Objective To investigate the clinical application of minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates. Methods The clinical data of 38 patients with minimally invagive fixation of complex proximal tibia fractures by uniaxial(n=21)and polyaxial(n=17)locking plates from January 2008 to June 2009 were retrospectively analysed,and the union rates and function recovery were compared between groups.Results All patients were followed up for 3 to 20 months,with an average of 12 months.All patients had bone union.The time of fracture union for fixation by uniaxial locking plates was 10 to 20 weeks,with an average of 14 weeks;and that for fixation by polyaxial locking plates was 11 to 18 weeks,with au average of 13 weeks.Evaluated by Johner-Wruhs method, there were 14 "excellent" cases,5 "better" eases,2 "good" cases and 0 "poor" case for fixation by uniaxial locking plates (rate of "excellent and better",90.4%),and there were 11 "excellent" cases,5 "better" cases,1 "good" cage and 0 "poor" case for fixation by polyaxial locking plates (rate of "excellent and better",94.1%). Conclusion Minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates is stable,has less effects on bone blood supply,high bone union rate and favourable function recovery,and is an effective way in the treatment of complex proximal tibia fractures.Fixation by uniaxial locking plate has a better mechanical intensity,while fixation by polyaxial locking plate can adjust the screw angle according to fracture situation,which can be clinically applied accordingly.

BACKGROUND:Currently, bone graft is mainly used for repair of bone defects, and tricalcium phosphate is the most used artificial bone material. But the effectiveness of the tricalcium phosphate bone graft is stil controversial, and there is also no detailed report about its function during the healing of bone defect. ＜br> OBJECTIVE:To observe the concentration changes of bone morphogenetic protein-2 and vascular endothelial growth factor as wel as bone healing after tricalcium phosphate graft in bone defects. ＜br> METHODS:Forty-eight C57 mice were randomly divided to experimental group and control group. A 2-mm-long diaphyseal segment and periosteum from the middle of the right femur was cut to prepare unilateral bone defect models. Tricalcium phosphate bone graft was used in the experimental group, and no bone graft in the control group. During the fol owing 4 weeks, X-ray examination was done once a week to observe the bone healing, and then the animals were executed for col ecting samples in the graft area. The concentrations of bone morphogenetic protein-2 and vascular endothelial growth factor in samples which were taken from the bone graft area were determined by using ELISA assay. ＜br> RESULTS AND CONCLUSION:X-ray films showed that 2 weeks later, bone fracture healed mostly in the experimental group except a smal part of cortical bone;3 weeks later, bone fracture was basical y healed, and only a smal amount of tricalcium phosphate remained;4 weeks later, bone fracture was completely healed, and the cal us grew obviously, and the tricalcium phosphate was nearly absorbed. In the control group, the fracture line was stil visible at 1-2 weeks, but it became vague at 3 weeks;then, the fracture was healed at 4 weeks except some of the cortical bone. The levels of bone morphogenetic protein-2 and vascular endothelial growth factor were significantly higher in the experimental group than in the control group at different time points (P＜0.05). These results suggest that tricalcium phosphate bone graft can up-regulate the expression of bone morphogenetic protein-2 and vascular endothelial growth factor and accelerate bone healing.

ObjectiveTo investigate the effect of pneumatic circulation treatment on lower extremity swelling and blood flow velocity after hip replacement.Methods48 patients after hip replacement were divided into two groups: treatment group (n=24) and control group (n=24). The treatment group received pneumatic circulation treatment and continuous passive motion, while the control group only received continuous passive motion 2 d after operation, all patients wearing elastic stockings. Circumference of the affected leg was measured and Visual Analogue Scale (VAS) was assessed, and Doppler ultrasonography was to check the blood flow velocity of femoral and deep veins in lower limb before, 3 d and 7 d after rehabilitation.ResultsThere was no difference in circumference, VAS, and the lower limb blood flow velocity between the two groups before operation (P>0.05). There was significant difference in circumference and VAS 3 d after treatment (P<0.01), and a significant difference in circumference and blood flow velocity (P<0.01) but no difference in VAS (P>0.05) 7 d after treatment between the two groups.ConclusionPneumatic circulation treatment may facilitate to eliminate lower extremity swelling and prevent deep vein thrombosis after total hip replacement.

