Objective To describe the operative procedures.fracture patterns and clinical outcomes of treatment of posterior column tibial plateau fractures.Methods From February 2005 to August 2006,36 patients with posterior column tibial plateau fracture were operated on.Twenty patients were treated with open reduction and buttress plate fixation via a posterior approach.They were 13 males and 7 females,with a mean age of 38.5(ranging from 29 to 52)years.The other 16 patients were operated on via anterior plus posterior approaches.They were 11 males and 5 females,with a mean age of 37.3(ranging from 27 to 49) yeam. Results All were followed up for an average of 14.5(ranging from 12 to 15)months.All frac- tures got united with an average radiographic bone union time of 15.7(ranging from 11 to 16)weeks and an average full weight-bearing time of 17.6(range from 13 to 21)weeks.The mean HSS(The Hospital for special surgery)score of all these patients at 12 months postoperatively were 83.4(ranging from 68 to 92). There were 1 case of inferior medial genicular vessel injury during the operation,1 wound dehiscence and 1 partial incision necrosis postoperatively which were all eventually healed with conservative treatments.Three cases of numbness within the posterior lower part of the calf occurred postoperatively.No screw toggle,slide, dislodging or fixation failure was found during follow-up.There were no significant differences both between TPA and PA on radiographies and between immediately after operation and 12 months psstoperatively. Conclusion Open reduction and internal fixation with buttress plates via a posterior or anterior plus posterior approaches is appropriate for treatment of posterior column tibial plateau fractures.

AIM The purpose is to study the effect of Di p Cl benzoyl linesinine on experimental arrhythmias. METHODS The models used were caused by aconitine, ouabain and CaCl 2 repectively. RESULTS Di p Cl benzoyl linesinine 5 mg?kg -1 could increase the threshold dose of ventricular ectopic(VE), ventricular tachyacardia(VT), ventricular fibrillation(VF) and cardiac arrest(CA) caused by aconitine in rats and that by ouabain in ginuea pigs; delay the onset time of arrhythmia and decrease the incidence of VE,VF and CA induced by CaCl 2 in rats. CONCLUSION Di p Cl benzoyl linesinine possesses extensive effects of antiarrhythmia on ventricle.

Objective To utilize the expert resource in central hospital for helping doctors in community hospital to make suitable diagnosis and treatment,improve the technical level of community medical care. Methods The Telemedicine Diagnosis System is developed based on B/S mode and Microsoft Visual Studio.net C#2005 in Windows platform. Results The Telemedicine Diagnosis System has been developed, and realized the function of interface display, information management, medical image transmission and telemedicine diagnosis. Conclusion The system has friendly interface, simple operation, more reliability and quick data transmission, and it can accurately realize the experts' telemedicine diagnosis in time.

OBJECTIVE: To discuss the critical questions on the development and evaluation of biosimilars. METHODS: Topics such as the option of developing approach and evaluation method, the original concept and understanding of biosimilars, the challenge and risk of developing biosimilars, the chapter and items related to application of biosimilars in regulation for drug registration, etc., were addressed in combination with the drafting of guidance on biosimilars. RESULTS AND CONCLUSION: It was recommended that comparative studies applicable for candidate drugs be designed and appropriate developing approach be selected refering to the guidance on biosimilars. The manufacturing process, scale, and batches used for the comparative studies should be evaluated in terms of representativeness and rationality. The technical requirements as well as the challenge and complexity for the judgement of similarity should also be well understood. The decision on developing biosimilars should be made based on risk analysis and comprehensive understanding of the internal characteristics including critical quality attributes of the reference products and candidate drug.

Objective To explore the psychological availability of the full-time candidates for master degree of nursing during the clinical work. Methods A phenomenological approach was adopted in this study. About 11 full-time candidates for master's degree of nursing took part in the semi-structured and in-depth interviews and the acquired data were analysed. Results About 4 themes promoting psychological availability were identified: strong research knowledge and skills, career development confidence, perception of attention from leaders and more satisfactory salary. The four themes hindering psychological availability were:clinical work tasks, lower level of expertise, lack of social support and lower perception of self benefit. Conclusions The full-time candidates for master's degree hold active perception and much expectation about their clinical work but meanwhile they feel passive and disappointed. Nursing administrators should develop distinguishing and definite clinical personnel training and continuing education programs for them, offer them an access to learning chances and emotional support in order to improve the psychological availability and stabilize the nursing team.

