Objective To evaluate the effect of the lactate clearance rate as a guide of the fluid resuscitation in multiple trauma patients with hemorrhage shock .Methods Sixty‐three multiple trauma patients with hemorrhage shock were divided into two groups ,which were group A (32 patients) and group B (31 patients) .In group A ,the central venous pressure (CVP) between8 and 12 mm Hg ,and the mean arterial pressure (MAP) (65 ± 5) mm Hg served as the goals of the fluid resuscitation .The B group ap‐plied the same goals of the CVP and MAP as group A .In addition ,the calculated lactate clearance rate (≥10% ) was used as the treatment target .The percent of patients reaching resuscitation goals and the ratio of the lactate clearance rate (≥10% ) at 2 hours after surgery ,the volume difference of infusion during the first 24 hours ,the incidences of organ dysfunction ,and the average days in ICU were compared between the two groups .Results The percent of patients reaching resuscitation goals at 2 hours after sur‐gery of group A was significantly higher than that of group B(P<0 .01) .The volume of the infusion of 24 hours in group A was less than that in group B(P< 0 .01) .There was no difference in the percent of patients reaching the lactate clearance rate at 24 hours after surgery(≥10% )and the infusin of red blood cells and plasma volume at 24 hours after surgery between the two groups (P>0 .05) .The incidence of organ dysfunction of group A was higher than that of group B (P<0 .05) .The average days in ICU of group A were longer than that of group B(P<0 .01) .Conclusion Based on monitoring CVP and MAP ,fluid resuscitation under the guidance of the lactate clearance rate(≥10% )may decrease the incidences of organ dysfunction and the days of patients in ICU .

Objective To explore the feasibility and curative effect of arthroscopic treatment of avulsion fracture of the tibial attachment of anterior cruciate ligament ( ACL ) using Ethibood line plus double Endobutton plates. Methods From May 2014 to January 2016, 26 cases of acute ACL tibial attachment fracture were treated surgically. They were 16 males and 10 females, aged from 9 to 45 years ( average, 26. 6 years ) . By the Meyers-McKeeve classification, there were 17 cases of type Ⅱand 9 ones of type Ⅲ. In preoperative examina-tion, their Lachman test and Anterior Drawer Test were all positive. All their bone blocks were fixated using Ethibond line plus double Endobutton plates. Results Their operative time ranged from 50 to 70 min, averaging 57 min. On average, the 26 patients obtained a follow-up of 8 months ( from 6 to 13 months ) . X-rays at 3 months after operation showed all fractures united. At the last follow-up, their Lachman test and Anterior Drawer Test were all negative. The range of motion of the knee joint was larger than 120° in all; their Lysholm score of the knee joint averaged 90. 6 ± 2. 9 points, significantly higher than their preoperative value ( 43. 6 ± 4. 7 points ) ( t=7. 583, P=0. 026 ); their International Knee Documentation Committee ( IKDC ) scores averaged 93. 1 ± 4. 2 points, significantly higher than their preoperative value ( 46. 3 ± 5. 1 points ) ( t=8. 162, P=0. 021 ) . No such complications as reflexive neural dystrophy, avascular necrosis or weak knee extension occurred during follow-ups. Conclusion The avulsion fractures of ACL tibial attachment can be treated arthroscop-ically using Ethibood line plus double Endobutton plates, because this technique has such advantages as simple operation, limited invasion, good fracture reduction, strong fixation, and possibility of early functional rehabil-itation of the knee joint.

Objective:To investigate the relationship of papillary thyroid microcarcinoma (PTMC) with serum thyroglobulin.Methods:Data of 539 patients with papillary thyroid nodule (≤1cm) in Department of Thyroid and Breast Surgery of the Second Hospital of Anhui Medical University and the Department of Oncology Surgery of Suzhou Municipal Hospital for thyroidectomy were retrospectively analyzed. All of the nodules were classified as TI-RADS 4b with ultrasound. According to the postoperative pathological results, patients were divided into PTMC group (experiment group) and benign tumor group (control group) . The PTMC patients were also divided into lymph node metastasis group (experiment group) and no lymph node metastasis group (control group) based on the cervical lymph node metastasis. Then we analyzed the relationship between thyroid stimulating hormone (TSH) , thyroglobulin antibody (TgAb) , thyroid peroxidase antibody (TPOAb) and thyroglobulin (Tg) with PTMC and lymph node metastasis by SPSS.Results:Age, TSH, Tg and TgAb were independent risk factors for PTMC, B: -0.020, 0.192, 0.026, 0.008, 95% CI: 0.962-0.998, 1.045-1.404, 1.015-1.038, 1.003-1.014, both P<0.05. The relations between PTMC and TSH, Tg and TgAb were positive, while age was in negative correlation with PTMC. Meanwhile, age and thyroglobulin (Tg) were also independent risk factors for lymph node metastasis in PTMC patients, B: -0.025, 0.014, 95% CI: 0.957-0.994, 1.008-1.021, both P<0.05. Age was negatively correlated with lymph node metastasis and Tg was positively correlated with lymph node metastasis. Tg level higher than 26.520 ng/ml indicated that the nodule was PTMC (sensitivity: 0.560, specificity: 0.719) , and Tg level higher than 36.695 ng/ml predicted lymph node metastasis in PTMC patients (sensitivity: 0.532, specificity: 0.788) . Conclusion:Tg is a sensitive serum index for identifying PTMC from benign thyroid nodule, and it is also related to lymph node metastasis in PTMC patients.

