Objective To explore achillis tendon-sliding procedure and subtalar joint capsula release by the same cut and individualization treatment used in the correction of congenital clubfoot.Methods Forty eight cases (76 feet) of congenital clubfoot who were first visit were treated by achillis tendon-sliding procedure and subtalar joint capsula release by the same cut,meantime,footplate fascia release and transfer of the anterior tibial tenden were made by individualization.Results All cases were followed-up,the average time follow-up was 1 year and 6 months,excellent were 71% and good were 15.7%.Five cases were recurrence and its rate was 6.94%.Conclusions Achillis tendon-sliding procedure and subtalar joint capsula release by the same cut can solve rotation of displacement between calcaneus and talus and individualization treatment can also solve high arch deformity and adduction of foot.This technique is a simple,safe and effective treatment for congenital clubfoot.

Objective To develop a method for the determination of 13 kinds of organic phosphorus pesticides in the water by gas chromatography-mass spectrometry with solid phase extraction(SPE).Methods The 13 organic phosphorus pesticide residues,including dichlorvos,mevinphos,phorate,diazinon,propetamphos,ddimethoate,methyl parathion,malathion,fenitrothion,parathion,phenthion,methidathion,ethion,were separated on DB-1701P elastic silica capillary column followed by SPE with carbon-amino group complicated column and analyzed by gas chromatography mass spectrometry.Methylene dichloride was elution solvent,injection inlet temperature was 280 ℃ and column flow rate was 1.2 ml/min.Results The leaner range and limit of detection was 0.05-2.5 mg/L,0.49 ?g/L for dichlorvos;0.10-2.5 mg/L,1.4 ?g/L for mevinphos;0.05-2.5 mg/L,0.96 ?g/L for phorate;0.05-2.5 mg/L,0.73 ?g/L for diazinon;0.05-2.5 mg/L,0.60 ?g/L for propetamphos;0.05-2.5 mg/L,1.8 ?g/L for ddimethoate;0.10-2.5 mg/L,2.2 ?g/L for methyl parathion;0.05-2.5 mg/L,0.34 ?g/L for malathion;0.05-2.5 mg/L,1.1 ?g/L for fenitrothion;0.10-2.5 mg/L,0.58 ?g/L for parathion;0.05-2.5 mg/L,1.2 ?g/L for phenthion;0.05-2.5 mg/L,0.77 ?g/L for methidathion;0.50-2.5 mg/L,0.26 ?g/L for ethion.For all thirteen organic phosphorus pesticides,the correlation coefficient was above 0.99.The average recovery rates were 94.40%-100.80% and RSDs were found in the range of 4.17%-14.73%.Conclusion The method is simple,rapid,sensitive,accurate and applicable to the simultaneous determination of 13 kinds of organic phosphorus pesticide residues in water.

Objective An analytical approach has been developed for determination of sildenafil blood with high performance liquid chromatography.Methods Sildenafil was extracted by solid phase extraction cartridges from blood and was separated by resered-phase gradient chromatography with DAD detection at 230nm.The analytical column was Nova-pak C18(150×3.9mm),5.0μm and the guard column was Phenomenex C18(ODS,4.0×3.0mm,Octadecyl).The mobile phase Was gradient mixture of acetonitrile(A) and 0.25% acetonitrile aqueous solution including 0.06% trifluoroacetic acid and 0.06% triethylamine (B).Results Linearity Was checked over the concentration range 1.5～80.0μg/mL.Limits of detection was 5.0ng.Average recovery was 82.45%.Conclusion This method issimple.exact and rapid.

For unresectable advanced hepatocellular carcinoma (HCC),besides sorafenib,alternative drugs and treatment modalities are required.Clinical studies of hepatic arterial infusion chemotherapy (HAIC),transcatheter arterial chemoembolization (TACE),and system chemotherapy have shown favorable efficacy and tolerance in advanced HCC patients.In addition,the potential efficacy of sorafenib combined with focal treatment is also an interesting issue.As more therapies become available,decision-making for treating advanced HCC becomes increasingly complex.In our opinion,diverse treatment modalities should be utilized for the best interest of patients.Based on predictive biomarkers,we should develop a precise patient stratification system to select suitable candidates for each treatment modality in future studies,as is useful for improving prognosis of patients with advanced HCC.

