This report presents a rare case of a dislocated tibial plateau fracture. The patient sustained a closed fracture of the tibial plateau following a traffic accident, exhibiting a fracture pattern not fitting into any existing classification of tibial plateau fractures. Preoperative imaging revealed a lateral plateau fracture with medial dislocation of the knee joint and entrapment of the medial meniscus within the gap. The injury mechanism is hypothesized to involve external and internal rotation of the tibia relative to the femur, occurring during neutral or hyperextended positions of the knee joint. The patient's knee joint X-ray showed a fracture line passing through the lateral plateau, accompanied by medial dislocation of the knee joint, which mirrored the imaging of a Schatzker Type IV fracture dislocation caused by the classic mechanism of flexion varus and internal rotation. Hence, it was designated as a "reverse Schatzker type IV" tibial plateau fracture. Open reduction and internal fixation were performed on the 8th day post-injury, followed by knee joint stabilization with a hinge brace and guided functional exercises. Six months post-surgery, reevaluation indicated complete fracture healing and a knee flexion-extension range of 125°-5°.

Hypoxia is an important basic feature of the solid tumor microenvironment. With the deepening of the research on the pathogenesis of renal cell carcinoma (RCC), the expression and function of hypoxia and hypoxia inducible factor (HIF) in RCC have attracted more and more attention. The hypoxia signal pathway has become a research hotspot of tumor and other diseases in recent years. This article reviews the current understanding of hypoxia signal pathway, its correlation with the occurrence and development of RCC, and the application prospect of HIF inhibitors, in order to guide the precise treatment of clinical RCC.

Objective:To investigate the efficacy of a minimally invasive three-window incision and internal fixation with a novel anatomical locking plate in the treatment of calcaneal fractures.Methods:A retrospective analysis was performed of the 46 patients with calcaneal fracture (Sanders typeⅡ and Ⅲ) who had been admitted to Department of Orthopedics, Luoyang Orthopaedic Hospital of Henan Province from February 2015 to May 2017. They were 22 males and 24 females, aged from 19 to 59 years (average, 39.0 years) and with 16 left and 30 right sides affected. They were all treated with a minimally invasive three-window incision and internal fixation with a novel anatomic locking plate. Their B?hler and Gissane angles, and height, width and length of the calcaneus were compared between preoperation, immediate postoperation and the last follow-up. Their ankle-hindfoot functions were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the last follow-up; their complications were recorded.Results:All the 46 patients were followed up immediately after operation and for 14 to 18 months (mean, 16 months). All the fractures achieved bony union after an average of 3 months (from 2 to 4 months). At immediate postoperation and at the last follow-up, their calcaneal B?hler angles (34.20°±3.62° and 34.05°±3.65°) and Gissane angles (131.45°±6.04° and 131.25°±5.88°), and calcaneal heights [(41.05±2.76) mm and (40.90±2.86) mm], widths [(25.65±1.53) mm and (25.55±1.64) mm] and lengths [(76.82±1.70) mm and (76.73±1.78) mm] were significantly improved compared with the preoperative values [10.55°±7.51°, 95.32°±12.16°, (26.10±4.54) mm, (37.71±3.42) mm and (65.91±2.10) mm] ( P<0.05). There were no significant differences in the above indexes between immediate postoperation and the last follow-up ( P>0.05). According to AOFAS ankle-hindfoot scores at the last follow-up, the efficacy was evaluated as excellent in 28 cases, as good in 12 cases and as fair in 6 cases, yielding an excellent and good rate of 87.0%. No incision infection occurred after operation. Conclusion:In the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ, the minimally invasive three-window incision and internal fixation with the novel calcaneal anatomical locking plate can achieve satisfactory reduction and rigid fixation, effectively reducing postoperative incision complications.

Medical insurance payment model is transforming from project-based purchases to service bundle-based strategic purchases. The new form of bundled purchases should found on a scientifically-led design process of such bundles. The core to bundled purchase would be the payment standard, and the key to its success would be process control. Establishment of such a foundation, a core, and a key, would promote the current price standards, and lead service providers to a standardized medical service standard, so as to ensure a precise rewarding system of payment and service. The big data diagnosis-intervention packet(DIP)is able to fulfill mentioned ambitions by integrating insurance payment and supervision into one management. DIP is a full-process payment mode that encompasses pre-service estimation, in-service process control, post-service grading, and resource allocation. It is an innovative practice in line with China′s national conditions for the modern governance of medical security and medical services.

