Objective To explore the initial effects of the treatment of proximal femoral nail-helical blade (PFNA) in elderly patients with intertrochanteric fracture of the incomplete lateral wall type. Methods A total of 25 patients were enrolled in this study including 8 cases of type A2, 17 cases of type A3 according to AO classification. All patients under-went three-dimensional CT scan. In all patients with type A2 fracture, there were 6 cases with coronal plane fracture on the greater trochanter, and PFNA was used instead of DHS when an iatrogenic fracture occurred in 2 patients. All other patients were treated with closed reduction and fixed with PFNA. Results All patients healed and the average healing time was 11 weeks, one patient fell down once again and the fracture occurred on the shaft, when a long PFNA was used, both of the frac-tures healed 14 weeks after surgery. In all of the 25 patients,1 patient died due to cerebral hemorrhage 13 months after sur-gery;2 patients needed walking aids due to the presence of osteoarthritis of the knee and calf muscular venous thrombosis was diagnosed in 3 cases. No complications were found in the other patients, such as infection, nonunion and fixation failure. According to the Harris hip score system, there were 14 cases of“excellent”,8 cases of“good”,2 cases of“fair”and1 pa-tient of“poor”.Conclusion The PFNA treatment can provide a good fixation for intertrochanteric fractures of incomplete lateral wall type, which allow patients to do exercise early and achieve an excellent initial outcome.

Objective To assess the current status of knowledge, attitude and practice (KAP) towards antibiotic use among community residents in Hangzhou, and to explore the correlations among them. Methods A total of 449 permanent residents in Hangzhou were randomly selected using a multistage stratified random sampling method. Self-reported data on basic demographic factors, and relevant KAP information were collected by the questionnaire survey. Differences in KAP scores according to each demographic factor were assessed by the t test or ANOVA test, and AMOS 21.0 was used for the path analysis. Results Scores for knowledge, attitude and practice regarding antibiotic use were (6.17±2.45), (6.45±0.99) and (6.21±1.02) respectively. Results of the path analysis showed that education level and age had effects on the knowledge (coefficients: 0.57 and -0.38 respectively) . Age, gender and knowledge had effects on the attitude (coefficients: -0.27, 0.12 和 0.02 respectively), and attitudes, gender, monthly income and the level of education had effects on the practice (coefficients: 0.48、 0.37、 0.06 and 0.02 respectively) . Conclusion Community residents in Hangzhou lack relevant knowledge, and there are some irrational attitudes and practices regarding antibiotic use. There is a correlation between knowledge and attitudes, as well as between attitudes and practices, but the knowledge and practices are not correlated.

Objective To detect the changes of hemodynamics in patients with portal vein embolization (PVE) before surgery for hilar cholangiocarcinoma, and analyze the relationship between hemodynamics and liver hypertrophy. Methods The clinical data of 21 patients with hilar cholangiocarcinoma who were admitted to the Eastern Hepatobiliary Surgery Hospital from April 2008 to December 2009 were retrospectively analyzed.Relevant hemodynamic variables were detected and analyzed before and 3, 7, 14 days after PVE. Data were processed using Student t test or linear correlation analysis. Results The main portal vein pressure after PVE was (25.9 ± 4.1 ) cm H2O ( 1 cm H2O = 0.098 kPa), which was ( 3.5 ± 2.5 ) cm H2O higher than that before PVE [( 22.4 ± 4.1 ) cm H2O] ( t = - 6. 504, P ＜ 0.05 ). The blood flow velocity in the non-embolized branch of portal vein increased after PVE, and reached peak [(26 ±9)cm/s] at the seventh day after PVE. A positive correlation was found between the hypertrophic rate of the non-embolized lobes and the ratio of embolized lobes to total liver volume ( r = 0. 593, P ＜ 0. 05 ). Conclusion Greater scope of the embolized vascular bed of portal vein induces higher hypertrophic rate of non-embolized liver.

