The criterion of injury severity is an important part of evaluation,which can affect the treatment for closed fracture.The reaction in soft tissue healing process contains microvascular responses and inflammation.Take soft tissue with low immunity as a incision will lead to wound dehiscence and deep infection.Therefore,realization of injury severity lays a foundation for effective treating with closed fracture.Many treatment methods,such as splint fixation,cryotherapy,compression or delayed operation,can prevent soft tissue from a second injury,and promote self-repair ability prior to operation.The newly development surgical tech-nique can improve efficacy of therapy,meantime,decrease the incidence of complications.

The glucose metabolism pathways including glycolysis and oxidative phosphorylation in vivo.The metabolism of tumor cells depends on glycolysis,which enhances the adaptability of tumor cells to the microenvironment and promotes the proliferation of tumor cells,which is called Warburg effect.Arsenic is one of the chemical pollutants,which is widely distributed in natural environment.International agency for research on cancer (IARC) has made it clear that arsenic and its compounds are carcinogens.However,the mechanism of carcinogenesis induced by arsenic still remains obscure.Recently,researchers have found that Warburg effect plays an important role in the process of arsenic carcinogenesis.In this paper,we have reviewed the definition and function of glycolysis,its relationship with inflammation and tumorigenesis,and the role of Warburg effect in arsenic carcinogenesis.

Objective To understand the effects of reform on clinical teaching taking patient's symptoms as the starting point and to investigate students' recognition degree towards this reform and their information feedback.Methods Totally 42 clinical students of the second clinical medical college (the second class) of China Three Gorges University were enrolled in the study and clinical teaching taking patient's symptoms as the starting point was conducted.Thirty-nine clinical students of the second clinical medical college (the fourth class) were enrolled as control group and traditional method was conducted.Effects of clinical teaching were evaluated by examination score and students' recognition degree towards this reform was investigated by self-made questionnaire and information feedback.Data were processed using SPSS 13.0 statistical software; t tests were used to compare students' scores of theoretical test and skill test; P ＜ 0.05 signifies that the difference is statistically significant.Results There was no statistical difference in theoretical test score between experiment group and control group (P ＞ 0.05).Skill test scores were higher in experiment group than in control group (P＜0.01).Students highly admitted this teaching mode and they thought that this mode can improve their self-study ability,clinical practice skill and clinical thinking ability without influencing their theoretical learning.Conclusions Practice of clinical teaching taking patient's symptoms as the starting point is feasible,which can increase scores of skill test significantly without influencing scores of theoretical test.

Objective To prove the existence of dry eye in children and to learn the clinical characteristics of them. Design Prospective observational case series. Participants 38 cases(76 eyes) of suspected children of dry eye diagnosed by adult standard and 38 normal children subjects. Methods 38 suspected child patients were studied who were diagnosed clinically with dry eye by adult standard, and were followed up 6 months. The control group consisted of 38 normal children with no significant difference in age. Dry eye examinations including Schirmer test, break-up time(BUT) and fluorescein staining were performed on these two groups. Following items were recorded in 38 suspected children of dry eye, including symptoms and causations. Main Outcome Measures Symptoms, Schirmer test, BUT and fluorescein staining. Results In the 38 suspected patients, frequent blinking was the most common symptom in 21 cases(55.26%), followed by dryness (15 cases, 39.47%), redness (14 cases, 36.84%) and photosensitivity (14 cases, 36.84%). The Schirmer test and BUT were decreased remarkably in the suspected patients compared to those of normal subjects (P=0.0000). In both groups, right eyes were correlated with left eyes in both Schirmer test and BUT. Between these two groups, Schirmer test was nol correlated with BUT. In the suspected patients, the results of BUT and fluorescein staining were improved (P

Objective To investigate colonization of multidrug-resistant organisms (MDROs)in neonatal intensive care unit (NICU)newborns on admission.Methods From April to November 2013,293 newborns who admitted to NICU of a hospital were screened for methicillin-resistant Staphylococcus aureus (MRSA)by nasal and throat swabs and for extended-spectrumβ-lactamases (ESBLs)bacteria and vancomycin-resistant Enterococcus (VRE)by anal swabs.Results Of 293 newborns,61 were detected MDROs (20.82%).The positive rate of MDROs screening in newborns aged <3 days(5.92%)was lower than those aged <3-6 days(37.74%)and 7-28 days (43.66%), the difference was significant (P =0.000).The major colonized MDROs were ESBLs-producing bacteria(83.60%), the major colonized site was anus(88.52%).Conclusion Neonatal anus and stool are important sources of MDROs in NICU;more attention should be paid to colonization screening for MDROs by anal swabs in newborns aged >3 days,and appropriate isolation measures should be taken for positive screening patients to prevent the transmission of MDROs.

