Development of national secondary reference materials of urea and creatinine in frozen human serum / 中华检验医学杂志

Objective:To develop a national secondary reference material of Urea and Creatinine in frozen human serum as a standard for metrological traceability.Methods:According to JJF1343-2012 "General and Statistical Principles for Characterization of Reference Materials" and JJF 1006-1994 " Technical Norm of Primary Reference Material ", the homogeneity, stability, and commutability were evaluated;Using the JCTLM recommended methods, the value of the reference materials was assigned through collaboration with 6 accredited reference laboratories from Guangdong Provincial Hospital of Chinese Medicine, Beijing Aerospace General Hospital, Shenzhen Mindray Bio-Medical Electronics, Maccura Biotechnology, Beijing Leadman Biochemistry, and Zhejiang MedicalSystem Biotechnology. Uncertainty components including inhomogeneity, stability and value assignment were evaluated.Results:The results of one-way analysis of variance of homogeneity for the reference materials showed P>0.05, and the stability evaluation was less than the critical value of the t-test. The measured values were in the 95% confidence interval in the four conventional detection systems for commutability, and the certified values and expanded uncertainties were urea:(14.7±0.3) mmol/L ( k=2),Cr:(313.9±14.5) μmol/L ( k=2). Conclusion:The prepared secondary reference materials of urea and creatinine had promising homogeneity, stability, and commutable, the values of urea and creatinine concentration in reference materials were accurate and reliable.

Long-term outcomes and influencing factors of idiopathic nephrotic syndrome in children / 中华肾脏病杂志

Pediatric idiopathic nephrotic syndrome (INS) is characterized by massive albuminuria, hypoproteinemia, edema and hyperlipidemia, with a long course and high probability of relapse and prolongation. Long-term complications caused by long-term usage of hormones and immunosuppressants in children with INS seriously affect their physical and mental health and quality of life. Most children with steroid-sensitive nephrotic syndrome can be cured before adulthood, while some of them relapse in adulthood. Long-term prognosis of children with steroid-resistant nephrotic syndrome is poor. There have been few studies in China followed the long-term outcomes and its related factors of children with INS over 10 years. The paper reviewed the literatures on the long-term outcomes of children with INS, including renal survival, growth, mental health, learning and work, marriage and fertility, disease recurrence and long-term related complications, to explore the factors related to the poor long-term outcomes of children with INS and to assist in clinical decision-making and follow-up management.

Research Progress of Etiology, Screening and Early Diagnosis of Esophageal Cancer in China / 肿瘤防治研究

Esophageal cancer (EC) is one of the most fatal cancers worldwide. According to GLOBOCAN 2020, it was estimated that there were 600, 000 new EC cases and 540 000 EC deaths, while nearly half of all newly diagnosed cases of EC and associated deaths worldwide occurred in China. The annual incidence and mortality of EC have been reduced in the last 20 years in China. However, the early symptoms and signs of EC are not easily distinguished and the disease tends to be within the middle and late stage of pathogenesis when identified, leading to its low 5-year survival rate. Therefore, it could help effectively reduce the burden of EC by clarifying its etiology and risk factors, as well as taking preventive and early diagnosis measures. This article reviews the epidemiology, etiology, screening and early diagnosis of EC in China, to provide systematic references for EC prevention and control.

A meta-analysis of factors influencing the development of gastric cancer in Chinese populations / 预防医学

