Objective To estimate the effect of open reduction and internal fixation for treating the trimalleolar fracture in the elderly.Methods 57 aged patients suffered from the trimalleolar fracture and were treated with internal fixation from January 2009 to June 2012.25 males and 32 females with an average age of 71.5 years ranged from 65 to 81 years were involved in this study.The supination-external rotation type were in 41 cases and pronation-external rotation type in 16 cases according to Lauge-hansen's classification.The posterior and lateral approach was taken for surgical procedure of lateral malleolar frature.The routine or locking plates were used to fix the fratures.The posterior malleolar fractures were usually fixed through the posterolateral approach as well.The screws or tension band fixation was selected for fixing the medial malleolar fragments.The parallel screwing fixation could be helpful for fixing the tibiofibular syndesmosis.Results The ankle function was evaluated by the criteria system of the American Orthopaedic Foot and Ankle Society (AOFAS).The efficacy was excellent in 23 patients,good in 24 patients,fair in 7 patients.The skin problems such as super facial infection and delayed union of incision were in 7 cases.Conclusions If choosing reasonable operation method and suitable internal plant,the open reduction and internal fixation has better effect in treating the trimalleolar fracture in the elderly,with fewer complications.

ObjectiveTo understand the clinical and microbiological characteristics of AIDS-associated bloodstream infection (BSI).MethodsThe clinical and laboratory ifndings of 143 cases of BSI in AIDS patients who were hospitalized during the period from 2013 to 2014 were retrospectively analyzed.ResultsThe prevalence of BSI in AIDS patients was 22.1%. The 143 patients were divided into two groups in terms of fungal or bacterial infection. The incidence of speciifc skin rashes, anemia, hepatosplenomegaly and lymph node enlargement in fungal infection group was higher than those in bacterial infection group (allP<0.05). CD4+ cell count, WBC, neutrophils, RBC, hemoglobin, and platelet count in fungal infection group were lower than those in bacterial infection group, while AST and Cr were the opposite (allP<0.05).Penicillium marneffei(84/143, 58.7%) was the most common pathogen isolated from AIDS-associated BSI, followed byEscherichia coli (10/143, 7.0%),Cryptococcus neoformans (9/143, 6.3%),Klebsiella pneumoniae (7/143, 4.9%),Salmonella (6/143, 4.2%),Candida albicans(3/143, 2.1%), andAeromonas (3/143, 2.1%). Most strains were still susceptible to the commonly used antibiotics.ConclusionsThe prevalence of BSI is high in AIDS patients. Fungal BSI is more likely to have skin rash, anemia, hepatosplenomegaly and lymphadenopathy, hematologic abnormalities, liver and renal function impairment. Fungi, especiallyPenicillium marneffei, are the main pathogen of AIDS-associated BSI. Most strains are susceptible to the commonly used antibiotics.

OBJECTIVE:To compare the clinical efficacy and safety of Kangshuling gel,mupirocin and lactate ethacridine in the treatment of diabetic foot. METHODS:90 patients with diabetic foot were randomly divided into Kangshuling group,mupiro-cin group and lactate ethacridine group. All the patients were treated by lowing blood glucose,nutritional support,improving micro-circulation and anti-infection,etc. On this basis,3 groups were given Kangshuling gel,Mupirocin ointment and Lactate ethacridine solution for wet compress by gauze. The course was 180 d. The clinic data was observed,including clinical efficacy,and wound ar-ea,healed patients’granulation,epithelial tissue,healing time and incidence of adverse reactions before and after treatment. RE-SULTS:The total effective rate in Kangshuling group was significantly higher than mupirocin group and lactate ethacridine group;healed patients’granulation,epithelial tissue and healing time were significantly shorter than mupirocin group and lactate ethacri-dine group,with significant differences(P<0.05). After treatment,wound area in each group were significantly smaller than be-fore,and Kangshuling group was smaller than mupirocin group and lactate ethacridine group,with significant differences(P<0.05);there were no significant differences between mupirocin group and lactate ethacridine group(P>0.05). There were no obvi-ous adverse reactions during treatment. CONCLUSIONS:Based on the conventional treatment,Kangshuling gel has better efficacy than mupirocin and lactate ethacridine in the treatment of diabetic foot,with good safety.

