OBJECTIVETo explore clinical outcomes of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision.

METHODSFrom January 2008 to January 2011,25 patients with posterior malleolar fractures with medial-extension type were treated by hollow lag screw. Among them, 15 patients were treated through posteromedial incision,including 9 males and 6 females,aged from 21 to 67 years old with an average of 48.1 +/- 1.3; there were 5 cases with type A, 6 cases with type B and 4 cases with type C,according to Denis-Weber classification. Ten patients were treated by through posterior-lateral incision,including 6 males and 4 females, aged from 23 to 64 years old with an average of 46.9 +/- 1.5; there were 3 cases with type A, 5 cases with type B and 2 cases with type C,according to Denis-Weber classification. Operation time, blood loss, length of incision, times of X-ray exposure and complications of two groups were recorded and compared, Baird-Jackson effective evaluation were applied for evaluate clinical outcomes.

RESULTSAll patients were followed up from 12 to 49 months with an average of 20.6 months. There were significant differences in operation time, blood loss, times of X-ray exposure and complications between two group (P < 0.05). While there was no obvious meaning in clinical outcomes between two groups (P > 0.05).

CONCLUSIONTreating posterior malleolar fractures with medial-extension type through posteromedial approach can expose and fix fracture under direct vision, has advantages of shorter operation time, less X-ray exposure and blood loss, is a good choice of surgical approach.

Adult ; Aged ; Ankle Fractures ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tarsal Bones ; injuries ; surgery

Objective To understand willingness of current medical undergraduates to work at community health-care service(CHS)institutions after their graduation to provides information for professional training for them.Methods Totally,2714 medical undergraduate students were recruited from three medical schools in east,middle and west China by multi-level sampling methods for questionnaire survey on their basic information and willingness to be employed at CHS institutions.results of the survey were described by relative numeric and tested by chi-square test for smtistical inference.Results About 60.6%of medical undergraduate students were willing to work at CHS organizations permanently or temporarily.Their willingness to work there differed with their native living areas and grades they were studying significantly(P＜0.01).Reason for those they would work at CHS organizations after graduation included work less stress and easier,and that for those reluctant to work there included low-income and lack of social respect for general practitioners.Conclusions Nowadays,few medical undergraduate students would like to work at CHS organizations after their graduation,which was influenced mainly by traditional ideas and concepts of employment,personal career devdopment,economic income,and so on.It is suggested that ideas of community work be strengthened for medical undergraduate students and their employment concepts be changed in the future.

Animals ; Animals, Newborn ; Drugs, Chinese Herbal ; therapeutic use ; Excitatory Amino Acid Antagonists ; therapeutic use ; Hypoxia-Ischemia, Brain ; metabolism ; prevention & control ; Memantine ; therapeutic use ; Platelet Activating Factor ; analysis ; Rats ; Rats, Sprague-Dawley

Objective Analysis of the etiological factors and the diagnostic methods of fever of unknown origin(FUO)in order to avoid misdiagnosis and missed diagnosis.Methods One hundred and twenty-eight patients with FUO were collected from our hospital.Results A final diagnosis was established in 118(92.2%)patients by using serological methods,bacteriological methods,body fluid test,bone marrow examination,tissue biopsy and diagnositic therapy.Infection(62.5%),connective tissue diseases(16.1%),malignancies(11.0%)were found to be the common causes of the fever in these patients while infection was the main cause of FUO in our research.The major pathogens responsible for the infec tion was bacteria,followed by virus and tuberculosis.Adult Still's disease was the most common connective tissue diseases in these patients.Lymphoma,malignant histocytosis and leukemia were the main forms of malignancy.Conclusion Infectious diseases was the most common cause of FUO while connective tissue disease and malignant tumors are also important in the pathogenesis of FUO.

The advantages and disadvantages , internal and external environments of Medical Journal of PAPF were analyzed by SWOT strategic management theory analysis with its opportunity and threats pointed out.Different fac-tors for the development of Medical Journal of PAPF were ranked to produce a SWOT matrix.The strategies were put forward for the development of Medical Journal of PAPF that represents the future direction of medical sciences in PAPF in order to keep abreast of competition with other domestic and foreign journals .

