Objective To explore the influence of QCC on the infection of orthopedic aseptic operation and healthcare workers in the operating room. Methods A total of 170 patients undergoing orthopedic aseptic operation from January 2015 to June 2015 were chosen as QCC group and 164 patients from June 2014 to December 2014 as control group. The wound infection rate,increased rate of WBC and temper-ature,the responsibility,initiative,problem solving skills,self-confidence,harmony,cohesion of doctors and nurses between two groups were recorded. Results The wound infection rate(2. 4%), increased rate of WBC(2. 4%) and temperature(1. 2%) in QCC group were signifi-cantly lower than those of control group(5. 5%,9. 1%,6. 7%). Moreover,the responsibility(4. 6 ± 0. 6) point,initiative(4. 4 ± 0. 3) point, problem solving skills(4. 1 ± 0. 8) point,self-confidence(4. 3 ± 0. 7) point,harmony(4. 8 ± 0. 9) point and cohesion (4. 2 ± 0. 4) point of doctors and nurses in QCC group were significantly higher than those of control group[(2.9±0.7) point,(2.3±0.5) point,(2.5±0.5) point,(2. 8 ± 0. 6) point,(3. 1 ± 0. 4) point,(1. 8 ± 0. 3) point,respectively)]. Conclusion QCC could effectively reduce the infection rate of orthopedic aseptic operation,and improve the overall quality of the participants health care workers in the operating room.

OBJECTIVE: To discuss the method of recurrent laryngeal nerve anatomy of thyroid surgery, for avoiding recurrent laryngeal nerve injury. METHOD: Recurrent laryngeal nerve of all 247 cases were found along tracheoesophageal groove or angle of thyroid cartilage, in front of the recurrent laryngeal nerve showed up next to the thyroid cartilage angle and cricothyroid membrane, or down to thyroid anatomy revealed under the lower pole artery and vein, and not have to deliberately look for a branch of the recurrent laryngeal nerve, a total of 258 recurrent laryngeal nerve were found. RESULT: Among two hundred and forty-seven cases, the recurrent laryngeal nerve injury was two cases, injury rate was 0.8%. And the two cases were incomplete injury, which about a month were back to normal, and significant deviation was found with no pre-conventional anatomy of of recurrent laryngeal nerve of 276 cases (P < 0.05). CONCLUSION Conventional recurrent laryngeal nerve anatomy in thyroid surgery could effectively avoiding recurrent laryngeal nerve injury.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; anatomy & histology ; surgery ; Thyroid Cartilage ; surgery ; Thyroid Gland ; surgery ; Young Adult

U1 trastuctrural changes of myocardium and lungs from 6 cases died of cranioce-rebral penerating gunshot wound 2 hours after injury is reportcd.In all cases theelectron microscopy of the myocardial and lung tissue samples showed the similar ultrastructural morphological changes of the cells and interstitial tissues.The mostpr-ominent ultrastructural changes of myocardium were disorderly arrangement of the Zband.focal dissociation of the myofibrills,mitochondrial swelling with decreasing ofmatrix density and disruption of cristae,and interstial edema.The changes of theung tissue were increasing of width of alveolar septa with decreasing of the electron density.Aggregation of neutrophils in the capillaries of alveolar septa and some alveolar space was observed.The significance and the pathogenesis of the mainpathological changes were discussed.It is suggested that the pulmonary interstitialedema was neurogenic.The pulmonary edema may be manifested as interstitial edemaor intra-lveolar edema depending upon the time elapsed after the gunshot injury.

Objective To examine the association of serum 25-hydroxyvitamin D levels with arterial stiffness and left ventricular hypertrophy (LVH) in elderly hypertension patients.Methods We recruited 166 elderly patients [mean age,(80.8 ± 6.2) years] with primary hypertension.Arterial stiffness was assessed by carotid femoral pulse wave velocity (cfPWV).Left ventricular mass index (LVMI) was determined according to the Devereux formula.Based on serum 25-hydroxyvitamin D levels,the patients were divided into two groups,the low 25-hydroxyvitamin D group (＜20 μg/L)and the high 25-hydroxyvitamin D group (≥20 μg/L).Results Faster cfPWV and larger LVMI values were observed in the low 25-hydroxyvitamin D group as compared with the high 25-hydroxyvitamin Dgroup [(15.00±3.04) m/s vs.(11.26±3.09) m/s;(120.14±25.82) g/m2 vs.(96.74±23.10) g/m2 ; t=-6.79,-5.16,respectively; both P=0.000].Multiple liner regression analysis showed that the 25-hydroxyvitamin D level was independently associated with LVMI (β=0.215,P=0.001) and cfPWV (β=-0.469,P＜0.001).Conclusions Serum 25-hyroxyvitamin D is independently associated with arterial stiffness,LVH Vitamin D may play an important role in the pathogenesis of arterial stiffness and LVH in elderly hypertension patients.

