Objective To investigate the effect through clinical practice on the treatment of clavicular fractures.Methods 89 patients with a aeries of strict clinical examination were provided to determine the diagnosis,treatment design.Results After anatomic reduction,if the end of fracture became stability,joint pain disappeared even with oppression and the activities of the shoulder became normal,the healing effect is excellent.There were 48 cases of this kind and it was 54%of the whole;after anatomic reduction,if the end of fracture becatne stability,surrounding local joint pain disappeared with oppression and the activities of the shoulder nearly became normal,the healing effect belongs to the good.There were 25 cascs of this kind and it was 28% of the whole;if patients only achieved a reduetion of 1/2,they would suffer various degrees of pain after lifting heavy objects or moving and their joint activities would be restricted.The healing effect is also OK and there were 11 cases of this kind and it Wsa 12% of the whole;besides,poor treatment outcome for five cases,accounting for 6%.Excellent rate is 94% altogether.Conclusion The treatment of clavicular fractures to open reduction and internsl surgery is better than the traditional solid eight characrers bandage external fixation approach reduction.The use of reconstruction plate and collarbone hook plate is a well-established method of selection,by which bones can be fixed solidly and patients can move their shoulders earlier.What's more,joint function can restore quickly,the results are satisfactory.

Objective To investigate the pathogenesis of chronic gluteal pain.Methods 79 cases with chronic gluteal pain were provided in series of strict clinical examination to make sure their final diagnosis.Results 67 cases were identified with lumbar disc herniation,7 cases were of sacroiliac joint disease,2 cases of L5 isthmic spondyloisthesis,2 eases of avaseular necrosis of the femoral head,1 case of compressive fracture of thoracolumbar re- gion.Meantime 2 other concealed factors ought to be noted:ankylosing spondylitis and 12th intercostals neuritis. Conclusion Most cases of chronic gluteal pain were resulted from lumbar disc herniation,next from sacroiliac joint disturbances and probably a few cases from hip ioint disease.

Objective To investigate the serial clinical course about osteoporosis and spinal fracture,so as to promote knowledge of diagnosis and treatment. Methods 53 cases with whole clinical stuff were provided for analysis and study,especially on the diagnosis and medical treatment,it helps us to draw a conclusion from experience and lessons. Results After a series of proper treatments, the patients became healthy and sound earlier on,and the rate of good-results is 92 % . Conclusion Normally, the cause of the death is not just because of the fracture itself, but the complication which results from bed rest. In order to get the best result of treatment,solve the ambivalence synthetically and relatively.

BACKGROUND:The quantity and function reduction of circulating endothelial progenitor cells(CEPCs)indicate that vascular endothelial repair capacity reduces in hypertension patients,but the impact of statins on the CEPCs is still not very clear.OBJECTIVE:To investigate the effects of atorvastatin calcium on endothelial cells and CEPCs in renovascular hypertensive rats.DESIGN,TIME AND SETTING:Randomized controlled animal experiment was performed in Chongqing Key Laboratory ofNeurology from June 2008 to Febmary 2009.MATERIALS:Totally 24 SD male rats of SPF grade,and atorvastatin calcium was produced by Lipitor,Pfizer Inc.with batch number of 65837003.METHODS:The renovascular hypertension was induced with 2-kindey and 1-clip method in 16 SD rats,which were then randomly divided into two groups:hypertensive group(n=8)and statins group(n=8).control group(n=8)underwent the same operation,without silver slip.At 4 weeks after model construction,statins group was treated with atorvastatin calcium MAIN OUTCOME MEASURES:At 4 and 12 weeks of the experiment.three groups of rats were measured blood pressure and blood lipids;at 12 weeks,the thoracic aortic endothelial cells continuity was investigated through hematoxylin-eosin stain;the quantity,proliferation,adhesion and migration capacity of CEPCs were determined.RESULTS:At 4 and 12 weeks of the experiment,there was no significant differences in the systolic pressure between statins RESULTS:At 4 and 12 weeks of the experiment,there was no significant differences in the systolic pressure between statins group group and model group,which were dramatically high than control group(P＞0.01):the blood lipids in the statins group was not changed.In the model group,rat aortic endothelial cells were greatly damaged;the injury of CEPCs was dramatically relieved in the model group.Compared with statins group and control group,the number of CEPCs was significantly decreased,the capacities of proliferation,adhesion and migration were also significantly reduced in the model group(P＜0.01);moreover,statins group was inferior to control group in terms of these capacities.with significant differences among three groups(P＜0.01).CONCLUSION:Renovascular hypertensive rats thoracic aortic endothelial calls are severely damaged,CEPCs decline in the humber and function;atorvastatin calcium can increase the number of CEPCs and improve the function of CEPCs.

