0.05). The length and the angle of the proximal tibial slope were (2.34?0.2) cm and (20.1?4.3)?, respectively. Conclusion The specification of entry point of intramedullary nailing must be individual because the shape of proximal tibia varies in different persons.

Objective To compare the effect of laparoscopic versus open appendectomy for acute appendici -tis in the obese population .Methods The clinical data of 96 obese patients performed LA and OA were analyzed ret-rospectively.According to the operation method ,they can be divided into LA ( laparoscopic appendectomy ) group 51 cases and OA(open appendectomy) group 45 cases.The surgical time,intestinal peristalsis recovery time,length of hospital stay ,hospital charges ,the rate of incisional infections and the rate of intra-abdominal infections between the two groups were observed and compared .Results The surgical time ,intestinal peristalsis recovery time ,length of hos-pital stay ,hospital charges ,the rate of incisional infections and the rate of intra-abdominal infections of LA group were (60.5 ±4.4)min,(15.23 ±3.80)h,(5.3 ±0.6)d,(9029.9 ±152.6)yuan,0.00%,7.84%,respectively,which were better than those of OA group[(43.5 ±7.2)min,(40.12 ±7.23)h,(7.3 ±1.2)d,(5 871.8 ±420.0)yuan, 8.89%,0.00%](t=14.1383,21.4633,10.5110,50.1093,χ2 =1.7934,3.6829,all P<0.01).Conclusion LA can be performed safely with superior outcomes compared with OA in obese patients and should be considered the pro -cedure of choice for appendicitis in these patients .

Objective To understand the consulting relationship among students of some teaching class of epidemiology.Methods Data were collected through questionnaire and the network characteristics were analyzed with social network analysis software-NetDraw.Results The consulting network relation of this class was loosening,but there were a few people who have more degree and betweenness than others;some cliques were associated with major and sex.Conclusions Social network analysis can help teacher understand the consulting relationship among students,which may provide the base for making the management strategy on teaching class.

OBJECTIVE To strengthen the hospital infection control to realize the potency feeling among malignant tumor patients under the conduct of psychological nurses and other medical staff.METHODS The related hospital infection control system and the psychological countermeasure of nursing were formulated,we used two groups of comparisons methods around implements,counting and analyzing the effect of the hospital infection control among malignant tumor patients.RESULTS The psychologically healthy instruction enabled the patient positively to coordinate the treatment,the ratio of hospital infection from the original 21.33% dropped to 15.41%,and make the certain dynamic function to the self-realization of the patients' potency feeling.CONCLUSIONS The hospital infection control is an essential and important link to the nursing of the malignant tumor patients;the psychologically healthy instruction is an effective way to promote the self-realization of patients potency feelings.

Objective To measure the parameters of anterior bow of the femoral medullary cavity by means of 3D spiral CT reconstruction and to provide the anatomical basis for the design of the femoral component prosthesis.Methods 105 healthy Chinese left femurs were scanned in standard neutral position by 3D spiral CT.Parameters of the anterior bow of the femoral medullary were measured by medical imagine software.Results The parameter values of the male femur were statistically bigger than those of the female,including the length of the femoral medullary and the distance from the point of maximum curvature to plane above lesser trochanter (P＜0.001).No significant differences between male and female in the position index of the point of maximum curvature were observed (P＞0.05).The relative curvature of the female femoral anterior arch was statistically bigger than that of the male (P＜0.001).The femoral curvature subtense and the length of the femoral medullary showed no significant correlation (r=0.106,P=0.281).Conclusion There are certain anatomic differences in the anterior bow of the femoral medullary between male and female.Appropriate length of femoral component should be considered in total hip replacement operation.And it is necessary to design the femoral components fitting the features of the femurs according gender difference.

