Objective To discuss the difference of preoperative examination and matters needing attention between osteoarthritis(OA)and rheumatoid arthritis(RA)patients who received total knee replacement(TKR).Methods Preoperative examination results were analyzed retrospectively between OA patients(362 cases)and RA patients(91 cases)who received TKR.Results The age of OA patients was significantly higher than RA patients[(66.55±7.78)years vs.(58.93±13.46)years,P＜0.05].There was significant difference in rate of diabetes between OA and RA patients[26.52％(96/362)vs.37.36％(34/91),P＜0.05].There was no significant difference in the rate of lumbar vertebrae disease between OA and RA patients[33.43％(121/362)vs.23.08％(21/91),P＞0.05].The body mass index,haematocrit and hemoglobin in OA patients were significantly higher than those in RA patients[(27.71±3.98)kg/m2 vs.(24.37±4.30)kg/m2,0.38±0.05 vs.0.33±0.06,(130.17±17.59)g/L vs.(111.45±18.56)g/L,P＜0.01].The erythrocyte sedimentation rate,C-reactive protein and D-dimer in OA patients were significantly lower than those in RA patients[(27.77±27.66)mm/1 h vs.(59.76±32.00)mm/1 h,(17.23±27.66)mg/L vs.(30.00±32.27)mg/L,(268.54±299.83)μ g/L vs.(990.09±550.91)μg/L,P＜0.01 or＜0.05].The rate of using glucocorticoid in RA patients was significantly higher than OA patients[8.8％(8/91)vs.0,P＜0.01].There was no significant difference in the rate of urinary system infection(P＞0.05).Conclusions The preoperative examination is found significantly different between OA and RA patients who received TKR.According to different focuses on,dealing with various kinds of complications and correct guidance on preoperative treatment,can ensure the safety of operation.

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan per time. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.
China ; Community Health Services/*economics ; Financing, Government ; Health Care Costs ; *Health Expenditures ; Health Plan Implementation/economics

Objectives:In order to study the immune function after postoperative parenteral nutrition enriched with arginine in patients with gastrointestinal carcinoma. Methods:Forty patients who underwent radical operation of gastrointestinal carcinoma were randomly divided into experimental group( n= 20),in which patients received TPN enriched with arginine,and control group (TPN, n =20).At day 1 before operation,day 1 and day 8 after operation,IgG,IgA,IgM,T cell subgroups.NK cell activity and IL 2 were dectected. Results:The immune function of patients with gastrointestinal carcinoma was depressed at different levels.At day 1 after operation,IgG,IgM,IgA,CD4 +,CD4 +/CD8 +,Nk cell activity and IL 2 decreased more significantly than those before operation.The immunefunction recovered rapidly and exceeded the level before preoperation in experimental group.The difference was significant( P

Objective To analyze the epidemiological characteristics and disease control of epi-demic cerebrospinal meningitis (meningitis) in Xi′an in order to optimize the measurement for disease con-trol and prevention .Methods The reported cases , pathogen surveillance data and immunization coverage for meningitis were analyzed to evaluate the epidemic status , the number of healthy carriers and the disease control efficacy.Results The incidence of meningitis was 22.51/100 000 from 1951 to 1984 in Xi′an. Since the implementation of Expanded Immunity Program in 1984 , the incidence dropped significantly from the average incidence of 4.87/100 000 in 1980′s to 0.59/100 000 in 1990′s.The average incidence of men-ingitis was 0.095/100 000 from 2001 to 2011 and then showed a dramatic downtrend with no cases reported during 2012 to 2013 .Conclusion The analysis suggested that an expanded coverage of vaccine immuniza -tion and an enhanced disease surveillance system for meningitis should be used as the comprehensive meas -urements for the prevention and control of disease .

Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group's mean age was (64.2 ± 6.0)years,mean of preoperative PSA was (14.5±7.6)ng/ml,Gleason score (13 cases≤6,17 cases =7,8 cases ≥8),the mean prostate volume (41.4 ±9.1) ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was (22.8 ± 2.2) kg/m2,mean of MUL (membranous urethral length) was (15.6 ±2.6) mm;34 cases in the 2D group,3D group's mean age was (61.9 ±6.6)years,mean of preoperative PSA was (16.7 ±6.8) ng/ml,Gleason score (10 cases≤6,18 cases =7,6 cases ≥8),the mean prostate volume (42.1 ± 10.6) ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was (21.7 ± 1.9) kg/m2,mean of MUL(membranous urethral length) was (15.5 ± 2.5) mm.All patients got a good function of micturition and urinary continence before the surgery.We compared surgical time,bladder neckurethral anastomosis time and blood loss in two groups.Membranous urethral length(MUL) were measured on preoperative and postoperative magnetic resonance imaging (MRI).Postoperative continence rate was analyzed at 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks and 36 weeks after the remove of the catheter.Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery.The age,PSA value,Gleason score,prostate volume,TNM stage,BMI (body mass index)and other relevant aspects of the clinical data showed no significant difference (P ＞ 0.05).The time of bladder neck-urethral anastomosis is less than the 2D group [(12.9 ± 1.7) min and (15.7 ±2.6) min,P =0.021],MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [(0.5 ±0.1) ml vs.(0.6±0.2) ml,P =0.044],the two groups in operative time [(162.7 ± 17.1) min vs.(175.7 ± 15.7) min,P =0.802],intraoperative blood loss[(191.1 ± 31.6) ml vs.(211.8 ±43.2) ml,P =0.021],intraoperative blood transfusion rate [5.2％ (2/38) vs.8.8％ (3/34),P =0.662],postoperative incidence of urine leakage [7.9％ (3/38) vs.14.7％ (5/34),P =0.463],postoperative the MUL [(15.1 ± 2.6) mm vs.(15.0 ± 2.6) mm,P =0.767),there was no statistically significant differen.All patients were followed up for urinary function at least 36 months.The continence rate between two groups at 8 weeks (60.5％ vs.35.3％),12 weeks (73.7％ vs.47.1％) got significantly difference.Conclusions Compared with 2D laparoscopic,3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy.

