Objective To explore the therapeutic efficacy for fractures around the knee with concurrent vascular and nerve injury.Methods The clinical data of 75 patients with fractures around the knee with concurrent vascular and nerve injury treated were retrospectively analyzed.And fracture reduction,vascular repair and nerve repair were given depending on degree of injure.Therapeutic efficacy of the treatments was recorded.Results 5 cases were amputation,while the others were alive,the rate of efficacy was 93.06％.27 of the 31 cases of contusion nerve were returned to normal,4 were returned to part of the sensory-motor,11 of 13 cases of completely torn nerve were recovering well,and 2 of which were 2 degree,and the rate of efficacy was 86.36％.Conclusion The appropriate measures and early treatment should be given,by which prognosis of limb could be improved comspicuously,and the order of vascular repair and fractures fixation is influential on surgery success.

After the concept of risk of literature acquisition was described, its universal, objective, losing, controllable and social featureswere pointed out , followed by an analysis of the factors and related conditions for its occurrence , its consequences and possible losses, with measures proposed for its control.

According to the main problems existing in the rural patriotic hygiene work at present, this article analyses the causes of these problems from both the subjective and objective respects. According to the goal of building a well-off society in an all-round way and safeguarding the health interests of 900 million farmers, this article tries to discuss the guideline and principle of ethics on the rural patriotic hygiene work and put forward the code of ethics to do a good job in the rural patriotic hygiene work.

Aiming at the litigation to medical treatment dispute since new rule, there are different reply words and actions existing in medical service providers,according to the request of the new rule, the author analyzed doctor-patient relationship and medical treatment dispute,medical service and reform,'proof'consciousness and work circumstance of doctors,bring upped the request that the medical treatment organization and its members should reply to the new rule from thought consciousness,doctor-patient relationship,rules in medical service practice, proof system,etc.

Objective To understand the prevalence of erectile dysfunction (ED) in elderly male and to provide the basis for clinical diagnosis and treatment of ED. Methods The questionnaire about sexual history was used, and related past history, medication and life-style were reviewed. Results Total prevalence of ED was 89.7% in the 272 elderly male persons. The prevalence of 60-years group, 70-years group and 80-88 years group was 75.9%, 78.6% and 100%, respectively. Among ED patients, 95.1% of them suffered from hypertension. Conclusions Prevalence of ED in elderly male persons is associated with the ageing and the hypertension.

The medical teaching assistant terrace has been established and finished in the digital libraries.It has increased library function,satisfied medical teaching innovating demand and advanced library value and position.It has also provided the chance and established the direction of the development for library and its workers.

It is required by objective reality to discuss the teaching conception and mode of evidence-based medicine,based on its nature and from the fundamental differences between it and traditional medicine.

Objective To observe the clinical effect of mifepristone combined with intramuscular injection of methotrexate in the treatment of cesarean scar pregnancy.Methods Fifty-six patients with uterine scar pregnancy after cesarean section were divided into observation group and control group by random number method.The control group was intramuscularly injected methotrexate,the observation group was given methotrexate combined with mifepristone therapy.The therapeutic effect,blood β human chorionic gonadotropin(β-HCG) decreased to normal time,vaginal bleeding time,mass size were observed.Results After treatment,the serum β-HCG decreased to normal time[(15.96±3.71)d] and vaginal bleeding time[(5.12±2.08)d] of the observation group were significantly shorter than those of the control group [(25.42±4.02)d,(7.39±3.37)d],the mass size of the observation group [(1.88±0.15)cm] was also significantly smaller than (2.14±0.33) cm of the control group,and there were significant differences between the two groups(t=4.3142,3.0331,3.7954,all P＜0.05).Conclusion Mifepristone combined with intramuscular injection of methotrexate has significant effect on uterine scar pregnancy after cesarean section.

