Under the impact of medical and health system reform and focal events in China, the medical vio-lence policy change is characterized by partial discontinuous equilibrium. It gradually evolves from policymaker-based discontinuity to participatory one, from single decision-making field to the collaborative one, and from the ex-cessive protection of unilateral interest to the maintenance of public interest as a core. In the future, if we want to re-alize the effective minimization of medical violence by public policy, the participation of all parties in the policy deci-sion should be strengthened, the focal events should be analyzed as policy issues, and the policy should be clear in order to overcome the negative influence of the inactivity of old policies.

ObjectiveTo explore the relationship between the changes of the blood platelet counts (BPC) in children with cerebral palsy (CP) and pather mechanism of CP in traditional Chinese medicine.MethodsBPCs of CP children and healthy children were analyzed with statistical method.ResultsThe BPC of CP children was higher than that of the healthy children ( P<0.05).ConclusionThe BPC of CP children is higher than that of the healthy children, and this is consistent with the theory of traditional Chinese medicine about pathogenic mechanism of CP that CP is related to blood stasis.

Dust ; Humans ; Lung ; pathology ; Mining ; Occupational Exposure ; adverse effects ; Tin ; adverse effects

Objective To present the preoperative planning protocol and surgical procedures of computerized navigation technique in arthroscopic anterior cruciate ligament (ACL) reconstruction, and the comparative study results of tibial and femoral bone tunnel positions between navigation and arthroscopy technique. Methods The proper placement of femoral and tibial tunnels were planned preoperatively in standard AP and lateral X-ray view. Intraoperative fluoroscopic images were taken and inputed into navigation computer system to form the virtual interactive working fields. After placement and registration, signals from patient trackers being fixed into distal femur and tibia respectively, and tool trackers being attached with ACL tibial and femoral guide, were identified and captured by the optic navigation camera and so, the navigation computer system could pursued the real-time position of the ACL guide tools and the virtual tunnel positions were projeted into the working fields to help precise placement of femoral and tibial tunnels. From December 2005 to April 2006, 46 patients underwent fluoroscopy assisted anterior cruciate ligament reconstruction. Of them, 40 cases were evaluated with the postoperative X-ray lateral view to measure the placement of both femoral and tibial tunnels, and compared with the group of 40 cases of arthroscopy assisted ACL reconstruction in the same study period. Results For the navigation group, the average position of tibial tunnel was 45.35%?3.827% (37% to 53%) and 62.25%?5.610% (52% to 73%) for femoral tunnel. For the arthroscopic group, the average tunnel positions was 41.05%?6.008% (25% to 54%) for the tibia, and 56.62%?7.316% (46% to 77%) for the femur. With reduced SD, the average positions for both of the 2 tunnels in the navigation group were significantly more posterior than the arthroscopic group(P

Objective To investigate surgical treatment for tumor involved inferior vena cava at the upper segment of kidney.Methods The clinical data of 35 patients with tumor involved inferior vena cava at the upper segment of kidney who were admitted to Changhai Hospital affiliated to the Second Military Medical University from January 2007 to May 2015 were retrospectively analyzed.All the patients received preoperative imaging examinations to insure the site and range of inferior vena cava involvement at the upper segment of kidney.Renal cell carcinomas with inferior vena cava involvement were found in 19 cases,leiomyosarcomas of inferior vena cava in 5 cases,leiomyomatosis involving inferior vena cava in 3 cases,adrenocortical carcinoma involving inferior vena cava in 3 cases,liver cancer involving inferior vena cava in 2 cases,right adrenal pheochromocytomas in 2 cases,retroperitoneal fibrosarcoma involving inferior vena cava in 1 case.According to tumor involvement types,the different surgical approaches,planes and method of inferior vena cava exclusion,reconstruction method and prevention of tumor embolus detachment were selected.Patients were followed up by outpatient examination and telephone interview till May 2015.Results Among 19 patients with renal cell carcinomas with inferior vena cava involvement,10 patients were placed inferior vena cava filters through internal jugular vein before surgery,10 patients underwent total hepatic vascular exclusion and 9 patients underwent intrahepatic inferior vena cava exclusion.All the 19 patients received tumor resection and inferior vena cava embolectomy.Of the 5 patients with leiomyosar-comas of inferior vena cava,3 patients underwent total hepatic vascular exclusion and 2 patients underwent intrahepatic inferior vena cava exclusion.The diseased segments of 5 patients were resected,including 4 patients of artificial vascular graft and 1 patient complicated with resection of right kidney receiving simple ligation of inferior vena cava and left renal vein at proximal and distal tumors.Of the 3 patients with leiomyomatosis involving inferior vena cava,2 patients received total hepatic vascular exclusion and 1 was treated surgically under cardiopulmonary bypass.All the 3 patients underwent inferior vena cava embolectomy and hysterectomy.Three patients with adrenocortical carcinoma involving inferior vena cava and 2 patients with liver cancer involving inferior vena cava underwent total hepatic vascular exclusion.Among the 5 patients,4 had direct suture after tumor removal combined with partial inferior vena cava resection,and 1 had patch repair after partial inferior vena cava resection.Two patients with right adrenal pheochromocytomas were exposed proximal and distal lifting devices of inferior vena cava without clamp,and the tumors were peeled off completely.Intraoperative death happened in the patient with retroperitoneal fibrosarcoma involving inferior vena cava who was prepared to undergo intrahepatic inferior vena cava exclusion but encountered intraoperative pulmonary embolism due to tumor thrombus shedding.Thirty-four patients of 35 patients underwent operation successfully without serious perioperative complications and a patient died in the perioperative period.The mean operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were 2.8 hours (range,1.5-5.0 hours),2 000 mL (range,400-5 000 mL) and 9.2 days (range,6.0-16.0 days).Thirty-four patients were followed up for a median time of 12 months (range,1-60 months).During the follow-up period,a patient with leiomyosarcomas of inferior vena cava and 2 patients with adrenocortical carcinoma involving inferior vena cava died of tumor recurrence,a patient with liver cancer had tumor recurrence,other patients were tumor-free survival.Conclusions Inferior vena cava at the upper segment of kidney is not contraindication for tumor resection.The appropriate way to expose,clamp and reconstruct are selected to safely remove the tumor based on extension and method of tumor involving inferior vena cava.