Objective@# To investigate the factors influencing the development of gastric cancer in Chinese populations, so as provide insights into creating a model for predicting gastric cancer incidence among Chinese populations.@*Methods@#The case-control and cohort studies pertaining to factors affecting the development of gastric cancer were retrieved in electronic Chinese and English databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science and Embase from their inception until September 30, 2021. A meta-analysis was performed using R package version 4.1.0. Sensitivity analysis was performed using the “leave-one-out” evaluation procedure, and the publication bias was evaluated using the Egger regression test and the trim-and-fill procedure. @*Results@# A total of 5 301 publications were screened and 116 eligible studies were included in the final analysis, including 103 case-control studies and 13 cohort studies, which covered approximately 3.23 million study subjects. A total of 45 factors affecting the development of gastric cancer were collected, and there were less than 4 publications reporting 7 factors, which were only qualitatively described. There were 38 factors included in the final meta-analysis. A total of 21 factors were identified as risk factors of gastric cancer, including a history of gastrointestinal diseases (pooled OR=4.85, 95%CI: 3.74-6.29), H. pylori infection (pooled OR=3.18, 95%CI: 2.35-4.32), binge eating and drinking (pooled OR=2.88, 95%CI: 2.09-3.97) and a family history of tumors (pooled OR=2.78, 95%CI: 2.17-3.56), and 10 factors as protective factors, including vegetable intake (pooled OR=0.48, 95%CI: 0.38-0.61), tea consumption (pooled OR=0.55, 95%CI: 0.47-0.64), administration of aspirin (pooled OR=0.53, 95%CI: 0.31-0.92) and administration of statins (pooled OR=0.59, 95%CI: 0.44-0.80). Sensitivity analyses of eating moldy food frequently, white meat intake, favoring spicy food and administration of sulfonylureas were not robust. Following correction with the trim-and-fill procedure, there was still a publication bias pertaining to high income, diabetes, administration of stains, alcohol consumption, tea consumption and white meat intake.@*Conclusions@# The development of gastric cancer is associated with a medical history of gastrointestinal disease, H. pylori infection, family history of tumors and poor dietary habits. Risk and protective factors of gastric cancer are recommended to be included in models used to predict gastric cancer incidence among Chinese populations.

Performance evaluation of serum progesterone measurement by ID-LC/MS/MS candidate reference methods and their clinical application value / 中华检验医学杂志

Objective:To establish a candidate reference method for serum progesterone using isotope dilution liquid chromatography tandem mass spectrometry (ID-LC/MS/MS) in our laboratory, validate the analytic performance of five clinical routine detection systems to explore the comparability of serum progesterone detection by different detection systems.Methods:A candidate reference method for serum progesterone using ID-LC/MS/MS method was established. The sample was pretreated by liquid-liquid extraction method, and the reversed phase liquid phase separation in positive ion mass spectrometry mode was used to detect progesterone in human serum, and the detection time of a single sample was controlled within 5 minutes by gradient elution. In order to improve the accuracy of the method, the bracketing calibration method (BCM) was used to establish the standard curve. The sensitivity, accuracy, precision and specificity of BCM and classical calibration curve method were evaluated according to CLSI C62-A, EP15-A2, EP6-A2 and EP9-A3, and the analytical performance and comparability of five clinical routine progesterone detection systems were evaluated,compared with ID-LC/MS/MS method, the bias at medical decision level 2 and 25 ng/ml was evaluated to see if they were <1/2TEa (12.5%).Results:The limit of detection (LOD) of ID-LC/MS/MS was 0.005 ng/ml. The recoveries of BCM method and classical calibration curve method are 97.95%-101.58% and 96.88%-110.70%, respectively. The measurement results of BCM method for certified reference materials are within its declared uncertainty range. The intra-and inter-assay coefficient of variation ( CV) of BCM method was less than 3.0%, which was better than that of classical calibration curve method ( CV: 2.48%-9.33%). The precision and linear range of the five clinical routine detection systems can meet the detection requirements. The measurement bias of detection system 1, 3 and 5 at 25 ng/ml of medical decision level was less than 1/2TEa, and the measurement bias at 2 ng/ml of medical decision level was more than 1/2TEa. The measurement bias of detection system 2 and 4 at two medical decision levels was less than 1/2TEa. Conclusion:The candidate reference method for serum progesterone ID-LC/MS/MS established in our laboratory meets the requirements of the reference method. BCM has better detection performance than classical calibration curve method. The precision and linearity of the five progesterone clinical detection systems are satisfactory. The five clinical detection systems could meet the clinical requirements at the medical determination level of 25 ng/ml, however, only two of the five clinical detection systems meet the clinical requirements at the medical determination level of 2 ng/ml.

