Objective To analyze, treatment of ipsilateral Pilon and calcaneal fractures (IPCF). Methods Injury causes included fallings in seven patients, traffic injury in two and impact injury in one, with ISS score of 5-22 points. There were seven patients with open injuries and 3 with close ones. Nine pa-tients had Ⅱ-Ⅲ degree of Pilon fractures according to the AO/OTA classification and six comminuted com-pression calcaneal fractures according to the Essex-Loprest classification. The Pilon fractures were fixed by cannulated nail, screw or Kirschner wire through open reduction in six patients including four fixed with ex-ternal fixators (the calcaneal fractures were fixed with percutaneous eannulated nail or Kirschner wire by poking reduction). The calcaneal fractures were fixed with only Kirschner wire through poking reduction in two patients and double fractures treated conservatively in two. Results The reduction of Pilon and cal-caneal fractures treated by operation were markedly improved in six patients, while there occurred angular deformity and joint surface introeession in the patients treated conservatively. The wound healing of soft tis-sue was sound in seven patients but unsatisfactory in the other three. The ankle-hind foot score was 82-94 points in four patients who were followed up. Conclusions IPCF is caused by the high energy force and characterized by severe injures of the soft tissues and the bone tissues at the distal tibia and calcaneua, for which limited internal fixation plus external fixation are suitable treatment choice.

Objective:To evaluate the effects of perioperatively administrated enteral immunonutrition in gastrointestinal cancer patients on immune and inflammatory responses,nutrition states and postoperative morbidity.Methods:Sixty patients with gastrointestinal cancer were divided randomly into two groups.Two groups perioperatively(from preoperative day 5 to postoperative day 7) received an supplemented diet with arginine,RNA,and ?-3fatty acids(immunonutrition group;n=30) or an isoenergetic and isonitrogenous standard diet (standard-nutrition group;n=30).All variables of immune and inflammatory responses,nutrition states and postoperative morbidity were measured on preoperative day 5 and postoperative day 1,4 and 8.Results:On postoperative day 4 and 8,most immune variables and prealbumin in the immuno-group were significantly higher than those in the standard-group(P0.05),and inflammatory variables as CRP in the immunonutrition group were significantly lower than those in the standard group.In the immunonutrition group,there were significantly fewer patients who experienced postoperative complications and shorter days of hospital stay compared with standard group(P0.05).Conclusion:The perioperative administration of enteral immunonutrition in gastrointestinal cancer patients can significantly modulate the postoperative immunosuppressive and inflammatory responses at the early postoperative day,can significantly decrease the occurrence of infectious and overall postoperative complications as well as the length of hospital stay.

Objective To study local people's habits and customs concerning the prevention of dental fluorosis in an indoor coal-combustion-type fluorosis area of Zhaotong city Yunnan province, and to provide reference value for monitoring and control of the disease. Methods In 2008, 600 people of a 12-year-old group (400 people) and a 35 - 44-year-old group(200 people) were examined for dental fluorosis and oral health status in an indoor coal-combustion-type fluorosis area of Zhaotong. A questionnaire survey of 120 students and 60 adults was carried out on their habits and customs, stove changing status, knowledge of prevention of dental fluorosis, social psychology status, oral health behavior and their need for medical treatment. Results The total prevalence of dental fluorosis was 91.0% (546/600), dental fluorosis index was 2.58. The total prevalence of dental fluorosis of 12-year-old group was 86.5%(346/400), and dental fluorosis index was 2.12. The total prevalence of dental fluorosis of rural student was 90.5% (181/200), which was obviously higher in the rural group than the urban group [82.5% (165/200), χ2 = 5.48, P < 0.05]. The total prevalence of dental fluorosis of 35-44-year-old group was 100% (200/200), which was obviously higher than that of the 12-year-old group(χ2 = 29.67, P < 0.01). The rates of using coal, baking of food, changing stoves were 66.7% (60/90), 14.4% (13/90),57.8% (52/90), respectively, and these values of the urban were much lower than those of the rural[95.6%(86/90) ,31.1%(28/90) ,76.7%(69/90),χ2 = 24.51,7.11,7.29, all P < 0.01]. Only 23.3% (42/180) of people surveied had the knowledge of prevention of dental fluorosis, and the rate in the adult group[56.7% (34/60)]was higher than that of the student group [6.7% (8/120), χ2 = 55.9, P < 0.01]. The same rate in the urban student group was 0(0/60), and the rural student group was 13.3%(8/60), there was a significant difference between them(χ2 = 5.66, P < 0.05). Seventy-three point nine per cent( 133/180) of these people thought dental fluorosis had significant effect on their life, 91.1%(164/180) of these 'people wished to be treated. Eighty-four point four per cent( 152/180) of the people had a habit of toothbrushing,and 50.7% (77/152) of these people were still using toothpaste containing fluorine. Conclusions Zhaotong is a serious indoor coal-combustion-type fluorosis area. Enhancing health education to local people especially to students, and changing people's unhealthy habits and customs are keies to control the prevalence of indoor coal-combustion-type dental fluorosis.