Objective:To compare the survival and prognostic factors of intraoperative radiotherapy (IORT) and postoperative radiotherapy (PORT) in female patients, aged≥50 years, diagnosed with node-negative breast cancer (≤ 3 cm in size).Methods:Clinical data of eligible early breast cancer patients between 2010 and 2015 were obtained from the SEER database. Patients were divided into the IORT and PORT groups according to the radiotherapy record and propensity score matching (PSM) was subsequently conducted. Kaplan-Meier curve was used to evaluate the overall survival (OS) and breast cancer-specific survival (BCSS) between two groups and Cox proportional hazard regression analysis was used to explore the risk factors of clinical prognosis.Results:7 068 patients were included after PSM. The median follow-up time was 32.0 months. The 5-year OS rates in the IORT and PORT groups were 96.8% and 93.8%, respectively. Univariate Cox analysis showed that radiotherapy, age, histological grade, T stage, estrogen receptor (ER) status and progesterone receptor (PR) status were the independent risk factors for OS, and histological grade, T stage, ER status, PR status and chemotherapy were the independent risk factors for BCSS. Multivariate Cox regression analysis demonstrated that patients who received IORT had better OS than PORT counterparts ( P=0.020). Besides, patients aged≥60 years obtained worse OS than those aged<60 years ( P=0.003). Patients with T 2 stage or ER-negative tumors had worse OS than those with T 1 stage tumors ( P<0.001) or ER-positive tumors ( P=0.001). Patients with grade Ⅲ-Ⅳ tumors achieved worse BCSS ( P=0.004). Subgroup analysis showed that IORT yielded better OS for elderly patients (≥60 years), grade Ⅲ-Ⅳ tumors, infiltrating duct carcinoma, T 2 stage tumors, ER-positive tumors, PR-positive tumors and patients without chemotherapy. Conclusions:IORT may bring benefit for highly selected patients with low risk of recurrence, which is not inferior to PORT in terms of short-term survival. Prospective studies with longer follow-up time are needed to confirm the findings.

Objective To explore a new way assisted by digital technology to establish a quantitative index to assess the matching performance of anatomically contoured plate. Methods We collected the thin-slice CT data of 20 adults with normal tibias who had received 32-slice spiral CT scanning from April 2015 to June 2016. They were 10 males and 10 females, aged from 28 to 52 years (average, 36.2 years). 3D reconstruction of the tibias was performed with Mimics 18.0. Two brands of 8-hole anatomically contoured plate for distal tibia (Kongli versus GE) were digitized. The curve of the plate facing the bone surface was extracted. The operational process of putting the plate curve on the medial surface of the distal tibia was simulated in Rhino 5.0. The volume of the gap between plate curve and bone surface was measured. The mean distance of the gap between plate cure and bone surface was figured out after the volume divided by the plate area. The inverse value of the mean distance of the gap was used as the index for matching performance. The wall thickness analyzing tool in 3-matic Research was used to mark the various thicknesses of the gap with different colors. The matching performances of the 2 brands of plate were assessed and compared according to the matching performance index and nephogram. Results Of the Kongli 8-hole distal tibial plate, the gap volume was 3,834 mm3± 701 mm3, the mean thickness 1.8 mm ± 0.3 mm, and the matching index 0.56 ± 0.10. Of the GE 8-hole tibial plate, the gap volume was 7,690 mm3± 1,503 mm3, the mean thickness 3.0 mm ± 0.6 mm, and the matching index 0.34 ± 0.06. The significant difference in matching performance between the 2 kinds of plate favored the Kongli plate (t=10.402, P <0.01). There were no significant differences in matching per-formance between different genders among the plates of the same brand (P> 0.05). The nephogram showed a large fixed red area at the proximal part in the GE 8-hole tibial plate. Conclusions As this index for matching performance is simple and intuitive, it can be used to assess and compare the matching performances between different kinds of plates. It can be also used before operation to assess the matching performance of a specific plate for a specific patient to avoid mismatch because of individual differences.

Objective To evaluate the equity of health human resources allocation in traditional Chinese(TCM)hospitals from 2012 to 2021,and forecast the number of various health technicians,so as to provide theoretical basis for the reasonable allocation of health human resources of TCM health service.Methods The data of health personnel in TCM hospitals were collected,and Theil index and clustering degree were used to analyze the equity of health human resource allocation.The grey GM(1,1)model was used to predict the demand of health personnel in TCM hospitals.Results From 2012 to 2021,the health human resources of TCM hospitals in China showed an overall growth trend.According to the analysis of Theil index in each region,the contribution rate of Theil index showed that the difference between regions was the main factor causing the difference in personnel allocation.The concentration degree of TCM hospitals in terms of geographical allocation was eastern region,central region and western region,respectively.Conclusion The expansion of high-quality medical resources and the rational allocation of TCM resources should be promoted.Clear target responsibility,promote fine management,improve the fairness of medical personnel allocation;Based on traditional advantages,broaden training ideas,and effectively build a multi-dimensional training system for TCM talents.

