Objective To explore and evaluate the application value of damage control theory in bilateral craniotomy operation of severe craniocerebral trauma.Methods Seventy patients with Glasgow coma scale score ≤ 5 scores were divided into 2 groups by random digits table method with 35 cases each:standard trauma craniotomy group (normal group),non-standard craniotomy and small dural window exposure strategy group (improved group).The clinical data were compared.Results There was no significant difference in postoperative cerebral tissue bone window embedded meal,large area cerebral infarction incidence rate between two groups (P ＞ 0.05).There was significant difference in the duration of surgery,blood transfusion amount within 24 hours,traumatic epileptic seizure within 1 month,the acute intraoperative encephalocele between normal group and improved group [(2.80 ± 0.63) h vs.(4.21 ± 1.04) h,(3.90 ± 1.02) U vs.(5.55 ± 1.32)U,14.3％(5/35) vs.48.6％(17/35),5.7％(2/35) vs.25.7％(9/35)] (P ＜0.05).Followed up for 6 months,good prognosis,moderate disability,severe disability,vegetative state,death was 4,4,8,6,13 cases in normal group and 8,9,5,4,9 cases in improved group,and there was significant difference (x2 =5.040,P =0.025).Conclusion Severe craniocerebral trauma bilateral craniotomy damage is bigger,damage control theory to guide the improved operation method,can improve the rescue efficiency.

Objective To observe the accuracy of the five-level adult emergency triage system (FLAETS) in determining the severity of critically ill patients,and to analyze the factors that influenced the accuracy of the triage.Methods The triage information of patients admitted to Huashan North Hospital Affiliated to Fudan University between 1 year before and 1 year (started in July 2014) after the implementation of the FLAETS were retrospective analyzed.The patients who triaged by FLAETS (from September 2014 to August 2015) were served as observational group,and those manual triaged by modified early warning score (MEWS,from July 2013 to June 2014) were set as control group.The patients with triage of Ⅰ,Ⅱ,and Ⅲ levels were enrolled (fatal,critical,urgent),and the triage results of emergency physicians-in-chief on duty were set as gold standard.The gender,age,triage level,the proportion of over-triage,the proportion of under-triage,and mortality were compared between two groups.The reasons for the overtriage and under-triage were analyzed.The accuracy of FLAETS in determining severity of critically ill patients was calculated.Results 18449 patients were enrolled in observational group,and 720,1641 and 16088 patients were triaged as level Ⅰ,level ⅡⅡ,level Ⅲ respectively;17 378 patients were triaged as critically ill patients according to gold standard,and level Ⅰ,level Ⅱ,level Ⅲ were 637,1476 and 15 265 patients respectively.6 352 patients were enrolled in control group,and level Ⅰ,level Ⅱ,level Ⅲ were 204,771 and 5 377 patients respectively;6002 patients were triaged as critically ill patients according to gold standard,and level Ⅰ,level Ⅱ,level Ⅲ were 308,836 and 4 858 patients respectively.There were no statistically significant differences in gender and age between two groups (both P ＞ 0.05).Compared with the control group,the proportion of over-triage of level Ⅲ was significantly lowered [8.3％ (1 329/16088) vs.12.5％ (674/5 377),P ＜ 0.01],the proportion of under-triage of level Ⅱ and level Ⅲ was significantly lowered [level Ⅱ:0.6％ (9/1 641) vs.7.0％ (54/771),level Ⅲ:0.4％ (63/16088) vs.4.7％ (254/5 377),both P ＜ 0.01].The success rate of resuscitation in observation group was significantly higher than that of control group [80.70％ (619/767) vs.75.23％ (410/545),P =0.020],and the mortality was significantly lowered [1.11％ (193/17 378) vs.2.35％ (141/6002),P =0.037].Over-triages were mainly found in patients with chronic obstructive pulmonary disease (COPD),hypertension and the main complaint of chest tightness,shortness of breath,and under-triages were mainly found in patients with the multiple organ dysfunction in the elder,atypical heart disease and pneumothorax.The accuracy rates of level Ⅰ,level Ⅱ and level Ⅲ in observation group (99.37％,97.42％ and 89.58％) were significantly higher than those of the control group (97.51％,92.54％,and 80.16％,all P ＜ 0.01).Conclusion The FLAETS in determining severity of critically ill patients were objective and reliable,which enable the nurse to better handle the relationship of the emergency and the ordinary,the severe and the mild,the priority and the non-priority,which made the patients received timely and effective treatment.