Objective To evaluate the value of predicting functional improvement of viable myocardium after percutaneous transluminal coronary angioplasty(PTCA) by strain rate imaging(SRI) combining with low-dose dobutamine stress echocardiography(LDDSE).Methods PTCA was performed in 20 patients with old myocardial infarction and 72 segments of resting dyskinetic wall motion at baseline were observed.Peak systolic strain rate(SSR) and systolic peak velocity(Vs) were measured in abnormal walls at baseline and SRI combined with LDDSE one day before PTCA.Increment of SSR and Vs was defined during stress echocardiography(?SSR% and ?V_S%).The follow-up analysis was performed 6 weeks after PTCA.Results The dyskinetic motion of 48/72 segments was improved according to the follow-up echocardiography 6 weeks after PTCA while that of 24/72 segments was not.Considering ?SSR%≥(2.02%),?V_S%≥(8.5%) in 5 ?g?kg~(-1)?min~(-1) stress and ?SSR%≥(24.7%),?V_S%≥(28.5%) in 10 ?g?kg~(-1)?min~(-1)stress as cut-offs for motion improvement of the left ventricular dyskinetic segments,the sensitivities were(93.8%),(89.6%) and(95.8%),(91.7%),respectively.At baseline SSRs of two groups were significantly different while Vs did not have significant difference.Conclusions Combined with LDDSE,SRI can more accuratly predict the motion improvement of viable myocardium than tissue velocity imaging can.

Background and purpose:Smac/DIABLO was the only apoptosis-related protein that could inhibit IAPs directly and simultaneously.The four amino-residual AVPI(Ala-Val-Pro-lie)in its N-terminal was the very important domain that could stimulate apoptosis.This study investigated the effect of synthetic Smac peptide (SmacN7) on chemotherapy sensitivity of bladder cancer cells.Methods:SmacN7 penetratin peptide was synthesized and delivered into T24 cells.MTT assay was adopted to evaluate the viability of T24 cells induced by low-dosage of MMC. Flow cytometry was applied to analyze the proportion of apoptosis and Western blot was used to detect the expression of XIAP and caspase-3;The activity of caspase-3 was measured and the effect of SmacN7 combined with MMC on T24 cell lines was also determined.Results:SmacN7 penetratin peptide could successfully interact with endogenous XIAP and increase the proportions of apoptosis of T24 cell lines induced by low-dosage of MMC in a dose-and time- dependent manner.An obvious down-regulation of XIAP expression and up-regulation of caspase-3 was identified by Western blot.The activity of caspase-3 in experimental group was significantly increased as compared with that in the control group;Combining the treatment with SmacN7 penetratin peptide,the viability of T24 cells decreased to 55% and 72.7% in 24 hrs and 48 hrs respectively.Conclusion:SmacN7 penetratin peptide could act as a cell-permeable IAP inhibitor,inhibit the proliferation,induce apoptosis and enhance the chemo-sensitivity of bladder cancer cells to MMC. When combined with chemotherapy,it may be a very promising strategy for bladder cancer therapy.

Objective To analyze the effect of N-acetyl-L-cysteine(NAC)on endoplasmic reticulum stress mediated HepG2 cells apoptosis and evaluate the role of NAC in the treatment of liver injury.Methods HepG2 cells were treated with thapsigargin(TG)to establish the model of oxidative endoplasmic reticulum stress mediated apoptosis,and NAC was used to intervene in apoptosis.To evaluate the apoptosis,various methods such as MTT assay,flow cytometry,DNA ladder and Western blot were performed.Results After treated with 2 μmol/L TG for 0,24,36 and 48 hours,the vitality of HepG2 cells decreased.The ratio of apoptotic cells increased along with the prolonged treatment duration of TG(0.7%±0.5%,27.6%±6.3%,29.7%±3.3%,47.9%±3.5% respectively,P<0.05),and the production of reactive oxygen species(ROS)also increased in time-dependent manner(14.0%±0.5%,36.1%±3.0%,38.2%±6.0%,48.3%±12.4%,P<0.05).The HepG2 cells showed typical morphologic change of endoplasmic retieulum stress induced by 2 μmol/L TG after 36 h and 48 h.DNA ladder was observed at the same concentration and time point correspondingly.Endoplasmic reticulum stress mediated-apoptosis was confirmed by Western blot.Both 10 mmol/L and 20 mmol/L NAC could protect ceils from apoptosis.The ratio of apoptotic cells decreased to 14.0%±1.3% and 11.0%±0.3%,respectively.The production of ROS decreased to 34.7%±0.8% and 31.5%±2.9%,respectively.The effect was related to the concentration of NAC.Conclusions As a Ca2+-adenosine triphoshatase inhibitor,TG may disrupt intracellular calcium homeostasis,which can induce endoplasmie reticulum stress and apoptosis.NAC,the precursor of the synthesis of-SH,can directly inhibit the ROS reaction and alleviate liver damage,which may play a role in the treatment of liver failure.