OBJECTIVE We used Al lergic Rhinitis Control Test (ARCT) questionnaire to evaluate the control level of allergic rhinitis, in order to get the data of prevalence rate, epidemiological characters and risk factors of uncontrolled allergic rhinitis. METHODS Patients with AR were recruited from our department and the treatment based on the Allergic Rhinitis and Its Impact on Asthma(ARIA) guidelines. Telephone interview will be taken after 2 weeks in these patients, compared to symptoms, impact on quality of life, ARCT value before and after treatment. RESULTS Among 134 patients enrolled, moderate/severe AR account for 95％. After 2 weeks of treatment, both symptom and quality of life were marked improvement(P <0.001). Patients with uncontrolled AR(26.1％) at day 15 more frequently presented higher height and weight(P <0.001), history of ear, nose, and throat(ENT) infection or antibiotics intake for respiratory infection in the last 12 months (40.4％ versus 62.9％, P =0.022), smoking (4.0％ versus 17.1％, P =0.02), and smell disturbance (10.1％ versus 25.7％, P =0.044). CONCLUSION Most of AR patients have remarkable improvements in symptom and quality of life after treatment, but 26.1％ of patients still remain uncontrolled. Smoking and nose infection are risk factors of uncontrolled AR.

ObjectiveTo observe the therapeutic effect of Qiwei Baizhusan（QWBZS） on diabetic encephalopathy（DE） rat model， and to explore the possible mechanism of QWBZS in the treatment of DE based on phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β） signaling pathway. MethodForty-eight SPF male Wistar rats were randomly divided into blank group（8 rats） and high-fat diet group（40 rats）. After 12 weeks of feeding， rats in the high-fat diet group were intraperitoneally injected with 35 mg·kg^-1 of 1% streptozotocin（STZ） for 2 consecutive days to construct a DE model， and rats in the blank group were injected with the same amount of sodium citrate buffer. After successful modeling， according to blood glucose and body weight， model rats were randomly divided into model group， low， medium and high dose groups of QWBZS（3.15， 6.3， 12.6 g·kg^-1）， combined western medicine group（metformin+rosiglitazone， 0.21 g·kg^-1）， with 6 rats in each group. The administration group was given the corresponding dose of drug by gavage， and the blank group and the model group were given an equal volume of 0.9% sodium chloride solution by gavage， 1 time/day for 6 weeks. Morris water maze was used to detect the spatial memory ability of DE rats. Fasting insulin （FINS） level was detected by enzyme-linked immunosorbent assay（ELISA） and insulin resistance index（HOMA-IR） was calculated. Hematoxylin-eosin（HE） staining was used to observe the morphological changes of hippocampus in rats， ELISA was used to detect the indexes of oxidative stress in hippocampal tissues， real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） was used to detect mRNA expression levels of PI3K， Akt， nuclear transcription factor-κB（NF-κB）， tumor necrosis factor-α（TNF-α） and interleukin-1β（IL-1β） in hippocampus， and Western blot was used to detect the protein expression of PI3K， Akt， phosphorylated（p）-Akt， GSK-3β and p-GSK-3β in hippocampus of rats. ResultCompared with the blank group， FINS and HOMA-IR values of the model group were significantly increased（P<0.01）， the path of finding the original position of the platform was significantly increased， and the escape latency was significantly prolonged（P<0.01）， the morphology of neuronal cells in hippocampal tissues was disrupted， the levels of reactive oxygen species（ROS） and malondialdehyde（MDA） in hippocampus of rats were increased， and the activity of superoxide dismutase（SOD） was decreased（P<0.05， P<0.01）， mRNA expression levels of PI3K and Akt were decreased（P<0.01）， mRNA expression levels of NF-κB， TNF-α and IL-1β were increased（P<0.05， P<0.01）， the protein expression levels of PI3K， p-Akt and p-GSK-3β were significantly decreased， and the protein expression of GSK-3β was significantly increased（P<0.01）. Compared with the model group， the FINS and HOMA-IR values of the medium dose group of QWBZS and the combined western medicine group were significantly decreased（P<0.01）， the path of finding the original position of the platform and the escape latency were significantly shortened（P<0.01）， the hippocampal tissue structure of rats was gradually recovered， and the morphological damage of nerve cells was significantly improved， the contents of ROS and MDA in hippocampus of rats decreased and the level of SOD increased（P<0.01）， the mRNA expression levels of PI3K and Akt were increased（P<0.01）， and the mRNA expression levels of NF-κB， TNF-α and IL-1β were decreased （P<0.05， P<0.01）， the protein expression levels of PI3K， p-Akt and p-GSK-3β were significantly increased（P<0.01）， and the expression of GSK-3β was significantly decreased（P<0.01）. ConclusionQWBZS can alleviate insulin resistance in DE rats， it may repair hippocampal neuronal damage and improve learning and cognitive ability of DE rats by activating PI3K/Akt/GSK-3β signaling pathway.