Efficacy comparison of buttress plating and cannulated screw fixation of Regan-Morrey type II ulnar coronoid fractures / 中华创伤杂志

Objective:To compare the clinical effect of buttress plate fixation and cannulated screw fixation of Regan-Morrey type II ulnar coronoid fractures.Methods:A retrospective case control study was made on 53 patients with Regan-Morrey type II ulnar coronoid fractures admitted to Wuxi No.9 People 's Hospital from April 2015 to January 2018，including 36 males and 17 females，aged from 21 to 63 years［（36.3±7.1）years］. Among them，24 patients were treated using buttress plates（plate group），and 29 patients using cannulated screws（screw group）. The operation time and fracture healing time were documented. The visual analogue score（VAS），range of motion of elbow flexion and extension and forearm rotation and Mayo elbow performance score（MEPS）were assessed at postoperative 1，3，6 months and at the last follow-up. The incidence of complications was observed as well. Results:All patients were followed up for 15-18 months［（15.9±1.3）months］. The operation time in plate group［（150.6±24.2）minutes］was longer than that in screw group［（126.8±18.3）minutes］（ P<0.05）. There was no significant difference in fracture healing time or VAS between the two groups（ P>0.05）. After 1，3，6 months and during the last follow-up，the range of motion of elbow joint flexion and extension in plate group［（87.2±5.8）°，（109.2±7.1）°，（121.3±6.2）°，（127.3±5.4）°］was higher than that in screw group［（70.5±9.1）°，（90.2±4.5）°，（108.3±5.1）°，（116.2±4.6）°］，the range of motion of forearm rotation in plate group［（78.3±9.1）°，（98.7±8.6）°，（130.2±7.1）°，（139.2±6.7）°］was higher than that in screw group［（60.1±5.1）°，（80.6±8.7）°，（116.1±5.5）°，（127.3±4.1）°］，and the MEPS in plate group［（30.6±7.6）points，（68.1±6.1）points，（90.2±4.3）points，（95.2±2.1）points］was higher than that in screw group［（27.2±8.1）points，（54.1±7.1）points，（82.1±5.3）points，（88.2±5.2）points］（all P<0.05）. In plate group，one patient sustained superficial wound infection at postoperative 1 week，which was healed uneventfully after surgical debridement and antibiotic therapy；two patients had heterotopic ossification without addition surgery. In screw group，three patients presented screw loosening and fracture redisplacement during early movement，which was healed by reducing the intensity of elbow functional exercise and prolonging the protection time of brace；four patients had heterotopic ossification，among which one combined with elbow stiffness showed improved range of motion of the elbow after elbow release at postoperative 12 months. The incidence of complications in plate group［13%（3/24）］was lower than that in screw group［26%（7/29）］（ P<0.05）. Conclusion:For Regan-Morrey type II ulnar coronoid fractures，the buttress plate fixation is superior to the cannulated screw fixation in fixation strength，recovery of elbow function and incidence of complications in regardless of longer operation time.

Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury / 中华创伤骨科杂志

Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.

The predictive value of the levels of carbohydrate antigen125 and N-terminal pro brain natriuretic peptide in peripheral blood on the readmission rate of patients with chronic heart failure / 中国医师进修杂志

