Objective　To investigate the incidence， clinical characters and pathogenesis of hyponatremia following acute stroke in the elderly patients.Methods　The clinical,serum natrium and CT data of 41 cases with hyponatremia following acute stroke in the elderly patients were retrospectively analysed.Results The incidence of hyponatremia following acute stroke in the elderly patients was 16.02% (taking hemorrhagic stroke),the occurrence of the patients' coma induced by hyponatremia and the fatality rate were higher than the controls (P＜0.05);Hyponatremia correlated closely with the localization of lesions in CT, the focus in brain ganglion (induding thalamus) and hematocele in the ventricles of brain caused easily hyponatremia.Conclusion　Dysfunction of hypothalamus-pituitarium was one of the risk factors in causing hyponatremia following acute stoke in the elderly patients.

Since the beginning of the surgery studies,disparities among medical students have existed. In order to avoid the disparities becoming more series among medical students in their surgery studies,based on author’s teaching experience in disparity teaching practices for the past few years,this article focuses on four aspects to expatiate: disparities of students,optimizing of teaching content,selection of teaching instrument and promotion of teacher’s self-quality.

This article summarizes the components,the formation and development of carotid atherosclerotic plaque,the factors affecting the stability of plaque,the mechanisms of plaquecaused ischemic cerebrovascular disease as well as the diagnosis of plaques and the treatmentstatus.

Objective To investigate the influence of infection factors on kidney transplantation after organ donation and possible countermeasures.Methods Thirty-seven cases of kidney transplantation in Organ Transplantation Center of Qianfoshan Hospital Affiliated to Shandong University from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to perioperative infection prevention programs:42 patients with postoperative routine use of cephalosporins or penicillin for 2 weeks,and 95 patients with postoperative application of carbapenems + micafungin.Postoperative infection rate,occurrence time,pathogen infection;donor age,perioperative pathogens of donor and receptor (organ preservation solution,drainage fluid,urine,sputum samples),acute rejection,delayed graft function (DGF),diabetes mellitus,and the use of immunosuppressive agents were recorded.Results The infection rate in carbapenem + micafungin group was 12.6％,and the infection rate in cephalosporin or penicillin group was 19.4％ (P＜0.05).Pathogen positive detection rate of the drainage fluid,urine and sputum was lower in carbapenems + micafungin group than that in cephalosporins or penicillin (P＜0.05).Within 2 weeks after operation,the detection rate of bacteria and fungi in the carbapenems +micafungin infection prevention group was lower than that in the control group (P＜0.05).There was no significant difference in the detection of viruses (P＞0.05).There were no significant differences in the detection of pathogens among the two weeks to six months after surgery (P＞ 0.05).Donor infection,acute rejection,DGF,and diabetes mellitus were the risk factors for postoperative infection (P＜0.05).Conclusion The application of carbapenems and micafungin can reduce the incidence of infection for the early stage of DCD kidney transplantation.Donor infection,acute rejection,DGF and diabetes mellitus are all risk factors for the postoperative infection.

Objective: To assess the predictive value of the platelet-to-lymphocyte ratio(PLR), neutrophil-to-lymphocyte ratio(NLR)and tumor-related factors on the peritoneal metastasis in advanced gastric cancer patients. Methods: A total of 701 pathologically confirmed gastric cancer patients who underwent surgery at the First Affiliated Hospital of Wenzhou Medical University between Jan 2009 and Jan 2012 were enrolled. Results: Univariate analysis indicated that tumor location, tumor size, serosal invasion, depth of invasion, pathological type, lymph node metastasis and PLR were related to peritoneal metastasis(all P<0.05). According to the area under the ROC curve, the optimal cutoff value of PLR for predicting peritoneal metastasis was 132.43 (sensitivity 71.8%, specificity 50.6%). There were significant differences in tumor size, TNM stage, lymph node metastasis and serosal infiltration between high PLR group and low PLR group. Multivariate Logistic analyses revealed that PLR (HR=2.205, P=0.003), lymph node metastasis(HR=3.113, P=0.010)and tumor size(HR=1.150, P=0.014) were independent risk factors for peritoneal metesfasis. Conclusions Preoperative PLR is valuable in predicting peritoneal metastasis of advanced gastric cancer and it is an independent risk factor for peritoneal metastasis of gastric cancer.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.