Objective To study the role of esophagogastric junction contractile index (EGJ-CI) in evaluating the function of anti-reflux barrier,and in differentiating patients with gastroesophageal reflux disease (GERD) from those with functional heartburn (FH).Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015.All subjects had completed Gerd-Q questionnaire and undergone gastroscopy,24-hour pH-impedance monitoring and esophageal high-resolution manometry.GERD patients were divided into as reflux esophagitis,acid-nonerosive reflux disease (NERD) and weakly acid-NERD groups.Patients with normal esophageal mucosa,normal acid exposure and negative proton pump inhibitor test were enrolled in FH group.EGJ-CI (mmHg · cm) as well as EGJ rest pressure and 4s integrated relaxation pressure (IRP 4s) were measured.Results Among the 115 patients,18 were reflux esophagitis [(49.0 ± 18.9) years,M ∶ F =10 ∶ 8],25 were acid-NERD [(48.7 ± 14.4) years,M∶F=13∶ 12],37 were weakly acid-NERD [(52.0 ±14.8) years,M∶F=15∶22] and 35 were FH [(53.6 ± 14.8),M∶ F =8∶27].No differences of Gerd-Q scores were noticed between the four groups.(1) Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time (r =-0.283,P =0.002),EGJ-CI and acid reflux events (r =-0.233,P =0.012),EGJ-CI and weakly acid reflux events (r =-0.213,P =0.022),EGJ-CI and non-acid reflux events (r =-0.200,P =0.032).(2)The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD(all P ＜ 0.01).EGJ rest pressure of FH group was higher than that of acid-NERD (P ＜ 0.01).IRP 4s in acid-NERD group was lower than that of FH and weakly acid-NERD (P ＜ 0.05).(3) The area under curve (AUC) of EGJ-CI was higher than that of EGJ-CIT,EGJ rest pressure or IRP 4s (0.686 vs 0.678,0.641 and 0.578).The cut-off value of EGJ-CI to differentiate GERD from FH was 9.74 mmHg · cm with sensitivity 82.86％ and specificity 51.52％.Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time,weakly acid reflux events and non-acid reflux events.Thus it might be used as a metric to reflect the anti-reflux function of EGJ.According to the cut-off value of EGJ-CI 9.74 mmHg · cm,patients with GERD can be sensitively differentiated from patients with FH.

Objective To develop a motor rehabilitation system based on Kinect somatosensory interaction technology to be used in families.Methods The Kinect skeleton real-time tracking technique was applied to develop three motor rehabilitation protocols to instruct patients in how to perform rehabilitation training and to evaluate their performance.Results Five subjects participated in the experiment.They achieved average scores of 79.15 ±4.89 and 98.89±0.67 for 3D movement and arm lifting respectively.In the pose recognition experiment,their average recognition rate was 90.37 ± 5.21％.Conclusion The proposed rehabilitation system can instruct patients in performing training exercises and evaluate their performance at home.

BACKGROUND:Artificial knee joint replacement in older patients often combines with basic diseases, such as hypertension and diabetes. Perioperative blood loss is an important factor affecting the safety of replacement. OBJECTIVE: To explore the effect of the early closure of drainage tube on blood loss after primary total knee arthroplasty. METHODS: We randomly selected 90 patients with osteoarthritis of the knee who underwent primary total knee arthroplasty in the Affiliated Hospital of Qingdao University from January 2014 to July 2015. The patients were randomly divided into three groups (n=30). In the 4-hour occlusion group, the drainage tube was closed for 4 hours in early stage of replacement. In the 2-hour occlusion group, the drainage tube was closed for 2 hours in early stage of replacement. In the control group, the drainage tube was not closed. Because of the use of tourniquet during surgery, the amount of intraoperative blood loss was considered as 0 mL. Drainage blood loss after surgery was recorded. Total blood loss was calculated according to Gross formula through patient height, weight and preoperative and postoperative hematocrit. Hidden blood loss was gotten by subtracting the visible blood loss from total loss. Under the observation of postoperative joint sweling and subcutaneous ecchymosis, knee Hospital for Special Surgery score was recorded at 6 weeks after replacement, and compared among groups. RESULTS AND CONCLUSION:Statistical analysis indicated that significant differences in total blood loss and dominant blood loss were detected among the three groups (P < 0.05), indicating that both occlusion for 2 hours and 4 hours could reduce total blood loss and dominant blood loss, but the range of reduction was greater in occlusion for 4 hours. At 6 months after replacement, no significant difference in knee Hospital for Special Surgery score and hidden blood loss was detectable among three groups (P > 0.05). The incidence of joint sweling and subcutaneous ecchymosis was increased in the 4-hour occlusion group (P < 0.05). Above results confirmed that drainage tube occlusion can decrease total blood loss and dominant blood loss after total knee arthroplasty, but cannot reduce hidden blood loss. 2-hour occlusion after total knee arthroplasty is an ideal choice, but the amount of hidden blood loss should be carefuly considered.

