Objective To investigate the clinical characteristics of posterior malleolar ankle fracture, and the selection of the surgical approach. Methods From January 2013 to September 2015, 83 cases of posterior malleolar fractures were retrospectively analyzed. Haraguchi typing was performed based on the three-dimensional CT. There were 54 cases with HaraguchiⅠtype, 16 cases with HaraguchiⅡtype, and 13 cases with HaraguchiⅢtype. The patients who were HaraguchiⅠand Haraguchi Ⅲtypes accepted the operation with posterolateral approach. The patients who were HaraguchiⅡtype and combined medial malleolus fracture accepted the operation with medial approach. The HaraguchiⅡpatients who were not combined medial malleolus fracture were used the medial paraachilles approach. Images of the ankle joint were filmed 2 weeks, 4 weeks, 12 weeks, 6 months and 12 months after the surgery. The healing time, complications and corresponding record outcome were determined by X-ray and clinical examination. At the last follow-up, ankle function and quality of life of patients were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and SF-36. Results Eighty-three patients were follow-up for 6-24 (mean 15.4± 6.2) months. The fractures healed on X-ray. The average X-ray healing time was from 12 to 24 (mean 18.6±4.2) weeks. AOFAS score was 71 to 100 (mean 88.4±8.4) points. Sixty-seven cases were excellent, 14 cases were good, 2 cases were moderate, and good rate was 97.59%. SF-36 physiological score was 31.6-69.2 points(mean 48.4 ± 4.8 points);SF-36 psychological score 28.6-64.5 points(mean 45.8 ± 3.5 points). Chronic ankle pain was complained by one patient. He was diagnosed traumatic arthritis, oral non-steroidal drugs was used to relief his ankle pain. One patient wound infected, and healed after treatment. No instrument failure and fracture displacement were found. Conclusion According to fracture morphology and clinical features after posterior malleolar ankle fracture, different surgical approaches are selected, which will be satisfied with the outcome.

Aim To investigate the cardioprotective effects of Cyclovirobuxine D on pure cultared neonatal rat cardiomyoeytes exposed to hypoxia-reoxygenation (H/R) injury and the mechanisms. Methods The hypoxia/reoxygenation(H/R) injury model of pure cultured neonatal rat cardiomyocytes was developed.The concentration of lactate dehydrogenase (LDH) and malonialdehvde (MDA), the activity of super-oxide dismutes (SOD) and caspase-3, the apoptosis rate of cardiomyocyte were measured.Results Compared with the control group, the model group showed lower activity of SOD and higher concentrations of LDH , MDA, the apoptosis rate and activity of caspase-3(P

Objective To explore the effects of dietary intervention on dietary behavior, dietary patterns, pregnancy weight gain control and prevention of adverse pregnancy outcome among singleton pregnant women. Methods From March 2017 to December 2017, a total of 1 000 primiparas with normal singleton pregnancy less than 13 weeks were randomly divided into intervention group and control group with the random number table, 500 cases in each group. Pregnant women of intervention group were received pregnancy diet nutrition health education and individualized nutrition guidance. Pregnant women of control group were treated with routine training on pregnancy nutrition and health care knowledge. The General Information Questionnaire, Nutrition Knowledge, Attitude, Practice (KAP) Questionnaire and the Case Report Form (CRF) were used to investigated related information in two groups, such as the population characteristics of sociology, pregnancy outcome, pregnancy complications, the score of KAP questionnaire and pregnancy weight gain. The Food Frequency Questionnaire (FFQ) was used to investigate the consumption of foods of pregnant women. Results A total of 986 pieces of valid data (494 in intervention group and 492 in control group) were collected in this study. The proportion of pregnant women with normal body mass index (BMI) and pregnancy weight gain in intervention group was higher than that in control group; the incidences of pregnancy complications, cesarean delivery, giant baby and premature baby of intervention group were lower than those of control group with significant differences (P＜0.05). There was no statistical difference in the score of KAP questionnaire of pregnant women between intervention group and control group during first-trimester (P＞0.05). The scores of KAP questionnaire of pregnant women during second-trimester and last trimester in intervention group were significantly higher than those in control group as well as those during first-trimester (P＜ 0.01). The consumption frequencies of foods of pregnant women in intervention group during last trimester were higher than those during first-trimester with significant differences (P＜ 0.05), except for the consumption frequency of "roughage and its products" (P＞0.05). Conclusions Pregnancy dietary intervention could help pregnant women to keep normal pregnancy weight gain, improve the level of KAP of pregnancy rational diet, better diet behavior and prevent pregnancy complications as well as adverse pregnancy outcome.

