Fractures of the calcaneus are most common of tarsal bone fractures and usually the result of a fall from a great height.Controversies are about the appropriate classification system,treatment options,indication for surgery,surgical approaches and post operative management.The calcaneal fractures are divided into extra-articular fractures and intra-articular fractures.Sanders classification is of great importance to the treatment options and the outcome assessments.The treatment of the calcaneal fractures is challenging,but the ideal treatment for the calcaneal fractures has not been found so that further research is needed.Nonoperative treatment continues to be the preferred method for non-displaced fractures.Displaced and comminuted fractures can be treated with operation.Complications after calcaneal fractures include blisters,compartment syndrome,wound dehiscence,wound infection,pain,subtalar arthritis and so on.This article reviews the classification,score,treatment and complication of the calcaneal fractures.

Objective:To explore the effect of postpartum fatigue(PPF) on maternal behavior in rats and its mechanisms.Methods:Sprague-Dawley (SD) rats on the first day after delivery were randomized into the control group and the PPF group using the random number table method, with eight rats in each group.The rat model of PPF was established by forcing rats to stand in a cage with water and last for seven days.To maintain galactosis and lactation, rats and pups were caged for 90 min after every 3 h of separation.The control group was separated routinely without any stimulus.The length and body mass of the pups were recorded at birth and postnatal day 7.On the seven days after modeling, the following maternal behaviors were observed via video recordings: suckling, nesting, clicking and retrieval.The morphology of neurons in the paraventricular nucleus of hypothalamus (PVH) was observed by HE staining.The expression of oxytocin in the paraventricular hypothalamus (OxtPVH) was determined by immunofluorescence and immunohistochemistry.Western blot and qRT-PCR were performed to detect mRNA and protein expression of prolactin (PRL) in pituitary gland, respectively.Statistical analysis was performed by SPSS version 22.0, normally distributed continuous variables were compared between the two groups using an independent-sample t test, and nonnormally distributed continuous variables were compared between the two groups by Mann-Whitney U test. Results:On the seventh day after modeling, the length and weight gain of pups in the PPF group ((5.82±0.17) cm, (5.33±2.54) g)were significantly lower than those of the control group ((6.24±0.36) cm, (7.92±2.54) g, t=3.199, 2.227, both P<0.05). Compared with the control group, the rats in PPF group exhibited abnormal maternal behaviors, such as gnawing cage, biting tails, turning circles, repeatedly nesting and refusal to suckling.The results from the maternal behavioral test revealed that the latency of first pup retrieval and last pup retrieval ((39.25±3.50) s, (280.75±59.16) s) in the PPF group were significantly prolonged compared with those in the control group((19.25±7.68) s, (146.00±49.62) s, t=-4.742, -3.490, both P<0.05), the duration of nesting building ((19.50±12.69) s)and clicking ((95.50±70.55)s) in the PPF group were significantly shorter than those in the control group((68.00±37.59) s, (243.00±62.07) s; t=2.445, 3.139, both P<0.05). Compared with control group, the neurons cells of PVH in the PPF group were in disordered manner and the OxtPVH content in the PPF group decreased significantly.The mRNA (0.33(0.29, 0.38) vs 0.85(0.76, 1.76), Z=-3.576, P<0.05) and protein ((1.00±0.65) vs (4.17±0.49), t=-7.726, P<0.05) levels of PRL in PPF group were significantly decreased compared with those in the control group. Conclusion:The behaviors of holding back, nesting and licking offspring are decreased in postnatal fatigued rats.This may be related to the decreased expression of OxtPVH and PRL in hypothalamus of female rats.

Objective To explore the hemodynamic assessment after radical surgery in children with tetralogy of Fallot (TOF) by both echocardiography and Mostcare monitor. Methods Clinical data of 63 children with TOF who underwent radical surgery in our hospital from February 2016 to June 2018 were retrospectively analyzed, including 34 males and 29 females, aged 6-24 (9.82±5.77) months. There were 19 patients undergoing transannular patch reconstruction of the right ventricular outflow tract (a transannular patch group) while 44 patients retained the pulmonary valve annulus (a non-transannular patch group) . The echocardiography and Mostcare monitor parameters were recorded and brain natriuretic peptide was tested at the time points of 0, 8, 12, 24 and 48 hours after operation (T 0, T 1, T 2, T 4) to analyze their correlations and the change trend at different time points after radical surgery. Results The left ventricular ejection fraction at T 1 (43.49%±3.82%) was lower than that at T 0 (48.29%±4.55%), T 2 (45.83%±3.69%), T 3 (53.76%±4.43%) and T 4 (60.54%±3.23%, P<0.05). The cardiac index at T 1 (1.85±0.35 L·min−1·m−2) was lower than that at T 0 (2.11±0.38 L·min−1·m−2), T 2 (2.07±0.36 L·min−1·m−2), T 3 (2.42±0.37 L·min−1·m−2) and T 4 (2.82±0.42 L·min−1·m−2, P<0.05). The cardiac circulation efficiency at T1 (0.19±0.05) was lower than that at T 0 (0.22±0.06), T 2 (0.22±0.05), T 3 (0.28±0.06) and T 4 (0.34±0.06, P<0.05). The right ventricular two-chambers view fraction area change at T 1 (23.17%±3.11%) was lower than that at T 0 (25.81%±3.74%), T 2 (25.38%±3.43%), T 3 (30.60%±4.50%) and T 4 (36.94%±5.85%, P<0.05). The pulse pressure variability was the highest at T 0 (18.76%±3.58%), followed by T 1 (14.81%±3.32%), T 2 (12.44%±2.94%), T 3 (10.39%±2.96%) and T 4 (9.18%±1.92%, P<0.05). The blood brain natriuretic peptide was higher at T 1 (846.67±362.95 pg/ml) than that at T 0 (42.60±18.06 pg/ml), T 2 (730.95±351.09 pg/ml), T 3 (510.98±290.39 pg/ml) and T 4 (364.41±243.56 pg/ml, P<0.05). There was no significant difference in left ventricular ejection fraction, cardiac circulation efficiency and heart index between the two groups (P>0.05). The right ventricular two-chambers view fraction area change of the transannular patch group was significantly lower than that of the nontransannular patch group at each time point (P<0.05). The blood brain natriuretic peptide and pulse pressure variability of the transannular patch group were significantly higher than those of the non-transannular patch group (P<0.05). Left ventricular ejection fraction was positively correlated with cardiac index (r=0.637, P=0.001) and cardiac circulation efficiency (r=0.462, P=0.001) while was significantly negatively correlated with blood brain natriuretic peptide (r=–0.419, P=0.001). Conclusion Both methods can accurately reflect the state of cardiac function. Mostcare monitor has a good consistency with echocardiography. Using transannular patch to recontribute right ventricular outflow tract in operation has more influence on right ventricular systolic function. The Mostcare monitor can guide the hemodynamic management after surgery in real time, continuously and accurately.