Objective To investigate the risk factors and outcomes of uteroplacental apoplexy complicating severe placental abruption in order to enhance the accuracy of early diagnosis and decrease the complication of mother and fetus.Methods A retrospective study of clinical data was conducted in 180 cases of placental abruption complicating uteroplacental apoplexy in 58 cases who delivered in the First Central Hospital of Tianjin from January 2007 to December 2011.Risk factors,clinical characteristics and outcomes were compared between the 58 cases complicating uteroplacental apoplexy (experimental group) and the other 122 cases without complicating uteroplacental apoplexy (control group).Results The incidence of placental abruption was 1.3％ (180/14 333),with the rate of uteroplacental apoplexy complicating placental abruption was 0.4％ (58/14 333) of all deliveries and 32.2％ (58/180) of all abruption cases.The duration of disease was significantly longer and the rate of placenta implanted on the posterior wall of uterus was significantly higher in the experimental group (9.14 ± 8.47) h; 63.9％ (23/36)) than in control group (5.88 ±4.31) h; 43.4％ (36/83)) (t =3.426,x2 =6.461 ; P ＜ 0.05).There were significant differences between the experimental group (12.1％,12.1％,13.8％ and 60.3 ％) and the control group (2.5 ％,2.5 ％,0.8％ and 11.5 ％) in postpartum hemorrhage,DIC,acute renal failure and stillbirth (x2 =6.919,6.919,13.929 and 47.388 respectively,P ＜ 0.05 or P ＜ 0.01).Conclusion Long duration of disease and posterior-wall placenta are risk factors for uteroplacental apoplexy complicating placental abruption which may lead to a poor maternal-fetal prognosis.

Eight-year medical program is a new style of medical education and a necessary trend of economic rapid development.In China,the clinical skill training system for eight-year medical students is exploring.Early contact with clinical practice,application simulation medicine and holding reading lecture were used for eight-year medical students of grade 2004 in pediatric clinical clerkship and were confirmed to have better effect.

Objective To evaluate the therapeutic effect and safety of Huangqi Danshen Drop Pill (HDP) for angina pectoris (AP) due to coronary heart disease (CHD) classified as qi- deficiency and blood- stasis syndrome. Methods A multi- center, randomized, double- blind, double- simulation, positive- controlled, parallel group trial was adopted. 209 cases of AP due to CHD classified as qi- deficiency and blood- stasis syndrome were enrolled in this study: 104 in HDP group and 105 in Yangxinshi Tablets group. Results The markedly effective rate was 43.27 % , total effective rate 86.53 % , and total effective rate in improving TCM symptoms 92.31 % in HDP group, which were better than those in Yangxinshi Tablets group(P

1 cm. Postoperative pathological findings showed negative cut surface. No hemorrhage or bile leakage were seen after operation. The abdominal drainage tube was indwelled for 3~4 d. The postoperative hospital stay was 3~5 d. Follow-up checkups for 1~20 months (mean, 12.5 months) revealed no tumor recurrence or incision implantation. All the patients survived. Conclusions Laparoscopic regular hepatic left lateral lobectomy can be carried out safely and effectively in clinically selected patients.

Objective To reveal the hepatitis A vaccine (HepA) coverage among pre-school children in Shandong province before Hepatitis A vaccine was introduced to the EPI and to provide evidence for improving the strategy for hepatitis A control.Methods A cross-section survey was conducted among children aged between 2 and 6 years old in Shandong province in March 2008.The study population was selected by random sampling method and HepA immunization history was obtained by immunization record or recall.Results 78.90% had received one dose of HepA at least.The coverage rate decreased with age and the differences in three age groups were statistically significant (x 2 =11.54,P=0.02).The coverage rates among the boys and girls were 77.67% and 80.30% respectively,the difference was not significantly(x 2 =1.17,P=0.28).The HepA coverage rates among the children living in the eastern areas and in the richer areas were higher than the centrale and western areas and poverty areas,the difference has statistic significance (x 2 =27.25,58.17,P

Objective:Venous indwelling needle has been widely used in clinical treatment as a replacement of scalp acupuncture, and keeps constantly upgrading. Emergency use and nutrient supply by intravenous infusion through venous indwelling needle. The article discusses venous indwelling needle in clinical treatment for dermatological patients. Methods:It compares different complications through two different puncture and sealing methods of venous indwelling needle. Results:It summarizes highly possible complications during and after operating venous indwelling needle, and it proves that the latest puncture and sealing methods of venous indwelling needle could be better for those patients with skin damage, according to the different states of their skin and vein. Conclusion:For dermatological patients, their skin and vein could be protected effectively through the latest clinical methods of venous indwelling needle. The occurrence of many complications and patients’ pain could also be reduced.

