A total of 20 patients with massive hemorrhage for pelvic fracture, underwent angiographic embolization with gelfoam sponge embolization agents in 3-8 hours after admitted at the Department of Orthopedics, Changhai Affiliated Hospital of Second Military Medical University of Chinese PLA between January 2001 and August 2003 were selected. The patients aged ranged from 18-70 years (mean 43.4-year-old), including 12 male and 8 female. Conduits were inserted into the internal iliac artery embranchment of 8 cases with method of ultraselection, and gelfoam sponge grain and contrast medium were injected together. Conduits combined with gelfoam sponge grain and contrast medium were inserted into 12 cases’ pathic internal iliac artery bole. The whole 20 cases were performed endovascular embolization, and blood pressures turned to normal level after operation gradually without serious complications of embolization. One case died of deterioration after blood pressure stabilization. The result reveals that anglo-graphic embolization with gelfoam sponge embolization agents is a safe, quick and effective method of controlling the severe hemorrhage caused by pelvic fracture.

Objective To study the types of autoantibodies in patients with primary biliary cirrhosis.Methods There were 60 patients with primary biliary cirrhosis from January 1995 to December 2004 in People's Hospital. We analyzed those patients' autoantibodies results and clinical data.Results There were 75% patients with anti-mitochondrial antibody(45/60),and antinuclear antibodies were detected in 60%(36/60)PBC patients,with the following hierarchy of specificities:23%(14/60)speckled,20%(12/60)multiple nuclear dots,16%(10/60)nuclear membranous,6%(6/60)anti-centromere,1.6%(1/60)homogeneous,20%(12/60)anti-SSA,10%(6/60)anti-SSB and 1.6%(1/60)anti-RNP. Several patients showed multiple specificities. Comparing PBC patients with or without AMA,no statistically significant difference was found on ages,biochemical and immunological parameters.Conclusion AMA-negative PBC patients share the same clinical features with AMA-passive PBC. Except for AMA,other antibodies may present in PBC patients. Multiple nuclear dots and nuclear member antinuclear antibodies may be helpful for diagnosing PBC patients without AMA.

Objective To review the safety and efficacy of fast track surgery in gastrectomy for gastric cancer.Methods The computer retrieved databases, including Pubmed, Medline, Cochrane library and Web of science, to collect randomized controlled trials (RCT) or controlled clinical trials (CCTS) on FTS was used in gastrectomy for gastric cancer between January 1994 and march 2014, and manual retrieval in Google.Using RevMan5.0 software analysis data that extract from collect literature.Results A total of five RCTs and two CCTs, involving 636 patients,were included, there were 309 cases in experimental group (FTS group) and 327 cases in control group.Meta-analysis showed: the FTS group had earlier postoperative flatus [WMD =-18.74, 95％ CI (-34.31,-3.17), P ＜ 0.05], shorter postoperative hospital stay [WMD =-2.46, 95％ CI (-3.75,-1.17), P=0.000 2], and lower hospital charge [SMD =-0.67, 95％ CI (-1.00,-0.34), P ＜ 0.000 1].However, there were no statistically significant differences in operation time, intraoperative blood loss, the number of retrieved lymph node intraoperative, the time of catheter removal and postoperative complication rate (P ＞ 0.05).Conclusion FTS in gastrectomy for gastric cancer can promote postoperative bowel function recovery, decrease postoperative hospital stay and reduce hospital charge.

