ObjectiveTo explore the effect and surgical management of the internal fixation with double steel plate by the olecranon osteotomy approach in the treatment of severe condyle humeral intercondylar splintered fracture.Methods50 patients with severe condyle humeral intercondylar splintered fractures were treated by double plate internal fixation through olecranon osteotomy.ResultsAll patients(50 cases) were followed up for 6 months to 2 years.The complications such as bone defect,ossifyingmyositis,tardive ulnar nerve compression,and internal fixation fail were not found.According to Aitken Rorabeck scale,the function of the elbow showed excellent in 35 cases,good in 9 cases,fair in 6 cases,the excellent and good rate was 88％.ConclusionThe internal fixation with double steel plate by the olecranon osteotomy approach in the treatment of severe condyle humeral intercondylar splintered fracture was a good approach.Anatomical reduction surgically reconstructed stabilization of the elbow and early active rehabilitation were crucial factors of functional rehabilitation of the elbow.

Objective To explore the efficacy and safety of plastic titanic plates internal fixation in the treatment of intra-articular calcaneus fracture.Methods 42 patients with intra-articular calcaneus fracture were selected and taken lateral calcaneal improvement “L” shaped incision for the correction of calcaneal shortening and valgus deformity.Skidmore needle went through collapse of the articular surface below from calcaneal fractures after block nodules along with bone shaft,and restored Bohler angle,Gissane angle and bone length,height,and the lateral fracture piece was reset.The fixation was taken by plastic reconstruction titanic plates,and the fracture was inspected by Xray.Results In 42 patients,the fracture healing time was (11.4 ± 0.6) weeks.The fracture position was good on the line,and the articular surface of calcaneus and talus was smooth,and the Bohler angle,Gissane angle of calcaneus were returned to normal.The excellent rate was 90.5％ by Maryland score.No surgical causes of broken plate and screw breakage were found.Conclusion Internal fixation with open reduction and plastic titanic plates internal fixation for the treatment of intra-articular calcaneal fractures has a significant effect and safety,which is worthy of promotion.

Objective To study the efficacy, safety and compliance of insulin human analog insulin aspart (NovoRapid) and insulin zinc protamine analog (Basulin) in the application on type 2 diabetes mellitus(T2DM)pafients during perioperative period. Methods Sixty T2DM patients were divided into 3 groups (n=20). Group A was treated with NovoRapid+Basulin, group B was treated with insulin human (Humulin R + Humulin N) and group C was treated with insulin pump (Humulin and NovoRapid). Blood glucose was detected in all of the patients before the meal, 2 hours after meal, before the sleep and during the operation. Results Blood glucose could all achieve the control level with the three methods of treatment. The rates of hypoglycemia in the three groups were 10%, 30% and 5% respectively, and the rates of patient satisfaction were 95%, 70% and 100% respectively. Conclusions Insulin human analog could control blood glucose effectively and safely, the compliance is also high. It is feasible of applying insulin human analog in the blood glucose control during perioperative period.

Objective To investigate the efficacy of short-term biological agent infliximab and immunosuppression combined therapy in patients with active ileocolonic Crohn′s diseases (CD)and to evaluate the mucosal healing.Methods From January 2013 to July 2014,forty hospitalized patients with active ileocolonic CD received at least six times scheduled infliximab injection were enrolled.At week 0, second,and sixth,infliximab 5 mg/kg was administered to induce remission.From the second week, immunosuppression was added.After that,infliximab 5 mg/kg was administered every eight weeks for maintenance treatment.The 36th week after treatment was the end point of follow-up.Before treatment and at the end point of follow-up,the levels of C-reactive protein (CRP),hemoglobin (Hb),clinical remission Crohn′s disease activity index (CDAI)< 150 points,mucosal healing simplified endoscopic activity score for Crohn′s disease (SES-CD)was 0 to 2,partial mucosal healing (SES-CD decreased,but>2 ) and deep remission (achieved both clinical remission and mucosal healing)were compared.T test and Wilcoxon rank sum test were performed for comparison before and after treatment.Results At the 36 th week after treatment,the clinical remission rate was 95 .0% (38/40 ),mucosal healing rate,partial mucosal healing rate and deep remission rate were 62.5 % (25/40),35 .0% (14/40)and 62.5 % (25/40), respectively.The mucosal inflammation of only one case (2.5 %)was not improved.After treatment,the CDAI was 99.3 ±29.3,which was lower than that before treatment (301 .3 ±73.1 )and the difference was statistically significant (t = 17.2,P <0.01 ).Median blood CRP level was 0.8 mg/L(0.1 mg/L, 8.1 mg/L),which was lower than that before treatment (26.8 mg/L(16.1 mg/L,61 .0 mg/L)),the difference was statistically significant (Z = - 5 .3,P < 0.01 ).However,the level of Hb ((134.0 ± 16.0)g/L)was higher than that before treatment ((117.0 ±20.0)g/L),the difference was statistically significant (t=-6.3,P <0.01 ).The median SES-CD was 0 (0,5 ),which was lower than that before treatment (14(8,24)),and the difference was statistically significant (Z =-5 .4,P <0.01 ).Conclusion The short-term (36 weeks)infliximab and immunosuppression combined therapy can achieve high mucosal healing rate and deep remission rate in active ileocolonic CD patients.

