Objective To observe the effect and its factors of open reduction and internal fixation of calcaneal fractures,and the influencing factors.Methods A retrospective analysis of 116 cases of calcaneal fracture were made.All patients were treated with open reduction and internal fixation,the effect was evaluated by Maryland foot score.The relation of the data before surgery (sex,age,cause of injury,associated injuries,injury and surgery,frac-tures sanders classification,opening and closing,diabetes,smoking history)and the effect,the surgical data (graft case,fixation,fractures,postoperative Bohler angle)and the effect were analyzed.The independent factors of the effect were analyzed by Logistic regression analysis.Results 116 patients with calcaneal fracture had been followed up for 6 -12 months,the excellent -good rate of Maryland foot score was 74.14%.Univariate analysis showed that different types of fractures,open and closed,with or without diabetes,with or without a history of smoking,different fixation methods,different fractures,patients with different postoperative Bohler angle foot function excellent rate differences were statistically significant (χ2 =17.194,4.077,6.766,9.116,5.136,6.919,4.458,all P <0.05).Logistic regres-sion analysis showed that the type of fracture,fixation,fractures,postoperative Bohler angle were independent risk factors for foot function excellent rate(OR =0.052,0.048,0.056,0.386,all P <0.05).Conclusion It has exact efficacy for open reduction and internal fixation with calcaneal fractures,the fracture type,fixation,fractures,postoper-ative Bohler angle are independent risk factors for affecting the calcaneal fractures patients.Perioperative treatment should take appropriate measures to avoid adverse factors affecting the efficacy of improved clinical efficacy.

[Objective] To investigate the surgical method of transforminal lumbar interbody fusion(TLIF)technique in treatment of upper lumbar intervertebral disc herniation.[Methods]From January 2002 to December 2006,a retrospective analysis on TLIF surgery treatment of 45 patients with upper lumbar intervertebral disc herniation were carried out and they acquired 12~24 months(mean,15 months)follow up.There were 29 males,and 16 females aging from 30~55 years(mean,39.2 years).Eleven intervertebral spaces were T12-L1 hernination,25 intervertebral spaces were L1、2 hernination,and 18 intervertebral spaces were L2、3 hernination of the space.Nine were double disc herniation.All cases were treated with TLIF technique.A retrospective analysis on surgical therapeutic effect was made.[Results]Five patients developed complications after operation and recovered by symptomatic treatment.Patients moved around in 2~3 d after surgery.Oswestry score improved from(52.32 ?9.17)to(20.33 ?5.72)in an average 15-months follow-up.X-ray showed that all cases had bone graft fusion and no adjacent segment degeneration occurred.[Conclusion]TLIF technique is an effective method in treatment of upper lumbar intervertebral disc herniation.It can offer satisfactory clinical effects.

Objective To analyze the space-time characteristics of hand-foot-mouth disease (HFMD) in Shijiazhuang by using geographic information system (GIS).Methods The data of HFMD during 2009 to 2011 in Shijiazhuang were collected and GIS database was created.Special map was drawn by PHGIS software to analyze the space-time characteristics of HFMD in Shijiazhuang.Results The epidemic situation of HFMD in Shijiazhuang appeared sporadic with local centralization.The attack ranked alternately rise year after year and high epidemic areas were geographically complimentary.Overall epidemic levels tend dropping from 2009 to 2011 and there were differences among areas.The high-attack areas of HFMD changed over time.Conclusions GIS can provide direct-viewing of the space-time characteristics of HFMD and further understand the prevalence of HFMD,which could help to provide the scientific basis of HFMD control in Shijiazhuang.

