Objective To investigate the impact of early enteral nutrition on the prognosis of severe head injury patients.Methods According to the different nutritional therapy,160 cases of severe craniocerebral injury patients were randomly divided into two groups using random digit.Two groups of patients were all given similarly conventional methods,the observation group were given early enteral nutrition therapy,the control group were given routine nutrition.CD3+,CD4+,IgE,IgG immune factors were observed after treatment for 10d.Results 10d later,the serum IgG,IgM,IgA in the observation group were significantly higher than those in the conventional nutrition group(t =2.18,3.42,11.23,all P ＜ 0.05),IgE was significantly lower than that in the conventional nutrition group (t =4.76,P ＜ 0.05) ;The serum T-lymphocyte subsets CD3+,CD4+ level in the observation group were higher than those in the conventional nutrition group(t =21.41,5.38,all P ＜ 0.05),the incidence of complications of the observation group was 23.75%,which was significantly lower than 55.00% in the conventional nutrition group(x2 =4.73,P ＜ 0.05).Conclusion Early enteral nutrition therapy can significantly improve the immunity of severe head injury patients,reduce complications,thereby improve the prognosis and the patient's quality of life.

Objective To observe the clinical effect of western medicine combined with traditional reatme medicine in the treatment of ear herpes zoster.Methods 60 herpes zoster oticus patients were selected,randomly divided into observation group and control group,30 cases in each group.The control group received conventional western medicine treatment,while the observation group treated with integrated traditional Chinese and western medicine treatment.Two groups of clinical curative effects,and the average healing time of clinical symptoms were observed.Results The total effective rate in observation group was 93.3 %,which was 73.3 % in the control group,the difference was statistically significant(x2 =4.32,P ＜0.05),the clinical symptoms of two groups of cure time average of the differences were statistically significant (t =5.24,7.72,7.70,6.21,all P ＜ 0.05).Conclusion The western medicine combined with traditional reatme medicine in the treatment of ear herpes zoster has better effect than that of western medicine.

Objective To explore the method of the major hospital indexes examination using clinical pathway as an opportunity.Methods Based on the material of our hospital from 2008 to 2010,reference the data of the same level hospital in Xinjiang Uygur Autonomous Region,we set the benchmark and formulated the examination standard of three examination indexes:average length of stay (ALOS),average hospitalization expense and drug proportion.Meanwhile,we took the subentry incentives to give the corresponding reward to clinical departments according to the decreases rate compared with the benchmark monthly.Results ALOS,average hospitalization expense and drug proportion of department and the whole hospital were obviously decreased compared with the same period last year,and the differences were statistically significant (Medical system:t =27.479,14.462,11.362,all P ＜ 0.01 ; Surgical system:t =18.944,16.029,12.071,all P ＜ 0.01).Conclusion After using the examination methods and combining clinical pathway,the effects are obvious,which can effectively shorten ALOS,reduce average hospitalization expense and drug proportion,so as to relieve the patients' economic burden.

Objective To explore the changes ofT lymphocyte subsets CD3+,CD4+,CD8+ in hepatitis B reactivation after chemotherapy.Methods Flow cytometry was used to detect T lymphocyte subsets of 32 patients with hepatitis B reactivation before and after chemotherapy.In addition,25 patients without hepatitis B reactivition were chosen as control group.Results After chemotherapy,the percentage of CD3+ and CD4+ T lymphocytes and the ratio of CD4+/CDs+ were significantly reduced than those before chemotherapy (P ＜ 0.05).However,the percentage of CD8+ T lymphocytes was not significantly changed(P ＞ 0.05).Conclusion The chemotherapy can change the number and ratio of T lymphocyte subsets,the inhibition of the cellular immune function is one of the reason of hepatitis B virus reactivation.

