Objective To explore the management strategy of hepatic trauma. Methods From January 1997 to January 2008, a retrospective study was performed on 112 cases of hepatic trauma. Base on the classification of AAST,non-operative treatment was used in 40 hemodynamic steady patients (grade Ⅰto Ⅱ), hepatic repair was therapeutic method to grade Ⅱ to Ⅳ (48 cases), while hepatectomy or plus selective ligation of hepatic artery were chosen for grade Ⅳ to Ⅴ (13 cases). Peripheral hepatic tamping or plus selective ligation of hepatic artery were effective therapeutic approaches to grade Ⅳ to Ⅴ (11 cases) according to damage control surgery. Results In the operative case.s, 60 cases were cured, 12 died. All non-operative cases were cured. Conclusions Non-operative management is widely becoming one of the most important strategies in the treatment of hepatic trauma with stable hemodynamics. Surgical intervention is still the principal measure of treatment for severe hepatic trauma. According to specific condition, appropriate operative procedures, damage control surgery and prompt management of associated injury will earn a higher success rate.

BACKGROUND:Hidden blood loss, after total knee arthroplasty, attracts surgeons’ attention. There are various hypotheses about etiopathogenisis of hidden blood loss, but no one can reasonably explain its mechanism. OBJECTIVE:To research the correlation of free fatty acids and hidden blood loss after total knee arthroplasty, and explore the etiology and mechanism of hidden blood loss after total knee arthroplasty. METHODS:Clinical data of 42 osteoarthritis patients who underwent primary unilateral total knee arthroplasty were colected in this study. Intraoperativeand postoperative dominant blood loss was recorded. Blood samples were colected preoperatively and 24, 48, 72, and 96 hours postoperatively. Changes in hemoglobin, erythrocyte count, hematocrit and free fatty acids were detected in blood. Hidden blood loss was obtained by Gross equation. Simultaneously, stains were added to the blood smear. Changes of cels morphology were observed under a microscope. RESULTS AND CONCLUSION:(1) Hemoglobin and erythrocyte count decreased significantly at 24 and 48 hourspostoperatively, and significant differences were determined as compared with that preoperatively (P< 0.01). (2) Free fatty acids levels increased significantly within 24 hours after surgery, and decreased to preoperative levels at 72 and 96 hours later.Hidden blood loss was also significant at 24 and 48 hours after surgery, which showed positive correlation with free fatty acids content. (3) A plenty of abnormal erythrocytes were observed under the microscope. At 24 and 48 hours postoperatively, erythrocyte shrinkage and damage were mainly presented. At 96 hours, no significant abnormality was found. (4) These results indicated that free fatty acids were strongly associated with postoperative hidden blood loss. Surgeon should pay attention to the fatty droplets which may enter into the circulation in the process of reaming the femoral canal so as to reduce intraoperative total blood loss.

