[Objective]To investigate the effect of atlanto-axial pedicle screw plate and fusion in treatment of upper cervical injuries. [Methods]Fifty-six cases of upper cervical spine injuries were treated with atlanto-axial pedicle screw plate and internal fixation,with total 200 screws,from March 2000 to September 2007.There were 36 males and 14 females,with an average age of 41.52 years(ranged,20~65 years).There were 23 cases of type II odontoid process fracture,12 cases of odontoid process nonunion,15 cases of transverse ligament injury.[Results]Greater occipital nerve pain occurred in 4 cases postoperatively and fully recovered after treatment 1 month later.The lateral cortical bone was penetrated by screws in 2 cases,without spinal cord or vertebral artery injury.Forty-eight cases were followed up for an average of 27.56 months(ranged,25~60 months).Bone fusion was achieved in all cases,without plate or screw broken.X-ray showed complete replacement of atlas and odontoid process of axis fracture.CT showed good position relation between screw and vertebral artery or spinal cord.According to JOA classification,excellent result was achieved in 34 cases,good in 13 cases,fair in 2 cases,poor in 1 case,with the good-to-excellent rate of 94.00%.[Conclusion]Atlanto-axial pedicle screw combined with plate fixation system is effective in treatment of upper cervical injuries.It can significantly improve the biomechanical stability of atlantoaxial joint,with high bone graft fusion rate.

Carcinoma, Hepatocellular ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; surgery ; Neoplasm Recurrence, Local ; surgery ; Reoperation

Objective To investigate the value of BISAP scoring system in predicting the severity of acute pancreatitis.Methods Medline,EMBASE,Science Direct,Springer link,CBM,Cnki,Wan fang and VIP database were retrieved by computer between January 2000 and March 2013,and articles of BISAP score system in predicting the acute pancreatitis were collected according to strict inclusion criteria.Quality assessment was made by QUADAS scale.Meta-Disc1.4 software was used to analyze the heterogeneity of included articles and perform quantitative synthesis,as well as calculate the pooled sensitivity and specificity,positive likelihood ratio,negative likelihood ratio,and draw the ROC curve,and the results were presented with 95％ CI.Results A total of 11 articles were included,and there were 7 Chinese articles and 4 English articles.According to QUADAS scale,there were 4 articles of A grade,5 articles of B grade,2 articles of C grade.There were 6 studies using 2 as BISAP cut-off value,and 9 articles using 3 as cut-off value,while 4 studies using 2 cut-off values.Pooled analysis showed diagnostic odds ratio of 8.03 (95 ％ CI 5.66-11.38) when cut-off value was 2,and diagnostic odds ratio of 7.49 (95％ CI 5.35-10.49) when cut-off value was 3.There were moderate heterogeneity in both groups (I2 =63.3 ％,P =0.018; I2 =56.1％,P =0.019).When BISAP cut-off value was 2,the pooled analysis of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and area under curve (AUC) were 59％ (95％ CI56％-63％),82％ (95％ CI 80％-83％),3.50 (95％ CI2.96-4.14),0.45 (95％ CI0.36-0.56) and0.82; and when BISAP cut-off value was 3,the corresponding values were 44％ (95％ CI41％-47％),90％ (95％ CI 89％-91％),4.59 (95％ CI 3.31-6.37),0.64 (95％ CI 0.61-0.68) and 0.64.The former had a high sensitivity,low specificity and large AUC,while the latter had a low sensitivity,high specificity and small AUC.Conclusions The best cut-off value of BISAP in predicting SAP is 2.When cut-off value is 2,the misdiagnosis rate is low,and the false positive rate is in the acceptable range,which is suitable for clinical application.

Objective To explore the efficacy, safety,time of drug taking effect and therapeutic dosage of sertraline in treatment of child emotional disorder. Method One hundred and forty-seven patientswith child emotional disorder were treated by sertraline and the efficacy rate, therapeutic dosage, the time of drug taking effect and adverse reaction was analyzed retrospectively. Results One hundred and thirty-seven patients were regular visited under supervision of a physician. Two months after treatment, the efficacy rate was 80.3%(110/137) and the rate of adverse reaction was 5.8%(8/137). The therapeutic dosage of sertraline was (47.9 + 19.0) mg/d. The time of drug taking effect was (20.4±13.2) d. The therapeutic dosage of sertraline in obsessive-compulsive disorder [(58.7±26.2) mg/d] was significantly higher than that in depression[(43.6±14.0) mg/d],anxiety disorder[(44.4±10.6) mg/d] and phobia[(43.5±15.5) mg/d](P < 0.01 ). The time of drug taking effect in depression[( 14.0±6.1 ) d] was significantly shorter than that in obsessive-compulsive disorder[(26.6±16.3) d,anxiety disorder [(22.3±13.9) d] and phobia [(21.4±12.8) d] (P <0.01). Conclusions Sertraline is an efficient and safe medicine in treatment of child emotional disorder. Its adverse reaction is slight and most patients can tolerate. But it takes higher therapeutic dosage in obsessive-compulsive disorder and the time of drug taking effect is earlier in depression than in other disorder.