Objective To compare the clinical effects of surgical treatment and ultrasonic guidance percutaneous radiofrequency ablation(PRFA) therapy in the treatment of liver cancer.Methods 78 patiens with live cancer were randomly divided into the operation group and PRFA group,each group had 39 patients.The operation group was treated with traditional open surgery,the PRFA group was treated with radiofrequency ablation.The clinical effect was compared between the two groups.Results All patients were followed up after therapy,the 1,2,3-year survival rate between operation group and PRFA group had no significant differences (all P ＞ 0.05),but in the patients whose tumor were central type and samller than 3cm,the 1,2,3-year survival rate of PRFA group were significantly higher than operation group(x2 =4.819,4.815,4.919,all P ＜ 0.05).Conclusion Ultrasonic guidance percutaneous radiofrequency ablation therapy in the treatment of liver tumor is effective,and the effect is better than operation group,especially for the patients with central type tumor and the tumor samller than 3cm.

Objective To summary and analysis the clinical experiences on the three hole method of VATS surgery in treatment of primary spontaneous pneumothorax.Methods The clinical data of 276 cases of primary spontaneous pneumothorax undergoing VATS surgery from July 2005 to July 2011 were analyzed retrospectively.Results The operating times were 25 to 76 minutes,averaging (41.7 ± 2.1) minutes ; all with traces of bleeding; transiting assisted small incision operation in 5 cases;postoperative thoracic closed drainage extubation time of 4-13 days,average (6.7 ± 0.2) days,mild postoperative air leakage in 27 cases,moderate in 9 cases without severe leakage,leakage,postoperative pulmonary atelectasis in 7 cases,pulmonary infection in 2 cases,reexpansion pulmonary edema in 1 cases,postoperative follow-up for 6-17 months,averaging(10.2 ± 1.7) months,recurrence occurred in 7 cases,1 case of operation again.Conclusion Three hole method of VATS technique has short operating time,less trauma,fewer complications,faster recovery,shorter hospitalization time and other advantages,and the recurrence rate is low,which is the ideal mode of operation for the treatment of primary spontaneous pneumothorax.

Objective To study the clinical treatment methods for properties of unknown in elderly patients with atypical squamous cell of undertermind significant and above cervical lesions.Methods According to the clinical grouping of ASCUS in elderly patients with cervical lesions of different treatment methods,observation group 1 (348 cases) underwent colposcopy;observation group 2(316 cases) for high-risk human papillomavirus(HPV) detection,HPV positive colposcopy ;observation group 3 (129 cases) of cervical cytology examination regularly,squamous intraepithelial lesion colposcopy,compared three groups of clinical treatment.Results Liquid based cytology and three groups of 574 patients (TCT) and colposcopy and cervical biopsy,the results of intraepithelial neoplasia(C IN) above cervical lesions in 223 cases(38.9%),in which CIN Ⅰ 136 cases(23.7%),CIN Ⅱ in 64 cases(11.2%),CIN Ⅲ 20 cases(3.5%),3 cases of carcinoma in situ(0.5%) ;the group1 were observed in 348 cases,348 cases underwent colposcopy biopsy(100%),CIN Ⅱ above 36 cases(10.3%) were observed in the group 2;213 cases of colposcopy biopsy(67.4%),CIN Ⅱ above 38 cases (12%) were observed in the group 3 ; colposcopy examination in 13 cases (10.1%),3 cases of biopsy CIN Ⅱ of the cases(2.3%).Biopsy of CIN Ⅱ above the detection rate,the observation group 1,observation of the 2 groups had no significant differences(P ＞ 0.05),and observe the difference between the 3 groups was statistically significant(x2 =7.014,9.156,all P ＜ 0.05).Conclusion High-risk HPV detection of shunt ASCUS can reduce cervical lesions treatment process misdiagnosis,missed diagnosis and treatment of the problem of excessive.