Objective:To explore the predictive value of the levels of carbohydrate antigen125 (CA125) and N-terminal pro brain natriuretic peptide (NT-proBNP) in patients with chronic heart failure.Methods:One hundred and thirty-five patients with chronic heart failure admitted to Jiashan Hospital of Traditional Chinese Medicine from January 2018 to June 2019 were selected as the observation group. According to NYHA classification standard of cardiac function, 51 patients was Ⅱ grade, 36 patients was Ⅲ grade and 48 patients was Ⅳ grade. Eighty healthy people in same period were selected as the control group. The levels of CA125 and NT-proBNP were measured by enzyme-linked immunosorbent assay and immunofluorescence respectively. The levels of serum CA125 and NT-proBNP were compared between the two groups, and the mortality and readmission of the patients with different levels of CA125 and NT-proBNP were observed after 6 months of follow-up.Results:The serum CA125 and NT-proBNP levels in the observation group were higher than those in the control group [(87.81 ± 23.51) kU/L vs. (15.24 ± 3.24) kU/L, (397.25 ± 72.15) ng/L vs. (30.54 ± 3.41) ng/L] , and there were significant differences ( P<0.05). The levels of serum CA125 and NT-proBNP gradually increased with the NYHA classification. There was no significant difference in mortality between patients with different CA125 and NT-proBNP levels ( P>0.05). The readmission rate of CA125 ≥ 35 kU/L was higher than that of CA125<35 kU/L [64.00% (48/75) vs. 41.67%(25/60)] , the readmission rate of patients with NT-proBNP ≥ 450 ng/L was higher than that of patients with NT-proBNP<450 ng/L [65.57%(40/61) vs. 44.59%(33/74)], and there were significant differences ( P<0.05). Conclusions:The levels of CA125 and NT-proBNP in the peripheral blood of patients with chronic heart failure are significantly increased, which are closely related to the classification of cardiac function, and have an important predictive value for the readmission of patients.

Bone transport versus induced membrane technique for large segmental tibial defects / 中华创伤骨科杂志

Objective To compare the effects of bone transport versus induced membrane technique for large segmental tibial defects.Methods The clinical data were analyzed retrospectively of 89 patients with large segmental tibial defect who had been treated at Department of Orthopaedics,Wuxi No.9 People's Hospital from June 2005 to February 2017 using bone transport or induced membrane technique.They were 58males and 31 females,aged from 13 to 74 years (average,38.0 years).The bone transport group had 59cases and the induced membrane technique group 30 cases.The 2 groups were compared in terms of preoperative general data and postoperative bone nonunion,bone healing time,complications and functional recovery of the adjacent joint.Results There were no statistically significant differences between the 2groups in terms of age,gender,cause or type of defects,associated injury,course of disease,functionary scores of the adjacent joint or number of operations,showing compatibility between the 2 groups (P ＞ 0.05).All the patients were followed up for 12 to 48 months (average,20 months).The bone transport group had significandy longer clinical healing time (14.7 ± 5.4 months) and significantly higher incidences of major complications (50.8％),minor complications (57.6％) and overall complications (83.1％) than the induced membrane technique group (11.2 ± 2.8 months,16.7％,26.7％ and 30.0％,respectively) (P ＜ O.05),but significantly lower functionary scores of the adjacent joint (86.4 ± 5.0 points) than the induced membrane technique group (88.8 ± 4.9 points) (P ＜ 0.05).Conclusions Both bone transport and induced membrane technique are effective repairs for large segmental tibial defects.However,induced membrane technique may be superior to bone transport in terms of bone healing,complications and functional recovery.

Treatment of traumatic lesions of popliteal artery by staged stretching / 中华创伤骨科杂志