Objective To explore the efficacy of hormone replacement therapy (HRT) for rheumatoid arthritis (RA).Methods The literature about HRT in the treatment of rheumatoid arthritis were searched.Eleven papers were subjected to a Meta-analysis and a heterogeneity test was conducted to evaluate the efficacy of HRT.Results HRT reduced the level of erythrocyte sedimentation rate (ESR) in RA patients (P=0.016),the SMD was-0.22(-0.40,-0.04); improved bone mineral density (BMD) in RA patients (P=0.022),the WMD was 2.83(0.41,5.26); decreased clinical parameters for disease activity evaluations of RA patients (P=0.048),the SMD was-0.19 (-0.38,0.00); decreased the level of C-reactive protein (CRP) in RA patients,the SMD was-0.08 (-0.37,0.21),but the difference was not statistically significant (P=0.591).Conclusion The findings from this Meta-analysis indicate that HRT can reduce the ESR level,improve clinical indexes and improve BMD level of RA patients.HRT may suppress disease activity and osteoporosis of RA patients,so it may be used as an auxiliary therapy in the treatment of RA.

Objective To evaluate the effectiveness of treating depressive patients with somatic symptoms with combined TCM and western medicine.Methods 69 patients were randomly divided into 2 groups:a combined therapy group (treated with Yangyin-Qinggan decoction and paroxetine) and mono-therapy (treated with paroxetine alone as an active control),The depressive and somatic symptoms were assessed before (0 week),during (2 weeks and 4 weeks) and at the end point (8 weeks) of the treatment.Results ①Both therapies alleviated the depressive symptoms:HAMD assessed among patients receiving combined therapy are listed as:(0 week:19.29±2.38),(2 weeks:17.38 ± 2.37),(4 weeks:15.27 ± 2.15),(8 weeks:13.35 ± 2.09) ;combined therapy started to ease the depressive symptoms after 2 weeks of treatment (2 week compared with 0weeks),similar improvements could also be noticed after 4 weeks of treatment 4 weeks with 2 weeks:P＜0.05)and at the end of this research (after 8 weeks of treatment:8 weeks with 4 weeks:P＜0.05).HAMD for mono-therapy are as:(0 week:18.69±3.03),(2 weeks:16.63±3.09),(4 weeks:15.20±2.95),(8 weeks:14.60±2.72) ; mono-therapy started to alleviate the depressive symptoms also,after 2 weeks of treatment (2 weeks compared with 0 week:P＜0.05),yet only slight improvements could be seen after 4 weeks (4 weeks with 2 weeks:P＞0.05) and 8 weeks of the treatment (8 weeks with 4 weeks:P＞0.05).The combined therapy turned to be more effective in alleviating depressive symptoms at the end point of the treatment (P＜0.05).②In terms of improving the somatic symptoms,the Somatization Symptom Scale (SSS) among patients with combined therapy were as follows:(0 week:48.74±4.07),(2 weeks:46.74±4.16),(4 weeks:43.74±3.77),(8 weeks:41.18 ± 3.50) ; Combined therapy was witnessed to start to ease those symptoms after 2 weeks o f treatment (2week compared with 0 weeks,P＜0.05),similar patterns were found again,after 4 weeks (4 weeks with 2 weeks:P＜0.05) and 8 weeks of the treatment (8 weeks with 4 weeks:P＜0.05).Mono-therapy was found to ease the somatic symptoms in a less-effective way,yet no difference was found between any two SSS after 2 weeks,4weeks or 8 weeks of treatment (P＞0.05,respectively).Combined therapy was better at improving the somatic symptoms (P＜ 0.01).Conclusion Combined therapy proved to be more effective in both relieving depression and somatic symptoms.

Objective The expression of anti-inflammatory cytokine interleukin(IL)-10 in protrusion and extrusion tissue of intervertebral disc and its correlation with clinical features.Methods The specimens were from 30 cases of disc herniation in single level.The patients were enquired about the medical histories and evaluated by JOA index preoperation before operation,which were all completed by one trained doctor.The contents of IL-10 in the inter=43vertebral disc were detected by enzyme-linked immunosorbent assay after operation.Results The level of IL-10 had no statistical significance between protrusion and extrusion tissue of intervertebral disc (t =0.032,P =0.725).Patient's JOA index has negative correlation with IL-10(r =-0.377,P =0.040),and positive correlation with Patient's history (r =0.449,P =0.013).Conclusion Protrusion and extrusion tissue of intervertebral disc have abilities of excreting anti-inflammatory cytokine IL-10.The level of cytokine has correlation with patient's clinical features.

