OBJECTIVETo measure the changes of plantar pressure of the first tarsometatarsal joint fracture and dislocation by three different implants to provide experimental reference in selecting implants.

METHODSEight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture and dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600 N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system.

RESULTSAfter first tarsometatarsal joint fracture and dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increased,whose differences were statistically significant (P<0.05). When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However,the staple fixation showed the statistical significant difference compared with normal state, although the peak pressure under the first and second metatarsal heads were recovered in some extent(P<0.05).

CONCLUSIONAfter the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads according to the regulation of the load transfer mechanism. While the first tarsometatarsal joint fracture-dislocation was fixated by screw or plate, the plantar pressure of the forefoot would return to the normal state. However,if the joint was fixated by the staple, it would still be difficult to return the plantar pressure to be normal.

Foot Joints ; injuries ; surgery ; Forefoot, Human ; physiology ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Pressure

Objective To evaluate the effects of nasal non-Hodgkin′s lymphoma(N-NHL) treated with chemotherapy alone, radiotherapy alone, chemotherapy plus radiotherapy and autologous peripheral blood stem cell transplantation(APBSCT) combined with total body irradiation(TBI);and to analyze the impact factors of prognosis. Methods 135 patients were treated between 1980 and 2000. All were confirmed by histopathology as N-NHL, including 122 T cell in origin, 12 B cell and 1 NK cell in origin. The main radiotherapy portal was set in front of the nose with a spade-like protrusion, supplement with a portal next to the ear on one side or both sides. Combined portal in facial cervical area was first used when there was invasion of the oropharynx. The median dose to the nasal cavity was 56.0Gy with a range of 35.2 to 75.5Gy, with added 30Gy to the primary lesion in two patients. Six patients received TBI combined with APBSCT, with 8Gy in the TBI group. Chemotherapy, given before or during after radiotherapy or alone, consisted of 2-6 cycles of COP, COPP, COMP, CHOP or COBDP. Prognostic factors were analyzed with Cox model. Results The local control rate was 12%,69%,76% and 83% in chemotherapy alone, radiotherapy alone, chemotherapy plus radiotherapy and APBSCT combined with TBI, respectively(P=0.057).The 5-year survival rate was 9%,52%,63% and 83%,respectively(P=0.032). Multi-factor analysis showed that tumor extension and treatment methods were the most important prognostic factors besides Ann-Arbor stage, but gender, pathology, age and symptoms had little effect on prognosis .Conclusions Chemotherapy plus radiotherapy group achieves a better survival rate than radiotherapy alone. It is helpful to evaluate prognosis to make more detail subareas on basis of local extensions in Ann Arbor staging system.For some N-NHL patients with good financial condition, APBSCT combined with TBI is a good choice.

OBJECTIVETo evaluate the clinical efficacy of manipulative reduction combined with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF) using meta-analysis method, in order to provide a reference for clinical treatment.

METHODSA systematic computer-based search (from January 1987 to April 2014) from CNKI, Wanfang database, Web of Science and PubMed were performed for the collection of controlled clinical researches on manipulative reduction combined with PVP or PKP in treating OVCF. The quality of selected researches was evaluated. Meta-analysis was adopted to evaluate visual analog scale, Cobb angle, anterior height ratio of the injured vertebra.

RESULTSA total of 7 researches of 410 patients were included in the present analysis, there were 5 RCTs and 2 non-RCTs and all come from China. Manipulative reduction combined with PVP could got better improvement in Cobb angle (WMD=-7.35; 95%CI: -12.15, -2.54) and anterior height ratio of the injured vertebra (P<0.01) than simple PVP, but no significant difference was found in improvement of visual analog scale (WMD=-0.01; 95%CI: -0.45, 0.42). There were no significant differences in the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra between manipulative reduction combined with PKP and simple PKP (P>0.05).

CONCLUSIONCompared with simple PVP, manipulative reduction combined with PVP may result in more clinical efficacy on the improvement of Cobb angle and anterior ratio of the injured vertebra. And compared with simple PKP, manipulative reduction combined with PKP has no obvious advantages on the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra. However, the number and quality of the literatures, may resulted in the effect of mistrust, so more large sample and high-quality RCTs are needed in future.

