BACKGROUND: In the treatment of senile distal tibia fractures, locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPO) exerts a satisfactory repair effect, and contributes to the function recovery of lower limbs.OBJECTIVE: To retrospectively analyze the efficacy of LCP combined with MIPO versus intramedullary interlocking nailing for senile distal tibia fractures.METHODS: Fifty-six elderly patients with distal tibia fracture were allotted to minimally invasive and intramedullary nailing groups (n=28 per group), and received the treatment of LCP combined with MIPO and intramedullary interlocking nailing fixation, respectively. The operation time, intraoperative blood loss, postoperative AOFAS ankle-hind foot scale scores, postoperative ambulation time, healing time, postoperative complications and the excellent and good rate in Johner-Wruhs' criteria were compared between two groups.RESULTS AND CONCLUSION: (1) The operation time, AOFAS ankle-hind foot scale scores, ambulation time, and healing time in the minimally invasive group were significantly superior to those in the intramedullary nailing group (P < 0.05). (2) The minimally invasive group showed a significantly higher excellent and good rate (96%) than the intramedullary nailing group (79%) (P < 0.05). (3) Compared with the intramedullary nailing group, the incidence of complications was significantly reduced in the minimally invasive group (P < 0.05). (4) Our findings suggest that the combination of LCP and MIPO not only preserves the most of blood supply, and soft tissues surrounding the fracture end as suggested by the BO principle, but also is conducive for fracture healing, and holds good efficacy.

OBJECTIVE:To observe clinical effect and safety of Shenfu injection combined with linezolid in the treatment of severe pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS:In retrospective study,62 MRSA severe pneumonia patients selected from ICU of our hospital during Jun. 2012-Oct. 2015 were divided into observation group (25 cases)and control group(28 cases)according to medication plan. Based on routine treatment,control group was additionally given Linezolid injection 600 mg,ivgtt,bid. Observation group was additionally given Shenfu injection intravenously with initial dose of 60 mL,and then given continuous intravenous infusion of 60 mL at a rate of 20 mL/h,q12 h,on the basis of control group. Both groups were treated for consecutive 2 weeks. Clinical efficacy,bacteriological efficacy,cardiac function indexes and serum levels of inflammatory factors before and after treatment as well as the occurrence of ADR were compared between 2 groups. RESULTS:The clinical response rate of observation group was 88.00%,which was significantly higher than 60.71% of control group,with statistical significance (P<0.05). Bacterial clearance rate of observation group was 72.00%, and that of control group was 64.28%,there was no statistical significance between 2 groups(P>0.05). Before treatment,there was no statistical significance in cardiac function indexes and serum inflammatory factor levels between 2 groups(P>0.05). After treatment,LVEF,SV,CO and CI of 2 groups were increased significantly compared to before treatment,while the levels of TNF-α,IL-6,CRP and PCT were de-creased significantly;the indexes of observation group was significantly better than those of control group,with statistical signifi-cance (P<0.05). No severe ADR was found in 2 groups. CONCLUSIONS:Shenfu injection combined with linezolid effectively improves the cardiac function of patients with MRSA severe pneumonia,enhances the anti-inflammatory effect,and have a very significant clinic effect with good safety.

Objective To research of aripiprazole in schizophrenia patients with olanzapine-induced weight gain and The influence on serum leptin, prolactin ( PRL) and weight.Methods 92 cases of schizophrenia patients with olanzapine-induced weight gain in the draw method was divided into control group and experimental group, all the 46 cases, the control group was treated with olanzapine,the experimental group based on the control treated with aripiprazole.Leptin, PRL, adiponectin, fasting plasma glucose, insulin resistance index, blood lipid, weight, body mass index, abdominal circumference, positive and negative symptom scale ( PANSS ) score and adverse reactions were compared between two groups.Results After treatmented, the leptin and PRL of experimental group was lower than the control group (19.46 ±2.70) μg/L, (470.31 ±67.25) mIU/L vs (28.78 ± 4.11) μg/L, (730.62 ±91.25) mIU/L, the difference was statistically significant (P<0.05).The adiponectin of experimental group was higher than the control group (19.40 ±2.70) mg/L vs (13.96 ±1.73) mg/L, the fasting plasma glucose, insulin resistance index of experimental group was lower than the control group (4.53 ±0.56)mmol/L, (2.11 ±0.26) vs (6.85 ±0.85) mmol/L, (4.35 ±0.62) (P<0.05).The blood lipid level of experimental group was better than that of control group (P<0.05).The body weight, fasting blood glucose, insulin resistance index of experimental group was lower than the control group ( P<0.05 ) .The PANSS score of experimental group was better than that of control group ( P<0.05 ) .The adverse reactions was no differences between the two groups.Conclusion The exact clinical effect of aripiprazole in schizophrenia patients with olanzapine-induced weight gain is effective,can decrease the serum leptin, PRL and weight.