Objective To explore the relationship of insulin resistance with serum 25-hydroxyvitamin D levels and arterial stiffness in elderly patients.Methods A total of 162 elderly inpatients (aged 60 years or over) were recruited from 2012 to 2014.Levels of fasting serum insulin,fasting serum glucose,creatinine and vitamin D were determined.Insulin resistance (IR) was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR).The patients were divided into the following three groups according to HOMA-IR:the low IR group with HOMA-IR less than 2 (n=78),the median IR group with HOMA-IR between 2 and 6 (n=43),and the high IR group with HOMA-IR greater than 6 (n=41).Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV).Arterial stiffness and serum vitamin D levels were compared among the three groups.Results cfPWV was increased and the serum 25-hydroxyvitamin D level was decreased in the high insulin resistance group compared with the low insulin resistance group[(13.2± 5.7) μg/L vs.(17.8±6.2) μg/L,(14.3±5.2) m/s vs.(11.9±3.0) m/s].Multiple liner regression analysis showed that IR was negatively correlated with the serum 25 hydroxyvitamin D level (r=-0.63,P＜0.05) and positively correlated with arterial stiffness (r=0.45,P＜0.05) after adjustment for age,sex and other confounders.Conclusions Elderly patients with high insulin resistance may have lower levels of serum vitamin D and higher arterial stiffness.

Objective:To explore the validity of a function assessing tool based on the International Classification of Functioning, Disability and Health′s (ICF′s) rehabilitation set in assessing aging-related disability.Methods:A total of 1610 elderly people from 15 nursing homes across China were assessed using the tool based on the ICF′s rehabilitation set and with the 12-item short form health survey (SF-12). The structural validity of the responses was analyzed using factor analysis, and criterion-related validity was also evaluated.Results:The factor analysis yielded three factors with eigenvalues greater than 1. Their cumulative explanatory power was 74.4%. Item d550 eating had double loading in the factor analysis. The item scores and the total scores of the disability assessment tool were significantly negatively correlated with the physiological function domain scores and the psychological function domain scores.Conclusion:The function assessment tool based on the ICF′s rehabilitation set when combined with a numerical rating scale has good structural and criterion-related validity in the assessment of disability due to aging.

Objective To discuss the clinical features of bilateral multiple renal angiomyolipomas (RAML) with tuberous sclerosis complex (TSC).Methods Clinical data of 10 cases of bilateral multiple RAML associated with TSC treated from Jan.2003 to Dec.2010 were retrospectively reviewed.There were 4 males and 6 females in the study group,aged from 18 to 45 years,with an average age of 34 years.Three cases were treated urgently due to RAML hemorrhage.Five cases were treated due to back pain.One case was treated for hematuria.One case was diagnosed during physical examination.Facial angiofibroma occurred in 7 cases and facial flat speckle in 1 case.Epilepsy was indentified in 6 cases.Four cases had hypophrenia and 2 cases presented with symptoms of the classic triad:epilepsy,facial angiofibroma and hypophrenia.One case underwent urgent selective transcatheter arterial embolization (SEA).Eight cases (9 sides) underwent renal sparing operation.Conservative therapy was adopted in 2 cases.ResultsThe SEA was done successfully and bleeding ceased.AⅡ surgeries were completed successfully.The diameter of the biggest tumor resected was 8.0 cm.The number of tumors resected was 2 - 6,with an average of 3.5.The mean operative time was 70 min (range 50 to 120 min).The mean time of controlling the renal artery was 26 min.The mean intraoperative hemorrhage was 150 ml.One case required a blood transfusion.None of the cases re-hemorrhaged after operation.Pathology revealed RAML.There was no recurrence in 8 cases and follow-up ranged from 3 to 60 months,with an average of 25 months.A hemorrhage did occur on the oppositer side in 1 case 4 months after surgery.In 2 cases,a conservative therapy of regular monitoring and follow-up at 24 and 36 months was chosen.The serum creatinine of all the patients was in a normal range.Conclusions The bilateral multiple RAML associated with TSC must be diagnosed as soon as possible and treated depending on the size,location and developing circumstance of the tumor in a timely fashion.Renal sparing surgery and SEA are effective therapies.

