Objective To evaluate the clinical results of femoral, tibial and humeral fractures treated with locked intramedullary nailing. Methods 546 fractures of femur, tibia, and humerus in 526 patients treated with locked intramedullary nailing from April 1994 to September 2004 were retrospectively reviewed. There were 430 fractures in 412 males, 116 fractures in 114 females, with an average age of 36.4 years. 432 were close fractures, 76 old fractures, and 38 open fractures. With image intensifier, 196 fractures were reduced closely, while 350 fractures failed to be reduced by close manipulation and required open reduction. Bone grafting were undertaken in 161 fractures of the latter group. 485 fractures were reamed, and 61 unreamed. 539 fractures were stabilized statically, and 7 dynamically. The nails were inserted antegradely in 519 fractures, and retrogradely in 27. Dynamization was undertaken in 10 statically locked fractures due to delayed union. The early postoperative weight-bearing was directed. The patients were followed up with an average of 31.6 months (9~123 months). Results Among the 546 fractures, 543 fractures(99.5%) were eventurally healed, with an average union time of 4.4 months. 530 fractures(97.1%)primarily healed, and 13 fractures(2.4%) healed after secondary operation. The complications were 11 delayed unions(2.0%), 4 nonunions(0.7%), 3 malunions(0.5%), 5 bone infections(0.9%), 2 traumatic fractures(0.4%), 9 hip heterotopic ossifications(1.6%), 6 implant failures(1.0%), with 3 nail breakages(0.5%), 3 interlocking screw breakages or back-outs, 1 radial nerve palsy, and 1 fatal pulmonary embolism. The ROM of the hips and the knees were excellent in patients with femoral or tibial fractures. Flexion restriction(90?~125?) of the knee were found in 10 patients. There were 5 and 10 anterior knee pains in femoral and tibial fracture patients respectively. The ratio of excellent and good function of the shoulder was high in the humeral shaft fracture patients, with the abduction less than 90? in 2 patients, extension loss of 15? in 2 elbows, and shoulder pain in 6 patients. Conclusion Interlocking intramedullary nailing is one of the good alternatives in treating long bone fractures, with a higher union rate and a lower complication rate. Close reduction for fresh fracture, open reduction for old fracture, static locking, reaming or unreaming in regard to the site and severity of the fracture, and individualized rehabilitation protocols all contribute to the excellence of the results.

[Objective]To conclude the result of comminnted fractures of humeral intercondyle treated by operation with variable approaches and variable fixations.[Method]Six-three cases with comminuted fractures of humeral intercondyle treated by operation with variable approaches and variable fixations were followed by averaged 44.0 months(14～84 months),functional result were evaluated with three rating systems.[Result]The function resume after trans-olecranon approach and AO plate fixation technique were satisfactiary with broad indications.[Conclusion]Trans-olecranon approach with AO plate fixation is recommended to be the best choice to treat comminuted fractures of humeral intercondyle.The severity of the initial trauma,operative scheme,postoperative functional training and patients' cooperation are the most important elements for postoperative functional recover.

[Objective]To analysis the factors influencing the results and complications of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation or sledging.[Method]Twenty-seven cases,29 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation or sledging were reviewed and followed with 7～60 months.The postoperative results were evaluated with AOFAS.[Result]The scores were between 53 and 100 with average 87.2,with good results.The functional results of Sanders Ⅲ and Ⅳ fractures were worse than type Ⅱ fracures.[Conclusion]The patients with displaced intra-articular calcaneal fractures should be treated with operation.With less invasive manipulation,extensive lateral L incision hasn't more relation to infection.The degree of initial injury and the operative quality are important factors influencing prognosis.

Objective To investigate the incidence and the risk factors of anxiety or depression and in the first degree relatives (FDRs) of patients with type 2 diabetes mellitus ( T2DM ). Methods A total of 102 T2DM patients who visited our hospital from May to July 2010 and their FDRs completed SAS,SDS,and life satisfaction evaluation. The medical history of T2DM patients was collected and compared with their FDRs with or without mental disorders. The correlations of risk factors with anxiety or depression were analyzed, t test or X2 test were used for statistical analysis and a P value less than 0. 05 was considered statistically significant. Results The incidence of anxiety or depression of FDRs was 31.4% and 17.6%,respectively. The life satisfaction score of FDRs with mental disorders was significantly decreased ( t = 4. 26 and 4. 09, P＜0. 05 ). Fasting glucose level of T2DM patients with anxious or depressive FDRs was significantly increased ( t = -2. 48 and -2. 15, P＜0. 05 ). Higher medical cost and multiple treatment strategies were positively correlated with SAS and SDS score of the FDRs. Conclusion Higher incidence of mental disorders and lower satisfaction scores could be found in the FDRs of T2DM patients. Better control of blood glucose and reduced treatment cost and strategies may be useful in improving metal condition and life satisfaction of the FDRs of T2DM patients.