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function (RRF) in patients on continuous ambulatory peritoneal dialysis (CAPD).Methods Fifty patients on CAPD from our department were enrolled in the study.Eight patients with residual urine volume ≤ 100 ml/d and 42 patients with residual urine volume ＞ 100 ml/d were enrolled into anuria group and non-anuric group respectively.The clinical and laboratory status of each group were compared and equations (Hoek' s,Yang' s and abbreviated MDRD equations) were validated in the non -anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF.Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46± 1.15) mg/L,t =2.39,P =0.02)].(2) RRF estimated by each equation was correlated well with measured RRF (r =0.56,0.56 and 0.39,all P ＜ 0.05).(3) Yang' s equation [0.10 ml· min1· (1.73 m2)-1]was least biased,followed by Hoek' s equation [-0.73 ml· min-1 · (1.73 m2) 1] and abbreviated MDRD equation [3.15 ml· min-1 · (1.73 m2)-1].(4) The precision of Yang' s equation was equivalent to that of Hoek' s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml· min-1 · (1.73 m2)-1].(5) 50％ accuracy according to Yang' s equation and Hoek' s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5％ and 54.8％ vs 23.8％,respectively,all P ＜ 0.01).Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias,precision and 50％ accuracy.For patients undergoing CAPD,the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.

BACKGROUND:Anterior cervical discectomy and fusion surgery is a good choice for repair of degenerative cervical disc herniation, but it is reported that fusion can affect the exercise of cervical neighboring stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration.
These two methods which applied in cervical degenerative intervertebral disc herniation stil remain controversial. OBJECTIVE:To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS:Total y 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month fol ow-up were included and retrospectively analyzed. These patients were divided into replacement group (n=21) and fusion group (n=27) according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or al ogeneic fibularing. They were fol owed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the fol ow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association (JOA) score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION:During the final fol ow-up, the fusion rate in fusion group was 93%(25/27). Comparisons between groups:at the 1 week and final fol ow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were al lower than those before treatment;the Japanese Orthopaedic Association scores were higher than those before treatment (P<0.05). In the final fol ow-up, the visual analog scale scores of neck and upper limbs and cervical dysfunction index were al lower than those after one week of treatment, and the Japanese Orthopaedic Association scores were higher than those after one week of treatment (P<0.05). There were no significant differences in the above indicators at each time point between these two groups (P>0.05). The cervical activity and surgical segmental motion after cervical disc replacement were significantly higher than those in the fusion group;the difference was statistical y significant (P<0.05). There were no serious complications in these two groups. There was no significant difference in the incidence of complications between these two groups (P>0.05). These results suggest that the artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single cervical disc herniation have the same effect in terms of patients’ symptoms mitigation. With respect to fusion technique, artificial disc replacement surgery has the advantage of maintaining cervical stability and activities of replacement segments.

Objective To investigate the current situation of precision of internal quality control (IQC) in total cholesterol,triglyceride,HDL-cholesterol,and LDL-cholesterol and provide improvement measurements.Methods Web-based External Quality Assessment (EQA) system was used to collect IQCdata of lipid tests from 581 EQA participant laboratories nationwide.The data include the coefficient of variation (CVs) of IQC data under control in April 201 1 and long-term cumulative data.Excel 2007 was applied for data processing after excluding the invalid data.Acceptable rates of CVs of two-lot internal quality controls in 4 lipid testing were calculated according to 6 criteria,that were 1/4TEa,1/3TEa,allowable imprecision of National Cholesterol Education Program (NCEP) and the specifications based on biological variation including the optimal,appropriate and minimal allowable imprecision.Results Four hundred and thirty-five,434,405 and 360 laboratories reported the data of level 1 IQC for total cholesterol (TC),triglyceride (TG),HDL-C,LDL-C respectively,while 214,214,192 and 171 reported the data of level 2 IQC respectively.Acceptable rates of TC,TG,HDL-C,LDL-C based on NECP criteria were 69.2％ (304/435),85.3％ (370/434),61.3％ (48/405) and 69.0％ (248/360) for level 1 respectively while 81.3％(174/214),91.6％ (196/214),75.5％ (145/192) and 81.3％ (139/171) for level 2 respectively.In the group which met the NECP criteria,the proportion of using matching detection system was much higher than the group which did not meet the criteria.Conclusions It is an effective way for clinical laboratories to improve test quality by monitoring the current and cumulative CVs of internal quality control and comparing them against proper evaluation criteria to evaluate if the analysis system can meet quality requirements.

