[Objective]To investigate the effect of minimally invasive treating proximal humeral fracture with PHILOS plate under acromial anterior lateral deltoid splitting approach.[Method]A retrospective analysis was done on 31 patients treated with minimally invasively with Philos plate under modified approach from April 2005 to March 2009.There were 17 males and 14 females,12 of them were injured in a traffic accident and 19 in daily life,with their ages ranging from 42 to 89 years.According to Neer classification,there were 5 cases of two-part fractures,11 cases of three-part fractures,and 15 cases of four part fractures.[Result]The postoperative radiographs verified good position of all screws,with satisfactory bone fracture reduction.Follow-up for 8-36 months(average 18.8 months) showed no necrosis of head of humerus and injury of axillary nerve and all patients gained bone union,supficial infection occurred in two patients but relieved by care.According to Neer scoring,the excellent to good result rate was 87.1%.[Conclusion]Philos plate for proxima humeral fracture using acromial anterior lateral deltoid splitting approach possesses such advantages as better individuation,less disturbance of the blood supply,stable fixation of the fracture.It is an new method to treat proximal humeral fractures.

Objective To investigate the relationship between fasting plasma glucose (FPG) in early pregnancy and diagnosis of gestational diabetes mellitus (GDM) and to confirm the rationality of the new standard for GDM diagnosis in early pregnancy set by the International Association of Diabetes and Pregnancy Study Groups (IADPSG).Methods Clinical materials of 2761 pregnant women without diabetes mellitus,who accepted prenatal cares in Peking University First Hospital from April 1,2011 to December 31,2011,were collected and analyzed.The difference between FPG levels of GDM and non-GDM women was compared.According to the early pregnancy FPG level,the subjects were divided into group A (FPG＜5.1 mmol/L,n=2431) and B (FPG≥5.1 mmol/L,n=330).The incidence of GDM and pregnant outcomes of the two groups were compared with t or Chi-square test.Relationship between FPG and GDM was analyzed by Logistic regression and receiver operating characteristic curve.Results (1) Among the 2761 subjects,515 were diagnosed as GDM (18.7％) and the early pregnancy FPG level in GDM group was significantly higher than that in non-GDM group [(4.84±0.46) mmol/L vs (4.57 ± 0.35) mmol/L,t =11.924,P =0.000].In early pregnancy,the risk of GDM increased by 7.984-fold (OR=8.984,95％CI:6.605-12.220) with every 1 mmol/L increase of the FPG level.(2) The diagnostic rate of GDM during mid-and last-trimester in group A (15.2％,370/2431) was lower than that of group B (43.9％,145/330),x2 =123.976,P =0.000.(3) Receiver operating characteristic curve analysis of FPG in early pregnancy and diagnosis of GDM:The largest area under the curve was 0.718 (95％ CI:0.690-0.747).The sensitivity and specificity were 0.600 and 0.612,or 0.735 and 0.726 respectively,when 4.795 mmol/L or 4.785 mmol/L were set as the cut-off value.(4) Among the 1208 cases delivered,GDM was diagnosed in 227 cases.The cesarean section rate (54.2％,123/227) of GDM women was higher than that (39.2％,385/981) of non-GDM women (x2 =16.884,P=0.000).There were no differences in the incidences of macrosomia,neonatal hyperbilirubinemia,low birthweight infant,premature delivery,fetal growth restriction and preeclampsia between GDM and non-GDM group (all P＞0.05).The incidence of premature birth in GDM women with FPG＜ 5.1 mmol/L was lower (5.8％,10/173) than that (14.8％,8/54) of women with FPG≥5.1 mmol/L (x2=4.601,P＜0.05).The incidence of cesarean section,insulin administration,macrosomia and preeclampsia increased from low FPG group to high FPG group,however there was no statistical significances.Conclusions Diagnosing GDM with FPG≥5.1 mmol/L in early pregnancy is not recommended as over diagnosis might happen.But this cut-off value might indicate that the patient are at risk of GDM,and this population should not be ignored.

Objective: To enhance the safety of intravenous infusion and reduce the working strength of the nursing staff, a novel auto-switched intravenous infusion system was developed. Methods: The system was controlled by a low power consumption microchip. A signal was detected when the infusion was finished in one channel and then a cam mechanism was used to switch the infusion channel automatically under the supervision of the microchip. Results:A novel auto-switched intravenous infusion system was proposed and analyzed. The proposed concept is innovative, feasible and of functionality. Conclusion: The proposed auto-switched intravenous infusion system is cost effective and practical. It has potential applications and can benefit for improving current intravenous infusion situation.

