Objective To discuss the clinical significance of internal fixation through anterolaterel and posteromedial approaches in the treatment of closed sagittal Pilon fractures of Topliss classification and compare the effects of the two approaches.Methods The study involved 57 patients with closed sagittal Pilon fractures treated with open reduction and internal fixation from 2007 to 2010,including 29 patients treated through anterolateral approach (Group A) and 28 through posteromedial approach (Group B).All patients were with closed fractures,and all surgery time windows were 10-19 days.The two groups were compared in aspects of gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window,operation time,intra-operative blood loss,ambulation time,infection and necrosis rate of skin and soft tissue,length of stay,ankle joint function recovery after internal fixation,and intra-operative X-ray reduction.Results All patients were followed up for 12-26 months (mean,20 months) except for one patient in the Group A,with total follow-up rate of 98％.The two groups showed no significant differences regarding the gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window selection,operation time,intra-operative blood loss,and ambulation time (P ＞0.05).While,the infection and necrosis incidence of skin and soft tissue,and the hospital stay we re significantly lower and shorter in the Group A than that in the Group B (P ＜ 0.05 ).Two patients in the Group A were complicated with toe extensor tendon adhesion,which was released by removing the fixation.Fifteen patients had wound infection during hospitalization,including three patients in the Group A and 12 in the Group B,but they were all cured after treatments like dressing.Fifteen patients were treated with stage Ⅰ allogeneic bone graft and 11 with autologous iliac bone graft.All the patients obtained bone union.Conclusions Topliss classification of closed sagittal Pilon fractures has clear clinical significance in surgical plan selection and operative procedures.Both of the anterolateral and posteromedial approaches can achieve good effects in the treatment of closed sagittal Pilon fractures due to high energy injury.However,the anterolateral approach is relatively a better choice,for it brings in a lower incidence of infection and necrosis of skin and soft tissue and a shorter length of hospital stay.

Inquisition language,as the information carrier on observing and describing disease status,makes it possible for patients to communicate well with doctors to acknowledge disease information.In order to make inquisition language possess specific properties of medical conversation,doctors need to master language skills in procedural inquisition,proper listening and responding to inquisition,distinguishing inquisition,transitional inquisition and secret-involved inquisition.Upholding inquisition language with courtesy,comfort,being explanatory,encouraging,and protecting is the basic requirement of clinical ethics.

Objective To study the preliminary effect of sartorius iliac flap in repair of acetabulum defect for developmental dysplasia of the hip (DDH) in elder children.Methods We retrospectively studied 17 elder children with acetabulum defect in DDH at the age＞6 years old who received acetabular repair with sartorius bone flap in this hospital from 2014 to 2016.All patients with acetabulum defect in DDH were treated with open reduction in general anesthesia.Three-dimensional osteotomy under the femur rotor was conducted to correct the femoral anteversion and neck-shaft angle.According to the height of femoral head dislocation lines,femur tuberosity was shorten and fixied with steel plates,joint capsule was reconstructed,The iliac sartorius musculocutaneous flap was took to the upper edge of the acetabular to repair the acetabular defect.The lower extremities were treated with plaster for 6 to 8 weeks after surgery.The hip joint function was trained and the function was evaluated with Mckay's criteria.The hip joint morphological evaluation was performed with reference to Severin's X-ray standard.Results Seventeen patients were followed up for 6 to 29 months.Postoperative reduction of the femoral head was good,the head mortar inclusive was satisfactory;there were no wound infection and femoral head necrosis.According to Mckay's criteria,2 patients got excellent,13 good,and 2 fair,with the fineness ratio at 88.2％;According to Severin's critera:11 patients excellent.Conclusion The overturned sartorius iliac flap can repair acetabulum defect,promote bone healing,and effectively improve acetabulum to cover head of femur.

