Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

OBJECTIVE: To explore the effect of wearing earphone to listen to music on the high-frequency noise-induced hearing loss(NIHL) in noise-exposure workers. METHODS: A total of 651 male noise-exposure workers in an automobile manufacturer were selected as study subjects by using judgment sampling method. The level of noise exposure in the individuals and the pure tone hearing threshold were tested. According to the frequency of wearing earphone to listen to music after work, the subjects were divided into low-, medium-and high-frequency earphone-using groups, with 60, 436 and 155 workers in each group, respectively. The effects of wearing earphone to listen to music combined with occupational noise exposure on high-frequency NIHL were analyzed. RESULTS: The high-frequency NIHL detection rate of the study subjects was 31.3%(204/651). The detection rate of high-frequency NIHL in these three groups from low to high was low-, medium-and high-frequency earphone-using groups(P<0.01). The detection rate of high-frequency NIHL in the high-frequency earphone-using group was higher than that of the low-and medium-frequency earphone-using groups(43.2% vs 25.0%, 43.2% vs 28.0%, P<0.01). Multivariate logistic regression analysis showed that wearing earphones to listen to music was a risk factor for high-frequency NIHL in noise-exposure workers(P<0.01) after eliminating the influence of confounding factors such as age, length and level of noise-exposure, and wearing anti-noise ear plugs. The higher frequency of wearing earphone to listen to music, the higher risk of high-frequency NIHL. CONCLUSION: Wearing earphone to listen to music after work and occupational noise exposure had a synergistic effect on high-frequency NIHL in noise-exposure workers.

Objective: To study the hearing status and analyze the related influencing factors in noise-exposed workers in an automobile manufacture enterprise, and put forward suggestions for prevention of noise-induced hearing loss. Methods: Noise exposure level testing, audiometry testing and questionnaires were performed for noise exposed workers in the automobile manufacture enterprise. To analyze the relationship between different factors and noise-induced hearing loss by cumulative noise exposure(CNE) calculated 8-hour continuous A-weighted equivalent noise level and seniority. Results: The detection rate of hearing loss in noise-exposed workers was 22.8%. The noise exposure intensity of stamping workshop is higher than other workshop, and the hearing loss detection rate of stamping workshop workers is higher than other workshop workers. The detection rate of hearing loss has significant difference in L_{Aeq·8 h}, seniority, CNE, age, high temperature and wearing earplugs (P<0.05). The results of logistic regression analysis showed that CNE, age and high-temperature were risk factors for noise-induced hearing loss (P<0.05 and OR>1) and there was an increasing tendency of hearing loss with increase in length of service and CNE, while using of earplugs was a protective factor (P<0.05 and OR<1). With the increase of CNE, the incidence of hearing loss is the rising trend. Conclusion It is suggested to strengthen the noise control and individual protection and improve the high-temperature working environment, which plays an important role in reducing the occurrence of noise-induced hearing loss.

Objective The aim of our study was to explore the relationship between prostate cancer and four serum markers,including Prostate specific antigen (PSA),Beta 2 Microglobulin (β2M),Neutrophil-to-lympochyte ratio (NLR) and Lactic dehydrogenase (LDH),and their variation rules in development of prostate cancer.Then to find one or more markers that can increase the sensitivity and specificity of diagnosis to provide reference for clinic.Methods A total of 149 prostate cancer patients,40 patients with benign prostatic hyperplasia,80 healthy subjects in our hospital were analyzed,and subsequent the T-PSA,F-PSA,β2M,LDH and NLR were measured.The correlation between these markers and prostate cancer as well as its different types and Gleason score was assessed statistically.We determined the cut-off point of the NLR and T-PSA according to the specificity and sensitivity levels derived from area under receiver operator characteristic (ROC) curve.Results The level of T-PSA was significantly higher in patients of prostate cancer and benign prostatic hyperplasia,and the level of NLR was higher only in patients of prostate cancer.Based on the area under ROC,the cut-off value of T-PSA was determined to be 4.625 ng/ml,and NLR was 2.11,and combined NLR and T-PSA can increase the specificity of diagnose.There is a statistical difference in Gleason scores in patients with different NLR of prostate cancer (P =0.030).Conclusions It could increased the specificity when combined NLR and T-PSA to diagnose prostate cancer.And NLR has positive correlation with the prognosis of patients of prostate cancer as well.