Objective To explore the value of peak systolic displacement of tricuspid annulus(TAD)in evaluation of right ventricular systolic function by speckle tracking imaging(STI).Methods The study population consisted of 24 healthy subjects(control group)and 16 patients with congestive heart failure(CHF).The apical four-chamber view was obtained and imput to Qlab 6.0 workstation. The TAD at the right ventricular free wall (TADla)and the midpoint of tricuspid annulus(TADmid)were measured and calculated automatically.Right ventricular ejection fraction(RVEF)was measured by real-time three-dimensional echocardiography.The correlation of displacement parameters with RVEF was analyzed.Results In all 40 subjects, the mean value of TADla was(19.3±5.9)mm with s range from 7.8 to 28.4 mm while the mean value of TADmid was(15.3±4.6)mm with a ranging from 7.2 to 22.2 mm.The parameters in CHF group were significantly lower than those of the control group(P<0.01).TADla and TADmid showed an excellent correlation with RVEF(r=0.87 and 0.91 respectively,P<0.01).The cut-off value of TADla for RVEF<45%was 17.2 mm with a sensitivity of 89%and a specificity of 93% while the cut-off value of TADmid for RVEF<45% was 13.1 mm with a sensitivity of 96%and a specificity of 1 00%.Conclusions TAD by STI showed an excellent correlation with RVEF, and it may be a new promising method for routine evaluation of right ventricular systolic function.

BACKGROUND: The incidence of diabetic peripheral neuropathy (DPN) is affected by various related factors, which can manifeste in patients with simple diabetes mellitus. However, which of these factors are involved in the occurrence of DPN in diabetic patients?OBJECTIVE: To analyze the risk factors for DPN in patients with type 2 diabetes mellitus.DESIGN: A hospital-based one-to-one pair-matched case-controlled investigation.SETTING: School of Public Health, Tianjin Medical University.PARTICIPANTS: Totally 111 outpatients or inpatients with DPN (DPN group) were recruited from the Metabolic Disease Hospital of Tianjin Medical University from December 2002 to November 2003, including 53 males and 58 females. Inclusive criteria: Diagnosed according to the diagnostic standards for diabetes mellitus recommended by American Diabetes Association (ADA) in 1997; Typing for type 2 diabetes mellitus according to the program by ADA in 1997; Decline or disappearance of achilles tendon reflex, knee tendon reflex, etc.; Decline or disappearance of pain sensation and thalposis; Decline or disappearance of diapason vibration sense. Meanwhile, 111 outpatients or inpatients with simple diabetes mellitus were selected as the control group. Informed consents were obtained from all the subjects.METHODS: The patients were investigated at admission or in the outpatient department with self-designed questionnaires, including more than 80 items of general information, past history, family history, etc. The results of laboratory examinations were recorded. The data were catalogized and input into computer. Multivariate conditional logistic regression was used to establish main effect equation for analyzing the risk factors for DNP.MAIN OUTCOME MEASURES: Risk factors for DNP.RESULTS: All the 111 patients with DNP and 111 patients with simple diabetes mellitus were involved in the analysis of results. The protective factors for DNP included higher educational level, intensive treatment, coronary heart disease and tea drinking. The risk factors for DNP included longer duration of diabetes mellitus, poor situation of blood sugar control, treating with insulin, diabetic nephropathy, diabetic retinopathy, history of diabetic ketonemia, more meat intake before diabetes mellitus, vertigo, dryness of skin, hypertension, history of injury, history of smoking, higher waist-to-hip ratio, higher level of blood cholesterol. The results of multivariate Logistic regression analysis showed that the following factors were significantly associated with DPN: longer duration of diabetes mellitus, treating with insulin, vertigo, more meat intake before diabetes mellitus, alcohol drinking and history of injury (operation, frostbite, etc.).CONCLUSION: DPN is related to various risk factors, such as longer duration of diabetes mellitus, treating with insulin, vertigo, alcohol drinking, more meat intake before diabetes mellitus, history of injury, etc., which all can increase the risk of diabetic neuropathy in patients with type 2 diabetes mellitus. Patients and physicians should pay more attention to these risk factors during the course of prevention and treatment.