BACKGROUND:Traditionally, forced expiratory volume in one second (FEV1) was used to evaluate exercise response of patients with asthma; however, patients obviously had panting after exercise, so FEV1 was affected commonly. Impulse oscillometry (IOS) is a new technique for measuring respiratory impedance that do not require maximal inspiration and forced expiration.OBJECTIVE: To study airway resistance with IOS before and after exercise in healthy and asthmatic patients and investigate the significance of exercise excitation and IOS assessment.DESIGN: Synchronically non-randomized case contrast study.SETTING: Department of Respiratory Medicine, East Hospital Affiliated to Tongji University.PARTICIPANTS: A total of 14 male patients with bronchial asthma who were regarded as the asthmatic group were selected from Department of Respiratory Medicine of Shanghai East Hospital from January to October 2006. They were in a clinical stationary phase. Another 14 male healthy subjects were selected as the control group and ages of all subjects ranged from 29 to 50 years. All subjects provided the confirmed consent.METHODS: IOS was used to measure basic value of respiratory resistance, and then subjects underwent exercise challenge. Nose of subjects was clipped breathing through mouth. Within 3-4 minutes, heart rate was increased to 90% and maintained for 6 minutes during challenge. Respiratory resistance was repeatedly measured at 1, 5, 10, 15 and 20 minutes after exercise, including airway hyperresponse (AHR), total respiratory resistance, central resistance, peripheral resistance and resonance frequency at 5, 20 and 35 Hz of pulse frequency, elasrtic resistance and inertia resistance (X5 and X35) at 5 and 10 Hz of pulse frequency. In addition, difference of AHR at 5 and 35 Hz was calculated, and change ratios of both Rcentral and Rperipheral were calculated as (highest value after exercise-baseline value)/baseline value × 100%.MAIN OUTCOME MEASURES: Basic value of respiratory resistance by using IOS and exercise challenge test.RESULTS: All 14 patients with bronchial asthma and 14 healthy subjects were involved in the final analysis. Peripheral resistance (Rperiphera) was significantly higher than central resistance (Rcentral) in asthmatic patients (P ＜ 0.01). The maximal increase of respiratory impedance occurred from 5 minutes to 10 minutes after exercise in asthmatics. Resonance frequency (Fres) of asthmatics before and after exercise was significantly increased than that of controls (P ＜ 0.01).Change ratios of Fres from asthmatics were higher than that from control group (P ＜ 0.01). After challenge, R5, R5-R20,Zrespir and X5 from asthmatics changed significantly than that from controls (P ＜ 0.01). The increment change value of After exercise Zrespir increased significantly, because obstruction of small bronchi during expiration and impedance increased abruptly. Air trapping was expressed in VT-Zrespir graph in 57.1% patients. There was no difference in the VT-Zrespir graph of controls before and after exercise.CONCLUSION: The main site of airflow obstruction was in small airways in asthmatics after exercise challenge. The general acceptance of IOS method was good among the asthmatic patients. The airway response of exercise challenge may be assessed more accurately with IOS that do not require a maximal inspiration and forced expiration.

Objective To investigate the effectiveness and safety of low-intensity warfarin anticoagulation in over 80-year-old patients with nonvascular atrial fibrillation (NVAF). Methods The 180 NVAF patients aged over 80 years were randomly assigned into 2 groups: 90 patients in lowintensity warfarin anticoagulation group (target value of INR 1.6-2.0), the other 90 patients in standard-intensity warfarin anticoagulation group (target value of INR 2. 0-3.0). All patients were followed up in outpatient-department for one year. Main outcome measures included the incidence rates of bleeding and thromboembolic events, and secondary outcome measures included the warfarin dosage and times of INR＞3.0. Results The incidence rate of thromboembolic events was 4.4% (4/90) in low-intensity group and 3.3% (3/90) in standard-intensity group with no statistically significant difference between these two groups (P＞0. 05). However, the incidence rate of hemorrhage was significantly lower in low-intensity group than in standard-intensity group [5.6% (5/90) vs. 16.7%(15/90), P＜0. 05]. Meanwhile the warfarin dosage was significantly lower in low-intensity group than in standard-intensity group [(1. 55±0. 63) mg vs. (2.31±0.57) mg, P＜0.05]. The times of INR＞3.0 were less in low-intensity group than in standard-intensity group (P＜0. 05). Conclusions Therapy with low-intensity warfarin anticoagulation in NVAF patients aged over 80 years may be equally effective as, but safer than that with standard-intensity warfarin.

