BACKGROUND:Peri-fracture nerve injury can inhibit osteoclast activity and promote early fracture healing. OBJECTIVE:To investigate dynamical y the effects of traumatic brain injury on the bone mineral density, microstructure, biomechanics property and bone metabolism in rat models of fractures. METHODS:Sixty-three male rats were randomly divided into three groups:sham group, simple fracture group and fracture combined with brain injury group. After 3, 6, and 3 months, the animals were sacrificed in batches under anesthesia, and then, the bones and serum specimens were used to detect the bone mineral density, microstructure, biomechanics property, serum cross-linked N-telopeptide of col agen type I and osteocalcin levels. RESULTS AND CONCLUSION:Compared with the simple fracture group, the fracture combined brain injury group had significantly increased bone mineral density of the proximal tibia, bone volume fraction of the cancel ous bone, trabecular thickness, cross-sectional area of tibial cortical bone and total area of the bone marrow, ultimate load and stress of the tibia, serum cross-linked N-telopeptide of col agen type I and osteocalcin levels at 3 and 6 weeks after modeling (P<0.05), but no differences in the above-mentioned indexes were found among the three groups at 3 months after modeling. These findings indicate that traumatic brain injury can increase the bone mineral density at the fracture site, improve bone microstructure and enhance biomechanical properties, thereby promoting bone healing and bone metabolism at the fracture site.

OBJECTIVE To analyze the cause,clinical characteristic and preventive measures in nosocomial infection of multiple sites. METHODS A total of 123 cases of nosocomial infection in multiple sites in our hospital in 2004 were prospectively monitored and analyzed retrospectively. RESULTS Among 1645 cases of nosocomial infection,123 cases suffered from nosocomial infection in multiple sites.The main infection sites were lower respiratory tract and urinary tract.The main risk factors were over usage of broad-spectrum antibiotics and invasive operation.The serious result was prolongation of duration in hospital,increase in mortality and expensiveness. CONCLUSIONS The nosocomial infection in multiple sites is a main object to be monitored.To prevent,discover and control nosocomial infection in time is an effective measure to reduce the risk of nosocomial infection.

OBJECTIVE To analyze the condition of nosocomical systemic fungus infection and make preventive and control measures against nosocomial systemic fungus infection.METHODS The 496 fungus-cultured positive cases with average age of 61.04 years old among the discharged patients from Jan 2003 to Dec 2005 were reviewed and analyzed.RESULTS The rate of nosocomical systemic fungus infection was 0.53%,from which the over 60 age senile patients accounted for 63.1%.Lower respiratory tract and urinary tract were the most frequent infection sites.The Candida albicans was accounted for 70.71%.The death rate of patients with nosocomial systemic fungus infection was 27.82%.The major correlated factors of nosocomial systemic fungus infection were the widespread use of broad-spectrum antibiotics and not be standardized and the iatrojenic injury of respiratory and urological tracts.CONCLUSIONS The causes of nosocomial systemic fungus infection are closely related to medical treatment;the death rate of patients with nosocomial systemic fungus infection is obvious higher than that without it;to prevent and control nosocomial systemic fungus infection is the key point of nosocomial treatment.

Objective To investigate the similarity and difference in chronic obstructive pulmonary disease ( COPD) evaluation and drug selection that were compared between global initiative for chronic ob-structive lung disease (GOLD) 2011 and GOLD 2006, and to explore treatment adherence by doctors ac-cording to GOLD 2011.M ethods We collected 224 patients with COPD from Department of Respiratory Medicine at the Second Xiangya Hospital to investigate the differences in COPD evaluation and drug selec-tion according to GOLD 2011 and GOLD 2006 with treatment adherence by doctors according to GOLD 2011.Results ⑴According to GOLD 2006, there were 38 patients in the most severe stage, which was different from that (Group D, 147) according to GOLD 2011 ( P <0.01).⑵The risk stratification by u-sing pulmonary function assessment was significantly different from that by using exacerbation history.⑶Symptom assessment by using COPD assessment test ( CAT) was significantly different from that by using modified British medical research council ( mMRC) .The kappa coefficient of these two questionnaires was 0.466, suggesting moderate agreement.⑷ According to GOLD 2011, 224 (100%) patients were recom-mended to use inhaled long-acting bronchodilators, which was higher than that (213, 95.18%) according to GOLD2006 ( P <0.01).⑸The level of appropriated actual prescription was 161 (71.9%) according to GOLD 2011, which was significantly different from that (120,53.1%) according to GOLD 2006 ( P <0.01).Conclusions ⑴ Compared to GOLD 2006, GOLD 2011 categorized more patients into the most severe group.⑵The risk stratification of COPD by airflow limitation severity or exacerbation risk was not i-dentical.Discordance between CAT and mMRC was observed.⑶GOLD 2011 recommends a wider range of using long-acting bronchodilators.⑷The adherence to GOLD guideline in our hospital is still far from satis-faction.

Objective To summarize the strategies for perioperative nursing of the patients with radical resection of esophageal carcinoma under combination of thoracoscopy and laparoscopy.Method Eighteen patients with radical resection of esophageal carcinoma were treated with a combination of thoracoscopy and laparoscopy and their histories were retrospectively reviewed.Results Before the operation,nursing care focused on psychological nursing and preparations of operating room and various operating instruments.During the operation,the key nursing points included position care,proper cooperation with doctors,strict aseptic procedures and non-tumor techniques to reduce postoperative infections and dissemination of tumor cells.All the patients lived through the successful operations,their recovery satisfactory.The blood loss ranged from 100 mL to 300 mL,averaged(225.00±24.30)mL. Conclusions Radical resection of esophageal carcinoma under the combination of thoracoscopy and laparoscopy is technically feasible and safe.The perioperative nursing care is important for the improvement of operative success.

