Open calcaneal fractures are relatively rare, but most of them are potentially devastating with severe injury of soft tissue and comminuted bone. Its management is still challenging and controversial. Improper treatment will l ead to wound infection, osteomyelitis and even amputation. Preservation or repai r of soft-tissue to partly cover the hindfoot is the most important factor for the treatment. Another important factor is to restore the alignment and function of the hindfoot. Variables in determining outcomes of different cases include s everity and type of injury, wound location and treatment options. It is suggeste d that different measures should be taken according to different types of injury . This article reviews the current development and progress in the diagnosis and treatment of open calcaneal fractures.

Objective To study the effect and mechanism of gene PBP2 and gene PBP3 in drug resistance of Klebsiella pneumoniae(KP) to different antibacterial agents.Methods A total of 203 strains of KP which isolated from clinical samples in each department in our hospital during the period from April 2014 to April 2015.Strains were identified and antibiotic susceptibility were determined with automatic bacteria identification system,then extracted DNA genome from bacteria,proceeded with electro-phoresis after the product of PBP2 and PBP3 were amplified by PCR,examined genetic expression with RT-PCR,and study their connection to drug-fast of the KP combining results of antibiotic susceptibility.Results In 203 strains of KP,105 strains resistant to β-lactam drug (51.7%),88 strains were sensitive,resistant rate to imipenem and meropenem were 5.4%,3.9% respectively.The PCR amplification products of the electrophoresis bands of PBP2,PBP3 gene,18 strains were negative,185 strains were positive,which was not parallel,there were respectively negative and positive strains among them.There was no significant correlation between PBP2,PBP3 and multiple drug resistance of KP(P=0.295,0.628).PBP2 was not related to the resistance of carbapenem(P=0.637).PBP3 had correlation with carbapenem resistance,but the correlation coefficient was not high(P=0.041,r=0.148).After reverse transcription of PBP2,PBP3,statistically analyze electrophoresis bands of amplification products of carbapenem-resistant KP and 16SrRNA amplification bands of gray gradient ratio,there was no statistical significance(PBP2:P=0.331,PBP3:P=0.383).Conclusion Gene PBP2,PBP3 might not be the necessary reasons of KP being multiple drugs resistant.

Objective To evaluate the efficacy and safety of methylprednisolone in the treatment of children with nephrotic syndrome ,and to observe its adverse reaction .Methods 62 cases with primary nephrotic syndrome were randomly divided into the two groups .32 cases in the treatment group were given methylprednisolone combined with prednisone ,30 cases in the control group were given prednisone therapy .Adreno-corticotropic hormone ( ACTH) and cortisol (Cr) in serum were detected by radioimmunoassay (RIA);plasma albumin,urine protein,creatinine,ala-nine aminotransferase ( ALT) ,blood uric acid were measured by conventional laboratory methods;bone mineral densi-ty was measured by bone mineral density machine .Results The curative effect of complete remission and partial remission between the two groups had no significant difference (χ2 =1.56,P>0.05).After treatment for 10 months, the concentrations of ACTH and Cr between the two groups had no significant differences (t=5.45,P>0.05).After treatment,the contents of plasma albumin in the two groups were (36.5 ±5.5)g/L,(36.7 ±5.9)g/L),the contents of urinary protein in the two groups were (1.5 ±1.1)g/24h,(1.6 ±1.5)g/24h.Before treatment,those in the two groups were albumin (25.7 ±3.3)g/L,(26.3 ±3.5)g/L,urinary protein (5.5 ±3.0)g/24h,(5.8 ±3.5)g/24h, the differences were significant (t=11.45,12.15,all P<0.05);The time of urinary protein changed to negative in the treatment group was 6 days,which was significantly shorter than 8 days in the control group ( Log Rank=10.56, P<0.05);The incidence rate of adverse reactions in the treatment group was 40%(13 cases),which was significantly higher than 26.6%(8 cases) in the control group (χ2 =23.11,P<0.05).Conclusion The combined treatment can shorten the time of urinary protein changed to negative ,but during the treatment ,it may increase adverse reactions in children with primary nephrotic syndrome .