In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit (ICU) so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The various specimens collected from the patients admitted into ICU in the First People's Hospital of Shunde Affiliated to the South Medical University from January 2007 to December 2014 were used to isolate the pathogens that might cause nosocomial infections and retrospectively analyze their clinical distribution and drug resistance. Kirby-Bauer paper diffusion and minimal inhibitory concentration (MIC) methods were applied to test the drug sensitivity, and according to National Committee for Clinical Laboratory Standards/Clinical and Laboratory Standards Institute (NCCLS/CLSI) standard, the results were identified.Results The sputum was the major specimen source in ICU, accounting for 68.8%, followed by urine (12.4%) and blood (6.8%). All together 557 pathogens in ICU causing nosocomial infections were isolated of which there were 377 gram-negative (G-) bacilli (67.7%), 103 gram-positive (G+) cocci (18.5%), and 77 fungi (13.8%). Among G- bacilli, the top three wereAcinetobacter baumannii (34.5%), Klebsiella pneumonia (17.8%), andPseudomonas aeruginosa (13.0%). Beside carbapenem, the drug resistance rates of Acinetobacterbaumannii to other antibiotics were more than 40%. The main G+ coccus causing nosocomial infection wasSaphylococcus aureus (36.9%) in ICU. The drug resistance rates ofSaphylococcus aureus to penicillin, gentamicin and erythromycin were higher than 50%. In 77 fungus strains,Candida albicans was ranked the first, accounting for 41.6%.Conclusion The main infection site in ICU is primarily respiratory tract, the G- bacilli are the predominate pathogens, and the drug resistance to antibiotics found in this report is serious, so clinically, the antibiotics should be properly used to avoid the occurrence of pathogenic strain with drug tolerance.

Objective To explore the clinical value of bedside gastrointestinal ultrasound exacerbations in evaluating gastro-intestinal function in patients with chronic obstructive pulmonary disease(AECOPD).Methods A total of 128 patients with AECOPD hospitalized in the Department of Intensive Care and Respiratory Medicine of Lanzhou First People's Hospital from June 2019 to December 2021 were selected and divided into mild to moderate group(63 cases without invasive respiratory sup-port treatment)and severe group(65 cases with invasive respiratory support treatment)according to the severity of their condi-tions.Fifty-four healthy subjects were selected during the same period.The general data,gastric emptying time(GET),anstral contraction frequency(ACF),anstral contraction amplitude(ACA),anstral motility index(MI),small intestine diameter,colon diameter,intestinal peristalsis,intestinal mucosal thickness,and colon mucosal thickness were compared among these pa-tients.Logistic regression analysis was performed to determine whether these indicators were associated with gastrointestinal function in patients with AECOPD.ROC curve and Jorden index were used to define the diagnostic threshold of these indica-tors,so as to evaluate the value of gastrointestinal ultrasound in the diagnosis of gastrointestinal dysfunction in AECOPD pa-tients.Results There was no significant difference in the general data among the three groups(P＞0.05).Compared with the healthy group,the GET of AECOPD patient was significantly prolonged,ACF was significantly reduced,ACA was significantly reduced,MI was significantly decreased,small intestine diameter and colon diameter were significantly increased,intestinal peri-stalsis was significantly slowed down,and intestinal mucosal thickness and colon mucosal thickness were significantly reduced(P＜0.01).Compared with normal group and light-medium group,GET was significantly longer,ACF was significantly lower,ACA was significantly reduced,MI was significantly decreased,small intestine diameter and colon diameter were significantly in-creased,intestinal peristalsis was significantly slowed down,and intestinal mucosal thickness and colon mucosal thickness were significantly reduced(P＜0.01)in severe group.These indexes were also associated with the degree of AECOPD(P＜0.01).Lo-gistic regression analysis showed that GET,ACF,ACA,MI,small intestine diameter,colon diameter and intestinal peristalsis were significantly correlated with gastrointestinal function in AECOPD patients.ROC curve analysis was performed in the indi-cators related to gastrointestinal function in AECOPD patients,and the area under ROC curve of all of them was greater than 0.5(P＜0.05).The comprehensive evaluation of gastrointestinal function by these indexes had a good diagnostic value,with good sensitivity and specificity.Conclusion Gastrointestinal ultrasound can be used to evaluate gastrointestinal motility dys-function in patients with AECOPD.Gastrointestinal ultrasound measurements of GET,ACF,ACA,MI,small intestine diame-ter,colon diameter and intestinal peristalsis can be used for early detection of gastrointestinal dysfunction in patients with AE-COPD.