Objective To explore the application value of plastic biliary stent and fully covered self-expandable metallic stent (FCSEMS) in endoscopic retrograde cholangio pancreatography (ERCP) for treatment of benign biliary stricture after liver transplantation.Methods The retrospective cross-sectional study was conducted.The clinical data of 54 patients with benign biliary stricture after liver transplantation undergoing ERCP treatment who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University between January 2010 and August 2016 were collected.Among 54 patients,44 had simple anastomotic stricture and 10 had non-anastomotic stricture.All the patients underwent stent implantation by ERCP.Patients with stricture within 1 month postoperatively initially selected single plastic stent or endoscopic nasobiliary drainage (ENBD),and then changed into multiple plastic stents at the second stent replacement.Patients with stricture after 1 month postoperatively selected multiple plastic stents,multiple plastic stents after balloon dilation or FCSEMS.Observation indicators:ERCP situations,stent implantation,time of stent indwelling,postoperative complications,stent dislocation,treatment outcome and follow-up situations.Patients were followed up by outpatient examination and telephone interview up to November 2016.Clinical symptoms of patients were observed within 1 month postoperatively and liver function and abdominal ultrasound were retested.Liver function and remission degree of biliary stricture were monitored regularly once every 3 months.Measurement data were described as average (range).Results All the patients underwent successful ERCP,of which 53 completed the process of ERCP and 1 rejected treatment due to economic problems.All the 54 patients received 140 times ERCPs with an average of 2.59 times per person,21 times ENBDs,11 times FCSEMSs and 108 times plastic stent implantations (including 35 times single stent implantations,46 times double stents implantations,23 times 3-stents implantations and 4 times 4-stents implantations).All the 54 patients were followed up for 3-143 months,with an average time of 73 months.Of 44 with anastomotic stricture,34 received plastic stent implantation and 98 times ERCPs,with an average number of stent implantation of 2 (range,1-4) and an average time of stent indwelling of 10.7 months (range,9.0-13.0months);the postoperative acute pancreatitis,biliary infection,hyperamylasemia and adverse stent implantation or dislocation were detected in 4 persons every time,7 persons every time,10 persons every time and 3 persons every time,respectively;26 patients were cured and 5 were improved,with an effective rate of 91.2％ (31/34);3 patients with noneffective treatment continued to undergo ERCP and 3 patients had recurrence of anastomotic stricture.Among 10 patients with initial FCSEMS implantation,12 times ERCPs were performed,with an average time of stent indwelling of 7.6 months (range,6.0-12.0 months);postoperative biliary infection,hyperamylasemia and stent dislocation were detected in 1 person every time,1 person every time and 1 person every time,respectively;8 patients were cured,with an effective rate of 8/10;of 2 patients with persistent stricture,1 patient received contrast examination after stent removal,showing a comparative stricture in level 1 branch of intrahepatic duct and considering combined ischaemia,and then underwent the second implantation using multiple plastic stents;the other patient had elevated level of jaundice at 3 months after stents removal and received ERCP,showing anastomotic inflammatory polyp,and then underwent FCSEMS implantation again.Ten patients with non-anastomotic stricture received plastic stent implantation and 30 times ERCPs,with an average number of stent implantation of 3 (range,2-4) and an average time of stent indwelling of 11.3 months (range,10.0-14.0 months);the postoperative acute pancreatitis,biliary infection,hyperamylasemia and adverse stent implantation or dislocation were detected in 2 persons every time,5 persons every time,2 persons every time and 1 person every time,respectively;3 patients were cured and 3 were improved,with an effective rate of 6/10;of 4 patients with noneffective treatment,2 died of gradually deteriorating liver function and 2 underwent the second liver transplantation.Conclusions Stent implantation in ERCP is safe and effective for treatment of benign biliary stricture after liver transplantation,single plastic stent should be used in the early period (within 1 month) and multiple plastic stents should be used in the later period.Although FCSEMS has a higher displacement rate,it should be recommended due to a better clinical effect,lower incidence of complications and simple operation.For patients with non-anastomotic stricture,plastic stent should be used for extrahepatic biliary stricture,with a good clinical effect,and there is worse effect in stent implantation through ERCP for multiple intrahepatic biliary strictures.

