BACKGROUND: Fracture healing occurrs by two ways: healing by first intention and healing by second intention, with the latter one similar to natural healing process. It has been proved that only 37% tibial farcture can reach healing by first intention, even it is fixed with strong AO steel plate. Different materials for intramedullary fixation have different influences on callus formation and callus content in the process of fracture healing.OBJECTIVE: To explore the influences of different internal fixations on callus formation and content in the course of fracture healing analysis with X ray computer image.DESIGN: Randomized controlled trialSETTING: At the Department of Orthopeadics of Changhai Hospital Affiliated to the Second Millitary Medical University of Chinese PLA and the Experimental Animal Center of the Second Millitary Medical University of Chinese PLA.MATERIALS: This study was carried out at the Experimental Animal Center and Orthopeadic Laboratory of the Second Millitary Medical University of Chinese PLA between March 2000 and July 2001. Totally 51New Zealand rabbits were randomly selected without gender limitation and divided, accccording to intermeduallry nails, into three groups with 17 rabbits in each group: rectangle-shaped intramedullary nails (RIN), Ender's nails (END) and stainless steel plates (SPL) groupsMETHODS: Fracture models were succccesufly established on rabbits.And then intramedullary nails were fixed 2 mm below the border of left tibial and fibula without exopexy. Positve and lateral X-ray films of each operational tibia were obtained at postoperational 2,3,4,8,12 weeks.Three rabbits in each group were killed for callus observation with naked eyes, and the maximal callus diameter at different time points was measured. The X-ray films at different periods were read carefully and quanatatively analyzed with computor image analysis system (lAS). The difference was compared with the analysis of variance and SNK test.MAIN OUTCOME MEASURES: The maximal callus diameter was determined with X-ray image at different time points so as to calculate the corrssponding integral of callus grey level.RESULTS: Totally 51 rabbits were enrolled in this study, 6 missed the experiment because 4 died for diarrhea and other two has exposed bone due to local infection, and then two rabbits were derived from each group; thereby, data of 45 rabbits were subjecte to the final statistical to the epak at postoperational 8 weeks; it was the longest in RIN group of the same stage,followed by Ender group and SPL group [(11.24±0.38), (10.86±0.65), (8.12±0.36) mm at postoperatively 4 weeks; ( 13.56±0.88 ), (12.84±0.20), (10.52±0.68) mm at postoperatively 8 weeks; ( 12.66±0.65 ), ( 11.84±0.55 ), (9.68±0.27) mm at postoperatively 12 weeks]. The difference between RIN, Ender and SPL was statistically significant, but the difference between the former two was unobvigroup; at the same postoperational time point, the intergral of callus grey level was the highest in RIN group, followed by Ender group and SPL group (89.11 ± 1.05,86.42±3.12,47.28 ± 1.57 at postoperatively 4weeks;159.69 ±3.64,148.72 ±1.68,79.63 ±2.41 at postoperatively 8 weeks;192.46 ±4.96,186.53 ±1.84,107.34 ±2.37 at postoperatively 12 weeks),The difference between RIN, Ender and SPL was obvious and moreover,the difference between RIN and Ender was significant at 8th week.CONCLUSION: The callus content in RIN and Ender group were higher than that in SPL group at each postoperational time point, which benefited for fracture healing. Callus content examination is a traditional means for the judgement of fracture healing. It prossesses that properties of intuition and persicuity, reliability, simplicity and practicibility. Moreover, subjectivity could be avioided if used in combination with X-ray image analysis system, since the digital management can help judging not only callus content but also callus quality, which may provide guidance for clinical treatment.

Objective To review the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus.Methods The Cochrane library,PubMed,China Journal Full Text Database,Chinese Scientific Journal Full Text Database,Chinese Biomedical Literature Database and Wanfang Database were searched with key words including“减重手术”,“胃切除术”,“胃绕道术”,“胃旁路手术”,“胃转流术”,“胃袖状切除术”,“糖尿病”,“bariatric surgery”,“gastric bypass”,“sleeve gastrectomy”,“diabetes,T2DM and et al.Literatures published between the time of database establishment and December 2012 were searched.Literatures focused on the comparison of the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus were retrieved.Data extraction and quality evaluation of the literatures were done by 2 researchers independently.Meta analysis was performed by RevMan 5.1.2 software.The count data were presented by risk ratio (RR) or odds ratio (OR),and the measurement data were presented by mean difference (MD) or standard mean difference (SMD).The heterogeneity of the literatures was analyzed by I2.Results Five literatures were retrieved,including 164 patients in the sleeve gastrectomy group and 184 patients in the Roux-en-Y gastric bypass group.The results of Meta analysis showed that Roux-en-Y gastric bypass could significantly increase the remission rate of type 2 diabetes (OR =0.48,95 ％ confidence interval:0.26-0.91,P ＜ 0.05),increase the percentage of patients without drugs during follow up (OR =0.37,95 ％ confidence interval:0.16-0.84,P ＜0.05),decrease the levels of HbA1c and body weight (MD =0.28,-0.44,95％ confidence interval:0.14-0.43,-0.76--0.13,P ＜ 0.05) when compared with sleeve gastrectomy.There was no significant difference in the incidence of complications between the 2 groups (OR =1.81,95％ confidence interval:0.20-16.73,P ＞ 0.05).Conclusion Roux-en-Y gastric bypass is superior to sleeve gastrectomy for patients with type 2 diabetes.