BACKGROUND: The extramedulary fixation system including dynamic hip screw (DHS) is commonly used in treatment of Intertrochanteric fracture. However, in patients with unstable intertrochanteric fracture, extramedulary fixation system often leads to the failure of fracture fixation. Intramedulary fixation system including both proximal femoral nail antirotation (PFNA) and InterTan nail has been widely used in the treatment of unstable intertrochanteric fractures. OBJECTIVE:To compare the therapeutic effects of extramedulary fixation system containing DHS, PFNA and InterTan nail in the treatment of intertrochanteric fracture. METHODS:Literatures were searched in Wanfang, PubMed, Embase, Medline, the Cochrane library to screen literatures published from January 1990 to November 2014. Relevant studies addressing extramedulary fixation system containing DHS, PFNA and InterTan nail were screened. RESULTS AND CONCLUSION: 346 articles were screened, and 13 of them were in accordance with the inclusion criteria. 1 271 patients with different types of intertrochanteric fracture were assessed in this study. Compared to DHS group, patients treated with PFNA and InterTan nail had shorter operation time and less blood loss. No significant difference in rehabilitation time and Harris score was detected among three kinds of fixation methods. Additionaly, PFNA and InterTan nail had a similar effect. These findings verify that compared with DHS, PFNA and InterTan nail can optimize the surgery, but cannot elevate postoperative outcomes.

Objective:To investigate the characteristics of magnetic resonance imaging and clinical application of multi-modality magnetic resonance imaging (MRI) for evaluating the response of neoadjuvant chemotherapy (NACT) in inflammatory breast cancer (IBC).Methods:A total of 36 IBC patients were enrolled in the study.The morphological, hemodynamic and diffusion-weighted imaging features of MRI were analyzed. Eleven patients underwent MRI examination before and after NAT. The imaging changes were analyzed and the efficacy of NACT was evaluated.Results:There were 38 identified breast carcinoma in these 36 cases, among which abnormal skin thickening and enhancement, extensive edema was found in 37 breast lesions. Enhancement of breast lesions in 25 cases was non-mass-like enhancement. Diffusion limitation was found in all lesions. The number of vessels in affected side was more than that in healthy side in MIP images. Thirty three cases had axillary lymph node enlargement.The sensitivity and specificity of MRI in evaluating residual breast tumors and vascular thrombus were high, but the evaluation of axillary lymph nodes was relatively low.Conclusions:Multi-modal MRI can be used for early and accurate diagnosis of IBC. It can also be used to predict and evaluate the effect of neoadjuvant chemotherapy.

Objective To evaluate the charateristics of CT and MR imaging of struma ovarii(SO).Methods 10 lesions of 10 pa-tients confirmed by pathology were analyzed retrospectively.6 cases were performed plain and enhanced CT scan and 4 were under-went MR before operation.Imaging features were analyzed retrospectively correlated with histological findings.Results All the SO tumors were appeared as solitary,well-defined,lobulated or oval masses.The largest diameter was less than 10 cm.Ascites were found in 4 cases.Six of SOs were solid-cystic and four were cystic.The cystic portion was low density or high density on CT images. High density cysts were shoewed in 4 cases.On MR images,the cystic portion was hypointenstiy on T1 WI and hypo/hyperintensity on T2 WI.Vacuum phenomenon (hypointenstiy on T1 WI and extremly hypointensity on T2 WI)was observed in 1 case.Solid compo-nent and cystic wall showed remarkable enhancement.Conclusion CT and MR images of SO can reflect its histopathologic charater-istics,which provides important value in the diagnosis and differential diagnosis of SO.

Objective To explore the effects of hyperbaric oxygen treatment on chronic stress and glucocorticoid receptor (GR) expression in the hippocampus.Methods A total of 60 male Wistar rats were randomly divided into a restraint group,an HBO (hyperbaric oxygen) group,an HBO-restraint group and a control group using a random number table,each group with 15 animals.All the rats in the restraint and HBO groups were constrained by immobilizing their fore-and hind-limbs on a self-made frame for 3h daily for 21 days,and those in the HBO group received HBO treatment once daily for the same 21 days.The HBO-restraint group was immobilized in the morning and treated with HBO in the afternoon.The control group was reared without any special intervention.On the 1st,11th and 21st day of treatment,rats from the different groups were assessed using the open field test.On the 21st day,all the animals were sacrificed and their brains were harvested to detect GR expression.Results In the open field test on the 11 th day,the restraint group scored (131.0 ± 20.6) in terms of motor level and (26.5 ± 4.6) for exploratory behavior,both significantly higher than before restraint and significantly higher than those in the HBO-restraint group at the same time point.Immunofluorescence assay showed that GR expression in the hippocampus of the restraint group was significantly decreased compared with the control group.There was no significant difference,however,between the HBO-restraint group and the control group.Conclusion Chronic restraint stress induces changes in behavior and GR expression in rats which can be alleviated by hypbaric oxygen treatment.

