OBJECTIVETo analyze causes of missed diagnosis of hiding post-malleolar fractures in treating ankle joint fractures of pronation-external rotation type according to Lauge-Hansen classification and assess its medium-term outcomes.

METHODSAmong 103 patients with ankle joint fracture of pronation-external rotation type treated from March 2002 to June 2010,9 patients were missed diagnosis,including 6 males and 3 females,with a mean age of 35.2 years old (ranged, 18 to 55 years old) . Four patients were diagnosed during operation, 2 patients were diagnosed 2 or 3 days after first surgery and 3 patients came from other hospital. All the patients were treated remedially with lag screws and lock plates internal fixation. After operation,ankle joint function was evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS).

RESULTSAll the 9 patients were followed up, and the duration ranged from 14 to 30 months (averaged, 17 months). No incision infection was found, and all incision healed at the first stage. At the latest follow-up, AOFAS was 83.0 +/- 4.4, the score of 4 patients diagnosed during operation was 85.0 +/- 2.9, and the score of 5 patients treated by secondary operation was 81.0 +/- 5.3. All the patients got fracture union observed by X-ray at a mean time of 2.2 months after operation. There were no complications such as internal fixation loosing, broken and vascular or nerve injuries.

CONCLUSIONAnkle joint fracture of pronation-external rotation type may be combined with hiding post-malleolar fractures. So to patients with ankle joint fracture of pronation-external rotation type, lateral X-ray should be read carefully, and if necessary, CT or MRI examination should be performed. If adding lateral X-ray examination after reduction of exterior and interior ankle joint fixation, the missed diagnosis may be avoided.

Adolescent ; Adult ; Ankle Fractures ; False Negative Reactions ; Female ; Fractures, Bone ; diagnosis ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Pronation ; Rotation ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Objective To understand the influencing factors of the post competency of health technical personnel in township hospitals in a prov-ince,so as to provide scientific reference for improving health professionals'post competency. Methods Using stratified cluster random sam-pling,1242 health professionals from township health centers and village clinics of 14 cities were extracted and then surveyed with questionnaire. Results The average score of the respondents'post competency was 3.43,which meant they could afford most of the work. Multiple linear re-gression analysis showed that the main influencing factors of the professionals'post competency included gender,age,specialty,and training. The female,senior,nursing and health-care professionals with training exhibited a better post competency. Conclusion To realize the further develop-ment of professionals'post competency,medical students should not only be early clinical and more clinical,but also actively participate in the training and continue the education after entering the clinic. On the other hand ,the government should define the function orientation of the town-ship healthy centers and explore human resource management mode based on the post competency.

Objective To evaluate if high energy spectral CT images of contrast-enhanced phase could replace the plain scan for radiation dose reduction in children with solid tumor in abdomen.Methods Thirty children with solid tumor in the abdomen underwent CT scan.Plain CT scan was performed as usual,and the contrast-enhanced scan was performed with spectral CT imaging mode.Eleven sets of monochromatic images were reconstructed from the enhanced spectral CT with energies from 40 to 140 keV with 10 keVinterval.CT values for liver,spleen,kidney,pancreas,muscle,vessel and tumors were measured on both the plain and contrast-enhanced spectral images and were statistically compared.Two board-certified radiologists reviewed both plain and contrast-enhanced spectral images for image quality,calcification and tumor characterization.Radiation dose was recorded(CTDIvol,DLP).Pair t test was used to analyze the difference.Results At 140 keV,CT values of the contrast-enhanced spectral images had good correlations with those of plain scan for various organs.The paired CT values between the 140 keV and plain phaseimages were (62.8± 1.1 vs.59.8±4.0),(69.4±2.6vs.63.1 ±5.6),(52.7 ±5.1 vs.51.4±4.0),(35.4± 5.9 vs.35.7 ±5.3),(51.4±8.6vs.50.0±5.7),(55.5±6.6vs.54.7±5.7) and (33.2± 10.4vs.35.4± 12.1) HU for vessel,liver,spleen,kidney,pancreas,muscleand tumor,respectively.There was no significant difference between two groups(t=0.335 to 2.127,P＞0.05).140 keV images of the contrast-enhanced spectral scan in pediatric tumor patients provided adequate image quality (4.4±0.8 points and 3.7±0.5 points)for describing solid tumor features and calcification.The radiation dose of plain phase and contrast-enhanced phase were [CTDIvol (1.6±0.8) mGy,DLP(46.4±36.8)mGy·cm and CTDIvol(12.7±0.1)mGy,DLP(378.6±91.4)mGy·cm.Conclusion It isfeasible to replace plain CT with 140 keV contrast-enhanced spectral images to reduce 10％ radiation dose.

