In the process of responding to public health emergencies,the conflicts between the principles of management and ethics are constantly revealed.Combining with a unit's practical experiences of participating in several major public health emergencies,this paper put forward that it should take into account both the rescue and notification to achieve the unity of effective rescue and informed consent;take into account both the enforcement and obedience to achieve the unity of the interest of groups and individuals;take into account both the equality and priority to achieve the unity of urgency priority and equal opportunity;take into account both the rescuing and suf-fering to achieve the unity of interest between the rescuers and the victims,and thus to provide references for the reasonable solution of the ethical conflicts in the process of responding to public health emergencies.

BACKGROUND:Percutaneous vertebroplasty with bone cement plus hyperextension position reset for acute thoracolumbar vertebral osteoporotic compression fractures has been reported to achieve good clinical efficacy.OBJECTIVE:To evaluate the efficacy of unilateral percutaneous vertebroplasty with bone cement plus hyperextension position reset for Kümmell disease in the elderly.METHODS:Twenty-two old patients with Kümmell disease were included,involving 8 males and 14 females,aged 55-84 years old,and the injuried vertebrae included T11 (n=2),T12 (n=8),L1 (n=7),L2 (n=4),L3 (n=2),L4 (n=2),and L5 (n=1).All patients underwent the unilateral percutaneous vertebroplasty with bone cement plus hyperextension position reset.The visual analogue scale and the Oswestry Disability Index scores,vertebral body height as well as vertebral kyphosis angle were determined before and after treatment.RESULTS AND CONCLUSION:(1) All patients were successfully operated,pain relieved or disappeared within 24 hours postoperatively.No spinal cord injury,pulmonary embolism and other complications were found.One patient presented with cement leakage without obvious clinical symptoms;two patients had non-adjacent vertebral fractures during follow-up.(2) The visual analogue scale and Oswestry Disability Index scores at 1 day postoperatively were significantly lower than those at baseline (P ＜ 0.05).(3) The anterior,medial and posterior height of involved vertebral body,kyphotic angle of involved vertebral body at 1 day postoperatively were significantly higher than those at baseline (P ＜ 0.05).(4) These results manifest that unilateral percutaneous vertebropiasty with bone cement plus hyperextension position reset to treat Kümmell disease in the elderly can significantly relieve back pain,restore partial vertebral height,correct local kyphosis and improve functional recovery of the injured vertebrae.

Objective To investigate the outcome of the urethral realignment simultaneous internal fixation in treatment of pelvic fracture associated with posterior urethral disruption. Methods The study included 33 patients with pelvic fracture associated with posterior urethral disruption treated simultaneously by urethral realignment and internal fixation from December 2003 to August 2009. According to AO classification, two patients were with type A2 fracture, six with type B1 ,seven with type B2,five with type B3 ,six with type C1 ,four with type C2 and three with type C3. All the patients were found with complete posterior urethral disruption. Primary urethral realignment combined with emergency open reduction and internal fixation of pelvic fracture were performed in 12 patients. Due to unstable condition, 21 patients underwent primary suprapubic cystostomy and external fixation, sequentially delayed urethral realignment and internal fixation.Results The mean follow-up time of all patients was 37 months ( range, 3-63 months). Of all the patients, 25 patients (76%) regained good without urethral dialation or needed only short term urethral dilatation, and eight patients (24%) suffered from urethral stricture and needed further complex surgery. The incidences of urinary incontinence and erectile dysfunction were 6%(2/33) and 18% (6/33). The erectile dysfunction of two patients was ascribed to sacral nerve injury.At the final follow-up, the mean score was 90.3 points (range, 66-100) according to the Majeed' s scoring system, which showed that the result was excellent in 24 patients, good in eight and fair in one.Conclusions Urethral realignment and simultaneous internal fixation can attain good clinical results for pelvic fracture associated with posterior urethral disruption. It takes advantages of minor surgical trauma,short treatment cycle, good outcome and low complication rate.