Objective To investigate the effect of psychological intervention combined with venlafaxine and risperidone in the treatment of refractory depression and its influence on the quality of life .Methods 97 patients with refractory depression were selected .According to the random number table , they were divided into the observation group(50 cases) and the control group(47 cases).The control group was given venlafaxine combined with risperidone treatment,the observation group received psychological intervention on basis of the control group .The Hamilton depression scale ( HAMD) of patients in the two groups before treatment ,4,8 and 12 weeks after treatment were recorded .The curative effect after 12 weeks of treatment was evaluated ,the adverse reaction was evaluated by the side effects scale ( TESS ) , and the quality of life ( WHOQOL-100 ) of the two groups before treatment , 12 weeks after treatment were compared .Results The HAMD score of the two groups had no statistically significant difference before treatment(t=0.307,P>0.05).After treatment for 4,8,12 weeks,the HAMD scores of the two groups were significantly lower than before treatment (t=5.743,17.756,27.288,4.595,15.801,23.247,all P<0.05),and the HAMD scores in the observation group after treatment for 8 weeks and 12 weeks were significantly lower than those in the control group(t=0.887,3.717,5.854,all P<0.05).After 12 weeks of treatment,the total effective rate of the observation group was significantly higher than that of the control group (90.00％ vs.74.47％,χ2 =4.043,P <0.05 ).There was no statistically significant difference in incidence rate of adverse reactions between the two groups (26.00％vs.25.52％,χ2 =0.003,P >0.05).The WHOQOL-100 scores of the two groups had no statistically significant differences before treatment(t=0.597,0.497,0.378,0.923,0.136,all P>0.05).The WHOQOL-100 scores of the two groups after treatment were significantly higher than those before treatment ( t =11.668,8.701, 6.857,7.053,2.247,4.815,4.639,2.999,4.117,2.011,all P<0.05).After treatment,the psychological and physiological independence and social relationship domain scores in the observation group were significantly higher than those in the control group(t=5.618,3.295,4.335,3.603,all P<0.05).Conclusion Psychological interven-tion combined with venlafaxine and risperidone in the treatment of refractory depression can significantly improve the clinical efficacy ,improve the clinical symptoms and the quality of life of patients .

Objective:To investigate the clinical efficacy and possible mechanism of bifidobacterium tetralogy combined with escitalopram oxalate in the treatment of patients with depression and to provide evidence for further clinical research.Methods:A total of 100 patients with depression who received treatment in Taizhou Second People's Hospital from September 2019 to March 2021 were included in this study. They were randomly assigned to receive either escitalopram oxalate and placebo (control group, n = 50) or escitalopram oxalate and bifidobacterium tetralogy (observation group, n = 50). All patients received 9 weeks of treatment. Psychological status pre- and post-treatment was evaluated using the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Serum cortisol, inflammatory factors interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels were detected using the enzyme-linked immunosorbent assay. Results:Physiological status scores in each group were significantly lower after treatment compared with before treatment. Scores of the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores post-treatment in the observation group were (10.78 ± 2.03) points and (6.37 ± 2.58) points, which were significantly lower than those in the control group [(16.78 ± 2.85) points, (13.23 ± 2.95) points, t = 11.40, 13.38, both P < 0.001]. Serum levels of cortisol, inflammatory factors IL-1β and TNF-α in each group were significantly decreased after treatment compared with before treatment. Serum levels of cortisol, inflammatory factors IL-1β and TNF-α post-treatment in the observation group were (137.34 ± 63.29) μg/L, (14.38 ± 6.08)ng/L, (13.95 ± 6.46) ng/L, which were significantly lower than those in the control group [(181.22 ± 59.27) μg/L, (25.94 ± 6.92) ng/L, (20.44 ± 6.24) ng/L, t = 15.29, 6.16, 9.24, all P < 0.001). Conclusion:Bifidobacterium tetralogy combined with escitalopram oxalate is highly effective on depression. The combined therapy can remarkably reduce depression and anxiety symptoms and greatly decrease serum cortisol, IL-1β, and TNF-α levels.