OBJECTIVE:To explore the clinical features and regularity of drug-induced liver injury (DILI),and to provide reference for clinical rational drug use. METHODS:104 DILI cases in our hospital from 2005 to 2014 were selected and analyzed retrospectively in respects of patient’s gender,age,allergic history,medication history,drug type and clinical manifestations. RE-SULTS:DILI hospitalized cases increased year by year. There were 47 males and 57 females,and average age was(8.71±13.90). The clinical symptoms appeared within 12 weeks after using the drug. The symptoms were no specific,including weak,anorexia, jaundice,yellow urine,etc. and 10.57% of patients were asymptomatic. Most of the DILI cases were hepatocyte type(80.77%), followed by cholestasis type(12.50%)and hybrid type(6.73%). The most common cause of drug-induced liver injury were TCM, antimicrobial drugs and the nervous system drugs. CONCLUSIONS:The incidence of DILI in females is slightly higher than males. DILI often occurs after 40 years old. The clinical symptoms have no specificity and are similar to viral hepatitis. The hepatic lesions can be caused by most of drugs. DILI by TCM should concerned. Clinical physicians should pay more attention to DILI.

Objective To explore the application of single-person operated mammotome minimally inva-sive surgery in treatment of benign breast lesions. Methods Clinical information of 403 patients were collected and retrospectively analyzed. 262 patients receiving ultrasound guided single-person operated mammotome mini-mally invasive surgery for benign breast masses were selected as the treatment group,141 patients undergoing open surgery for treatment of benign breast masses were selected as the control group.Operative time, introopera-tive blood loss,length of stay,postoperative healing time, as well as the occurrence of complications were com-pared between the two groups. Result Compared with the control group, the operative time was shorter, the in traoperative blood loss was less, the scar size and the postoperative healing time were shorter for the treatment group. The difference had statistical significance (P<0.05).The rate of postoperative pain, local ecchymosis, local infection and breast deformity for the treatment group was significantly lower than those of the control group (P<0.05). The difference had statistical significance (P<0.05). The recurrence rate between the two groups had no sta-tistical significance (P>0.05). Conclusions Single-person operated Mammotome minimally invasive surgery has the advantages of good operative time,good cosmetic effects, small surgical trauma, less blood loss, fast postoper-ative healing and few complications, which is worthy of clinical application.

OBJECTIVE: To assess the evaluation on auditory rehabilitation effect for 42 deaf children with GJB2 gene mutation after cochlear implantation to provide a reference for the cochlear implant effect evaluation of such patients. METHOD: To conduct the detection on common genetic deafness gene mutation hotspots of hearing impaired children with cochlear implantation. To conduct auditory rehabilitation effect evaluation on 42 cases of patients with GJB2 genetic deafness after 3 months, 6 months and 12 months of the operation respectively. The single factor repeated measure ANOVA was applied to analyze whether there were significant difference among the results of initial consonant of a Chinese syllable recognition at 3 different stages after the operation, the results of vowel of a Chinese syllable recognition at 3 different stages after the operation, and the results of two-syllable recognition at 3 different stages after the operation. RESULT: 235delC is the high-incidence mutational site in 42 cases of patients with GJB2 genetic deafness, the total detection rate is up to 90.48%. There were significant differences in the initial consonant of a Chinese syllable recognition rate, the vowel of a Chinese syllable recognition rate, the two-syllable recognition rate as well as the vowel of a Chinese syllable recognition rate after 3 months, 6 months and 12 months of the operation (P < 0.01). CONCLUSION Cochlear implantation is a safe and effective measure for auditory reconstruction, it can help patients with GJB2 hereditary severe sensorineural deafness to improve auditory speech recognition.
Asian Continental Ancestry Group ; Child ; Cochlear Implantation ; Connexin 26 ; Connexins ; genetics ; Deafness ; genetics ; rehabilitation ; Hearing Loss, Sensorineural ; genetics ; rehabilitation ; Humans ; Language ; Mutation

