0.05). However, compared with group II, group I had higher cardiac event rates (34.6% vs 20.4%, P =0.020). Conclusion Coronary stenting in ostial lesions may have similar procedural success rate, but less late benefit, compared with that in nonostial lesions.

The three links theory" refers to the three key links in an emergency medical services system, viz. pre-hospital first-aid system, hospital emergency care system, and the ICU system. The construction of an emergency medical services system in China ought to be guided by the three links theory so as to set up a practical and highly efficient emergency medical services system, an instantly operating monitoring system, a smooth and real-time information system, a rational and long-lasting system of laws and contingency plans, and a system for cultivating universalists. The goal is to build an emergency green passage in the hospital.

The paper gives an account of the new ideas in trauma care and the transition of emergency care of trauma from the traditional model to the modern model,viz.the transition of emergency care of trauma by the emergency department from a paradigm of general practice to a paradigm of specialized care;the transition of trauma physicians training from a paradigm of general practitioners to a paradigm of specialists;and the transition of the flow of emergency care of trauma from a paradigm of "links" to a paradigm of "whole course".Based on the practice of the emergency department of the hospital the authors work with in setting up a quick clinical response mechanism of emergency care of trauma,a mechanism of priority to emergency care of trauma,a hospital-wide linking and coordinating mechanism of emergency care of trauma,a standardized management mechanism of wards for emergency care of trauma,and an operational mechanism of the team of emergency care of trauma,the paper discusses building an integrated model of emergency care of trauma on the basis of the "three links theory" by the emergency department.

Objective To observe the effect of core stability training on the associated reaction of upper limbs in stroke patients with hemiplegia. Methods From November, 2014 to May, 2016, sixty stroke patients with hemiplegia were randomly divided into control group (n=30) and treatment group (n=30). Both groups accepted routine rehabilitation, while the treatment group received core stability training for 20 minutes during exercise. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Fugl-Meyer Assess-ment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS) and Associated Reaction Rating Scale (ARRS) before and 6 weeks after treatment. Results The scores of FMA-UE, FMA-LE, BBS and ARRS improved significantly in both groups after treatment (t>12.158, P<0.001), and improved more in the treatment group than in the control group (t>2.317, P<0.05). Conclusion Core stability training can re-lieve the associated reaction of upper limb in stroke patients with hemiplegia.

Objective To investigate the effective methods for the treatment of periprosthetic fracture after hip replacement.Methods The clinical data of 13 cases underwent the artificial total hip replacement (THR) with postoperative periprosthetic femur fractures were analyzed.Results The happening time was 12 days to 2 years after primary THR.According to Vancouver classification,there were 2 cases of type A,two cases of type B1,7 cases of type B3,and 2 cases of type C.The treatment included nonoperative treatment in 2 cases,3 cases received open reduction with memory alloy encircling fixer fixation,one case received wire binding with autologous iliac bone grafting,7 cases received revisions with modular revision implant combined with wire binding and autologous iliac bone grafting.The stem was loosened in one type B1 patient at 3 months after surgery.X-ray examination showed that the fractures were united and no infection occurred after operation in 12 patients.No migration or breaking of the instruments was observed.The average Harris hip score was 81 (70 ～ 86points).Conclusion The effective treatment method of periprosthetic fracture after THR should determined by Vancouver classification,degree of bone defect and economic situation of the patients.

Objective To analyze the effect of bifrontal decompressive craniectomy on patients with refractory diffusing of brain swelling after severe traumatic brain injury.Methods The clinical data of 68 patients with refractory diffusing of brain swelling after severe traumatic brain injury were analyzed retrospectively.Thirty-five patients were performed with bifrontal decompressive craniectomy as observed group,continued intracranial pressure monitoring after surgery.Thirty-three patients were treated conservatively to reduce intracranial pressure as control group,continued intracranial pressure monitoring.The Glasgow outcome scale after discharge 6 months were assessed.The efficacy,the incidence of complications were observed in observed group.Results The admission intracranial pressure in observed group was significantly higher than that after surgery [(35.9 ±6.9) mmHg (1 mmHg =0.133 kPa) vs.(17.5 ±5.2) mmHg,P ＜0.05].The admission intracranial pressure in control group was (34.2 ± 8.6) mmHg,after admission 10.5 h was (32.0 ±4.8) mmHg (P ＜0.05),difference was no statistically significant (P＞ 0.05).The intracranial pressure after admission 10.5 h in control group was significantly higher than that in observed group after surgery (P ＜0.05).Two cases of subdural effusion,1 case of postoperative hydrocephalus in observed group.The better prognosis rate in observed group was significantly higher than that in control group [45.7％ (16/35) vs.18.2％ (6/33),P ＜ 0.05].Conclusions Bifrontal decompressive craniectomy is a suitable measure to decrease the intracranial pressure in the patients with refractory diffusing of brain swelling.If carried out early,it could provide better outcome for these patients.

