Objective:To inquire into the prophylaxis and treatment of fungal infection following abdominal surgery.Methods: Retrospectively analyzed the diagnoses,the inducing factors, the treatments and the progreoses of 136 cases fungal infections complicated by abdominal sugery from 1990 to 1999 June. Results : Analyzed and explained that the fungal kinds and invasions relate to the abuse of artibiotic, oldness and weakness, the use of immunosuppression and the low immunity function. Couclusion : We should raise the cognition of the fungal infection following abdominal surgery and achieve early diagnosis and prompt treatment in order to avoid the serious consequences of fungal septicemia and multiple organ dysfunction syndrome.

BACKGROUND:Denis B thoracolumbar burst fractures are common spinal injury and may be involved in the upper end plate injury. Fracture reduction and pedicle screw fixation are used to repair above injury. This scheme can effectively achieve the aim of correcting deformity, but the trabecular bone after crushing cannot be fuly recovered. OBJECTIVE:To observe the repair effect of fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body on Denis B thoracolumbar burst fracture, and compare with fracture reduction and pedicle screw fixation alone. METHODS:Clinical data of 70 cases of Denis B thoracolumbar burst fractures, who were treated in the Department of Orthopedics, Zhangjiagang Aoyang Hospital from January 2012 to December 2014, were retrospectively analyzed. According to repair scheme, they were equaly divided into two groups. Patients in the control group received fracture reduction and pedicle screw fixation. Patients in the observation group received fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body. Oswsetry Disability Index, height of anterior border of injured vertebral body, lower back pain visual analogue scale and vertebral kyphosis Cobb’s angle were compared and observed between the two groups before repair, 1 week, 3 and 6 months after repair. RESULTS AND CONCLUSION:No significant difference in Visual Analogue Scale was detected at 1 week, 3 and 6 months after repair between the observation and control groups (P > 0.05). Oswsetry Disability Index was significantly lower in the observation group than in the control group (P < 0.05). No significant difference in the height of anterior border of injured vertebral body was detected between the observation and control groups (P > 0.05). Cobb’s angle was significantly lower in the observation group than in the control group (P < 0.05). These findings suggest that fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body obtained good repair effects on Denis B thoracolumbar burst fracture, not only effectively corrected Cobb’s angle and the height of anterior border of injured vertebral body, but also helped to restore normal spinal loads by filing bone in the injured vertebral body.

Objective To investigate the clinical application of acupuncture combined with general anesthe -sia in gynecologic laparoscopic surgery .Methods 60 ASA( the American society of anesthesiologists )Ⅰ-Ⅱpatients undergoing elective gynecologic laparoscopic surgery were randomly divided into the acupuncture group and control group.Patients in the acupuncture group were chosen Hegu (LI 4),Neiguan(PC 6) on both sides.After acupuncture, the two acupoints,electroacupuncture stimulated 20-30min,then administered general anesthesia ,electroacupuncture until surgery finished ,the control group received general anesthesia only .The drug dosages of the two groups was regu-lated,maintained anesthesia depth bispectral index ( BIS) between 40 and 60.The changes of the blood pressure ( BP) ,heart rate and BIS of the two groups at the same time points were observed;the propofol and remifentanil dos-age after the surgery ,the awaken time and extubation time ,OAA/S score and pain score after wake ,the happening of restlessness,chills,nausea and vomiting ,the usage of narcotic analgesics postoperation ,and the intraoperative aware-ness were recorded .The effect of acupuncture combined with general anesthesia was evaluated .Results Anesthetic dosage propofol of the acupuncture group [(7.44 ±1.30)μg· kg-1· h-1] was less than [(8.66 ±1.24)μg· kg-1· h-1] of the control group (t=3.720,P=0.001),remifentanil dosage was also less than the control group [acupunc-ture group (10.59 ±2.58)μg· kg-1· h-1,control group (11.93 ±2.27)μg· kg-1· h-1,t=2.168,P=0.034]. Compared with the basic value ,the BP values were higher at the time of intraoperation ,waking,extubation and 10 min after extubation (all P<0.05),the acupuncture group had more stable BP .Compared with the acupuncture group , heart rates in the control group were faster at extubation and 10min after extubation .Recovery time and extubation time of the acupuncture group were (9.05 ±2.36)min and (1.61 ±2.40)min,which were shorter than (12.50 ± 3.20)min and (15.90 ±3.37)min of the control group (P<0.05).Pain score(VAS) in the acupuncture group was lower than that of the control group .Consciousness score was higher in the acupuncture group ,the incidence rates of restlessness,chills were less.Conclusion The use of acupuncture combined with general anesthesia in gynecologic laparoscopic surgery can reduce the dosage of general anesthetics ,shorten the awaken time and extubation time ,increase the OAA/S score of the patients ,relieve pain ,and the recovery quality is higher .

Chongqing Three Gorges Medical College comprehensively reformed ‘2 + 1 ’ training mode and established the new training model based on the concepts of ‘ general practice,diagnosis and treatment ability in all subjects,progressive teaching,integration between college of clinical medicine and affiliated hospital’.Meanwhile,Chongqing Three Gorges Medical College redefined objectives of talent training; reconstructed curriculum,launched progressive teaching,reformed teaching contents and methods thus promoted the teaching quality of clinical medicine in junior college and improved quality of clinical medicine talents who are willing to go and stay in hospitals at primary level and who are practical in clinical medicine.