Objective To investigate the change of 25-hydroxyl vitamin D level and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients.MethodsTwo hundred and fifty-eight cases of type 2 diabetic patients in our hospital were collected.In accordance with 25 (OH) D =50 nmol/L for the critical values,they were grouped into vitamin D deficiency group ( n =192) and the relative lack of vitamin D group ( n =66).Dual-energy X-ray absorptiometry (DXA) measurement of the lumbar vertebrae L2 - L4 and femoral neck bone mineral density were undertaking.Taking the total value of the lumbar spine,femoral neck and total value as judgment indicators,homeostasis model assessment of insulin resistance (HOMA-IR),we collected and statistically analyzed glucose metabolism and bone metabolism indicators in patients with diabetes.Results Among 258 cases of type 2 diabetes,there were 57 cases of osteoporosis accounting for 22.1％.There was significant difference on the duration of diabetes [ (7.98 ± 1.09 ) years old vs (3.77 ± 1.21 ) years old,t =4.849,P ＜0.05],FINS [ (6.42 ± 1.30) mU/L vs (5.79 ± 1.08) mU/L,t =3.871,P ＜0.05] and HOMA-IR [ (2.35 ±0.54) vs ( 1.85 ±0.41 ),t =2.705,P ＜0.05],but no significant difference on the FPG and HbA1c ( P ＞ 0.05 ) between two groups.PTH [ ( 36.51 ± 7.59) ng/L vs ( 32.02 ± 6.89 ) ng/L,t =2.008,P ＜ 0.05 ],bone mineral density in the lumbar total value [ (0.87 ±0.14) g/cm2 vs (0.99 ±0.12) g/cm2,t =2.799,P ＜0.05 ],femoral neck Neck [ ( 0.70 ± 0.10 ) g/cm2 vs ( 0.79 ± 0.11 ) g/cm2,t =2.564,P ＜ 0.05 ] and Total [ (0.84 ± 0.14) g/cm2 vs (0.97 ± 0.15 ) g/cm2,t =3.340 P ＜ 0.05 ] were statistically different,but no significant difference on the rest of the indicators.Conclusion The prevalence of vitamin D deficiency was found in patients with diabetes.Vitamin D level could affect insulin resistance and glycemic control and bone mineral density level.Therefore,routine vitamin D testing to the diabetic patients and giving vitamin D replacement therapy to vitamin D deficiency patients in a timely manner were necessary.

Objective To explore the hospitalization costs of patients with diabetic foot ulcer and analyze key influencing factors.Methods A total of 570 diabetic foot inpatients were recruited from January 2008 to March 2012 for analysis of the relationship between their hospitalization costs and clinical symptoms.The multifactor regression analysis model was used to identify main influencing factors for their hospitalization costs.Results The medical costs of such inpatients amounted to 1 9 825.6 yuan (12 476.6~32 745.9)yuan,while average hospitalization costs of the 3 401 diabetic patients admitted over the same period were but 9 757.1 yuan (6 282.1 ~ 1 5 723.7 )yuan,a difference of statistic significance.The single-factor analysis found statistical differences from the differences of hospitalization among various age,occupation,dorsal artery of foot,B ultrasound of lower extremity arteries,wagner classification,amputation,transfer,leucocyte,hemoglobin,serum albumin,serum creatinine and high density lipoprotein.Multifactor analysis found that the significant factors influencing the medical costs of inpatients were days of stay,albumin,wagner classification,dorsal artery of foot,leucocyte and age. Conclusion Hypoalbuminemia,high stage of wagner classification,weak or absent pulsation of foot dorsal artery,severe infection and aging were significant factors contributing to higher medical costs of hospitalization for patients with diabetic foot ulcer.

