ObjectiveTo investigate relationship between the degree of placenta praevia, vaginal bleeding and clinical outcomes. MethodsRecords of 89 patients with placenta praevia(mild praevia group 43; severe praevia group 46) were reviewed retrospectively, and outcomes were compared. ResultsThe gestational age at the first bleeding and diagnosis was significantly smaller in severe group than that in mild one (P<0.05). The incidence of antepartum haemorrhage, the times of bleeding and the episodes of heavy bleeding in two groups showed no significant differences(P>0.05). The gestational age at diagnosis and delivery and birthweight were significantly smaller in women with antepartum bleeding than in those without( P<0.01 ). The number of deliveries by emergency caesarean section in women with antepartum bleeding was significantly higher than that in those without (P<0.01). ConclusionThe clinical outcomes of placenta praevia are highly variable. There are no obvious clinical features that are typical in predicting the clinical outcomes. The number of bleeding episodes and the degree of praevia are not associated with outcomes, so they can't be the proof to determine the treatment plan ahead of time.

Objective To discuss the clinical application and therapeutic effect of repairing deformed thumb in the way of transposition of abandoned polydactyly with neurovascular bundles.Methods From January 2005 to December 2011,six cases of type Ⅳ deformities of thumb duplications were treated with excision of thin and deformed thumb phalangette of trunk,the redundant hyperdactylia,which was well-formed and involved in the first web space,was then transposed with neurovascular bundles to the thumb phalangette of trunk by the first web space and the side of thumb for fixation followed by repairation of form of thumb phalangette.The surplus metacarpal bone and phalanx of duplications were removed and the first web space was reconstructed.Results All 6 cases of heterotopic thumb phalangette transplanted to the deformed thumb phalangette were completely survived.Kirschner wires were removed 4 weeks after operation.Fracture healing occured after 4 to 6 weeks after operation.Postoperative follow-up period ranged from 3 months to 1 year.Transplanted thumbs possessed well-formed appearance with previous sensation on the finger pulp as well as excellent function of grabbing and opposing.Conclusion To repair deformity of trunk thumb in the way of microsurgery by means of transposition of duplicated thumb with neurovascular bundle which should be abandoned,is a simple operation with satisfactory and reliable postoperative effect.It shall be spred and applied.

Objective:To determine the inflammatory factor levels and inflammatory cell percentages in the patients with cough variant asthma (CVA ), and to clarify their potential role in the pathogenesis of CVA unresponsive to bronchodilator treatment.Methods:60 patients with CVA were randomly selected and divided into CVA unresponsive to bronchodilator treatment group (n=30)and CVA responsive to bronchodilator treatment group (n=30).As the same time 30 cases of healthy persons were used as normal control group.The levels of interluekin-8 (IL-8)and esoinophil cationic protein (ECP)in their induced sputum were detected,the classification of inflammatory cells in their induced sputum were observed, and their scores of cough symptom were recorded. Results:The IL-8 level in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group was higher than that in CVA responsive to bronchodilator treatment group and normal control group (P<0.05).The ECP level in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group was lower than that in CVA responsive to bronchodilator treatment group (P<0.05),but it was similar to the level in normal control group (P>0.05).The neutrophil percentages in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group were higher than those in CVA responsive to bronchodilator treatment group and normal control group (P<0.05).The scores of cough symptom of the patients in CVA unresponsive to bronchodilator treatment group was positively correlated with IL-8 level (r=0.764,P<0.01), and the scores of cough symptom of the patients in CVA unresponsive to bronchodilator treatment group was positively correlated with the neutrophil percentage in induced sputum (r=0.889,P<0.01).Conclusion:IL-8 and neutrophil may be associated with the incidence of CVA unresponsive to bronchodilator treatment. They can aggravate the inflammation and hypersensitivity of airway and cough symptom. The determination of IL-8 and neutrophil can be used as an accessory method in the diagnosis and j udgement of severity degree and curative effect of CVA in clinic.

