The general clinical abilities of attending doctors are closely linked with the overall quality of patient care in a hospital. A set of quality standards for ward rounds by attending doctors were formulated in the author's hospital and an intensive evaluation was conducted by the experts team of the results of inspection and assessment. It is suggested that the hospital should tighten the quality control of ward rounds by attending doctors and pay serious attention to various problems that may occur. In particular, the hospital should set strict assessment standards for post qualification for attending doctors and strive to cultivate their clinical abilities after their post assumption. In addition, it should bring their talent into full play on the basis of vigorous management and assessment and discover and correct their shortcomings in ward rounds in a timely manner.

OBJECTIVE:To study the plasma total homocysteine(tHcy)level in the uremia patients and to study the therapeutic effects of folic acid combined with methylcobalamin in the intervention treatment of uremia patients with homo-cysteinemia.METHODS:Levels of plasma tHcy of60uremia patients(treatment group)and40normal subjects(control group)were determined both before treatment and8weeks after intervention treatment with folic acid combined with methylcobal-amin.RESULTS:The plasma level of tHcy in uremia patients were significantly higher than that in the normal subjects(P

Objective Routine perioperative intravenous antimicrobial agents,was administered as surgical prophylaxis.However,whether balanced ultrafiltration during extracorporeal circulation can remove antimicrobial agent remains unclear.The concentrations of antimicrobial agent in plasma and ultrafiltrate samples were measured in this pseudo-extracorporeal circulation model.Methods Extracorporeal circulation consisted of cardiotomy reservoir (Ningbo Fly Medical Healthcare CO.,LTD.Ningbo,China),D902 Lilliput 2 membrane oxygenator (Sorin Group Asia Pte Ltd,Beijing,China) and Capiox (R) AF02 pediatric arterial line filter (Terumo Corporation,Beijing,China).HEMOCONCENTRATOR BC 20 plus (MAQUET Cardiopulmonary AG,Hirrlingen,Germany) was placed between arterial purge line and oxygenator venous reservoir.Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24％-28 ％.After 30 minutes of extracorporeal circulation,zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100 mm Hg(1 mm Hg =0.133 kPa) with Hoffman clamp.The rate of ultrafiltration (12 ml/min) was controlled by ultrafiltrate outlet pressure.Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during 45 minutes of experiment.Plasma and ultrafiltrate samples were drawn every 5 minutes and concentrations of antimicrobial agent (including Cefmetasole and cefotiam) were measured with high performance liquid chromatography.Results All these two antimicrobial agents were detected in ultrafiltrate,demonstrating hemoconcentration may remove antimicrobial agent.The concentration of plasma antimicrobial agent decreased lineally with the increase of ultrafiltrate volume.At end of balanced ultrafiltration,the concentration of plasma cefotiam was (104.96 ± 44.36) μg/ml,which is about (44.38 ± 7.42) ％ of the initial concentration (238.95 ± 101.12) μg/ml; the concentration of plasma cefmetazole decreased linearly to (25.76 ± 14.78) μg/ml,which is about (49.69 ± 10.49) ％ of the initial concentration (51.49 ± 28.03) μg/ml.The total amount of cefotiam in ultrafiltrate is (27.16 ± 12.17)％ of the total dose administered,whereas cefmetasole in ultrafiltrate is (7.74 ±4.17)％.Conclusion Balanced ultrafiltration may remove antimicrobial agent from serum and has significant influence on plasma concentration of antimicrobial agent.The strategy of surgical prophylaxis should consider this unique technique during extracorporeal circulation.

Objective To evaluate a new platelet function analyzer PL-11 with three major platelet function methods.Methods A randomized controlled trial was adopted.Totally 20 healthy young students from People's Liberation Army Medical School were enrolled in the study during July and August in 2013.Subjects were treated with aspirin or clopidogrel and the platelet function was measured by using of PL-11,as well as light transmittance aggregometry (LTA),VerifyNow and thromboelastography (TEG).Results When monitor aspirin response,correlations between arachidonic acid (AA) induced PL-11 and other methods were:LTA,0.614; VerifyNow,0.829; TEG,0.697,respectively.Biases between AA induced PL-1 1 and LTA were 1.94％ at baseline and 24.02％ during aspirin treatment.Cut-off value of aspirin response tested with AA induced PL-11 was 33.3％.When monitor clopidogrel response,correlations between adenosine piphosphate (ADP) induced PL-11 and other methods were:LTA,0.767; VerifyNow,0.851; TEG,0.608.Biases between ADP induced PL-11 and LTA were 3.01％ at baseline and 6.56％ during clopidogrel therapy.Cut-off value of clopidogrel response tested with ADP induced PL-1 1 was 66％.Conclusion Results of different platelet function testing methods were not equally effective.PL-11 has a high capability when monitoring short aspirin or clopidogrel response.