Objective To analyze the diagnosis and treatment for complications of renal caliceal diverticulum with calculi or infection. Methods A retrospective investigation was performed on 29 cases with renal caliceal diverticulum. The 29 cases included 11 males and 18 females aged 18 to 61 years. Among the study group, 3 cases were simple renal caliceal diverticulum, 12 cases were diagnosed as diverticular calculi and 14 cases presented recurrent urinary tract infections including 3 cases with urinary fistula after unroofing and decompression as renal simple cyst from another hospital. Ten cases underwent an open operation that unroofed and decompressed the cyst, and sutured the diverticular neck. Eight cases underwent laparoscopic operation similar to the open operation, including lithotomy in caliceal diverticulum in 2 cases. Eleven cases diagnosed with caliceal diverticular calculi were taken one-stage percutaneous nephrolithotomy including dilating the diverticular neck, remaining the nephrostomy catheter and Double-J ureteral stents, and 1 case was transferred to open operation.Results The open and laparoscopic operations were performed successfully. One case was cured by Double-J ureteral stenting after postoperative urinary leakage. One case was transferred to open operation for the failure of percutaneous puncturation. X-ray examination revealed that there were no remaining stones after the operation. All the patients were followed up for 6 to 24 months without calculi and infection recurrence. Conclusions Stones and infection are common that complications of renal caliceal diverticulum. Percutaneous nephrolithotomy, laparoscopy and other operations were effective and feasible treatment options for cases with complications of renal caliceal diverticulum. Exact diagnosis was very important for treatment of renal caliceal diverticulum before operation.

Objective To explore the mechanism of Panax notoginsenosides in the treatment of sepsis based on network pharmacology and molecular docking technology.Methods The action targets of total saponins of Panax notoginsenosides were obtained by searching the databases of TCMSP,Swiss Target Prediciton and PharmMapper,and the disease-related targets of sepsis were searched in the databases of Genecard,Drugbank,Disgenet and OMIM.The selected targets of total saponins of Panax notoginsenosides were intersected with the disease-related targets of sepsis,which were used as potential targets for the treatment of sepsis.The protein-protein interaction(PPI)network of potential targets was constructed by STRING database,and the key targets were screened;the potential targets were analyzed by GO function and KEGG pathway enrichment analysis,and the drug-disease-target-pathway network was constructed;the molecular docking of five monomer saponins of Panax notoginsenosides and the key targets of Panax notoginsenosides in the treatment of sepsis was studied by AutoDock Vina software.Results A total of 206 potential targets of Panax notoginsenosides in the treatment of sepsis were obtained,and key targets such as AKT1,TP53,SRC,STAT3,JUN,TNF,IL6,MAPK1,PIK3R1 and IL1B were screened.A total of 2 548 biological process(BP)items,174 molecular function(MF)items and 47 cellular component(CC)items were obtained by GO functional enrichment analysis of potential targets,and 171 signal pathways were obtained by KEGG pathway enrichment analysis.The main active components of Panax notoginsenosides R1,ginsenoside Rg1,ginsenoside Re,ginsenoside Rb1 and ginsenoside Rd have strong binding activity with key targets AKT1,TP53,STAT3,SRC and JUN.Conclusion Panax notoginsenosides may act on the main signal pathways such as PI3K-Akt and AGE-RAGE through the key targets such as AKT1,TP53,SRC,STAT3 and TNF,and then affect the physiological processes such as inflammation,apoptosis and blood coagulation in sepsis,and play a role in the treatment of sepsis.

Objective To investigate the influence of fear of falling on clinical ,functional ,and gait variables in elderly patients with type 2 diabetes and to identify predictive factors for fear of falling in this population. Methods A total of 238 community-dwelling older persons with type 2 diabetes (aged 65 to 89 years ) were divided into two groups according to Falls Efficacy Scale-International scores.Participants with a score<23 were assigned to the no-fear group (n=118) and those with a score≥ 23 were assigned to the fear group (n= 120 ).Demographics ,anthropometrics ,number of diseases and medications ,physical activity level ,history of falls ,frailty level ,cognition ,depressive symptoms ,fasting glucose level ,and disease progression were collected. Timed Up and Go test (TUG) ,five times sit-to-stand test (5-STS) ,and tests for grip strength and pace were run. Results Participants in the fear group were more frail and presented more depressive symptoms and worse performance in the TUG and 5-STS tests than in the no-fear group.The fear group also showed a slower pace ,a shorter step length ,a longer step time ,and a longer swing time.Multivariate regression analysis revealed that the likelihood of having fear of falling increased by 1.32 times (OR :1.32 ,95％CI :1.09-1.58) for every one-point increase in the Geriatric Depression Scale (GDS-15) score and by 1.35 times (OR :1.35 ,95％ CI :1.06-1.70) for every one-second increase in TUG. Conclusions The fear of falling in community-dwelling elderly patients with type 2 diabetes mellitus is associated with frailty ,depressive symptoms ,dynamic balance ,functional mobility ,and abnormal gait. Furthermore , both GDS-15 and TUG test can predict fear of falling in this population.