[Objective]To investigate the effects of self-contrive antomical dynamic hip lock plate(ADHLP) in fixation of intertrochanteric fracture.[Method]Seventy-three cases (male 52,female 21) of intertrochanteric fracture were treated by internal fixation with ADHLP.The age were from 19～92y,average 54.7y.Traumatic causes:traffic accident,32 cases;pedesteian tumble,21 cases;fall from height,9 cases;other reasons,11 cases. According to the evans' classification:type Ⅰ,42 cases;type Ⅱ,17 cases;type Ⅲ,9 cases;type Ⅳ,5cases.[Result]Operating time averaged 60 minutes(ranged from 40～90 minutes). Blood loss in operation:average 200 ml (ranged from 100～400 ml).Complication was not found,(such as:coxa vara;femoral head concis;rotation displacement;infection;re-fracture;lock plate broken or loosening,et al.).All cases were followed-up from 6 to 48 months,average 36 months.The function of all hips were satisfactory.The excellent and good rate was 98.6%.[Conclusion]ADHLP in fixation of intertrochanteric fracture is accord with the demands of biomechanism,The indication is widespread,applicable for osteoporotic patients or old patients mespecial.This operation is simple and reliable,with little invasive injury and less blood losing.

Objective The study was designed to compare the effects of desflurane and isoflurane on the vecuronium-induced neuromuscular block in the elderly patients. Methods Thirty ASA class I - II elderly patients aged over 70 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups: desflurane group ( I , n = 10) ; isoflurane group ( II , n = 10) and 3 control group ( III , n = 10). Anesthesia was induced with midazolam 0.02-0.05 mg? kg-1 , propofol 0.5-2.0 mg ? kg-1 and fentanyl 2-5?g? kg-1 maintained with inhalation of 6% desflurane(1 MAC) +50% N2O in oxygen (group I ) or 1.15% isoflurane + 50% N2O in oxygen(group II ) or 50% N2O in oxygen (group III ) supplemented with intermittent iv boluses of propofol and fentanyl when necessary. Neuromuscular block was monitored using accelograph (TOF GUARD , Denmark) .A total dose of vecuronium 40 mg ?kg-1 was divided with 4 equal doses of 10?g ? kg-1 , which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak (T1 was no longer depressed in the height of 3 successive stimuli) .The cumulative dose-response curves of the 3 groups were established. The onset time and maximum depression of T1 of the initial dose and 3 incremental doses were recorded. After the last increment of 10 ?g?kg-1, the time for T1 to returned to 25% ,75% ,90% and TOF ratio(T4/T1) to 70% were recorded. The recovery index was also calculated.Results The demographic data were comparable between the 3 groups. The ED50 and ED95 were significantly lower in desflurane and isoflurane groups than those in control group(P 0.05 ) . The time for T1 to return to 25 % , 75 % and 90 % was significantly longer in desflurane and isoflurane group than that in the control group. The recovery from vecuronium-induced neuromuscular block was slower in desflurane group than that in isoflurane group( P

Abstract:The present case report retrospectively analyzed 36 cases of injury to posterior pelvic dng who received treatment in the Department of Orthopedics,Yan'an Hospital between January 2004 and April 2007. According to the Denis classification,there were 20 cases of type I injury to posterior pelvic ring,12 of type Ⅰ,and 4 of Ⅲtype Ⅲ; according to Tile classification,there were 16 cases of B3,10 of C1,6 of C2,and 4 of C3. Pedicle screw fixation system was employed. Two curvy incisions were made on the bilateral posterior superior lilac spine and a hole was chiseled on each side to fit the pedicle screw. Then,a universal pedicle screw was driven between the inner and outer lilac plates until the screw were sunk. A rod was finally traversed through erector spinae to connect two pedicle screws. Thirty cases were available at follow-up with a mean of 11 months (range:6-11 months). None of 30 cases presented with nerve or vessel injury and breakage,loosening of screws,or redislocation of sacroiliac joints. According to functional rating scale,excellent results were found in 15 cases,good in 13,and fair in 2 cases. These findings suggest that treatment for injury to posterior pelvic ring with pedicle screw fixation system is simple and reliable with microtrauma and little bleeding; in addition,it affords good recovery and can be employed in primary hospital without monitoring of X-ray,so it will deserve popular practice.