Objective To evaluate the efficacy,local control rate,survival rate and adverse reaction of intensity modulated radiation therapy (IMRT) combind with Tp concurrent chemoradiotherapy (docetaxel and cisphtin) for superior segment of esophageal cancer.Methods Seventy-eight patients with superior segment of esophageal cancer were divided randomly into IMRT combined with TP concurrent chemoradiotherapy group (chemoradiotherapy group) and single IMRT group (radiotherapy group) by double blind method with 39 cases each.The patients in chemoradiotherapy group received chemoradiotherapy,while other patients in radiotherapy group received only radiotherapy.For both groups,the same radiation technic was given with chemoradiotherapy,the total dose was 6 400 cGy/32 f.For the patients in chemoradiotherapy group were also given with TP concurrent chemotherapy weekly.The efficacy,local control rate,survival rate and adverse reaction was observed.Results Complete remission in 17 cases,partial remission in 20 cases,stable in 2 cases,the total effective rate was 94.9％ (37/39) in chemoradiotherapy group.Complete remission in 9 cases,partial remission in 19 cases,stable in 11 cases,the total effective rate was 71.8％ (28/39) in radiotherapy group.There was significant difference in the total effective rate between two groups(P ＜ 0.05).The 3-year local control rate was 69.2％ (27/39) in chemoradiotherapy group,which was higher than that in radiotherapy group[35.9％(14/39)],and there was significant difference(P ＜ 0.05).The 3-year survival rate was 74.4％(29/39) in chemoradiotherapy group,which was higher than that in radiotherapy group [43.6％(17/39)],and there was significant difference (P ＜0.05).Conclusion IMRT combined with TP concurrent chemoradiotherapy can improve the efficacy,local control me,survival rate of esophageal cancer,but can also increase the acute toxic effect.

AIM: There is a controversial argument about the choice of total hip replacement (THR) and bipolar artificial femoral head replacement (FHR) for elderly patients with femoral neck fracture. This study was designed to explore the long-term biocompatibility and functional recovery of joints in patients over 70 years with femoral neck fracture by THR and bipolar artificial FHR. METHODS: Sixty patients with femoral neck fracture over 70 years were enrolled from the First Department of Bone and Joint Surgery in the First Hospital of Jilin University from January 2002 to December 2006. There were 21 cases (8 males and 13 females) receiving THR, with a mean age of (72.1?3.5) years, and 18 of them were complicated with internal diseases. While 39 cases (16 males and 23 females) received bipolar artificial FHR, their average ages was (75.1?6.4) years, and 35 of them were complicated with internal disease. ①Choice of artificial prosthesis: Sixteen prosthesis were produced by Germany Link Company and American Zimmer Company, 44 artificial joints were offered by Beijing Mengtaiyin Medical Instrument Co., Ltd. ②All the patients were operated by senior doctors who were qualified for post technique owing to more than 10-years working experience about artificial joints. ③The mean time of follow-ups for all patients was 37 months. The difference was compared in biocompatibility between materials and host, joint function, Harris scoring, time of operation, blood loss, time of hospitalization, cost of hospitalization and adverse effect. RESULTS: ①Comparison of biocompatibility: Two revisions for abrasion of acetabular wall were carried out 5 years after bipolar artificial FHR, and there was no infection of incision, dislocation of hip joint or loose of artificial joint in other patients of these two groups. ②Comparison of adverse effect: There was one patient with complications of pain and red swelling of hip in each group. No infection occurred around the prosthesis, and these two patients recovered after symptomatic treatment. ③Comparison of follow-ups for joint function: The average Harris scores was 89.8?8.6 in THR group and 72.7?9.5 in bipolar artificial FHR group, and there were significant differences in these two groups (P 0.05). ⑤Comparison of operation time and blood loss: The average operation time were (150.2?24.3) minutes in THR group and (105.8?22.1) minutes in bipolar artificial FHR group, with significant differences (P

Objective:To study the effect of learning plan guidance based on clinical nursing pathway applied in the teaching of surgical nursing.Methods: The nursing specialty students from two classes of grade 2010 were divided into experiment group and control group for the research randomly. Learning plan guidance based on clinical nursing pathway was performed in experiment group, while traditional teaching method was performed in control group. Students were evaluated by teacher during the course; Theoretical examination was carried out after the course. The students in the experiment group were required to fill in questionnaire.Results: Attitude of students in the experiment group is positive. Experimental group was excelled control group obviously in theoretical examination, and the difference was statistically significant (P<0.01).Students in the experiment group made a positive evaluation for teaching effect.Conclusion: Learning plan guidance based on clinical nursing pathway is suit for the reform in teaching of surgical nursing. It can improve the student nurses' comprehensive abilities.