Probability of causation (PC) was used to facilitate the adjudication of compensation claims for cancers diagnosed following exposure to ionizing radiation. In this article, the excess cancer risk assessment models used for PC calculation are reviewed. Cancer risk transfer models between different populations, dependence of cancer risk on dose and dose rate, modification by epidemiological risk factors and application of PC are also discussed in brief.

Objective To analyze the ultrasound features of ultrasonograpy-false-positive benign thyroid nodules in 37 cases. Methods With pathology results as the golden standard, thirty-seven patients with forty-six nodules were misdiagnosed as thyroid cancer by ultrasonography. The pre-operative diagnosis of ultrasonography were retrospectively reviewed and analyzed. Results Among forty-six thyroid nodules, twenty-one nodules had a diameter of 10.0 mm or smaller, while the other twenty-five nodules had a diameter of larger than 10.0 mm. In all forty-six thyroid nodules, the pre-operative ultrasonography found the majority of nodules with 3 or more than 3 malignant signs. The forty-six thyroid nodules showed solid (89.1%, 41/46), cystic-solid (10.9%, 5/46), marked hypoechogencity (87.0%, 40/46), ill-defined margin (56.5%, 26/46), calcification (76.1%, 35/46),microcalcification and macrocalcification), and taller-than-wide shape (30.4%, 14/46). The thyroid imaging reporting and data system (TI-RADS) lexicon was introduced to describe the lesions:forty-one nodules were categorized as TI-RADS 4c and 5 nodules were categorized as TI-RADS 5. On histology, these misdiagnosed thyroid nodules revealed severe fibrosis, hyalinization and calcification. The ultrasonic images were complicated and difficult to be differentiated from thyroid cancer. Conclusion Benign thyroid nodules with fibrosis, hyalinization, hemorrhage and calcification will lead tothe significant change on lesions' morphology, echo intensity and internal structure. When the benign and malignant signs ultrasound co-existed in a single thyroid nodule, benign thyroid nodules might be easily misdiagnosed as thyroid cancer.

Objective To evaluate the early effects on insulin resistance following sleeve gastrectomy with ileal interposition duodenojejunal bypass operation.Methods From Jun.2010 to Sep.2011,37 cases of type 2 diabetes mellitus patients [23 male,14 female; mean age (45.2 ± 2.4) years,mean BMI (21.7 ± 1.8) kg/m2] underwent sleeve gastrectomy with ileal interposition duodenojejunal bypass operation.Fasting plasma glucose(FPG),fasting insulin(FIns),body mass index(BMI),and homeostatic model assessment for insulin resistance (HOMAIR) were detected before surgery and on the 10th,20th,30th,and 60th day after surgery.Results The level of FPG was (6.8 ± 0.7) mmol/L,(7.2 ± 0.6) mmol/L,(6.9 ± 0.3) mmol/L respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery[(10.2 ±0.4)mmol/L].The difference had statistical significance (P ＜ 0.05).The level of Fins was (6.3 ± 1.1) mIu/L,(7.1 ± 1.3) mIu/L,and (7.3 ± 1.6) mIu/L respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery[(12.6 ± 1.4)mIu/L].The difference had statistical significance (P ＜ 0.05).The level of lnHOMA-IR was 0.7 ± 0.2,0.9 ± 0.5,and 0.8 ±0.4 respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery (1.8 ±0.6).The differenc had statistical significance(P ＜0.05).However,the change of BMI was not obvious between before surgery and on the 10th,20th,and 30th day after surgery.The difference had no statistical significance (P ＞ 0.05).on the 60th day after surgery,the level of FPG,Fins,lnHOMA-IR and BMI was significantly reduced compared with that before surgery.The difference had statistical significantce(P ＜0.05).Conclusion After sleeve gastrectomy with ileal interposition duodenojejunal bypass operation,the early improvement of insulin resistance occurs rapidly and it is iadependent of the loss of BMI.