group and the PC group increased (P＜0.05),while the escape latency of CAP group was shorter than that of the PC group (P＜ 0.05).And in the space exploration experiment,compared with the SHAM group (1.87 ± 0.64),the times of crossing the platform in CCH group (0.75 ± 0.89) and the PC group (1.00± 0.93) decreased,while the latency of crossing the platform increased (P＜0.01).And the times of crossing the platform in CAP group((2.38±0.74) increased compared with that of PC group,and the latency of crossing the platform of CAP group decreased compared with that of PC group (P＜0.01).(3) Results of Western blot showed that compared with the SHAM group,the level of TRPV1 in rat hippocampus of CCH group was down regulated (P＜0.05),and the expression of TRPV1 in CAP group was higher than that of PC group (P＜0.05).Conclusion Capsaicin can effectively improve cognitive impairment in rats with chronic cerebral hypoperfusion,which may be related to the up-regulation of TRPV1 protein expression in hippocampal tissues.

significantly save the time of diagnosis and facilitate the clinical application of large samples.

Objective:To explore the process of regression of the hyaloid vessels and development of retinal vessels in C57BL/6J mice and the relationship between them.Methods:Seventy-five healthy SPF C57BL/6J mice on postnatal day 1 (P1) were selected and divided into control group (65 mice) and oxygen-induced retinopathy (OIR) model group (10 mice) by the random number table method.No treatment was given to control group.Mice in OIR model group were continuously fed in (75±3)% oxygen for 5 days from P7 and in normoxic condition for 5 days from P12.In control group, 5 mice were randomly selected and killed from P1 to P12 and P17, and the eyeballs were collected.In OIR model group, 5 mice were randomly selected and killed on P12 and P17, and the eyeballs were collected.The number of hyaloid arteries (HA), vasa hyaloidea propria (VHP), and tunica vasculosa lentis (TVL) of mice at different time was observed with a microscope.Another 5 adult mice aged 15 months old were selected to detect the vitreous vasculature using optical coherence tomography.The relationship between retinal astrocytes and retinal vascular development, VHP was observed by immunofluorescence staining.This study was approved by the Ethics Committee of Nankai Hospital (No.NKYY-DWLL-2021-070). The use and care of experimental animals followed the Regulations for the Administration of Affairs Concerning Experimental Animals and the ARVO statement.Results:In control group, HA did not degenerate rapidly during eyeball development, which still presented even 15 months after birth.The number of VHP reduced rapidly from P4 to P8, and tended to be stable at 2.33±1.32 on P10 and 1.80±0.92 on P17.The number of TVL reduced rapidly from P5 to P9, reduced to 2.30±1.42 on P10, with most of the TVL blood vessels being transparent without blood supply, and decreased to 0.30±0.48 on P17.Under the guidance of astrocytes, the retinal vessels of mice grew from the optic disc to the peripheral retina from P1 to P8, forming the primary retinal vascular layer.During the development of retinal superficial vessels, VHP showed synchronous regression and the decreased density and thinner diameter in the area covered by retinal vessels.VHP detached from the retina when retinal vessels developed to the peripheral retina, and there was no structural overlap between astrocytes and VHP.In OIR model group, the number of VHP increased from 2.14±0.90 on P12 to 4.60±1.35 on P17 and the number of TVL increased from 2.90±1.55 on P12 to 5.80±1.75 on P17, showing statistically significant differences ( t=4.188, P<0.001; t=4.668, P<0.001). There was no significant difference in the number of VHP and TVL between the two groups on P12 ( t=0.429, P=0.232; t=1.116, P=0.134). The number of VHP and TVL were significantly larger in OIR model group than in control group on P17 ( t=5.422, 9.574; both at P<0.001). Conclusions:In the vitreous vascular system of mice, the regression of VHP and TVL tends to be stable 10 days after birth, and the regression of HA was not obvious.The normal regression of vitreous vessels in mice depends on the normal development of retinal vessels and astrocytes.Retinal hypoxia delays vitreous vascular regression.