Objective To evaluate the efficacy and safety of common therapy and individualized treatment in newly diagnosed patients with Helicobacter pylori (H.pylori) infection.Methods From March 2008 to February 2010,September 2013 to April 2014,January to October 2015,a total of 1 440 patients with H.pylori infection who received eradication therapy and with complete clinical data were retrospectively enrolled.Each was 350 cases in individualized treatment group,clarithromycin and bismuth containing quadruple therapy group and concomitant therapy group.A total of 100 cases were in standard triple therapy group,90 cases in sequential therapy group,and 200 cases in levofloxacin and bismuth-containing quadruple therapy group.The eradication rate of H.pylori,incidence of adverse events and compliance rate were compared in the six groups.Chi square test was performed for statistical analysis.Results The results of intention-to-treat analysis indicated that there was no statistically significant difference in H.pylori eradication rates among six groups (x2 =0.985,P=0.323).However,the results of modified intention-to-treat analysis showed that H.pylori eradication rate of individualized treatment group was the highest (92.5％ (282/305) and 93.3％ (278/298)),second was levofloxacin and bismuth-containing quadruple therapy group (90.3％ (167/185) and 91.6％ (164/179)),and the differences were statistically significant (x2 =11.285 and 13.981,both P＜0.01).There was statistically significant difference in indcidence of adverse events among the six groups (x2 =5.692,P=0.018),the incidence of adverse events in levofloxacin and bimuth-containing quadruple therapy group was lowest (16.2 ％ (30/185)),and second was individualized treatment group (21.0％ (64/305)).There was statistically significant difference in compliance rates among the six groups (x2 =4.712,P=0.023),the compliance rates of standard triple therapy group and sequential therapy group were highest (100％ (100/100) and 100％ (90/90)),and second was individualized treatment group (97.7％ (298/305)).Conclusions Both the levofloxacin and bimuth-containing quadruple therapy group and individualized treatment group can effectively eradicate H.pylori infection.The former may be safe and effective to patients unable to receive individualized therapy.

Postprandial hyperglycemia is a risk factor for atherosclerosis and cerebro-vascular diseases. This article reviews the mechanisms of cerebrovascular diseases caused by postprandial hyperglycemia from aspects of postprandial hyperglycemia participating in the pathophysiological mechanisms of atherosclerosis, and the relations between postprandial hyperglycemia and cerebrovascular diseases.

Objective To investigate the clinical characteristics of the patients with portal hypertension secondary to primary myelofibrosis (PH-PMF). Methods The clinical data of patients with PH-PMF retrieved from Peking University Third Hospital were collected and analyzed. Results A total of 6 from illness onset to definite diagnosis was 24 months. The symptoms related to portal hypertension included bloating, abdominal mass, hematemesis and melena. The signs related to portal hypertension included splenomegaly ( moderate or severe in all patients), hepatomegaly ( mild or moderate in most of patients),shifting dullness positive and varices in abdominal wall. Only a small portion of patients had jaundice, liver palms and spider angioma. The indexes related to liver functions were normal or only mild abnormal in most cases. The average diameters of portal vein and splenic vein were ( 16. 0 ±3.2) mm and ( 11.0 ±3.4) mm,respectively. Thrombosis of portal vein or splenic vein was found in 2 cases. Liver biopsy revealed extramedullary hemopoiesis in one patient. In addition to medicine therapy related to portal hypertension in 5 patients with PH-PMF, 1 patient received splenectomy and another received endoscopic variceal ligation.Conclusions The patients with PH-PMF were clinically rare and easy to be misdiagnosed. The main keys to differentiate PH-PMF from cirrhosis included marked splenomegaly, mild or moderate hepatomegaly, good liver functions, lack of liver palms or spider angioma and extramedullary hemopoiesis showed in liver biopsy samples.

