Aim To test the strength of Kraekow bilateral locking stitchfor tendon or ligament free end fixation and evaluate the stitch which wasused in reconstruction of cruciate ligament or secure fixation of soft tissue tobone. Methods Twenty-four specimens of patellar tendon free end, whichwere divided into 3 groups according 2 or 3 stitches and 6 subgroups ac-cording No1 Ethilon or 0.4 mm diameter stainless steel wire different suturematerials, fixed with Krackow locking stitch, were undertaken the tensiletest respectively, so as to find out the least stitches and efficient suture pat-tern. Results 2 Krackow locking stitches had more strength than that of0.4 mm diameter stainless steel wire, the fixation strength of 2 stitcheswhich used No1 Ethilon was more than 80 N, superior to the failure strengthof material itself, it still maintained the same strength if the first stitch wasacross the tendon tissuetransversely. There was no significant differencebetween 2 and 3 Krackow locking stitches in suture strength statistically, thefixation strength was superior to the suture material, it could reduce the'suture exposure when the first stitch is across the tendon tissue while main-tains a comparable strength to other suture. Conclusion If attempt to makea higher strength of suture, we should focus on selecting a stronger materialsor adding the suture materials in number rather than the stitch number.

The diagnosis of polypoid lesions of the gallbladder plays a key role in the selection of treatment methods.However we still lack of effective means to exclude the malignant transformation currently.It is believed that lesions,whose diameter more than 10 mm,tend to be malignant.In addition,multiple imagings and related risk factors can also bring us some valuable tips.This article summarizes the current research progress related to the differential diagnosis of the disease,hoping to provide help for the clinicians in the timing of operation for such disease.

Objective To investigate the effect of the personalized nursing care plan sheet for critically ill patients in the emergency intensive care unit. Methods The personalized nursing care plan sheet including general, personalized nursing issues and related measures was designed according to the standard from the nursing department. A group of 116 critically ill patients were divided into the observational group (58 patients) and control group (58 patients) from January 2012 to September 2014. The personalized nursing care plan sheet were applied for record and hand over in the observational group, while the unified problem statement nursing care plan sheet were used in the control group. The indicators of nursing quality were observed in the two groups and the nurses′satisfaction with the nursing care plan sheets was compared. Results The nursing quality in the observational group was higher than it in the control group with the lower incidence of failure rate in fundamental nursing, professional nursing, plan sheet, disease treatment and adverse event (32.76% vs. 62.07%,37.93% vs. 67.24%,29.31% vs. 68.97%, 20.69% vs. 53.45%, 10.34% vs. 72.41%, the χ2 values were 2.98, 2.98, 4.09, 3.46 and 6.60 respctively, P<0.05). The nurses′satisfaction with the personalized nursing care plan sheet was also higher than the unified problem statement nursing care plan sheet (P<0.05). Conclusion The incidence of nursing defects could be reduced by avoiding the incomplete nursing assessment and omitted nursing plan.

Objective To compare the clinical value of three-dimensional dynamic contrast enhanced magnetic resonance angiography (3D DCE MRA) and digital subtraction angiography (DSA) in diagnosing inferior vena cava diseases in suspected case of Budd-Chiari syndrome (BCS).Methods Radiological findings of 91 suspected BCS cases obtained from 3D DCE MRA and DSA in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.DSA test was considered as golden standard,which assess the capacity of 3D DCE MRA in diagnosing inferior vena cava diseases,including sensitivity,specificity and accuracy.Kappa test was utilized to compare the coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases.Results Among 91 suspected BCS cases with 3D DCE MRA,a total of 17 cases without inferior vena cava diseases were misdiagnosed as inferior vena cava stenosis,two patients with inferior vena caval obstruction was misdiagnosed as falsely negative.Seventy-two patients with 3D DCE MRA were confirmed via DSA in diagnosing inferior vena cava diseases,sensitivity was up to 97.7％ (58/60),false positivity 54.8％ (17/31),specificity 45.2％ (14/31),respectively.Fair coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases (Kappa =0.474,P ＜ 0.05).Conclusions There could be clinical value of 3D DCE MRA for its high sensitivity and low specificity in diagnosing inferior vena cava diseases,and favorable coincidence ratio was discovered between 3D DCE MRA and DSA.Comprehensive consideration is needed for suspected cases of inferior vena cava stenosis detected by 3D DCE MRA,and further analysis may figure out potential causes of misdiagnosis and decline false positive events.

