Objective To analyse the treatment results of proximal humerus fracture in over sixty-years-old patients. Methods From January 1999 to January 2003, 32 cases suffered from fractures of the proximal humerus were studied, which involved 13 males (mean age 73.2 years, range 60-88 years), and 19 females (mean age 75.5 years, range 60-94 years). There were 22 cases (65.7%) with two-part fractures, among them, 68.1% was surgical neck fracture. 3 cases with two-part and 1 with three-part fracture were treated conservatively because of either their poor health condition or their refusal to operation. The other 28 patients were operated. According to the Neer classification, through the statistic and analysis for the method and outcome, all the cases were evaluated in term of the American UCLA scale system. Results 25 of the 28 operated patients were available at the final follow-up, the mean period was 1.5 years with a range of 1 to 3 years. All the fractures had united. 5 patients with healing time more than 3 months were those fractures classified as three or four-part, which needed the tension-band fixation. All the patients complained with joint stiffness in different degree, 6 of the patients with three or four-part remained with sustaining shoulder contracture. According to the UCLA, the good-excellent rate was 81.2% in the two-part fractures, and only 33.3% in the three or four-part fractures. Conclusion The treatment methods of proximal humerus fracture in aged patients should be selected according to individual condition. The tension band fixation is a good choice for those who can't accept the joint replacement, though the outcome after the four-part fractures fixation is less satisfactory. Joint contracture and humeral head necrosis may be the common complications among the patients rated as three or four-part fractures. After operation, early and complete rehabilitation are closely related to the treatment results.

Objective:To explore the learning experience of the medical massive open online course (MOOC) teaching design standard system constructed by the research group in the early stage.Methods:In this study, the questionnaire was adapted from four dimensions: academic analysis, curriculum content design, teaching process design, and teaching evaluation design, including 519 students majoring in clinical medicine of a university who had studied MOOC cases like "Ultra-early Diagnosis and Treatment of Acute Cerebral Infarction" based on the system. SPSS 25.0 was used for statistical analysis.Results:The system had a high degree of recognition in all dimensions, with 64.5% of academic analysis, 57.6% of content design, 54.5% of teaching design process, and 59.3% of teaching evaluation design.Conclusion:The study has found that the medical MOOC teaching design system has good learning experience effect. According to the data feedback, the key teaching design points such as the core factors of learning experience analysis and the suitability of teaching content in the practical operation of teaching design has been explored, providing the practical basis and method reference for the design of medical MOOC teaching design.

Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.MethodsFrom Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification.Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months.No necrosis of humeral head appeared and 30 (83.3％) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.

Objective: To explore influence of nursing health education on morning blood pressure surge (MBPS) fluctuations in aged patients with hypertension.Methods: A total of 100 outpatients and inpatients with non-dipper hypertension, who haven't been treated, were selected from Apr 2011 to Sep 2015.According to random number table method, patients were randomly and equally divided into routine treatment group and health education group (received nursing health education based on routine treatment group), both groups were treated for four weeks.MBPS, trough/peak(T/P) ratio and smoothness index (SI) were measured and compared between two groups after treatment.Results: Compared with routine treatment group after four-week treatment, there were significant reductions in systolic blood pressure (SBP) morning surge[(46.95±5.17) mmHg vs.(42.21±5.19) mmHg]and diastolic blood pressure (DBP) morning surge[(16.31±3.23) mmHg vs.(14.21±3.58) mmHg], and significant rise in SBP T/P[(59.22±6.65)% vs.(70.11±6.41)%], DBP T/P[(50.91±5.04)% vs.(56.97±5.12)%], SBP SI[(1.19±0.13) vs.(1.42±0.12)]and DBP SI[(1.11±0.09) vs.(1.29±0.08)]in health education group, P<0.05 all.Conclusion: Health education can effectively improve blood pressure fluctuations and may likely improve prognosis in patients with non-dipper hypertension, which is worth extending.

