Objective To report effect on treatment tibial fracture asynthesis by external fixator combined with spongy bone implant.Methods From Februryl 999 to February 2002,11 cases of the tibial fractures asynthesis were treated with the external fixator combined with spongy bone implant.Results Follow-up was both clinically and ra-diologically performed in 1 leases.The healing rate of the fracture was 100% in this group.The average healing time was 3.2 months.Conclusion The external fixation combined with spongy bone implant is simple and effective in treatment of the tibial fracture asynthesis.

Objective:To investigate the clinical efficacy of integrated steel plate system combined with Kirschner wire internal fixation in the treatment of Lisfranc injury.Methods:Data of 30 cases with Lisfranc injury who were admitted from January 2010 to December 2018, including 22 males and 8 females were retrospectively analyzed. The age ranged from 22 to 58 years, with an average age of 44.5 years. All of them were closed injuries, including 8 cases involving metatarsal tarsal base fracture, and 2 cases with compression fracture of dice. Classification of Lisfranc joint injury: 6 cases of injury of the inner column alone, 10 cases of injury of the inner column and the middle column, 4 cases of injury of the middle column and the outer column, 10 cases of injury of the three columns. Cause of injury: traffic injury in 12 cases, machine injury in 10 cases, fall injury in 8 cases. The time from injury to operation was 2-7 d, with an average of 5 d. After the improvement of soft tissue conditions, all patients were treated with open reduction and internal fixation using integrated plate system combined with Kirschner wire, followed up by regular post-operative imaging examination, and the therapeutic effect was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) midfoot score.Results:Thirty patients were followed up for 12-30 months (mean 24 months), during which no soft tissue complications such as wound infection and skin necrosis were observed. Average postoperative healing was observed at 12 weeks (10-16 weeks) for them who combined with fracture. At the latest follow-up, the AOFAS midfoot score was 65-95 points (mean 85 points). The midfoot function scores of the 30 patients were: excellent in 15 cases, good in 10, fair in 3, poor in 2. The excellent and good rate was 83.3% (25/30). One patient showed low toxicity and red skin 8 months after the operation. The integrated steel plate system was removed and the skin healed smoothly after the operation. One year after surgery, 10 patients requested removal of the internal fixation. None of the patients had the complication of plate, screw and Kirschner wire fracture. Two patients with three-column injury developed traumatic arthritis and walking pain 12 and 18 months after surgery, respectively, and then underwent metatarsal tarsal joint fusion. The postoperative pain disappeared.Conclusion:The integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury is simple, can avoid joint redislocation and articular cartilage reinjury, is a safe and effective method for the treatment of Lisfranc injury.

Objective To investigate the current status of perceived social support and challenge-hindrance working pressure source and explore the association between the perceived social support and challenge-hindrance working pressure source in clinical nurses. Methods The perceived social support scale and challenge-hindrance working pressure source scale were investgated in the study among 295 clinical nurses. Pearson correlation analysis was used to explore the association between the clinical nurses' perceived social support and challenge-hindrance working pressure source. Results The total score of clinical nurses' perceived social support was (62.12 ±10.48), the score of clinical nurses' challenging working pressure source was (22.63 ±3.67), and the score of hindrance working pressure source was (15.17±3.41). The clinical nurses' perceived social support and its dimensions were significantly positively related with the challenging working pressure source (P ＜0.01). Other support dimension of perceived social support was significantly negatively related with the hindrance working pressure source (P ＜0.01). Conclusions The perceived social support and challenge-hindrance working pressure source of clinical nurses are at a medium to high level. The higher level of clinical nurses' perceived social support is, the higher level of challenge working pressure sources. The family members, friends, leaders and colleagues should give more support for the clinical nurses, so as to enhance their subjective support, increase positive effect of working pressure source, promote their progress and improve their quality of nursing.

AIM: To examine whether Akt signal pathway proteins, including Akt, NF-?B and I?B?, are activated in kidney tissue of murine chronic graft-versus -host disease (GvHD) lupus nephritis in vivo , and whether prednisone suppres ses activation of them. METHODS: Akt activity and phosphorylated I?B? were detected by Weste rn-blot. Activation of NF-?B was detected by electropheretic mobilit y shift assay (EMSA). RESULTS: Activity of Akt, NF-?B and phosp horylated I?B ? were significantly increased in kidney tissue of murine chronic graft-versus -ho st disease (GvHD) in 8th week and 12th week after monocell injection, respective ly. However, they were no significant elevation in 16th week, when compared with controls. Prednisone treatment significantly prevented the increase in serum an ti-dsDNA antibody level, urinary protein excretion and glomerular cell prolif eration in GvHD mice, indicating the beneficial effects of prednisone on t his model. Prednisone also significantly suppressed the increase in the activities o f glomerular Akt, NF-?B and phosphorylated I?B?. CONCLUSION: T his study provides t he first evidence of marked increase in glomerular Akt-NF-?B signal pathway act ivities in murine chronic graft-versus-host disease lupus nephritis. The benefic ial effect of prednisone on this lupus nephritis model may be partially mediated by the suppression of abnormal Akt- NF-?B activation.

