Objective To investigate the combination appr oach used to treat the complex acetab ular fractures.Methods Form January 1998to August 2001,31c ases of acetabular fractures were tr eated through combination of Kocher-Langenbeck a nd ilioinguinal approaches.26case s of them resulted from traffic injur ies,and 5from fall injuries.The average interval from injure to operation wa s 17.6days.The average blood loss wa s1890ml.The average operative duration was 252minutes.According to the classification of Letournel and Jud et,associated fracture types accounte d for 27cases,and simple type 4cases.They were fixed by the reconstructi ve plates and /or plates +lag screws.Results The average follow-up was 20.2month s.According to criteria of Matta,of the 20cases who underwent a natomic reduction,10were satisfac tory while 1unsatisfactory.21case s had excellent and good clinic results,8fair,2poor.Conclusion Because of the advantages of excelle nt ex-posure,convenient reduction,rigid fixation and lower heterotopic ossification,the combination approach is good to treat the complex acetabular fractu res involved the two columns.[

OBJECTIVE:To determine the contents of Icariin,Psoralen and Isopsoralen in Yishenling granule by HPLC. METHODS: The chromatographic separation was performed on Phenomenex luna C18 column (250 mm?4.6 mm, 5?m) with mobile phase consisted of acetonitrile-0.1% acetic acid solution (gradient elution) at a flow rate of 1.0 mL?min-1.The UV detection wavelength was set at 310 nm, and the column temperature was 20 ℃. RESULTS: Icariin,Psoralen and Isopsoralen in Yishenling granules were well-separated with good linearity within their respective concentration range. And the average recoveries for the three constituents were all within 99%～101% with RSD all less than 1.20%. CONCLUSION: The method is simple, feasible and reproducible, and it can be used for the quality control of Yishenling granule.

Objective To explore the impacts of 24-hour medical records archiving on the DRGs grouping ratio and payment.Methods Retrospective survey was made in a tertiary hospital in Beijing during its pilot from November 18,2011 to May 31,2012.The study covered such categories as the 24-hour medical records archiving ratio,48-hour medical records archiving ratio,DRG grouping ratio and payment for discharged patients prior to and after the practice of such archiving requirement.The data were subject to a multilinear regression analysis.Results The practice of 24-hour archiving,since in place,has significantly raised the 24-hour ratio,48-hour ratio,DRG grouping ratio and payment ratio,with the differences statistically significant (averaging P＜0.0001).DRGs payment amount is positively correlated to the number of DRGs grouping (regression coefficient 0.75284,P＜0.0001).DRGs grouping amount is positively correlated to the number of 24-hour medical records archiving (regression coefficient 0.44233,P＜0.0001).Conclusion The 24-hour archiving practice has significantly raised DRGs grouping and payment ratio,making it one of requisites for hospitals to successfully carry out DRGs payment system.

Objective To explore the diagnosis and surgical treatment of primary intestinal tumors (PIT), to improve the diagnosis and treatment. Methods Retrospectively analysis was made on the clinical data of 72 patients with PITs admitted to our hospital from 1988 to 2002. Results Out of the 72 cases, 20.8% (15/72) had benign tumors, while the remaining 79.2% (57/72) were malignancies. The former were mostly adenoma and liomyoma, each accounting for 40.0% (6/15) of the benign tumors. Adenocarcinoma was the most common type of malignancy (36.8%,21/57), following lymphadenoma (30.0%, 17/57). The main diagnostic methods were X-ray,B-ultrasonic,CT, endoscopy and superior mesenteric arteriography.The misdingnosis rate was 62.5% before operation in this series.Of the 72 cases underwent operation,25 underwent emergent operation (33.3%, 25/72), because acute intestinal obstruction, digestive tract bleeding or perforation,acute appendicitis were diagnosed before the operation.In this series,there was no operative death;the 1,3,5 year survial rates of malignance were 62.5%,47.5%,25.0%,respectively. Conclusions PIT is not easily diagnosed before operation, and the misdiagnosis rate and emergent operation rate are high. Superior mesenteric arteriography,radiologic contrast examination of the small bowel are the important means of diagnosis in jejunum or ileum tumour, and the best way to diagnosis duodenal neoplasms is hypotonic duodenography and endoscopy. Once the diagnosis of PIT is made, the best choice of treatment is operation.

OBJECTIVETo verify the clinical efficacy of acupuncture for mild cognitive impairment of stroke at subacute stage.

METHODSOne hundred patients at subacute stage of cerebral infarction or cerebral hemorrhage with scores of Montreal cognitive assessment (MoCA) less than 26 were randomly divided into an observation group and a control group,50 cases in each one. Based on the regulation of blood pressure and blood sugar and anticoagulation,cognitive rehabilitation training was adopted in the control group. On the basis of treatment in the control group,acupuncture was applied in the observation group. The acupoints were Baihui(GV 20), Sishencong (EX-HN 1), Shenting (GV 24), Yintang(GV 29), Hegu (LI 4) and Taichong(LR 3). Sishencong(EX-HN 1), Shenting (GV 24) and Yintang (GV 29) were connected to electroacupuncture apparatus. The treatment was given once a day,5 times a week, and 8-week treatment was acquired in the two groups. In the 4th week and the 8th week,limbs motor function, daily life ability and cognitive function were evaluated by Fugl-Meyer assessment (FMA) scale,Bathel index and MoCA scale.