Objective To observe the rat cardiac size and cardiac function changes before and after trimetazidine administration plus bone-marrow stem cells transplanting through echocardiography.Methods Forty wistar rats were divided into the following 4 groups randomly:control group (T),myocardial infarction group (Ⅱ),bone marrow stem calls transplantation group (Ⅲ),and bone marrow stem cells transplantation plus trimetazidine administration group(Ⅳ).The rats' left anterior coronary artery in group Ⅱ,Ⅲ and Ⅳwas ligated to produce myocardial infarction model,then bone-marrow stem cells were injected around the infarcted area into the later two groups.Furthermore,rats in group Ⅳ were administrated with trimetazidine.The size and systolic function of the hearts were measured 4 weeks after transplantation.The left ventricular systolic pressure(LVSP) and the end-diastolic pressure(LVEDP) were also measured at the end of experiment.Results The left ventricular diameter of rats in group Ⅲ and Ⅳ was smaller than that in group Ⅱ,and the ventricular systolic function increased,LVSP increased and LVEDP decreased statistically in group Ⅲ and Ⅳ.the amelioration of cardiac size and function was significantly notable in group Ⅳ than that in group Ⅲ.Conclusions Bone marrow stem cells transplantation can release the enlargement of left ventricle and improve cardiac function after myocardial infarction.The therapeutic efficacy can be further elevated if administrated with trimetazidine simultaneously.

Objective:To explore the monitoring value of left ventricular functional parameters obtained by bedside ultrasound combined with clinically relevant indicators in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A retrospective study was conducted. A total of 24 patients receiving VA-ECMO adjuvant support in Renmin Hospital of Wuhan University from June 2018 to January 2020 were selected. The bedside ultrasound was performed on the first day of ECMO support, the day before weaning, the clinical indicators before weaning were obtained. The differences in clinical indicators and the left ventricular functional parameters between the two groups of whether weaning successfully were compared; univariate Logistic regression analysis was used to screen out the related factors affecting weaning.Results:Sixteen patients were successful weaned and 8 patients failed. Compared with the weaning failure group, patients in the weaning success group required less continuous renal replacement therapy (CRRT, cases: 4 vs. 6, P < 0.05), mean arterial pressure (MAP) before weaning was higher [mmHg (1 mmHg = 0.133 kPa): 84.64±9.55 vs. 62.30±8.79, P < 0.05], and the pulse oxygen saturation (SpO 2) was also higher (0.966±0.670 vs. 0.866±0.061, P < 0.05), while vasoactive-inotropic score (VIS), serum creatinine (SCr) and serum lactic acid (Lac) were lower [VIS score: 7.27±1.42 vs. 16.93±8.52, SCr (μmol/L): 123.60±83.64 vs. 213.10±117.39, Lac (mmol/L): 1.94±0.91 vs. 5.62±5.48, all P < 0.05]. Univariate Logistic regression analysis showed that the MAP, VIS, SCr, Lac, SpO 2 before weaning were the related factors affecting weaning [odds ratio ( OR) were 0.306, -0.740, -0.011, -0.632, -4.069; 95% confidence interval (95% CI) were 1.065-1.732, 0.235-0.899, 0.979-0.999, 0.285-0.992 and 0.001-0.208; P values were 0.014, 0.022, 0.038, 0.047, 0.002]. In the weaning success group, left ventricular ejection fraction (LVEF), velocity of mitralannulus in systolic (LatSa), maximum flow velocity of aortic valve (AV-Vmax), velocity-time integral (VTI), left ventricular global longitudinal strain (LVGLS), left ventricular global longitudinal strain rate (LVGLSr) were all increased on the day before ECMO weaning compared with the first day of ECMO support [LVEF: 0.40±0.05 vs. 0.28±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.62±1.02, AV-Vmax (cm/s): 104.81±33.98 vs. 64.44±16.85, VTI (cm): 14.56±3.11 vs. 7.96±1.98, LVGLS: (-8.95±2.59)% vs. (-5.26±1.28)%, LVGLSr (1/s): -0.48±0.11 vs. -0.29±0.09], whereas the ECMO flow was significantly reduced (L/min: 1.46±0.47 vs. 2.64±0.31), the differences were statistically significant (all P < 0.05). There was no significant difference in left ventricular functional parameters between the first day of ECMO support and the day before ECMO weaning in the weaning failure group. Compared with the weaning failure group, the weaning success group had higher LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr on the day before ECMO weaning [LVEF: 0.40±0.05 vs. 0.26±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.31±1.03, AV-Vmax (cm/s): 104.81±33.98 vs. 67.67±18.46, VTI (cm): 14.56±3.11 vs. 7.75±2.77, LVGLS: (-8.95±2.59)% vs. (-4.81±1.81)%, LVGLSr (1/s): -0.48±0.11 vs. -0.30±0.10, all P < 0.05] and lower ECMO flow (L/min: 1.46±0.47 vs. 2.20±0.62, P < 0.05). Conclusion:Bedside echocardiographic left ventricular function parameters (LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr) combined with clinical indicators (MAP, VIS, SCr, Lac, SpO 2) were helpful to evaluate the therapeutic effect of patients receiving VA-ECMO support and can provide important guiding value in the selection of VA-ECMO weaning timing and the judgment of prognosis.