OBJECTIVE: To analyze the effect of occupational noise exposure on reproductive function in Chinese female workers.METHODS: The published literatures that showed the relationship between occupational noise exposure and female workers' reproductive function from Chinese National Knowledge Infrastructure,Wanfang Data,Chinese Biology Medicine Database and China Science and Technology Periodical Database from 1985 to 2016 were collected,screened and analyzed using bibliometric method.The Rev Man 5.2 software was used to calculate the pooled odds ratio(OR) and the 95%confidence interval(CI).RESULTS: A total of 25 original research papers were included.The occupational exposure to noise was significantly associated with abnormality of female menstrual cycle(OR = 2.26,95% CI: 1.70-3.01),dysmenorrheal(OR = 2.21,95% CI: 1.78-2.75),abnormal menstrual period(OR = 2.11,95% CI: 1.40-3.18),abnormal menstrual blood volume(OR = 1.73,95% CI: 1.34-2.23),pregnancy-induced hypertension(OR = 1.82,95% CI: 1.49-2.22),anemia in pregnancy(OR = 1.71,95% CI: 1.25-2.34),threatened abortion(OR = 1.98,95% CI: 1.23-3.20),spontaneous abortion(OR = 1.76,95% CI: 1.49-2.08),stillbirths(OR = 1.61,95% CI: 1.22-2.13),premature birth(OR = 1.57,95% CI: 1.36-1.81),neonatal low birth weight(OR = 1.66,95% CI: 1.39-1.98),and congenital malformations(OR = 1.58,95% CI: 1.10-2.27) compared with the controls(P<0.01).There was a doseresponse relationship between the above-mentioned indicators and the intensity of noise exposure.Occupational noise exposure was not associated with over-term birth(OR = 1.32,95% CI: 0.81-2.15,P>0.05) compared with the controls.CONCLUSION: Occupational noise exposure can affect the reproductive function and pregnancy outcomes of female workers.It is suggested that pregnant women should not be engaged in noise operations.

Objective To investigate the nutritional management level of Department of Clinical Nutrition in elderly inpatients through analyzing the actual hospital dietary intakes in elderly inpatients in Peking Union Medical College Hospital from 2013-2015.Methods Using continuous sampling, the nutrients contents and the eating rates of hospital meals ordered by the elderly inpatients on the 1st, 15th, 29th of every month from May 2013 to October 2015 were selected.The intake levels of energy, protein, calcium, vitamin A, vitamin B1 , and vitamin C were calculated and compared with the Chinese dietary reference intakes (DRIs).The nutritional in-take differences between diabetes diet and the basic hospital diet were also compared.Results A total of 90 days of hospital dietary data from 8 402 elderly inpatients were included in the study.The average eating rate was (50.1 ±4.2)%, which was lower than the general eating rate of the hospital [ (59.0 ±4.0)%, P<0.001]. Only protein intake from hospital diet reached the requirement target [male (103.1 ±47.3)%, femal (98.3 ± 33.8)%].Individual compliance rates were 63.2%and 59.8%, respectively, while the other kinds of nutrients were lower.The compliance rates of energy [ (73.3 ±26.3)%vs.(62.1 ±38.2)%, P<0.001] and ma-jor nutrient intake [ protein: ( 119.1 ±41.2 )% vs.( 93.3 ±65.1 )%, P <0.001; calcium: ( 55.5 ± 26.7)% vs.(34.3 ±34.2)%, P <0.001; vitamin A: (75.2 ±48.3)% vs.(57.4 ±97.1)%, P<0.001;vitamin B1:(76.4 ±38.2)%vs.(52.1 ±46.6)%, P<0.001;vitamin C:(92.2 ±51.4)%vs. (49.3 ±55.0)%, P<0.001) in diabetes diet group were significantly higher than those in the basic hospi-tal diet group.Conclusions The nutritional intakes from hospital diets may not meet the nutritional require-ments based on DRIs in elderly inpatients.Medical diet designed by physicians and dietitians should be ex-panded to improve the nutritional management level for these patients.