ObjectiveA single pump and double arterial lines piglet model was established in this piglet's experiment.The preliminary study of cerebral blood flow proportion and distribution was performed continuously during the procedure.MethodsEight female piglets were utilized in this study.The body weight ranged from 18 kg to 22 kg.The right atrium was carmulated for venous drainage.Double arterial lines were established through cannulating into right carotid artery and ascending aortic aorta.Selective antegrade cerebral perfusion (SACP) through right carotid artery started after bladder temperature was decreased to 20℃ and the perfusion from ascending aortic aorta was interrupted.The perfusion through ascending aortic aorta resumed following 60 minutes of circulatory arrest.Traditional rewarming strategy was adopted and the experiment ended when bladder temperature attained 36℃.The real-time blood flow in the double arterial lines was monitored using a TS410 transit-time tubing flowmeter (Transonic Systems Inc.,Ithaca,NY).Blood pressure in femoral artery,intra-circuit pressure was recorded every five minutes interval.Regional cerebral oxygen saturation ( rSO2 ) was assessed with NIRO-200 oximeter using Near-infrared spectroscopy (Hamamatsu Photonics,Hamamatsu City,Japan )and mixed venous oxygen saturation ( SvO2 ).Blood samples were drawn for blood chemistry measurement prior to extracorporeal circulation,before circulatory arrest and at the end of experiment.ResultsArterial blood pressure was maintained at (60 ± 20) mm Hg.Total blood flow perfusion was(85.30 ±6.81)ml · kg-1 · min-1 and(14.42 ±1.76) ml · kg-1 · min-1 in right carotid artery.The proportion of cerebral blood flow was (16.72 ± 2.77 )％ of total perfusion.Cerebral blood perfusion was controlled with( 15.11 ± 0.44)ml · kg - 1 · min - 1 during SACP.Compared to SvO2,rSO2 remained stable during the procedure.The plasma concentration of

OBJECTIVETo analyze the clinical manifestations and hematologic parameters and observe the cytomorphological features of metastatic tumors in the bone marrow originating from different primary sites.

METHODSThe clinical data of 77 patients with bone marrow metasta tumors admitted between 2009 and 2014 between 2009 and 2014 in General Hospital of PLA were studied retrospectively to analyze the indications of laboratory examinations (hematological laboratory tests, tumor markers, peripheral blood films, and bone marrow aspirates).

RESULTSOf the 77 patients analyzed, 64.9% were over 50 years of age. The most common clinical characteristics were bone pain (65%), anemia with thrombocytopenia (63.6%) and leukoerythroblastic reaction (61%). The hematological abnormalities included elevation of ESR, ALP, LDH, tumor markers, and hypoproteinemia. Cytological examination of bone marrow aspiration samples revealed different morphological characteristics of the metastatic cells from different primary sites; in most of the cases, scattered or clustered metastatic cells and degenerative tumor cells were found on the edge of the bone marrow smears.

CONCLUSIONDetection of the primary tumor site is difficult by cytological examination of bone marrow aspiration samples, but the cytological findings can be of value in the diagnosis of neuroblastoma, small cell lung cancer and gastric cancer (signet ring cell carcinoma). A definite diagnosis of bone marrow metastatic tumor relies on a combined evaluation of the disease history, clinical symptoms and laboratory findings.

Anemia ; Biomarkers, Tumor ; blood ; Bone Marrow ; pathology ; Bone Marrow Examination ; Bone Marrow Neoplasms ; secondary ; Carcinoma ; pathology ; Hematologic Tests ; Humans ; Neuroblastoma ; Retrospective Studies ; Small Cell Lung Carcinoma ; Stomach Neoplasms ; Thrombocytopenia

BACKGROUND:Although traditional screw fixation has been successful in treating ankle fractures,rigid fixation solutions tend to restrict ankle movement and delay fracture healing,whereas elastic fixation is more compatible with human mechanics and has unique advantages in patients with ankle fractures. OBJECTIVE:To compare the clinical effectiveness of elastic fixation and absolute fixation in repairing ankle fractures in the elderly with lower tibiofibular instability. METHODS:The clinical data of 108 elderly ankle fractures with lower tibiofibular instability in Hengshui People's Hospital from August 2019 to August 2021 were retrospectively collected.They were divided into screw group and elastic fixation group(n=54 per group)according to the surgical protocol,and traditional screw internal fixation and elastic internal fixation were performed respectively.The perioperative indicators,surgical results,economic benefits,and American orthopedic foot and ankle society scores were collected and compared between the two groups.Serum tumor necrosis factor-α,interleukin-8 levels,ankle cavity width,depth,and lower tibiofibular space were compared before and after surgery. RESULTS AND CONCLUSION:(1)The full weight-bearing time was shorter in the elastic fixation group than that in the screw group;the operating angle was greater in the elastic fixation group than that in the screw group,and the complication rate was lower in the elastic fixation group than that in the screw group(P<0.05).(2)Serum tumor necrosis factor-α and interleukin-8 levels in the elastic fixation group were lower than those in the screw group 3 days after surgery(P<0.05).(3)American orthopedic foot and ankle society scores in the two groups were higher than those before surgery at 6 and 12 months after surgery,and the depth and width of the inferior tibiofibular space and ankle cavity were lower than those before surgery(P<0.05);but no significant difference was detected between the two groups(P>0.05).(4)There was no significant difference in the excellent and good rate between the two groups at 12 months after surgery(P>0.05).(5)There was no significant difference in the comparison of direct non-medical costs,direct medical costs,and total costs between the two groups(P>0.05).(6)It is indicated that elastic fixation for the repair of ankle fractures with lower tibiofibular instability in the elderly can obtain effective outcomes,which can shorten the time of complete weight-bearing,diminish complications,and alleviate inflammatory stress.