Objective To investigate the clinical effects of the pulse indicator continuous cardiac output (PiCCO) in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure.Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013.The PiCCOtechnology was applied to monitor intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI).We compared the relationship of ELWI with ITBI and oxygenation index,and a simple correlation analysis was used for statistical analysis.Results A significantly negative correlation was found between ELWl and oxygenation index (r=-0.743,P＜0.01).ELWI =14 ml/kg was defined as the cutoff value for the subgroup analysis.A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but it had no significant difference (r=-0.533,P=0.080),while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg (r=-0.961,P＜0.01).There was no significant correlation between ELWI and ITBI (r=0.477,P=0.072).ITBI=1 000 ml/m2 was defined as the cutoff value for the subgroup analysis.There is no significant correlation between ELWI and ITBI in the subgroup with ITBI＜1 000 ml/m2(r=0.338,P=0.116),but in the subgroup with ITBI≥1 000 ml/m2,a significantly positive correlation between ELWI and ITBI was found (r=0.677,P＜ 0.01).Conclusions The results suggest that when ELWI is higher than 14 ml/kg,ELWI becomes an important influencing factor for oxygenation,which can be decreased to improve oxygenation in patients with AECOPD,and when ITBI≥ 1 000 ml/m2,ITBI can be reduced by decreasing ELWI.PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.

AIM: To investigate the efficacy and safety of 577nm subthreshold micropulse laser(SML)in patients with chronic central serous chorioretinopathy(CSC).METHODS: Prospective single-arm case study. There were 24 patients(32 eyes)with chronic CSC treated by using 577nm SML. A total of 6mo was followed up after treatment, the best corrected visual acuity(BCVA, LogMAR)and optic coherence tomography(OCT)were performed at each month. Fluorescein fundus angiography(FFA)was performed at 1,3 and 6mo after treatment.RESULTS: The BCVA was 0.46±0.34 and central retinal thickness(CRT)was 259.15±57.54μm of 32 eyes at baseline period. After treatment of SML at 1mo, there was no subretinal fluid in 21 eyes(66%), and subretinal fluid was observed in 11 eyes(34%). The BCVA was 0.43±0.27, the CRT was 232.13±42.58μm. CRT was significantly reduced compared to the baseline period(P<0.05). After treatment of SML at 3mo, subretinal fluid and fluorescein leakage from retinal pigment epithelium(RPE)were observed in 5 eyes(16%). The BCVA was 0.39±0.26 and CRT was 231.26±49.25μm. The CRT was still significantly lower than baseline period(P<0.05). The 5 eyes with subretinal fluid and leaked fluorescein were treated by using SML again. After treatment at 6mo, subretinal fluid was observed in only 3 eyes(9%). The BCVA was 0.19±0.47 and CRT was 217.25±35.54μm. Both of the BCVA and CRT showed a significant improvement from the baseline period(P<0.05). CONCLUSION:SML seems effective and safe for treatment of chronic CSC. It may be an alternative way for treatment of chronic CSC.

Objective To observe the change of the serum ABCG2 level of patients with non‐small cell lung cancer(NSCLC)be‐fore and after chemotherapy ,and explore its clinical significance .Methods Venous blood specimens of 15 healthy adults and 50 pa‐tients with NSCLC were collected before and chemotherapy ,the serum ABCG2 level of these specimens were detected by ELISA . the relation between the ABCG2 level and the chemosensitivity was investigated .Results The serum ABCG2 level of patients with NSCLC before chemotherapy was significantly higher than that in healthy adults(P<0 .05);the serum ABCG2 level was not related with TNM stage in NSCLC(P<0 .05);The serum ABCG2 level of patients with NSCLC after chemotherapy was significantly high‐er than that of before(P<0 .05);in chemosensitive patients ,the different of serum ABCG2 level was not significantly before and af‐ter chemotherapy(P>0 .05);among chemoresistant patients ,the serum ABCG2 level of patients with NSCLC after chemotherapy was significantly higher than that of before(P<0 .05);the serum ABCG2 level was higher in patients with pleural effusion than the patients without pleural effusion ,but the different was not significantly(P>0 .05) .Conclusion The serum ABCG2 level of patients with NSCLC is higher than that of healthy adults ;serum ABCG2 level may become a useful indicator in predicting the effect of NSCLC chemotherapy .