BACKGROUND:Apart from a complete resection of tumor tissues, the therapeutic goal for bone tumors is to maximize the repair and restoration of tissue defects and damaged functions. Autologous inactivated bone graft is of practical value for transplantation and reconstruction.
OBJECTIVE:To investigate the effect of improved Malawer method combined with replantation of inactivated tumor segment in the treatment of proximal fibular tumors.
METHODS: Since 2007, five patients with proximal fibular tumors (six sides) were admitted in the Affiliated Hospital of Inner Mongolia Medical University. These five patients were subjected to distal femoral amputation, intralesional curettage and bone grafting, upper fibular osteotomy + tumor segment heating (boiling in 70℃ distiled water for 15 minutes) + inactivated bone replantation. Therapeutic effects were folowed.
RESULTS AND CONCLUSION: One case of amputation had no recurrence and systemic metastasis during 4 years of folow-up; one case of intralesional curettage and bone grafting relapsed 1 year after operation; three cases of upper fibular osteotomy + tumor segment heating + inactivated bone replantation folowed for 5 months recovered walking function and exhibited good healing of the outer structure of the knee, showing non-healing of inactivated tumor segment, non-remarkable calus formation, no local tumor recurrence, no loosening of internal fixation, and inactivated bone without fracture and absorption. These results confirmed that the tumor curettage and amputation both have obvious limitations; based on Malawer method, the replantation of inactive tumor segment can better ensure the structure integrity of the lower leg and in suit reconstruct the lateral biceps femoris tendon and the lateral colateral ligament, but geneticaly the revascularization and healing of inactivated bones wil be difficult and slow with temperature increases, and therefore the period of postoperative brace protection should be relatively extended, alowing time delay of strenuous exercise and avoiding complications such as fractures.

Objective To investigate the risk factors of bronchopulmonary dysplasia(BPD)in very low birth weight infant.Methods The clinical data of 49 very low birth weight infants in our NICU from Sep 2006 to Sep 2009 were reviewed,and divided into BPD group(n =15)and without BPD group(n =34).The risk factors of BPD were analysed.Results Compared with the infants without BPD,there were significant differences in gestational age[(29.30 ± 1.48)week vs(30.54 ± 1.60)week],hospital-acquired infection(9 cases vs 10 cases),intrauterine infection(9 cases vs 8 cases),the time for continuous positive airway pressure(CPAP)[(12.47 ± 5.83)d vs(4.24 ± 4.19)d],the time for hyperoxia[(1.47 ± 1.41)d vs (0.18 ±0.63)d],patent ductus arteriosus(5 cases vs 1 cases)(P＜0.05).Logistic regression revealed that intrauterine infection and the time for CPAP were independent risk factors of BPD(P ＜0.05).Conclusion Prophylaxis of intrauterine infection may decrease the mortality and severity of BPD.The prolonged time for CPAP may predict the risk of BPD.