Objective To determine the prevalence of mortality and respiratory support therapy evolved for severe respiratory failure in pediatric intensive care units(PICU)in China. Method Two sessions of prospective, multicentric, and descriptively epidemiological survey of acute respiratory distress syndrome(ARDS)was carried out in year 2004 and 2006,and survey of alveolar hypoventilation respiratory failure(AHRF)in 2006 by 20 PICUs in China. Data about severity, outcome and respiratory therapy of critically ill patients, as well as PICU facilities were documented prospectively. PICU facilities, patients' mortality and respiratory therapy in different years were compared. Mortality risk factors were analyzed by multivariate logistic regression. Results Compared with those data in year 2004,the number of PICU bed and ventilator increased in year 2006.But,there was no increase in area per bed in year 2006.Proportion of critically ill patients in 2006 was significantly higher than that in 2004(69.0%vs.57.5%,x2=318,P<0.01).There were no significant difference in mortalities of critically ill patients between these two years. According to multivariate regression analysis, mortality was lowered in PICU with increase in heavy working load of physicians, evidenced by linear trend test P=0.013.Mortality of ARDS in year 2006 was significantly lower than that in 2004(39.7%vs 55.8%,x2=6.59,P<0.01).Whereas there was no significant difference in ventilation mode,tidal volume and airway pressure level for ventilated patients between two years.Conclusions With increasing the capacity of PICU there was a significant improvement of treatment as reflected by outcome of ARDS.Mortality of PICU patients was inversely correlated to the working load done by physicians.

Objective:To compare the clinical effect of anterior mediastinal tumor resection with video assisted thoracoscopic surgery(VATS) through approach of trans-subsagittal incision and trans-intercostal incision.Methods:The clinical data of 118 patients including 67 males and 51 females with anterior mediastinal tumors using VATS resection from January 2013 to October 2020 in Tongren Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. According to different incisional approach, these patients were divided into two groups of trans-subsagittal incision group including 45 cases with 25 males and 20 females, and trans-intercostal incision group including 73 cases with 42 males and 31 females. The sternal incision group was treated with the sub xiphoid incision plus the subcostal arch incision and the sternal retractor traction sternum, and the intercostal incision group was treated with the traditional intercostal space incision. Subsagittal incision combined subcostal arch incision and sternum traction with sternal retractor was used in the approach of trans-subsagittal incision group, and the traditional thoracotomy was used in the intercostal incision group. The clinical data of operation time, volume of intraoperative blood loss, rate of transfer to open thoracotomy, duration of postoperative chest tube drainage, visual analogy score(VAS)assessed on the 1st and 3rd days after surgery, hospitalization time, average cost of hospitalization, and incidence of postoperative complications, were compared between the two groups.Results:The operative time, volume of intraoperative blood loss, the number of cases of transfer to open thoracotomy, duration of postoperative chest tube drainage, VAS score of the first and third days after operation, length of hospitalization, average hospitalization cost and the incidence of postoperative complications were lower than those in the transcostal incision group( P<0.05). Conclusion:Compared to the group of trans-intercostal incision VATS resection of anterior mediastinal tumor, the trans-subsagittal incision group has many advantages as follows, shorter operation time, less intraoperative blood loss, no transfer to open thoracotomy, much simpler and safer operative procedure, less body trauma, lighter postoperative pain, less postoperation complications, shorter hospitalization time, less average hospitalization cost, and rapid rehabilitation after surgery.

Microribonucleic acid (miRNAs) is a widely existing endogenous single-stranded non-coding small RNA, which is stably expressed in tissues and body fluids. By complementing messenger RNA(mRNA) sequences, miRNAs degrade target mRNA and block the expression of protein-coding genes, playing a key role in post-transcriptional regulation and different biological processes. In recent years, more and more studies have shown that miRNAs are closely related to the occurrence and development of tumors. Among them, as a member of the miRNAs family, microribonucleic acid-196 (miR-196) is abnormally expressed in the serum, tissues and cells of patients with non-small cell lung cancer, participating in the occurrence and development of non-small cell lung cancer and playing an important regulatory role in various biological processes such as proliferation, invasion and metastasis, providing diagnostic evidence for early screening of non-small cell lung cancer.This paper reviews the progress of miR-196 in the development and diagnosis of non-small cell lung cancer.

