0.05). The operation time in the intertrochanteric fracture group was significantly longer than the femoral neck fracture group (P

OBJECTIVE To improve the standardized management of medical waste disposal and prevent the spread of the disease to protect the human health.METHODS Establishing hospital monitoring committee of medical waste through the director of hospitce as the first responsible figure.The management system and education training for all levels staffs and inspection were established.RESULTS By making the management measures scientific and effective,it was praised by many patients and social departments for providing good diagnosing environment.CONCLUSIONS Improving the standardized management of medical waste disposal is an important messure to secure the prevention of hospital cross-infection and improve the quality of medical care.

BACKGROUND: Some studies have considered the influence of body mass index (BMI) on the function following total knee replacement (TKR), but the cases were few and follow-up time is short in most of them.OBJECTIVE: To analyze the function outcome influenced by BMI after TKR. METHODS: A total of 320 osteoarthritis patients who were admitted in Department of Bone and Joint at Peking University People's Hospital, were involved in this study. They all received primary knee joint patellar resurfacing, including both knees replacement in 200 case of 520 knees, left 219 and right 301. The involved 320 patients underwent primary TKR performed by a single surgeon with the same type of prosthesis (Scorpio posterior stable prosthesis). The patients were divided into four groups based on obesity (overweight group, BMI 25.1-27.0 kg/m2; obese group, BMI 27.1-30.0 kg/m2; morbidly obese group, BMI > 30 kg/m2; control group, BMI < 25 kg/m2). According to the Hospital for Special Surgery (HSS) rating scale, their knee score and functional scores were recorded before replacement and at follow-ups, as well as maximal range of flexion and extension, complications. Preoperative and postoperative assessment was based on the HSS score. RESULTS AND CONCLUSION: A total of 320 patients received clinical recheck at 28.3 months (range 12-46 months). Compared with control group, patients in overweight, obese and morbidly obese groups had lower preoperative functional score (P < 0.05), but knee scores were not significantly different for any patient group. The postoperative mean HSS score of all the groups rose significantly at the last follow-up. These differences were not statistically significant among groups (P > 0.05). The rate of perioperative complications was significantly higher in the obese and morbidly obese patients (P < 0.05). Of the 181 knees in obese and morbidly obese patients, 14 knees (9.2%) had a wound complication, 1 knee (0.5%) had an infection, and 2 knees (1.3%) had an avulsion of the medial collateral ligament. The infected case developed within ten weeks after the operation, and was associated with a wound complication. Among 266 knees in the overweight patients, 6 knees (2.3%) had a wound complication. There was 1 knee (1%) of the 81 knees in the control group had a wound complication. No death or pulmonary embolism cases were observed in perioperative period. It is suggested that BMI has no obvious influence on the functional outcome following TKR in the short-term.

Diabetic Ketoacidosis (DKA) is a condition biochemically characterized by the combination of hyperglycemia, hyperketonemia and acidemia. The extracellular concentration of glucose and ketone bodies in human body can respectively increase 5 and 20 times as more as usual, and the pH of arterial blood can decrease below 7.0. Accumulation of gluccse, ketone bodies and hydrogen must be due to the imbalance of the rate of production, ulilization, and excretion of these substance. In DKA, the metabolism of several hormones and substances is probably involved in the initiation and maintenance of ketone body over-production. At present, 14 patients with DKA have been investigated and it has been found that relative insulin deficiency appears to be necessary, and the excess production of growth hormone, glucagon and catecholamincs (the urine adrenaline and noradrenaline were measured) may be also important in the pathogenesis of DKA.

Objective To compare the efficacy and safety of duloxetine and gabapentin in the treatment of diabetic peripheral neuritis .Methods 135 patients with diabetic peripheral neuritis were divided into the observation group(71 cases) and the control group (64 cases) according to random number table method ,and all patients received hypoglycemic therapy based on diabetes treatment principle .Furthermore,the observation group received oral duloxe-tine,while the control group was given oral gabapentin .The pain scores of all patients were evaluated using visual ana-log scale(VAS) and medical outcomes study (SF-36),and the adverse reactions were recorded during treatment . Results (1) Compared with before treatment ,both VAS scores and SF-36 scores in observation group and control group declined significantly at the end of 1st,2nd,4th week after treatment(all P<0.05),while there were no statis-tically significant differences in VAS scores and SF-36 scores between the two groups at the same time point ( all P>0.05).(2)The incidence rates of dry mouth ,drowsiness,fatigue and dizziness in observation group were significantly lower than those in control group (18.31% vs.34.38%,4.23% vs.26.56%,0.00% vs.23.44%,0.00% vs. 15.63%,χ2 =4.059,13.308,4.059,4.059,all P<0.05),while there were no statistically significant differences in incidence rates of nausea ,diarrhea and flustered between the two groups (all P<0.05).Conclusion The duloxetine and gabapentin in the treatment of diabetic peripheral neuritis have similar efficacy , but the duloxetine has better security.