Objective:To analyze the relevant risk factors for restenosis after percutaneous transluminal angioplasty of patients with Takayasu′s arteritis.Methods:Clinical data of 43 patients undergoing percutaneous angioplasty due to Takayasu arteritis were retrospectively analyzed. Univariate and multivariate Logistic regression analysis was used to explore the relevant risk factors for restenosis after percutaneous transluminal angioplasty.Results:There were 9 males and 34 females. The mean age was 23 (18-33) years old, 59 times of PTA were performed, including 44 in renal artery, 9 in aorta, 2 in iliac and 2 in carotid artery, 1 in brachiocephalic trunk and 1 in left subclavian artery. The mean follow up time was (64±42) months. The rate of restenosis was 47.5%(28/59)and the mean time of restenosis was (23±27) months. The restenosis rate of aorta and iliac artery was 9.1%, that of renal artery was 52.3% and that of supra aortic artery was 100% . The rate of restenosis was higher in patients with symptoms of headache, syncope and low back pain, the elevated ESR and CRP increased the risk of restenosis (all P<0.05). Multivariate Logistic analysis showed that preoperative elevation of ESR and CRP were risk factors for restenosis after percutaneous angioplasty for Takayasu arteritis. Conclusions:PTA was safe and effective in Takayasu arteritis involving aorta-iliac and renal artery, the elevated ESR and CRP was related to high risk of restenosis.

Objective To investigate the compliance of follow-up and the associated factors of diabetic retinopathy screening among diabetes patients in Muping District,Yantai City.Methods 438 diabetes patients who received free diabetic retinopathy (DR) screening in Traditional Chinese Medicine Hospital of Muping District of Yantai City from April 2012 to June 2013 were enrolled in the cross-sectional study.The re-examination rate at five years later,as well as the possible associated factors,including age,gender,height,weight,education level,occupation,past medical history,smoking and drinking habits,diabetes process,diabetes medication history,severity of DR,glycosylated hemoglobin (HbA1 c),renal functionand blood lipid were analyzed and evaluated.Results Among 438 patients,159 returned for check up five years later,with a follow-up rate of 36.3％.Further analysis revealed that follow-up rate was related to occupation types (P =0.003) and HbAlc level (P =0.006).Other factors did not show statistical significance (P ＞ 0.05).Conclusions The compliance of DR screening visits is related to occupational type and blood glucose control.It is suggested that in the screening of DR in China,we should pay attention to the propaganda and education of diabetic patients to control blood glucose,and focus on some occupational diabetes people,such as housework workers and farmers.

Objective: Preliminary study on the clinical effect of preoperative ultrasound endoscopy combined with staining labeling technique to locate the actual boundary of esophageal and gastric cancer Methods: From September 1, 2015 to October 30, 2017, 18 patients with esophageal adenocarcinoma were enrolled in this study. The actual boundaries of esophageal and gastric-derived adenocarcinoma lesions were localized by endoscopic ultrasonography and staining. There were 10 males and 8 females. After completing the preoperative examination, 1-2 days before operation, endoscopic ultrasonography was used to locate the edge of the lesion. Two point injection of carbon nano suspension was used to mark the location of 1cm at the longest distance from the longitudinal axis of the tumor. According to the length of longitudinal axial staining, the thoracotomy was performed. Intraoperative proximal margin resection was used to send frozen pathology. According to the results of freezing, the operation was decided. After the operation, the specimens from the margin of the tumor were segmented into paraffin section, which was about 0.5cm in each segment, and the tumor cells were observed under the electron microscope at all levels of the paraffin sections. Results: The average time of preoperative endoscopic ultrasonography staining was(10.16±1.38) min, and the diameter of nano carbon diffusion was(1.43±0.41)cm. All patients in the operation could clearly see the nano carbon staining area under the naked eye. In the field, the average time of locating lesions was(1.27±0.53)min. 5 patients underwent thoracoabdominal surgery and 13 underwent abdominal surgery. The average length of the cut margin of the tumor was(4.74±1.12)cm, and the frozen pathology of the incision margin was negative, and no additional operation was performed. The routine pathology confirmed that all the specimens were negative. Conclusion The staining and labeling technique for adenocarcinoma of the esophagogastric junction under endoscopic ultrasonography can detect the tumor edge and the scope of invasion accurately. It provides guidance and guarantee for the smooth implementation of AEG precision surgery. It is a safe, rapid and effective positioning technique.