Objective To assess the peripheral arterial structural and elastic remodeling in patients with lower extremity atherosclerotic disease (LEAD).Methods Thirty-one patients with LEAD and 34 age-,sex-matched healthy subjects (control group) were enrolled in this study.The intima-media thickness (IMT),diameter (D) and parameters of arterial stiffness (β,pulse wave velocity (PWVβ)) were measured by acquiring the longitudinal view of left and right common femoral artery (LCFA,RCFA) and common carotid artery (LCCA,RCCA) by quality intima-media thickness (QIMT) and quality arterial stiffness (QAS) techniques.The factors correlated with arterial stiffness in LEAD patients were analyzed.Results ① The systolic blood pressure(SBP),pulse pressure(PP),smoking pack-year and smoking extent (nonsmoker,smoker with ＜40 pack-year,or smoker with ≥40 pack-year) were significantly higher in LEAD group than those in the control group (P ＜0.05).②IMT of the LCCA and the diameters (D) of LCCA and RCCA were significantly increased in the LEAD group (P ＜0.05-0.01).As to the both sides CFA,IMT and IMT/D values were significantly increased (P ＜ 0.01).The mean IMT (mIMT) of both sides of CCA and CFA were increased (P ＜0.05).The values of β,PWVβ of LCCA and PWVβ of RCCA were significantly increased,and β and PWVβ values of both sides of CFA were significantly increased in the LEAD group (P ＜ 0.05).There was a positive correlation between the stiffness indexes of the carotid artery and that of the femoral artery (P ＜0.01).③The femoral mβ was correlated with femoral mIMT,SBP,PP,smoking amount and smoking extent,and the femoral mPWVβ was also correlated with mIMT,age,SBP,PP,smoking pack-year and smoking extent (P ＜0.05-0.01).In multivariable stepwise regression analysis,mIMT and PP were factors independently correlated with femoral mβ.And SBP,smoking extent,and mIMT were independently correlated with femoral mPWVβ.Conclusions Peripheral arteries in patients with LEAD experience vascular remodeling,as well as increased carotid and femoral stiffness.Femoral stiffness is correlated with IMT,arterial blood pressure and smoking extent.

Objective To evaluate the clinical outcome of external bracket fixation in the treat- ment of complex tibia diaphysis fracture involving intra-articular fractures.Methods Forty-two cases of complex tibia diaphysis fracture with proximal and distal intra-articular fractures treated surgically in our hospital from January 1999 to January 2004 were analyzed.The complex tibia diaphysis fractures were categorized according to the AO classification as type C2 (multiple segments fracture) and type C3 (ir- regular fracture),proximal and distal intra-articular fractures in 23 and 19 cases,respectively.Definite operation was done within one week.Twenty-two cases were treated with simple external fixator,and 20 cases treated with screws and external fixator.Results All the 42 cases were followed-up regularly. According to AO evaluation of the knee and ankle joint movement,83% (35/42 cases) of the cases gained satisfactory functional outcome,14% (6/42 cases) had quite satisfactory results and 2% (1/42 case) had unsatisfactory functional outcome.Conclusion External bracket fixation can obtain outcome of relative length of the tibia and fibula,tube structure reconstruction,smoothness of the articular surface and the parallel and symmetric relation of knees and ankles for complex tibia diaphysis fracture with proxi- mal and distal intra-articular fracture.The arthritis resulting in pain in movement and restriction of func- tion is considered to be the most important factor affecting the joint function.Early functional exercise is important for best recovery of knee and ankle function.

Objective To analyze the role of tissue factor (TF) regulating the invasive ability of human colorectal carcinoma cells (HT-29). Method The plasmids pcDNA3.1/Zeo bearing either sense or antisense TFcDNA were transfected into HT-29 cells by lipofactamine 2000. TF proteins in transfectants and its parental cells were detected by Western blot. Matrigel invasion assays and nude mice inoculation assays were used to show the invasive ability of cancer cells in vitro and in vivo respectively. Microvessel density of the implanted tumors was counted. Result HT-29 cells with sense-TFcDNA transfection upregulated TF expression and invasive ability compared with the parental cells, and tumor tissues after sense transfection were of greater microvessel density than the parental cells. HT-29 cells transfected with antisense-TFcDNA had a downregulated TF expression and are of less microvessel density. Conclusion Positive TF expression increases the invasive ability of HT-29 cell in vitro and in vivo.

Through forty years' sustained efforts in the prevention and treatment of malaria in Zhejiang Province, the malaria incidence dropped from 76. 65k in the Fifties to 0. 91 in the Eighties. Three malaria epidemics emerged in 1954 ,1962 and 1973, respectively, among them the epidemic in 1962 was the most serious one with 0. 88 million cases reported and an incidence of 330. The annual incidence of the overall counties/cities was below 1 after 1988. Only 172 malaria cases were found in 1992, the incidence being 0. 04. No indigenous malaria case was found in 38 counties in 1992, accounting to 43. 7% of the total malaria endemic counties. The number of imported malara cases was 3 829, amounting to 89. 2 % of the total number of cases. Through the spot-check of the Ministry of Public Health in 1993, it was confirmed that the criteria of basic elimination of malaria in the province was attained.

