Objective　To study the clinical features of duodenal trauma and its surgery to improve the level of diagnosis and treatment. Methods　Methods of diagnosis and results of surgical treatment were analysed retrospectively of 35 cases of duodenal trauma. Results　The positive rates of abdominal X-ray and abdominal puncture were 32.0%, 13.3% respectively. The extraperitoneal duodenal injuries occured in 30(85.7%) cases. 25(71.4%) cases were complicated by additional intraabdominal organ injuries. The rate of failure to diagnose intraoperatively was 11.4%. The postoperative complication rate was 37.1% and the death rate was 11.4%. Conclusion　Duodenal trauma is characteristic of low diagnostic rate preoperatively, high failure rate intraoperatively and most of the cases are complicated by other intraabdominal organ injuries, so both the complication and mortality are high. If the diagnosis is certain, surgery should been taken suitably. This is the key to improve prognosis. The procedure performed is based on the condition of duodenal injuries.

The effective guarantee of the supply of low-price medicine in common use is of great significance for the protection of public health, the safeguard of social equality and the smooth progress of new healthcare reform. On the basis of the governance tools theory, the paper focuses on an analysis of approaches to combine and optimize the diverse utilization of governance tools in order to integrate the means of supply of the low-price medicine in com-mon use. In other words, the paper utilizes the ‘Voluntary-Directive-Mixed’ governance tools framework to provide possible solutions for the supply of low-price medicine in common use, namely, the locations of the voluntary tools ( household and community, volunteers, and market) , the directive tools ( government command-control regulation, establishment of public enterprises, and direct provision) , and the mixed tools ( information disclosure and advice, subsidies, auctions of property rights, tax and user charge) . Lastly the paper proposes specific policy suggestions in four aspects to confirm the total strategy of guaranteeing the supply of low-price medicine in common use:clever use of price leverage, improvements to procurement methods, establishment of an information disclosure system for medi-cine price, and a confirmation of government subsidies and industrial policy strategies.

Objective To analyze the problems in the diagnosis of Coats disease and its main causes of misdiagnosis. Methods The clinical data of a group of patients with Coats diseases who had undergone indirect ophthalmoscopy, ocular fundus photography, fundus fluorescein angiography (FFA) and follow-up examination were retrospectively analyzed. The main causes of misdiagnosis were analyzed via reviewing the images of FFA and revising or confirming the initial diagnosis of Coats diseases according to the main features of abnormal dilation of retinal capillary vessels. Result In 68 patients (75 eyes), there were 45 cases whose initial diagnosis was Coats disease while the final diagnosis was not, in whom the final diagnosis was old retinal vein occlusion in 21, retinal vasculitis in 9, diabetic retinopathy in 3, old posterior uveitis in 3, congenital retinoschisis in 3, and proliferative vitreoretinopathy, familial exudative vitreoretinopathy, racemose hemangioma, old rhegmatogenous retinal detachment, macular epiretinal membrane, and idiopathic juxtafoveal telangiectasis in 1, respectively. There were 23 patients who was diagnosed as Coats disease in the final diagnosis but not the initial one. The initial diagnosis was old posterior uveitis in 6 patients, retinal vasculitis in 5, exudative age-related macular degeneration in 4, retinal main arterial tumor in 2, retinal angioma in 3, intraocular tumor in 2, and central serous chorioretinopathy in 1. Conclusions There are many problems in the clinical diagnosis of Coats disease. The main reason of misdiagnosis is that the clinicians can not comprehensively master the core of the definition of Coats disease and its clinical characters.

Objective To develop an assay of HPLC for the content determination of dryocrassine in Guanye Jinsitao drop pills. Methods The column was Kromasil-C18 (150 mm×4.6 mm, 5μm);mobile phase was acetonitrile-chloroform-isopropanol-0.1% phosphoric acid (52∶8∶30∶10);flow rate was 1.0 mL/min;UV detection was performed at 285 nm;detected drift tube temperature was set at 25 ℃. Results The calibration curves were linear in the range of 0.236-2.124 μg for dryocrassine (r=0.999 9). The average recovery rate of dryocrassine was 99.64% (RSD=1.90%). Conclusion The method is simple and accurate. It is suitable for the determination of dryocrassine in Guanye Jinsitao drop pills.