Objective To assess the anal and pelvic floor function in patients with rectocele (RC),and to afford the evidence for the treatments of RC.Methods Patients with functional constipation (FC) and healthy controls were consecutively enrolled,and all the subjects underwent defecography and anorectal manometry.According to defecography,the subjects were divided into four groups as no RC,mild RC,moderate RC and severe RC.The t-test,analysis of variance,rank sum test and Chi-square test were performed to compare the results of anorectal manometry between different RC groups in FC patients,and the results of anorectal manometry between moderate RC group in FC patients and control group with moderate RC were also compared.Results A total of 54 FC patients and 17 healthy controls were enrolled.No RC was found in all of male subjects.Of 48 female patients with FC,nine cases (18.8％) had no RC,seven (14.6％) had mild RC,18(37.5％) had moderate RC,and 14(29.2％) had severe RC.Three of the 12 female controls had no RC,one had mild RC,and eight had severe RC.Among all female patients with FC,the defecation rectal pressure in severe RC group ((34.4 ± 14.2) mmHg,1 mmHg=0.133 kPa) was significantly higher than of no RC group ((20.8 ± 13.1) mmHg,t=3.663,P=0.001),mild RC group ((19.1± 15.1) mmHg,t=3.719,P＜0.01) and moderateRC group ((25.6±16.3) mmHg,t=2.525,P=0.010).The left rectal pressure after defecation in mild RC group ((55.1 ± 19.7) mmHg) was significantly higher than that of moderate RC group ((43.3±17.6) mmHg,t=2.507,P=0.019) and severe RC group ((40.0±20.9) mmHg,t=2.619,P=0.006).The anal relax ratio in mild RC group (3.0％,0.5％ to 25.5％) was significantly lower than that of moderate RC group (19.5％,10.0％ to 29.0％,Z=-2.583,P=0.010) and severe RC group (22.0％,7.3％ to 54.5％,Z=-2.830,P=0.005).There were no significant differences in rectal and anal resting pressure,anal squeezing pressure,rectal sensory threshold and constituent ratio of manometry among four groups (all P＞0.05).The left rectal pressure after defecation in FC patients with moderate RC ((43.3 ± 17.6) mmHg) was significantly higher than that of controls with moderate RC ((26.3±20.8) mmHg,t=2.997,P＜0.01),and anal relax ratio was significantly lower than that of controls with moderateRC ((23.4±20.2)％ vs (55.2±16.3)％,t=-5.266,P=0.008).Conclusions RC is found in female and also found in individuals with normal defecation.FC patients with mild RC lack enough anal relax during defecation.However,defecation is relatively coordinate in FC patients with severe RC,which indicates that severe RC may be part of manifestation of pelvic floor relaxation.

Objective To investigate the discrepancy of anorectal function in patients of Parkinson's disease (PD) with constipation and functional constipation (FC).Methods Fifteen consecutive male PD patients with constipation and 45 male FC patients were recruited for the study.All subjects underwent colonoscopy or barium enema in order to exclude organic colon diseases.Every patient underwent anorectal manometry and was categorized into subgroups of either dyssynergic defecation (F3a) or inadequate defecatory propulsion (F3b).Results The ages of PD with constipation and FC patients were (70 ± 11) and (68 ± 11) years old respectively.The rectal resting pressure in PD with constipation was higher than that in FC group without statistical significance [9.0 (4.0,15.0) mm Hg vs 6.0 (3.0,9.5) mm Hg,P=0.082,1 mm Hg =0.133 kPa].The anal resting pressure in PD group was not different from FC group [(51.2±17.2) mm Hg vs (59.7 ± 20.4) mm Hg,P =0.152].During anal squeezing,the maximal contraction pressure and area under the squeeze curve in PD with constipation group were both significantly lower than FC patients [maximal contraction pressure:(136.9 ± 43.8) mm Hg vs (183.0 ± 62.1) mm Hg,P=0.010; area under the squeeze curve:(823.5 ±635.7) mm Hg · s vs (1392.4± 939.9) mm Hg · s,P =0.033].During forced defecation,both of the defecation rectal pressure and defecation anal pressure in PD with constipation group were significantly lower than that of FC patients [22.0(15.0,30.0) vs42.0(31.0,55.0)mm Hg,P=0.000; and (46.3 ±23.3) vs (77.9 ±35.1) mm Hg,P =0.002].The proportions of F3a subtype were 10/15 and 46.7％ (21/45) in PD with constipation and FC patients respectively.There was no significant difference in the constituent ratio (P =0.120).Initial rectal sensory volumes were (91.3 ± 56.9) ml and (67.2 ± 38.9) ml in PD with constipation and FC patients respectively.Even both volumes were higher than the normal controls,there was no significant difference between the two groups (P =0.074).Conclusions Both PD with constipation and FC patients have abnormal anorectal motility and sensation comparing to the FC group,the parameters of anal contraction and defecation are significantly lower,F3b is dominant,and rectal sensory threshold is higher in PD with constipation patients.These parameters could possibly characterize the anorectal manometry for PD with constipation patients,which is helpful to understand the pathogenesis of PD and differentiate from other diseases.