Objective To investigate the clinical effects of treating traumatic lesions of the popliteal artery by staged stretching.Methods From July 2011 to March 2016,29 patients with traumatic lesion of the popliteal artery underwent staged stretching after direct end to end anastomosis at Department of Orthopaedics,The 9th People's Hospital of Wuxi.They were 19 males and 10 females,with a mean age of 38.3 years (range,from 16 to 61 years).The average length of popliteal artery lesions was 3.7 cm (range,from 2 to 5 cm).After the keen joint was immobilized at flexion by external fixation,direct end to end anastomosis was performed with a proper segmental vascular freedom.From 4 weeks after operation,the popliteal artery was stretched stage by stage to its original length by gradual adjustment of the external fixation till the knee joint was fully extended.The color,skin temperature,pulp tension and capillary reaction of the toes were closely observed after surgery.CT angiography (CTA) was performed 6 months after surgery.The active range of motion was assessed at 12 months after surgery for the knee and ankle joints on the injured limb.Results All the patients were available for an average follow-up of 2 years (range,from 1 to 3 years).Blood supply was good for all the affected limbs.The staged stretching of the popliteal artery resulted in no rupture of any anastomotic stoma or no thrombus.CTA at 6 months after surgery showed fine patency of the popliteal artery and no formation of false aneurysm or arteriovenous fistula.At 12 months after surgery,the knee function was excellent in 15 cases,good in 10 and fair in 4;the ankle function was excellent in 18 cases,good in 8 and fair in 3.Conclusion Staged stretching is a safe,convenient and effective treatment of traumatic lesions of the popliteal artery.

Clinical study on transcription and protein expression of tumor necrosis factor α mRNA in peripheral blood and activation of signal path PI3K/AKT in patients with chronic heart failure / 实用医学杂志

Objective The study was to investigate the activation of tumor necrosis factor α (TNF-α) mRNA transcription and protein expression in peripheral blood and activation of signal path PI3K/AKT in patients with chronic heart failure. Methods From February 2015 to April 2018, 244 patients with heart failure in the cardiovascular department of our hospital were selected as heart failure group, while 244 healthy cases were enrolled as the control group at the same time. The peripheral blood samples of two groups were collected. We detected the transcription and protein expression of TNF-α mRNA and the activation of PI3K, AKT in peripheral blood. The left ventricular ejection fraction (LVEF) were measured in two groups. The correlations between influencing factors and LVEF were analyzed. Results The levels of PI3K, AKT in the heart failure group were higher than those in the control group. The differences were statistically significant respectively (P < 0.05). The mRNA relative content and protein content of TNF-α in peripheral blood mononuclear cells of heart failure group were higher compared with those of control group (P < 0.05). The LVEF of heart failure group was significantly lower than that of the control group (34.50 ± 6.33) ％ versus (55.60 ± 2.49) ％, P < 0.001). Among 244 patients with heart failure, Spearman correlation analysis showed that there were significant positive correlations between TNF-a mRNA and protein expression levels and the levels of PI3K, AKT respectively (P < 0.05). Multiple factors unconditional Logistic regression analysis showed that the TNF-α mRNA, protein expression and PI3K, AKT levels in peripheral blood were independent risk factors for LVEF (P < 0.05). Conclusion The expression levels of PI3K, AKT and TNF-α are all significantly increased in chronic heart failure patients, which could participate in the occurrence and development of heart failure.

Incidence of lung cancer in Jiashan, Zhejiang province: trend analysis from 1987 to 2016 and projection from 2017 to 2019 / 浙江大学学报·医学版

OBJECTIVE@#To predict the incidence of lung cancer in Jiashan county from 2017 to 2019 on the basis of the incidence rates of lung cancer during 1987-2016.@*METHODS@#Lung cancer incident cases were derived from cancer registry system of Jiashan. Crude incidence, age-standardized incidence rate by the Chinese standard population (ASR China) and the world standard population (ASR world) were calculated. Annual percent change (APC) was used to examine the temporal trend, and the autoregressive integrated moving average method (ARIMA) of time series model was used to predict the incidence rates from 2017 to 2019.@*RESULTS@#There were 6103 lung cancer incident cases during 1987-2016 in Jiashan county. Averagely, the crude incidence rate, ASR China and ASR world were 53.77/10, 25.24/10 and 34.15/10, respectively. The crude incidence rate, ASR China and ASR world in male were 78.30/10, 34.77/10 and 51.87/10, which were higher than those in female (29.15/10, 14.31/10 and 17.99/10). Crude incidence rate increased from 27.58/10 in 1987 to 111.24/10 in 2016, and the APC was 5.28%. Crude incidence rate predicted by ARIMA model from 2017 to 2019 would be 135.64/10, 145.97/10 and 152.63/10, and the predicted crude incidence rate for 2017 was close to the real incidence rate in 2017 (135.95/10).@*CONCLUSIONS@#The incidence of lung cancer in Jiashan has been increased dramatically over the past 30 years and will continue to increase in the future.