Objective To explore the correlations of extravascular lung water index (ELWI),oxygenation index and intrathoracic blood volume index (ITBI) in patients with acute exacerbation chronicobstructive pulmonary disease (AECOPD) and examine the significance of ELWI in fluid management.Methods A total of 63 hospitalized AECOPD patients with respiratory failure were recruited from our hospital from October 2010 to April 2013.Pulse indicator continuous cardiac output (PiCCO) technology was employed to monitor ITBI and ELWI.We compared the relationship of ELWI,ITBI and oxygenation index.And simple correlation analysis was used for statistical processing.Results Significant negative correlation existed in ELWI and oxygenation index (r =-0.741,P ＜ 0.01).ELWI 14 ml/kg was defined as a cutoff value for subgroup analysis.A negative correlation existed between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but there was no significant difference (r =-0.524,P =0.080) ; in the subgroup with ELWI ≥ 14 ml/kg,there was significant negative correlation (r =-0.952,P ＜ 0.01).No significant correlation existed between ELWI and ITBI (r =0.477,P =0.072).ITBI 1 000 ml/m2 was defined as a cutoff value for subgroup analysis.No significant difference existed in the subgroup with ITBI ＜ 1 000 ml/m2 (r =0.332,P =0.117).However,significant positive correlation existed in the subgroup with ITBI≥ 1 000 ml/m2 (r =0.677,P ＜ 0.01).Conclusion Excessive extravascular lung water is an important factor for acute exacerbation of COPD leading to respiratory failure.

BACKGROUND:Classical deltopectoral approach leads to a great injury to soft tissues. It is difficult to lay the steel plate on the lateral side. The steel plate is frequently laid on the anterolateral side of humerus. Fixed position is not ideal.
OBJECTIVE:To evaluate the safety and feasibility of lateral deltoid-splitting approach in treatment of proximal humeral fractures.
METHODS:From August 2008 to August 2013, 114 patients with fracture of surgical neck of humerus, who were treated in the Department of Orthopedics, Yan’an Hospital Affiliated to Kunming Medical University in China, were enrol ed in this study. They were treated with locking compression plate, and assigned to deltoid splitting approach group and deltopectoral approach group (n=57). Surgical trauma, fracture healing, curative effects, functional recovery and Constant shoulder score were compared between the two groups.
RESULTS AND CONCLUSION:Al patients were fol owed up for at least 8 months. Compared with the deltopectoral approach group, the proximal humeral fractures were healed as scheduled in the deltoid splitting approach group, and the anteflexion, abduction, shoulder lifting of the shoulder joint, and sensation of lateral skin of the upper arm were not impacted. No significant difference in Constant shoulder score was detectable between the two groups (P>0.05), which suggested that deltoid splitting approach for treating the proximal humeral fractures was safe and feasible. In addition, in accordance with the Neer’s classification system, the excellent and good rate in the deltoid splitting approach group (91%) was significantly higher than that in the deltopectoral approach group (75%) (P<0.05). Therefore, the deltoid splitting approach can be used as the first choice for the treatment of proximal humeral fractures.

Objective To establish a new N-stage system combining the number of metastatic lymph nodes and the ratio of metastatic lymph nodes for postoperative M0 stage inflammatory breast cancer patients. Methods Based on the data of inflammatory breast cancer patients in the SEER database, the number of metastatic lymph nodes and the ratio of metastatic lymph nodes were calculated.A new N-staging system was established and compared with the 8th edition of AJCC TNM staging system of breast cancer.The nomograph prognostic model was constructed and validated. Results The prediction performance of the new N-staging system for postoperative survival of M0 inflammatory breast cancer patients was better than the traditional N-staging system.The nomograph prognostic model showed an excellent clinical efficacy with a consistency index of 0.711. Conclusion The new N-staging system has good predictive performance for postoperative survival of M0 inflammatory breast cancer patients and can accurately reflect the prognosis.

【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.