Intertrochanteric fracture,a common kind of injury in orthopaedic surgery,often requires surgical intervention,especially the unstable ones.Since far back in 1995,Baumgaertner et al.recommended using the distance between the screw tip and femoral head apex (tip-apex distance,TAD) as a predictor of the risk of lag screw cutout,the importance of TAD has been recognized by orthopaedic surgeons.This concept has been widely accepted in practice,and even used as a standard in determining the helical blade position.It is not clear,however,whether the helical blade system is equal to lag screws in terms of TAD.After the limitations of TAD had been reported,Kuzyk et al.proposed a tip-apex distance referenced from the calcar (Cal-TAD) as a predictor of lag screw cutout to improve the concept further.In this article,these concepts and the latest clinical applications of TAD and Cal-TAD are reviewed based on the publications available.

AIM:We conducted an evaluation of clinical data with meta analysis to investigate the preventive effect of 5-aminosalicylic acid (5-ASA) on inflammatory bowel disease ( IBD)-associated colorectal cancer ( CRC) or dys-plasia (Dys) (IBD-CRC/Dys).METHODS: The information was retrieved from the main databases such as PubMed, Web of Science, the Cochrane Library, etc.All full-text articles about the prevention of IBD-CRC/Dys by 5-ASA were in-cluded if they conformed to the standards.The odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. According to the types of IBD and the treatment course, the subgroup analysis was conducted, respectively.RESULTS:Fifteen articles were selected, including 5 038 IBD patients.Pooled analysis showed a protective association between 5-ASA and IBD-CRC/Dys (OR=0.53, 95%CI:0.37~0.76).Among them, both ulcerative colitis patients (OR=0.45, 95%CI:0.27~0.77) and Crohn disease patients ( OR=0.39, 95% CI:0.16~0.97) with 5-ASA therapy were less likely to develop CRC/Dys compared with those without 5-ASA treatment.5-ASA treatment for 1~20 years shows a pre-ventive benefit (OR=0.43, 95%CI:0.25~0.74).However, a minimum 5-ASA exposure of 2~6 months did not show a preventive benefit (OR=0.59, 95%CI:0.26~1.34).CONCLUSION:5-ASA protects against CRC/Dys in IBD pa-tients.Additionally, the protective effect is treatment time dependent.Treatment course for 1~20 years shows an evident preventive benefit.

【Objective】 To study the incidence, possible etiology, diagnosis and prognosis of endometrial carcinoma with multiple primary carcinom a. 【Method】 45 cases of EC with other primary tumors were eligible for the ret rospective study. 【Results】 Of 1389 cases with EC, the rate of EC accompanied wit h other primary carcinoma was 3.2% (45/1389); the interval between two tumors d iagnosed was ranged from 8 months to 19 years. The percentage of interval more t han 5 years accounted for 62% (16/26). Among these 45 patients, the percentage o f EC complicated by other reproductive tract tumor was 53%(24/45), of them, 19 were synchronous carcinoma. The rate of EC with breast cancer and colo-rectal carcinoma were 169%(7/45), and 11%(5/45) respectively. Clinical staging for pati ents with EC plus multiple primary malignancy were 30 with stage Ⅰ, 9 stage Ⅱ, 3 stage Ⅲ and 2 stage Ⅳ. All patients with first primary tumors were treated by radical treatment. While 8 cases were also treated by radiation and 6 cases t reated by chemotherapy. In this group, all multiple primary tumors were treated by radical therapy. The overall 5-year survival rate was 63%. 【Conclusions】 ①The possibility of second primary tumor, such as female reproductive tract tu mor , breast cancer, and colo-rectal carcinoma should be considered in the patients with EC. ②The etiology of EC with multiple primary tumor may be relevant to th e same embryonic histogenesis, estrogen receptor, radiotherapy and chemotherapy.

Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.