Objective to evaluate the analytical performance of 7 open automatic biochemistry analysis systems in terms of precision,linearity,anti-interference ability and trueness on determination of cholesterol.Methods Performance verification test.There were 7 open analysis measurement systems composed of 7 kits as well as calibrators from Biosina,Baiding,Fosun,Dongou,Kehua,Maker and Wako company respectively,and Hitachi 7170 automatic analyzer were chosen as test systems.The repeatability CV and inter-lab CV were assessed according to Clinical and Laboratory Standards Institute (CLSI) protocol EP5-A2.The linearity range was evaluated on the basis of CLSI EP6-A,the series concentrations of cholesterol were 0,2.07,4.14,6.21,8.28,10.35,12.93,20.69 and 25.86 mmol/L cholesterol.Hemoglobin,ascorbic acid (vitamin C) and intralipid were applied as interfere materials in interference testing according to CLSI EP7-A2.The trueness was evaluated on the basis of China national lipids standardization program,the concentrations of 10 samples ranged from 2.88 to 5.42 mmol/L measured by reference methods.Results When the low level sample (2.71 mmol/L) measured,the repeatability CV were 0.54％,0.79％,0.56％,0.51％,0.56％,0.48％ and 0.49％ respectively,intra-lab CV were 1.00％,1.06％,1.28％,0.89％,1.08％,1.13％ and 1.05％ respectively.When the high level sample (5.12 mmol/L) measured,the respective repeatability CV were 0.40％,0.41％,0.51％,0.48％,0.47％,0.45％ and 0.47％,the respective intra-lab CV were 0.82％,0.69％,1.27％,0.70％,0.70％,1.08％ and 0.69％.The upper limits of linearity range of A,B,D,F was 12.93 mmol/L and for C,E,G was 20.69 mmol/L.There is no significant interference on 7 systems with chyle concentration of 1.6％ or hemoglobin concentration of 4 g/L.Given the interference bias ≤ 4％,the interference concentrations of ascorbic acid were 228,215,225,2840,2840,217 and 2840 μmol/L respectively.In trueness verification experiment,the bias of 7 systems all met the target value (≤ 3％).Conclusion The analytical performance of 7 systems in terms of precision,linearity,trueness and anti-interference all met the requirements of clinical specifications.The performance of anti-interference and measurement trueness of several systems could be improved.

Objective To investigate the comparability between laboratories and the performance of precision in clinical laboratories for blood gas and acid-base analysis by external quality assessment (EQA) and internal quality control (IQC).Methods Fifteen vials of EQA materials were distributed to the laboratories by global Express Mail Services (EMS).The activities were carried out three times,five-level samples were determined every time.After the measurement results and coefficients of variation of internal quality control data of April were reported,the collected data were divided into peer groups based on laboratory instruments.The medians of each group were taken as the target value to analyse the pass rate and coefficient of variation (CV) of each group after the removal of outliers.Internal quality control data was collected by Web-based the EQA software acquisition system which collect the CVs of the control data of nationwide blood gas and acid-base analysis project in April 2012 internal quality control,the CVs of IQC data were compared according to analyzers and testing items after the removal of outliers.All the data were analyzed using EXCEL 2007 and SPSS.Results A total of 570 laboratories participate in the EQA scheme.The CV of Inter-laboratory of PO2 was largest in all the same instrument groups; For the same item,Siemens group displayed larger CVs than other instrument groups.A total of 525 laboratories returned internal quality control data in accordance with the provisions,there are no significant difference in CVs among the same instrument group and among the same test of inter-instrument.Conclusions The comparability of results for blood gas and acid-base analysis are mostly good between laboratories in China,besides,some of which need to improve.The laboratories should pay more attention to IQC so as to secure the reliability of results.

Objective To evaluate the analytical performance of lipid testing with six sigma(a) in order to promote the quality improvement.Methods Sixty-four Laboratories participated in trueness verification program and Internet-Based Interlaboratory Comparison of Internal Quality Control Data program lipid testing in 2012 were included in this study.The CVs and Bias of TC,TG,HDL-C,and LDL-C for each laboratory were evaluated from the reporting data.The sigma metrics based on the Tea from National Cholesterol Education Program according to the formula:σ =(TEa-Bias)/CV for each analyte.Quality goal index (QGI) was also calculated to investigate the reason for dissatisfied performance as follows:QGI =Bias/ (1.5CV).Results The rates for σ≥6 of TC,TG,HDL-C,and LDL-C were 21.9％,34.4％,9.38％,and 18.8％,respectively.The corresponding rates for 3 ≤ σ ＜ 6 were 31.3％,29.7％,29.7％,and 34.4％,while the rates for σ ＜ 3 were 46.9％,35.9％,60.9％,and 46.9％,severally.For analytes which σ were less than 3,91.3％-100％ of the laboratories should improve the trueness first,0.00％-8.75％ of the laboratories should improve the precision,and 0.00％-2.08％ should improve both.Conclusions Six sigma is an effective tool for quality control in clinical laboratory,which can help improve the quality level for laboratory testing.The analysis of performance of the lipid testing shows that further effort is acquired to enhance the supervision of the trueness verification.