A community-based survey on risk factors of type 2 diabetic kidney disease in Ningbo, China / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the prevalence and risk factors of diabetic nephropathy in Ningbo Yinzhou district.</p><p><b>METHODS</b>Nephropathy screening was conducted among patients with type 2 diabetes mellitus (T2DM) registered in Ningbo Yinzhou district. Demographic information, clinical examination information, diabetes complications and behavioral risk factors of enrolled patients were collected. Logistic regression model was used to identify possible risk factors for the occurrence of diabetic nephropathy.</p><p><b>RESULTS</b>Among 10 604 T2DM patients included in this study, there were 3744 cases of diabetic nephropathy(35.31%). Univariate analysis showed that gender, age, education level, diabetes duration, glycemic control, hypertension, stroke, smoking and waist circumference were associated with diabetic nephropathy (<0.05 or <0.01). Multivariate logistic regression analysis showed that male, elders, long diabetes duration, hypertension and smoking were independent risk factors of diabetic nephropathy (<0.05 or <0.01).</p><p><b>CONCLUSIONS</b>sDiabetic nephropathy is of high prevalence in T2DM patients. Male patients, elders, and those with long diabetes duration, hypertension and smoking habits are more likely to have diabetic nephropathy.</p>

Exploration and practice in the construction of curriculum on epidemiology in preventive medicine / 中华流行病学杂志

Epidemiology is one of main courses for undergraduate students majoring in preventive medicine.There are some limitations in the traditional epidemiology teaching,which is usually characterized in indoctrinated education:"lectured by the teachers and listened by the students." In Zhejiang University,staff of the epidemiology division tried to explore a new teaching mode as ‘student-centered,teacher-leading,question-based,and combining with literature discussion and course practice.'After practicing for two years,students were inspired in learning initiatives,with teaching effectiveness obviously improved.

Cost-effectiveness analysis of cefoperazone sulbactam sodium in nosocomial infection / 中国生化药物杂志

Objective To investigate the cost-effectiveness of cefoperazone sulbactam sodium in treating nosocomial infection (lower respiratory tract infection).Methods 80 cases of nosocomial infection in Jincheng Second People's Hospital from January 2014 to January 2017 were treated as the subjects: the observation group was treated with cefoperazone sulbactam sodium and the control group was treated with cefodizime sodium.The data of two groups of patients were recorded and the data were analyzed statistically.The cost-effectiveness of cefoperazone sulbactam sodium in hospital infection was discussed.Results There was no significant difference in the clinical curative effect between the two groups.The cost of observation group (cefoperazone sulbactam sodium) was lower than that of the control group (cefodizime sodium), the difference was statistically significant (P< 0.05).Conclusion Patients with nosocomial infection choose to use cefoperazone sulbactam sodium as the treatment method, which has exact clinical efficacy, high cost-effectiveness.It is worthy of clinical wide application.