Objective To observe the effect of the modified Yulin Decoction on improving the living quality of patients with yang-deficiency of the spleen and kidney of premature ovarian failure. Methods One hundred and twenty-seven patients were divided into experimental group (80) and control group (47) by non-randomized noninferiority comparative study. The experimental group was treated with modified Yulin Decoction daily orally once a day. The control group was treated with oral estradiol valerate and progesterone cycle. Two groups received continuous medication for 21 d, and treatment interval was 5 d. Three cycles of treatment were set as one course, and treated for 2 courses. The SF-36 scale was used to calculate the total scores and scores of eight dimensions before and after treatment. Results Before treatment, there was no significant difference (P>0.05) in the scores of SF-36 dimensions (except somatic pain) and total score between the two groups. Compared with before treatment, the score and total score of SF-36 in the experimental group increased (P<0.05, P<0.01). The mental health score of the control group was higher than that of before treatment (P<0.05, P<0.01). After treatment, there was statistical significance in the two dimensions of vitality and mental health in the two groups (P<0.05). There were significant differences (P<0.01) in the total score and scores of SF-36 physiological function, physical pain, general health, vigor, social function, emotional function and mental health between the two groups. Conclusion Modified Yulin Decoction can improve the living quality of patients with yang-deficiency of the spleen and kidney of premature ovarian failure.

ObjectiveTo determine the levels of type Ⅳ collagen and matrix metalloproteinase-9 ( MMP-9 ) in the serum and kidney of rats with the multiple organ dysfunction syndrome ( MODS ) and investigate the mechanism of extracellular matrix damage in renal failure of MODS.MethodsForty adult male Sprague- Dawley (SD) rats were randomly (ramdom number) divided into two groups,namely the normal control group ( n =8 ) and the MODS model group ( n =32 ).The rats of model group were further divided into four sub-groups as per different intervals,6 h,12 h,24 h and 48 h,after modeling (n =8 in each).The animal models of MODS were established by two hits,the left eyeball of each model rat was removed to bleed to 2 ml bloocd/100 g body weight and lipopolysaccharide ( LPS,5 mg/kg) was injected into intraperitoneal cavity of model rats four hours later. The same volume of saline instead was injected intraperitoneally into rats of control group.All rats were sacrificed at different intervals.Creatinine (Cr)and blood urea nitrogen (BUN) were determined by using a Hitachi Automatic Biochemical Analyzer.The histological changes in renal tissue were observed under light microscope and transmission electronic microscope.The levels of serum type Ⅳ collagen and MMP - 9 protein were measured by using enzyme linked immunosorbent assay (ELISA).Type Ⅳ collagen and MMP- 9 protein levels in renal tissue were detected by western blot.One - way ANOVA was used for comparison among multiple groups.Results Compared with the control group,Cr and BUN were significantly higher in MODS group ( P ＜0.05 ).There were no histopathological changes in kidney of rats in control group,and the renal injury was serious in rats with MODS.The remarkable edema of basement membrane and defect of collagen fibers in renal tissue were observed in MODS group.Compared with the control group,the levels of MMP-9 in serum increased 6-48 hours after modeling and peaking at interval of 12 hours after modeling ( P ＜ 0.05 ).The protein levels of type Ⅳ collagen increased not significantly in 6 h group and 12 h group in comparison with control group (P ＞ 0.05 ),while those in 24 h group and 48 h group significantly increased ( P ＜ 0.01 ).The levels of MMP -9 in renal tissue of rats with MODS increased in 6 h group and 12 h group (P＜0.05),peaked in 24 h group ( P ＜ 0.05 ),and decreased in 48 hours.However,the level of Ⅳ collagen in serum of rats with MODS decreased significantly 6-48 hours after modeling (P ＜ 0.05 ) Conclusions The injury of extracellular matrix is an important factor to the kidney damage in MODS and it may he used for early diagnose and as a treatment target for kidney injury in MODS.

ObjectiveTostudy the value of color Doppler sonography in diagnosisof rhabdomyolysis.Methods The color Doppler sonography images of twenty-one patients with diagnosed rhabdomyolysis were retrospective analyzed.The pathological changes of the muscle were observed.Results The appearance of ultrasound was cloundness and rough-cast glass change in the diseased area of rhabdomyolysis.The diseased region can be found by ultrasound,and location and scope can be displayed clearly.There were major differences in the location of rhabdomyolysis because of etiological factor.The muscle volume and tension of rhabdomyolysis were increased for trauma,the individual patients will lead to the osteofascial compartment syndrome.There was no blood flow signal or little blood flow signal in the diseased area of rhabdomyolysis.Conclusions The color Doppler sonography is an efficient method for diagnosis of rhabdomyolysis.