Combined Modality Therapy ; Fractures, Compression ; therapy ; Humans ; Manipulation, Spinal ; methods ; Minimally Invasive Surgical Procedures ; methods ; Osteoporotic Fractures ; therapy ; Spinal Fractures ; therapy

Objective To analyse the plasma glucose change in the patients with severe acute respiratory syndrome (SARS) and to discuss its possible mechanism. Methods The clinical data of 61 cases with SARS in Tianjin were retrospectively analysed. Results Plasma glucose level increased in 26 cases with SARS, among them, 2 cases suffered from diabetes before SARS onset, 24 cases were diagnosed as the secondary diabetes whose blood glucose level recovered normal after SARS were cured, except 4 cases who were dead. All of the 61 cases were treated with glucocorticoids. If the patients were grouped by the dose of methylprednisolone they received, 9 out of 14 cases with large dose, 14 out of 26 cases with middle dose and 1 out of 21 cases with small dose were led to secondary diabetes. There was significant difference in the incidence of the secondary diabetes between the small dose group and middle/large dose groups (P

OBJECTIVE:To evaluate 3 therapeutic schemes for the infections of urinary tract and look for the more rational one METHODS:To use pharmacoeconomic decision tree analysis RESULTS:By means of therapeutic schemes A,B,C,the anticipant costs for curing one case of urinary tract infection were 1 586 36 yuans,931 13 yuans and 899 24 yuans respectively CONCLUSION:The scheme C is the best one among 3 therapeutic schemes for infection of urinary tract

Objective To investigate the status quo of transformational leadership,psychological empowerment,team psychological safety and team effectiveness,and test whether the supposed structural equation is tenable.Methods Totally 380 nurses completed the Transformational Leadership Questionnaire,Psychological Empowerment Questionnaire,Team Psychological Safety Questionnaire and Team Effectiveness Questionnaire,structural equation model was used to verify the relationship of the above,Bootstrapping confidential interval and product of coefficient were used to test the mediating effect.Results Significant correlations were found between transformational leadership,psychological empowerment,team psychological safety and team effectiveness (P ＜ 0.01),transformational leadership played indirect effect on team effectiveness (Z=6.195,P ＜ 0.05),psychological empowerment and psychological safety had a totally mediation effect.Conclusions Healthcare workers should make psychological empowerment and team psychological safety as the breakthrough point,fully play the advantages of transformational leadership on team effectiveness in order to increase the working ability of nurses and make them complete the clinical work effectively and with high quality.

Objective To compare the puncturing hit rate,positive rate of pathological diagnosis and the incidence of complications between color Doppler ultrasound-guided and CT-guided percutaneous biopsy for the qualitative diagnosis of ultrasonic-visual chest lesions.Methods A total of 112 patients,who were encountered from January 2015 to June 2016 in authors' hospital and whose imaging materials suggested the presence of ultrasonic-visual chest lesions,were enrolled in this study.There were no bones or lung air between the thoracic skin and chest lesion to hinder imaging observation.Ultrasound-guided puncturing was employed in 52 patients (ultrasound-guided group) and CT-guided puncturing was adopted in 60 patients (CT-guided group).The puncturing hit rate,positive rate of pathological diagnosis and the incidence of complications were compared between the two groups.Results The puncturing hit rate in ultrasound-guided group was 100％ (52/52),which was higher than 91.7％ (55/60) in CT-guided group.The positive rate of pathological diagnosis in ultrasound-guided group was 96.2％ (50/52),which was higher than 80.0％ (48/60)in CT-guided group.The incidence of complications in ultrasound-guided group was 3.8％ (2/52),which was lower than 18.3％(11/60) in CT-guided group.Conclusion For the qualitative diagnosis of ultrasonic-visual chest lesions,ultrasound-guided percutaneous biopsy is more reliable than CT-guided percutaneous biopsy.