Objective To investigate whether the bilateral nipple discharge with the background of hypothyroidism and pituitary tumor causes intraductal neoplasm. Methods Clinical data of 222 bilateral nipple discharge patients with hypothyroidism or pituitary tumor undergoing mammary ductoseopy (MDS) examination were analyzed. Those diagnosed as intraductal papilloma received surgery and pathological exam. 158 cases with inflammatory comedomastitis diagnosed by MDS received milk duct washing with gentamycin, dexamethasone and corresponding medical treatment. Results Among the 222 cases, 158 cases(71.17%) were diagnosed as inflammatory comedomastitis by MDS, 64 cases (28.83%) were diagnosed as intraduetal papilloma (64/222) by MDS and received operation,59 cases were pathologically diagnosed as intraductal papilloma,the other 5 cases were pathologically diagnosed as mammary duct ectasia. The pathological coincidence was 92.2% and no breast cancer was observed. 68.10% of inflammatory comedomastitis cases suffered from breast pain. There were no significant difference in the disease distribution of the ethnic groups. During pre-menopause period, the incidence of period neoplasia is higher in pituitary tumor than hypothyroidism; However, during the post-menopause the situation was vice versa. The color of niplle discharge is mostly milk-like in patients with pituitary tumor, while serous in patients with hypothyroidism. 71.19% of duct papilloma locate at the branch of the main duct. Conclusion The bilateral nipple discharge with hypothyroidism or pituitary are usually concomitant with intraduetal lesions. Mammary ductosopy is helpful to discover intraduetal neoplasia.

Objective To investigate the relationship between serum vitamin B12 level and arsenic methylation and the risk of arsenic poisoning in the arsenic exposed population.Methods Three villages in Midu County,Dali City,Yunnan Province were investigated.Cross-sectional study was used to select 103 subjects.The population was divided into three groups according to drinking water arsenic exposure situation and whether arsenic poisoning patients:28 cases of control group (not exposed to high arsenic),30 cases of arsenic patient group and 45 cases of non patient group.Instant peripheral blood samples and urine samples were collected.The content of arsenic in urine was determined by hydride generation cold trap and atomic absorption spectrophotometry.The levels of vitamin B12 in serum were determined by chemiluminescence immunoassay.The urine arsenic and serum vitamin B12 contents in different groups were compared,the arsenic poisoning prevalence rate in people with different levels of serum vitamin B12 was investigated,and the correlation between serum vitamin B12 level and the metabolism of arsenic methylation was analyzed.Results The level of urinary inorganic arsenic (iAs),monomethylated arsenic (MMA) and dimethylated arsenic (DMA),total arsenic (tAs) were significantly different between groups (F =13.032,20.778,21.978,22.155,all P ＜ 0.05).The levels of urine arsenic in patients with arsenic exposure [(94.56 ± 107.62),(75.76 ± 54.31),(270.19 ± 185.10),(444.02 ± 323.28) μg/g Cr] and non patient with arsenic exposure [(40.05 ± 47.47),(45.11 ± 46.06),(183.91± 151.45),(270.84 ± 231.45) μg/g Cr] were significantly higher than those in control group [(7.58 ± 4.82),(4.27 ± 2.01),(26.89 ± 11.45),(38.91 ± 13.34) μg/g Cr,all P ＜ 0.05].The serum levels of vitamin B12 were significantly different between groups (F =6.650,P ＜ 0.05),patients exposed to arsenic [(366.05 ± 120.03) ng/L] was significantly lower than the control group [(533.70 ± 180.12) ng/L,P ＜ 0.05].There were significant differences in the detection rate of arsenic poisoning among different levels of serum vitamin B12 (x2=8.13,P ＜ 0.05),the lower dose of vitamin B12,the more serious the incidence of arsenic poisoning.The content of vitamin B12 was negatively correlated with MMA％ (r =-0.21,P ＜ 0.05),and positively correlated with SMR (r =0.21,P ＜ 0.05).Conclusion Low levels of vitamin B12 in serum may increase the risk of arsenic poisoning.

Objective:To study the transdermal characteristics of myrrh essential oil and its percutaneous penetration enhancement for ibuprofen. Methods:The content of ibuprofen was determined by HPLC. Ibuprofen was used as the model drug and mouse skin was used as the permeation barrier in vitro. The transdermal properties of myrrh essential oil and its effect on percutaneous absorption of ibuprofen were investigated using Franz diffusion cells. Results:Without myrrh essential oil or with 1%, 2% and 3% myrrh essential oil, the cumulative transdermal penetration amount in 12h of ibuprofen in vitro was (0. 427 05 ± 0. 069 82), (0. 315 04 ± 0. 032 24), (0.230 50 ±0.031 14) and (0.181 34 ±0.053 70) mg·cm-2, with Jss of(0.031 4 ±0.005 7), (0.020 8 ±0.002 8), (0.017 2 ±0.001 6) and (0.013 9 ±0.003 4) mg·(cm2·h) -1, respectively. Conclusion: Myrrh essential oil shows no transdermal en-hancement for ibuprofen in vitro, to the contrary, it shows inhibitory effect with positive correlation to the concentration.