Objective To learn the present acceptance of patients from outside Tianjin by local hospitals, for improving the management of their medical services.Methods A study of the hospitals′ network system identified 5 306 inpatients from other places in 2016 as evidenced by their hospital settlement account, with analysis of the patient flow from other places by the hospitals surveyed.Medical workers of eight medical institutions which signed the online settlement contract for non-local patients were subject to questionnaire survey.Results Of the 876 respondents,the number of patients willing to receive non-local insured patients accounted for 78.08%.Non-local patients aged 60 or above accounted for 82.31% among the total non-local patients, of whom 48.55% selected hospitals with national key disciplines, and 30.53% chose those with municipal key disciplines.Conclusions An analysis is required for the demand of non-local patients in terms of the social background and population characteristics.Based on such, non-local patient population needs a better management while those with irrational needs should be discouraged with rules and regulations.

Objective To explore the relationship among the changes of five coagulation indexes and clinical stage,metastasis in pre-operative patients with gastric carcinoma,and to investigate the coagulation in patients with different clinical stages and its clinical significance.Methods Eight hundred and sixty-eight gastric carcinoma patients( carcinoma group) who were firstly diagnosed and 213 patients ( control group) who were diagnosed as inguinal hernia in the same hospital during the same period were enrolled.Levels of rothrombin time (PT),activated partial thromboplastin rime (APTT),fibrinogen (FBG),plasma thrombin time (TT) and platelet count (PLT)were observed and compared in these two groups.Results (1)Compared with health control group,PT( [ 11.51 ± 1.21 ] s vs [ 11.27 ± 0.91 ] s,t =- 3.226,P ＜ 0.01 ),FBG( [ 3010.0 ±470.4] mg/L vs [ 2307.1 ± 651.8 ] mg/L,t =- 4.240,P ＜ 0.01 ) and PLT ( 238.57 ± 78.50 ) x 109/L vs (206.79 ±61.01 ) x 109/L,t =-5.514,P ＜0.01 )were significantly increased in gastric carcinoma group.(2)PT,FBG and PLT were significantly different between control group and different clinical stages of gastric carcinoma group ( P ＜ 0.05 or P ＜ 0.01 ).The levels of APTF,TT exhibited no significant difference between control group and different clinical stages of gastric carcinoma group ( P ＞ 0.05 ).( 3 ) Compared with gastric carcinoma without metastasis group,preoperative blood PT extended significantly ([ 11.41 ± 0.99] s vs [ 11.57 ± 1.32 ]s,t =- 2.095,P ＜ 0.05 ),FBG concentration increased significantly ( [ 2639.1 ± 748.6 ] mg/Lvs [ 3233.2 ± 591.60 ] mg/L,t =- 2.307,P ＜ 0.05 ) and PLT count increased significantly ( [ 224.02 ±76.94] x 109/L vs [ 247.32 ± 78.37 ] x 109/L,t =- 4.299,P ＜ 0.01 ) in gastric carcinoma with metastasis group.(4) Correlation analysis on four coagulation and PLT count with clinical stage:PT ( r =0.071,P ＜ 0.05 ),FBG ( r =0.271,P ＜ 0.01 ) and PLT( r =0.166,P ＜ 0.01 ) were positively correlated with clinical stage of gastric carcinoma and TT( r =- 0.077,P ＜ 0.05 ) was negatively correlated with clinical stage,among the total,the correlation coefficient of FBS with clinical stage was maximum.Conclusion Most patients with gastric cancer present state of blood coagulation and bleeding tendency,particularly in advanced gastric cancer,and with increased clinical stage of gastric cancer,some coagulation indicators showing a rising trend.Detection of coagulation index indirectly indicates the incidence,invasion and metastasis of gastric carcinoma.

ObjectiveTo study the effects of early intervention on physical psychomotor development of premature infants.Methods120 survival premature infants were divided into two groups randomly.The infants in intervention group accepted early intervention according to the Early Intervention Program of 0-2 Years Infants,while that in the control did not. The physical and neurological condition and intelligence were tested periodically till 2 years old.ResultsThere were no significant differences between the two groups on physical development.The mental development index(MDI) and psychomotive development index(PDI) in intervention group showed higher than those in control group (P<0.05 and P<0.01 respectively). The abnormal rate of MDI and PDI,the incidence of cerebral palsy in intervention group was lower obviously than that in control group (P<0.01).ConclusionsThe application of early intervention could improve the prognosis of premature infants.