Objective To explore the value of serum insulin-like growth factor-1(IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3)in diagnosis of children with idiopathic short stature (ISS).Methods 36 ISS and 50 normal children were collected and divided into preadolescent group and adolescent group respectively.Serum IGF-1 and IGFBP-3 were detected by chemiluminescence analysis.Results There were significant positive correlations between age and the serum levels of IGF-1 and IGFBP-3(r =0.435,r =0.718,P <0.01)in both groups.The concentrations of IGF-1 and IGFBP-3 in adolescent group were significantly higher than those in preadolescent group,and the concentrations of IGF-1 and IGFBP-3 in ISS group were significantly lower than those in the control group (P <0.01).Conclusion The detections of IGF-I and IGFBP-3 have a great value in the diagnose,growth monitoring and the treatment with GH for children with ISS.

Objective To explore the value of serum insulin-like growth factor-1(IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3)in diagnosis of children with idiopathic short stature (ISS).Methods 36 ISS and 50 normal children were collected and divided into preadolescent group and adolescent group respectively.Serum IGF-1 and IGFBP-3 were detected by chemiluminescence analysis.Results There were significant positive correlations between age and the serum levels of IGF-1 and IGFBP-3(r =0.435,r =0.718,P <0.01)in both groups.The concentrations of IGF-1 and IGFBP-3 in adolescent group were significantly higher than those in preadolescent group,and the concentrations of IGF-1 and IGFBP-3 in ISS group were significantly lower than those in the control group (P <0.01).Conclusion The detections of IGF-I and IGFBP-3 have a great value in the diagnose,growth monitoring and the treatment with GH for children with ISS.

OBJECTIVE To study the protective effect and possible mechanism of soybean isoflavones against threatened miscarriage rats. METHODS Female mice were selected to promote estrus and mate with male mice. After pregnancy， they were randomly divided into normal group （purified water， i.g.， n＝10）， model group （purified water， i.g.， n＝9）， positive control drug group （progesterone 4 mg/kg， i.m.， n＝9）， low-， medium- and high-dose soybean isoflavone groups （25， 50 and 100 mg/kg， i.g.， n＝10）. Except for the normal group， the rest were given mifepristone+misoprostol on the 8th day of pregnancy to establish threatened miscarriage model， and then given purified water or drugs， once a day， on days 1-7 and 9-12 of pregnancy， respectively. At 14 days of pregnancy， the rates of fetal protection were counted. Serum levels of β-human chorionic gonadotrophin （β-HCG） and progesterone （P） in rats were detected. Pathological and morphological changes in rat placenta and decidua tissues were observed， and the apoptosis indexes of cells were detected； mRNA and protein expressions of factor of apoptosis related （Fas）， factor of apoptosis related ligand （FasL）， proliferating cell nuclear antigen （PCNA） and heparin binding epidermal growth factor （HB-EGF） were determined in placenta tissues， and mRNA and protein expressions of Fas， PCNA and HB-EGF in decidua tissues were detected. RESULTS In the model group， the placental tissues of rats were hyperemia and dilatation， with fewer and irregular blood vessels； severe stromal edema，inflammatory cell infiltration and iron-choledrin depositionwere observed. Compared with model group， the fetal survival rates， serum levels of β-HCG and P， the expressions of PCNA and HB-EGF mRNA and proteins in the placenta and decidua tissue of soybean isoflavone groups increased significantly （P＜ 0.05）， while pathological changes were improved significantly； cell apoptosis index in the placenta and decidua tissue， the expressions of Fas， FasL mRNA and proteins in the placenta and Fas mRNA and protein in the decidua tissue decreased significantly （P＜0.05）. The effect of soybean isoflavones was dose-dependent （P＜0.05）. CONCLUSIONS Soybean isoflavone has protective effect on threatened miscarriage， the mechanism of which is related to down-regulating the expressions of Fas and FasL mRNA and protein at the maternal-fetal interface， and up-regulating the expressions of mRNA and protein of PCNA and HB- EGF.