Objective To evaluate the effects of continuous intra-tracheal gas insufflation (TGI) during mechanical ventilation for protecting the juvenile piglets with acute lung injury (ALI) induced by endotoxin. Method Twelve healthy juvenile piglets were anesthetized and mechanically ventilated at 2 cmH2O PEEP with 10 cmH2O peak inspiration pressure. The piglets were challenged with lipopolysaccharide (LPS) and randomly (random number) assigned to two groups (n = 6 each): (1) piglets treated with mechanical ventilation alone (group MV) and (2) piglets treated with TGI by continuous airway flow of 2 L/min (group TGI). FiO2 was set at 0.4 to avoid oxygen toxicity, and the piglets were continuously monitored with an oxygen analyzer. Results Tidal volume, ventilation efficacy index and mean airway pressure were significantly improved in piglets of TGI group (P < 0.01 or P < 0.05). Four hours after ALI, pH decreased to below 7.20 in piglets of MV group, and was higher in piglets of TGI group (P < 0.01). Similarly, PaCO2 was stable and was significantly lower in piglets of TGI group than that in piglets of MV group (P < 0.01). PaO2 and PaO2/FiO2 increased in piglets of TGI group (P < 0.05). There were no significant differences in heart rate, respiraaatory rate, mean arterial pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between two groups. Lung histopathological changes showed severe inflammation,and intra-alveolar hemorrhage and interstitial patchy hemorrhage were ameliorated and the lungs were more homogenously expanded in piglets of TGI group. Conclusions Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy, and may provide a better treatment for acute lung injury.

Objective To investigate the relationship among the spinous process open degree,the relative displacement of the lumbar facet joints(LFJ),and the morphologic change of the intervertebral foramina.Methods From Nov 2010 to Jun 2012,a total of 6 human fresh cadaveric spines was used in this study.All the ligaments were kept.The relative displacement of the corresponding segments LFJ,and the change of height and width of intervertebral foramen were measured through the corresponding open L3-4 and L4-5 spinous process,respectively.Results Lumbar degeneration was described with the following indices including the proliferation and displacement of LFJ,deformation of the intervertebral foramen morphogenesis,nerve root oppression,and lumbar intervertebral stenosis.When the interspinous process spacer was opened up to 2 mm,lumbar intervertebral foramen heights at the L3-4 and L4-5 [(15.62 ± 0.73) mm,(14.67 ± 0.75) mm] were significantly increased (t =26.00,16.02,P ＜ 0.01) compared to the original state [(13.89 ± 0.77) mm,(12.48 ± 0.80)mm].When the interspinous process spacer was opened up to 4mm,lumbar intervertebral foramen heights at the L3-4 and L4-5 [(17.13 ± 0.78) mm,(16.74 ± 0.76) mm] were significantly increased (t =36.15,30.69,P ＜ 0.01) compared to the original state.The foraminal height with a 4 mm distraction was significantly greater than the 2 mm distraction (t =20.82,21.72,P ＜0.01).When the interspinous distraction was 2 mm,L FJ displacement at the L3-4and L4-5 [(0.31 ±0.04) mm,(0.34 ± 0.07) mm] was significantly better than the original state [(0.63 ± 0.03) mm,(0.56±0.05)mm] (t =61.97,58.91,P ＜0.01).When the interspinous distraction was 4 mm,LFJ displacement at the L3-4 and L4-5 [(0.10 ±0.04) mm,(0.12 ±0.06) mm] was significantly better than the original state (t =18.69,18.88,P ＜0.01).No significant difference was found in the change of the intervertebral foramen width [(8.65 ± 0.38) mm,(7.78 ± 0.37) mm] at the 2 mm interspinous distraction compared to the original state(P ＞ 0.05),but a statistically significant difference was found at the 4 mm interspinous distraction compared to the original state [(9.03 ± 0.41) mm,(8.05 ± 0.32) mm] (t =7.78,7.97,P ＜ 0.01).Conclusions Spinous process shove off can effectively improve LFJ displacement,and increase the intervertebral foramen height,but the increase of its width needs to shove off enough distance.

Objective:To compare drug policies in Brazil, Russia, India, China, and South Africa (BRICs), sum-marize the experiences from the process of implementation and provide some suggestions to further improve the national drug policy in China. Methods:National drug polices of BRICs and experiences in the implementation of essential medicine policy were summed up systematically by means of systematic review. Results:Essential medicine policy and popular phar-macy are implemented in Brazil;Pharmaceutical separation system is established in Russia;the mode of essential medicine policy in Delhi is typical in India;Government of South African focuses on procurement and distribution of drugs. Although drug policies of BRICs have their own characteristics, the objective is to increase the public access to low-cost, high-quality drugs. Conclusions:Despite the BRICs have attained some achievements, they still face serious challenges in deep-ening the health care reform. Hence, they need to explore the measures continuingly consisting with their national condi-tions, and learn from the experiences of developed countries to further consolidate and improve the national drug policies.