Objective:To investigate the Philips 256-slice CT coronary angiography images on a variety of forms of coronary artery calcification and coronary stenosis in relation to predict the value of the study of acute coronary events by coronary angiography and coronary artery calcification score.Methods: From May 2014 to February 2015 in the Third Affiliated Hospital of Qiqihar in patients with suspected coronary artery disease, with256-slice spiral CT coronary artery enhancement scanning and DSA, and using software of automatic analysis for coronary artery calcium score analysis, and comparing the accuracy of the two methods of inspection, combined with the clinical data of patients with scientific prediction of acute coronary events.Results: Different forms of coronary artery calcified plaque resulting in local differences in the proportion of luminal stenosis were statistically significant. AS calcium score standard are in grouped in patients with coronary heart disease (CHD),along with increasing calcium score,the risk of coronary heart disease also increase.Conclusion: The diagnosis of coronary artery calcification score of coronary heart disease have a higher value. Calcium score for judging coronary artery stenosis to have high specific degrees, worthy of clinical popularization and application.

Objective:According to the tumor of children psychology, explore a set of suitable for children accurate tumor radiotherapy positioning method, in order to improve the positioning accuracy, thus improve the tumor clinical cure rate.Methods: 1.Eliminate fear; 2.Adaptability training; 3.The methods of psychological suggestion. Evaluation method: take psychological induction of radiation induced by radiation therapy in children with and without taking mental children from the placement time, downtime in drug utilization rate, treatment rate and bit error rate comparison.Results: There is obvious difference between two groups (P<0.05).Conclusion: radiotherapy positioning of children with psychological intervention in the method, can improve the treatment of children's compliance.

Objective To establish a rapid,accurate and sensitive method for the determination of toluene diisocyanate(TDI) in plastic playground.Methods The samples were distilled continuously for 12 hours by acetone at 80-85 ℃ in water bath,and after centrifuged,precipitated and filtered,separated by using GC1490,7% SE-30 column,the contents of TDI in the samples were determined by gas chromatography.The qualitative and quantitative analyses were carried out by the retention time and peak area respectively.Results The linear range of the method was 0.001 30-0.043 80 mmol/L.Regression equation was y=28 612x-29.336,with r=0.999,and the limit of detection was 0.001 30 mmol/L.The rates of recovery ranged 100.8%-103.6%,with RSD of 5.7%.Conclusion The developed method was rapid,accurate,sensitive and is applicable to the determination of TDI inplastic playground.

Objective To introduce the method of arthroscopically assisted closed reduction and percutaneous screw fixation for intra-articular calcaneal fractures and to discuss its clinical indications, advantages and disadvantages. Methods From February 2003 to December 2004, 12 unilateral intra-articular calcaneal fractures were treated with the method of arthroscopically assisted closed reduction and percutaneous screw fixation. 7 cases were males and 5 cases were females. The average age was 36.8 years (range, 23-61 years). 8 feet were on right side and 4 feet were on left side. The mechanism of injury was fall from a height in 11 cases and vehicle accident in 1 case. According to Sanders classification, 8 cases were type Ⅱ fractures(1 type ⅡA, 5 type ⅡB, 2 type ⅡC) and 4 cases were type Ⅲ fractures(2 type ⅢAB,1 type ⅢAC,1 type ⅢBC). Results Arthroscopy in the operation showed the fracture space and step were less than 1 mm. The preoperative X-ray film showed that B?觟hler angle was 18.4??5.8?, Gissane angle was 109.1??10.2?, calcaneal width was (35.9?2.2) mm. The postoperative X-ray film demonstrated that B?觟hler angle was 25.4??3.5?, Gissane angle was 118.1??6.4?, calcaneal width was (32.3?1.1) mm. The average follow-up of nine patients was 17.4 months (range, 10-25 months). According to Maryland foot score, all patients had satisfactory results with the mean score of 92.5 score (range, 82-100 score), 6 were excellent and 3 were good. None of the patients had re-displacement of fracture, significant lame or other late complications. They regained normal shape of foot and wore normal footwear. Conclusion Arthroscopically assisted closed reduction and percutaneous screw fixation is an effective and applicable minimal-invasive treatment for Sanders type Ⅱ and selected type Ⅲ intra-articular calcaneus fractures. It can significantly reduce the risk of soft tissue injury and other complications while ensuring satisfactory reduction of the posterior calcaneal facet of the subtalar joint and reliable fixation.

