Objective To discuss the issue of the limb salvage versus the amputation of serious lower limb injury. Methods The history, the age, the clinical presentation, the treatment time and method of the 72 severe open fractures of the lower limb were studied. Following the patients admission, they were examined completely in emergency room and were sent to radiological department for taking X ray films. According to Gustilo and Andserson classification, there were 48 limbs of type ⅢB and 24 limbs of type ⅢC.16 limbs had multiple trauma as well as severe lower extremity injury. Among them, there were 7 (9.7%) limbs with head or spine injury, 5(6.9%) limbs had abdominal trauma, 4(5.6%)limbs had thoracic trauma. Results 16 limbs in 72 limbs were amputated, in which 7 limbs were type ⅢB and 9 limbs were ⅢC. 4 limbs in 8 limbs of more than 50 years old were amputated. The ratio of amputation was 50.0 %. 12 limbs in 64 limbs younger than 50 years old were amputated. The ratio of amputation was 18.8%.Their comparison has statistically significance(?2=4.018, P

Objective To explore serratus anterior muscle transplantation for the repair of soft tissue defects in foot and ankle. Methods Seventeen patients consisted of 11 males and 6 females aging from 13 to 58 years with the mean age of 35.2 years. The anatomical parameters of serratus anterior of 17 cases were measured, the thickness of the muscle was (1.24?0.65) cm, and the diameter of origin point of the nutrient artery to the muscle was (1.4?0.6) mm. There were two veins arising from the muscle, the diameter of larger one was (2.5?0.8) mm. The length of vascular pedicle was (8.31?1.48) cm. 17 patients with soft tissue defect of foot and ankle were treated with free serratus anterior muscle transfer and split skin graft overlying the muscle. The primary lesions were soft tissue defect around the ankle and Pilon fracture in 5 cases, non-union of distal tibial fracture in 3, Achilles tendon and soft tissue defect in 3, metatarsal fracture and soft tissue defect in 4, and calcaneal fracture with soft tissue defect in 2. All of the patients suffered from infection or exposure of bone or applied plate, the area of soft tissue defect ranged from 4.5 cm?6 cm to 11 cm?13 cm. Results The average operative time was (6.5?1.2) hours. The complications included local hematoma in 2 cases, superficial infection in 2, winged scapula without function loss in 1,scar pain in 2, and numbness of lateral thoracic wall in 1. Furthermore, weakness and decreased shoulder mobility were noted in 3 patients comparing with the contralateral side, but the condition improved half year following the operation. The transferred muscle flap appeared thinner and less bulky , and healed intimately with the adjacent foot tissue, the patients resumed good function in walking. Conclusion The serratus anterior muscle flap is a good choice for treatment of soft tissue defects in foot and ankle.

Objective To investigate the effect of persistent ST-segment elevation after successful direct percutanous coronary intervention (PCI) on the late phase of left ventricular (LV) systolic function in acute anterior wall myocardial infarction.Methods Serial electrocardiograms were record before PCI and 1 hour after reperfusion in 72 patients with acute anterior wall myocardial infarction. The reduction of ST-segment elevation after successful PCI more than 50% was defined as ST-segment resolution (ST reduction group). Persistent ST-segment elevation was defined as ≥50% of peak ST elevation (ST elevation group). Echocardiography was performed on 2 to 3 weeks (early phase) and 5 to 6 months(late phase)after PCI to evaluate the LV function and ventricular wall motion abnormality (VWMA). Results Fifty-three patients (74%) had early ST segment elevation resolution and 19 patients (26%) did not. The LV function and VWMA were similar in two groups during early phase. But during the late phase, ST elevation group patients had lower LVEF and higher LVEDVI, LVESVI, VWMA index compared with ST reduction group (P

