BACKGROUND:Kirschner wire fixation is the most extensive method to repair metacarpal and phalangeal fractures,but it has some disadvantages such as poor stability and many complications.Present studies suggest that surface rigidity,stability of fracture fragments and fracture healing of mini-plate were better than other fixation methods.Based on anatomical reduction,mini-plate fixation can firmly fix the bone,does not destroy articular surface,so it can restore hand function to the maximum extent.OBJECTIVE:To compare and analyze the therapeutic effects and adverse reactions of Kirschner wire and mini-plate fixation for repair of metacarpal and phalangeal fractures.METHODS:A total of 76 patients with metacarpal and phalangeal fractures,who accepted surgical treatment in Department of Orthopedics,Yixing No.2 People's Hospital from January 2011 to January 2014,were selected.Patients were randomly divided into observation group and control group,with 38 cases in each group.The patients in the observation group (46 places) were treated by mini-plate fixation,while those in the control group (50 places) were fixed with Kirschner wire.Hand function was evaluated after treatment.Healing and complications were compared in both groups.RESULTS AND CONCLUSION:The excelent and good rate in the observation group was 91％(42/46),and 68％(34/50) in the control group,and the significant differences between the two groups were detected (P＜0.05).Total active flexion degree,length of hospital stay and healing time were respectively (147.2±89.6)°,(5.1±2.1) days and (51.4±18.3) days in the observation group,and (132.4±35.3)°,(6.9±2.4) days and (65.5±23.8) days in the control group.Length of hospital stay and healing time were shorter,but total active flexion was greater in theobservation group than in the control group (P＜0.05).Incidence of infection and delayed healing of bone were significantly lower in the observation group than in the control group (P＜0.05).Results suggest that compared with the Kirschner wire,mini-plate fixation for metacarpal and phalangeal fractures can obviously improve hand function,shorten length of hospital stay and healing time.It is safe and reliable,and is one of good clinical treatment options.

Immune factor is one of the main mechanism of children glomerular diseases. Tacrolimus has a strong and effective immunosuppressive action comparing with CsA. In recent years,the curative effect of ta-crolimus in the treatment of children with kidney disease has attracted doctors attention. Tacrolimus in the treat-ment for refractory nephrotic syndrome ( steroid-dependent nephrotic syndrome, steroid-resistent nephrotic syn-drome and the frequent recurrence of glomerular syndrome) has obtained the good effect. This article reviews the application of tacrolimus in nephrotic syndrome,focal segmental glomerular sclerosis,mesangial proliferative glo-merulonephritis,membranous nephropathy,lupus nephritis( LN) in the children with kidney disease.

Objective To investigate the effect of δ-aminolevulinic acid(ALA)-induced photodynamic reaction on biological characteristics of skin fibroblasts.Methods Human skin fihroblasts were isolated from the foreskin of children and cultured in the presence of 0.5 to 5.0 mmol/L ALA;three hours later,they were irradiated with 632.8 am laser followed by additional 12-hour culture.Then,MTI"assay and flow cytometry were used to measure the proliferation and apoptosis of cells.The levels of matrix metallopmteinase(MMP)1,-2 and-3 and hydroxyproline in the culture supematant of irradiated cells were determined by avidinbiotin complex-based ELISA and alkaline hydrolysis-based method,respectively.Results With the rise of ALA concentration from 0.5 to 5.0 mmol/L.the proliferation level of fibroblasts expressed as the absor-bance at 570 nm dropped from 0.45±0.05 to 0.32±0.04.and cell death rate increased from 6.4%±2.0% to 29.6%±2.2%.Meanwhile,the contents of MMP-1,-2 and -3 increased at the early stage,but decreased at the late stage,whereas the hydroxyproline level showed an inverse tendency during the increase of ALA concentration from 0.5 to 5.0 mmol/L.Conclusions Proper intensity of photodynamic reaction induced by ALA could enhance the secretion of MMP and inhibit the synthesis of collagen by skin fibroblasts,however,high concentration of ALA may exert an inverse effect.

Objective To probe into the indication, operative skill of intrapericardial pneumonectomy, the prevention and cure in postoperative complication of intrapericardial pneumonectomy for locally advanced lung canc-er. Methods The clinical data of 43 cases of locally advanced lung cancer undergoing intrapericardial pneumonec-tomy from February 1998 to November 2007 were retrospectively analyzed. Results No surgical death occurred. The main postoperative complication was arrhythmia, acute pulmonary edema and pneumonia, with incidence as 41. 86%. The 1-,3- and 5-year postoperative survival rate was 79.1% ,30.2% and 11.6%. Conclusions The intrap-ericardial pneumonectomy skill not only can improve resection rate, reduce exploration rate, but also offer more oppor-tunity of further therapy in a part of locally advanced lung cancer.