Objective To investigate the status of life quality in the elderly in Shanxi Province Changzhi City, and to analyze its influencing factors. Methods The quality of life, activities of daily living and status of community services were measured simultaneously by 36-Item Short Form Health Survey (SF-36). Activities of Daily Living Scale, Community Healthy Needs Scale and survey results were used and analyzed using t-test, correlation and stepwise regression analysis. Results According to the criterion of life quality in the elderly which were proposed by Zhang Lei, the quality of life in the elderly scored 72. 1-117.0, reached 98.5%. The quality of life in the elderly was impacted by the ability of caring oneself, marital status, degree of culture, economic situation and so on. The demand rate for health guidance and periodic physical examination was higher. Conclusions The quality of life in the elderly is at a medium level. There is a wide gap between the demand of community healthy services and the utilization of community healthy services.

BACKGROUND:The morphological and mechanical transfers of unstable intertrochanteric fractures were complicated, so it is difficult to analyze the biomechanical characteristicsof the common experimental methods in a comprehensive way. Moreover, the high cost, long cycle and poor repeatability of common tests limit its application in biomechanics. OBJECTIVE:To analyze the biomechanical characteristics of unstable intertrochanteric fracture in different fixation ways by three-dimensional finite element analysis. METHODS:Intertrochanteric fracture locking dynamic hip fixation model (C1), Gamma nail fixation model (C2) and proximal femoral anatomical locking plate model (C3) were established. The distal end of the femur was fixed, and subjected to the hip reaction force of 2800 N and abduction muscle strength of 1 200 N. Three-dimensional finite element analysis was used to analyze the stress distribution, stress concentration and maximum displacement of unstable intertrochanteric fracture in three different fixation ways. RESULTS AND CONCLUSION:(1) Stress: the anterolateral stress and anteromedial stress of C3 were the maximum. Posterolateral stress and posteromedial stress ofC3 were the minimum. There were significant differences among the three groups (alP< 0.05). (2) Stress of fracture space: significant differences in anterolateral stress, anteromedial stress, posterolateral stress and posteromedial stress were determined in C1, C2 and C3 (P< 0.05). Anterolateral stress of C3 was significantly less than anterolateral stresses of C1 and C2 (P< 0.05). Anteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). Posterolateral stress of C1 was significantly larger than that of C2 and C3 (P<0.05). Posteromedial stress of C1 was significantly larger than that of C2 (P< 0.05). Posteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). (3) Significant differences in bone stress around the screw top were detected among the three groups (P< 0.05). Bone stress around the screw top of C3 was significantly larger than that of C1 and C2 (P< 0.05). (4) Thus, locking dynamic hip screw, Gamma nail and proximal femoral anatomical locking plate have their advantages and disadvantages for treatment of unstable intertrochanteric fracture of the femur. The appropriate internal fixation device should be selected according to the need.

ObjectiveTo induce monocyte-derived dendritic cells(MoDC)from acute myeloid leukemia (AML) and healthy persons by rhCD40L in normal human AB serum system in vitro and to identify the morphology and phenotype of MoDC. MethodsPeripheral blood mononuclear cells(PBMNC)of AML and healthy persons were cultured in RPMI 1640 media including human AB serum, GM-CSF, rhIL-4 and rhCD40L, respectively. MoDC were identified by morphological features, surface antigen expression and the ability to stimulate T cells. ResultsAfter cultured for 7 days, MoDC displayed typical morphology with elongated dendritic process,and upregulation of the costimulatory molecules CD40,CD80,CD86 and CD83.The morphology and expression of costimulatory molecules were not significantly different between AML and healthy persons (P＞0.05),but were significantly different between rhCD40L group and without rhCD40L group (P＜0.05). MoDC had the ability to activate T cells, and there were no statistical differences between AML and healthy persons(P ＞0.05), but were significant differences between rhCD40L group and without rhCD40L group (P＜0.05). MoDC started to secrete IL-12 on day 5, and there was no statistical differences between AML and healthy persons(P＞0.05),and had differences between rhCD40L group and without rhCD40L group (P＜0.05).ConclusionMoDC can be cultured from the peripheral blood of AML and healthy persons.There were no significant differences in morphology and phenotype.Monocyted-derived DC can be used as an alternative to generate leukemia-specific cytotoxic T cells,especially in the presence of rhCD40L.