Objective To evaluate the value of the short-segment nerve conduction studies (SSCSs, inching test) in the diagnosis and localization of cubital tunnel syndrome (CubTS).Methods The clinical and electrophysiologic data of 46 patients (92 limbs from 32 men and 14 women, aged from 19 to 59 years, with average age of 41.2 years) with CubTS were collected.The symptoms occurred in unilateral arm in 41 patients and bilateral arms in 5 patients, involving 35 left arms and 16 right arms.SSCSs were performed in both arms in all the 46 patients.Sixty ulnar nerves were studied in 30 healthy control subjects using SSCSs.Results The 51 symptomatic arms with CubTS were abnormal in long segment motor nerve conduction studies.There were 68 abnormal arms ( 51 symptomatic arms, 17 asymptomatic arms ) in SSCSs.The lesions were located 2 cm proximal to the elbow-the elbow segment ( AE2-E ) in 41 arms (44.6%),the elbow-2 cm distal to the elbow segment (E-BE2) in 23 arms (25%), 4 cm proximal to the elbow-2 cm proximal to the elbow segment (AE4-AE2) in 18 arms (19.6%), 6 cm proximal to the elbow-4 cm proximal to the elbow segment (AE6-AE4) in 9 arms (9.8%), 2 cm distal to the elbow-4 cm distal to the elbow segment (BE2-BE4) in 8 arms(8.6%) and 4 cm distal to the elbow-6 cm distal to the elbow segment (BE4-BE6) in 6 arms(6.5%),respectively.Conclusions SSCSs are more sensitive in detecting CubTS than the conventional long segment motor conduction studies.SSCSs could precisely localize the entrapment lesions in patients with CubTS ,might be a useful tool for the detection of ulnar mononeuropathy at the elbow, especially for diagnosing the patients with CubTS who have no clinical features or have a normal long segmental nerve conduction findings.

Objective To detect the routine coagulation indicators in breast cancer patients receiving the trastuzumab treatment and to analyze the influence of the coagulation indicators on clinical treatment response .Methods Totally 67 hospitalized breast cancer patients receiving the trastuzumab treatment in 401 Hospital of PLA from Jan .2006 to Dec .2012 were collected and divided into the effective group(47 cases) and ineffective group(20 cases) according to the curative effect .The levels of PT ,APTT ,TT ,Fib and D‐D were statistically analyzed .The differences of coagulation indicators were compared between the two groups .The correla‐tion between the coagulation indicators with the curative effect was analyzed .Results Compared with the effective group ,PT , APTT and TT in the ineffective group were slightly extended ,while the D‐D level was slightly increased ,the differences were not statistically significant(P> 0 .05);but the Fib level was significantly increased with statistical difference(P< 0 .05) .Conclusion The breast cancer patients with ineffectiveness in the trastuzumab treatment are easily appear the high Fib status .Determining its plas‐ma concentration is conducive to judge the prognosis of the trastuzumab treatment in breast cancer patients .

Objective To study the expression of CDK4 andβ-Catenin and their relevance in glioma. Methods We used immunohistochemistry to detect the expression of CDK4 andβ-Catenin in forty-five glio-ma tissues and eight normal tissues.According to the classification standard of WHO in 2000 classify and grade the tissues.Results There were significant differences of CDK4 andβ-Catenin expressions between normal tis-sues and glioma tissues(P<0.01).The expression of CDK4 and β-Catenin had positive correlation with the pathological grades of glioma and histological type and increased(P <0.05).Furthermore,the expression of CDK4 was positively correlated with the expression ofβ-Catenin in glioma(r=0.52,P<0.01).Conclusion The increased expression of CDK4 andβ-Catenin may have correlation with malignant change of glioma and oc-curance of glioblastoma,and their combination is expected to become an important indicator in assessing malignant glioma.

Spontaneous splenic rupture in acute leukemiapatients was rarely seen and the prognosis was ex-tremely bad. In this article the authors discussedthe early diagnosis, mechanism and treatment ofsplenic rupture in acute leukemia patients on thebasic of 3 cases treaed in our hospital. The authorsrecognized that it was a useful diagnostic methodto chech up with "B" model utrasound wave andthat to conduct splenectomy was an effectivemethod of live-saving treatment.