Objective To provide basis for the diagnosis,treatment,prevention and control of pertussis by analyzing serological test findings and clinical features of inpatients.Methods Serological test findings (including outpatients and inpatients) of suspected cases and medical records diagnosed as pertussis (severe group and non-severe group) were analyzed in Shandong Provincial Hospital Affiliated to Shandong University from January 1,2012 to December 31,2014.This retrospective study was conducted to explore the epidemiological characteristics,clinical manifestations,image manifestations of pertussis in recent years.Results The incidence of pertussis was obviously higher in 2014 than the previous 2 years,nearly 10 times than that of 2013;summer and autumn were high-occurrence seasons;pertussis was found predominately in children under 6 years old,as 68％-80％,and the majority of them were 3 months-1 year old and 4-6 years old,and there was a notable increase in children more than 6 years old in 2014;the clinical manifestations tended to be atypical,primarily spasmodic cough (79.01％,64/81 cases),cyanosis (60.49 ％,49/81 cases),vomiting after cough (35.80％,30/81 cases),conjunctiva haemorrhage (22.22 ％,18/81 cases) apnea or heart rate decrease(9.88％,8/81 cases),and whooping cough (7.41％,6/81 cases).There were significant differences(all P ＜ 0.05) in age (t =2.940),paroxysmal cyanosis (x2 =4.505),elevated white blood cell count (x2 =4.410),and lymphocyte percentage increase(x2 =7.830) between severe group and non-severe group.There was no statistical difference in sex(x2 =0.847),season (x2 =0.178),spasmodic cough (x2 =0.097),whooping cough (x2 =0.002),conjunctiva hemorrhage (x2 =0.395),apnea (x2 =0.395) and fever (x2 =0.301) between the 2 groups (all P ＞ 0.05).Mixed infection with mycoplasma was most common.Imaging manifestations of pertussis were not specific,and they might manifest uneven density,patchy inflammatory infiltrates and atelectasis.Conclusions The morbidity of pertussis is rising and atypical cases is increasing in these years,and severe cases are seen most frequently in small infants,it is necessary to perfect the laboratory test methods and immunization strategy.

Abstract Based on the teaching goal of "self designed exercise prescription plans that meet their own characteristics", the teaching content and perfermance evaluation system are built, and the teaching implementation path is designed. The teaching mode of exercise prescription takes four aspects as the main contents of PE course teaching, namely, the cognition of students physical state, the monitoring of physical state, the design of exercise prescription and the implementation of exercise prescription.According to Bloom s learning classification, five implementation steps of health care knowledge learning, prescription preparation, prescription implementation, effect feedback and prescription adjustment were set up.With the help of "Internet+teaching" approach, the teaching efficiency of abstract sports technology and health care theory is promoted, and the in class and after class connection is made to expand the space time conditions of physical education teaching. In order to enhance the fairness and accuracy of performance evaluation, an evaluation system should be established with the main contents of mastering and applying health care knowledge, making and implementing sports prescription, and cultivating sports interest and habits. Exercise prescription teaching mode has the characteristics of health education leading, sports and health care knowledge system, new teaching methods and means integration, sports performance evaluation fairness, respect for students individuality and subjectivity.

Traditional Chinese medicine has a long history, unique system and perfect technology, which has been used to prevent or treat a variety of diseases in the form of compound medicine. Recently, some of the active ingredients from Chinese medicine were found to have self-assembly properties, mainly through non-covalent interactions, including π-π stacking, electrostatic interaction, hydrogen bond and coordination interactions, etc. Carrier-free nanoparticles based on self-assembly of active ingredients from Chinese medicine could not only improve the solubility of insoluble active ingredients, but also the bioavailability. As nanocarriers, the natural active ingredients could exert synergistic therapeutic effects. The strategy of self-assembly without carrier is safer and almost non-toxic compared to the commonly used nanocarriers. In addition, some ingredients from Chinese medicine could coordinate with metal ions to form stable nanoparticles, which could be applied to photothermal therapy. In this paper, we summarized and analyzed the recent achievements of carrier-free nanoparticles based on self-assembly of active ingredients from Chinese medicine, and briefly outlined the future development of this kind of nanomedicine.