Objective: To investigate the relationship between type 2 diabetes mellitus (T2DM) and the pathogenesis and metastasis of colorectal cancer. Methods: A case-control study was performed to compare 852 colorectal cancer patients with 940 controls (patients without cancer) recruited from 2001 to 2006, with respect to their sex, cancer subsite, the course of T2DM, hepatic metastasis, smoking and drinking. Correlated risk factors were analyzed. Results: The risk of colorectal cancer was increased in patients with T2DM and the relative risk (OR) was 2.466. The OR of male patients was higher than that of female patients, but with no significant difference (2.775 vs 2.070, P=0.394). The incidence of T2DM in patients with left hemicolon cancer was higher than that in those with right hemicolon cancer and rectal cancer, but with no significant difference between them. The colorectal cancer risk in T2DM patients with a DM course of 10 ～ 20 years was the highest, and the OR was 4.696. The rate of hepatic metastasis was higher in T2DM patients with colorectal cancer than that in celorectal cancer patients without T2DM and the OR was 2.888. Conclusion: T2DM may be one of the important pathogenic risk factors for colorectal cancer. The OR is increased with the extension of DM course within 20 years. Colorectal cancer patients with T2DM may be more prone to hepatic metastasis.

Objective To introduce 13 clinical cases of reconstructing traumatic defect on skin of thumb and first web using nail skin flap of big toe connectedwith tibial flap of second toe.Methods From May 2003 to April 2007,a series of 13 case8 of traumatic thumb and first web defect were treated by transplantation of nail skin flap of big toe connecting with tibial skin flap of second toe.Among which two total hand degloving injury cages were included too.Two kind of way according the Gilbert type of the Ist metatarsus dorsal artery were used.Results All the cases were successful and healed by first intention.The contour of reconstructed thumbs showed to be normal or approximately normal.Follow-up examination were obtained in nine cases for 3-17 postoperative months(average 7 months).Sensations of pain,touch and temperature recovered.The two-point-discrimination sensation were found to be 7-17 mm respectively.Opposition measured were 60°-85°(average 75°).All the patients can be back to work and restored activities of daily living.Conclusion In treating soft tissue defect of thumb and first web,transplantation of the nail skin flap of big toe connecting with tibial lateral skin flap Can yield ideal skin covering and exceHent motor function.

Objective To present some revision surgery for correcting short and bulky outward appearance of reconstructed finger pulp in toe-to-hand transfer. Methods Since Sep. 1998 to Dec. 2006,in a series of 33 patients, 39 fingers had been reconstructed with 2nd toe. In order to change the shape of bulbous distal toe segment into a normal tapering fingertip, revisional operations had been designed, i.e. (1)Excision of bulky skin and excessive soft tissue from one or both sides of the finger pulp. (2)Transfer and inlaid the excised lateral soft tissue flap to the central constricting part of the finger pulp. (3)Full thickness skin graft to palmar central narrow part of toe pulp. 4. Rotational transfer of local lateral "L" shape flap. Results All the patients healed by first intention with no skin necrosis occurred. The bulbous rectangular shaped toe pulp were corrected and outward appearance were much improved in most cases. Though the outward appearance in one simple skin graft case was not satisfactory in correcting flexion deformity of distal segment and increased its circumference. Conclusion In toe-to-hand transfer, the distal segment of reconstructed finger often shown to have an bulbous toe pulp appearance, which may bring psychological burden to the patient and their relatives. Simple revisional surgery recommended here may yield favorable improvement.

Objective To describe the structure and the level of the stress of nursing students in clinic practice,and supply reference for reform of clinical teaching method.Methods Totally 100 undergraduate nursing students in clinic practice,who would graduate from nursing school and begin to work in 2013,were interviewed and investigated.Results The main stress sources were divided into five aspects:recognition,clinical nursing ability,career development,field response and exhaustion of body and mind.Conclusions The structure and level of the stress of nursing students changed a lot.Some new appropriate reform should be introduced into clinic education,in order to help nursing students to complete psychological change and role adaptation.