Objective To evaluate the effects of nutritional intervention on puerperal dietary behavior and postpartum recovery in puerperae. MethodsTotally 596 normal single uniparas who were pregnant for more than 28 weeks were selected and randomly divided into intervention (n=299) and control (n=297) groups. Patients in the intervention group received puerperal nutrition and healthcare knowledge training and individualized dietary guidance, while patients in the control group received routine puerperal nutrition and healthcare knowledge training. The intake of various food, recovery and complications during puerperium were compared between the two groups. ResultsThe intake of various food during puerperium in the intervention group was higher than that in the control group except for cereal grains and eggs (P＜0.05). The height of fundic uteri (7.2±3.2) cm, Visual Analogue Scale (VAS) score (2.64±1.10) and Body Mass Index (27.87±8.86) kg/m2 in the intervention group was lower than those in the control group 6 weeks postpartum, and there was statistically significant difference between the two groups (P＜0.05). The morbidity of puerperal infection was 1.3% in the control group, while that in the intervention group was 6.4%, and there was statistically significant difference between the two groups (χ2=10.28,P＜ 0.05). The rate of breast feeding was 84.3% in the intervention group, while that in the control group was 76.1%, and there was statistically significant difference between the two groups (χ2=6.30,P＜ 0.05). ConclusionsNutritional intervention can enable puerperae to choose an appropriate dietary structure and method during puerperium, improve their puerperal dietary behavior, accelerate rapid postpartum recovery, reduce puerperal complications, and improve the rate of breastfeeding.

Objective To explore the expression and significance of vitamin D (VitD) in patients with rheumatoid arthritis (RA),and analyze the relationship between its expression and clinical indicators.Methods Clin-ical parameters and laboratory examinations of RA cases (n=250) were collected.Clinical parameters included were gender,age,disease course,swollen joints number,tenderness joints number,visual analog pain score (VAS),disease activity score (DAS)28 score.Laboratory examinations included erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody,antinuclear (ANA) antibody,antikeratin (AKA) antibody,anti-perinuclear factor (APF),anti-mutated citrullinated vimentin (MCV),antibody and anti-6-glucose phosphate isomerase (GPI) antibody,lymphocyte subsets in the peripheral blood and lymphocyte subsets of CD4+T cells.The level of 25-(OH)-Vit-D and clinical parameters,laboratory examinations were analyzed retrospectively.One-way ANOVA and KruskalWallis test were used for comparison among the groups;and the correlation analysis was performed by Pearson and Spearman rank correlation analysis.Results ① The level of 25-(OH) D in RA patients was significantly lower than that in healthy controls (t=11.676,P＜0.01).② According to 25-(OH)D level,RA patients were divided into the deficiency group,insufficient group and normal group,the tender joints count (x2=17.793,P＜0.001),the number of swollen joints (x2=12.635,P=0.002),ESR (F=6.330,P=0.002),VAS score (F=5.095,P=0.007,DAS28 (F=4.990,P=0.008) were different significantly amorg the three groups.③RF (x2=6.742,P=0.034) and anti-CCP antibody (x2=6.836,P=0.033) were different significantly among the three groups and the level of 25-(OH) D was negatively correlated with RF (r=-0.202,P=0.001),anti-CCP antibody (r=-0.220,P＜0.01),anti-MCV antibody (r=-0.109,P=0.002) and AKA (r=-0.215,P=0.001).④ The level of 25-(OH) D in the RF (t=-2.715,P=0.007),anti-CCP antibody (t=-2.03,P=0.044),AKA (t=-2.108,P=0.036) negative group was significantly higher than that in patients with antibody positive group.⑤ The level of Th1 (IFN-γ) cells (F=3.259,P=0.043) and Treg (CD4+CD25+Foxp3+) cells (F=4.342,P=0.031) were significantly different among the three groups and the level of 25-(OH) D was positively correlated with Treg (CD4+CD25+Foxp3+) cells (r=0.146,P=0.025).Conclusion Vitamin D is generally deficient in RA patients,which is significantly correlated with disease activity,RF,anti-CCP antibody,anti-MCV antibody,AKA and Th1,Treg cells.It is suggested that vitamin D may play an important role in the immunological pathogenesis and disease progression of RA.