Objective To evaluate the diagnose value of nonenhanced electrocardiogram (ECG)?gated quiescent?interval single?shot MR angiography (QISS MRA) in lower extremity arterial stenosis. Methods A retrospective analysis of 30 patients with lower extremity ischemic manifestations and concurrent lower extremity arterial CTA and QISS MRA was performed from April to December 2017 at the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. All patients underwent CTA and ECG?gated non?contrast?enhanced QISS MRA. The entire lower extremity arteries were divided into 19 segments (lower abdominal aorta, common iliac artery, internal iliac artery, external iliac artery, superficial femoral artery, deep femoral artery, radial artery, anterior tibialis anterior tibial artery, posterior tibial artery, radial artery). Two radiologists scored QISS MRA and CTA image quality using a 4?point scale and assessed the severity of arterial stenosis. Kappa analysis was used to evaluate the degree of stenosis of different examination methods in the same patient and the consistency of the scores of different radiologsts in the same patient. Result A total of 570 vessel segments were collected from 30 patients. The image quality of 560/570 (98.2%) and 548/570 (96.1%) of radiologist 1 was rated as excellent or good by CTA and QISS?MRA (grades 3 and 4), and 561/570 (98.4% of radiologist 2) The image quality of the segment and the 544/570 (95.4%) segment were rated as excellent or good by CTA and QISS?MRA, respectively. The image quality scores of radiologist 1 to CTA and QISS MRA were (3.87±0.38) and (3.70± 0.53), respectively, and radiologist 2 were (3.86±0.40) and (3.68±0.54) respectively. On the QISS?MRA, only 7 of the 570 segments (1.2%, 7/570) obtained images that could not satisfy the diagnostic image quality. The two radiologists used CTA and QISS MRA to evaluate the consistency of different degrees of vascular stenosis. The radiologist 1 evaluated the Kappa value of CTA and QISS MRA between 0.714 and 0.939 for different degrees of vascular stenosis. Radiologist 2 had a Kappa value of 0.603 to 0.939. QISS MRA was used to evaluate the consistency of vascular stenosis in different segments between the two radiologists. The Kappa value ranged from 0.813 to 0.933. Conclusion QISS?MRA is of great value in the diagnosis of lower extremity arterial stenosis.

Objective: To investigate the shortage of emergency medicines in emergency department of 76 medical institutions in China, and find out the reasons and the measurements. Methods: The shortage of emergency medicines in 76 class-Ⅰ, class-Ⅱ and class-Ⅲmedical institutions from 22 provinces, autonomous regions and municipalities across the country was investigated by question-naires, and the data obtained from the survey were collected and analyzed by Excel 2007. Results: Totally 76 questionnaires were sent out, and all of them were recycled with the effective recovery of 100% . Pralidoxime chloride injection ranked the first in 59 investiga-ted medicines with the shortage rate of 63. 16% , which was at the top spot in the list of the different medical institutions as well. The main reasons of drug shortage were as follows: less clinical requirements, lost-bid in centralized bidding and price inversion. Conclu-sion: It is suggested that the relevant management departments should establish a reasonable pricing mechanism and carry out policy guarantee for the urgent need of emergency medicines with low dosage and low price.

OBJECTIVE：To rapidly evaluate the effectiveness，safety and economics of rosuvastatin （RSV）in the treatment of dyslipidemia，so as to provide evidence-based support for clinical drug use. METHODS ：Retrieved from PubMed ，Embase， Cochrane Library ，CNKI，Wanfang database and CBM ，etc.，health technology assessment （HTA）related website and database were searched systematically to select HTA report ，Meta-analysis/systemic evaluation and pharmacoeconomics study about RSV versus placebo or other positive drugs in the treatment of dyslipidemia. According to the inclusion and exclusion criteria ，two researchers independently screened the literatures ，extracted and summarized the data ，then performed qualitative description of results. RESULTS ：Totally 11 Meta-analysis and 11 pharmacoeconomic studies were included ，and no relevant HTA report was retrieved. Results of the study showed that compared with the control group ，RSV could regulate dyslipidemia ，and reduce the levels of LDL-C ，TG，TC，C-reactive protein and sdLDL ；RSV could also reverse atherosclerotic plaque ，reduce all-cause mortality with good safety. In terms of economy ，compared with other statins or placebo ，RSV could prolong quality-adjusted life year，its incremental cost-effectiveness ratio is lower than the desired payment threshold ，which had more economic advantages. CONCLUSIONS：RSV is effective ，safe and economical in the treatment of hyperlipidemia.