Objective To compare the serum microelement changes between patients aged ≥80years and adults aged ＜ 60 years,and to compare the levels of serum microelement,total protein,albumin,hemoglobin between the long term in-bed and non in-bed oldest patients.Methods Beijing Bohui BH5100 type atomic absorption spectrometer was used to determine serum microelement.Total protein,albumin,hemoglobin were also determined.Results The amounts of ferrum,zinc,calcium,copper,magnesium were (7.21 ± 1.21) mmol/L,(93.29 ± 10.96)mmol/L,(1.63 ± 0.21)mmol/L,(17.31±3.61)mmol/L,(1.49±0.20)mmol/L in people aged over 80 years,(8.91±1.25)mmol/L,(121.85±11.24)mmol/L,(1.51±0.23)mmol/L,(15.89±3.87)mmol/L,(1.51±0.21)mmol/L in people aged less than 60 years,respectively.The ratios of Ferrum deficiency were 42.9 ％,zinc deficiency 14.3％,calcium deficiency 21.4％,copper deficiency 14.3％ in oldest-old,whereas were 9.1％,13.6 ％,31.8％,27.3％ in people aged less than 60 years.The amount of ferrum was significantly lower in people aged over 80 years than in people aged less than 60 years (P＜0.01).Proportion of ferrum deficiency was higher in patients aged over 80 years (P＜0.01).The amount of calcium and copper was markedly lower in people aged less than 60 years than in people aged over 80 years (P＜0.01).The proportions of calcium,copper deficiency were higher in people aged less than 60 years (P＜0.01).The amounts of ferrum,zinc,total protein,albumin,hemoglobin of the patients aged over 80 years in long-term in-bed group were significant decreased as compared with those of people in non long-term in-bed group [(6.44±0.89)mmol/L vs.(8.16±1.16)mmol/L,(84.48±8.98)mmol/L vs.(103.62±10.31)mmol/L,(62.8±3.9)g/L vs.(66.3±1.7)g/L,(33.7±2.6)g/L vs.(36.7±l.8)g/L,(109.0±12.5)g/L vs.(132.0±5.2)g/L,all P＜0.01].The amount of calcium of people in none long-term group was much lower [(1.57±0.23)mmol/L vs.(1.71±0.19)mmol/L,P＜0.01].Ferrum,zinc,calcium and copper deficiencies were 60.9％,18.8％,13.0％,13.0％ in long-term in-bed group,21.1％,8.8％,31.6％,15.8％ in non long-term in-bed group.Proportion of ferrum deficiency was higher in long term in-bed group than non long-term in-bed group (P＜0.01).Proportion of calcium deficiency was higher in non long-term in-bed group than long-term in bed group (P＜0.01).There was no significant difference in the amount of copper between people in long term in bed group and non long-term in-bed group (P＞0.05).There was no absence of magnesium in both two groups.Conclusions There is more absence of ferrum,zinc,total protein,albumin,hemoglobin in the patients aged 80 years and over in long-term in-bed.There is more calcium and copper absence of people aged less than 60 years.So it is necessary to supply high ferrum food and nutrients in order to get well sooner,especially to patients aged over 80 years.

Objective To analyze the monitoring data of the fever clinic during the epidemic period of COVID-19 in Xiangyang City, and to provide a scientific basis for the government to carry out the prevention and control of new coronavirus pneumonia in the next step. Methods Monitoring data from the "Symptom Monitoring System of Fever Outpatients in Xiangyang City" from February 11, 2020 to March 16, 2020 was obtained. The data combined with the confirmed cases was statistically analyzed. Results A total of 28 296 outpatients with fever were monitored and 38 confirmed cases were found. According to trend chi square test, the visit rate of the fever clinic (Z =629.11，P = 0.000＜0.005 ) decreased gradually from the second week. The analysis of the rate of the fever clinic visits (χ²=2819.54，P=0.000＜0.05 ) and the rate of confirmed cases in different areas ( χ²=7.80，P=0.005＜0.05) indicated that the diagnostic confirmation rate in the urban area was higher, while the rate of visits in counties was higher. The rate of visits to fever clinics (Z=2 261.99, P=0.000<0.008) and the rate of diagnostic confirmation (Z=10.69, P=0.001<0.008) in different age groups showed that the visit rate decreased with the increase of age, while the diagnostic confirmation rate increased with the increase of age. Conclusion The prevention and control of the new coronavirus in Xiangyang City had been effective. It is important to strengthen the screening of patients in fever clinics in key areas (urban areas) and key age groups (children and adolescents) in the next step.

Kidney plays an important role in maintaining the homeostasis as an important excretory and endocrine organ.The occurrence and development of kidney disease is closely associated with glomerular filtration barrier dysfunction and renal interstitial remodeling.Matrix metalloproteinase-9 (MMP-9),a major enzyme in the extracellular matrix (ECM),plays an important role in the process of kidney disease by regulating the ECM components and its interaction with cytokines.The paper reviews the pathophysiology of MMP-9 in glomerular filtration barrier dysfunction and renal fibrosis to provide a theoretical basis for clinical treatment of kidney disease.

Objective To investigate the effect of early early enteral nutrition combined with parenteral nutrition support on postoperative gastrointestinal function,nutritional status and liver function of patients with obstructive jaundice.Methods Sixty-two patients with obstructive jaundice of hepatobiliary who were treated in the General Surgery Department of the Affiliated Hospital of North China University of Science and Technology from July 2013 to July 2014 were randomly divided into the control group and the observation group,31 cases in each group.The control group were treated with simple parenteral nutrition,and were injected by central venous catheter at the first day after operation,with the injection tiem of 12-15 h and continuous infusion of 7 d or more.The observation group were received enteral nutrition combined with parenteral nutrition,parenteral nutrition was given first,and the preparation method of the nutrient solution was identical with that of the control group;and then slowly dropped 250 ml physiological saline into the jejunum nutrition tube at the second day,dropped into the enteral nutrition liquid at the third day with the initial dose of 300 to 500 ml per day,slowly dropped in the speed of 20-30 ml/h.Results The first exhaust time,first defecation time and hospitalization time in the observation group were (41.37±6.85) h,(46.85±7.13) h and (12.79±3.76) d,significantly shorter than those in the control group ((57.21 ± 9.23) h,(61.43 ± 10.62) h and (16.94 ± 4.33) d;t =7.67,6.35,4.03;P＜O.05),daily hospitalization expenses was (1637.65± 138.24)yuan,significantly less than that in the control group((2121.42±112.38)yuan;t=15.12;P＜0.05).The serum albumin berofe and after the operation in the control group and observation group were (28.73±3.24) g/L and (29.21±3.31) g/L,(36.85±4.05) g/L and (47.21±4.13) g/L,respectively.The serum pre albumin berofe and after the operation in the control group and observation group were (162.81±31.27) g/L and (163.14±30.56) g/L,(248.95±58.62) g/L and(324.24±61.34) g/L,respectively.There was no difference before operation between the two groups (P＞0.05),while the serum protein levels were significantly increased in observation group than the control group (P＜0.01).There were no difference in ALT,total bilirubin and direct bilirubin levels between the two groups before operation (P ＞ 0.05),after treatment,the levels of ALT,total bilirubin and direct bilirubin in the observation group were significantly higher than those in the control group(P＜0.01).The patients in the two groups recovered well,and no serious adverse reactions occurred.Conclusion Early enteral and parenteral nutrition support in patients with obstructive jaundice has better effect and safety in the clinical treatment.

