Objective To study 3D imaging and pelvic angiography for multiple pelvic fracture. Methods 30 cases suspected with multiple pelvic fracture with vascular injury were performed with 3D imaging and pelvic angiography, whose dada were analyzed retrospectively. Results 30 cases had multiple pelvic fracture to different extents, of which 25 ones had no abnormality at lower part of abdominal aorta, left & right common iliac artery, left & right iliac artery, external iliac artery and upper part of left & right femoral artery, and 1 case, complicated with local hematoma, had a raptured left external iliac artery at the middle piece of the ilium, and another two cases, also complicated with local hematoma, had a raptured left iliac artery due to the comminuted fracture of the sacrum and a raptured right anterior femoral artery due to the fracture of light femur respectively. Conclusion 16-slice CT has to be involved in when the patient with multiple pelvic fracture is suspected with vasculaer injury.

Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.

Objective To explore the effect of two different enema methods in congenital megacolon children. Methods 70 cases of congenital megacolon children were randomly divided into the experimental group and the control group with 35 cases in each group respectively. The control group used traditional reflux-enema; The experimental group was implemented systemic and modified back reflux-enema (negative pressure drainage vessel to reflux-enema plus the padded-fixation of anal canals, cooperated with manual massage of lower abdomen along the direction of colon, if necessary, changed body position). The average enema time, the postoperative hospital stay and the effect of cleaning the intestine in the two groups were observed. Results Compared with the control group, the average preoperative enema time and hospitalization time was significantly shorter, and intestine cleaning effect was better in the experimental group. Conclusions Modified reflux-enema could increase preoperative enema time and postoperative hospitalization time, and had good effect on cleaning intestine.

OBJECTIVE:To prepare domiphen bromide osmotic tablets,and to observe,analyze the mechanism of drug release.METHODS:Coating prescription was optimized by uniform design and the cumulative rates of drug release of different formulated preparations were measured,pharmaceutical features of domiphen bromide osmotic tablet and mechanism of drug release were studied.RESULTS:The dosage of PEG-400 and the coating membrane thickness all had an effect on drug release.The optimal coating technique was analyzed as 12%of PEG-400 and 10mg of coating.Spray speed,temperature and rotation speed did not affect releasing profiles.CONCLUSION:Improvement in formulation of coat of domiphen bromide osmotic tablet can result in drug release for 12h,whose mechanism includes diffusion and osmotic pump principle.

OBJECTIVE:To establish a HPLC method for determining the concentration of dexketoprofen in rabbit’s pla_ sma.METHODS:Dexketoprofen was extracted from samples with ether.HPLC was performed on C 18 column with methyl al?cohol-50mmol/L sodium dihydrogen phosphate as mobile phase.Detection wavelength was260nm.RESULTS:The linear range was0.05～25?g/ml.Recovery was99.92%～100.54%.Within-day and between-day RSDs were0.56%～2.94%and0.6%～2.89%respectively.CONCLUSION:This method is simple,accurate and good in repetitiveness.Satisfactory results have been obtained in determining plasma concentrations of dexketoprofen in6rabbits after taking dexketoprofen-?-cy?clodextrin inclusion microspheres.

Thirty assistant general practitioners (GPs) of Jiading District Shanghai were trained for clinical skills and communication skills by using standardized patients (SP) in outpatient department from January to April 2014.The scores of clinical skills and communication skills were evaluated and compared before and two months after training.The results showed that the score of clinical skills [(72 ± 5) vs (56 ± 7), t=7.871, P＜0.05] and communication skills [(71 ±4) vs (45 ±5), t =9.573, P＜0.05] were significantly improved after training.After training, the scores of medical history taking [(36 ±5) vs (28 ± 6), t =4.352], clinical thinking [(17 ± 2) vs (14 ± 3), t =3.974], health education [(3 ± 1) vs (2 ± 1), t =3.090] and medical record v,riting [(13 ± 1) vs (8 ±2), t =5.317] were significantly higher than those before training (all P ＜ 0.05).But there was no difference in reception time management [(4 ± 0) vs (4 ± 0), t =1.025] before and after training (P ＞ 0.05).After training, the scores and the proportions of the trainees qualified for building physician-patient relationship [(20 ± 3) vs (15 ± 4), t =4.056],collecting information and providing feedback [(22 ±4) vs (13 ±3), t =4.682], understanding complaints from patients' perspective [(5 ± 2) vs (3 ± 2), t =3.107], sharing information and obtaining informed consent [(19 ± 4) vs (11 ± 5), t =4.322] and closing consultation [(6 ± 2) vs (3 ± 1), t =2.987] were higher than before training (all P ＜ 0.05).The results indicate that training by using SP can effectively improve the clinical skills and communication skills of assistant GPs.