Objective To explore the expression and their significance of peripheral Th17 cells and regulatory T cells (Tregs) in idiopathic inflammatory myopathy,and analyze the relationship between the expression and clinical indicators,imaging and pathological changes.Methods Clinical data,laboratory tests,imaging and pathological changes of IIM cases (n=85) and healthy controls (n=70) were enrolled.Clinical data included the classification,age,gender,course of the disease;laboratory tests including erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),creatine kinase (CK),creatine kinase isoenzyme-MB (CKMB),lactate dehydrogenase (LDH),hydroxybutyrate dehydrogenase (HBDH).The level of peripheral Th17,Treg cells and clinical indicators,laboratory tests,imaging and pathological changes were analyzed retrospectively.Since the data was disregarded from the normal distribution,the median four quantile method was used for statistical description.Two samples were compared with Mann-Whitney U test,and the correlation between variables was Spearman rank correlation analysis.Results ①) The levels of Th17 cells in the case group was not significantly different from that in the control group [6.18(3.42,13.65) cell/μl vs 7.42(5.02,11.13) cell/μl,P＞0.05],the levels of Treg cells in patients was significantly lower than that in the control group [21.25(12.48,35.67) cell/μl vs 36.95(30.37,47.12) cell/μl,P＜0.05],the ratio of Th17/Treg was also significantly higher than that in the control group [0.31(0.21,0.47) vs 0.18(0.14,0.31),P＜0.05].② Peripheral Treg cells levels were not correlated with ESR,CRP,CK-MB,LDH and HBDH (P＞0.05).Peripheral Treg cells levels were negatively correlated with CRP (r=-0.279,P＜0.05),but no correlated with ESR,CK-MB,LDH and HBDH (P＞0.05).③ According to the involvement of important organs,patients were classified into two groups:organ involvement group and non-organ involvement group.The levels of Treg cells in the organ involvement group was fewer than that in non-organ involvement group [16.54(8.84,27.34) cell/ul vs 24.87(14.44,43.37) cell/ul,P＜0.05],and the ratio of Th17/Treg in the organ involvement group was significantly higher than that in non-organ involvement group [0.41(0.29,0.68) vs 0.29(0.19,0.39),P＜0.05].④) Peripheral Th17 cells levels in patients with skeletal muscle inflammatory edema was significantly higher than that of non-inflammatory edema patients [10.70 (4.11,14.51) cell/μl vs 3.10 (1.27,5.15) cell/μl,Z=-2.460,P＜0.05].⑤ The levels of Th17,Treg cells and ratio of Th17/Treg did not correlate with pathological features of inflammatory infiltration (P＞0.05).Conclusion The absolute number of peripheral Treg cells decreases significantly in IIM,and correlates with CRP.Patients with organ involvement have fewer Treg cells,and there is imbalance between Th17 and Treg.When muscle MRI presents with inflammatory edema,patients may have high level of Th17 cells.Our results suggest that Treg cells may play an important role in the pathogenesis of IIM.

Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.