RESULTSIn 4 weeks and 8 weeks, the scores of FMA, Bathel index and MoCA in the two groups were improved compared with those before treatment (all P < 0.05). After 8-week treatment, the scores of Bathel index and MoCA in the observation group were better than those in the control group (both P < 0.05).

CONCLUSIONBased on the cognitive rehabilitation training and the conventional treatment, acupuncture can improve the cognitive function and daily life ability of stroke patients at subacute stage with mild cognitive impairment.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Cognition ; Cognitive Dysfunction ; psychology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; psychology ; therapy

Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.

Objective To investigate the changes of B lymphocyte subsets ( naive B cells, memory B cells and plasmablasts) in peripheral blood of patients with rheumatoid arthritis ( RA) and their correla-tions with the clinical manifestation and laboratory indexes.Methods Sixty-six patients with RA were di-vided into two groups including the group with active RA and the group with inactive RA according to the dis-ease activity score in 28 Joints (DAS28).A control group with healthy subjects was set up accordingly.The distributions of B lymphocyte subsets in peripheral blood samples were detected with flow cytometry analysis and their correlations with clinical manifestations and laboratory indicators were analyzed.Results ( 1 ) Compared with healthy subjevts, the mean fluorescence intensities ( MFIs) of CD19 and the percentages of memory B cells in peripheral blood of the patients with RA were significantly decreased, while the percenta-ges of naive B cells were increased (P<0.05).The percentages of plasmablasts in the patients with active RA were significantly increased as compared with those of healthy subjects and the patients with inactive RA (P<0.05).(2) The percentages of plasmablasts in peripheral blood of the patients with RA were positively correlated with the joint tenderness count, joint swelling count and joint swelling index (P<0.05).(3) A positive correlation was found between the MFIs of CD19 and the erythrocyte sedimentation rates ( ESRs ) among the patients with RA.The percentages of plasmablasts were positively correlated with C reaction pro-tein (CRP) and anti-cyclic citrullinated peptide (anti-CCP) antibody (P<0.05).(4) The percentages of plasmablasts were also positively correlated with the DAS28 among the patients with RA ( R2=0.343, P<0.01).Conclusion The distributions of B lymphocyte subsets varied among the patients in different stages of RA, which were related to the patient′s clinical symptoms and laboratory indexes.The study suggested that different subsets of the B lymphocytes might play an important role in the pathological process of RA.

Objective To compare the clinical efficacy of Rivaroxaban and Warfarin in the treatment of lower extremity deep vein thrombosis.Methods From January to December 2015,51 patients of deep vein thrombosis of the lower limb divided into.Warfarin group (21 cases) and Rivaroxaban group (30 cases).The time of each therapy lasted for 3 months or longer.The characteristics and the change of lower limb venous patency rate in two groups of patients were analyzed to evaluate the curative effect.Results Rivaroxaban group had shorter therapy time than Warfarin group.The lower limb venous patency rate in Rivaroxaban group were higher than that in Warfarin group (85.7％ vs.60％,P ＜0.05).Ultrasonography showed partial patency in 5 mixed thrombus patients of Warfarin group,while complete patency in 2 and partial patency in 3 of Rivaroxaban group.Normalized rate in peripheral venous thrombosis patients of Rivaroxaban group were higher than Warfarin group (84％ vs.25 ％ P ＜ 0.001).Conclusions Rivaraxaban is superior to Warfarin in the complete recanalization of DVT,while safe and reliable.

In recent years, the number of ICU survivor is ever-growing with the increase of cure rate. The survivors′ outcome has aroused more and more attentions from medical personnel. ICU survivors tend to experience lasting physical, psychological and cognitive injuries, the post-traumatic stress disorder is one kind of significant psychological injury associated with patients′ critical experience. This review aims to summarize relevant literatures, introduces the prevalence, risk factors, complications, and interventions of ICU survivors′ post-traumatic stress disorder symptom, in order to prevent ICU survivors from post-ICU psychological injury and improve their long-term outcome.

Objecfive To detect the specific autoantibodies against platelet in idiopathic thrombocytopenic purpura (ITP) and to study the relationship between these autoantibodies and the severity of ITP as well as therapeutic effect.Methods Autoantibodies (GPⅡbⅢa and GPIb) against platelet glycoprotein was measured by a monoclonal antibody immobilization of platelet antigen assay (MAIPA) in 40 ITP patients.Results 10 patients had mono-specific antibodies to GP Ⅱ bⅢa and 6 patients had mono-specific antibodies to GPIbα.Another 20 patients had antibodies to both antigens and 4 patients had no detectable antibody to either platelet antigen.There Was negative correlation between the antibody against GPⅡbⅢa(b=-0.071,P<0.01),CPIbα(b=0.092,P<0.01) and platelet counts.The ratio of refractory cases in patients with antibodies to both antigens(8/20) was significantly higher than that in patients with mono-specific antibodies(1/16)(χ2=6.09,P<0.05).Conclusion The specific autoantibadies against platelet might be valuable for discrininafion of idiopathic thrombocytopenic purpura and non immune thrombocytopenia.The types of antibodies are related with severity of ITP and therapeutic effect.