Objective:Our aim was to study the levels of atrial natriuretic peptide (ANP) and pulmonary perfusion imaging in determining of pulmonary artery hypertension (PAH). Methods: We measured ANP levels by using radioimmunoassay after making various types of PAH in rabbits. Catheterization and pulmonary perfusion tomographic imaging were used in the control group. Results: When the pulmonary artery pressure increased slightly, the ANP levels were lower in PAH group than that of control group, but the difference was not significant (t=1, P>0.05). At the same time, pressure measured by catheterization did not change as the control group, but the ratio of back/abdomen radiopharmaceuticals distribution which was measured with pulmonary perfusion tomographic imaging was significantly higher in PAH group than that of the control (t=2.5, P<0.05). The difference between the ANP levels when the pulmonary artery pressure increased medially and seriously was significant (t＝4.0 and 6.5, P＜0.05). The other two methods got the same result (P＜0.05). Results of three examining methods were positively related. Conclusion:The ANP levels can determine the degree of PAH, and it was simple. But it was not as sensitive as that of pulmonary perfusion tomographic imaging.

Objective To explore the technique of maximum entropy model for extracting Oncomelania hupensis snail habi?tats in Poyang Lake zone. Methods The information of snail habitats and related environment factors collected in Poyang Lake zone were integrated to set up the maximum entropy based species model and generate snail habitats distribution map. Two Land?sat 7 ETM+remote sensing images of both wet and drought seasons in Poyang Lake zone were obtained,where the two indices of modified normalized difference water index(MNDWI)and normalized difference vegetation index(NDVI)were applied to ex?tract snail habitats. The ROC curve,sensitivities and specificities were applied to assess their results. Furthermore,the impor?tance of the variables for snail habitats was analyzed by using Jackknife approach. Results The evaluation results showed that the area under receiver operating characteristic curve(AUC)of testing data by the remote sensing?based method was only 0.56, and the sensitivity and specificity were 0.23 and 0.89 respectively. Nevertheless,those indices above?mentioned of maximum en?tropy model were 0.876,0.89 and 0.74 respectively. The main concentration of snail habitats in Poyang Lake zone covered the northeast part of Yongxiu County,northwest of Yugan County,southwest of Poyang County and middle of Xinjian County,and the elevation was the most important environment variable affecting the distribution of snails,and the next was land surface tem?perature(LST). Conclusions The maximum entropy model is more reliable and accurate than the remote sensing?based meth?od for the sake of extracting snail habitats,which has certain guiding significance for the relevant departments to carry out mea?sures to prevent and control high?risk snail habitats.

Objective To investigate the value of critical scoring system in the treatment of multiple organ dysfunction after exposure to poisoning by analyzing 3 cases of industrial organic fluorine gas poisoning.Methods Clinical data of symptoms,signs,treatments,outcome and the changes in the scores as APACHE Ⅱ,SOFA,MODS were collected,the differences among the patients were compared and the relevance was analyzed.Results The first APACHE Ⅱ was 19-26.Scores of case 1 in the three scoring systems constantly increased and different components were found,with the suggestion of sequential organ dysfunction.Other two patients' scores decreased and survived without complications.Conclusiorn Multiple critical scoring systems can be used to evaluate the outcome of multiple organ dysfunction due to organic fluorine gas poisoning.System evaluation and individualized treatment are both important.More studies can help to set up a special critical scoring system.