Objective To investigate the clinical efficacy of fixation of distal radius fracture with dorsal instability with locking compression plate (LCP) via radial approach.Methods From September 2009 to October 2012, 21 cases underwent LCP fixation of the distal radius fracture with dorsal instability via radial approach.The study included 14 males and 7 females (mean age, 54.5 years;range, 38-81 years).Twelve cases were injured in traffic accidents, 7 in falls and 2 in high falls.Fracture AO classification was type A3 in 10 cases, type C1 in 8 cases and type C2 in 3 cases.Two cases (one type A3 and one type C1) had malunion.When the lateral column, intermediate column, radial edge and dorsal plane were exposed by radial incision, LCP fixation with bone grafting was performed to restore the height of radial styloid process, ulnar deviation and palmar tilt.According to the GartlandWerley score, wrist joint function was evaluated.Results Mean duration of follow-up was 13.5 months (range, 12 to 24 months).Stage Ⅰ bone union was shown on X-rays, with the healing time of 7.5 weeks.Based on the X-rays at postoperative 6 months, 1 year and 2 years, the shortening of radial styloid process was ≤ 2 mm, mean volar tilt was 12.5°(range, 8°-17°) , mean ulnar tilt was 20.5° (range, 15°-26°), and step-off or gap of the articular surface was ≤ 2 mm.In postoperative wrist motion assay, mean volar flexion was 60°(range, 30°-70°), mean dorsal flexion was 55° (range, 30°-65°), mean radial deviation was 17°(range, 10°-20°), mean ulnar deviation was 25.5° (range, 20°-30°),pronation was 65.5° (range, 60°-70°) , and mean supination was 75.5° (range, 60°-80°).Mean grip strength was 75％ (60％-95％)of the contralateral side.Two cases suffered from pain (one complained of moderate pain and one minor pain occasionally).According to the Gartland-Werley score, 16 cases were rated excellent, 2 good, 2 fair and 1 poor, with the excellent rate of 86％.No complication was found as injury of the superficial branch of radial nerve, infection, nonunion, nail loosening, medium neuritis and tendon injury.Conclusions Lateral column, intermediate column, radial edge and dorsal plane can be shown via the radial approach.LCP fixation combined with bone grafting contributes to fracture anatomical reduction.

OBJECTIVEThis study aims to conduct a survey of the oral health status of disabled individuals in Liangshan Autonomous Prefecture in Sichuan province. This study was also conducted to prepare caries prevention planning in the region.

METHODSOn the basis of the Oral Health Surveys: Basic Methods of WHO and the Third National Oral Health Epidemiological Sample Survey Scheme, we investigated caries infecting disabled individuals who live in one big city (Xichang city), three counties (Bhutto county, Muli Tibetan autonomous county, and Huili county), and 46 towns and villages of Liangshan Autonomous Prefecture in Sichuan province, by multi-stage stratified and cluster sampling.

RESULTSAmong 3,439 disabled individuals, 2,085 were males and 1,354 were females; among these individuals, 815 live in the city and 2,624 live in rural areas. Furthermore, 2,177 were Han natives and 1,262 were Yi natives (ethnic). The caries prevalence rate and mean DMFT of disabled individuals in Liangshan Autonomous Prefecture in Sichuan province were 87.1% and 9.53, respectively. In Yi, the caries prevalence rate and mean DMFT of disabled individuals in Liangshan Autonomous Prefecture in Sichuan province were 85.8% and 9.93, respectively; in Han, the caries prevalence rate and mean DMFT of disabled individuals in Liangshan Autonomous Prefecture in Sichuan province were 87.9% and 9.29, respectively. No significant difference was found in the two groups of native (P > 0.05). A very low filling rate of 0.2% was also recorded.

CONCLUSIONDisabled individuals from Liangshan Autonomous Prefecture in Sichuan province exhibited a high prevalence of caries in permanent teeth. The oral health status of this special group of disabled individuals should be provided intensive care.

Objective: To assess the risk of public health emergencies in Zhejiang Province, March 2021. Methods: An expert counsel was conducted to assess the risk of coronavirus disease 2019 ( COVID-19 ) , enteritis due to norovirus, chicken pox and influenza by professionals in Zhejiang CDC, based on the information from infectious disease and public health emergency surveillance in Zhejiang Province, domestic health administrative departments, World Health Organization, and European CDC. Results: In March 2021, the risk of imported COVID-19 epidemic will be high in Zhejiang Province, and the possibility of local spread could not be ruled out. The possibility of a large-scale outbreak of enteritis due to norovirus and a small-scale outbreak of chickenpox in schools and kindergartens could not be ruled out after the new term begins. An increased risk of influenza epidemic is predicted in collective units such as schools and kindergartens, yet the risk of a large-scale one will be low. Conclusion High attention should be paid to COVID-19 and enteritis due to norovirus, and general attention should be paid to chicken pox and influenza outbreak.