Objective To investigate the significance of early postoperative enteral nutrition with esophageal cancer in the elderly. Methods A total of 62 cases of esophageal cancer patients aged 70 years and older were randomly divided into the enteral nutrition(EN)group and the parenteral nutrition(PN)group. In preoperative and the first day and eighth day of postoperative serum albumin,prealbumin,peripheral blood lymphocytes,serum immunoglobulin(IgG,IgM,IgA),complement C3 and C4 were measured,and the postoperative infectious complications and cardiovascular complications were observed. Results During the eighth day after operation,the statistic analysis of the data between EN group and PN group showed: tALB = 2. 535,tPA = 2. 880,tLymphocyte =2. 720,tIgA =2. 166,tIgM =2. 065 ,tC3 =4. 103 ,tC4 =2. 478,P ＜0. 05. The result indicated that the EN group was better than the PN group in improving the nutritional status of patients,strengthened the immune system. The complication comparison between the two groups after operation: x2 Infection = 4. 24,x2 Cardiovascular =15.55,P ＜ 0. 05. The result indicated that the EN group had lower incidence of infectious complications and cardiovascular complications than the PN group. Conclusions Early enteral nutrition can significantly improve the nutritional status of elderly patients with esophageal cancer after postoperative,enhance immunity,and reduce the incidence of complications.

Objective To explore the nutrition support route of enteral nutrition (EN) and parenteral nutrition(PN) on the cellular immune function of patients after esophagectomy.Methods Sixty-two patients with esophageal surgery were randomly divided into EN group and the PN group,and each was 31 cases.Cellular immune indexes(including T lymphocyte subsets,natural killer cells,B lymphocytes) were measured at the preoperation,the postoperative 1st day and 8th day.The t test was preformed to compare the measurement data of two groups,and repeated measures analysis of variance was used to compare multiple time points of measurement data of two groups.Results The levels of CD3,CD4,CD8,CD4/CDS,NK cells and B cells in EN group at before operation were (60.46 ± 6.41) ％,(39.03 ± 5.64) ％,(25.06 ± 5.39) ％,(1.60 ± 0.24),(13.86 ±4.91)％,(13.14 ± 3.81)％ respectively,and those indices at 8th day after operation were (65.18 ±7.81)％,(40.45 ±6.82)％,(22.81 ±4.47)％,(1.78 ±0.16),(16.97 ±4.85)％,(15.69 ± 3.88)％ respectively,and the differences were statistically significant(P ＜ 0.05).The levels of CD4,CD4/CD8,NK cells and B cells in PN group at before operation were (59.78 ± 5.17) ％,(39.10 ± 5.49) ％,(24.94 ± 3.97) ％,1.57 ±0.20,(14.02 ± 4.47) ％,(12.96 ± 3.39) ％ respectively,significantly different from that of 8th days ((59.78 ±5.17)％,(39.71 ±5.63)％,(24.74 ±3.80),(1.62 ±0.15),(15.35 ±4.31)％,(14.33 ±3.43) ％ respectively),and there were significant difference compared to before operation in terms of CD4,CD4/CD8,NK cells and B cells.At the 8th day after operation,there was significant difference between in EN group and PN group in terms of CD3,CD8,CD4/CD8,NK cells and B cells(P ＜0.05).Conclusion Early EN for patients after esophageal carcinoma operation can significantly improve the cellular immune function of patients.

Objective To explore the value of video-assisted thoracoscopy for the diagnosis of indeterminate solitary pulmonary nodules.Methods A total of 42 patients with indeterminate solitary pulmonary nodules(

Objective To sdudy the percentage of defect size following acute coronary syndromes(ACS) before and after percutaneous coronary intervention(PCI)therapy by myocardial tomography.Methods ~(99m)Tc-MIBI myocardial imaging was performed on 106 ACS patients to estimate the defect size before and after reperfusion.Results A significant difference in defect size was found between groups before and after PCI[(26.7?4.9)% vs (12.8?4.6)%,P

0.05).The gene frequencies of ACG-T235M and ACE-DD plus AGT-TT were significantly higher in the patients with CAD than in the controls respectively(all P

Objective To understand the current economical operation of public hospitals in Hubei province and its effect on their public welfare performance. Methods To collect data in field survey and to analyze the current economic situation of such hospitals in the province based on relevant statistics.Results Financial revenue and expenditure of these hospitals keep rising and achieving a balance in general; for the insufficient government financial subsidy, 90% of the revenue of such hospitals come from their medical services and drugs sold; the per capita revenue of these public hospitals maintains a yearly rising trend; their asset-liability ratio was relatively high. Conclusions The public welfare performance of these hospitals tends to be impeded by the reform on the macro economic system and health policy changes, on top of the attraction of economic interests. Improving the government subsidy mechanism for public hospitals and standardizing the financial management mechanism of public hospitals.