Objective To investigate the influence of murine cytomegalovirus(MCMV) infection on differentiation and differentiation gene expression of neural stem cells (NSCs) in vitro for studying the mechanisms of brain abnormalities calmed by congenital cytomegalovirns infection. Methods NSCs were separated from fetal BALB/c mouse and cultured and identified in vitro. The differentiation potency of NSCs was observed by immunnfluorescence. The NSCs infected by MCMV at dosage of multiplicity of infection (MOI) equaled to 5, I and 0. 1, respectively, were cultured in differentiation medium. The morphological changes of the cells were observed by inverted microscope. The ratios of NSCs and its differentiated cells were detected by flow cytometry. The expression changes of nestin, GFAP and NSE, markers of NSCs and its differentiated cells, were studied by immunofluorescence ( MOI = 1 ). The expression of early antigen (EA) of MCMV was detected to observe the infection process. Real-time RT-PCR method was employed to measure the expression levels of the key differentiation genes Wnt-3 and Wnt-7a in Wnt signal pathway of NSCs at early phage of differentiation culture. Results NSCs isolated from embryonic mouse brains could proliferate to form neurnspheres and strongly express Nestin and differentiate into NF-200 positive neurons or GFAP positive astrocytes. The NSCs of the infected groups couldn't adhere to the wall and appear differentia-tion growth, but showed swollen gradually after differentiation culture. The nostin expression of the infected groups downregulated slowly and was higher than that of the control groups ( P < 0.05 ). The GFAP and NSE expression of the infected groups were lower than that of the control groups (P <0.05). The EA of MCMV could be always detected in the cells of the infected groups. The ratios of nestin positive cells of the infected groups were higher than that of the control groups, but the ratios of GFAP and NSE positive cells of the for-mer were lower than that of the latter from 3rd to 9th day after differentiation culture ( P < 0.05 ). The levels of Wnt-3 mRNA and Wnt-7a mRNA of the infected groups were markedly lower than that of the control groups from 1st to 2nd clay and from 12th hour to 2nd day after differentiation culture respectively ( P < 0.05 ) . These changes of the infected groups became more obvious as MCMV MOI increased . Conclusion MCMV could inhibit significantly NSCs differentiate to neurons and astrocytes and lead to the decrease of dif-ferentiated cells. MCMV could inhibit or interfere with the gene expression of Wnt-3 and Wnt-7a in Wnt sig-nal pathway of NSCs. The effect that MCMV inhibited the differentiation and the differentiation gene expres-sion of NSCs showed dose-dependent with MCMV MOI. The inhibitory effect of MCMV on the differentiation of NSCs might be induced by interfering the differentiation gene expression of NSCs, which is possibly the one of primary causes of brain development disorders caused by congenital CMV infection.

Dose-effect relationship is an important topic as well as difficulties in clinical studies on Chinese herbal compounds. The relevant concepts of the dose-effect relationship, its features, its backgrounds, directions and roles of clinical studies on the dose-effect relationship of Chinese herbal compounds were discussed in this essay. The current state of clinical studies was introduced. The confronting challenges of clinical studies were also analyzed, thus providing references for the establishment of appropriate clinical research methods in line with Chinese medicine features.
Dose-Response Relationship, Drug ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; Humans ; Phytotherapy

To study the equipment modular allocation in the emergency medical unit after Beijing emergency public affairs. Using an improved Delphi method, 25 experts from various fields in Beijing were involved into two rounds consultations. The questionnaire of the first round consultation was formed based on analysis of emergency rescue equipment. Based on the result of the first round consultation, the questionnaire of the second round consultation was set up. The two rounds of questionnaires had the responding rates of experts 100% respectively, and the au-thoritative coefficients of the experts were 0.81 and 0.88. An emergency medical rescue equipment solution with three de-grees modular configuration in Beijing was made based on the consultations and experts' advices. The solu-tion develops the emergency medical service ability of mobile medical units and vehicle-mounted mobile hospital. LUO Ying and GAO Hong-wei are the first authors who contributecl equally to the article.