Instructional system design is an important component of instruction. Chaos theory is used in instructional system design of clinical teaching. Application of butterfly effect, fractals and strange attractors theory enhances students’clinical capabilities and comprehensive ability to analyze and solve problems.

OBJECTIVETo explore methods of treating middle and distal tibia nonunion with the treatment of advanced bone graft combined with locking compression plate.

METHODSFrom January 2011 to December 2012, 12 patients with middle and distal tibia nonunion were treated with advanced bone graft combined with locking compression plate. Among patients, there were 8 males and 4 females aged from 20 to 69 with an average of 47 years old. The time from first injuries to bone nonunion was from 9 months to 5 years, avergaed 19 months. Four cases were treated with external fixation, 6 cases were treated with plate fixation, 2 cases of 12 patients occurred broken of plate and nail. Eleven patients were non-infective bone nonunion and 1 patient was infective bone nonunion. Preoperative X-ray and CT showed all patients had sequestration and formation of ossified bone with different degrees. Operative time, blood loss, wound healing were observed, fracture healing time was evaluated by postoperative X-ray. Johner-Wruhs scoring standards was used to evaluate ankle joint function after operation at 10 months.

RESULTSOperative time ranged from 90 to 185 min with an average of (125.00±20.15) min; blood loss ranged from 225 to 750 ml with an average of (415.00±120.00) ml. All patients were followed up from 10 months to 2.5 years with an average of 1.5 years. Postoperative X-ray showed bone union was formed around fracture after operation at 4 months in all patients, 3 cases obtained bone healing within 6 months after operation, 9 cases obtained from 8 to 12 months. No infection, injury of nerve and vessles, and broken of plate and nail were ocurred. According to Johner-Wruhs scoring at 10 months after operation, 10 cases obtained excellent results, 1 good and 1 moderate.

CONCLUSIONAdvanced bone graft combined with locking compression plate, which can build fracture multi-point supporting based on full compression of bone nonunion to get effective fixation, is an effective method in treating middle and distal tibia nonunion.

Adult ; Aged ; Bone Plates ; Bone Transplantation ; Female ; Fracture Healing ; Fractures, Ununited ; surgery ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

Adenocarcinoma, Mucinous ; classification ; metabolism ; pathology ; Biomarkers, Tumor ; metabolism ; Breast Neoplasms ; classification ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Mucin-1 ; metabolism ; Mucin-2 ; metabolism ; Mucins ; metabolism ; WT1 Proteins ; metabolism

AIM:To establish the quality specification of Yinzhihuang Injection (extract of Herba Artemisiae scopariae,extract of Fructus Gardeniae,extract of Radix Scutellariae,extract of Flos Lonicerae Japonicae); METHODS:Extractum Artemisiae Scopariae、 Extractum Fructus gardeniae、 Extractum Flos lonicerae and Extractum Radix scutellariae were identified by TLC and were determined by HPLC. RESULTS:The average recoveries of chlorogenil、gardenoside、baicalin and p-hydroxyacetophenone were 99.8%,99.2%,100.1% and 99.9%,respectively.RSD were 0.81%,1.20%,1.90% and 0.55%,respectively.The TLC sports developed were fairly clear,and the blank test showed no interference. CONCLUSION:The method developed is simple and accurate with good reproducibility,and the method can be used for quality control of Yinzhihuang Injection.