To investigate the semi-quantitative method for evaluating lipid accumulation in livers, male C57BL/6J mice (CON), HFD mice characterized with the mild fatty liver induced by high-fat diet, and KKAy mice charactered with the moderately severe fatty liver induced by high-caloric diet were used. The lipid accumulation was estimated by the histological examination (HE staining) and the content of hepatic triglyceride, separately. Echo-intensity of two selected regions along the ultrasound transmission direction was recorded using a small animal ultrasonographic system, and the echo-intensity attenuation coefficient was calculated. Correlation between the echo-intensity attenuation coefficient and the content of hepatic triglyceride was analyzed by the Spearman's rank correlation analysis. The results showed that the lipid accumulation in livers increased significantly in both HFD and KKAy mice compared with CON mice and it was more serious in KKAy mice than that in HFD mice. The values of echo-intensity attenuation coefficient were also increased in sequence according to group. These values were positively associated with the content of hepatic triglyceride (r = 0.744, P < 0.01). In conclusion, the echo-intensity attenuation coefficient is a simple, impersonal, and non-invasive method for evaluating the hepatic lipid accumulation. It can be used to research the process and the treatment of fatty liver diseases in mice.

Objective To investigate the therapeutic efficacy of the canalith repositioning maneuver to benign paroxysmal positional vertigo (BPPV). Methods Epley maneuver, Barbecue rotation and Semont maneuver were applied to twelve cases of BPPV. Results Positional vertigo in all subjects disappeared completely 48 hours later by treatment with manipulative reduction, and no obvious adverse reaction was found. There was no recurrence during a follow up from 3 to 11 months.Conclusion The canalith repositioning maneuver is effective, simple and safe for the patients with BPPV and may be recommended as the first-selected treatment modality.

Objective To evaluate efficacy and therapeutic satisfaction of novel analogue glargine combined with repaglinide in type 2 diabetic patients(T2DM) after switching from the most frequently used twice daily injection of premixed insulin(Humulin 70/30 30% rapid acting and 70% NPH before meals).Methods 18 patients with T2DM whose blood glucose control was poor receiving twice daily premixed insulin had been switched to receive a once daily injection of glargine together with repaglinide and biguanides(metfomin) or TZDS(reglitazone) was continued if it was taken to relieve insulin resistance.After 16 weeks the blood glucose concentrations and HbA1c levels were detected and hypoglycemia was reported.Results At the time of post-16week after the switch,fasting blood glucose access to normal;blood glucose fluctuation relieved and HbA1c levels decreased(from 7.84?0.21 to 6.52?0.13).Symptomatic hypoglycemia decreased.Conclusion These results indicate that insulin glargine combined with repaglinide can be replaced from the twice daily premixed insulin injection regiment for the T2DM even with poor glucose control.