Objective:To evaluate the performance of RapidArc technique on cervical cancer patients with various filling status of the bladder. Methods: Conventional fixed field intensity modulation radiated therapy (IMRT) is used as the benchmark. In 10 fe-males suffering from cervical cancer, two CT scans were performed for treatment planning:one with an empty bladder and the other with filled bladder. The prescribed dose was 50 Gy. The images of that with an evacuated bladder and that with filled bladder were planned in the dual-arc RapidArc and the 7-field IMRT, respectively. The implementor of the plan was the Varian TrueBeam linear ac-celerator. Dose-volume histogram was used to evaluate the data from each plan. Results:When the bladder was filled, IMRT and Rapi-dArc homogeneity were 1.05 and 1.04 (P>0.05), respectively. When the bladder was emptied, the homogeneity was 1.04 for both plans (P>0.05). With or without bladder filling, the conformity index was 0.71 and 0.73 for IMRT and RapidArc (P>0.05), respectively. The effect of V30 and V40 (volume for receiving doses of 30 and 40 Gy) on the intestine and the bladder was more favorable in a full than in an empty bladder. No significant difference between the two plans was observed. IMRT exhibited improved V30 on the rectum and on the bladder. RapidArc was much better in terms of monitor unit (MU) and deliver time. Conclusion:No significant differences in the homogeneity and conformity index between dual-arc RapidArc and 7-field IMRT were observed. Filled bladder is better than empty bladder in intestine and bladder protection in both RapidArc and IMRT. IMRT is better on V30 of the rectum and the bladder, whereas RapidArc improved MU and deliver time.

Objective To determine the role of human serum albumin therapy in the post-operative management of patients with hepatocellular carcinoma (HCC) associated with cirrhosis.Methods Between January 2011 and December 2012,we treated 171 consecutive cirrhotic patients with HCC.88 patients were treated with 5％ human serum albumin for 48 hours followed by 20％ human serum albumin in the post-operative period (the observer group) ; 81 patients were only treated with 20％ human serum albumin during the same time duration (the control group).The prognosis,complications,average amount of human serum albumin and plasma used as well as the in-hospital stay were observed.Results There were no deaths or major complications in either of these 2 groups.After treatment,the observer group was lower than the control group in the amount of intravenous fluid infused,the volume of peritoneal drainage,the amount of human serum albumin and plasma used as well as the mean post-operative hospitalization days (P ＜ 0.05).At the same time,the daily urine output,the central venous pressure and the mean arterial pressure within 48 hours after surgery were higher in the observer group than the control group.Furthermore the observer group had a smoother post-operative recovery in liver function,and the difference was significant between the two groups (P ＜ 0.05).Conclusion Not only did treatment with 5 ％ and 20％ human serum albumin gave the advantages of a more stable blood circulation,better organ perfusion and improved liver function recovery but it also reduced the amount of consumption of human serum albumin and plasma and shortened the hospital stay.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Arsenicals ; administration & dosage ; Carcinoma, Hepatocellular ; drug therapy ; Cisplatin ; administration & dosage ; Doxorubicin ; administration & dosage ; Female ; Fluorouracil ; administration & dosage ; Humans ; Liver Neoplasms ; drug therapy ; Male ; Middle Aged ; Oxides ; administration & dosage

Objective To observe the clinical characteristics of progressive stroke (PS) patients with vascular stenosis and the relationship between PS and cerebral blood flow (CBF). Methods Fifteen patients of PS with anterior circulation vascular stenosis were chosen, their clinical documents and CBF were analyzed with Xenon-CT when they were in progression. Results These patients mostly presented hemiparalysis and language dysfunction at the beginning ( 13/15 ) before the disease developed rapidly into a serious state. The infarction usually happens in the periventricular area (10/15). Upper limbs paralyzed more severely than low limbs(11/15). Cerebral hypoperfusion areas around the infarction in 11 patients ( 10 ml·100 g-1·min-1 < CBF < 20 ml·100 g-1·min-1 ) were found. Conclusions Patients of PS with vascular stenosis present typically clinical characteristics, Low CBF caused by cerebral artery stenosis may be one of the most important factors leading to PS.