Objective To investigate the effectiveness and safety of intravenous thrombolytic therapy with low-dose alteplase for elderly patients with acute ischemic stroke.Methods The elderly patients with acute ischemic stroke were enrolled prospectively (onset within 4.5 h,aged ≥75 years).They were randomly divided into either a low-dose group (0.6 mg/kg) or a standard-dose group (0.9 mg/kg).The primary outcome was the modified Rankin Scale (mRS) score determined the good outcome (mRS score 0-2) and poor outcome (mRS score ＞2) at 90 d after treatment;the secondary outcome was intracranial hemorrhage and symptomatic intracranial hemorrhage at 24 h after thrombolysis,and death within 90 d.Results A total of 65 elderly patients with acute ischemic stroke were enrolled,including 32 in the low-dose group and 33 in the standard-dose group.There were no significant differences in all baseline clinical data between the two groups.Compared with before treatment,the proportions of patients with the mRS score 0-2 were significantly higher in both groups at 7 d,14 d,and 90 d after treatment,but there were no significant differences in good outcome rate at the same time point after treatment between the two groups.In addition,there were no significant differences in intracranial hemorrhage (36.4％ vs.25.0％;x2 =0.985,P =0.321),symptomatic intracerebral hemorrhage (21.2％ vs.9.4％;x2 =1.749,P =0.186) at 24 h after treatment,and incidence of death within 90 d after treatment (12.1％ vs.6.3％;x2 =0.151,P=0.697)between the two groups.Conclusions The effectiveness and safety of intravenous thrombolytic therapy with low-dose alteplase (0.6 mg/kg) in elderly patients with acute ischemic stroke is equivalent to the standard dose.

Objective:To investigate the perioperative impact of closure of mesenteric fissure in laparoscopic right hemicolectomy.Methods:The prospective randomized controlled trial was conducted. The clinical data of 320 patients who underwent laparoscopic right hemicolectomy in 11 medical centers, including The First Affiliated Hospital of China Medical University et al, from November 2022 to August 2023 were selected. Based on block randomization, patients were alloca-ted into the mesenteric fissure non-closure group and the mesenteric fissure closure group. Observa-tion indicators: (1) grouping of the enrolled patients; (2) intraoperative conditions; (3) postopera-tive conditions. Measurement data with skewed distribution were represented as M( Q1, Q3) and com-parison between groups was conducted using the Mann-Whitney U test. Count data were represen-ted as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher's exact probability. Comparison of ordinal data was conducted using the rank sum test. Comparison of visual analog scores was analyzed using generalized estimating equations. Results:(1) Grouping of the enrolled patients. A total of 320 patients with colon cancer were screened for eligibility, including 156 males and 164 females, aged 68(59,73)years. All the 320 patients were allocated into the mesenteric fissure non-closure group with 164 cases and the mesenteric fissure closure group with 156 cases. There was no significant difference in the age, body mass index, American Society of Anesthesiologist score, maximum tumor diameter, anastomosis location, anastomosis method, surgical approach, range of lymph node dissection, tumor staging between the two groups ( P>0.05) and there was a significant difference in the sex between them ( P<0.05). (2) Intraoperative conditions. There was no significant difference between the mesenteric fissure closure group and the mesenteric fissure non-closure group in the volume of intraoperative blood loss, operation time, conversion to laparotomy, intraoperative complication ( P>0.05). Three patients in the mesenteric fissure non-closure group were converted to laparotomy. One patient in the mesenteric fissure closure group was converted to laparotomy, and 2 cases with intraoperative complication were mesenteric hematoma. (3) Postoperative conditions. There was no significant difference between the mesenteric fissure non-closure group and the mesenteric fissure closure group in the overall postoperative complications ( χ2=0.28, P>0.05). There was no significant difference in the occurrence of postoperative intestinal obstruction, abdominal distension, ascites, pleural effusion, gastric paralysis, anastomotic bleeding, anastomotic leakage, or surgical wound infection between the two groups ( P>0.05). There was no significant difference between the two groups in the reoperation, postoperative gastric tube replacement. There was no significant differ-ence in time to postoperative first flatus, time to postoperative initial liquid food intake, time to post-operative resumption of bowel movements, duration of postoperative hospital stay, total hospital expenses between the two groups ( Z=-0.01, 0.43, 1.04, -0.54, -0.36, P>0.05). One patient in the mesenteric fissure non-closure group received reoperation. No perioperative internal hernia or death occurred in either group. The visual analog score decreased with time in both groups. There was no significant difference in the visual analog score between the mesenteric fissure closure group and the mesenteric fissure non-closure group [ β=-0.20(-0.53,0.13), P>0.05]. Conclusion:Compared with closure of mesenteric fissure, non-closure of mesenteric fissure during laparoscopic right hemi-colectomy dose not increase perioperative complications or postoperative management risk.