Objective To investigate the effect of emergency case video segmentally introduction combining with simulation in cultivation of undergraduate nursing students′skills of trauma management. Methods A group of 55 undergraduate nursing students, recruited in the control group from September 2013 to April 2014, were instructed by traditional teaching method, the trauma management skill was delivered by lecture, video and group based practice. Another 50 undergraduate nursing students, recruited in the observation group from September 2014 to April 2015, were located in the simulation group, while the key point of trauma management was segmentally introduced by emergency case video, the skill of trauma management was delivered by lecture and video, a multiple injury case scenario was used for group practice. The score of the practice test and the evaluation of the teaching were compared among the two groups. Results The students in observation group demonstrated more skilled trauma management compared with that in the control group (90.42±8.50 vs. 84.68±8.77, t=3.56, P<0.05). The students in observation group presented significantly higher satisfaction with the teaching, improving study interesting 93.33%(56/60), promoting the theory knowledge deepen 91.67%(55/60), improving the ability of thinking and observation 95.00% (57/60/) , improving the ability of analyzing and solving problems 100.00% (60/60), enhancing the ability of independent learning 96.67%(58/60), while in the control group, they were 76.36%(42/55), 69.09%(38/55), 65.45%(36/55), 69.09%(38/55) and 80.00%(44/55), the differences between the two groups were significant (χ2 =2.30-4.40, P < 0.05). Conclusions Application of emergency case video segmentally introduction combining with simulation provided more opportunity to the undergraduate nursing students to apply relevant knowledge in analyzing and dealing with trauma cases, which contributes to the improvement of undergraduate nursing students′ skills of trauma management.

Objective To investigate the surgical method and clinical efficacy of hilar cholangio carcinoma in Bismuth type Ⅳ.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with hilar cholangiocarcinoma in Bismuth type Ⅳ who was admitted to the Renji Hospital affiliated to Shanghai Jiaotong University in October 2014 were collected.The patient had complaint about right upper abdominal pain for half month.Enhanced CT scan showed soft-tissue mass at hepatic hilum.After accurate assessment,the patient underwent radical resection of hilar cholangiocarcinoma + right hemihepatectomy + perihilar resection + right caudate hepatectomy + Roux-en-Y hepaticojejunostomy.The operation time,volume of intraoperative blood loss,results of pathological examination,postoperative complications,time of drainage tube removal,discharge time and follow-up were observed.The follow-up was performed to detect the life quality and tumor recurrence by outpatient examination and telephone interview up to July 2015.Results The patient received successful radical resection of hilar cholangiocarcinoma + right hemihepatectomy + perihilar resection + right caudate hepatectomy + Roux-en-Y hepaticojejunostomy.Operation time and volume of intraoperative blood loss were 480 minutes and 300 mL,respectively.The result of pathological examination showed that the size of hilar bile duct was 4 cm× 3 cm × 2 cm and poor-differentiated adenocarcinoma infiltrated through bile duct into liver tissues and right branch of portal vein.Two lymph nodes in the 8th group,1 in the 12a group and 3 in the 12p group were positive by detection,showing the metastasis of cancer cells.The resection margins of liver and bile ducts were negative,achieving a R0 resection.The patient had a removal of negative pressure drainage tube at postoperative day 7 and discharged from hospital at postoperative day 12,with a good recovery and without the complications of biliary fistula,abdominal infection and hepatic failure.During the 9-month follow-up,there was a good life quality and no tumor recurrence.Conclusion The radical resection rate of Bismuth type Ⅳ tumor can be increased by accurate preoperative evaluation,rational surgical approach,individualized surgical planning and precise intraoperative procedures.

