Objective To estimate the effect of open reduction and internal fixation for treating the trimalleolar fracture in the elderly.Methods 57 aged patients suffered from the trimalleolar fracture and were treated with internal fixation from January 2009 to June 2012.25 males and 32 females with an average age of 71.5 years ranged from 65 to 81 years were involved in this study.The supination-external rotation type were in 41 cases and pronation-external rotation type in 16 cases according to Lauge-hansen's classification.The posterior and lateral approach was taken for surgical procedure of lateral malleolar frature.The routine or locking plates were used to fix the fratures.The posterior malleolar fractures were usually fixed through the posterolateral approach as well.The screws or tension band fixation was selected for fixing the medial malleolar fragments.The parallel screwing fixation could be helpful for fixing the tibiofibular syndesmosis.Results The ankle function was evaluated by the criteria system of the American Orthopaedic Foot and Ankle Society (AOFAS).The efficacy was excellent in 23 patients,good in 24 patients,fair in 7 patients.The skin problems such as super facial infection and delayed union of incision were in 7 cases.Conclusions If choosing reasonable operation method and suitable internal plant,the open reduction and internal fixation has better effect in treating the trimalleolar fracture in the elderly,with fewer complications.

Objective To explore the clinical characteristics and operative methods of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Methods The data of 15 patients who were suffered the ankle fracture combined with the simultaneous fractures of Tillaux-Chaput and Volkmann between Septenber 2005 and January 2012 were analyzed.There were 8 males and 7 females with an average age of 27.3 years (range,16-57 years).All had medial malleolar and fibular fracture with Tillaux-Chaput and Volkmann tubercle avulsed fracture.X-ray film shows that there were 8 cases in which the patients had Tillaux-Chaput fracture,among whom 7 were diagnosed by CT scan.Classified by Lauge-Hansen system,ankle fracture could be divided into pronation-exterual rotation type in 4 cases,and pronation-abduction type in 11 cases.The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach.The fibular fracture was fixed with plate.The medial malleolar fracture was explored from medial curve approach.Tillaux-Chaput fracture was treated by the mierotubule cut.All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS).Results All patients were followed up for 8-20 months (average,12.5 months).The fracture healed 12-36 weeks later in all the 15 patients,with an average of 23.5 weeks.Twelve patients walked normally and 3 with mild claudication in the last follow-up.The AOFAS score was average 85.4 points,9 were excellent,4 were good,2were fair,with the good-excellent rate being 86.7％ (13/15).The movement of ankle joint limited in 3 patients,tenderness occurred when weight bearing in 3 patients.Conclusion The ankle fracture include the simultaneous fractures of Tillaux-Chaput and Volkmann were more seen in the type of pronation-abduction.It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments.The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Inferior tibia fibular screw was not routinely used in this fracture.

To study the effects of the material of a buildup cap to the determined value of Output FactorSc．Material and MethodsUsing two buildup caps made of plastic A－150 and copper respectively．The ionizing values of ionization chamber were measured with Farmer 2570 electrometer in the fields of all kinds of sizes respectively and calibrated to reference field．Two groups of values of Sc were obtained and compared． Results The ionizing values measured with the buildup cap of copper is evidently larger than with the buildup cap of plastic A－150 and the maximum is 14％ but the difference between two groups of the values of Sc is not much evident and all is in the range of 1％． Conclusions Though the material of high density is not equivalent with airthe effects of that to the measured value of Sc is less．So using the buildup cap made of the material of high density for the measurement of Sc is also a quite good method specially in the fields of the small sizes．