Objective To explore the effect of extended care on behavior mental state of patients with Hirschsprung disease.Methods 40 cases of patients with Hirschsprung disease underwent surgery in our hospital from January 2009 to June 2010 were set as the control group.42 cases of patients with Hirschsprung disease underwent surgery in our hospital from July 2011 to June 2012 were set as the experimental group.The patients in the control group received conventional guidance after Hirschsprung disease surgery before discharge,which included dietary guidance,anus functional exercise,regular anal expansion,follow-up upon discomfort and regular re-visit.The patients in the experimental group not only received conventional guidance after Hirschsprung disease surgery before discharge,but also received systematic extended care plan.The nursing effect was compared between two groups.Results Conduct problems and hyperactivity index of patients in the experimental group were compared with those in the control group,the differences were significant.The scores of learning problems,psychosomatic disorders,impulsivity-hyperactivity and anxiety were lower,and compared with those in the control group,the differences were not significant.Conclusions Implementation of extended care for patients with Hirschsprung disease surgery can improve behavior mental state of them.

Objective To prepare Domiphen osmotic tablets of zero release above 80% in vitro. Methods Coating prescription was optimized by uniform design and the drug release characteristic was tested in vitro. Results The lemma thickness was (shown as lemma weight) 10.75 mg and the content of the porosity-making agent was 12%. The three batchs of drug tablets release pattern were in accord with zero order kinetics during 12 h. Conclusion This method is easy to produce and reaches initial devise request.

Objective To prepare microspheres of dextro ketoprofen ? cyclodextrin (S KP ? CD) for prolonging the drug releasing time in vitro . Methods Microspheres containing S KP ? CD were prepared by complex coacervation method with gelatin and acacia. Trap efficiency, drug loading, and drug content were determined. The dissolubility of S KP in the intestinal liquid was compared with that in the gastric liquid. Results In comparison with S KP, microspheres of S KP ? CD possessed slow releasing property. Conclusion Drug microspheres prepared by this simple, easy, and accurate method are of slow releasing property.

Objective To establish a simple, efficient and low-cost method for the detection of Salmonella typhimurium carrying SSeC gene. Methods In this study, a nano-biosensor ( FAM-P/GO) was successfully established based on the noncovalent assembly of carboxy-fluorescein ( FAM)-labeled probe and graphene oxide ( GO) . The target gene at different concentrations and SSeC gene-harbored bacterium sam-ples were detected by the FAM-P/GO nano-biosensor to evaluate its sensitivity. The specificity of the estab-lished nano-biosensor was evaluated by using DNAs with mismatched base pairs and single-stranded DNAs ( ssDNAs) extracted from various species. Results The established strategy for SSeC gene detection showed a good linear range of 0. 05-1. 0 μmol/L (R2=0. 992 1) with a lower limit of 0. 05 μmol/L. Moreover, the lower detection limit for target bacterium samples was 103 CFU/ml and the fluorescence intensity increased linearly with the concentration from 103 CFU/ml to 108 CFU/ml. The signal-to-noise ( S/N) of the experi-mental group was much greater than that of the control group, which indicated that the establish method was highly specific. Conclusion The FAM-P/GO nano-biosensor was successfully established in this study, which provided a new and possible way for the rapid detection of Salmonella typhimurium harboring SSeC gene.