Objective: To investigate the effects of Ginkgo biloba extract 50 (GBE50) preconditioning on contents of inflammation-related cytokines in rats with myocardial ischemia-reperfusion. Methods: Fifty-eight SD rats were divided into sham-operated group, untreated group, Salviae miltiorrhizae (SM) injection group and low-, medium- and high-dose GBE50 groups. After intragastric administration for 7 d, the left anterior descending (LAD) coronary artery was occluded for 30 min followed by 60-min reperfusion to induce ischemia-reperfuion injury. Myocardium histopathologic change was observed by HE staining under a light microscope; myeloperoxidase (MPO) activity in myocardium was measured by colorimetric detection; tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8 were detected by radioimmunoassay; IL-4 and IL-10 were tested by enzyme-linked immunosorbent assay (ELISA). Results: Compared with untreated group, rats in medium-dose GBE50 group had lower inflammatory reaction and MPO activity (P<0.01). GBE50 also decreased the content of IL-6 (P<0.05, P<0.01) and increased the content of IL-4 in myocardium (P<0.05, P<0.01) as compared with the untreated group. The content of TNF-alpha in myocardium in the medium-dose GBE50 group was lower and IL-10 was higher than those in the untreated group, but without significant differences. Conclusion: GBE50 can decrease the content of IL-6 and increase the content of IL-4 in myocardium after ischemia-reperfusion injury. It suggests that GBE50 can regulate the inflammatory reaction after ischemia-reperfusion injury via inhibiting inflammatory cytokines and promoting anti-inflammatory cytokines.

BACKGROUND: Plasminogen activator inhibitor 1 is the main regulator of the fibrinolytic system in vivo. The increase of plasminogen activator inhibitor 1 is closely related to thrombotic disease and it is also an independent risk factor for development of thrombotic disease.OBJECTIVE: To investigate the effect of huangqi(Astragalus), danggui (Angelica) and ligustrazine as medicines activating blood and eliminating stasis on the expression of plasminogen activator inhibitor 1 in HepG2 hepatocarcinoma cell strain.DESIGN: A randomized controlled study.SETTING: First Cadre Department of General Hospital of Chinese People' s Armed Police Force.MATERIALS: The experiment was completed in Academy of Military Medical Sciences of PLA from August to December 2004. HepG2 hepatocarcinoma cell strain was cultured. According to different drugs in culture medium, they were divided into six groups: control group, huangqi group,danggui group, huangqi + danggui group, compound danshen group and ligustrazine group.METHODS: Huangqi, danggui, huangqi + danggui, compound danshen and ligustrazine were added in HepG2 culture medium respectively. MTS assay was used to detect the effect of medicines activating blood and eliminating stasis on proliferation of HepG2 cells, plasminogen activator inhibitor 1 was assayed by specific enzyme-linked immunosorbent assays(ELISA),plasminogen activator inhibitor 1 activity was measured by amidolytical assay. 0.5 μg/mL of transforming growth factor β1 cells was added in HepG2 culture medium to stimulated production of plasminogen activator inhibitor 1. Control group was treated under the same conditions but without Chinese herbs.RESULTS: The inhibitory rates of cellular proliferation in huangqi and danggui groups werc(6.51 ±2. 66)% and (4.42 ±2. 19)%, but those in huangqi + danggui, compound danshen and ligustrazine groups were (12. 06 ±4. 98)%, (16. 38 ±4.06)% and(32. 83 ±9.8)% respectively,t = 2. 447 - 3. 707, P ＜ 0.05. Compared with the control group, huangqi,danggui, compound danshen and ligustrazine significantly inhibited plasminogen activator inhibitor 1 expression(22.68 ± 2.20, 11.11 ± 1.23,19.66±1.53, 15.45±1.27, 16.90±0.33, 14.01±0.74, t=2.447-3.707, P ＜ 0.05) and activity(2.16±0.014, 2.01 ±0.006, 1.95±0.014, 1.79±0. 104, 1.53±0.045, 1.48±0.012, t =2.447-3. 707,P ＜ 0.05) in HepG2 cells. The evident inhibitory effects were observed in the group of huangqi + danggui, especially in compound danshen and ligustrazine.CONCLUSION: The plasminogen activator inhibitor 1 expression and activity were inhibited effectively by huangqi, danggui, compound danshen and ligustrazine.