Objective To quantify Contribution to LE at Birth from Mortality Variation for Some Diseases in Shanghai.Methods Health problem for population was classified into 5 group: infectious group,tumor,cerebrovascular group,injury and others.Cause elimination life table methods was employed to analyze the mortality registry data for Shanghai residents during 1953 to 1999.Chisquare for trend was used to analyze the variation for ASMR and Pearson correlation was used to describe the relationship between the variation of LE at birth and social economic factors.Results During 1953 to 1999,crude mortality rate(CMR),mortality rate by area,age-specific mortality rate(ASMR) from infectious group diseases showed obvious trends of descending.Also CMR and ASMR from injury for urban residents showed obvious trends of ascending.However,for suburb residents,CMR from injury had a trend of decline but ASMR had no significant trend.CMR from tumor and cerebrovascular group for Shanghai residents showed a rising trend but mortality rate by area and ASMR not.After 1979,the proportion of contribution for the rise of LE at birth for Shanghai urban residents from infectious group was about 33%,which was much higher than that of other 3 groups.The proportions of contribution in suburb male group from injury and cerebrovascular were 40.26% and 25.18%,respectively.The variation of mortality risk from tumor for urban male residents gave a negative contribution to respondent rise of LE at birth.Besides,the proportions of contribution in suburb female group from infectious disease(21.60%) and injury(12.55%) were largest.Compared to the mortality in 1996,among infectious group,injuries,tumor and cerebrovascular group,potential decline of mortality from tumor contribute the most to the rise of LE at birth,cerebrovascular group has the second,injury had the third and infectious group has the least.Development of Shanghai medical service resource showed a significant correlation with the rise of LE at birth.Conclusion Shanghai has successfully prevented and controlled the infectious disease group.The future strategy for disease prevention and control ought to focus on tumor,cerebrovascular diseases and injury.Based on the theory of risk competing,cause elimination life table method help greatly to set proper LE aims for public health plan.

OBJECTIVE The roles of sense neuropeptides in the allergic rhinitis were investigated by observing the symptoms and changes in the level of the neuropeptides in rabbits sensitized after severing of their sphenoidpalatine or sympathetic nerve. METHODS ①SP and CGRP were observed in nasal mucosa of rabbits in four weeks. ② Twenty rabbits were divided into three groups: group C(sphenoidpalatine nerve severed),group D(sympathetic nerve severed) and group E(not operated on).Groups C and D were sensitized three days after the operation. Four rabbits were killed at two and four weeks post-operation in groups C and D. RESULTS ①There was no difference between SP and CGRP levels in four weeks. ②The levels of SP in the nasal mucosa of group C at two and four weeks after sensitization were 16.1?0.77 and 15.02?0.24, respectively. The levels of SP in group D were 34.13?1.45 and 33.23?1.99, respectively. The levels of SP in group E were 20.68?0.01 and 20.56?1.27, respectively. The level of SP in Group C was lower than in Group E. The level of SP in Group D was higher than in Group E. The level of CGRP correlates with the level of SP. CONCLUSION SP and CGRP levels are correlated with the occurrence and development of allergic rhinitis.

Objective To improve the ingestion protocol of esophageal capsule endoscopy in right lateral supine (RLS) position. Methods A total of 53 patients were randomized into RLS group and improvement group. The time of passing the esophagus, visual range and clarity of esophagus and z-line, and comfort of the procedure were compared between the two groups. Results The time of capsule passing the esophagus in improvement group was significantly longer than that in RLS group [ 202 (20-480) s vs.63 (8-210) s, P ＜ 0. 001 ) ]. The range of visualization in esophagus (2. 69 ± 0. 21 ) and Z-line (2. 54 ±0. 22) in improvement group was significantly larger than that in RLS group (2. 55 ± 0. 23 and 2. 40 ± 0. 24,respectively, P =0. 019 and P =0. 037, respectively). No significant difference was detected in clarity of esophagus or Z-line between 2 groups (P ＞0. 05). Two patients (7.7%) in RLS group had transient cough due to frequent water drinking, while no cough was observed in improvement group. Conclusion Compared with the ingestion protocol of esophageal capsule endoscopy in right lateral supine position, the improved ingestion protocol shows larger range of visualization, better safety and the same definition.