Objective To improve the antenatal diagnosis of placental abruption by ultrasound. Methods A retrospective analysis was conducted on 33 placental abruption cases in our hospital between Jan. 1988 and Apr.2003. Results Among 33 cases, 28(84 8%) were found by ultrasound. There were more cases with anterior placental and severe abruption than posterior placenta and mild abruption without symptoms. The sonographic characteristics of placental abruption was dark and low echo area between placenta and uterine wall. Among these cases, mild and mixed echos were detected in 15 cases, partial thickened placenta 6 cases, protruding masses at the edge of placenta or under chorionic plate 8 cases(one case was misdiagnosed as chorioangioma). No signals of blood flow was shown the abruption area of placenta by color Doppler flow image. Conclusion Antenatal sonography has an important role in diagnosing placental abruption.

Objective To investigate the early diagnosis and treatment of pelvic fracture with vaginal injury.Methods From January 2000 to July 2010,13 patients suffered from pelvic fracture with vaginal injury were treated in our hospital,whose average age was 31.7 years.According to the Tile classification,there were 4 cases of type B1,1 case of type B2,4 cases of type B3,3 cases of type C1,and 1 case of type C2.Emergency repair of vagina together with open reduction and internal fixation of pelvic fracture was performed in 3 patients.After the patients' condition became stable,5 patients with shock were treated with emergency repair of vagina together with primary external fixation of pelvic fracture.Prompt repair of vagina together with open reduction and internal fixation or primary external fixation of pelvic fracture was performed in 2 patients who underwent delayed diagnosis.Two cases of extensive pelvic abscess due to missed diagnosis of vaginal laceration were treated with debridement and external fixation of pelvic fracture,and reconstructions of vagina were performed after infection control.Results Twelve patients survived,and 1 patient died 6 h after admission.Eleven patients were followed up for 8 to 36 months (average,17 months).Among 9 patients who underwent one-stage repair of vagina,5 married patients had normal sexual life,1 suffered from pain during sexual intercourse,and 3 unmarried patients had normal menses.Two patients who underwent second-stage reconstruction of vagina suffered from pain during sexual intercourse.At final follow-up,the mean Majeed score was 82.2 (range,56 to 96),and the results were excellent in 6 cases,good in 3 cases,fair in 2 cases.Conclusion Vaginal injury should be highly suspected in females with anterior pelvic ring fracture.Early diagnosis and repair of vaginal injury is crucial to good clinical outcomes.Delayed diagnosis and treatment may lead to severe complications.

Objective To compare the effect of sacroiliac anterior papilionaceous plate (SAPP) and the traditional reconstruction plate for the treatment of sacroiliac joint disruption.Methods 11 consecutive patients with sacroiliac joint disruption associated with pelvic fracture enrolled in our hospital.Detailed physical examination,X-rays,CT and FAST were performed before surgery.11 patients underwent SAPP fixation.Of the 11 patients,there were 5 males and 6 females.Their average age was 39.6 years.12 patients enrolled in last year as control group underwent reconstruction plate.There were 7 males and 5 females in this group.Their average age was 39.1 years.Operation time,blood loss,placing time of SAPP were recorded.X-ray films were performed after surgery to evaluate reduction condition by Matta criteria.X-ray films and Majeed outcome were performed in follow up.Results According to Tile classification,there were 13 Type B and 10 Type C.For SAPP group,operation time was (100.9±32.1) min,blood loss (998.8±365.7)ml,Placing time of SAPP was (6.6±3.2) min.For control group,operation time was (110.8±29.6) min,blood loss was (136.0±279.3) ml,placing time of reconstruction plate was (15.4±1.1) min.According to Matta criteria,8 cases were rated as excellent,11 as good,3 as fair,and 1 as poor.Lumbosacral nerve injury occurred in 1 case,lateral femoral cutaneous nerve injury in 7,and massive blood loss in 2 cases.No posterior infection occurred.Compared with control group,SAPP group experienced shorter placing time,and less blood loss in type B pelvic fracture.Conclusion As a new instrument,SAPP could be well applied in the treatment of sacroiliac disruption.Compared with reconstructed plate,SAPP obviously shortens placing time and facilitated placing procedure,and does not increase blood loss,neurological risk and infection rate and does not need different incision and reduction method.