Objective To explore the follow-up value of phonocardiogram D/S ratio in CHF patients with treatment.Methods Forty-eight CHF patients who had never under-went regular treatment were collected in our hospital,given the regular anti-heart failure treatment for 3 months.NYHA heart failure classification,resting heart rate(RHR),and D/S ratio of phonocardiogram were recorded,six-minutes walk distance(6MWD),Left ventricular end diastolic diameter(LVEDd),the left ventricular ejection(LVEF) were tested before and after treatment.After 3-month treatment,the resting heart rate 65 times as the watershed,the patients were classified into two groups:one was up to standard,and the other was not up to standard.D/S ratio,RHR,6MWD,LVEDD,LVEF and the improvement of the heart function were compared between the two group.Results Exception the resting heart rate,the in-dicators had no significant improvement in the group of not up to standard compared with the before treatment,and D/S ratio, 6MWD,LVEF was improved significantly after three months treatment(P <0.05).In the group of up to standard,the D/S ratio was improved significantly after one months treatment(P <0.05),while after three months treatment all indicators were improved significantly(P <0.05).Comparison between the two groups,the RHR,D/S ratio were significantly improved(P <0.05 ),LVEF was significantly improved after three months treatment(P <0.05).At the same time,the D/S ratio,6MWD and NYHA classifica-tion of cardiac function was significant negatively correlated(P <0.05).Conclusion The D/S ratio could reflect heart functional im-provements in patients with CHF after anti-heart failure treatment,and it could reflect the heart functional improvement earlier and more significant in the group up to standard,it has a good clinic follow-up value in CHF patients with anti-heart failure treatment.

Objective To evaluate the value of iterative modal reconstruction (IMR) for reducing radiation dose and controlling image quality in cardiac CT. Methods Ten pigs were included. All pigs were scanned on a 256?slice prospectively ECG?gated cardiac CT utilizing routine dose (group A) and tube current reduced by 30%(group B), 50%(group C) and 70%(group D), respectively. Filtered back projection (FBP), hybrid iterative reconstruction (iDose4) and IMR were used for all data, respectively. Image noise and contrast?to?noise ratio (CNR) of ascending aortic root were measured, while overall image quality and coronary artery image quality was rated (five point scale). All results reconstructed by FBP, iDose 4 and IMR were compared. Objective measurements were compared with one?way analysis of variance, and subjective assessments were compared with Kruskal?Wallis H test andχ2 test. Results Compared with that of FBP and iDose4, image noise of IMR was(15.1 ± 6.1),(18.8 ± 5.5),(22.1 ± 4.8)and(33.0 ± 4.0)HU, respectively in group A, B, C and D with significant reduction (F=82.77, 90.71, 96.59, 95.51 respectively, all P<0.01). Using IMR, groups A, B, C, D had higher CNR (42.0±11.1, 37.2±10.4, 31.4±8.7, 23.7±7.0;F=50.65, 53.55, 76.60, 57.36, all P<0.01) and overall image quality (5.0 ± 0.0, 4.8 ± 0.4, 4.6 ± 0.5, 4.5 ± 0.5;H=20.96, 15.63, 18.66, 23.56, all P<0.01) than FBP and iDose4. Using IMR, group A (100%, 40/40) and group B (100%, 40/40) had no significant difference (P>0.05) in the diagnosis rates of proximal coronary arteries compared with that using FBP and iDose4, while group C (100%, 40/40) and group D(92%, 37/40) had significantly increased diagnosis rates (χ2=20.05, 45.72, both P<0.01). The diagnosis rates of distal coronary arteries of IMR reconstruction which were 100%(50/50), 98%(49/50), 90%(45/50), 78%(39/50), respectively in groups A, B, C, D had significant increase compared with that of FBP and iDose4 reconstruction (χ2=7.39, 16.75, 34.62, 81.33, all P<0.05). Conclusions IMR can significantly reduce image noise, improve CNR and image quality compared with iDose4. Application of IMR can reduce radiation dose but without compromising image quality.