Objective To evaluate effects of different types of gingival flap suture on the quality of life in patients after removal of mandibular third molar. Methods A randomized, controlled clinical trial design was adopted. Sixty-two patients in oral surgery department, Stomatology Hospital of Tianjin Medical University were selected. Patients were required removal of bilateral symmetry impacted mandibular third molars, and enclosed suture (primary suture) was used in one side, open drainage suture (secondary suture) was used in the other side. The postoperative symptom severity scale (PoSSe scale) was used to evaluate the quality of life in patients after removal of mandibular third molar. The evaluation was completed 7 days after surgery, and the scale was compared between two groups. Results A total of 57 cases of clinical data were enrolled in the final analysis. The operative time for primary suture group was (17.7±4.6) min, and the operative time for secondary su?ture group was (16.3 ± 5.1) min, the difference was not statistically significant (t=1.539, P>0.05). The PoSSe score was sig?nificantly higher in primary suture group (26.348 ± 12.414) than that of secondary suture group (21.633 ± 11.382, P<0.05). Conclusion Secondary suture reduces the influence of teeth removal on quality of life in patients through relieving pain and swelling, and which is suitable for clinical application.

Objective To explore the potential clinic value of NSE and S-100 in the serum as early diagnosis in the Bilirubin Encephalopathy(BE)of newborns.Methods 46 neborns were choosed as group A with TSB≥342μmol/L;48 with TSB(256-342)μmol/L as group B;and 30 full term deliveries newborns as normal control group C.Their TSB,NSE and S-100 in the serum were measured.Meanwhile,the BAEP scores were carried out.Results The concentrations of NSE,S-100 and the BAEP scores in newborns of group A and B had significant differences as compared with group C (P <0.05 ).Correlation analysis showed that there was a significant positive correlation between serum NSE,S-100 protein and TSB(P <0.05),while there was a negative correlation between serum NSE, S-100 protein and BAEP scores(P <0.05).Conclusion Serum NSE and S-100 protein can use as early diagnosis targets for the the Bilirubin Encephalopathy(BE)of newborns clinically.

Objective To describe the arthroscopic reductions and fixation of tibial intercondylar eminence fracture with cannulated screws. Methods During February 2003 to September 2005, 40 patients were treated arthroscopically for fracture of the tibial intercondylar eminence. The average age was 29.5 years (11-58 years), with a mean follow-up time of 20.1 months(6-37 months). Among the 40 patients, there were 4 type Ⅱ fractures (10%), 24 type Ⅲ fractures (60%) and 12 type Ⅳ fractures (30%). The fragments were reduced and fixed with cannulated screws. All-arthroscopic technique was adopted in all cases. The hematoma and the fragment were debrided, and the bony fragment was reduced and temporarily fixed with 2-3 guide wires through the portal superomedial to the patella. Intra-operative X-ray was taken to prove the reduction. One or two cannulated screws were used to fix the fragment as the definite fixation. Results The fracture healed completely in all but 1 patient. Lachman test were negative in all patients postoperatively. The average postoperative KT-1000 manual maximum displacement(MMD) was 0.625 mm(?蛳1-2 mm) and average Lysholm score was 98.3 points(87-100 points). The range of motion was normal in 34 patients. Flexion deficit was found in 5 cases, but within 10?. Knee joint stiffness was found in 1 case with range of extension and flexion 0?-30?-45?. A secondary operation with arthroscopic release was performed. The range of extension and flexion was improved to 0?-10?-80? postoperatively. Mild anterior knee pains were found in 8 patients. For 4 young patients with open epiphysis, the cannulated screws were removed 10-12 weeks post operation. No growth disturbance was detected for these 4 patients at final follow-up. Conclusion Arthroscopic fixation of fracture of the tibial intercondylar eminence with cannulated screw is a simple, safe and effective procedure suitable for both children and adult patients.