Objective To explore the relationship between Adult-onset Still's disease (AOSD) and macrophage activation syndrome (MAS). Methods A total of 78 patients with AOSD who had completed medical information were included in this study. Eleven patients who were diagnosed as rheumatic disease associated hemophagocytic syndrome among 26 patients who had hemophagocytic syndrome with histological evidence consisted of the MAS group. Clinical and laboratory data were analyzed in 78 patients with AOSD and 11 patients with MAS. Results Among 78 cases of AOSD, 9 patients (12%) could be diagnosed as MAS but didn't have hemophagocytic histological evidence. In the 11 MAS cases with hemophagocytic phenomenon, 6 patients fulfilled the diagnostic criteria of AOSD, 2 cases with panniculitis, 1 case with SLE, 1 case of dermatomyositis and 1 case of systemic vasculitis. Logistic analysis showed that splenomegaly (OR =2.13, 95%CI=1.11-3.42), leukopenia (OR=3.57, 95%CI=2.30～4.86), anaemia (OR=0.85, 95%CI=1.03～2.76), thrombocytopenia (OR=2.98, 95%CI=1.17-4.30) and hypertriglyceridemia (OR=1.66, 95%CI=1.02～2.74) were associated with development of MAS in AOSD. Conclusion The development of MAS in AOSD patient is frequent and hemophagocytic histological evidence could be found in severe cases. When splenomegaly and hypocytomsis present in AOSD patients, bone marrow examination should be done and the level of triglyceride and fibrinogen and activity of NK cells should be measured for early diagnosis.

Objective To investigate the quality of life of elderly caregivers and its factors. Methods Elderly caregivers living in Changzhi City were enrolled in this study. 36-item short-form (SF-36) health survey and Activity of Daily Living Scale ( ADL) were used as study tools. The data was analyzed by statistical description,t test or multiple regression. Results Those with score of quality of life reaching 72. 1 to 117. 0 accounted for 98. 8%. The total score and score of eight dimensions of SF-36 showed statistically significant difference between different daily living activity groups ( P < 0.05) . The state of health and self-care ability of the elderly imposed a major impact on eight dimensions of SF-36. Age, sex, level of education, marital status and wage had different impact on each dimension of SF-36. Conclusion The quality of life of elderly caregivers is at a medium level. The main factors of quality of live of elderly caregiver are their state of health and self-care ability of the elderly.

Objective To assess the clinical significance of detecting the immune markers in idiopathic thrombocytopenic purpura (ITP). Methods The frequencies of circulating B cells secreting platelet-specific antibody, platelet-specific antibody, the percentage of T lymphocyte subsets, the percentage of reticulated platelet and the level of thrombopoietin in 64 ITP patients and 31 healthy controls were measured with enzyme-linked immunospot assay (ELISPOT),modified monoclonal antibody immunobilization of platelet antigens assay (MAIPA), flow cytometry and sandwich enzyme-linked innnunosorbent assay respectively. Results Compared with the controls[1.3 ± 0. 5/105 peripheral blood mononuclear cell (PBMC), (0.33±0.06,0.41±0.03), (22.08±4.54)% and (8.19±2.46)%], the frequencies of circulating B cells secreting platelet-specific antibody (7.6±4.6/105 PBMC in acute ITP group, 5.3±3.0/105 PBMC in chronic ITP group), platelet-specific antibody (including the anti-GP Ⅱ b/Ⅲa antibody, anti-GP Ⅰ b/X antibody) (0.51 ±0.11, 0.48±0.06 in acute ITP group; 0.49±0.10,0.46±0.09 in chronic ITP group), the percentage of CD8+ T Lymphocyte (27.09±9.86 ) %, the percentage of reticulated platelet in ITP patients[the megakaryocyte cytosis group (24. 85 ± 19. 18)%, the normal megakaryocyte group (23.89±18.90)%]were significantly increased ( all P＜0.05).The frequencies of circulating B cells secreting platelet-specific antibody in acute ITP patients were notably increased (P＜0.05) compared to the chronic ITP patients. In T lymphocyte subsets, the percentage of CD3+T lymphocyte and CD4+ T lymphocyte and the ratio of CD4+/CD8+ in the patients with ITP[(60.88±14.59)%, (28.41±10.55)%, 1.18±0.59]were notably decreased than those in the healthy controls [(69.89±6.43)%, (35.38±5.05) %, 1.64±0.29, P＜0.05]. There was no apparent difference of the level of thrombopoietin between ITP patients with megakaryocyte cytosis (72. 09 ± 41.64 ) and health controls (75.37± 26. 32, P ＞ 0. 05 ), however, the level of thrombopoietin of ITP patients with normal megakaryocyte apparently increased (118.60±70.72, P＜0.05). Conclusion Detecting the frequencies of circulating B cells secreting platelet-specific antibody, platelet-specific antibody, the percentage of T lymphocyte subsets, the percentage of reticulated platelet and the level of thrombepoietin in the patients with ITP may improve the diagnosis and guide clinical therapy.