Objective To study the imaging of arteriovenous malformation(AVM)and cerebral cavernous angiomas(CCA)by 3D-TOF MRA and SWI.Methods The clinical manifestations and MR imaging characteristics of 44 cases with intracranial vascular malformations were retrospectively analyzed.The MRA imaging and SWI imaging of 26 CCA cases and 18 AVM cases were compared.Results The location,size,input.artery and output vein of arteriovenous fistula were clearly showed by 3D-TOF MRA.3D-TOF-MRA did not show the artery of hemangioma.The imaging of SWI can clear display the number and increase of cavernous hemangioma,comparing with the conventional sequence.Moreover,SWI was effective to show the tortuous veins of arteriovenous malformation.However,it was not able to directly show the overview of abnormal blood vessels and big arteries such as input artery.Conclusion 3D-TOF MRA technologies is powerful to show the arteriovenous malformation with high flow velocity and low resistance(Such as AVM),while SWI has advantages in showing the cavernous hemangioma with low flow velocity and small diameters.Joining 3D-TOF-MRA and SWI techniques will improve the detection of cerebral vascular malformations and reduce the misdiagnosis and missed diagnosis.

Objective To investigate the effects of the gene expressions of FAS、FASL、FADD and caspase-8 in esophageal carsinogenesis. Methods Immunohistochemical method was applied to detect the expression of FAS、FASL、FADD and caspase-8 proteins in esophageal epithelium. In situ hybridization method was applied to detect the expression of FADD and caspase-8 mRNA in esophageal epithelium. Results The positive rates of FAS, FADD and caspase-8 proteins and FADD、caspase-8 mRNA were decreased from normal epithelium to dysplasia and carcinoma tissues gradually. The positive rates of FASL protein were increased from normal epithelium to dysplasia and carcinoma tissues gradually. There was very significant statistical difference between carcinoma and normal epithelium(P

Objectives To study the performance of different microbial automated inoculation systems and to evaluate the performance of the Probact microbial automated inoculation and incubation system ( Probact system) and its applications in clinical microbiology laboratory.Methods A total of 160 clinical specimens, including respiratory secretions ( n=61 ) , urine ( n=49 ) , and feces ( n=50 ) , that were submitted to the Clinical Microbiology Laboratory in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from February 2015 to April 2015 were evaluated.These specimens were processed with conventional manual method, the Probact automated inoculation system, and PREVI Isola Inoculator.The quantity of bacterial species recovery, number of effectively isolated colonies, total number of colonies recovery per plate, and time of processing the 160 specimens by the three methods were evaluated. Wilcoxon signed-rank test and Kruskal-Wallis rank sum test were used for statistical analysis.Results The Probact system had significantly higher quantity of bacterial species recovery (respiratory specimens 3.41 ±1.40, urine 1.92 ±0.86, and feces 1.16 ±0.79) than those by the Isola Inoculator (respiratory specimens 3.75 ±1.29, urine 2.24 ±0.97, and feces 1.92 ±0.72), (P=0.006, 0.011, <0.001).Compared to the manual method, Probact performed less quantity of bacterial species recovery for respiratory specimens(3.85 ±1.38), but higher in feces(0.80 ±0.81)( P<0.001).There is no significant differences for urine ( 1.84 ±1.23 ) ( P=0.266 ) .As for number of isolated colony, the Probact system ( respiratory specimens 12.16 ±7.72, urine 2.71 ±4.24, and feces 5.40 ±5.04 ) had significant smaller numbers than that of Isola Inoculator (respiratory specimens 16.56 ±5.76, urine 4.35 ± 4.89, and feces 8.40 ±3.70) (P<0.001,0.007,0.003).However, both system had larger numbers of isolated colonies than those by the manual method (respiratory specimens 11.30 ±8.42, urine 2.67 ±4.34, and feces 1.90 ±3.90) and the difference was significant for fecal specimens(P<0.001).Regarding the total number of colonies recovery, larger number was found by Isola Inoculator than that by the Probact system for fecal specimens, however, there were no significant differences for respiratory or urine specimens (P=0.524,0.738).Compared with manual method, the Probact system had significantly more numbers of colonies recovery for respiratory and fecal specimens ( P<0.001 ) . The total time for processing 160 specimens was shortest for manual method (281 min), followed by Probact system (419 min) and Isola Inoculator (495 min) .Conclusions The performance of the Probact system is better than the manual method but no superior to the Isola Inoculator.The Probact system can meet the clinical need in terms of full automation and standardization of specimen inoculation and prevention of bias of processing by laboratory staffs using manual method.