Objective To discuss the clinical treatment of unstable dislocation of the sternoclavicular joint with clavicle hook plates. Methods From April 2005 to October 2007, 19 cases of unstable dislo-cation of stemoclavicular joint were treated with open reduction and internal fixation by clavicle hook plates. There were 17 cases of Grade type Ⅲ and 2 cases of Grade type Ⅱ. After open reduction and internal fixation, all patients received arthroplasty and repair of eostoclavicular and sternoclavicular ligaments. Results None had intraoperative injury to nerves and blood vessels. Follow-ups from 6 to 24 (mean, 8) months showed 16 excellent cases, 2 good cases and 1 fair case by Roekwood criteria, the good to excellent rate being 94.7%. The healing duration lasted 3 to 6 (averaging 4) weeks. No infection, sliding or loosening of internal fixation, nonunion or re-dislocation was found postoperatively. Conclusion The clavicle hook plate is an effective and advanced surgical treatment of sternoclavieular joint injuries, because its easy and mini-invasive operation can provide sturdy fixation and lead to good functional recovery.

0.05).Complications included 6 cases of delayed union,1 cases of severe elbow stiffness,3 cases of heterotopic ossification,2 cases of ulnar nerve palsy,in which one case recovered after 6 months,another case remained symptoms.[Conclusion]With appropriate training aids,the majority of patients have good effect.Same good clinical outcome have been achieved for treatment of intracondylar humeral fractures with either triceps splitting approach or the olecranon osteotomy approach.

Objective To investigate clinical effects of neoadjuvant chemotherapy(NAC)for phase II B breast cancer.Methods From Jan.2002 to Nov.2004,330 female patients with phase II B unilateral breast cancer were enrolled in the study and they were randomly divided into 2 groups.Group A was NAC group and 152 cased were enrolled in this group,among whom 78 cases had left-side cancer and 74 cases had right-side cancer.The mean age of group A was 42.6 years(ranging from 32 to 73 years).Group A were given beth taxane-and anthracycline- based chemotherapy,according to the protocol of group A.After 4 cycles of chemotherapy,patients in group A underwent conservative breast surgery or radical mastectomy according to the result of chemotherapy.Group B,the non-NAC group,had 178 cases in it,among whom 98 had left-side cancer and 80 had rightside cancer.The mean age of group B was 41.4 years(ranging from 31 to 72 years).Group B also underwent conservative breast surgery or radical mastectomy according to tumor size and axillary node status.According to standards of International Union against Cancer(UICC),the primary focus and axillary node status in NAC group were analyzed before and after chemotherapy.Results Group A had a total effective rate of 91.45%.Breast conservation rate in group A and group B was 44.70%and 21.90%respectively.The overall 3 and 5 year survival rate in group A was 96.05%and 75.00%respectively.which was significantly higher than that in group B.Conclusion NAC is effective in reducing clinical stage of phase II B breast cancer,which increases breast conservation rate and postoperative survival rate.

Objective To explore the relationship between platelet to lymphocyte ratio (PLR) and microangiopathyin type 2 diabetes mellitus. Methods In this case-control study, the clinical data on 428 adult patients with type 2 diabetic microangiopathy in our hospital from January 2009 to December 2015 were retrospectively analyzed. PLR, age, sex, fasting blood glucose, glycosylated hemoglobin, total cholesterol and triglyceride were tested to investigate their relationship with type 2 diabetic microangiopathy. Results Logistic regression analysis showed that PLR was a risk factor of type 2 diabetic microangiopathy (OR = 3.162, 95%CI:1.556 ~ 7.421, P < 0.05). Conclusions Greater PLR is closely related to type 2 diabetic microangiopathy, and we should pay attention to type 2 diabetic microangiopathy with a greater PLR in clinical practice.