Objective To evaluate potential clinical risk factors for the development of early-onset myocardial damage following multiple trauma (MT), and to determine whether early-onset myocardial damage was caused by the combined effects of thoracic and systemic injury factors in MT patients.Methods A total of 231 patients with MT over the last 3 years were retrospectively reviewed. With myocardial damage being a dependent variable and other twenty factors being independent variables, univariate and multivariate logistic regressions were applied to investigate the risk factors for early-onset myocardial damage and to identify the association of thoracic and systemic risk factors with early-onset myocardial damage.Results Multivariable logistic regressions showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score ≥10, injury severity score (ISS) ≥ 25, shock index ≥ 2,coexisting chest trauma, abbreviated injury scale (AIS) of chest≥3, and hypoxia time ≥ 0.5 h were risk factors. The risk of earlyonset myocardial damage following MT obviously increased when thoracic and systemic injury risk factors were coexisting.Conclusion Our results indicated that thoracic injury combined with systemic injury increased the overall risk of early-onset myocardial damage following MT. Prospective validation of these findings in other clinical settings is warranted.

OBJECTIVE To investigate resistant genes encoding ?-lactamases and aminoglycoside modifying enzymes in Pseudomonas aeruginosa isolated from clinical specimens,and phylogenetic analysis was performed.METHODS Antimicrobial susceptibility test was performed by PhoenixTM-100 system.Resistant genes encoding ?-lactamases,aminoglycoside modifying enzymes and antiseptic resistance were detected by PCR amplification and verified by DNA sequencer.RESULTS The resistant rates of ?-lactams including ampicillin/sulbactam,piperacillin,piperacillin/tazobactam,cefotaxime,ceftazidime,cefepime,imipenem and meropenem in 190 strains of P.aeruginosa were 98.9%,59.5%,45.8%,77.4%,34.2%,38.4%,15.3% and 6.8%,respectively.Ciprofloxacin and levofloxacin still showed powerful activities with resistance being 15.3% and 21.0%.The positive rates of blaVEB, blaGES and blaCARB genes were 9.5%,9.5% and 57.1% in 21 isolates.Twenty strains lost oprD2 genes.However,the ?-lactamase genes of TEM,SHV,OXA,PER,IMP,VIM,SPM,GIM and DHA were not found.Three resistant genes encoding aminoglycoside-modifying enzymes were found in 21 isolates,such as aac(6′)-Ⅰ,aac(6′)-Ⅱ and ant(2″)-Ⅰ,and they accounted for 9.5%,61.9% and 66.7%,respectively.The positive rate of qacE△1-sul1 genes was 66.7% in 21 isolates.CONCLUSIONS P.aeruginosa isolated in clinic has carried many resistant genes.The loss of oprD2 gene may be the important cause of P.aeruginosa resistant to imipenem.Cluster analysis indicates that the spread of clones occurred in our hospital.

BACKGROUND: Both biological and physical methods contribute to the repair of white meniscal tears, so the combined use will be better. OBJECTIVE: To study the influence of radiofrequency combined with platelet-rich plasma (PRP) on the repair of white meniscal tears. METHODS: Forty-eight adult New Zealand white rabbits were randomly divided into four groups, including simple suture, radiofrequency, PRP, and combination groups, and then the model of medial meniscus posterior root tears was established in all experimental animals. The simple suture group underwent interrupted mattress suture; the radiofrequency group was treated with radiofrequency (20 W, 45 ℃) after suture; the PRP group received the intra-articular injection of PRP after suture; the combination group was firstly treated with radiofrequency after suture, and then underwent the intra-articular injection of PRP. The gross and histological changes of the meniscus were observed, and the expression levels of transforming growth factor β1, vascular endothelial growth factor and platelet-derived growth factor were detected at 3 and 12 weeks postoperatively. RESULTS AND CONCLUSION: At 12 weeks after operation, the simple suture group showed no healing; the radiofrequency and PRP groups healed partially; and the combination group healed completely, and chondrocytes and collagen fibers arranged regularly. There was a significant difference in the healing rate between combination and simple suture groups (P=0.003). At 3 weeks postoperatively, the expression levels of vascular endothelial growth factor in the radiofrequency, PRP and combination groups were obviously higher than that in the simple suture group, which decreased markedly at the 12th week. At 3 weeks postoperatively, the expression level of platelet-derived growth factor was increased in all groups, especially in the PRP and combination groups. The PRP group showed the highest level of transforming growth factor β1 at 12 weeks postoperatively. These results manifest that the combination of radiofrequency and PRP promotes the repair of white meniscal tears by increasing the cell proliferation, cell mitosis and angiogenesis.

Objective To investigate blocking ascending branch of uterine arteries in operation of hysteromyomas rejecting by laparoscope.Methods 60 petients(except cervix myoma,intraligamentary myoma,submucosa myoma),randomly devided to reseach group(30 cases)and control group(30 cases).Blocking ascending branch of uterine arteries before rejecting hysteromyomas by laparoscope in reseach group,directly rejecting hysteromyomas by laparoscope in control group.The volumes of blood loss in operation,the duration of operation,postoperative recovery(Time of passing flatus,wound healing,length of stay)were compared between two groups.During the follow-up months,observing hysteromyoma recidivism and improvement of menstruation.Results All patient were rejected hysteromyomas by laparoscope.The volumes of blood loss in research group were less than that in control group(P0.05),All wounds were well healed in both groups,the rate of hypermenorrhea improvement was 100%(26/26)in research group,but That in control group was 80%(16/20),There was significant difference between two group.Conclusions Blocking ascending branch of uterine arteries may obviously decrease the volumes of blood loss in operation of hysteromyomas rejecting by laparoscope,It presents rapider convalescence,higher rate of symptom improvement and less complication operation.