Objective To investigate the causes, diagnosis and surgical treatment of ERCP related duodenal per﹣foration. Methods Clinical data of 6 cases of surgical treatment of ERCP related duodenal perforation were retro﹣spective analyzed. All the 6 perforation patients underwent emergency surgical procedure, including 3 cases trans﹣fered from other hospital after duodenal perforation. 4 cases with a history of abdominal surgery. Preoperative con﹣firmed bravery manager stone 4 cases, 1 case of obstructive jaundice after gallbladder surgery, bile duct expansion in 1 case. Results Perforation causes include duodenum mirror improper operation related in 2 cases, duodenal papilla sphincterotomy related 3 cases (1 case of pre-dissection operation with needle knife), small endoscopic sphincteroto﹣my combined with endoscopic papillary balloon dilation lead to perforation in 1 case.4 cases of intraoperative found right kidney week pneumatosis, 2 cases of postoperative CT found after peritoneal pneumatosis, effusion. All patients with surgery including common bile duct exploration, T tube drainage, duodenal perforation repair, jejunum colostomy, among them 2 cases at the same time line of gastrointestinal anastomosis. 5 cases recovered, 1 case died. Conclusions Inappropriate duodenal papilla sphincter incision indications and Many previous abdominal surgery have higher perforated ration;Found in time, reasonable treatment is the most important;For serious typeⅠand typeⅡperforation, active surgical treatment in time, can effectively reduce serious consequences caused by the ERCP related perforation.

Objective To investigate the status and influencing factors of pleasant events among community-dwelling dementia patients. Methods Totally 266 community-dwelling dementia patients were recruited from Bei-jing,Guangzhou and Tianjin,and were investigated with the Chinese-version Pleasant Events Schedule-AD(PES-AD). Results The overall score of PES-AD was (14.0±6.7). The factor scores from high to low were sensory stimulation activities(0.9±0.5),family activities(0.8±0.5),emotional stimulation activities(0.8±0.4) and autonomy activities(0.6± 0.5). Multiple linear regression showed that the severity of disease,without chronic disease,educational level of de-mentia patients and their caregivers were significant influencing factors of pleasant events,which explained 41.1% of the total variance. Conclusion Sensory stimulation activities of community-dwelling dementia patients were relatively satisfactory,followed by family activities and emotional stimulation activities,but autonomy activities were relatively unsatisfactory. It is suggested to choose appropriate pleasant activities according to the severity of disease for de-mentia patients to improve their quality of life.

To modify the surface property of poly lactide-co-glycolide (PLGA) by biomimetic mineralization to construct a new kind of artificial bone. PLGA films and 3-diamensional (3-D) porous scaffolds hydrolyzed in alkaline solution were minerilized in SBF for 14 days. The morphology and composition of the mineral grown on PLGA were analyzed with SEM, FTIR and XRD. The porosity of the scaffolds was detected by using the liquid displacement method. The compressive strength of the scaffolds was detected by using a Shimadzu universal mechanic tester. An obvious mineral coating was detected on the surface of films and scaffolds. The main component of the mineral was carbonated hydroxyapatite (HA) similar to the major mineral component of bone tissues. The porosity of the un-mineralized and mineralized porous scaffolds was (84.86 +/- 8.52) % and (79.70 +/- 7.70) % respectively. The compressive strength was 0.784 +/- 0.156 N/mm2 in un-mineralized 3-D porous PLGA and 0.858 +/- 0.145 N/mm2 in mineralized 3-D porous PLGA. There were no significant differences between the mineralized and un-mineralized scaffolds (P > 0.05) in porosity and biomechanics. Biomimetic mineralization is a suitable method to construct artificial bone.
Biocompatible Materials ; Bone Substitutes ; Calcification, Physiologic ; Durapatite/metabolism ; Lactic Acid/*chemistry ; Polyglycolic Acid/*chemistry ; Polymers/*chemistry ; Porosity ; Tissue Engineering