Objective To explore effects of endoscopic subtotal thyroidectomy on nodular goiter and its clinical significance.Methods From Jun.2004 to Dec.2009,72 patients with nodular goiter underwent endoscopic subtotal thyroidectomy in Southwest Hospital.Of the 72 cases,22 cases had left-side nodule,31 cases had right-side nodule and 19 cases had bilateral nodules.Single thyroid nodule occurred in 41 cases and multiple nodules in 31 cases.The total number of nodules was 113.The average nodule size was 2.8 cm(ranging from 0.4 to 6.3 cm).Results Of the 72 cases,19 patients underwent bilateral subtotal thyroidectomy and the mean operative time was 97 min(ranging from 80 to 150 min).53 patients underwent unilateral subtotal thyroidectomy and the mean operative time was 65 min(ranging from 25 to 120 min).The mean intraoperative blood loss was 45 ml (ranging from 5 to 120 ml).Of the 72 cases,68 cases were given cervical plexus block regional anesthesia and among them 66 cases(97%)acquired good anesthesia.Temporary hoarse voice occurred in 2 cases and postoperative bleeding occurred in the subcutaneous tunnel of breast in 2 cases.Patients were followed up from 3 to 5years and the cosmetic result was satisfactory.The postoperative review half year later showed that unilateral nodule recurred in 1 case and the recurrence rate was 1.4%.Conclusions Endoscopic subtotal thyroidectomy through anterior chest wall or breast approach under local anesthesia is a safe and effective treatment in nodular goiter.In the process of dissecting thyroid,blunt maneuver and proper use of ultrasonic knife instead of clamping thyroid nodules directly are recommended in order to reduce intraoperative blood loss and enhance safe practice.

Objective To explore the operative methods and clinical outcomes in emergency or sube- mergency repair for the complicated tissue defects in hand in first stage applying microsurgical technique. Methods From Jan.,2000 to Aug.,2005,49 emergency cases of complicated hand tissue defects were re- paired in the first stage with replantation,reconstruction,free flaps,combined finger reconstruction and flap transplantation,including 21 cases in mini tissue mass replantation or reconstruction,15 cases in replantation combined with free flap transplantation,8 cases in replantation and reconstruction combined with free flap transplantation,5 cases in combined multiple digits reconstruction with free flap transplantation.The free flap transplantation included the anterolateral femoral flap,the latissimus dorsi myocutaneous flap,the dorsalis pe- dis flap,the media pedis flap and the instep flap.Results All the flaps,the replanted and reconstruceted finger survived uneventfully except for one replanted finger necrosis.45 cases healed in the first stage and the other 4 cases healed in the second stage.During a follow-up from 6 months to 3 years postoperatively,a satis- factory appearance and function of the reconstructed hand was achieved.The excellent and good rate was 85.7% assessed with provisional functional assessment criterion for upper limbs issued by Chinese Society of Hand Surgery.Conclusion The emergency or subemergency repair for the complicated tissue defects in hand has the advantage of short-term treatment and desirable functional outcome.The emergency replantation and reconstruction combined with various flaps or tissue mass can be applied to repair tissue defect in hand in the first stage according to the position and area of the defect along with the technique level of the surgeon, having been proved to achieve desirable clinical outcomes.And the key points leading to a successful operation is the correct treatment for the raw surface of the defects,suitable choice for various flaps,logical design of combination pattern and prevention and timely treatment for vessel crisis.

Objective To evaluate the short term effect of bipolar arthroplasties in aged cases with intertrochanteric fractures.Methods There were 23 males and 15 females(at age of 70-93 years, average 76 years)with unstable intertrochanteric fractures treated with the third generation cementing techniques and bipolar arthroplasties that were followed up for average 2.4 years.The clinical effect was evaluate with Harris scale,X-ray films and complications.Results Of all,34 cases(89.5%)could walk freely.The average Harris scale was 84.2 points.The average period until walk with full-weight load was 5.6 weeks.The greater trochanters was united in 35 cases(92%)during average 4.2 months.No peri-prothetic ossteolysis and loosening or subsidence occurred.Conclusions Cemented bipolar arthro- plasty has good advantages of reduced laying up period and few complications.The short-term outcome is satisfactory hut the long-term outcome needs deeper observation.