Objective To analyze the safety and effectiveness of ambulatory surgery in inguinal herniorraphy.Methods The clinical data of 3 852 cases of inguinal hernia repair patients admitted from January 2009 to December 2013 in this single center was analyzed retrospectively.Cases of emergency surgery were excluded.Results All patients had long-term follow-up (12-60 months).1 575 patients underwent day-surgery,mean operation time was (43.84 ± 12.35) min,mean time of ambulation was (1.12 ± 0.91) d,mean time of recovery was (5.78 ± 1.12) d,mean hospitalization was (1.34 ± 0.48) d,mean hospitalization cost was (7 546.49 ±2 962.57) RMB.In contrast,there were 511 patients underwent a non day-surgery,mean operation time was (48.59 ± 14.52) min,mean time of ambulation was (2.43 ± 1.38) d,mean time of recovery was (7.46 ± 2.62) d,mean hospitalization was (4.8 ± 2.91) d,mean hospitalization cost was (9 165.16 ± 4 281.83) RMB.Patients with day-surgery were significantly superior to those with non day-surgery in operation time (P =0.000),mean time of ambulation (P =0.000),mean hospitalization (9 =0.000),mean hospitalization cost (P =0.000) and mean time of recovery (P =0.000).Infection and readmission in non day-surgery patients was higher than that in day-surgery (P =0.000).There was no difference in postoperation pain and hernia recurrence.Conclusions Ambulatory surgery in inguinal herniorraphy is safe with similar recurrence rate;but significantly lower cost and shorter hospitalization.

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Objective To investigate the clinical effects of preoperative eye position training on femtosecond laser-assisted laser in situ keratomileusis(FL-LASIK)? Methods One hundred and sixty-eight myopia patients(328 eyes)scheduled for selective FL-LASIK were randomly divided into the experiment group of 85 cases(166 eyes)and the control group of 83 cases(162 eyes)?The patients in the control group were given the routine preoperative education and the patients in the experiment group received the preoperative intervention of eye position besides routine preoperative education? The two groups were compared in terms of intraoperative changes of eye position,corneal topography and the postoperative visual acuity? Results The frequency of eye position adjustment and machine stopping in the experiment group was significantly smaller than that of the control group(P < 0?001)? But no significant differences were found between the two groups in corneal topography and the postoperative visual acuity(P > 0?05)? Conclusion Preoperative training of eye position may maintain ideal eye position and reduce the frequency of downtime due to eye position adjustment during FL-LASIK,which may ensure the successful completion of FL-LASIK?

Objective To evaluate the effect of dexmedetomidine on the intestinal mucosal injury in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 40-75 kg,of ASA physical status Ⅱ or Ⅲ (NYHA class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and dexmedetomidine group (group D).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with 0.8％-2.0％ sevoflurane inhalation and intermittent iv boluses of sufentanil 0.5-1.0 μg/kg and vecuronium 0.04-0.06 mg/kg.Before routine induction of anesthesia,a loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min,followed by continuous infusion at 0.3 μg · kg-1 · h-1 until the end of surgery in group D,while the equal volume of normal saline was given in group C.Before CPB,at 30 min after aortic clamping,at the termination of CPB,at the end of surgery and at 6 and 24 h after surgery,central venous blood samples were taken for determination of concentrations of tumor necrosis factor-alpha,interleukin-6 (IL-6) and IL-10 and intestinal fatty acid binding protein in plasma (by ELISA),and the plasma concentration of endotoxin (using turbidimetry).The time of postoperative mechanical ventilation and duration of ICU stay were recorded.Results Compared with group C,the concentrations of tumor necrosis factor-alpha,IL-6,IL-10 and endotoxin and intestinal fatty acid binding protein in plasma were significantly decreased,and the time of postoperative mechanical ventilation and duration of ICU stay were shortened in group D.Conclusion Dexmedetomidine infused continuously at 0.3 μg · kg-1 · h-1 (until the end of surgery) after a loading dose of 1 μg/kg before routine induction of anesthesia can reduce intestinal mucosal injury in the patients undergoing cardiac valve replacement with CPB.