Objective To explore the effects of chlamydia and mycoplasma infections on the healing of wounds after surgical operation for haemorrhoids,fistula and anoschisis.Methods Sixty-two patients with haemorrhoids,fistula and anoschisis undergoing the surgical operation during 2000.1 to 2008.10 were collected,and wounds did not heal 40 days after operation and the wound's surface infection occurred after postoperative anti-inflammatory therapy and dressing change.All patients were positive at least for laboratory Ct or Uu,and those with infections caused by other fungi,bacteria,viruses and the other systemic diseases were excluded.The correlation between the infections in 62 cases and sex,surgical types was analyzed.Results In 62 patients,there were 30 cases (48.4%) positive for both Ct and Uu,22 cases for single Ct (35.5%),and 10 cases for single Uu (16.1%),respectively.The infection rate in females was higher than in males (P<0.01).The surgical types included:surgery for 8 cases of haemorrhoids (12.9%),for 18 cases of fistula(29.0%),and for 36 cases of anoschisis(58.1%).respectively.Conclusion There is the possibility of chlamydia and mycoplasma infections in the patients with delayed healing of wounds following the surgical treatment on the anal region.Early diagnosis,early treatment,avoidance of ineffective medicines and repeatedly management of the wounds can shorten the healing period.

This paper discusses issues involved in the deployment of the shelters of campaign-grade rapid medical support system in such aspects as entering of the vehicles,unloading of the shelters and grouping of the staffs. It suggests that the vehicles should rapidly move in at their positions and be butted bidirectional. As the system is deployed,such things should all be fixed as the position of the vehicles & equipments as well as the deployment motions and sequence. The system is positioned at hard surface,the shelters should be pushed towards the immobilized vehicles,but for the system located at soft surface,it is quite the contrary. With the above-mentioned measures implemented,the duration for shelters of campaign-grade rapid medical support system can be reduced largely.

Objective To investigate the value of electroencephalogram(EEG), transcranial Doppler sonography (TCD), somatosensory evoked potentials (SEP) on evaluating brain function in coma patients. Methods The brain function in 72 cases of coma(mild coma 12,moderate coma 17,open eyes coma 4 and severe coma 39 cases) were examined using EEG,SEP ,TCD and scored. Results For the first time of exam, the results of EEG in 25 cases were electrical silence; no blood stream signalthe were found in 28 cases by TCD; the wave of P14 were disappeared in 26 cases by SEP and all of them belonged to severe coma group. For the second time exam, the results of finally EEG in 17 cases were electrical silence. The results of TCD in other 24 cases were surge waves and nail waves spectra eumorphism. Brain function grading: the EEG grade V in 42 cases, grade Ⅳ in 10 cases, grade Ⅲ in 14 cases were affirmed; TCD grade V in 28 cases, grade Ⅳ in 9 cases and SEP grade Ⅲ in 27 cases were affirmed. All the 28 cases of death and the most of 25 cases abandoned treatment for many reasons were belong to severe coma group. Conclusions The more severe of coma, the higher grade of EEG,TCD and SEP, the worse of prognosis. EEG,SEP,TCD testing can provide an objective indicator not only for evaluating brain function of coma patients, but aslo for estimating prognosis.

Objective To analyze the outcomes of arthroscopy for secondary osteoarthrosis of the ankle joint. Methods From March 2000 to February 2006,62 patients with osteoarthrosis of the ankle joint were treated with arthroscopy in our department. Among the cases,52 received follow-up. We analyzed the therapeutic outcomes by evaluating the AOFAS,McGuire,and Mazur scores. Results The 52 cases were followed up for 12 to 84 months (mean,36.2 months). During the follow-up,we observed significantly increased scores of AOFAS,McGuire,and Mazur [postoperation vs. peroperation:57.6?12.8,56.5?14.9,and 61.5?12.6 vs. 82.4?11.5 (t=11.02,P=0.00),84.8?12.6 (t=9.52,P=0.00),and 84.1?14.7 (t=8.70,P=0.00)] with the rate of excellent and good results of 80.8% (42/52),82.7% (43/52),and 84.6% (44/52).Conclusions Arthroscopic treatment is effective for osteoarthrosis of the ankle joint with satisfactory results especially in patients with mild or moderate osteoarthrosis or those with loose bodies.

Objective This research aimed to compare two regimens of anesthesia(vecuronium-fentanyl and cisatracurium-remifentanil)for kidney transplantation patients.Methods 108 patients were studied,45 patients(Group Ⅰ)received balanced anesthesia with vecuronium and fentanyl,to the others 63(Group Ⅱ),cisatracurium and remifentanyl was given.Comparison of the difference between the two groups was made on the extubation time,intraoperative hemodynamics,postoperative urine output,serum creatinine and anesthesia complications.Results Extubation time of the Group Ⅰ was significantly longer than that of Group Ⅱ(33.5min ±17.5min,P＜0.05),but there was no difference between two groups on intraoperative hemodynamics,postoperative urine output,serum creatinine and anesthesia complications.Conclusions Both of the two regimens can provide safe anesthesia for kidney transplantation.Patients received regimen of cisatracurium and remifentanil experienced shorter extubation time.This regimen may be a better anaesthesic regimen for renal transplantation.