Objective To study the consistency in the diagnosis of preoperative TNM rectal cancer staging using high resolution magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) combined with carcinoembryonic antigen (CEA) and postoperative pathological TNM.Methods 156 cases pathologically proven were retrospectively analyzed and divided into 4 groups including preoperative MRI group (39 cases),TRUS group (39 cases),MRI and TRUS group (39 cases),MRI and TRUS combined with CEA group (39 cases).The differences between preoperative T,N staging and postoperative pathologic T,N staging were analyzed.Results There were statistically significant differences in the diagnosis of preoperative T and postoperative pathological T in 4 groups (T: Kappa =0.685,P =0.000; N: Kappa =0.544,P =0.000),but there were no significant differences in preoperative N and postoperative pathological N staging in preoperative MRI group,TRUS group,MRI and TRUS group (Kappa =0.142,P =0.329; Kappa =0.154,P =0.645; Kappa =0.154,P=0.229),and significant difference was observed in MRI and TRUS combined with CEA group (Kappa =0.544,P =0.000).There were no significant differences in the accuracy of T staging among the 4 groups (x2 =0.326,P =0.574; x2 =0.562,P =0.719; x2 =0.287,P =0.986),but significant difference in the accuracy of N staging were showed among the 4 groups (x2 =4.643,P =0.026; x2 =6.643,P =0.026; x2 =5.243,P =0.019).Conclusion Preoperative evaluation by the MRI add TRUS combined with CEA can improve the accuracy of preoperative staging,which can provide more reliable basis for decision-making and improve the coincidence rate of operative procedures in line with the estimate.It also provides the basis fur the accurate preoperative diagnosis and individualized treatment.

Objective To investigate an accurate,reliable and objective method to evaluate persistent vegetative state at bedside.Methods The brain function of 34 cases with persistent vegetative state as a result of acute brain injury was evaluated,involving clinical examinations and neuroelectrophysiological evaluations(EEG,BAEP,SLSEP).Results The most common cause of brain damage was anoxic encephalopathy(30/34,88.2%).The patients were in mild,moderate or deep coma with complete or partial existence of brainstem reflection,activities distributed by cerebral nerves,voluntary extremity activities,spinal cord reflection and automatic spinal cord reflection as well as partial existence of pathologic reflection.According to the Young Criteria of EEG,64.5%(20/31)and 29.0%(9/31)of the cases were in grade Ⅰ and Ⅵ respectively,6.5%(2/31)were in grade Ⅲ and Ⅳ.According to the Cant Criteria of evoked potential,34.8%(8/23),21.7%(5/23)and 43.5%(10/23)of the cases were in gradeⅠ,Ⅱ and Ⅲ of brainstem auditory evoked potential,respectively.43.5%(10/23),4.4%(12/23) and 52.2%(12/23)were in grade Ⅰ,Ⅱ and Ⅲ of short-latency somatosensory evoked potential respectively.29.4%(10/34)of 34 cases died,and 11.8%(4/34)resuscitated during 35—90 days. Conclusion Combination of multiple neuroelectrophysiological tests was an accurate,reliable and objective approach to evaluate the brain function of patients with persistent vegetative state,which provides evidence for decision-making in agrypnotic therapy.

OBJECTIVETo discuss clinical effects of surgical treatment for desmoplastic fibroma of bone.

METHODSBetween June 2000 and June 2010, 15 cases of desmoplastic fibroma were treated by surgical operation including 4 males and 7 females with an average age of 39 years old (ranged from 18 to 64 years old). The site of tumor was proximal femur in 4 cases, distal femur in 3, distal tibia in 2, proximal humerus in 1, distal humerus in 1, scapula in 1, pelvic in 2, manubrium of sternum in 1. The simple intralesional curettage was performed in 1 case. The other 14 cases were divided into two groups, 7 cases had an aggressive curettage with inactivation and the last 7 cases had a wide resection. Recurrence condition were observed after operation. The function was valuated in two groups after the operation according to Enneking's standard.

RESULTSThe mean duration of follow-up was 56 months (ranged, 18 to 132 months). Two cases recurred, but no metastasis. The patient with simple intralesional curettage recurreed, 1 of the 7 patients with a wide resection recurred. The recurrence rate was 13.3% (2/15). There was no recurrence in the group with an aggressive curettage with inactivation. According to Enneking's standard, Enneking scoring was 21.6 +/- 3.8 in the group with a wide resection and 28.3 +/- 1.3 in another group, The results were excellent in 2 cases and good in 5 in the group with a wide resection, excellent in 7 in the other group.

CONCLUSIONThe aggressive curettage with inactivation has better functional recovery than the wide resection,and it should be chosen when the lesion is small or located in an area where reconstruction is difficult.

Adolescent ; Adult ; Bone Neoplasms ; pathology ; surgery ; Female ; Fibroma, Desmoplastic ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Young Adult