Objective To investigate the significance of routine exposure of recurrent laryngeal nerve (RLN)in thyroidectomy.Methods The data of consecutive 232 patients with thyroidectomies during 2009-2010 were retrospectively reviewed.All operations,either lobectomy or total thyroidectomy were performed by the same surgeons.The RLN was identified routinely during the operation.Results Totally 280 RLNs were exposed in 181 thyroid lobectomies and 51 total thyroidectomies(98.9%).Ten patients experienced post-operative hoarseness(3.6%).Seven patients were diagnosed with paralysed vocal cord post-operatively,although the RLN were identified intact during the surgeries,and their voice became normal in 2 months.Another 3 patients'RLNs were transected injured and re-anastomosed during the same procedures and their voice became normal in 4 months.Conclusions Exposing the recurrent laryngeal nerve in the thyroidectomy is an effective way to prevent permanent injury to RLN.

Objective To evaluate the efficacy of recessive placement of nasolacrimal stent in the treatment of nasolacrimal duct obstruction and factors affecting the prognosis of the procedure.Design Retrospective case series.Participants One hundred eighty six patients(207 eyes) with nasolacrimal duct obstruction.Methods One hundred eighty six patients(207 eyes) of nasolacrimal duct obstruction confirmed by dacryocystography had undergone recessive placement of nasolacrimal stent after probing and dilation of nasolacrimal duct.All patients received regular postoperative nasolacrimal duct syringe.Main Outcome Measures Status of postoperative lacrimal syringe.Results The stents were removed 3～12 months postoperatively,the patients were followed-up average 6 months.The operation success rate was 97.1%.167 eyes achieved complete success(80.7%).25 eyes became better(12.1%),and nasolacrimal duct obstructed again in 15 cases(7.2%).Conclusions Recessive placement of nasolacrimal stent combined with postoperative nasolacrimal duct syringe is a simple,effective and safe technique in the treatment of nasolacrimal duct obstruction.Selecting correct patients,skillful technique of nasolacrimal duct probing and regular postoperative syringing of nasolacrimal duct are the main factors of successful procedures.

Objective To explore the effects of the therapeutic effects of interventional heated chemotherapy( IHC) for moderate and advanced huge primary hepatocellular carcinoma and compare with transcatheter arterial chemoembolization( TACE) . Methods The 68 pa-tients with moderate and advanced huge primary hepatocellular carcinoma accepted the treatment of IHC were considered as the observation group,and 32 patients managed TACE were regarded as the control group. The therapeutic effects,living quality,secondary surgery rates,The reduced level of serum AFP,survival rate,and toxic side effects of 2 groups were contrasted. Results The effective rate of observation group was obviously higher than that of control group (79. 4% vs 56. 3%,P <0. 05),and secondary surgery rates was increased(70. 6% vs 43. 8%,P<0. 01). The ratio of increased Karnofsky score was more than 20 in observation group,which was obviously higher than that of control group(35. 3% vs 12. 5%,P<0. 01). T The reduced level of serum AFP was more than 50% in observation group,which was higher than that of control group (52. 9% vs 25. 0%,P<0. 01). The survival rate of 12,18,24 months after treatment in control group was in-creased than that in control group individually (P<0. 01). Conclusion IHC is effective for huge primary hepatocellular carcinoma and in-creases the secondary surgery rates,which is one of the safe and effective methods for huge primary hepatocellular carcinoma.

Ojective To study the gastrostomy implemented by minimally invasive surgery for long enteral nutrition. Methods With the help of endoscopy the site of Puncture was selected between the lesser and greater curvature of the stomach. Under local anesthesia percutaneous gastrostomy was performed in 6 patients for long enteral nutrition. Results It took 10 to 15 minutes to finish the operation. No complication occurred during and after operation. Conclusions Percutaneous endoscopic gastrostomy may decrease the surgical invasion and shorten the operative time.

With the advance of hospital digitization, the computer technology and the utilization of database are greatly enhanced, and thus the information security situation of hospital has been more and more serious. The computer entering hospital's network illegally and the unauthorized application program seriously threaten the security of hospital's database and network. This article discusses a security model of medical database of LAN in practice from the aspects of authorized document library, daemon program and monitoring, reporting and the orientation of the illegal computer. With source creativity, the model is significant to the security of medical network or other network. It is suggested that a real-time medical database monitoring system be set up to monitor network.