Objective To compare the clinical outcomes of arthroscopy versus mini-incision surgery for the treatment of avulsion fracture of the tibial attachment of the posterior cruciate ligament (PCL).Methods From March 2001 to September 2009,84 patients with acute displaced avulsion fracture of the tibial PCL attachment were treated operatively in our department.Thirty-five patients were treated with arthroscopic reduction and suture fixation (Group 1); 49 patients were treated with open reduction through a mini-incision and internal fixation with cannulated screw(s) and washer(s) (Group 2).There were 27 males and 8 females in group 1,with a mean age of 29.6 ± 5.6 years old,and 40 males and 9 females in group 2,with a mean age of 32.2 ± 7.6 years old.Based on the Meyers & Mckeever classification,there were 24 type Ⅱ fractures and 11 type Ⅲ fractures in group 1,and 31 type Ⅱ fractures and 18 type Ⅲ fractures in group 2.The 2 groups were compared in terms of range of motion,posterior drawer test (PDT),Lysholm score,International Knee Documentation Committee (IKDC) grading,and clinical results.Results All the patients obtained an average follow-up of 21.5 months (range,13 to 34 months).Primary union was achieved in all the fractures 3 months postoperatively.There were no significant differences between group 1 and group 2 regarding the PDT negative rate [82.9％ (29/35) versus 91.8％ (45/49)],the Lysholm score (95.1 ± 5.6 versus 96.1 ±4.7),therate ofIKDC grade A [88.6％ (31/35) versus91.8％ (45/49)],or the rate of normal range of motion [94.3％ (33/35) versus 93.9％ (46/49)] (P ＞ 0.05).On average,group 1 used significantly longer operative time (92.4 ± 15.9 minutes) than group 2 (53.8 ± 14.3 minutes).Conclusions Both arthroscopy and mini-incision surgery can achieve satisfactory clinical outcomes in the treatment of PCL tibial avulsion fracture.Although the 2 methods make no significant differences in stability of the knee joint and clinical scores,mini-incision surgery can result in much shorter operative time and thus permit an early postoperative rehabilitation.

Objective To explore the clinical significance of dynamic determination of serum procalcitonin(PCT)levels in judgment of infection and prognosis in patients with severe craniocerebral injury.Methods A total of 80 patients with severe craniocerebral injury were selected and they were divided into infection group and non-infection group.Infection group was divided into improved group and non-improved group.Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and Glasgow coma scale(GCS)score was compared between infection group and non-infection group.The level of serum PCT,white blood cell count(WBC),C-reactive protein(CRP)and interleukin(IL)-6 was compared on the first,third,fifth day of admission in intensive care unit among these groups.Results Infection group in 48 patients,and non-infection group in 32 patients.There was no significant difference in age,sex and GCS score between two groups(P ＞0.05).APACHE Ⅱ score in infection group was higher than that in non-infection group [(21.71 ± 7.13)scores vs.(15.32 ± 6.17)scores],and there was significant difference (P＜ 0.05).The level of serum PCT on the first day of admission in intensive care unit in infection group was higher than that in non-infection group[(2.15 ± 1.79)ng/L vs.(0.56 ± 0.47)ng/L],and there was significant difference(P＜ 0.05).There was no significant difference in WBC,CRP and IL-6 between two groups(P＞0.05).The level of serum PCT,WBC,CRP,IL-6 on the third day of admission in intensive care unit in infection group was higher than that in non-infection group,and there was significant difference(P＜ 0.05).The level of serum PCT on the fifth day of admission in intensive care unit in infection group was higher than that in non-infection group [(3.09 ± 1.98)ng/L vs.(1.06 ± 0.63)ng/L],and there was significant difference (P＜0.05).WBC,CRP,IL-6 on the fifth day of admission in intensive care unit was(15.13 ±6.32)×109/L,(103.56 ±40.62)mg/L,(230.41 ± 121.83)ng/L in improved group(38 cases),and (18.62 ±8.89)× 109/L,(134.38 ± 34.16)mg/L,(268.73 ± 138.12)ng/L in non-improved group(10 cases),and there were significant differences between two groups(P ＜ 0.05).The level of serum PCT on the first,third,fifth day of admission in intensive care unit in improved group was lower than that in non-improved group,and there was significant difference(P ＜ 0.05).Conclusion The alteration of serum PCT level may be used as one of the effective predictors for infection in patients with severe craniocerebral injury and for their prognosis.