Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.

As harmful effect on human healh and on existence of biological population etiological system may caused by endocrine disruptors, it has become the focus of many studies of public health and environmental protection. This paper briefly summarized the current status of studies on the definition, classification, adverse effects and screening methods of endocrine disruptors, and also reviewed the scientific theory and advantages of vitellogenin that was qualified as a biomarker in screening environmental endocrine disruptors. On the basis of the matters mentioned above, the paper specifically introduced the principle, application, merits and shortcomings for methods for detecting vitellogenin protein and its encoding gene.

Most literature consider that the application of decompressive craniotomy with severe brain injury is a great significance,especially in the treatment of refractory in intracranial hypertension after severe traumatic brain injuries to better effect,But its surgical indications and efficacy remains controversial.A review of recent literature at home and abroad,focusing on the surgical indications,surgical methods,timing,effects and complications of decompressive craniectomy for craniocerebral trauma

OBJECTIVE: To prepare fumeisong cream and establish its quality control method. METHODS: Ingredients including carbamide, triamcinolone acetonide acetate, camphor, and laurocapram were mixed in an oil-in-water matrix for preparation of fumeisong cream. HPLC was adopted to determine the content of triamcinolone acetonide in the cream. RESULTS: The prepared cream was white in color, with test items all in line with specifications stipulated in 2005 version of China Pharmacopoeia. The linearity concentration range of triamcinolone acetonide was 2.06～20.6 ?g?mL-1(r=0.999 6) and the average recovery rate was 99.6% (RSD=1.0%,n=9). CONCLUSION: The cream is simple and feasible in preparation techniques, and its quality is stable and controllable.

Objective To discuss the clinical feature of cholestasis preterm infants who have used parenteral nutrition early after birth,and analyze the relative factors and preventive meatures of parenteral nutrition associated cholestasis (PNAC).Methods We retrospectively analyzed the preterm infants who were born and hospitalized at Shengjing Hospital of China Medical University from January,2011 to April,2016.There were 89 cases in total that used at least 2 weeks of parenteral nutrition in the early stage after birth and were developed to cholestasis afterwards.We divided 89 cases into PNAC group and multifactor group:the former was corresponded to PNAC diagnosis standards,accounting for41 cases (46.07％);the latter with other etiology in addition to parenteral nutrition accounts for 48 cases.The clinical characteristics were studied and analyzed using case-control method.Results The sex ratio of premature cholestasis was 2.18:1,the mean gestational age was (31.05 ±2.15) weeks,the mean birth weight was (1360.55 ±421.14) g,and the mean using-time of parenteral nutrition was (26.22 ± 9.78) d.Futhermore,PNAC group was divided into hepatitis group and non-hepatitis group according to the alanine aminotransferase level,and they both had statistical significance in gestational age,starting time of parenteral nutrition,appearance time of jaundice,enteral feeding time,starting dose of amino acid,maximum dose of fat emulsion (P ＜ 0.05).We divided them into long-term group (≥20 d) and short-term group (＜ 20 d) according to the using time of parenteral nutrition.The level of alanine aminotransferase,glutamic oxalacetic transaminase,total bilirubin,direct bilirubin and bile acid of longterm group was higher than those of short-term group,but with P≥0.05.The multifactor group was mostly accompanied with multiple infections in the order of bacterial infection (75.0％),fungal infection (20.83％),cytomegalovirus infection (8.33％) and syphilis infection (2.08％),etc.The other complication's incidence rate of PNAC group and multifactor group had no statistical significance.In terms of prognosis,the liver function of two group improved remarkably than before,with PNAC group having more significance (P ＜0.05).Conclusion PNAC is the major factor of preterm cholestasis,and the degree of liver damage of PNAC preterm was related to starting time of parenteral nutrition,using time of parenteral nutrition,enteral feeding time,starting dose of amino acid and maximum dose of fat emulsion.The liver function of PNAC group is recovered obviously through regulatory treatment,and it possesses a better prognosis than multifactorgroup.

Objective To investigate the present situation of social practice of medical students and to analyze its influencing factors, to provide scientific basis for improving students' participation and quality of participation. Methods The survey of 374 medical students of Peking University was conducted in July 2015, using a self-made questionnaire including the cognition of social practice, social practice experience, etc. The sample of students was selected by cluster sampling from 2007 to 2014 grades. There were 370 valid questionnaires; the effective response rate was 98.8%. IBM SPSS statistics 20.0 was used to make statistical analysis and data were processed by description analysis and ordinal regression analysis. Results 328 persons (88.6%) affirmed the importance of social practice. However, 120 students (32.4%) did not take part in social practice in last school year. There were 357 students participating in social practice during the university. 341 students (95.5%) achieved and even exceeded the practice expectations. Secondly, it depicted the influence factors of students' participation in social practice, including family economic factor, former social practice experience before entering university, and the personal factors which included grade, overall rating scores points, and position. Moreover, factors influencing the quality of their participation included the preparation time of social practice, the output, the awards and the guide teacher. Conclusions It showed that the situation of medical students' participation in social practice was not satisfactory. It sug-gested schools set social practice credit requirements, and strengthen the freshmen education, to establish students' inertia effect of social practice.

Objective To investigate the application value of prescription examination in the management of antimicrobial agents in hospital.Methods The prescriptions of antibacterials were examined,the irrational use of drugs was counted,and the application value of drug prescription examination in the management of antibacterial drugs in hospital was discussed.Results A total of 488 960 prescriptions were examined,including 133 534 prescriptions for antimicrobial agents,and 27.31％ for antimicrobial agents.Unqualified antibiotics use prescription in 60 086,unqualified rate was 45.00％,among them not standard prescription in 108,occupied 0.18％,medication unsuitable prescription in 59 907,occupied 99.70％,exceed prescription in 71,occupied 0.12％.Conclusion There is an irrational use of antibiotics in outpatient service,and the examination of antibacterial prescription should be strengthened so as to improve the level of rational use of antibiotics in hospital.

The effect of free radicals induced by electrolysis on endothelium derived relaxing factor (EDRF) was studied in the isolated rabbit basilar artery using bioassaytechnique. It was found that after the injury was made by the free radicals, the relaxa-tion of the artery rings induced by Ach was decreased markedly while the contractioninduced by NE was very much augmented. Meanwhile, in the basilar arteries MDA con-tent was increased and SOD activity was decreased. Pretreated the basilar artery with SOD,led to the recovery of decreased relaxation and attenuation of changes in MDA and SOD.These results suggested that during subarachnoid hemorrhage, the release of EDRF wasdecreased which was closely related to the free radicals injury of the basilar arteries.

Diagnostic methods play important role in theoretical system of Inner Canon of Huangdi.There are 74 articles about diagnostic methods,which contains near 50 kinds of TCM diagnostic methods referred to pulse diagnosis,colour inspection and so on.This paper analyze the connotation and extension of the term "diagnostic method",establish a theoretical framework of dynamic whole concept,bi-directional discrimination,characteristics of triple pathogens and four kinds of methods.The diagnostic model of"shape-spirit-transporting qi"and the modern language"nature-biology-psychology-society" four-dimensional diagnostic method are constructed.