Objective:To investigate the importance of measuring and restoring distal radius tear drop angle in the treatment of distal radius middle column fracture with anterior collapse of lunate fossa joint.Methods:Thirty one cases of distal radius fractures in 29 patients was reported for 2 years from January 2018 to January 2020. Two patients with both distal radius fractures were included in this study. All cases in this group were treated by operation. Among the 29 patients, there were 20 males and 9 females. Their ages were 44.9±15.1 years (ranged from 20 to 78 years). Two patients with both distal radius fractures were included in this study, due to both teardrop angle (TDA) reduced. The time from injury to operation was 4-17 d, with an average of 6.9 d. Except for 2 cases of fracture with simple volar approach, the other cases were treated with combined volar and dorsal approach. All patients were treated with open reduction and internal fixation with plates and bone grafting. The teardrop angle was measured before and after operation, and the effect of surgical recovery of teardrop angle was compared. The wrist function was evaluated by Gartland-Werley scores.Results:The wounds of all patients healed in one stage without postoperative infection. The follow-up time of 29 patients were 15.1±5.2 months, ranged from 7 to 31 months. The healing time for all fractures was 10.3±2.9 weeks (from 8 to 16 weeks). No fracture nonunion or redisplacement. In 31 cases, the tear drop angle was 33.4°±5.83° (20°-45°) before operation, and 58.9°±9.89° (35°-70°) after operation. At the end of follow-up, Gartland-Werley scores was 4.7±4.6, ranged from 0 to 17. Among them, 10 cases were excellent, 16 were good, 5 cases were fair, and the excellent and good rate was 83.9%. The Gartland-Werley scores of the two subgroups with postoperative tear drop angle recovery ≥50° and <50° were compared, and the results were significantly different (the excellent and good rate for two subgroups were 96.2% and 20.0% respectively ( P=0.001). Conclusion:The distal radius fracture with significantly reduced tear drop angle should be actively treated. The measurement and recovery of tear drop angle is an important factor affecting the functional outcome of distal radius fracture with anterior edge collapse of lunate fossa joint, which should be highly concerned by clinical doctors. The recovery of teardrop angle mostly requires dorsal approach.

Objective:To investigate the efficacy of dual plate fixation in the treatment of proximal humeral fracture with comminuted calcar.Methods:From July 2018 to April 2020, 25 patients (7 males and 18 females) were treated operatively for proximal humeral fractures with calcar comminution using anterior plate and lateral Philos plate. The data of patients who were followed up for more than 12 months was retrospectively analyzed. The mean age was 58.3 years (range 33-79 years). There were 13 right sides (all principal sides) and 12 left sides (all non-principal sides). The causes of injuries included: falling on flat ground (12 cases), traffic accidents (11 cases) and falling from height (2 cases). According to Neer classification, there were 7 cases of two-part fractures, 16 cases of three-part fractures and 2 cases of four-part fractures. A number of parameters including patient demographics, mechanism of injury, operative time, time to union, the range of shoulder motion, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder joint score, neck-shaft angle and the complications were recorded.Results:All of 25 patients were operated and followed up for 24.7 months (range 14 to 36 months). The operation time was 124.3 min (75-185 min), and the blood loss was 178.4 ml (100-350 ml). All patients had healed fractures at the last follow-up, and the neck-shaft angle was 132.88°±8.11° immediately after surgery, and 132.68°±8.36° at the last follow-up. All 25 patients healed completely in 4.7 months (range 3-5 months). Range of shoulder joint motion were forward flexion 161.20°±13.01° (range 140°-180°), external rotation 37.60°±7.65° (range 20°-45°), and internal rotation T 4-L 4 levels. VAS score was 0.36±0.81 points (range 0-3 points), while ASES score was 87.32±8.78 points (range 57.7-100 points) and Constant-Murley score was 89.40±8.37 points (range 60 to 100 points). Overall satisfaction score (Constant-Murley score) was excellent in 23 cases, and good in 2 cases. No obvious complications occurred. Conclusion:The combination of anterior plate and lateral Philos plate in the treatment of proximal humerus fractures with comminuted calcar can achieve stable fixation and satisfactory postoperative results.

Objective:To systematically review the correlation between caesarean section and delayed onset of lactogenesisⅡ (DOLⅡ) .Methods:We searched PubMed, Web of Science, China Biomedical Medline Disc, China National Knowledge Infrastructure, WanFang Data, and VIP through computers. The search period was from the establishment of the database to March 31, 2022. After two evaluators independently selected literature, extracted data, and evaluated the quality of the included studies, Meta-analysis was conducted using R 4.1.0 statistical software.Results:A total of 25 studies were included, involving 36 233 caesarean section women. Meta-analysis showed that the risk of DOLⅡ in caesarean section group was 1.74 times higher than that in natural childbirth group [ OR=1.74, 95% CI (1.46, 2.08), P<0.01]. Conclusions:Current evidence shows that caesarean section can increase the risk of DOLⅡ in delivery women. Due to the limitation of the number and quality of included studies, future studies need to further confirm the causality between caesarean section and DOL Ⅱ.