ObjectiveTo investigate the independent risk factors of 30-day mortality of nontraumatic acute chest pain in emergency department so as to get non - traumatic acute chest pain risk score,MethodsThe clinical data of 532 patients with non - traumatic acute chest pain were reviewed.The independent risk factors of 30 - day mortality were identified after analysis of medical history,symptom and sign,laboratory findings by uuivariate analysis and logistic regression.Non- traumatic acute chest pain risk score was made as per the odds ratios of these risk factors. ResultsThe average age of the patients was (55.7 + 12.7 ) years,and 45 patients ( 8.4％ ) died after 30 days.In patients with non - traumatic acute chest pain,history of hypertension (OR:4.28; 95％ CI:1.59-11.55 ),prolonged chest pain (OR:1.1; 95％ CI:1.05-1.15),dyspnea (OR:6.61; 95％CI:2.40-18.10) and tachycardia (OR:1.02; 95％CI:1.00-1.04),high leucocyte count (OR:1.18; 95％CI:1.06-1.31) and D - Dimer ( OR:1.002; 95％ CI:1.001-1.002 ) predicted 30 - day mortality independently,whereas chest pain relieved by medicine (OR:0. 15; 95％ CI:0.04-0.65),high blood oxygen saturation (SaO2) (OR:0.89; 95％CI:0.83-0.98) and normal hematocrit (OR:0.92; 95％CI:0.86-0.99) were good markers to predict optimistic prognosis.Non - traumatic acute chest pain risk score was higher in 30 - day dead group than those in survival group significantly ( P ＜ 0.01 ),and mortality was significantly different between groups with various risk stratification (P ＜ 0. 01 ).Conclusions Clinical physician can predict 30 - day mortality and evaluate prognosis in patients with acute chest pain by using non - traumatic acute chest pain risk score quickly and effectively.

The purity of 4,4′-dimethoxy-5,6,5′,6′-bis (methylenedioxy)-2′-morpholine methylenebiphenyl-2-methyl formate methanesulfonate (IMH), a new drug for fatty liver treatment, was determined through differential scanning calorimetry (DSC). Analysis of two-factor non repeatability method was performed in the investigation the effects of two factors (heating rate and sample weight) on purity determination. The DSC experimental parameters were optimized as follows: heating rate was 10 ℃·min^-1, temperature range was 150-300 ℃, sample weight was 2.0-4.1 mg, and N₂ flow rate was 80 mL·min^-1. The linear correlation coefficient (r) of this DSC method was 0.999 8. The RSD value (n = 6) of precision was 0.03%. The standard value and uncertainty of the purity results of the multiple batches of IMH drugs were (99.74 ± 0.29)%, (99.91 ± 0.28)%, (99.90 ± 0.28)%, and (99.81 ± 0.28)% with inclusion factor (K) of 2 and confidence probability (P) of 0.95. The results were basically consistent with the results of the mass balance method. The DSC mehod is a simple, rapid and accurate method, and provides a new reference method for determining the purity of IMH drugs, improves the accuracy and reliability of purity determination.

Objective To explore the effect of the rational-emotive-behavior therapy (REBT) on mood, cognition and activities of dailyliving (ADL) of patients with poststroke depression (PSD). Methods 80 PSD patients were divided into control group (n=40) and observationgroup (n=40). Both groups were given Prozac (20 mg/d) for 8 weeks, and the observation group received REBT (3 times per week, 20min every time) additionally. Hamilton Rating Scale for Depression (HAMD), Mini Mental State Examination (MMSE) and Barthel Index(BI) were evaluated before and after treatment. Results After 8-week treatment, the scores of HAMD in two groups reduced significantly(P<0.01), and the scores of MMSE and BI increased significantly (P<0.01). The scores of HAMD were lower in the observation group thanin the control group (P<0.05), and the scores of MMSE and BI were higher in the observation group than in the control group (P<0.05). TheBI score was related with sleeping disorder in control group (P<0.05). The BI score was both related with sleeping disorder and somatizationin the observation group (P<0.05). There was no significant difference in the extent of effectiveness on depression between two groups(P>0.05), but there was the trend that the efficacy of the observation group was better than the control group. Conclusion REBT combinedwith antidepressant drugs can better relieve the symptoms of depression and improve cognitive function and ADL of PSD patients. The improvementof somatization and sleep disorders by REBT has a relationship with the enhancement of ADL.