Objective To establish the HeLa cell line that can stably express EYFP fluorescent protein as the model for anion channel blocker (halide ion) screening ,which lays the foundation for high throughput screening of anion channel blocker (halide ion) .Methods Through gene recombination technology ,a new lentivirus vector which can express mutant protein YFP (EYFP‐H148Q/I152L) and puromycin resistance ,was built .The mixture of lentivirus vector and packaging plasmid was transfected into 293T cells to produce lentivirus particles . After infection of HeLa cells by the lentivirus particles ,puromycin was used to screen the cells as YFP‐positive HeLa cell line .Then cell amplification was carried out after purification and efficiency of EYFP‐H148Q/I152L was further detected by Real‐time quantitative PCR (RT‐PCR) and Western blot .We then verified the activity of EYFP‐HeLa transfected cell line as a screening model of anion channel blocker .Results Gene sequencing verified that EYFP‐H148Q/I152L was successfully inserted into lentivirus vectors .RT‐PCR and Western blot results showed that the target gene was overexpressed in HeLa cells . The specific yellow fluorescence of EYFP of HeLa cells could be observed under fluorescence microscope with the efficiency of nearly 100% . I- (low permeability ) solution stimulated the opening of anion (halogen) channels ,and the yellow fluorescence was quenched by I - flow into cells . Conclusion The EYFP‐HeLa cell line can stably express EYFP yellow fluorescent protein and is sensitive to the internal flow of I - .Therefore ,it can be used as an ideal screening model of anion channel blocker (halide ion) .

Objective To evaluate the clinical value of pro-gastrin-releasing peptide (ProGRP) for small cell lung cancer ( SCLC ).Methods Serum levels of ProGRP and neuron-specific enolase (NSE) were measured by both chemiluminescent immunoassay and electrochemiluminescent immunoassay in 46 patients with SCLC (26 patients with limited disease,20 patients with extensive disease ),51 patients with non-small cell lung cancer (NSCLC),45 patients with benign pulmonary diseases and 56 healthy subjects.Patients were recruited by the Affiliated Hospital of Medical College,Qingdao University,from September 2010 to April 2011.The receiver operating characteristic curves (ROC) was used to set the cutoff value of ProGRP and NSE and the areas under ROC ( ROC-AUC).The sensitivity and specificity of ProGRP and NSE were analyzed for diagnosing SCLC.Results Serum levels of ProGRP in healthy subjects,benign pulmonary diseases,NSCLC and SCLC groups were 22.9 ( 19.5 - 28.7 ),23.7 ( 20.0 - 27.8 ),28.9 (23.8-34.7) and 370.9( 129.4- 1951.6) ng/L respectively; the serum levels of NSE were 14.1 (12.5- 15.7),13.3(10.3- 15.3),16.8(11.7-22.1) and 39.9(16.1-93.9) μg/L,respectively.The Kruskal-Wallis H test showed significantly difference amoun groups of ProGRP and NSE (H =92.116 and 55.481,P ＜0.001 ).The serum levels of ProGRP in limited disease SCLC (LD-SCLC) group[ 156.2(65.4-547.5 ) ng/L]were also significantly higher than those in the healthy group,benign pulmonary diseases group and NSCLC group ( U =57,70 and 144,P ＜ 0.001 ).In extensive disease SCLC (ED-SCLC) group,the ProGRP and NSE results[ 1933.1 (325.9 -4512.1) ng/L and 61.0(35.4- 115.5 ) μg/L ]were higher than those in the LD-SCLC group ProGRP,NSE [ 24.3 ( 15.1 - 16.3 ) μg/L,U =119 and 153,P ＜ 0.05 ].Using healthy subjects group as control,the largest Youden index point of ROC was used to set the cut-off value of ProGRP and NSE (34.0 ng/L and 20.2 μg/L).The ROC-AUC of ProGRP (0.96 ) was statistically higher than that of NSE ( 0.86 ) in the SCLC group ( Z =2.57,P ＜0.05).The ROC-AUC results between combining detection of ProGRP and NSE (0.96 ) and ProGRP itself (0.96) were not significant difference ( Z =0.21,P ＞ 0.05 ).The sensitivity of ProGRP ( 89.1％ ) was statistically higher than that of NSE in the SCLC group (71.7％,x2 =4.90,P ＜0.05 ) ; the specificity of ProGRP (98.2％) compared with NSE did not have statistical significance (96.4％,x2 =0.00,P ＞0.05 ).The combining detection of ProGRP and NSE had no influence on the sensitivity and specificity compared with ProGRP itself (91.3％ vs 89.1％,94.6％ vs 98.2％,x2 were all 0.00,P ＞ 0.05 ).Using benign pulmonary diseases group as control,the largest Youden index point of ROC was used to set the cutoff value of ProGRP and NSE (49.5 ng/L and 23.1 μg/L).The ROC-AUC of ProGRP (0.95) was statistically higher than that of NSE (0.87) in the SCLC group (Z =1.99,P ＜0.05 ).The ROC-AUC of combining detection of ProGRP and NSE ( 0.95 ) and ProGRP itself ( 0.95 ) were not difference significantly ( Z =0.02,P ＞ 0.05 ).The sensitivity of ProGRP (84.8％ ) was statistically higher than that of NSE in the SCLC group (69.6％,x2 =4.00,P ＜0.05);the specificity of it (97.8％) was equal to that of NSE (97.8％,x2 =0.50,P ＞0.05 ).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself ( 87.0％ vs 84.8％,95.6％ vs 97.8％,x2 were all 0.00,P ＞0.05 ).Using NSCLC group as control,the largest Youden index point of ROC was to set the cut-off value of ProGRP and NSE (49.1 ng/L and 23.0 μg/L).The ROC-AUC of ProGRP ( 0.90) was statistically higher than that of NSE (0.76) in the SCLC group (Z=2.90,P＜0.05).The ROC-AUC of combining detection of ProGRP and NSE (0.90 ) and ProGRP itself (0.90 ) were not difference significantly ( Z =0.00,P ＞ 0.05 ).The sensitivity of ProGRP ( 84.8％ ) was higher than that of NSE in the SCLC group ( 69.6％,x2 =4.00,P ＜ 0.05 ) ; the specificity of it ( 96.1％ ) was also higher than that of NSE (80.4％,x2 =6.13,P ＜ 0.05 ).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself ( 87.0％ vs 84.8％,95.6％ vs 96.1％,x2 were all 0.00,P ＞ 0.05 ).Conclusion ProGRP has a higher diagnostic value than NSE in SCLC.

