Objective To probe the feasibility and efficacy of damage control orthopedics(DCO) in treating multiple injuries.Methods A retrospective analysis was done on clinical data of 41 case with multiple injuries treated by DCO from 1995 to 2005.Results Devascularization of internal iliac arteries was performed in 29 cases with multiple injuries complicated by massive bleeding and fractures of the pelvis,of which 23 were treated with ligation of bilateral internal iliac arteries and eight with angioembolization of bilateral internal iliac arteries.External fixation cage for the pelvis was used in an early period in 10 cases,primary debridement with simple external fixation in 10 with multiple injuries complicated by open femoral fractures and simple laminectomy in two with spinal fractures combined with spinal cord compression.All cases received discriminating internal fixation posterior to resuscitation in ICU.The overall mortality rate was 12.1%(5/41),with average injury severity score(ISS) for 41.4 and with shock and associated injury as the main causes for death.The complications occurred in seven cases including three with acute respiratory distress syndrome(ARDS),one with thrombosis of right common iliac artery,two with subphernic abscess and one with deep wound infection of the lower extremities,all of whom got cured.Conclusions Prompt diagnosis and integration of treatment are key to enhancing the survival rate of multiple injuries.In the meantime,DCO is effective and safe for cases with multiple injuries.

OBJECTIVE To reduce or avoid the risk factors of idiopathic sudden hearing loss in Qinghai. METHODS The clinical data of 143 sudden hearing loss patients was analyzed in Qinghai by the questionnaire. RESULTS The high incidence of sudden hearing loss happened at 2 to 6 hours after waking up in the morning. And most of the patients occurred at 18～50 years old(accounted 70.63%). 79.65% of the patients were mental laborers, 57.34% were drinkers, and 59.44% were very tired before illness. There were significant differences(P

Objective To explore the early diagnosis, option of the surgical procedures, preven-tion and treatment of the complications in patients with pancreatic trauma.Methods All patients with pancreatic trauma during the past 20 years were studied retrospectively in respect of sex, age, cause of injury, grade by AAST, style of operation, therapeutic efficacy, complications and factors for death etc.Statistical analysis was made with Chi-square test.Results In all 148 cases of the present series, 132 underwent surgical interventions including simple suture or external drainage alone, distal pancre-atectomy, distal pancreaticojejunostomy or other internal drainage, diverticularization, Whipple's pro-cedure, and Damage Control Surgery (DCS) etc.Postoperative morbidity was 27.83% with a signifi-cant difference of the incidence of pancreatic fistula between pancreas grade Ⅲ-Ⅴ injuries and grade Ⅰ-Ⅱ(P＜0.01).The mortality rate was 11.49%.The cause of the deaths was mainly massive bleed-ing due to severe associated injuries(76.47%).Among various grades, the difference of the mortality was not significant (P＞0.05).Conclusion To improve the survival rate, it is important to control massive hemorrhage from associated injuries precedes dealing with pancreas trauma.Selection of surgi-cal procedures should be based on whether the main duct is injured.The removing of devitalized tis-sue, adequate external and internal drainage are essential for treatment of pancreatic injuries.Early recognition of pancreatic injury and correct choice of surgical procedures may obviously decrease the in-cidence of postoperative complications.

OBJECTIVE:To optimize the preparation technology of roxithromycin microspheres.METHODS:The microspheres of roxithromycin were prepared by the emulsion-solvent diffusion method with ethylcellulose used as capsule wall material.The preparation technology of microspheres was optimized by orthogonal experiment taking encapsulation efficiency as index with the ratio of roxithromycin to ethylcellulose(A),the concentration of ethylcellulose(B)and the ratio of water phase to oil phase(C)as factors.The appearance,particle diameter,drug-loading amount,encapsulation efficiency,in vitro release and bitter smell were studied.RESULTS:The optimal preparation conditions were as follows:A was 1∶1,B was 30 ?g?mL-1 and C was 4∶1.The microspheres obtained were round and well-distributed with mean diameter of 75.0～90.0 ?m,drug-loading amount of 45%～46%,encapsulation efficiency of over 90% and sustained release for over 13 hours.No bitter taste of the roxithromycin-ethylcellulose microspheres was felt by the majority of subjects.CONCLUSION:The roxithromycin microspheres made by optimization technology was bitter-masked and sustained release.