Objective The purpose of this study is to investigate the factors associated with incisional surgical site infection (SSI) in colorectal cancer. Methods We retrospectively analyzed impacting factors of SSI including age, gender, BMI, diabetes mellitus, operation, albumin levels, hemoglobin levels, tumor staging, and length of stay post-operation in 327 colorectal patients from 2001 to 2005. Results The incidences of SSI and fat liquefaction were 2. 4%(8/327) and 12. 2%(40/327) respectively. The incidences of SSI in patients with obesity and diabetes mellitus increased significantly (16. 8% vs. 10. 0% ,28. 6% vs. 13. 7%). The length of stay in patients with SSI prolonged significantly (29.0 d vs. 15.8 d). Conclusion Obesity and diabetes mellitus are the most important factors associated with SSI in colorectal cancer patients.

Objective To analyze the effects of the " Clinic-pharmacy separation" reform in Beijing. Methods Following the chronological order, 60-month operational data of a pilot hospital from 2012 to 2016 were analyzed. These data included medical statistics reports, financial information, HIS information,authority information,and patients′satisfaction on site. Results Pilot hospital showed that its medical work efficiency continued to grow. During 2013 -2016, its outpatients volume growth rate ranged 3.53% ~15.20%, and its number of discharged patients growth rate ranged 3. 12% -8. 48%. The hospital harvested 12.21 million yuan of converted income from September 2012 (when the reform was in place to cancel the drug markup and collect medical service fees) to August 2013,scoring a smooth shift of revenue sources. Medical insurance fund expenditure did not increase as a result. The percentage of drug expense was significantly decreased,dropping over 15% in 5 years. Outpatient drug fees and inpatient drug fees continued to decline year by year. Patients expressed higher satisfaction over medical services due to longer time of consultation with physicians. Conclusions " Clinic-pharmacy separation" reform has achieved the following objectives. The revenue is maintained stable; Patients flow is diverted under guidance, with less financial burden; and medical insurance expenditure is under control. We propose to improve the performance incentive and constraint mechanism for drug prescriptions by physicians.

OBJECTIVE: To investigate the diagnosis and treatment of neurinoma of the head and neck. METHOD: The clinical data of 33 patients with neurinoma of the head and neck, from 1980 to 2004, were retrospectively reviewed and analysed. RESULT: The tumors of all the cases were totally resected. Thirty of thirty-three cases have been followed up. Twenty-seven cases were fully recovered without any serious complication. One case with malignant tumor were died. The other 2 cases were died of other diseases. CONCLUSION Tumor resection is still the most effective treatment available for patients with neurilemmomas of the head and neck. Resection of tumor should be performed as soon as possible with careful protection of the function of the nerve. Extensive resection should be performed to treat malignant tumors.
Adolescent ; Adult ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Neurilemmoma ; surgery ; Retrospective Studies ; Young Adult

Objective To explore the relationship of HBV genotypes and the age of patients,the positive ratio of HBV e antigen (HBeAg),DNA load in serum of patients,and its clinical significance.Methods We tested HBV B and C genotypes in 344 Zhejiang patients with hepatitis B,compared their clinical differences.Enzyme linked immune sorbent assay(ELISA) was used to test the HBeAg;HBV DNA copies was detected by time fluorescence quantitative PCR.Make comprehensive analysis of these indexes.Results Among the 344 Zhejiang HBV patients,113 patients (32.8％),217 patients (63.1％) and 14 patients (4.1％) were infected by HBV genotype genotype B,C and B + C,respectively.Positive ratio of HBeAg and HBV DNA in genotype C were higher than that of genotype B(P ＜0.01).The ratio of high level virus load(HBV DNA ＞ 105 copies/ml) in genotype C patients was higher than that in genotype B patients (P ＜ 0.01).Conclusion Genotype C is the major genotype in Zhejiang province.Genotypes are associated with the age of patients,positive ratio of HBeAg,DNA load in serum of patients.

OBJECTIVETo compare the safety and efficacy between extralevator abdominoperineal excision(ELAPE) and traditional abdominoperineal excision(APE) in patients with low rectal cancer.

METHODSFrom January 2011 to December 2013, 61 patients undergoing abdominoperineal excision for low rectal cancer at the Department of Gastrointestinal Surgery, Peking University People's Hospital were enrolled. The safety and efficacy of two procedure groups, ELAPE group (33 patients) and traditional APE group (28 patients) were reviewed retrospectively.

RESULTSLess intraoperative blood loss [(201 ± 147) ml vs. (343 ± 308) ml, P=0.022], shorter exhaust time [(3.8 ± 1.5) d vs. (4.6 ± 1.6) d, P=0.039] and lower perineal wound complication rate (9.1% vs. 25.0%, P=0.042) were observed in the ELAPE group as compared to the traditional APE group. However, longer operation time [(292 ± 46) min vs. (256 ± 28) min, P=0.008] and perineal drainage removal time [(11.1 ± 4.8) d vs. (7.1 ± 2.7) d, P<0.01] were noted in the ELAPE group than those in the traditional APE group. Number of lymph node retrieved and positive lymph node retrieved was not significantly different between two groups. The ELAPE group had lower rate of IOP (intraoperative perforation) (6.1% vs. 17.9%, P=0.055), but no significant difference was found. There were no significant differences in bowel movement, diet restoring time, average perineal drainage, postoperative hospitalization time and removing perineal stitches time between the two groups (all P>0.05).

CONCLUSIONELAPE possesses less intraoperative blood loss and lower perineal wound complication rate than traditional APE. ELAPE is associated with better safety and efficacy than traditional APE.