Objective To investigate the effect of idarubiein to imensify the MAC (IMAC) as preparative regimen for autologous peripheral blood stem cell transplantation(APBSCT)in acute myeioid leukemia.Methods Fourteen patients with acute myeloid leukemia who underwent APBSCT were analysed. IMAC was used as preparative regimens.Results All patients were engrafted successfully.The disease-free survival could be Ben in 8 cases(57.1%),the median disease-free survival duration were 26(8-72)months and no treatment-related mortality was present.Conclusion This study suggested that addition of Idarubicin to the MAC preparative regimens Was safe,effective and feasible for patients with acute myeloid leukemia,and may improve disease-free survival and overall survival.

Background: Sorafenib and sunitinib are widely used as first-line targeted therapy for metastatic renal cell carcinoma (mRCC) in China. This study aimed to compare the efficacy, safety, and quality of life (QoL) in Chinese mRCC patients treated with sorafenib and sunitinib as first-line therapy. Methods: Clinical data of patients with mRCC who received sorafenib (400 mg twice daily; 4 weeks) or sunitinib (50 mg twice daily; on a schedule of 4 weeks on treatment followed by 2 weeks off) were retrieved. Primary outcomes were overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL (SF-36 scores), and secondary outcomes were associations of clinical characteristics with QoL. Results: Medical records of 184 patients (110 in the sorafenib group and 74 in the sunitinib group) were reviewed. PFS and OS were comparable between the sorafenib and sunitinib groups (bothP > 0.05). The occurrence rates of leukocytopenia, thrombocytopenia, and hypothyroidism were higher in the sunitinib group (36.5％ vs. 10.9％, P < 0.001; 40.5％ vs. 10.9％,P < 0.001; 17.6％ vs. 3.6％,P= 0.001), and that of diarrhea was higher in the sorafenib group (62.7％ vs. 35.2％,P < 0.001). There was no significant difference in SF-36 scores between the two groups. Multivariate analysis indicated that role-physical and bodily pain scores were associated with the occurrence rate of grade 3 or 4 AEs (P= 0.017 and 0.005). Conclusions: Sorafenib has comparable efficacy and lower toxicity profile than sunitinib as first-line therapy for mRCC. Both agents showed no significant impact on QoL of patients.

3 cm)and small lesions(diameter≤3 cm)were 80.6%(79/98)and 67.2% (45/67),respectively(P

0.05).Conclusions ATP-TCA could be used to individualize chemotherapy by selecting agents for particular patients of cervical cancer.The expression of GST-? and TS protein might be useful biomarkers to predict the resistance to DDP and 5-FU in patients with cervical cancer.

Objective To evaluate the the effect of microalbuminuria of combined treatment with fosinopril and losartan,or fosinopril,losartan monotherapy in patients with hypertension.Methods In this double-blind, intention to treat study,136 patients with hypertension were randomly assigned to receive fosinopril 10 mg/d(n= 50),losartan 50 mg/d(n=41),or a combination of fosinopril 5 mg and losartan 25 mg (n=45) qd for 4 weeks, followed by titrating to the maximum recommended doses for another 4 weeks.The primary endpoint was the difference of mean sitting blood pressure and microalbuminuria excretion at baseline and week 8.Results At week 8,the combination of fosinopril and losartan therapy lowered mean mieroalbuminuria from baseline by 26.1?10~(-8) mol/L,significantly more than either monotherapy approaches (fosinopril 20 mg,18.3?10~(-8)mol/L,P

Objective To explore the clinical significances of blood gas and dynamic monitor of respiratory mechanics in respiratory failure children with mechanical ventilation.Methods Sixty-four children who need mechanical ventilation over 24 hours were divided into pulmonary disease group(44 cases) and non-pulmonary disease group(20 cases) in pediatric intensive care unit(PICU),from Jan.2005 to May 2008.By Evita 4 ventilator,dynamic monitor of respiratory mechanics,such as respiratory system compliance(Crs),airway resistance(Raw),mean airway pressue(MAP),minute ventilation(MV),oxgen index(OI),Qs/Qt,respiratory index(RI) and blood gas in these children were determined.Their characteristics and clinical significance were analyzed.Results Many parameters such as Crs,Raw,MAP,MV,Qs/Qt,OI,RI were significantly different between 2 groups(Pa