Objective To objectively analyze the manifestation of sleep disorders in patients with Parkinson' s disease (PD) using polysomnogram (PSG) and multiple sleep latency test (MSLT). Method Twenty-six patients (PD group)with PD and 31 controls without CNS diseases( control group) underwent all night ambulatory video-polysomnographic monitoring and MSLT on the next day. Sleep architecture, mean sleep latency,sleep onset rapid eye movement (REM) periods(SOREMPs) and sleep attacks(Sas) of the two groups were analyzed. Results When compared to the controls, percentage of NREM stage 2 sleep,percentage of REM sleep, mean sleep latency in the PD patient group were significantly decreased (32.8% ±13.1% vs40.2% ±9.1%,t = -2.515;8.6% ±5.3% vs 11.5% ±5.1%,t = -2.054;(9.6 ± 4. 4) min vs ( 15.7 ± 3. 1 ) min, t = - 6. 1 64, all P ＜ 0. 05 ), while arousal index was significantly increased ( (41.8 ± 32. 1 )/h vs ( 28.6 ± 1 1. 0 )/h, t = 2. 151, P ＜ 0. 05 ). The prevalence of excessive daytime sleepiness (EDS; 7/26, 26. 9% ) was higher in the PD patient group than in the controls (1/31,3. 2%; ×2 =4. 764,P＜0. 05). Multivariate linear regression analysis showed that after adjusting for sleep efficiency, apnea hypopnea index, arousal index, decreasing mean sleep latency in PD patients was significantly associated with both age( β = -0. 328) and levodopa equivalents( β = -0. 008; t = -2. 829,-2. 352,all P ＜ 0.05). SOREMPs occurred in 5 of 26 (19.2%) PD patients and Sas occurred in 3 ( 11.5% ) PD patients but did not occur in the controls. Conclusion Changes in sleep architectures and EDS are more common in PD patients. Physicians should be highly vigilant in recognizing Sas, which are uncommon in PD patients.

Objective To compare the dosimetry between inversely optimised intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy using the field-in-field technique (FIF) for whole-breast radiotherapy with a boost to the tumor bed after breast-conserving surgery.Methods IMRT and FIF treatment plans were respectively performed and optimised for 9 patients with early stage leftbreast cancer after breast-concerving surgery.The prescribed dose of breast was 50.4 Gy in 28 fractions,1.8 Gy per fraction and that of tumor bed was 61.6 Gy in 28 fractions,2.2 Gy per fraction.The conformity index,the dose and volume for OAR( organs at risks),time of planning and treatment for the two plans were compared.Results The conformity index(CI) for IMRT was improved compared with the FIF in breast [(1.82±0.16) vs.(2.21±0.15)] and tumor bed [(1.19±0.04) vs.(1.59±0.11),t=2.08,3.97,P ＜ 0.05 ].There was no difference for V20 of ipsilateral lung and V30 of heart between two plans.The Dmax and Dmean of the contralateral lung of FIF were (5.41 ±2.76) and (0.51 ±0.10) Gy,lower than those of IMRT [ (25.72 ± 2.61 ) and (7.46 ± 0.39) Gy,t =-22.44,- 21.14,P ＜ 0.05 ].The Dmax and Dmean of the contralateral breast of FIF were (8.50 ± 5.61 ) and (0.47 ± 0.11 ) Gy,lower than those of IMRT [(27.73±4.30) and (6.38±0.48) Gy,t=-5.66,-14.83,P＜0.05].ForFIF,theV5of the contralateral lung and breast were (0.09 ± 0.09) ％ and (0.45 ± 0.45 ) ％,respectively,lower than those of IMRT,which were (84.66 ±3.06) ％ and (60.79 ±4.94)％ (t =-28.19,- 12.80,P＜0.05).The time of optimised plan was (61.57 ± 0.89) min for FIF and(241.28 ± 1.06) min for IMRT (t=-32.35,P＜0.05),and that of treatment were (16.14±1.42) min for FIF and (29.85 ±0.59) min for IMRT (t =- 8.82,P ＜ 0.05).Conclusions For patients with early stage breast cancer after breast-concerving surgery,IMRT could improve the conformity index of target but increase the dose of eontralateral lung and breast.However,FIF has advantage on the time of optimising plan and treatment.

Objective To observe the effects of ultrashort wave diathermy on the expression of tumor necrosis factor-α (TNF-α) andBcl-2 in hippocampus, striatum and motor cortex of rats with cerebral ischemia/reperfusion. Methods The model of focal ischemia/reperfusionin Sprague-Dawley rats was induced with intraluminal middle cerebral artery occlusion (MCAO) with nylon monofilament suture. Therats were divided into 3 groups: sham group (n=6), model group (n=6) and ultrashort wave diathermy group (n=6). Brain tissue slices wereimmunohistochemically stained (SABC) to observe the expression of TNF-α and Bcl-2. Results The expression of TNF-α and Bcl-2 in lefthippocampus, striatum and motor cortex was higher in the model group than in the sham group (P<0.01). The expression of TNF-α was lowerbut Bcl-2 was higher in the ultrashort wave diathermy group than in the model group (P<0.05). Conclusion Ultrashort wave diathermycan affect the expression of TNF-α and Bcl-2, which may associate to the neuroprotection from focal cerebral ischemia/reperfusion injury.