BACKGROUND:The displacement change parameters of the bone structure of the first metatarsal bone at the two-dimensional level of hallux valgus deformity are of great significance for clinical diagnosis and treatment,while the quantitative analysis of the three-dimensional deformity index may have some influences on the postoperative efficacy. OBJECTIVE:To explore the quantitative change of the three-dimensional deformity index of the first metatarsal bone after routine osteotomy and orthosis for hallux valgus deformity and to provide reference for clinical work. METHODS:100 patients with hallux valgus deformity(foot)in Hengshui People's Hospital from October 2020 to April 2023 were selected and all of them underwent conventional osteotomy and orthosis.Foot function was assessed by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale 6 months after surgery.Anterolateral X-rays of the foot in weight-bearing position and CT images in simulated weight-bearing position were taken before surgery and 6 months after surgery.The three-dimensional deformity indexes of the first metatarsal bone before and after surgery were quantitatively analyzed in patients with different ages,genders and therapeutic effects,including first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle.The value of the difference of three-dimensional deformity indexes of the first metatarsal bone before and after operation in evaluating the curative effect was analyzed. RESULTS AND CONCLUSION:(1)Six months after operation,the American Orthopedic Foot and Ankle Society score was 75-98(88.25±4.14)points,among which 56 cases were excellent,28 cases were good,14 cases were average,and 2 cases were poor.The excellent and good rate was 84%(84/100).(2)Compared with the preoperative results,first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle were significantly improved in patients of different ages and genders 6 months after surgery(P<0.05).First-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle were all lower in patients with good curative effect 6 months after surgery than those with poor curative effect,and the difference before and after surgery was greater than those with poor curative effect(P<0.05).(3)The area under the curve of the difference evaluation of the first metatarsal three-dimensional deformity index before and after surgery was above 0.7,and the area under the curve of the combined evaluation of all indexes was the largest(0.902),which was significantly greater than the first metatarsal rotation α angle and distal metatarsal articular angle(P<0.05).(4)The quantitative analysis of the three-dimensional deformity index of the first metatarsal in patients with hallux valgus deformity is related to the postoperative effect,which has important guiding significance for improving the accuracy and comprehensiveness of preoperative evaluation and improving the treatment plan.

Objective To evaluate the long?term efficacy of transjugular intrahepatic portosystemic shunt(TIPS)for gastric variceal bleeding. Methods A retrospective analysis was performed on the data of 65 cirrhotic patients with type 1 isolated gastric variceal bleeding in the First Affiliated Hospital of Anhui Medical University from January 2014 to January 2016.Patients were divided into two groups,TIPS treatment group(n=28),and gastric variceal obturation(GVO)treatment group(n=37). The long?term follow?up results of the two groups were compared. Results Operations of the two groups were succeed. Postoperative complications in the TIPS group and GVO group were 7.14%(2/28)and 13.51%(5/37), respectively, (P=0.801).Nine cases(32.14%)had mild hepatic encephalopathy in the TIPS group,and no occurred in the GVO group. During the 20.18 ± 6.90 months of follow?up in the TIPS treatment group, 2(7.14%) patients died, and the cumulative rebleeding?free rate at 6, 12 and 18 months was 88.4%, 83.7% and 76.1%,respectively.During the 16.14±6.03 months of follow?up in the GVO treatment group,5(13.51%) patients died, and the cumulative rebleeding?free rate at 6, 12 and 18 months was 86.5%, 70.2% and 60.9%,respectively. The survival rate between the two groups had no significant difference(P=0.690). There was a statistically significant difference in the cumulative non?bleeding rate in 18 months of follow up(log?rank test,χ2=6.304,P=0.012). Conclusion TIPS is superior to GVO for controlling gastric variceal bleeding in the long run,but clinicians should be vigilant to the occurrence of hepatic encephalopathy after operation.

Extracorporeal cardiopulmonary resuscitation (ECPR) is a salvage therapy for patients suffering cardiac arrest refractory to conventional resuscitation, and provides circulatory support in patients who fail to achieve a sustained return of spontaneous circulation. ECPR serves as a bridge therapy that maintains organ perfusion whilst the underlying etiology of the cardiac arrest is determined and treated. Increasing recognition of the survival benefit associated with ECPR has led to increased use of ECPR during the past decade. Commonly used indications for ECPR are: age<70 years, initial rhythm of ventricular fibrillation or ventricular tachycardia, witnessed arrest, bystander cardiopulmonary resuscitation within 5 min, failure to achieve sustained return of spontaneous circulation within 15 min of beginning cardiopulmonary resuscitation. This review provides an overview of ECPR utilization, recent outcomes, risk factors, and complications of ECPR. Identifying ECPR indications, rapid deployment of extracorporeal life support equipment, and high-quality ECPR management strategies are of paramount importance to improve survival.