Objective To study the clinic value of digital three-dimensional shaping titanium mesh in repairing skull defects and reconstructing temporal muscle attachment points. Methods Eighty-two patients with skull defects from December 2013 to January 2016 were enrolled in this study. They were divided into two groups according to patients' will with 41 patients in each group. The patients in control group received traditional hand-shaping titanium mesh repair, the patients in observation group received individual digital forming technology to produce titanium mesh repair and reconstruct the temporal muscle attachment points at the titanium mesh temporal corresponding position. The rate of appearance satisfaction, operation time, the number of titanium nail and the rate of postsurgery adverse reaction was compared between the two groups. Results The rate of appearance satisfaction in observation group was significantly higher than that in control group: 97.56%(40/41) vs. 80.49%(33/41), P<0.05. The operation time and the number of titanium nail and in observation group was significantly lower than that in control group:(8.9 ± 1.6) h vs. (12.4 ± 2.4) h, (10.3 ± 0.9) pieces vs. (11.8 ± 1.8) pieces, P < 0.01. The rate of postsurgery adverse reaction in observation group was significantly lower than that in control group: 0 vs. 9.8%(4/41), χ2 = 4.21, P < 0.05. Conclusions The operation of repairing skull defects and reconstructing temporal muscle attachment points with digital three-dimensional shaping titanium mesh is simple. It can shorten the operation time, decrease the postsurgery adverse reaction, and increase the appearance satisfaction.

Objective To observe the curative effect of abdominal acupuncture on postoperative pain of patients with mixed hemorrhoid after Milligan-Morgan hemorrhoidectomy.Methods A total of 100 mixed hemorrhoid patients with postoperative pain after Milligan-Morgan hemorrhoidectomy under spinal anaesthesia from September of 2014 to December of 2015 were included into the study.The patients were evenly randomized into trial group and control group.The trial group was treated with abdominal acupuncture at acupoints of Shuifen,Guanyuan,Qihai,Sanxing needles under Qihai,lower Fengshi,Tianshu for 15-30 min.The control group was treated with intramuscular injection of Tramadol Injection 0.1 g.Before treatment and 0.5,1,2,3 hours after treatment,the pain visual analogue scale (VAS) scores and body activity scores were recorded.Results (1) After treatment,pain VAS scores of the two groups at different time points were obviously decreased(P ＜ 0.05 compared with those before treatment),and the decrease of pain VAS scores of the treatment group 0.5 hours after treatment was superior to that of the control group (P ＜ 0.05),but there was no significant difference between the two groups at other time points (P ＞ 0.05).(2) After treatment,body activity scores of the two groups at different time points were obviously decreased(P ＜ 0.05 compared with those before treatment),but the difference was insignificant between the two groups(P＞ 0.05).(3) The average dose of Tramadol Injection used in the trial group was 0.013 ± 0.034 1 g,while was 0.103 ± 0.017 7 g in the control group,the difference being significant (P ＜ 0.05).Conclusion The analgesic effect of abdominal acupuncture is similar to that of Tramadol Injection.For its safety,and being cheap,practical and painless,abdominal acupuncture can be expected to be another option of effective analgesic method for the postoperative pain of patients with mixed hemorrhoid after Milligan-Morgan hemorrhoidectomy.

County -level public hospitals reform is an important measure of deepening reform of the medical and health system.Medicare payments system reform is therefore an important part of public hospitals reform.By abolishing drugs addition,registration fee,treating fee and setting up medical service fee instead,our hospital carried on a diversified management style in the aspect of medical insurance total prepaid system.The implementation of the reform measures turns out a good result:reasonably keeping a control on the medicare spending and really embodying the transformed of interests patterns.On the premise of ensuring patients interests,medical personnel′s interests are improved to a new level and medical insurance fund are also brought under a reasonable control.The medicare payments system reform puts equity in access and people benefit as the starting point and footing of county -level public hospitals reform,thus lays a foundation of further development of public hospitals reform.

Objective To study the effect of sodium ?-aescin on the matrix metalloproteinase-9 (MMP-9) and laminin (LN) expression in rats after focal cerebral ischemia and reperfusion, and provide experimental evidence for the relationship of MMP-9 and LN expression change with the neuroprotection of sodium ?-aescin. Methods The Spraque-Dawley (SD) rat model of focal cerebral ischemia and reperfusion of cerebral middle artery was prepared. Fifty-six rats were randomly divided into the normal, sham, ischemia and reperfusion, as well as ischemia and reperfusion-treated with sodium ?-aescin groups. The latter two were further divided into six subgroups according to reperfusion time interval of 3h, 6h, 12h, 24h, 72h and 7d after brain ischemia, with 4 rats in each subgroup. Immunohistochemical staining and image analysis were used to measure the expression of MMP-9 and LN in the ischemic region. Results The expression of MMP-9 started to increase at 6h, reached the peak at 12h, decreased in 24h, and reached the lowest on 7d in cerebral ischemia and reperfusion group. The expression of MMP-9 in the same time groups of the cerebral ischemia and reperfusion-treated with sodium ?-aescin group all obviously decreased (P

Objective To evaluate the cause and the treatment of the vagus nerve reflex in patients with hemoptysis during bron-chial artery embolization (BAE).Methods 1 12 patients with much hemoptysis were enrolled,9 of whom represented vagus nerve reflex in the process of interventional embolization.Results In 9 patients with mixed vagal reflex,5 occurred in the process of bron-chial artery embolization,1 in removing of sheath,1 in hemostasis by compression and 2 in returning to the ward.The intraoperative vagus reflex during BAE was related to over tension and unnormolized operation,and it improved by block of vagus nerve,raising blood pressure and fluid expansion without serious complications.Conclusion Vagus nerve reflex during BAE should be noticed, and early detection and timely intervention may improve its prognosis.