ObjectiveTo analyze the role of postmastectomy radiotherapy in different molecular subtypes of breast cancer patients with Stage T1 -T2 and one to three positive axillary nodes. MethodsA total of 436 breast cancer patients with T1 -T2 and one to three positive axillary lymph nodes treated with mastectomy and axillary dissection were retrospectively analyzed. Patients were grouped as the following four subtypes:Luminal A, Luminal B, Her2+ and triple-negative. The local recurrence (LR), distant metastasis ( DM ), disease free survival (DFS) and overall survival (OS) rates were compared between paitents with or without radiotherapy in univariate analyses. Multivariate analyses for LR were performed. Results The follow-up rate was 86. 0％. In patients with Luminal A subtype, radiotherapy decreased the 5-year LR rate (4.6％ vs 15.8％ ,x2 =5.74,P=0.017) but had no influences on DM, DFS or OS rates (17.2％ vs 19.7％,x2 =0. 17,P=0.682;77.0％ vs 67. 1％ ,x2 =1.99,P=0. 158 or87.4％:85. 5％ ,x2 =0. 12,P=0. 733 ). In patients with Luminal B subtype, radiotherapy decreased the 5-year LR rate (3.7％ vs 12. 1％,x2 =4. 13, P =0. 042), increased DFS and OS ( 84. 0％ vs 57.6％ ( x2 =14.61, P =0. 000) and 91.4％ vs 70. 7％ ( x2 =11.87, P =0. 001 ), but had no influence on DM ( 12. 3％ vs 22. 2％, x2 =2. 97, P =0. 085).In patients with Her2+ subtype, radiotherapy decreased the 5-year LR rate (5. 6％ vs 31.0％ ,x2 =4. 31,P=0. 035) , increased DFS (61. 1％ vs 13. 8％ ,x2 =11.44,P=0.001 ) ,but had no influence on DM and OS (27.8％ vs 41.4％, x2 =0. 89, P =0. 345 and 66. 7％ vs 48. 3％, x2 =1.52,P =0. 218 ). In patients with triple-negative subtype, radiotherapy had no influence in LR, DM, DFS or OS (8. 7％ vs 26. 1％ ,x2 =2.42,P=0.120;39.1％ vs47.8％,x2=0.35,P=0.552;52.2％ vs 26.1％ , x2 =3. 29, P =0. 070 or 65.2％ vs 56. 5％ ,x2 =0. 37 ,P =0. 546). Tumor size and radiotherapy were independent prognostic factors for LR rate in multivariate analyses ( x2 =4. 76, P =0. 029 and x2 =8.06, P =0. 005 ). ConclusionsFor patients with stage T1 -T2 and one to three positive axillary nodes, patients with all molecular subtypes except triple-negative can benefit from postmasteetomy radiotherapy.

Clinical tutor system is a unique exploration and practice with characteristics of our school,which has been carried out in the process of clinical course learning and clinical practice among eight-year-program clinical majors.Through analyzing and summarizing the implementation among 2005 and 2006 grade students,we found that the clinical tutor played an active role in cultivating students' clinical thoughts and personal ethics and in improving clinical ability and scientific ability.However,some problem were existed in tutors themselves-specialized major,busy,unclear cultivation objective,etc.Therefore,further improvement of the system was needed in order to better meet the needs of the eight-year-program medical talent training and to provide related references.

Objective To evaluate the assistant diagnostic value of low dose CT in patients with pulmonary embolism (PE) based on ventilation/perfusion (V/Q) SPECT imaging.Methods One hundred and two patients with clinical suspected PE had been enrolled for this retrospective study.The final diagnosis of PE was made according to the 2008 guidelines of European Society of Cardiology (ESC).All patients underwent V/Q SPECT/CT (Hawkeye 4,GE).The imaging findings from low dose CT lung window were used for differential diagnoses of abnormal regions in SPECT imaging.The diagnostic efficiency of V/Q SPECT alone was compared with that of V/Q SPECT combined with low dose CT scan.Crosstabsx2 test was performed using SPSS 13.0 software.Results Twenty-nine patients (28.43％,29/102) were finally diagnosed as PE.V/Q SPECT alone had a sensitivity of 93.10％ (27/29),a specificity of 90.41％ (66/73),and an accuracy of 91.18％ (93/102).With additional diagnostic information from low dose CT,the diagnostic specificity increased to 95.89％ (70/73,X2 =1.72,P ＞ 0.05 ),and the accuracy increased to 95.10％ (97/102,x2 =1.23,P ＞ 0.05) though the sensitivity remained the same.Conclusion Imaginginformation from low dose CT in hybrid SPECT/CT may enhance V/Q diagnostic accuracy for PE.