To investigate the clinical course and management of congenital vaginal atresia.This retrospective analysis included patients with congenital vaginal atresia treated from March 2004 to August 2014 at the Obstetrics and Gynecology Hospital of Fudan University.Thirty-nine patients were included in this study.Their average age was 16.87±2.2 years when they came to our hospital.Totally,51％ of the patients had isolated congenital vaginal atresia with a normal cervix,whereas the others had either cervical atresia or imperforate hymen.The primary presenting signs and symptoms included primary amenorrhea (71.8％),periodic abdominalgia (41.0％),abdominal pain (36.0％),dyspareunia (10.3％),menstrual disorders (5.1％),and pelvic mass (5.1％).Ultrasound and magnetic resonance imaging (MRI) were effective inspection methods for the screening of urogenital tract-associated anomalies.Vaginoplasty mainly included simple vagina reconstruction with insertion of a mold (n=22) and split-thickness skin grafting (n=4).In 64％ of surgical patients,normal menstrual bleeding was achieved.Four of the patients subsequently became pregnant and delivered at term.Primary amenorrhea,periodic abdominalgia and abdominal pain are the main reasons for the post pubertal patients to visit doctors.Surgical methods can successfully provide these patients an opportunity for subsequent conservative management,can result in normal menstrual bleeding,resolve cyclic pelvic pain,and provide some potential for fertility.

OBJECTIVE: To investigate the method of surgical management for cervical esophageal carcinoma and the feasibility of the operation with preservation of laryngeal function. METHOD: Sixteen patients with cervical esophageal carcinoma who received surgical treatment were reviewed in our retrospective study. Removal of total hypopharynx and larynx and the inversion stripping esophagectomy were conducted in thirteen patients, of which one underwent the reconstraction with residual larynx and tracheal flap and the other twelve patients underwent the reconstraction with gastric-pharyngeal anastomosis. One patient received the cervical esophagectomy and partial hypopharyngectomy with laryngotracheal flap. The inversion stripping esophagectomy with laryngeal function preservation were conducted in two patients, who received the reconstraction with gastric-pharyngeal anastomosis and preserved total larynx. All the patients were carried out the bilateral neck dissections. RESULT: The surgical resection rate was 100% and no operative death occurred. The postoperative complications included pulmonary infection in two cases, anastomotic fistula in two cases, anastomotic stenosis in two cases and congestive heart failure in one case. The retained rate of the laryngeal function is 12.5%. The 3-year survival rate is 30.7%, and the 5-year survival rate is 23.1%. CONCLUSION The surgical treatment of cervical esophageal carcinoma is possible. The inversion stripping esophagectomy without thoracotomy is performed to resect the tumor. The esophageal defect could be reconstructed by laryngotracheal flap or gastric-pharyngeal anastomosis. The laryngeal function should be remained as far as possible according to the location and extension of the tumor.
Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Neck ; Retrospective Studies