BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.

Objective To investigate the significance of early blood lactic acid and lactic acid clearance in patients with post-cardiac arrest syndrome(PCAS).Methods 87 cases were divided into the survival group(26 cases) and the death group(61 cases).The clinical data of two groups were analyzed statistically.Results The 6h blood lactate (8.46 ± 2.37) mmoL/L,6h blood lactate clearance rate (34.53 ± 14.75) ％,the residual alkali (-3.08 ± 3.68) mmol/L,6h SevO2 (68.35 ± 6.33) ％,APACHE Ⅲ score (19.64 ± 2.48) points in the survival group were significantly better than those of the death group [blood lactic acid value (12.32 ± 3.56) mmol/L,6h blood lactate clearance rate (27.71 ± 11.38) ％,the residual alkali (-5.61 ± 4.14) mmol/L,6h SevO2 (63.22 ± 5.94) ％,APACHE Ⅲ score (24.32 ± 5.33) points],with significant differences between two groups (t =5.99,2.36,2.73,3.66,5.62,all P ＜ 0.05).The 6h blood lactate clearance rate,6h SevO2 and APACHE Ⅲ score were independent risk factors for the prognosis of PCAS (OR =1.23,1.64,1.28,all P ＜ 0.05).Conclusion The early blood lactate clearance rate can be used as a sensitive indicator for evaluating the prognosis of PCAS.

Objective: To evaluate therapeutic effect of aortic endovascular stent-graft exclusion (EVGE) combined percutaneous coronary intervention (PCI) on patients with descending thoracic aortic dissection (DTAD) complicated coronary heart disease (CHD).Methods: A total of 58 DTAD + CHD patients undergoing aortic EVGE combined PCI were regarded as EVGE group (received aortic EVGE at first, then PCI on 3d after operation).Another 60 DTAD+CHD patients undergoing open surgery combined PCI in our hospital were selected as open surgery group.Both groups were observed and followed up, and their therapeutic effects were compared.Results: Compared with open surgery group, there was significant rise in complete cut closure rate (78.33% vs.91.38%), and significant reductions in bleeding volume during operation [(919.83±242.12) ml vs.(58.17±9.53) ml], postoperative infection rate (15.0% vs.3.4%) and hospital stay [(16.40±0.96)d vs.(9.10±0.83)d] in EVGE group, P<0.05 or <0.01.Success rate of PCI was 100% in EVGE group, and there was no PCI-related severe complications.During follow-up, coronary restenosis rate within 12 months in EVGE group was significantly lower than that of open surgery group (5.20% vs.15.30%, P=0.04).Conclusion:It is safe and possesses significant effective to treat descending thoracic aortic dissection complicated coronary heart disease using aortic endovascular stent-graft exclusion combined percutaneous coronary intervention, which is worth extending.

Radiotherapy and interventional thearapy are the main means for unresectable advanced primary hepatic carcinoma.However,the efficacies are restricted by their respective adaptability.The development of radiotherapy,especially the application of radiotherapy combined with transcatheter hepatic artery chemoembolization provide more suitable treatment means for patients.

Objective To study the clinical effects of delayed surgery for Maisonneuve fractures.Methods Between January 2006 to June 2011,we treated 21 patients with Maisonneuve fracture by delayed surgery.They were 18 men and 3 women,aged from 17 to 63 years (average,36.8 years).Rupture of inferior tibiofibular ligaments was complicated in all,lateral malleolus fracture in 17 cases,medial malleolus fracture in 14 cases,rupture of deltoid ligament in 7 cases,and posterior malleolus fracture in 15 cases.None of them got timely surgery due to complicated injuries,poor skin condition or missed diagnosis.Six patients had surgery after 2 weeks,11 after 3 weeks and 4 after 4 weeks.The interval from injury to surgery ranged from 14 to 32 days,averaging 21.3 days.Fractures of lateral,medial and posterior malleolus were treated with open reduction and internal fixation.Ruptures of deltoid ligament and anterior ligament of inferior tibiofibula were repaired and reconstructed.Functional recovery of the ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.Results The patients were followed up for 10 to 18 months (average,12.3 months).All the fractures healed after an average time of 12.4 weeks (from 10 to 22 weeks).No infection or implant failure was observed in this group.The affected ankle restored inflexion basically to the range of the contralateral 6 months post-surgery,but was limited in the ranges of varus and valgus.Pain was extensively experienced.At the last follow-up,10 patients (47.6％) showed obvious disparity between the 2 sides,and 5 ones had lateral displacement of the talus and widened ankle mortise.AOFAS results were excellent in 5 cases,good in 9,fair in 4 and poor in 3,yielding a good to excellent rate of 66.7％.Conclusion Because delayed surgery increases the difficulties in surgery and functional recovery,early diagnosis and early surgery are crucial for treatment of Maisonneuve fractures to achieve satisfactory outcomes.

OBJECTIVE:To standardize prescription management and to promote rational drug use.METHODS:The "Prescription Management Method" was implemented,and the role of pharmaceutical management committee was brought into full play by strengthening pharmaceutical management and building up the long-term supervision mechanism.RESULTS & CONCLUSIONS:Due to the building up of a series of new measures such as the 3-level supervision mechanism,the pharmaceutical management in our sanatorium area has achieved remarkable efficacy.However,there are some shortages which remain to be improved.

The ABCB4 gene,also called MDR3,encodes the MDR3 protein which is localized to the hepatocyte canalicular membrane and is demonstrated to be a phosphatidylcholine translocase.The recent study showed that ABCB4 deficiency was associated with several cholestatic disorders,but the pathogenesis is not clear.This review highlights recent advances in the structure and function of ABCB4 gene,and the relationship between ABCB4 gene and cholestatic diseases.

Three new points of view were reported in this study:1.Found out the distribution of KaschinBeck disease (KBD) in Tibet,the complexity of bone disease composition,and the types of osteopathy coexisted which need to be identified;2.The clinical symptoms of KBD in Tibet were significantly different from those in other areas of our country;3.The new clinical subtypes of KBD were found in Tibet,which had humeral shortness and short stature,but with normal hands and feet.This discovery made us understand KBD more profoundly and comprehensively,and promoted the research and prevention work of KBD.

Autonomic nerve dysfunction is common after onset of ischemic stroke.Heart rate variability (HRV) has been used widely because of the regulation effect of heart rate by the quantitative analysis of the autonomic nervous system.This article reviews the evaluation method of HRV and its clinical significance in ischemic stroke.