Objective To investigate the clinical value of digital three-dimensional shaping titanium mesh and traditional hand-shaping titanium mesh in the repairing of skull defect surgery.Methods The clinical data of 78 patients with skull defect were retrospectively analyzed,they were divided into digital three-dimensional shaping titanium mesh group (41 cases) and traditional hand-shaping titanium mesh group (37 cases) according to the different titanium net,then the hospital stay,operative time,hospital costs,shaping satisfaction and postoperative complications between two groups were compared.Results The hospital costs and shaping satisfaction in digital three-dimensional shaping titanium mesh group were significantly higher than those in traditional hand-shaping titanium mesh group [(12 978.1 ± 4 765.7) yuan vs.(9 436.6 ±3 798.7) yuan,(9.87 ±0.13) scores vs.(9.41 ±0.09) scores],the complication rate was significantly lower than that in traditional hand-shaping titanium mesh group [4.9％ (2/41) vs.29.7％ (11/37)],there was significant difference (P ＜ 0.05).The hospital stay and operative time between two groups had no significant difference (P ＞ 0.05).Conclusion The digital three-dimensional shaping titanium mesh repair is convenient to operate,it can largely reduce the risks and complications of surgery,and can also achieve a high standard of modeling results,so is worthy of promotion.

Objective To discuss the value of combining superselective mesenteric angiography (SSMA)with methylene blue in-jection for localization of the Obscure Gastrointestinal Bleeding (OGIB).Methods 12 patients presenting with OGIB had preopera-tive localization of the bleeding site by SSMA.The microcatheter was remained inside the bleeding artery branch after angiography. Then the methylene blue was injected via the microcatheter for localization during exploratory laparotomy and the dyed intestine was then removed.Results The detected rate of bleeding sites by using preoperative SSMA was 100%.The lesions in total 12 patients were found quickly during the exploratory laparotomy.The length of the removed intestine was 9 -12 cm (median,10 cm).After followed up for 10-24 months (median,18 months),all patients with OGIB had no recurrence.Conclusion The method of SSMA combined with the use of methylene blue injection is a safe and effective procedure for the localization of OGIB and could be beneficial for increasing the surgical success rate of hemostasis.

Objective To evaluate the forensic application of TE-MAGS technology based on magnetic beads kit on TECAN pipetting platform and establish the automated DNA extraction system of case work samples. Methods Sensitivity test: 10 different DNA samples from 0.1ng to 1ng were prepared with a commercial standard DNA 9947A diluted into 200μL TES. DNA samples were purified by the TE-MAGS technology automatically on the TECAN pipetting platform and then typed using the IdentifilerTM Kit and get the profile of STR with the software GeneMapper ID-X; the power of purification was tested with a trail that purified 1ng DNA mixed with humus acid and hemachrome. Comparative test: 304 casework samples were divided into two purified by TE-MAGS technology and silicon beads respectively to compare the power of purification and the possibility of forensic utility. Results Sensitivity test: 0.3ng and more imported DNA can obtain a good quality of DNA profile compared to the lower imported DNA with dropout of STR peaks (0.1ng and 0.2ng). The power of purification of the TE-MAGS technology was not affected by humus acid and hemachrome. The comparison result between automatic TE-MAGS technology and manual silicon beads extraction methods from 304 casework samples showed that the former's success rate(50%) was higher than the latter(40.8%). Conclusion The established DNA purification method of TE-MAGS technology automatic DNA extraction system in this study was obviously advantaging at the aspect of success rate, stability, and uniformity and suited to application in the forensic utility future.

In this article,we reviewed the CT/MRI imaging features of carcinoma of the duodenal papilla in 15 cases.The characteristic CT and MR imaging findings of duodenal papillary carcinoma included mass in the descending part of the duodenum,the mass and duodenum wall showed a "target" sign or " diamond ring" sign;a ring-enhancing lesions around the distal end of the common bile duct/pancreatic duct,and thickening of the wall of the second portion of the duodenum near the papilla.The use of MPR MDCT images and MRI coronal images are very useful to show these imaging features as an aid in early diagnosis of carcinoma of the duodenal papilla.

Objective To evaluate the value of clinical application in chest tumor biopsy by DSA rotating reconstruction technology and CT guided technology.Methods The 63 cases of chest tumors collected,38 cases of lung tumors,25 cases of mediastinal tumors.Applicating of CT and DSA scan and formulating puncture path,according to their respective descending thoracic tumor puncture guide way.DSA and CT guided traditional way from the success rate of puncture,operation time,X-ray exposure and complications were analyzed.Results 45 cases take CT guidance,18 cases take DSA guidance.60 cases,the pathological results achieved and positive rate was 95.2％.CT group success rate of first puncture in 68.9％ (31/45),DSA group 88.9％ (16/18),statistically significant.CT group pneumothorax rate 17.8 ％ (8/45),DSA group pneumothorax rate 11.1％ (2/18),no statistical difference.Operation time CT group (23.111 ± 4.281) minutes,DSA group (12.889 ± 3.693) minutes,with significantly statistical differences.CT group exposure (11.563±3.023) mGy,DSA group exposure (9.956±2.193) mGy,statistically significant.Conclusion The chest tumor puncture biopsy by DSA rotating reconstruction technique guided with flexible,fast and convenient,and superior to traditional CT with real-time monitoring,shorten the operation time,reduce the exposure,the success rate of first puncture aspects.