Objective To analyze clinicopathologic characteristics and prognostic factors of the patients with invasive lobular carcinoma of breast. Methods Clinical data of 125 patients with invasive lobular carcinoma of breast treated at Cancer Center of Sun Yat-sen University from Jan. 1990 to Dec. 2008, were analyzed. The clinical characteristics, recurrence and survival of the patients were summarized. Results Median age of 125 patients was 45 years old (range, 27 to 76 years old). The patients with large tumor mass (≥ 3cm), positive local lymph node, more than Ⅱ stage and positive hormone receptor at diagnosis were 77 cases(61.6 %), 64 cases(51.2 %), 101 cases(80.8 %) and 112 cases(89.6 %), respectively. The median time of follow-up was 58 months (range, 11-222 months). Of the 125 patients, 32 had local recurrence and metastasis, and 18 died. The 5-year disease-free and overall survival rates were 82.2 % and 87.3 %, respectively. Multivariate COX regression analysis showed that whether endocrine therapy or not was only a prognostic factor of patients with invasive lobular carcinoma of breast. Conclusion There is no difference in media age of patients with invasive lobular carcinoma of breast at diagnosis from other pathologic type of breast cancer. These patients are usually with larger tumor masses, more lymph node metastasis and a higher proportion of positive hormone receptor. The prognosis of patients is not affected by clinicopathologic parameters.

Objective To understand the distribution and antimicrobial resistance of pathogens causing wound in-fection in army officers and soldiers following military training injury,and provide reference for antimicrobial use in clinical anti-infection treatment.Methods Wound secretion from injured army patients who were admitted to a mili-tary hospital between January 2014 and June 2015 was performed bacterial culture and antimicrobial susceptibility testing.Results 647 pathogenic bacteria strains were isolated from 1 029 wound secretion specimens ,isolation rate was 62.88%,the top 6 isolated bacteria were Staphylococcus aureus (S .aureus ,29.99%,n =194),Escherichia coli (E.coli,19.32%,n=125),Pseudomonas aeruginosa (19.17%,n=124),Enterococcus spp .(13.60%,n=88), Klebsiella pneumoniae (K .pneumoniae ,7.73%,n =50),and Acinetobacter baumannii (A.baumannii,5.87%, n=38).S .aureus and Enterococcus spp .had high susceptibility to vancomycin,linezolid ,and daptomycin (resist-ance rates ≤3.41 %),44.33% of S .aureus were methicillin-resistant,2.27% of Enterococcus spp .were vancomy-cin-resistant .E.coli and K .pneumoniae had high susceptibility rates to piperacillin/ tazobactam (resistance rates were 1 .60% and 0 respectively),except A.baumannii,resistance rates of gram-negative bacteria to carbapenems were all low (resistance rates ≤4.00%).Conclusion Military clinicians should select appropriate antimicrobial agents according to antimicrobial susceptibility testing results,reduce the disability rate due to infection in trauma patients,and provide clinical support for the treatment of the wounded.

Objective To study the clinical efficacy of robotic sacral hysteropexy in treatment of uterine prolapse.Methods From January 2012 to December 2013,3 patients undergoing robotic sacral hysteropexy in treatment of uterine prolapse in General Hospital of People's Liberation Army were studied retrospectively.Operation time,blood loss and postoperative recovery exhaust time and pelvic organ prolapse quantification (POP-Q) staging were evaluated.Results Three patients were treated by robotic sacral hysteropexy successfully.The mean operation time was 221 minutes (210-240 minutes),mean blood loss was 45 ml.One case with Ⅱ degree perineal laceration patients simultaneously perineal repair,neither intranor post-operative complications occurred.The mean postoperative recovery exhaust time was 16 hours.At three months of follow-up,all 3 patients got satisfaction.Although one patient at the first six months of postoperation had leakage of urine when coughing,instruct exercise pelvic floor muscle function and acupuncture one month their symptoms disappear.Conclusion Robotic sacral hysteropexy pave the way for an effective option in the management of uterine prolapse.