Background:Colonoscopy is difficult in elderly patients and is accompanied by more frequent abdominal pain and tissue injury. Aims:To investigate the impact of water infusion colonoscopy on abdominal pain and inflammatory response in elderly patients. Methods:Forty elderly patients requiring colonoscopy were enrolled from Jan. 2014 to Jun. 2016 at the Nanyang Second People’s Hospital and randomly allocated into two groups:colonoscopy with traditional air insufflation and colonoscopy with water infusion instead of air insufflation for cecal intubation. Times of cecal intubation and withdrawal were recorded;visual analogue scale( VAS)was used to assess the severity of abdominal pain;and serum levels of three inflammatory indices,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)were determined by ELISA before and after the procedure. Results:VAS score at colonoscopy in water infusion group was significantly lower than that in air insufflation group(P﹤0. 05),however,times of cecal intubation and withdrawal were not significantly different between the two groups(P﹥0. 05). Before the procedure,serum levels of inflammatory indices were similar between air insufflation group and water infusion group(P﹥0. 05);0,6 and 24 hours after the procedure, serum levels of TNF-α,IL-6 and CRP in air insufflation group were significantly increased(P﹤0. 05)and higher than those in water infusion group at the same time points(P﹤0. 05). These inflammatory indices were recovered more rapidly in water infusion group than in air insufflation group. Conclusions:For elderly patients,colonoscopy with water infusion might ameliorate abdominal pain and inhibit systemic inflammatory response effectively.

Objective To study the pathological spectrum of neonatal sepsis and antibiotic resistance of bacteria and fungi isolated from neonatal blood samples. Methods Clinical information of neonates with sepsis admitted to neonatal ward of our Hospital were retrospectively collected from January 2007 to December 2014 and analyzed. Results During the study period, a total of 23 224 infants were admitted to neonatal ward. Among them, 608 were diagnosed with sepsis (2. 62% , 608 / 23 224). Blood culture samples were positive in 412 cases, the rest (196 cases) were diagnosed according to clinical manifestations and laboratory tests. The composition ratio of sepsis during the first 4 years was significantly lower than that of the subsequent 4 years (2. 58% , 225 / 9 805 vs. 2. 85% , 383 / 13 419, P < 0. 05). Of 412 bacterial strains isolated, gram-positive bacteria, gram-negative bacteria and fungi accounted for 62. 38% , 30. 34% and 7. 28% , respectively. For the 155 strains isolated during first 4 years, the number of G + bacteria, G - bacteria and fungi were 106 strains (68. 39% ), 40 strains (25. 81% ), 9 strains ( 5. 81% ), respectively. The coagulase-negative staphylococcus ( CONS ) accounted for 90. 57% of G + strains. Klebsiella pneumoniae and Escherichia coli accounted for 50. 00%and 15. 00% of G - strains respectively. 257 strains were isolated during the subsequent 4 years, of which G + bacteria, G - bacteria and fungi accounted for 151 strains (58. 75% ), 85 strains (33. 07% ), 21 strains (8. 17% ), respectively. CONS accounted for 74. 83% of G + strains, Klebsiella pneumoniae and Escherichia coli accounted for 30. 58% and 35. 29% of G - strains. The composition ratio of CONS and Escherichia coli were significantly different between first and subsequent 4 years (P < 0. 05). G +bacteria were resistant to penicillin, oxacillin and macrolide, sensitive to piperacillin / tazobactam and quinolone. We did not identify any G + strain resistant to vancomycin. In general, G - bacteria were resistant to ampicillin and cephalosporins, sensitive to the beta lactamase inhibitor compound preparation and quinolones, and highly sensitive to carbapenems. Fungi generally were sensitive to conazoles. Conclusions Neonatal sepsis are mainly caused by CONS, Klebsiella pneumoniae and Escherichia coli also play important roles. G + bacteria and G - bacteria in general are resistant to penicillin and cephalosporins. All G + bacterial strains isolated from our cohort are sensitive to vancomycin. G - bacteria are generally sensitive to carbapenems. Fungi generally are sensitive to conazoles.