Based on microfabrication technology and electrochemical modification method, a micro electrochemical sensor for nitrate ( NO-3 ) determination was developed. A micro sensor chip with working electrode and counter electrode was used as the signal convertor of the sensor. The area of the micro working_electrode was only 1 mm2 . As an electrocatalysis sensitive material, copper was electrodeposited onto the working electrode by square_wave pulse current electrodeposition method. The morphologies and components of freshly deposited materials were examined by scanning electron microscopy ( SEM ) and X_ray diffraction ( XRD) to explore key factors that affected the electrocatalytic ability of the deposited copper layer for reducing nitrate ions. The experimental results revealed that under the optimal conditions, the deposited copper layer was macroporous and had a larger effective surface area that could serve as a more effective electrocatalyst in facilitating nitrate reduction. Electrochemical response of the macroporous copper layer was characterized by linear sweep voltammetry in acidic supporting electrolytes ( pH=2 ) . The electroanalytical results showed that the modified microsensor had marked sensitivity for standard nitrate samples within the concentration range from 12. 5 to 3000 μmol/L (in the range of 12. 5-200 μmol/L yielded straight line:y1=-0. 1422x-10. 326, R12=0. 9976, while in the range of 200-3000 μmol/L yielded straight line: y2=-0. 0984x-22. 144, R22=0. 9927) with a detection limit of 2 μmol/L (S/N=3). The developed electrochemical microsensor was also employed for nitrate determination in water samples collected from lakes and rivers near the city of Beijing. The results were in good agreement with the data given by qualified water quality detection institute, with the deviations from 3 . 9% to 15 . 4%.

Objective To probe timely diagnosis and surgical intervention of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 161 patients with TDR treated surgically in our department during the past 17 years were analyzed retrospectively in respects of diagnostic methods,accuracy of preoperative judgment of TDR,incidence of diaphragmatic hernia,surgical procedures and outcome,etc. Results There were 139 males and 22 females at a mean age of 32.4 years(9-84 years),with average ISS of 27.8 points(13-66 points).Of all patients,65.2%had shock at admission.For these 161 patients,36 suffered from blunt injuries and 125 from penetrating injuries.For diaphragmatic injury.preoperative diagnostic rate was 88.9%for blunt injuries and 78.4%for penetrating injuries (P＞0.01).The incidence of diaphragmatic hernia was 94.4%in blunt injuries and 14.4%in penetrating injuries(P＜0.05).In this series,thoracotomy was performed in 30 patients,laparotomy in 106,thoracotomy plus laparotomy in 18 and combined thoraco-laparotomy in 7,with overall fatality rate of 10.6%and a mean ISS of 41.6 points.The mortality rate was 22.2%in blunt injuries and 7.2%in penetrating injuries(P＜0.01).The main causes for death were hemorrhagic shock and septic complications; Conclusions Blunt diaphragmatic injury can be diagnosed by radiographic signs of diaphragmatic hernia.According to"offside sign",which implies a thoracic wound with positive physical or radiological signs in the abdomen or in the thorax,penetrating diaphragmatic injury can be recognized.To deal with diaphragmatic hernia,it is important to judge the vitality of viscera.Penetrating injury has a relatively good prognosis.

Objective To assess the clinical value of laparoscopic colorectal resection combined with simultaneous radiofrequency ablation for liver metastases.Methods Twenty-two patients with colorectal cancer and synchronous liver metastases were treated by laparoscopie colorectal resection and simultaneous radiofrequency ablation(RFA)in Third People's Hospital of Chengdu from December 2001 to July 2006.Areas of colliquative necrosis were detected by contrast-enhanced computed tomography postoperatively.The outcomes were analyzed by chi-square test.Results Of all patients,8 had muhiple liver metastases,16 had complications.Thirty-one liver metastases were treated by RFA,and no complication oecurred.The mean postoperative hospital stay was(14±5)days,and there was no perioperative death.Five of the 22 patients were identified as incomplete ablation of the tumor,and the RFA was reperformed.The recurrence of liver metastases in the RFA necrotic zone was observed in 4 patients,and RFA was reperformed on 2 of them.Six patients died,and 2 of them died of liver metastases recurrence in the RFA necrotic zone.The recurrence rate of liver metastases and mortality was 18%(4/22)and 27%(6/22),respectively.The recurrence rate of patients with the diameter of the metastatic lession≥2.0 cm was significantly higher than those with the diameter of the metastatic lession＜2.0 cm(x2=5.867,P＜0.05).Conclusions Laparoseopie colorectal resection combined with simultaneous RFA provide a curative opportunity for colorectal cancer patients who are old and have multiple liver metastases,complications,poor tolerance of operation,and for patients whose tumors are difficult to resect.