Objective To investigate the clinical effect of vertical incision for breast surgery.Methods According to Lejour method,the first breast shape on the patients who needed operation was designed,and make a mark line corresponding to the breast,and then removal of excess tissue during the operation,operation process should pay attention to the protection of important part of breast of vessels and nerves,to prevent the impact of breast lactation function.Results The operation in 48 patients with breast because of too much too small in patients with 2 cases,1 cases of patients areola was too large,the patients were followed up survey,all the patients were satisfied with the operation of the breast shape,1 cases of operation the scar not satisfied,then the operation scar resection of operation after further results were satisfied,the total satisfaction rate was 98%.Conclusion Breast reconstruction process using vertical incision method for patients with relatively small,less bleeding,almost did not affect the normal function of patients with breast,breast shape is preferred for patients with operation scheme.

Objective To observe the clinical effect of low-dose dexmedetomidine plus tramadol hydrochloride for patient-controlled interscalene analgesia (PCIA) after laparoscopic hysterectomy.Methods Seventy ASA Ⅰ ～ Ⅱ female patients with elective laparoscopic hysterectomy were randomly divided into two groups:the tramadol hydrochloride PCIA group(group A),and the dexmedetomidine plus tramadol hydrochloride PCIA group(group B),35 cases in each group.Visual analog scale (VAS),Ramsay scores,Sleepiness scale and the tramadol consumption were recorded.And the adverse events such as nausea and vomiting,dizziness and respiratory depression were observed.Results All patients got good analgesia in both two groups,VAS scores ＜ 4.In group B,VAS scores of postoperative 24h and 48h were (3.2 ±0.3) (2.7 ±0.3),which were significantly lower than (3.8 ±0.4) and (3.2 ± 0.2) in group A (t24 =7.099,t48 =8.204,all P ＜ 0.05).Sleepiness scale (3.1 ± 0.7) in group B was lower than group A (4.2 ± 0.8) (t =6.122,P ＜ 0.05),while there was no difference of Ramsay scores between two groups (P ＞ 0.05).And in group B,the tramadol consumption [(625.2 ± 113.7) mg] and the intramuscular pethidine times (2.1 ±1.9) were fewer than group A[(782.9 ± 102.6)mg,(5.2 ±2.2) times] (t =6.092,6.309,all P ＜0.05).Conclusion Low-dose dexmedetomidine may improve the effect of tramadol hydrochloride PCIA after laparoscopic hysterectomy,and help to reduce the tramadol consumption and adverse effects.

Objective To explore the correlation between the depression status of patients with post-stroke depression(PSD) and nerve function defect.Methods 75 patients in the first 24h of acute stroke onset were selected.According to the Zung depression self rating scale(SDS),75 cases were divided into simple stroke patients group and PSD group,and the Hamilton depression scale (HAMD) and Scandinavian nerve function defect rating scale (SSS) were used for further evaluation.The score results were statistically analyzed.Results Of 75 cases with acute stroke,32 cases(42.7％) were diagnosed PSD.Admission day 2,at the end of 1,2 and 3 weeks,the HAMD scores between PSD patients and simple acute stroke group had statistically significant differences (all P ＜ 0.01).The HAMD scores of three groups of PSD patients (light,medium,heavy) appeared obvious changes with the prolonged time,which were significantly higher than the simple stroke group.The SSS score of simple stroke group and mild PSD patients increased with prolonged observation time,the difference between the two groups was significant (q =9.75,P ＜ 0.05).The SSS score of moderate and severe PSD patients decreased with prolonged observation time,compared with the simple stroke group,the differences were statistically significant(q =50.23,46.82,all P ＜ 0.05).In simple stroke patients and mild PSD patients,HAMD scores and SSS score had no correlation (r =0.062,P ＞ 0.05).In moderate and severe PSD patients,HAMD score and SSS score had correlation (r =4.682,P ＜ 0.05).Conclusion The incidence rate of PSD in acute brain stroke patients was 42.7％,and in patients with moderate and severe PSD,HAMD scores correlated with the degree of nerve function defect.Early intervention on depression treatment and promote the recovery of neural function is also important.