Objective:To explore the price formation method and price standard in the big data diagnosis-intervention packet.Methods:The expenditure data and income data of 95 medical institutions in Shanghai in 2018 were used for analysis, including 33 municipal hospitals and 62 district hospitals. After using the standardized data of disease score, the medical institutions in the region were divided into four quadrants with the regional average of unit price per index and cost per index as the coordinate axis. The best quadrant of income and cost was found out, namely the high quality range. The geometric center was calculated in the high quality range, and the unit price per index of the geometric center was taken as the cost standard.Results:For the district hospitals, there were 20 hospitals in the first quadrant, 8 in the second quadrant, 24 in the third quadrant and 10 in the fourth quadrant; For the municipal hospitals, there were 7 hospitals in the first quadrant, 5 in the second quadrant, 12 in the third quadrant and 9 in the fourth quadrant. In the third quadrant, the average income and cost of medical institutions were lower than the average of the city, and the income could cover the cost. The third quadrant was the high quality range. The unit price per index of the third quadrant geometric center of district hospitals was 14 115.4 yuan, and that in municipal hospitals was 15 559.1 yuan, which could be used as the corresponding cost standard.Conclusions:The price discovery mechanism based on objective data and high-quality interval geometric center method can remove the impact of unreasonable charges or unreasonable behavior on medical income, and reflect the guidance of the standard price of medical insurance payment.

Objective:To compare the curative effects between anatomic locking plate and common reconstruction plate in the treatment of acetabular posterior wall fracture.Methods:The 50 patients with acetabular posterior wall fracture were retrospectively analyzed who had been admitted to Department of Pelvic Trauma Surgery, Luoyang Orthopaedic Hospital of Henan Province from February 2015 to February 2020. They were assigned into 2 groups according to different internal fixation methods. In the reconstruction plate group of 24 patients whose fractures were fixated by a common reconstruction plate from February 2015 to June 2017, there were 21 males and 3 females with an age of (38.9±10.9) years. In the anatomical plate group of 26 patients whose fractures were fixated by an anatomic locking plate between July 2017 and February 2020, there were 20 males and 6 females with an age of (38.0±10.0) years. The 2 groups were compared in terms of operation time, intraoperative blood loss, reduction quality, hip function and complications at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating the 2 groups were comparable ( P>0.05). The 50 patients were followed up for 18 to 26 months (mean, 22 months). The operation time [(132.8±8.6) min] and intraoperative blood loss [(357.0±14.7) mL] in the anatomic plate group were significantly less than those [(177.2±5.9) min and (492.0±17.6) mL] in the reconstruction plate group( P<0.05). Postoperative CT examination showed that 96.2% (25/26) of the patients in the anatomical plate group and 91.7% (22/24) of the patients in the reconstruction plate group had a fracture step ≤3 mm, showing no significant difference ( P>0.05). At the last follow-up, the excellent and good rate by Harris hip score was 92.3% (24/26) in the anatomic plate group, significantly higher than that (66.7%, 16/24) in the reconstruction plate group ( P<0.05). The incidence of complications was 3.8% (1/26) in the anatomic plate group, significantly lower than that [29.2% (7/24)] in the reconstruction plate group ( P<0.05). Conclusion:Anatomical locking plate is better than common reconstruction plate in the treatment of acetabular posterior wall fracture.

Objective:To evaluate the curative efficacy of a buttress plate combined with Kirschner wires for treatment of Regan-Morrey type Ⅱ coronoid fracture after elbow terrible triad injury.Methods:A retrospective study was conducted of the 20 patients who had been surgically treated for Regan-Morrey type Ⅱ coronoid fracture after elbow terrible triad injury from August 2014 to August 2018 at Department of Pelvic Trauma, Henan Luoyang Orthopedic-Traumatological Hospital. They were 12 men and 8 women, aged from 18 to 60 years (average, 39 years), with 6 left and 14 right sides affected. All the coronoid fractures were fixated with Kirschner wires plus a buttress plate through the anterior approach, the radial head and lateral collateral ligaments (LCL) were repaired through the posterolateral approach, and the medial collateral ligament (MCL) was repaired or fixated with a hinged external fixator if necessary. The curative efficacy was evaluated at the last follow-up by range of motion (ROM) of the elbow, Mayo elbow performance score (MEPS), American Shoulder and Elbow Surgeons Scale (ASES) and radiographs of the elbow. Complications were also recorded.Results:The mean follow-up time was 18 months (from 12 to 24 months) and the mean healing time 5 months. At the last follow-up, ROM in flexion and extension of the affected elbow joint averaged 132.5°, ROM in elbow pronation-supination 150°, MEPS 88, and ASES 87. No subluxation or dislocation occurred after elbow surgery. The fracture of coronoid process was slightly displaced in one case but eventually healed without affecting any elbow function; fat liquefaction occurred around the posterolateral incision in 2 cases but healed after debridement; traumatic arthritic changes occurred in 5 patients but no significant dysfunction of the elbow was observed.Conclusion:A buttress plate combined with Kirschner wires can lead to fine curative efficacy for Regan-Morrey type Ⅱ coronoid fracture after elbow terrible triad injury.