Objective To investigate the effect of tandem mass spectrometry and gas chromatography-mass spectrometry to make prenatal diagnosis of methylmalonic acidemia (MMA) by detecting organic acid and acylcarnitine in amniotic fluid.Methods From October 11,2007 to December 20,2014,131 pregnant women with MMA proband received prenatal diagnosis of MMA in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (case group).Another 120 cases of pregnant women for conventional prenatal diagnosis at the same period were as control group.The pregnant women of two groups had the amniocentesis at 16 to 20 weeks of gestation.The levels of propionylcarnitine(C3) and acetylcarnitine(C2)in amniotic fluid were detected by tandem mass spectrometry.The methylmalonic acid and methylcitrate acid were detected by gas chromatography-mass spectrometry.MMA gene of cells in amniotic fluid of eighty fetuses with proband clearly diagnosed were detected by gene testing.Data were analyzed by Wilcoxon test.Results In case group,29 fetuses were found positive for higher level of C3,C3/C2,methylmalonic acid and methylcitrate acid compared with normal reference value,and the detected rate of fetal MMA was 22.1％(29/131).The levels of C3 and C3 / C2 in amniotic fluid of these 29 cases were higher than those in control group[8.13(2.42-16.70) vs 1.04(0.52-3.40) μmol/L,Z =-8.313; 0.77(0.30-1.79) vs 0.10(0.05-0.22),Z=-8.374; P ＜ 0.05 respectively].The levels of methylmalonic acid and methylcitrate acid were also higher[9.13(1.68-61.78) vs 0.00(0.00-1.31) mmol/mol Crea,Z=-11.348; 0.58(0.00-1.90) vs 0.05(0.00-0.52) mmol/mol Crea,Z=-6.632,P ＜ 0.05 respectively].For the other 102 cases in case group,the levels of C3,C3/C2,methylmalonic acid and methylcitrate acid were not higher than normal reference value,and were similar to those in control group (P ＞ 0.05); while they were lower than those of positive MMA fetuses (all P ＜ 0.05).Among 29 positive fetuses,16 fetuses were detected MMA gene,five were diagnosed as MUT forms of MMA and 11 were MMACHC forms of MMA.In 102 MMA negative fetuses,64 fetuses were detected MMA gene,44 were found one mutant site and 20 were found no gene mutation.The coincidence rate between gene detecting and mass spectrometry was 100％(80/80).Conclusions Mass spectrometry could be used to measure the C3,methylmalonic acid and methylcitrate acid levels in amniotic fluid of pregnant women with MMA proband to make prenatal diagnosis.

BACKGROUND: Measuring the slope of proximal tibiofibular joint may elucidate the anatomical structure and type of proximal tibiofibular joint, and evaluate the stability of proximal tibiofibular joint. OBJECTIVE: To investigate the measurement methods and clinical significance of the joint slope by comparing the slope measurement of bilateral proximal tibiofibular joint surface on X-ray and 64-row spiral CT reconstruction.METHODS: One hundred normal adult volunteers, including 50 males and 50 females, aged 18-90 years, were photographed in double knees via internal rotation to 30°, 45° and 60°, respectively and scanned with 64-row spiral CT, tibiofibular bone (including knee joints) was reconstructed. The included angle between proximal tibiofibular articular surface and the longitudinal axis of the fibula shaft, between the proximal tibiofibular articular surface and the horizontal line, were measured using an angle square.RESULTS AND CONCLUSION: There were great variations of the data in the same proximal tibiofibular joint measured by X-ray and spiral CT. X-ray results are affected by the site of photograph position, and the slope of articular surface is estimated, so the 64-row spiral CT is an accurate and convenient method to reconstitute the slope of proximal tibiofibular joints. Spiral CT could be used to distinguish the dislocation and instability of the proximal tibiofibular joint, accordingly reduce the clinical misdiagnosis.

Objective To evaluate the efficacy and safety of radiation combined with targeted therapy of EGFR-TKI in the patients with stage IV non-small cell lung cancer ( NSCLC). Methods There were 17 female and 9 male patients with NSCLC enrolled into this study, which included 19 adenocarcinoma, 4 alveolar carcinoma and 3 uncertain carcinoma according to the iconography findings. Sixteen patients suffered from single or multiple bone metastasis,and 10 cases with brain metastasis. Gefitinib 250 mg or Erlotinib ISO mg per day were administrated during and after the process of radiation until the disease progressed. Results All patients had complete combined therapy, 12 of them suffered from diarrhea, 8 from emesia and 12 from erythra. The average score of ECOG improved from 3 to 2 after combined therapy. The bone metastasis control rate was 93.8% ,brain metastasis control rate was 70.0% , and the 6-month local lung lumps control rate was 84. 6%. Conclusion Palliative radiation combined with targeted therapy of EGFR-TKI is an effect and safe therapy for the patients with the stage IV of NSCLC, but the influence on survival shall be observed in further study.