Objective To compare the outcome of proximal femoral nail anti-rotation (PFNA)versus anatomical locking plate (ALP) in treatment of unstable intertrochanteric fracture.Methods The study included 89 patients who had received PFNA fixation (PFNA group,n =45) or ALP fixation (ALP group,n =44) for unstable intertrochanteric fracture between February 2008 and September 2009.Operation time,amount of bleeding,drainage volume,postoperative complications,fracture healing time and hip joint score after fracture healing were compared between two groups.Results Mean operation time in PFNA group was obviously shorter than that in ALP group (61.4 minutes vs 114.8 minutes,P ＜0.01).Mean amount of bleeding and drainage volume were significantly lower in PFNA group than in ALPgroup (119.3 mlvs 136.8ml,P＜0.01; 74.9mlvs80.3 ml,P＜0.01).While,PFNA group was not significantly different from ALP group with regard to average fracture healing time and Harris hip joint score after fracture healing (4 months vs 4.1 months,P ＞ 0.05; 91.2 points vs 89.8 points,P ＞0.05).Two patients had poor fracture reduction in PFNA group,but all patients had good fracture reduction in ALP group.No obvious adverse postoperative complications occurred in PFNA group,but one patient had fracture nonunion in ALP group.Conclusions PFNA and ALP fixation of unstable intertrochanteric fracture present insignificant differences in fracture healing time,postoperative complications and hip joint function after fracture healing.Whereas,PFNA is more suitable for the elder patients on account of shorter operation time and less intraoperative bleeding.

Objective To observe the expression level of stromal cell-derived factor-1 (SDF-1) in bone marrow stromal cells of acute leukemia at initial diagnosis and complete remission. Method Bone marrow stromal cells were isolated and cultured from five patients of acute leukemia at the time of initial diagnosis (Group A), five patients of acute leukemia at complete remission (Group B), and five healthy individuals or persons with no serious hematopathy (Group C). The content of SDF-1 protein in cultured supernatants was determined with enzyme-linked immunosorbent assay (ELISA). Results The contents of SDF-1 protein in supernatants of groups A, B and C were 2 941?374, 2 891?305 and 1 583?157pg/ml, respectively. The contents in both group A and group B were significantly higher than that in group C. Conclusion The SDF-1 expression level in acute leukemia bone marrow stromal cells was elevated at initial diagnosis, and the abnormality persisted until the stage of complete remission.

Objective To study the cause of mis-diagnosis on carcinoma of large intestine in young people. Methods We retrospectively reviewed and analyzed the diagnosis and treatment of 62 young people with carcinoma of large intestine from 1990 to 2002. Results Among 36 cases of rectal carcinomas, 7 were diagnosed as colonitis,5 as hemorrhoid,3 as dysentery and 2 as perianal abscess with anal fistula. Among 26 cases of colon carcinomas, 3 were diagnosed as periappendic abscess,2 as colonitis and 1 as iron deficiency anemia.The rate of mis-diagnosis was 37 1%. Conclusions Carcinoma of large intestine in young people was a high malignant tumor with bad prognosis and little symptom in early stage. Surgeons should pay a great attention to the characteristic of this carcinoma to diagnose and treat early

Under the patterns of net-teaching,the construction of net-teaching database is an important tache to develop teaching favourably and improve the quality and efficiency of teaching quickly.This paper introduces the process of constructing a net-teaching database for medical haematology,the course learning of clinical hematology for the undergraduates and graduate students and the applications of the clinician in learning.

Objective To investigate the medium-term efficacy of total hip replacement with CFP handle prosthesis.Methods Thirty-two patients (34 hips) undergoing total hip replacement with CFP handle prosthesis were selected.The preoperative diagnosis was:femoral neck fracture in 6 cases,femoral head necrosis in 12 cases,osteoarthritis in 10 cases,ankylosing spondylitis in 3 cases,and pigmentation villi nodular synovitis in 1 case.Ten days,1 month,6 months,and 1 year (a year later) after surgery,the hip joint function and X ray film performance were followed up.Results There was no complication such as infect and injury of blood vessel and nerve.Postoperative X ray film showed the femoral handle prosthesis position was good.The average Harris hip score was 32.6 (20-53) scores before surgery,and back to 95.3(90-100) scores after surgery,no patients needed revision surgery.Postoperative Engh score was above 10 scores after half a year.Conclusion The medium-term efficacy of total hip replacement with CFP handle prosthesis is good,and can be used as one of the choice of primary total hip replacement.