Objective To investigate the correlation between serum procalcitonin (PCT) levels and infection sites,as well as between PCT and bacterial species in gram negative (G-) bacteria induced sepsis,so as to provide rationale for therapeutic strategy of using antibiotic in sepsis.Methods The data of patients with sepsis admitted in Emergency Department and ICU from January 2014 to June 2015 were retrospectively analyzed.The blood culture of G-bacteria and PCT detection were carried out simultaneously within 24 hours after admission.The clinical data was analyzed to find out the correlation between PCT levels and infection sites,as well as between PCT levels and pathogenic bacterial species.Results A total of 187 specimens (came from 162 patients) were enrolled in the study with a median age of 70 years old and a median sequential organ failure assessment (SOFA) score of 4.PCT levels were found to be associated with bacterial species.PCT level caused by Escherichia coli bacteremia infection was higher than that caused by Acinetobacter baumannii bacteremia and Burkholderia cepacia bacteremia infection (4.62 ng/mL vs.2.44 ng/mL;4.62 ng/mL vs.0.81 ng/mL;P ＜ 0.05).Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) for PCT was 0.61 to discriminate Escherichia coli infection from Acinetobacter baumannii infection and an AUC was 0.66 to discriminate Escherichia coli infection from Burkholderia cepacia infection.When the cutoff point of PCT was 30.32 ng/mL,it could predict Escherichia coli infection rather than Acinetobacter baumannii infection with 94.10％ specificity,90.00％ positive predictive value and positive likelihood ratio for 4.24.When the cutoff point of PCT was 8.01 ng/mL,it could predict Escherichia coli infection rather than Burkholderia cepacia infection with 85.70％ specificity,93.94％ positive predictive value,and positive likelihood ratio for 3.01.When PCT cutoff value reached 47.31 ng/mL,the specificity and positive predictive value were both 100.00％.PCT level caused by urinary tract infection was higher than that caused by pulmonary infection (11.58 ng/mL vs.2.07 ng/mL,P ＜ 0.05),and the AUC was 0.69.When the cutoff point of PCT was 32.11 ng/mL,it could predict Escherichia coli infection rather than Acinetobacter baumannii infection with 90.60％ specificity,86.18％ negative predictive value and positive likelihood ratio for 3.68.Conclusions PCT elevation in G-bacteria induced sepsis might be associated with infection sites and bacterial species.

Objective To probe into the feasibility and efficacy of damage control surgery (DCS) in treating severe pelvic fracture combined with abdominal organ injuries.Methods A retrospective analysis was done on the clinical data of 39 patients with severe pelvic fractures combined with abdominal organ injuries treated by DCS from 1995 to 2010.Results Devascularization of internal iliac arteries was performed to treat massive hemorrhage in the 39 patients with severe pelvic fractures combined with abdominal organ injuries,including ligation of bilateral internal iliac arteries in 31 palients and angioembolization of bilateral internal iliac arteries in eight.Meanwhile,early pelvic external fixators were used in 31 patients.All patients received discriminating internal fixation after resuscitation in ICU.The overall mortality rate was 21％ (8/39),with average ISS of 41.6 points and with hemorrhagic shock and combined injury for the main causes of death.Complications occurred in seven patients including combined acute respiratory distress syndrome (ARDS) in three patients,thrombosis of right common iliac artery in one,subphernic abscesses in two,and deep infection of lower extremity in one,but all the complications were cured.Conclusions Reasonable and timely use of DCS can enhance the rescue survival rate of patients with severe pelvic fraclure combined with abdominal organ injuries.

Objective To probe the causes,early recognition and effective therapy of posttraumatic biloma.Methods The data of all patients with the injury of the liver and bile duct treated in our center during the past 10 years were reviewed.Patients,diagnosed with biloma were retrospectively analyzed in respects of sex,age,cause of biloma,methods and efficacy of diagnosis and treatment.Results There were 46 patients with biloma.Of them,40 were found after liver trauma of grade Ⅲ-Ⅴ.The incidence of biloma was 15.2％ (40/263).In grade Ⅳ,Ⅴ,and Ⅲ,it was 22.6％ (31/137) and 7.1％ (9/126) respectively (x2 =12.20,P ＜ 0.01) and in blunt and penetrating injury,it was 19.3％ (35/181) and 6.1％ (5/82) respectively (x2 =7.67,P ＜ 0.01).Of these 40,36 were found during the course of conservative therapy of severe liver trauma; and 4 were found after laparotomy for the liver trauma.The remaining 6 cases of biloma had a history of injury to extrahepatic bile duct with a incidence of 18.8％(6/32).All 46 patients received spiral CT scaning plus MRI in 9,and ERCP in 11.Of those 40 with biloma after severe liver trauma,28 were cured by ultrasound-guided or computed tomography scan-guided pigtail drainage; and the remaining 12,in whom the biloma volume ＜ 30 cm3 resolved spontaneously.Six patients in whom the biloma as a result of injury to extrahepatic bile duct were cured by surgical intervention.There was no death and complication related with the therapy of biloma.Conclusions Attention should be given to biloma formation,when nonoperative therapy is exercised for severe liver trauma.Ultrasound-or CT scan-guided pigtail drainage is an effective option,but those due to injury of extrahepatic bile duct require surgical intervention.