Treatment of bone defects using Masquelet technique / 中华创伤骨科杂志

Objective To analyze the therapeutic effect of Masquelet technique in the treatment of bone defects.Methods From January 2008 to December 2014,20 patients with bone defects were treated by Masquelet technique.There were 15 males and 5 females,from 18 to 69 years of age (average,38.4 years).Four cases had open bone defects and 16 infectious ones.At the first stage,radical debridement of the bone defects and soft tissue was conducted via conventional approaches.The bone defects ranged from 2 to 9 cm,averaging 6.1 cm.At the second stage,internal fixation was applied in 18 cases and external fixation in 2.The interval from the second stage to the first stage operation ranged from 6 to 23 weeks (average,11.5 weeks).The healing of bone defects and the functional recovery of adjacent joint were evaluated by Paley scoring at the last follow-up.Results The 20 patients were followed up for 12 to 50 months (average,19.7 months) after the second stage operation.All the patients obtained uneventful wound healing and control of infection after the first stage operation except the one with infectious defects who had to receive 2 operations to control the infection at the first stage operation.At the second stage operation,obvious injury and defect of the induced membrane occurred in 4 cases.All the patients achieved clinical healing of bone defects after 3 to 6 months (average,4.8 months).The bone defect healing was graded as excellent in all.After bone healing,all the patients resumed weight-bearing activities,with no breakage or infection of fixators,or recurrence of infection.By the Paley scoring at the last follow-up,the functional recovery of the adjacent joint was excellent in 8 cases,good in 10 and fair in 2,yielding an excellent and good rate of 90.0％.Conclusion As a kind of modified free bone grafting,Masquelet technique has advantages of simplicity,limited complications,a high rate of healing,and good control of bone infection.

Investigations on the effect of measuring value transfer for human serum samples assigned by the reference laboratory network / 临床检验杂志

Objective To investigate the effect of measuring value transfer for human serum samples assigned by the reference laboratory network on improving the trueness of seven enzyme activities in clinical laboratories,such as ALT,AST,GGT,LDH,CK,AMY and ALP.Methods Depending on the medical imtitutions at all levels contacted by 5 reference laboratories in North China,South China,East China and Southwest China,the corresponding clinical laboratory measuring value transfer/traceability network was established.The frozen human serum samples with good interehangeability and standard material characteristics,including calibrator,sample 1 and sample 2,were provided by Beijing Aerospace General Hospital,and were assigned by 5 reference labotatories in four regiom.These samples were sent to 48 clinical laboratories.These clinical laboratories measured sample 1 and sample 2 according to their standard operating procedures,and then measured.the two samples again after adjusting their measurement system by using the supplied calibrator.The changes of trueness of detection results in these laboratories were evaluated according to the WS/T 403-2012 standard,and the changes of consistency for ALT and AST before and after measuring value tramfer were investigated.Results The results of AMY,ALP,GGT,CK and LDH calibrator,sample 1 and sample 2 assigned by the established network were 138.7 U/L,278.5 U/L and 68.3 U/L,265.3 U/L,94.5 U/L and 134.4 U/L,195.8 U/L,89.0 U/L and 158.9 U/L,393.7 U/L,260.0 U/L and 645.3 U/L,and 302.0 U/L,250.0 U/L and 452.7 U/L,respectively.The percentages of sample 1 and sample 2 which met the bias requirements of the WS/T 403-2012 standard before measuring value transfer for AMY,ALP and GGT were 65.9％ and 61.0％,76.6％ and 78.7％,and 66.7％ and 70.8％,respectively,while after measuring value transfer,they were 89.2％ and 83.8％,86.7％ and 80.0％,and 85.4％ and 91.7％,respectively.The percentages of sample 2 which met the bias requirements of the WS/T 403-2012 standard before measuring value transfer for CK and LDH were 64.6％ and 58.3％,respectively,while after measuring value trander,they were 93.5％ and 84.8％,respectively.The coefficients of variation (consistency) of sample 1 and sample 2 for ALT and AST before measuring value tramfer were 12.9％ and 11.3％,and 10.2％ and 8.9％,respectively,while after measuring value transfer,they were 9.3％ and 8.2％,and 5.6％ and 5.9％,respectively.Conclusion The calibration of routine measurement systems based on the measuring value transfer for human serum samples assigned by the reference laboratory network may improve the comparability of 7 enzyme actvities measurement results in chnical laboratories at all levels obviously,which deserves to be further spread.

Exploration and practice in the construction of curriculum on epidemiology in preventive medicine / 中华流行病学杂志

Epidemiology is one of main courses for undergraduate students majoring in preventive medicine.There are some limitations in the traditional epidemiology teaching,which is usually characterized in indoctrinated education:"lectured by the teachers and listened by the students." In Zhejiang University,staff of the epidemiology division tried to explore a new teaching mode as ‘student-centered,teacher-leading,question-based,and combining with literature discussion and course practice.'After practicing for two years,students were inspired in learning initiatives,with teaching effectiveness obviously improved.