BACKGROUND: At present, treatment of diabetes mellitus with western medicine starts from the angle of stimulating injured β cell of islet to strength insulin secreting. Treatment with traditional Chinese medicine is very important in protecting injured β cells.OBJECTIVE: To observe the protective effect of lycium barbarum polysaccharide and nourishing yin and activating blood compound recipe on pancreatic islet function in rats with streptozotocin-induced diabetes mellitus.DESIGN: A randomized and controlled animal experiments.SETTING: First Affiliated Hospital and Medical College of Henan University of Science and Technology.MATERIALS: Totally 70 male Wistar rats, aged 6 weeks, with body mass of 200 g, were used in this experiment.METHODS: This experiment was carried out at the Animal Room of Henan University of Science and Technology from October 2001 to April 2002. Totally 70 rats were divided into two groups: normal control group (n=10) and modeling group (n=60). Totally 30 successful model rats were randomly subdivided into 3 groups: streptozotocin model group, compound recipe treated group and lycium barbarum polysaccharide-treated group,with 10 rats in each group ;Intragastric administration of 60 g/kg Chinese herb compound recipe for nourishing yin and activating blood was performed on the rats in the compound recipe treated group at 9:00 every day (huangqi, shanyao, gegen respectively 30 g, gouqizi, danshen, huafen,digupi respectively 15 g, danggui, zhimu respectively 12 g, danpi, wuweizi respectively 10 g, shuizhi 5 g, shanyurou 20 g, etc, provided by drug store of First Hospital Affiliated to Henan University of Science and Technology,were decocted and condensed to be equivalent crude drug 3.0 kg/L with routine method). Intragastric administration of 0.5 g/kg lycium barbarum polysaccharide was given in the lyciun barbarum polysaccharide treated group (lycium barbarum polysaccharide was isolated and purified from ningxia barbary wolfberry fruit). Intragastric administration of comparative volume of normal saline was performed in the streptozotocin model group and normal control group, totally 3 weeks. The levels of fasting blood glucose (FBG) and insulin were measured at 3 weeks before and after experiment, and function index of β cell of islet was calculated; Pancreas was taken out to detect SOD activity, NOS activity and concentrations of NO and MDA were also detected.RESULTS: Ten rats in normal control group and 30 successful model rats in model group entered the stage of result analysis. ① In the initial stage of experiment, FBG level in each modeling group was significantly increased (t=16.51 to 10.07,P ＜ 0.01), while fasting insulin level and function index of β cell were significantly decreased (t=13.64 to 100.99 ,P ＜ 0.01 ) in comparison with normal control group. ② At 3 weeks after experiment, levels of FBG, NO , MDA , NOS activity were significantly decreased in the compound recipe treated group and lycium barbarum polysaccharide group compared with streptozotocin model group (t=8.08 to 72.68 ,P ＜ 0.01 ), while level of fasting insulin and function index of β cell, SOD activity were significantly increased in the compound recipe treated group and lycium barbarum polysaccharide group compared with streptozotocin model group (t=4.39 to 17.87,P ＜ 0.05-0.01 ). ③ Levels of FBG and MDA , NOS activity and concentration of NO were significantly decreased in the compound recipe treated group, and fasting insulin and function index of βcells were significantly increased in comparison with lycium barbarum polysaccharide group(P ＜ 0.01 ).CONCLUSION: Lycium barbarum polysaccharide and nourishing yin and activating blood compound recipe increase the level of fasting insulin and function index of βcell of rats with streptozotocin induced diabetes mellitus, decrease the level of blood glucose, improve the function of βcell of islet, which might be related to the increase of pancreatic islet SOD activity and decrease NOS activity.