Objective To evaluate the functional recovery of unstable ankle fractures prospectively after early weight-bearing and cast immobilization. Methods From October 2003 to October 2007, 100 patients who had sought medical management in our department for unstable ankle fractures were enrolled in this prospective study. All patients were treated with open reduction and internal fixation (ORIF), according to the AO/ASIF principles. They were randomized into 2 even groups, one receiving early weight-bearing and the other cast immobilization. The functional recovery was evaluated in terms of Olernd score, Tegner score, pain intensity[merical rating scale (NRS)], full weight-bearing time, return-to-work time, and hospital stay time. Results Forty-six patients in early weight-bearing group and 45 patients in immobilization group finished follow-ups. There was no difference in Olernd score, Tegner score or NRS between the 2 groups, and all pa-tients got a good Olerud score and returned to work. Total weight-beating time in early weight-beating group was 4 weeks less than in immobilization group. Conclusion Early weight-bearing may be recommended for patients who have got a stable osteosynthesis of their fractured ankles as judged by their responsible surgeons, fine compliance, and a high motivation.

Recently,commercialized infant body plethysmography has been widely used in clinic and re-search,especially with the publication of recommendation for this equipment and methodology. As the most valu-able equipment in measuring airway resistance and lung volume,infant body plethysmography can show series of valuable data on lung function,which is important in assessing pulmonary growth and development,evaluating respiratory mechanics and helping diagnose disease. However,the application of infant body plethysmography in clinic and physiology measurements is still limited by the effectivity of this equipment and appropriate reference values. This review is to introduce body plethysmography in infants,describe frequently-used data of lung func-tion,and discuss its potential clinical significance and availability of reference values.

Objective To investigate the risk factors that may affect postoperative complications in patients with meningiomas. Methods Of all 300 patients with diagnosed pathologically intracranial meningiomas undergoing resection were retrospectively ana-lyzed in terms of clinical datas and radiological features of preoperative MRI.These patients were divided into two groups according to whether postoperative complications occurred after tumor resection.Both univariate and multivariate regression models were used to analyze the effect of patient age and several MRI characteristics on postoperative complications.Results There were several signif-icant differences between the two groups in patient age,tumor location,tumor size,shape of tumor,wrapping around nerves and blood vessels,and tumor enhancement (P <0.05).According to the results of multivariate Logistic regression analysis,tumor loca-tion,tumor size,wrapping around nerves and blood vessels,and tumor enhancement were independently identified risk factors in the prediction of postoperative complications associated with meningioma resection.Conclusion The features of preoperative MRI may be useful for clinicians in predicting postoperative complications of intracranial meningiomas,and can provide imaging evdience for effective treatment and prognostic assessment in patients with meningiomas.

[Objective]To analyze the clinical and biological characteristics of suspected malignant thyroid nodules associated with Hashimoto thyroiditis .To summarize different characteristics of benign and malignant nodules,diagnosis and treatment of suspected malignant nodules associated with Hashimoto's thy-roiditis. [Methods]Surgical y and pathological y confirmed, 58 cases of suspected malignant thyroid nodules associated with Hashimoto's thyroiditis were retro-spectively analyzed with clinical and pathological data. The differences of gender, age, number of nodules, calcification, and thyroid hormone and thyroid an-tibodies levels between malignant and benign nodules were compared from January 2009 to December 2011 .[Results] The average age of malignant thyroid nodules coexisting with HT group was significantly lower than that of benign nodules coexisting with HT group( P<0.05). The proportion of nodular calcifi-cation in malignant thyroid nodules coexisting with HT group was significantly higher than that in benign nodules coexisting with HT group( P<0.05). Pre-operative TSH and anti-TG levels in malignant thyroid nodules coexisting with HT group were significantly higher than that in benign nodules coexisting with HT group. Preoperative FT3, FT4, anti-TPO levels, sex ratio and number of lesions between the two groups were not statistical y significant. [Conclu-sions] The key point of preoperative diagnosis:patients of malignant thyroid nodules coexisting with HT are associated with youth, calcified nodules, elevated serum TSH and anti-TG levels.