Aim To investigate the drug-containing serum of Rhizoma drynariae on osteogenesis differentiation of bone marrow mesenchymal stem, and discuss the possible mechanism.Methods BMSCs were cultured in media with different concentrations of medicine containing serum.BMSCs proliferation ability was detected in 3,5,7,9 days by CCK-8.ALP activity was detected after 7,10,14 days′ induction.After 3 weeks culturing, alizarin red staining was performed to observe the formation of calcium nodules.The expression of β-catenin,LRP5,RUNX-2 and Osteriex mRNA were detected using RT-PCR.The protein expression of β-catenin,LRP5 was detected using Elisa method.Results Rhizoma drynariae drug-containing serum could obviously promote the proliferation of BMSCs and calci-fied nodule formation.Besides, the ALP activity was improved in a certain period of time.The expression of β-catenin,LRP5,GSK-3β,RUNX-2 and Osteriex mRNA were significantly up-regulated,and the protein expression of β-catenin,LRP5 was up-regulated too.The expression of GSK-3β was down-trgulated.Conclusions Rhizoma drynariae drug-containing serum promotes mineralization and osteogenic differentiationof BMSCs, and the mechanism is closely related with activating WNT/beta-catenin signaling pathway, raising the beta-catenin, LRP5, RUNX-2, and Osteriex mRNA expression, beta-catenin, LRP5 protein expression,and down-regulation of GSK-3β mRNA expression.

Objective To explore the surgical skills and clinical efficacy of laparoscopic splenectomy (LS). Methods The operative duration, perioperative blood loss and postoperative complications were determined in 42 patients receiving LS in our hospital from October 2006 to May 2008 were retrospectively analyzed. Of the 42 patients, 12 suffered from splenomegaly due to blood disease, 1 from splenic tuberculosis, 1 from splenic cyst, 4 from traumatic splenic rupture,1 from malignant lymphoma and 23 from hypersplenism due to portal hypertension. Results LS was successfully performed in all the 42 patients. The mean perioperative blood loss was (300±110.60)ml, average operative duration (170±45.65) min (60-260 min) and mean postoperative inhospitalization duration (8.10±3.52)d. There was no severe complication after the operation. Conclusion For most types of splenic diseases, LS is safe and feasible. It is crucial to manage the splenic pedicle according to disease type, size, morphology and splenic hilus.

Objective To explore the operative main point and clinical effects of laparoscopic treatment for hepatic cyst. Methods Between August 2006 and April 2009, Forty-eight cases of laparoscopic treatment for hepatic cyst were performed, and the data were analyzed retrospectively. Of these treatments, there were laparoscopic fenestration (46 cases) and laparoscopic anatomical resection of left hepatic lobe (2 cases). Of the patients, there were solitary cyst (41 cases) and multiple cyst (7 cases). Results Fortyeight cases all performed laparoscopic treatment successfully. There were no converting to open operation, no biliary leakage and no bleeding. Except for resection of left hepatic lobe, the operating time was 30 -96 minutes (mean, 45 minutes), the intraoperative blood loss was 10 -90 mL (mean, 26 mL) and the postoperative hospital stay was 3 - 9 days (mean, 5 days). All the 48 patients were followed up for 6 to 36 months (mean, 32 months), 2 cases were found recurrence. Conclusions Affluent experience and proper standard of operation are key points for avoiding recurrence and complication in laparoscopic treatment for hepatic cyst. Laparoscopic treatment for hepatic cyst is safe, characterized by less pain and rapid recovery.

Objective To investigate the circadian and seasonal distribution of cardiovascular events (CVE) and the relationship between average monthly temperature and the incidence of CVE. Methods A total of 5837 emergency patients with CVE were enrolled from 1997 to 2007. The exact admission time of each patient was registered. The average monthly temperature data from a regional weather station for this time period was supplied by the meteorological office of the city. The relationship between the average monthly temperature and the incidence of CVE was explored and the corresponding curves were plotted. Results The occurrence of CVE has obvious seasonal variation, and its a higher tendency of episodes was found in spring and winter periods. High incidence of acute myocardial infarction, angina pectoris, acute left-sided heart failure, hypertensive crisis, and sudden death occurred in spring and winter as wee as the time for a change of season, that is, January, February, March, April, October, November, and December. There was a significant negative correlation between the incidence and the average monthly temperature (P<0.005-0.001). Circadian rhythm of CVE was present, with a peak in the early morning and forenoon. Conclusion There are circadian and circannian rhythms of the incidence of CVE. Cold weather condition is a risk factor for the occurrence of CVE, which usually peaks in the early morning and forenoon.