Objective To evaluate the clinical efficacy of microwave ablation and surgical resection for the treatment of early primary hepatocellular carcinoma (HCC).Methods The Cochrane Library, Medline,PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang database, VIP database were searched with the key words of tumor, liver cancer, primary hepatic carcinoma, hepatocellular carcinoma, HCC,surgery, surgical, surgical resection, liver resection, hepatic resection, thermal ablation, percutaneous thermal ablation, microwave coagulation, microwave ablation, 肝癌, 原发性肝癌, 肝细胞癌, 手术, 切除, 手术切除, 肝切除, 微波, 热消融, 微波治疗, 微波凝固, 微波消融 between the database establishment and February 2015.Chinese and English literatures on microwave ablation and surgical resection for the treatment of early primary HCC were retrieved, and data were extracted and analyzed by 2 independent researchers.All the patients were divided into the microwave ablation group and the surgical resection group.Measurement data were represented by the standardized mean difference (SMD) and 95％ confidence interval (CI), and count data were represented by the odds ratio (OR) and 95％ CI.Heterogeneity of the publication was analyzed using the I2 test.Results Seven literature including 6 retrospective cohort studies and 1 randomized controlled trial were retrieved, and total sample size were 993 patients including 648 in the microwave ablation group and 345 in the surgical resection group.There were significant differences in the volume of blood loss and duration of postoperative hospital stay between the2groups (SMD=-5.03,-1.74, 95％ CI:-6.21-3.85,-2.21--1.28, P＜0.05).There were no significant difference in the incidence of postoperative complications, 1-, 3-year overall survival rates, 1-, 3-year tumor-free survival rates and 1-, 2-, 3-year recurrence rates between the 2 groups (OR =1.57, 1.10, 1.20,0.77, 1.23, 1.32, 2.31, 1.39, 95％CI: 0.25-9.78, 0.43-2.86, 0.70-2.06, 0.19-3.12, 0.54-2.81,0.62-2.80, 0.96-5.55, 0.47-4.14, P ＞ 0.05).Conclusions The safety, feasibility and clinical efficacy of microwave ablation for the treatment of early primary HCC is comparable to surgical resection, and microwave ablation has the advantages of lesser blood loss and shorter duration of hospital stay.

Objective To compare the effect of repairing large perimembranous ventricular septal defect (VSD) with a new continuous stitching and two classical methods. Methods From January 2005 to January 2008,321 cases with VSD were operated. All the cases were divided into 3 groups according to operational way, with discontinuous stitching in group A (70 cases), continuous stitching in group B(116 cases),new continuous stitching in group C (135 cases). All the patients were total corrected with hypothermic cardiopulmonary bypass. Results Group C had the shortest cardiopulmonary bypass and aortic cross-clamp times [(48 ± 36) min and (26 ± 18) min]among the three groups (P < 0.05). Group C had not residual shunt and incidence rate was lowest among the three groups (P < 0.05). Temporary second degree auriculo-ventricular bolck (AVB) was found in the early stage and no third degree AVB among the three groups. Tricuspid regurgitation was higher in group A,but there was no significant difference between group B and group C. Follow-up was completed in a duration of 1-3 years and all the cases had a good health after discharged. Conclusions The new continuous stitching method has short eardiopulmonary bypass and aortic cross-clamp times. It has fewer residual shunt than other two classical methods and has no evidence of higher AVB occurrence.

Eight patients with chronic pancreatitis or benign pancreatic head tumors were investigate to evaluate the use of Bern procedure in duodenum-preserving pancreatic head resection.Our data indicated no periopemtive deaths and serious complications.During median follow-up of 10 monks(range,6 to 14 monks),all patients reported impmvod clinical symptoms,and those with chronic pancreatitis had weight increased by 7.9 kg(range,4 to 18 kg).Pancreatic exocfine function wag improved,although the endocrine function showed no change.The Bern procedure might be a relatively safe and effective procedure for the treatment of chronic pancreatitis or benign pancreatic head tumors.