OBJECTIVE:To analyze the pathological characteristics and therapy method for influenza A(H1N1/H3N2)in-fection complicated with plastic bronchitis (PB). METHODS:Clinical information of 3 children with influenza A (H1N1/H3N2) infection complicated with PB were reported to summarize the experience of aerosol inhalation of Budesonide suspen-sion combined with fiber bronchoscope lavage. Based on literatures,this rare disease were analyzed. RESULTS:Among 3 chil-dren,2 children suffered from influenza A H1N1 infection and one child influenza A H3N2 infection complicated with PB;2 of them got basic disease,i.e. bronchial asthma and primary renal syndrome. 3 children were diagnosed as severe pneumonia,re-spiratory failure and pulmonary atelectasis;2 of them suffered from mediastinal emphesema and subcutaneous emphysema. The branchlike foreign bodies,removed by fiber bronchoscope,were fibrin complicated with neutrophile granulocyte,eosinophile granulocyte and leukomonocyte infiltration by pathological examinations. It was diagnosed as PB. 3 children received symptom-atic support treatment as assisted respiration,respiratory tract management and anti-infective treatment,and aerosol inhalation of Budesonide suspension combined with fiber bronchoscope lavage. And then they were cured and discharged from the hospi-tal. CONCLUSIONS:PB is one complication of influenza A pneumonia and severe. Fiber bronchoscope must be carried out as soon as possible based on aerosol inhalation of Budesonide suspension once PB is suspected,so as to diagnose early and treat promptly.

Objective To investigate the clinical features of invasive pneumococcal disease (IPD) and the antimicrobial susceptibility of invasive Streptococcus pneumoniae (Sp). Methods The clinical features of 54 children with IPD and the antimi-crobial susceptibility of 54 invasive Sp isolates were retrospectively analyzed from 2009 to 2012. Results The ratio of boys to girls in IPD was 1.35:1. Most of the children with IPD were within 2 years old. Few of the children had the onset in summer. Most of the children were diagnosed with septicemia, followed by meningitis. All of the children had middle or high fever. Forty-four children had an increased white blood cell count and 42 children had an increased C-reactive protein.β-lactam antibiotics was most frequently used in clinics, followed by vancomycin. Most of invasive Sp were resistant to penicillin. Multiple drug resis-tance was common in invasive Sp. Conclusions The incidence of IPD has seasonal difference. The clinical manifestations of IPD are diverse, with septicemia being the most common. The resistant rate to penicillin is high in invasive Sp.

To explore the associations between the presence of bacteria and virus in the nasopharyngeal secretions, and wheezing, condition and hospitalization period in infants with community acquired pneumonia. Methods Clinical data, inclu-ding detection of bacteria and viruses, conditions and hospitalization period, of 1106 hospitalized infants with community ac-quired pneumonia from March 2009 to February 2010 were retrospectively analyzed. The infants were classiifed into wheezing (697 cases) and non-wheezing (409 cases) groups. Results Viruses were detected in 540 infants (48.8%), and the total detection rate of viruses and detection rate of respiratory syncytial virus in wheezing group were signiifcantly higher than those of non-wheezing group (P=0.000). Bacteria were detected in 590 cases (53.3%) and no signiifcance was found between two groups (P=0.821). The detection rate of Streptococcus pneumonia was higher in wheezing group than that of non-wheezing group (P=0.038). Comparing to the infants detected with both viruses and bacteria, no signiifcances were found in the occurrence of severe pneumonia and hos-pitalization period in those infants detected with viruses only (P>0.05), as well as in the wheezing time of period (P>0.05). Con-clusions Wheezing in infants with community acquired pneumonia is related to the infection of viruses, especially to respiratory syncytial viruses. Virus infection accompanying bacterial infection has no impact on duration of hospitalization and wheezing. The infection of Streptococcus pneumonia may relate to wheezing in infants.

Objective To invcstigate the value of preoperative imaging morphologic classification in solitary small hepatocellular carcinoma treated by RFA.Methods The clinical data of 73 patients with small hepatocellular carcinoma who rcccivcd radiofrequency ablation at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to December 2012 were analyzed retrospectively.The lesions were classified into three types according to gross appearance in preoperative contrast-enhanced computed tomography (CT):single nodular type (type 1);single nodular with extranodular growth type or confluent multinodular type (type 2);infiltrating type (type 3).Thc clinicopathological features of patients with 3 types of tumors were compared by statistical methods.Patients were followed up via outpatient examination and telephone interview up to August 2014 or death.Results There were 24 cases of type 1,35 cases of type 2,14 cases of type 3,and the proportion were 20.2％,32.9％,47.9％,19.2％,respectively.The preoperative alpha-fetoprotein of type 3 was significantly higher than othcr types.The disease-free survival time of the three types were (37.2 ± 3.3) months,(20.9 ± 4.0) months,(14.4 ±4.9) months.The prognosis of the irregular types (type 2,type 3) is poor than the regular types (type 1).The overall survival time were (72.5 ± 4.7) months,(66.2 ± 7.3) months,(31.2 ± 5.3) months.The type 3 was the worst.The results of univariate analysis showed that morphologic classification,preoperative AFP,tumor size were related factors affecting the prognosis of patients (P ＜ 0.05).The results of multivariate analysis showed that morphologic classification was the independent risk factors affecting the prognosis of patients (P ＜ 0.05).Conclusion The preoperative imaging morphologic classification is the independent risk factors affecting the prognoses of patients with small HCC,which is help to choose the best treatment for patients with small hepatocellular.