Objective To analyze projects funded by NSFC and SCI paper publication in orthopedic research field (Code:H06) from 2010 to 2016,the current research status and development trend in this field were reviewed and discussed.Methods The data of the projects and funding subsidized by NSFC in orthopedic research field from 2010 to 2016 were collected and analyzed;the papers published were collected by searching in the Web of Science core collection by orthopedics as keyword (article included,conference abstract and book chapters excluded;data collected by December 25,2016) and compared for analyzing the global and China's SCI papers publication in orthopedic field and the role of NSFC in it.Results During the period of 2010 to 2016,1603 projects were funded by NSFC in orthopedic field and the total subsidy fund reached ￥ 730 850 000 (direct funding reported in 2015 and 2016);821 projects of General Program were funded and subsidy fund amount to ￥481 490 000;567 projects of Young Scientists were funded ￥ 118 130 000;130 projects of Fund for Less Developed Regions were funded ￥ 56 040 000;12 projects of Key Program were funded ￥ 33 560 000;3 projects of Distinguished Young Scholars were funded ￥ 7 500 000;5 projects of Outstanding Young Scholars were funded and funding up to ￥ 5 900 000.In the past seven years,the volume of SCI papers published in the world exceed 1 million per year and the papers from the orthopedics field accounted for 0.7％ to 0.8％,ranked 54.The number of SCI papers published by Chinese institutions in the field increased year by year and country ranking climbed to No.3 in 2016 from No.8 in 2010.Among these SCI papers from Chinese institutions,the number of the papers from NSFC grants also increased year by year,ranked Top One in Chinese founding agency for 7 consecutive years.Conclusion In recent years,with the increasing of NSFC budget,the orthopedic research has been developed rapidly,but it still needs to be further strengthened in the advanced talents and high-level research.

Objective To investigate the incidence and influencing factors of healthcare-associated infection (HAI) in inpatients with nasopharyngeal carcinoma during radiotherapy period.Methods The occurrence of HAI among patients with nasopharyngeal carcinoma in a tertiary first-class cancer hospital in Jiangsu Province between July 2012 and June 2014 were analyzed retrospectively.Results A total of 1 396 patients were investigated,the incidence of HAI was 2.29%,case incidence of HAI was 2.44%.The most common infection site was oral mucosa (n =24, 70.59%),and most infection occurred 2-4 weeks after the start of the radiotherapy.A total of 38 pathogenic iso-lates were isolated,24 (63.16%)were gram-positive bacteria,12 (31 .58%)were gram-negative bacteria,and 2 (5.26%)were fungi.Incidences of HAI were high in patients >50 years old,with chemotherapy,length of hospital stay>60 days,and used at least 2 kinds of antimicrobial agents (all P <0.05).Conclusion Prevention and control of HAI in patients with nasopharyngeal carcinoma during radiotherapy period should be strengthened,especially for the elderly,patients with chemotherapy,long length of hospital stay,and extensive use of antimicrobial agents.

Objective To discuss the clinical application and value of dual-source spiral CT enhanced scan and multiplanar reformatting ( MPR) in the diagnosis of gastric cancer. Methods The 335 patients with gastric cancer who conducted dual-source spiral CT enhanced scan of upper abdomen under the hypotonic state before the definite pathological diagnosis were retrospectively analyzed,and had multi-di-mensional multiplanar reconstruction for the enhanced thin-section CT data by the multiplanar reformatting technique. Results Of 335 ca-ses,288 cases were detected by simple axial data,the detection rate was 86. 0%,320 cases were detected by MPR,the detection rate was 95. 5%,the differences were statistically significant (P<0. 05). The overall accuracy rate of Preoperative T staging by conventional axial and MPR images were 78. 3% and 89. 1% respectively, the difference was statistically significant. The overall accuracy rate of preoperative N staging by two methods were 73. 6% and 82. 3%,respectively,the difference was not significant. Conclusion Application of dual source spiral CT multiplanar reconstruction can significantly improve the detection rate of gastric cancer,and the average accuracy rate of preopera-tive TNM staging for gastric cancer is 84. 6%.