Objective 　To investigate the prevalence, characteristics and correlates of depressive symptoms in first episode schizophrenic patients. Methods　To examine 164 first episode schizophrenic patients at the time of admission and at 3,6,9, and 12 months after starting treatment using the HAMD, BPRS, the Chinese version of SANS, CGI and GAF. Results　71% of the patients had depressive symptoms (mild or more) at damission, but the prevalence of depressive symptoms dropped to a mean of 12% during the recovery period. The most prominent depressive symptoms during the acute phase of schizophrenia were ‘cognitive disturbance’ and ‘retardation’ (the respective subscales constituted 35% and 29% of the total HAMD score on admission). Depressive symptoms improved in parallel with the schizophrenic illness. The severity of depressive symptoms was not related to gender, age of onset, educational level, duration of prodromal period or duration of illness. At admission the severity of depressive symptoms was only related to the BPRS anxiety and depression subscale score, but during the recovery period the HAMD total score was significantly correlated with all of the other clinical scales. The level of depressive symptoms at admission and at three months after starting treatment was not related to the subsequent course of positive or negative symptoms. Conclusions　Depressive symptoms appeared to be a separate symptom cluster during the acute phase of first episode schizophrenia. The severity of depressive symptoms did not predict the clinical outcome of first episode schizophrenic patients.

Objective To explore the risk factors of surgical site infection(SSI)in patients undergoing selective brain tumor resection,and provide reference for clinical prevention and treatment.Methods Patients who under-went selective brain tumor resection in the neurosurgery department of a hospital during April-September 2013 and April-September 2014 were monitored prospectively,monitoring programme and individualized questionnaire were formulated,the basic data,operation condition,postoperative symptoms/signs,laboratory test results,infection-related factors,and antimicrobial use in patients were collected,risk factors for infection were analyzed.Results A total of 205 patients were investigated,23 (11 .22%)of whom had SSI;univariate analysis showed that body mass index (BMI),NNIS score,and cerebrospinal fluid leakage were related to the occurrence of SSI(all P<0.05);lo-gistic regression analysis showed that high NNIS score and cerebrospinal fluid leakage were independent risk factors for SSI in patients undergoing selective brain tumor resection(both P<0.05).Conclusion Incidence of SSI is high-er in patients with selective brain tumor resection,corresponding preventive measures should be taken according to different risk factors including cerebrospinal fluid leakage.

Objective To study the protective effects of tBHQ on type 2 diabetic rats retina and its related mechanism.Methods Sixty SD rats were divided into normal control group (NC group),model group (diabetes mellitus,DM group) and tBHQ group.After feeding with high fat and high sugar diets for 4 weeks,the rats in model group were induced by intraperitoneal injection of STZ for the model of type 2 diabetes mellitus.1％ tBHQ were added into the high fat and high sugar feed 1 week later after successfully modeled in the tBHQ group.Fasting plasma glucose (FPG) and fasting serum insulin (FINs) were detected at 4 and 12 weeks after modeled.Immunohistochemical method and real-time fluorescent quantitative PCR (qRT-PCR) were respectively used to detect the distributions and relative expression levels of nuclear factor erythroid 2-related factor 2 (Nrf2),heme oxygenase 1 (HO-1),B-cell lymPhoma 2 (Bcl-2) and vascular endothelial growth factor (VEGF) in retinas of the rats.Results FPG levels totally comparative differences were statistically significant between each group (F =78.531,P =0.000).The level of FPG in DM and tBHQ group were obviously higher than that in NC group,the 12 weeks was higher than 4 weeks in DM group,and the 12 weeks was lower than 4 weeks in tBHQ group (all P ＜ 0.05).Totally comparative differences in the level of FINs were statistically significant (F=22.480,P =0.000),NC group was lower than DM and tBHQ group,12 weeks was higher than 4 weeks (all P ＜ 0.05).Immunohistochemical detection showed that each factor in each group were expressed in the retina of rat,and the relative expressions of Nrf2,HO-1,Bcl-2 and VEGF protein in retina have totally statistically differences in different time points after modeled (all P ＜0.05).The expressions of each factor in DM group were more than those in the NC group.The Nrf2,HO-1 and Bcl-2 in tBHQ group were more than those in the DM group,but the VEGF was lower.At 12 weeks,the expressions of VEGF and Nrf2 in DM group were more than those at 4 weeks,but the HO-1 was lower;the Nrf2,HO-1 and Bcl-2 in tBHQ group were more than those at 4 weeks (all P ＜ 0.05).PCR tests revealed that the relative expressions of Nrf2,HO-1,Bcl-2 and VEGF mRNA in retina have totally statistically differences in different time points after modeled(all P ＜ 0.05).The expressions of each factor in DM group were more than those in the NC group.The Nrf2,HO-1 and Bcl-2 mRNA in tBHQ group were more than those in the DM group,but the VEGF mRNA was lower.At 12 weeks,VEGF mRNA in DM group and Nrf2,HO-1,Bcl-2 in tBHQ group were more than those at 4 weeks (all P ＜ 0.05).Conclusion tBHQ maybe have protection for islet function on diabetic rat,and can induce the expressions of Nrf2,HO-1,Bcl-2 in retina of diabetic rats and reduce the expression of VEGF,inhibit the oxidative stress of retinal tissue damage,reduce cell apoptosis and inhibit the proliferation of retinal blood vessels.tBHQ may protect the retina of diabetic rats through the Nrf2/HO-1/VEGF and Nrf2/Bcl-2 way.