Objective To investigate the effects of tagged fluid and substraction in CT virtual colonoscopy (CTVC) on the conspicuity of polyps and to confirm the optimal attenuation value and the optimal viewing window. Methods Polyps measured 3-10 mm were created in fresh porcine colon in vitro and submerged in saline and mixed with positive contrast medium for the CT values of 200 HU, 400 Hu, 600 HU, and 800 HU. Polyps were measured before and after substraction and compared with those in the control group. The effects of different viewing windows and different attenuation values on the measurement and conspicuity of polyps were analyzed. Results The optimal attenuation value of tagged fluid was 800 HU and the optimal viewing window was colon (-150 HU, 1 500 HU) and bone (500 HU, 2 500 HU). Conclusion The combination of tagged fluid and CT substraction can improve the conspicuity of small polyps covered by colonic fluid.

Objective To investigate the diagnostic value of macrophage migration inhibitory factor (MIF) for hepatocellular carcinoma (HCC).MethodsThe research was divided into 2 parts,including testing research and confirmatory research.The clinical data of 269 patients with HCC ( group A) and 390 individuals (including 135 patients with hepatic cirrhosis,106 with benign hepatic diseases and 149 healthy individuals,control group A) who were admitted to the Zhongshan Hospital of Fudan University from January to May,2004,and 173 patients with hepatic cancer (group B) and 257 individuals (including 86 patients with hepatic cirrhosis,79 with benign hepatic diseases and 92 healthy individuals,control group B ) who were admitted from August to December,2004,and 80 patients with HCC who received radical hepatic resection in January 2005 were retrospectively analyzed.Samples of plasma of patients in the group A and individuals in the control group A were collected before operation.Samples of plasma of patients received radical hepatic resection were collected preoperatively and at postoperative day 3,7 and 30.HCC and adjacent issues of patients in the group A were collected.The levels of MIF in the plasma and tissues were detected by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry,respectively.Non-normal distribution data were described as M( QR).Differences between the groups were analyzed by using the Mann-Whitney U test,and the relationship between the levels of MIF in the plasma and tissues was detected by the Spearman correlation coefficient.The diagnostic value of MIF was analyzed by the ROC curve.ResultsThe levels of MIF in the plasma of patients in the group A and individuals in the control group A were 85.7 μg/L (58.8 μg/L) and 15.5 μg/L(31.6 μg/L),respectively.The levels of MIF in the plasma of the patients with hepatic cirrhosis,benign hepatic diseases and healthy individuals were 24.9 μg/L (12.6 μg/L),12.5 μg/L(7.3 μg/L) and 13.2 μg/L (7.7 μg/L),respectively.There was a significant difference in the level of MIF between the group A and the control group A (F =54.235,P ＜ 0.05 ).The area under the ROC curve reached peak when the level of MIF in the plasma was 35.3μg/L.Compared with the control group B,the vdues of AUC,sensitivity and specificity were 92.1％,90.7％ and 93.4％ in the group B.The levels of MIF of the patients with HCC before operation and at 3,7,and 30 days after operation were 81.0 μg/L(54.0 μg/L),76.1 μg/L(47.5 μg/L),50.9 μg/L (40.7 μg/L) and 18.7 μg/L ( 15.1 μg/L),respectively.The levels of MIF decreased with time passed by,and were back to normal at 30 days after the operation.The median expressions of MIF in the HCC and adjacent issues were 0.083 and 0.007,respectively,with a significant difference ( U =3.975,P ＜ 0.05).The expression of MIF in the plasma was positively correlated with its expression in the HCC tissue ( r =0.759,P ＜ 0.05 ).ConclusionMIF plays an important role in the genesis and development of HCC and has potential to be one of the molecular markers for the diagnosis of HCC.