Psychological problems interrupt the study and life of overseas students, and even lead to a crisis. Based on a study on the results of questionnaires for undergraduate overseas students' on-campus lives in Chongqing Medical Universities,solitude,frustration and depression,the three most popular psychological problems of overseas students in medical universities are analyzed and countermeasures are put forward.

Resident doctor is the beginning period of a doctor career. Resident standardization training is the basement period for the clinical ability training and is the important part for medical students after graduation education. Vascular ultrasonography belongs to ultrasound medicine and has its own discipline characteristics. The diagnosis accuracy of vascular ultrasonography largely depends on the accumulation of basic knowledge of multiple clinical sciences , standardization of operation techniques and especially the accurate application of hemodynamic theory. According to the discipline characteristics of vascular ultrasonography, we train the residents from the following five aspects: basic theory knowledge, operation techniques, clinic thinking ability, sciences research ability, communica-tion and team work ability. On the basis of practice, we explore the establishment of standardized training mode for medical professionals of vascular ultrasnography in China, training practical, innova-tive and independent talents, to provide reference for improving the professional level of vascular ultra-sound in our country.

Doctor-patient trust is the core and foundation of harmonious doctor-patient relationship, because our country is at the stage of social transformation and deepening medical reform, various problems make the doctor-patient relationship unoptimistic, and there appeared crisis of confidence between doctors and patients. This arti-cle analyzes the current situation of doctor -patient trust in our country, based on the clarification of doctor -patient trust. It also comb the researches focused on doctor-patient trust evaluation on the basis of domestic and foreign literature. It is expected to provide a reference to the future evaluation of doctor-patient trust, to improve the level of trust between doctors and patients, and to build a harmonious doctor-patient relationship.

The mentorship for young college instructorspolicy is aiming to provide an individual training for the young teachers to improve their teaching skills efficiently. In this article, the advantages for improving the young teachers teaching ability through the fundamental teaching, scientific research quality and clinical practice were briefly discussed.

Objective:To report one case of hilar hepatic tumor treated by ultrasound-guided percutaneous puncture 125 I radioactive seed implantation,and to review the associated literatures.Methods:One patient’s CT and ultrasonic examinations were taken,and the plan of TPS was taken.The patient was treated by ultrasound-guided percutaneous puncture 125 I radioactive seed implantation according to the plan of TPS.The needles were parallel, and the distance between the seeds were 1.0 to 1.5 cm. Results:The operation was successfully completed.No postoperative complications were encountered during 1 month follow up.The volume of tumor was obviously reduced 1 month after operation detected by ultrasound and CT. The local control effect of tumor was good.Conclusion:Ultrasound-guided percutaneous puncture 125 I radioactive seed implantation is a safe and effective method in treating hilar hepatic tumor.

Objectives:To observe the effect of rhGH in the treatment of chronic wasting diseases. Methods:Twenty two cases of chronic wasting diseases needing nutrition support were chosen,including 10 cases of COPD,12 cases of cerebral infarction or cerebral hemorrhage with decubital ulcer in recovery phase.They were in the age of 60～75,in combination with morderate malnutrition.These patients were divided into control group and experimental group.In the experimental group,rhGH(4.5 U/d) was given hypodermically for 10 days.Serum albumin,prealbumin,transferin,24 h urea nitrogen in urine,the surface area of decubital ulcer and mental state were monitored before and after the treatment. Results:In the experimental group,many nutritional indices were increased markedly,24 h urea nitrogen excretion was decreased,the healing of decubitus was faster and mental state was better when compared with control group. Conclusions:The rhGH plays an important role in improving the nutritional status and mental state in patients with chronic wasting diseases. On the base of supplying enough nutrients, rhGH can promote anabolism,reduce the excretion of urea nitrogen in urine, accelerate the healing of decubital ulcer and improve the prognosis.