Objective: To evaluate the efficacy of fumigation with Shujin-Jieluan Decoction combined with Pingheng-Shujin Manipulation (manipulation of balance and muscle tendon relaxing) in the treatment of chirospasm after stroke. Methods: A total of 104 patients with chirospasm after stroke who metthe inclusion criteria from July 2016 to June 2018 were selectedand divided into tow groups with the digital table methodwith 52 cases in each group. The control group was given routine rehabilitation training while the observation group was given fumigation with Shujin-Jieluan decoction combined with Pingheng-Shujin manipulation based oncontrol group, and the two groups both were treated for 8 weeks. The Modified Ashworth Scale (MAS) was used for chirospasm classification, and Key Point tabletop electromyography device was used to record the frequency, average amplitude and the shortest latency of F wave of median nerve. Fugl-Meyer motor function rating scale was used to evaluate hand motor function, and modified Barthel Index (BI) was used to evaluate life functionand clinical efficacy. Results: The effective rate was 88.5% (46/52) in observation group and was 65.4% (34/52) in control group (χ²=7.800, P=0.005). After treatment, the frequency (15.11 ± 2.06 vs. 16.72 ± 1.95, t=4.093), average amplitude (0.52 ± 0.04 mV vs. 0.59 ± 0.05 mV, t=7.883) and the shortest latency (24.37 ± 2.85 ms vs. 25.88 ± 2.43 ms, t=2.907) of F wave in observation group were significantly lower than the control group (P<0.01). Fugl-Meyer hand function score (6.51 ± 1.45 vs. 5.09 ± 1.22, t=5.404) and BI index score (60.87 ± 5.16 vs. 56.54 ± 4.25, t=4.671) were significantly higher than the control group (P<0.01). The distribution of MAS classification in observation group was significantly lower than that of control group (Z=8.410, P=0.004). Conclusions Fumigation with Shujin-Jieluan Decoction combined with Pingheng-Shujin Manipulation can improve the neuromuscular transmission of patients with chirospasm after stroke, and facilitate the recovery of hand function and viability.

Objective: To discuss possible ethical and boundary issues when contacting clients through WeChat in different situations. Methods: Self-made questionnaires were utilized to investigate 194 counselors' (18 counselors gave clients their job WeChat ID, 64 counselors gave their private WeChat ID, and 115 counselors do not give WeChat toclients) attitudes and behaviors of encountering multiple relationship issues when using WeChat Results: For WeChat boundary, counselors who had job WeChat ID would post more private photos and videos on the post than counselors with no job ID and without ID(P <0.01). Although 41％ of counselors would use WeChat during the counseling and other related activities, only 10％ of the counselors had job ID. Counselors with no ID tended to accept clients breaking the boundaries through other ways (P <0.01). Conclusion: The study indicates that counselors have encountered ethic issues of multiple relationships when using WeChat Counselors who only have private WeChat ID should increase their sensitivity of the boundary issues in the use of WeChat.

Objective To investigate the influence of Zafirlukast on the inflammatory factors and immune function of patients with seasonal allergic asthma.Methods 182 patients with seasonal allergic asthma from the department of respiratory in our hospital were selected and divided into two groups, 91 cases in each group.The control group treated with budesonide and formoterol fumarate powder for inhalation, the experiment group received Zafirlukast on the basis of the control group,serum levels of inflammatory cytokines,peripheral blood T lymphocyte subsets,serum immunoglobulin levels, lung function,and the clinical effect were compared after the treatment.Results Compared with the control group, serum levels of TNF-,IL-4,IL-6 were lower, level of IL-10 was higher in the experiment group after treatment, CD8 +T lymphocyte levels was lower, CD3 +, CD4 +T lymphocyte and CD4 +/CD8 +ratio levels were higher after treatment, serum levels of IgE, IgG, IgA were lower after treatment, levels of PEF,FEV1 ,FEV1/FVC were higher after treatment, the difference was statistically significant (P<0.05).The effective rate in the experiment group 94.51% was higher than the control group 81.32% (P<0.05).Conclusion Zafirlukast can significantly reduce the levels of serum inflammatory factors in patients with seasonal allergic asthma, improve the cellular immune function, reduce the level of immunoglobulin, effectively improve lung function, shorten the length of hospital stay, has better clinical curative effect.