To investigate the efficacy and safety of treatment of rabbit knee joint toughness with autogenous synovium transplantation, we carried out the experiment at the experimental center of Department of Surgery, the Medical College of Xianning University between October 2003 and October 2005. Sixty black rabbits aged 6-10 months were selected and the lateral synovium of joint was resected to establish the artificial knee joint toughness models 4 weeks later. Then the rabbits were randomly divided into simple relaxation group (SR) and synovium transplantation group (ST) with 30 animals in each group. The latter group was subjected to antogenous synovium transplantation besides the relaxation of knee joint toughness. At the end of the 8th week, the ranges of motion of knee joint of the SR group: 16 cases were 0?-20?, 10 were 20?-40?, 4 were 40?-60?, and 0 was 60?-90?. The range of the ST group: 2 cases were 0?-20?, 8 were 20?-40?, 16 were 40?-60?, and 4 was 60?-90?. There were significantly differences between the two groups (P

Metrology as a main real-time detection method for equipment performance,plays an important role in improving the medical treatment and realizing the modernization of medical science.What's more,suggestions are given on how to site the international standards as example to improve the hospital quality management system and metrological approval system;to normalize and promote hospital foundational management and the development of metrological technology;to realize unified,accurate metrology;and to enhance medical quality and social benefit,which catering the requirement of hospital metrological management and sustainable development.[Chinese Medical Equipment Journal,2008,29(2):105-106]

Objective To investigate the clinical efficacy of imipenem and cilastatin sodium on the clinical efficacy of elderly patients with severe bacterial infection, and to observe the clearance rate to different floras.MethodsA total of 206 elderly patients with severe bacterial infection as the research object in our hospital outpatient treatment, were divided into control group and observation group, the patients were collected with sputum, blood and urine samples sent for bacterial culture.All patients were given positive treatment and nursing care, the observation group was given imipenem and cilastatin sodium treatment,the control group was given cefotaxime sodium treatment.The clinical efficacy, bacterial clearance and adverse reactions of the two groups were recorded and compared.ResultsThe total efficiency rate was 91.26% in the observation group, and 79.61% in the control group.The number of effective cases was significantly higher in the observation group than in the control group (P<0.05), the number of ineffective cases was significantly lower than that of the control group (P<0.05);The bacterial clearance rate was 85.71% in the observation group, and 43.33% in the control group, the clearance rate of Bauman Acinetobacter, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus was significantly higher in the observation group than in the control group (P<0.05).Through the detection of adverse reactions showed that the observation group and the control group after treatment, few patients mild symptoms of nausea and vomiting and itching rash, on the occurrence of adverse reactions of the two groups of patients were compared, the difference was not statistically significant.ConclusionFor elderly patients with severe bacterial infection with imipenem and cilastatin sodium for treatment, the effective rate is high and can timely remove a variety of pathogenic bacteria, and rare adverse reactions, high safety, worthy of clinical application.

BACKGROUND: Critical organ hypofunction and complications are common in elderly patients, so perioperative treatment becomes important for the success of total knee replacement (TKR).OBJECTIVE: To explore clinical perioperative complications of TKR in the patients over 70 years old. DESIGN, TIME AND SETTING: Retrospective analysis of case data was performed at First Hospital of Gannan Medical University and People's Hospital of Peking University from January to December 2002.PARTICIPANTS: 109 patients (168 knees), including 29 males and 80 females, underwent TKR. Of them, 50 underwent single knee surgery, aged (74.2±15.1) years (range 70-85 years), and 59 underwent bilateral knee surgery, aged (73.4±13.2) years (range 70-85 years). In addition, 92 cases (84.4%) were obesity, and 88 were complicated by internal diseases. METHODS: The surgery was performed by the same operator. All patients underwent patellar replacement with Scorpio posterior stable knee prosthesis. Knee anterior median incision and medial patellar approach was applied, and anterior and posterior cruciate ligaments were excised during the surgery, osteophyma and corpus liberum of posterior articular capsule were cleared. Patellofemoral joint track was tested until meeting the requirements. The prosthesis was fixed using antibiotics mixed with bone cement, and the incision was sutured at flexed position.MAIN OUTCOME MEASURES: Early complications following replacement; knee joint and functional evaluation.RESULTS: During surgery and 24 hours after replacement, 8 cases developed hypertension, 7 cases hypotension, and 6 cases arrhythmia. All patients safely passed the perioperative period under treatment of related departments. One case developed pulmonary embolism, 1 case deep infection, 3 cases pulmonary infection, 5 cases urinary system infection, 1 case rapid reduction of platelet caused by Subining, 1 case cognitive disturbance, and 1 case dislocation of knee joint (Charcot arthritis). According to standards of HSS, the knee joint scores were significantly improved from 26.1 prior to replacement to 82.0 at discharge, and function scores were significantly improved from 32.1 prior to replacement to 89.1 at discharge. During 12.4-month follow-up (range 3-22 months), 18 cases lost the follow up; the retention rate was 83.5%. Of 91 retention patients, knee pain disappeared or relieved, restored self-care ability, and no prosthesis loosening or infection was found. At the final follow up, the HSS knee joint scores were significantly improved from 82.0 at discharge to 85.4, and function scores were improved from 89.1 at discharge to 92.3 at discharge.CONCLUSION: Skilled operative technique and positive treatment of complication can effectively prevent perioperative infection, dislocation and other complications following total knee replacement.

Objective:To investigate the association between anxiety and the change of humoral immune functions and its correlation with HLA-DQB1 polymorphisms.Methods:Total 31 resident doctors were selected randomly and tested by State-Trait Anxiety Inventory(STAI).IgG,IgA,IgM,complement C3 and complement C4 were detected with BECKMAN array360 system;HLA-DQB1*02、*03、*04、*05 and*06 alleles were individually amplified by polymerase chain reaction(PCR)using exon2 group-specific primers.The correlation between immune function and HLA-DQB1 polgmorphisms were investigated.Results:Statistical analysis showed that there was positive correlation with State Anxiety (Ta) and complement C3,either Trait Anxiety (Tc) and complement C3.There was significant difference between HLA-DQB1*02 positive and negative in Ta (P＜0.05),while no difference in complement C3(P＞0.05).There was significant difference between HLA-DQB1*04 positive and negative in Ta and Tc(P＜0.05),while no difference in complement C3(P＞0.05).Conclusion:Anxiety could change some humoral immune functions and this is related with HLA-DQB1 polymorphism.