Objective To evaluate the effect of bladder volume change on the doses to normal tissues in cervical cancer patients undergoing external three-dimensional conformal radiotherapy (3DRT)plus 3D conformal brachytherapy (3DCBT).Methods The study included 56 patients with cervical cancer who were admitted to our hospital from 2012 to 2013 and received radical external 3DRT and 3DCBT.During 3DCBT,the doses to 0.1,1.0,and 2.0 cm3(D0.1 cm3,D1.0cm3,and D2.0cm3,respectively) for the rectum,small intestine,sigmoid colon,and bladder under different bladder filling status (empty,50,100,and 150 ml) were compared and analyzed by paired t-test.Results The rectum D0.1cm3 with bladder volumes of 50and 100 ml were significantly reduced compared with that with an empty bladder (P =0.000,0.000).The D0.1 cm3,D1.0cm3,and D2.0cm3 for the small intestine with bladder volumes of 50,100,and 150 ml were significantly reduced compared with those with an empty bladder (P =0.008,0.000,0.000 and 0.000,0.000,0.000 or 0.000,0.000,0.000).The D0.1 cm3,D1.0cm3,and D2.0cm3 for the bladder with bladder volumes of 100 and 150 ml were significantly increased compared with those with an empty bladder (P =0.000,0.000 and 0.000,0.000 or 0.000,0.000).Conclusions The doses to the bladder and small intestine are influenced by different bladder filling status,but the doses to the rectum and sigmoid colon show no significant variation.The increase in bladder volume is helpful in reducing the dose to the small intestine.Without any change in the bladder dose,the bladder volume of 50 ml is more beneficial to reduce the dose to the small intestine than those of 100 and 150 ml.

Objective To investigate the expression of cytokeratin 34βE12 in esophageal squamous cell carcinoma (ESCC),and its mechanism of action in the process of occurrence and development of an ESCC.Methods Immunohistochemistry was used to analyze the expression of cytokeratin 34βE12 in 252 ESCC patients,66 patients with esophageal carcinoma in situ,and 106 patients with adjacent normal esophageal mucosa before the relationship between its expression and biological behavior was evaluated on the basis of complete clinical information.In addition,Western blotting was used to determine the expression of cytokeratin 34βE12 in 60 patients with esophageal cancer and adjacent normal esophageal tissues.Results (1)The positive rate of caveolin-1 in ESCC,carcinoma in situ,and adjacent normal tissues was 85.7％,54.5％,and 25.7％,respectively.The difference between them was statistically significant (P ＜0.01).(2)The positive rate of cytokeratin 34βE12 in stages Ⅰ,Ⅱ,Ⅲ of ESCC was 76.5％,84.7％,and 96.3％,respectively.The expression intensity of cytokeratin 34βE12 in carcinoma tissue was gradually increased with the advance of clinical stages with a statistically significant difference (P =0.038).The positive rate of cytokeratin 34βE12 with group of lymph node metastasis was significantly higher than those without lymph node metastasis (P ＜ 0.01).(3)Western blotting results further confirmed that the expression of cytokeratin 34βE12 in ESCC was significantly higher than that in adjacent normal esophageal tissue (P ＜0.01).Conclusions The high expression of caveolin-1 might be involved in the occurrence and development of esophageal cancer.The expression of cytokeratin 34βE12 was correlated with the clinical stage of esophageal cancer.cytokeratin 34βE12 was a potential therapeutic target and a valuable prognostic indicator of esophageal cancer progression.

BACKGROUND: Whether one-stage bone healing with red bone marrow or mesenchymal stem cell transplantation is needed? Whether closed reduction with intramedullary interlocking nailing combined with autologous red bone marrow transplantation can promote osteogenesis in the one-stage treatment of femoral comminuted fracture still remains unclear. OBJECTIVE: To explore the effects of closed reduction with intramedullary interlocking nailing and one-stage treatment with autologous red bone marrow transplantation on fracture healing. METHODS: Twenty healthy New Zealand rabbits were selected and anesthetized, and then the models of femoral comminuted fracture were established at the hinder limbs after throwing a 5 kg of hammer from 30 cm height. All rabbits underwent intramedullary fixation using Kirschner wire (diameter: 2 mm); the right limbs served as control groups, and the left limbs as transplantation group, subjected to the injection of autologous red bone marrow (1 mL) into the fracture region. Then the rabbits were respectively killed at 14, and 28 days after modeling, the thickness of thickest callus was measured on X-ray films, and the number of chondrocytes and relative area of bone trabecula in the fracture region were observed through hematoxylin-eosin staining under light microscope.RESULTS AND CONCLUSION: (1) The thickness of callus formation in the control group was significantly less than that in the transplantation group at 14 days after modeling (P < 0.01). (2) The number of chondrocytes in the transplantation group was significantly more than that in the control group at 14 days after modeling (P < 0.01),and the fracture healing in the transplantation group was faster that in the control group. (3) Compared with the transplantation group, the relative area bone trabecula in the fracture region in the control group was significantly reduced at 28 days after modeling (P < 0.01). (4) These finding indicate that red bone marrow transplantation promotes fracture healing in the intramedullary fixation for femoral comminuted fracture in rabbits.