OBJECTIVE: To observe the morphological differences between normal uncinate process(UP) mucosa and inferior turbinate mucosa, and explore the physiology function of the UP with the electron microscope. METHOD: The experiment chose 12 patients who have taken nasal endoscopic surgeries(8 cases for normal UP, 4 cases for normal inferior turbinate mucosa). During the surgery, take the mucosa upwards on the filter paper and immediately use scanning electron microscopy and transmission electron microscopy specimens for standard sample preparation methods. Observe the cilia shape, structure and the distribution and the swing direction. RESULT: (1)The internal side and the external side of UP mucosa and inferior turbinate mucosa are all pseudostratified ciliated columnar epithelium, the shapes of cilia are classic "9+2" structures. The distribution of cilia on internal and external lateral of UP and inferior turbinate mucosa are in high density. (2)The direction of cilia on normal inferior turbinate mucosa are generally swing to up and backwards; the cilia on internal lateral of the UP generally swing towards inner side, down and backwards; the cilia on external lateral of the UP generally swing towards down and backwards. CONCLUSION The cilia on internal side and the external side of UP mucosa and inferior turbinate mucosa are in the same structure and shape, but the swing direction of cilia have their own characteristics. It can be concluded that the internal and external lateral of UP may have different functions in nasal sinuses mucus cilia clearance system.
Cilia ; ultrastructure ; Endoscopy ; Epithelium ; ultrastructure ; Humans ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Nasal Mucosa ; ultrastructure ; Nasal Surgical Procedures ; Paranasal Sinuses ; Turbinates ; ultrastructure

According to the financing characteristics of military hospitals and problems in financial management; financial statement, special fund, internal control and financial indicator are used to audit economic benefits of military hospital;so that military hospitals can maximize the realization of social profits while providing good health surport.

Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Exercise Therapy ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; therapy ; Treatment Outcome

Objective: To establish a white noise-induced stress ulcer model in rats and to assess the changes of gastric parietal cell configuration and acid secretion under noise stress. Methods: Rats were randomly divided into 3 groups: NS 4 h,8 h and control groups. The rat NS model was induced by white noise. The pH values of gastric juice were measured by the pH/mV pH meter and the gastric ulcer index (UI) was evaluated. The stomach tissue was processed for immunofluorescence detection and the β subunit of H+, K+-ATPase was immunostained. The gastric parietal cell configuration was observed with conventional microscopy and confocal laser scanning microscope. Results: (1)The pH value of NS 4 h group (2.22±0.05) was significantly lower than that of control group (2.59±0.21, P<0.05), but higher than that of NS 8 h group (1.31±0.06, P<0.01). (2) The UI of NS 4 h group (10.5±1.29) was significantly higher than that of the control group (P<0.05), but significantly lower than that of NS 8 h group (34.36 ± 2.22, P < 0.01). (3) The reticular pattern parietal cells in NS 4 h group (55.5±3.42)/100 was significantly higher than that in control group (42.5±3.70/100, P<0.01), but lower than that in NS 8 h groups (62.0±3.46/100, P<0.05). (4) The pH was negatively related with both UI (r=-0.85, P<0.05) and the number of reticular parietal cells (r=-0.89, P<0.05). Conclusion: A white noise-induced stress ulcer model has been successfully established in rats. NS rats develop gastric mucosal lesions with increased acid secretion, which is closely related with the oxyntic function of parietal cells.