Background Apoptosis is a primary clinical pathological mechanism of diabetic retinopathy (DR).Oxidative stress and high glucose can activate cell apoptosis pathway and thus leads to cellular damage.It is confirmed that tert-butyl hydroquinone (tBHQ) plays an antioxidation effect,however,whether it has a protective role on retinal cells in DR is still unelucidated.Objective This study was to investigate the effect of tBHQ on vascular endothelial growth factor (VEGF) and bcl-2 expressions in retina of type 2 diabetic rats and its possible mechanism via nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE) signal pathway.Methods Fifty clean healthy male SD rats were included in this experimental study.Ten rats were fed with normal diet as the normal control group,and other rats were fed with high fatty and high sugar food for 4 weeks.After 12 hours of fasting,streptozotoin (STZ) (30 mg/kg) was intraperitoneally injected to induce the type 2 diabetic models.The model rats were randomly divided into the diabetic control group and tBHQ group and 1％ tBHQ was added into the high fatty and sugar food 1 week after modeling in the tBHQ group.Fasting plasma glucose (FPG) level,blood total cholesterol (TC) level,blood triglyceride (TG) level,high density lipoprotein-cholesterol (HDL-C),low density lipoproteincholesterol (LDL-C) and fasting serum insulin (FINs) were detected 4 and 12 weeks after modeling,respectively,and radio immunoassay was used to detect the FIN levels of the rats.The relative expression of VEGF and bcl-2 in retinas of the rats were assayed by immunohistochemistry and fluorescence real-time quantitative PCR (qRT-PCR).The use of the animals complied with the Regulations for the Administration of Affairs Concerning Experimental Animals by State and Technology Commission.Results Type 2 diabetic models were successfully established in 35 rats with successful rate 92.1％.The FIN levels were significantly different among different groups and time points (Fgroup =22.480,P =0.000;Ftime =7.636,P =0.008).The FPG,TC,TG and LDL-C levels were significantly different among the groups (FPG:Fgroup =78.531,P =0.000;TC:Fgroup =28.049,P =0.000;TG:Fgroup =13.108,P =0.000;LDL-C:Fgroup =6.804,P＜0.05).Immunohistochemistry showed that VEGF and bcl-2 were mainly expressed in retinal ganglion cell layer,inner plexiform layer and outer plexiform layer.The expressions of VEGF and bcl-2 proteins were significantly different among different groups (VEGF:Fgroup =11.805,P =0.000;bcl-2:Fgroup =22.943,P =0.000);the expression level of bcl-2 protein was higher in 12 weeks after modeling than that in 4 weeks after modeling in the tBHQ group (P＜0.05).The expressions of VEGF and Bcl-2 mRNA in rat retinas were significantly different among different groups and time points (VEGF:Fgroup =79.220,P =0.000;Ftimo =6.090,P＜0.05;Bcl-2:Fgroup =105.000,P=0.000;Ftime =13.170,P=0.001).Four and eight weeks after modeling,the expressions of VEGF and Bcl-2 mRNA in the diabetic control group and tBHQ group were significantly higher than that in the normal control group,and the expressions of Bcl-2 mRNA in the tBHQ group were significantly higher than that in the model control group (all at P＜0.05);the expression of Bcl-2 mRNA was higher at 12 weeks after modeling than that at 4 weeks in the tBHQ group (P＜0.05).Conclusions tBHQ produces anti-oxidative-damage and anti-apoptosis effects on retinal cells by up-regulating VEGF expression and down-regulating bcl-2 expression in DR rats.In addition,tBHQ may have effects on lowering high blood sugar,regulating insulin and blood lipid levels.

Objective To investigate the quality of life and analyze related factors of all the disabled at the entry of the Home Service Program in Zhabei district, Shanghai. Methods All the disabled were surveyed using the Chinese version of Short-Form 36 Health Survey(SF-36). Results 280 disabled people finished the survey, the total score was (59.72±20.03). There were significant differences in the scores among different ages, types of disabilities and status of subsistence allowances (P<0.01). The age was negatively correlated with quality of life (P<0.01). The education degree and the status of subsistence allowances were positively correlated with quality of life (P<0.05, P<0.01).Conclusion People with disability have poor quality of life in Zhabei district, Shanghai.