Arthroscopy-assisted minimally invasive treatment of posterior tibial plateau fractures / 中华创伤骨科杂志

Objective To explore the therapeutic efficacy of arthroscopy-assisted minimally invasive treatment for posterior tibial plateau fractures.Methods From July 2010 to June 2014,10 posterior tibial plateau fractures were treated at our department by arthroscopy-assisted minimally invasive treatment with percutaneous lag screws.They were 8 men and 2 women,with a median age of 31 years (from 18 to 52 years).All the fractures were closed and fresh,including 3 posteromedial tibial plateau ones,5 posterolateral tibial plateau ones,and 2 posteromedial and posterolateral tibial plateau ones.They were followed up periodically by radiological examinations.At the final follow-up,their knee functions were evaluated by Rasmussen scoring system,and their pain was evaluated by the visual analogue scale(VAS).Subjective factors included swelling,stairs climbing,joint stability,job participation and satisfaction with recovery.Results The follow-ups averaged 18 months (from 12 to 24 months).All fractures healed within 3 months postoperatively,with no infection or serious complications like implant failure.At 12 months postoperation,the mean Rasmussen score was 26 points (from 19 to 30 points).Eight cases were rated as excellent,one as good,and one as fair.Their mean VAS score was 1.2 points (from 0 to 4 points).Conclusion Arthroscopy-assisted minimally invasive management of posterior tibial plateau fractures with cannulated screw fixation is feasible,because it results in limited invasion,satisfactory reduction,reliable fixation,quick functional recovery and a low rate of complications.

Effects of head rotation on the anatomic relationship of the internal jugular vein and the common carotid artery-an ultrasonographic study / 临床麻醉学杂志

Objective To observe the relationship of right internal jugular vein (RIJV)and common carotid artery (CAA)by scanning strictly from the anterior to posterior using ultrasound at different head rotation.Methods Using ultrasonic scanning,the anatomic features of RIJV and CAA both at thyroid cartilage level (prominentia laryngea level)and at the apex of the angle formed by the division of the sternocleidomastoid muscle (triangle level)with 0°,1 5°,30° and 45° right rotation were observed in 131 patients with ASA physical status Ⅰ or Ⅱ (male 55 cases,female 76 cases, aged 18~74 years).Based on the ultrasound images,the safe puncture range,the overlapping ratio, the angle between the horizontal axis and the line from the midpoint of RIJV to that of CAA (αangle) were measured.In addition,the relationship between the RIJV and CAA was defined as anterior-lat-eral, lateral, posterior-lateral or extremely-posterior-lateral position according to α angle. Results The safe puncture range of RIJV augmented as head rotated from 0° to 30° position(P <0.05);The safe puncture range of RIJV at triangle level was significantly higher than at prominentia laryngea level at all the four head positions(P <0.05).The overlapping degree decreased as head rota-ted from 0°to 30°head position at prominentia laryngea level(P <0.05).No siginificant differences of the overlapping degree were found between head positons at triangle level;The overlapping degree at triangle level was less than at prominentia laryngea level when at 0°and 1 5°head positon(P <0.05). At both prominentia laryngea and triangle levels,RIJV located mainly at lateral and posterior-lateral positions.In addition,the part of lateral position increased while the part of posterior-lateral position decreased as the head rotated from 0°to 45°position(P <0.05).Conclusion The puncture conditions for RIJV catheterization were more optimal at 30°to 45°head rotation for a safer puncture range and less overlapping between RIJV and CAA.RIJV located mainly at lateral and posterior-lateral positions at different rotations and RIJV gradually shifted to lateral position while head rotation increasing.It would be much better to select triangle level for central venous catheterization than prominentia laryn-gea level.