Objective To explore the influence of social network on the quality of life of elderly stroke patients in communities. Methods The general situation questionnaire, the stroke impact scale ( SIS) and social network scale for the elderly were used to investigate the community elderly stroke patients. Results The total score of social network was(39. 82±5. 87). The scores of social participation,social con-tact and social support were(11. 79±1. 61),(14. 90±3. 31) and (13. 13±3. 19). Results of univariate a-nalysis showed there were statistically significant differences ( P<0. 05) in quality of life among stroke pa-tients of different ages (F=7. 803),educational level (F=2. 664),family income (F=4. 754),smoking (F=5. 467),alcohol consumption (F=7. 058),physical exercise (F=10. 393),body mass index (t=4. 841) and hypertension (t=-2. 862). Multiple linear regression results showed that 3 times or more exercises per week ( B=5. 689),normal body mass index (B=6. 613),high degree of social support (B=0. 710),social partici-pation (B=1. 421) and social contact (B=1. 372) were protective factors for the quality of life of stroke pa-tients. Age 80 years and above (B=-10. 426),frequent smoking (B=-9. 005),frequent drinking (B=-8. 419) and hypertension ( B=-5. 224) were risk factors for quality of life. Conclusion The elderly stroke patients should quit smoking and alcohol,strengthen exercise,maintain a normal body mass index and avoid overweight and obesity in daily life. While promoting health-related behaviors,more attention should be paid to the promotion effect of social network on treatment,rehabilitation and overall quality of life of stroke patients.

Objective: To understand the prevalence of low vision among Tujia and Han children and adolescents in Tujia inhabited areas, and to provide reference for the prevention and control of myopia in children and adolescents in minority areas. Methods: A cluster sampling of Tujia and Han primary school students from two primary schools in Lichuan City, Enshi Tujia and Miao Autonomous Prefecture, Hubei Province (2 466 Tujia and 971 Han) were selected for visual acuity assessment. Univariate χ 2 test and multivariate Logistic analysis were used. Low vision and associated factors between Tujia and Han nationality were compared. Results: The overall detection rate of low vision among children and adolescents in Tujia inhabited areas was 44.9%. There were differences in the degree of low vision in the left and right eyes of individuals, and the detection rate of low vision varied significantly by ethnic, gender and grade ( χ 2=22.10, 18.43, 19.06, 17.97 for the left eye, 17.52, 20.44, 21.49, 18.61 for the right eye, P < 0.05). There were many factors affecting low vision among children and adolescents in Tujia inhabited areas, overweight and obesity were negatively associated with low vision ( OR=1.81, 1.70, 95%CI=1.76-1.92, 1.66-1.82, P <0.01). Conclusion Low vision is highly prevalent in Tujia children and adolescents. Effective intervention measures should be taken to treat and prevent myopia in children and adolescents.

Objective: To understand physical activity status of children and adolescents in Tujia inhabited areas, and to provide reference for the intervention model of physical activity of children and adolescents in minority areas. Methods: A cluster sample of 2 466 Tujia pupils from two primary schools in Lichuan City, Enshi Tujia and Miao Autonomous Prefecture of Hubei Province was selected to investigate physical activity status of Tujia pupils. The univariate χ 2 test was used to analyze the physical activity status of Tujia children and adolescents and its influencing factors. Results: The median duration of high intensity activity was 49.9 minutes/day in the last week, and 47.93% of participants met the physical activity standard( χ 2=80.47, P <0.01), the median duration of sitting was 396.1 minutes/day in the last week, and the qualified rate of screen time was 78.99%, and the differences of qualified rate between daystudents and residential students were of statistical differences( χ 2=35.12, P <0.01)). Conclusion The children and adolescents in the Tujia community are lack of physical activity. Therefore, it is necessary to take effective intervention measures to pay attention to the children and adolescents physical activity.