Objective To evaluate the hepatic pathological damage after orthotopic liver transplantation (OLT) in rats with integrated backscatter (IBS). Methods Thirty-two SD rats and 40 Wistar rats were included, and stable OLT models were established except 8 Wistar rats as blank group. The rat models were randomly divided into 4 groups (each n=8):normal group (given no treatment), CsA-treated group (30 mg/[kg·d]), SIN-treated group (40 mg/[kg·d]), SIN and CsA-treated group (SIN 40 mg/[kg·d]+CsA 15 mg/[kg·d]). Hepatic IBS (peak to peak intensity:PPI; average image intensity:AII; standard deviation of image intensity:SDI) was measured on 4th and 10th day after OLT. The rats were sacrificed and a part of liver was cut off for pathological examination. Result Four days later, AII of control and SIN groups were higher than those in other groups (P<0.05), and of CsA-treated and SIN+CsA-treated groups were higher than that of blank group (P＜0.05), while no difference of PPI and SDI was detected between each two groups. Ten days later, AII in CsA-treated, SIN+CsA-treated and SIN-treated groups were lower than that of control group (P＜0.05), no difference of PPI and SDI was detected between each two groups. IBS was positively correlated with liver pathological damage (r=0.814, P＜0.01). Conclusion Detecting hepatic IBS contributes to the diagnosis of the level of liver damage after OLT.

Objective To evaluate the performance of the hypersensitive C-reactive protein(hs-CRP) rapid quantitative chemilu-minescent detection kit .Methods According to National Committee for Clinical Laboratory Standards (NCCLS) EP10-A2 docu-ment ,hs-CRP rapid quantitative chemiluminescent detection kit was employed to measure the CRP at low ,medium and high con-centration levels of quality control serum .Bias ,total imprecision and their slope rates ,intercepts ,carryover ,non-linearity and drift were calculated ,and its clinical acceptability was evaluated .Results Bias and total imprecision of hs-CRP rapid quantitative chemi-luminescent detection kit were within the allowable ranges ,the average values of slope rates ,intercepts ,carryover ,non-linearity and drift were 1 .005 7 ,0 .537 8 ,0 .789 6% ,0 .019 2 ,0 .036 0 ,respectively ,the differences showed no statistically significance ( P>0 .05) .Conclusion hs-CRP rapid quantitative chemiluminescent detection kit has good accuracy and precision ,stable perform-ance ,and consistent with the clinical testing requirements .

To explore the effect of coriaria lactone (CL)-activated astrocyte-conditioned medium on the cerebral TNF-alpha of normal rats, the CL-activated astrocyte-conditioned medium (ACM) was injected into the lateral ventricle of SD rats. The rats were observed for behavioral changes, and the changes of the expression of TNF-alpha in the cerebral cortex and hippocampus were immunohistochemically examined by employing SP method. TNF-alpha level was assessed by means of radioimmunoassay in homogenate of cerebral cortex and hippocampus as well as cerebrospinal fluid. Seizure episodes were observed in ACM group 30 min after the ACM injection, but they were not observed in the control group. Immunohistochemical detection showed that the immunoreaction of TNF-alpha in hippocampus and cerebral cortex of rats were stronger than that of the control group 4 h after the ACM injection (P<0. 05). In this group, the concentrations of TNF-alpha in homogenate of cerebral cortex and hippocampus and cerebrospinal fluid were higher than those of the control group (P<0.05). It is suggested that the ACM activated by CL can enhance the expression of TNF-alpha in normal rats, and is related to epileptogenesis.

Objective To explore the effects of astrocytes on the N-ethylmaleimide-sensitive fusion protin,(NSF) and AMPA receptor of the neurons as well as their function in epileptogenesis. Methods ACM was injected into lateral ventricle of SD rats and the behaviour changes were observed; Immunohistochemical method was used to assess the changes of the expression of NSF in the cerebral cortex and hippocampus; The cultured neurons were divided into control group, ACM group and CNQX+ACM group at random, immunocytochemistry was used to assess the changes of the expression of NSF, Western blotting was used to assess the changes of the content of NSF of the cultured neurons. Results Seizure was observed in ACM group 30 min after injecting ACM. the immunoreaction of NSF in hippocampus and cerebral cortex of rats were depressed than those of the control group 2h, 4h after injecting ACM (P