BACKGROUND:Distal femoral fractures are mainly treated with less invasive stabilization system (LISS) plate or retrograde interlocking intramedul ary nail fixation, but choosing which method is controversial, and studies on their biomechanical properties are few. OBJECTIVE:To compare the biomechanical stability of retrograde interlocking intramedul ary nail and LISS plate fixation in the treatment of distal femoral fractures. METHODS:Twelve male cadaveric femurs were col ected, and the injured, with abnormal bone density and osteonosus specimens were excluded through X-ray examination, fol owed by randomly divided into two groups. Models of AO type A3 supracondylar fracture were prepared, and were fixed with LISS plate and retrograde interlocking intramedul ary nail, respectively. The compressive stiffness and displacement values under axial compression and loading of 100, 300 and 500 N, as wel as the bending strength of the specimens under bending load were observed. RESULTS AND CONCLUSION:(1) The resistance to axial deformation capacity (compressive stiffness) of the LISS plate was superior to the retrograde interlocking intramedul ary nail (P<0.05);while the resistance to bending deformation capacity (flexural strength) of the retrograde interlocking intramedul ary nail was not significantly greater than that of the LISS plate (P>0.05). (2) Under axial compressive loading of 100, 300 and 500 N, the displacement values of LISS plate were significantly less than those of the retrograde interlocking intramedul ary nail (P<0.05). (3) In conclusion, in the distal femoral fracture fixation, the stiffness of the retrograde interlocking intramedul ary nail is low. While the LISS plate not only has certain deformation, but also has strong rigidity with firm internal fixation, which provides excel ent biological environment for fracture healing;thus it is a reliable treatment for distal femoral fractures.

Object To establish a process for the preparation of QINGXUE JIANGZHI CAPSULE(Hemocathartic Antilipemia Capsule)  Methods The study was carried out by uniform experimental design guided by the content of total organic acid and polysaccharide in the resulting preparation, to optimize the ratio of solvents used for the extraction, time needed for the decoction and alcoholic concentration for precipitation Results The most favorable preparative conditions were: decocting the drug twice with 10 times of water for 60 min each time, and precipitate the product at a concentration of 50% alcohol Conclusion Products prepared by this process ensured the content of total organic acid with no loss of polysaccharides

Objective To investigate the risk factors and clinical manifestations of placental abruption, and to analyze the causes of missed diagnosis and misdiagnosis. Methods A retrospective analysis was conducted in 135584 women who delivered in Women′s Hospital, School of Medicine, Zhejiang University from January 2005 to December 2015. The diagnosis of placental abruption was made in 1212 cases. According to the consistency of prenatal and postnatal diagnosis, they were divided into 3 groups.(1) The diagnosis was consistent prenatally and postnatally in 715 cases(58.99%,715/1212) as the diagnosis group.(2)In 312 cases (25.74%,312/1212), the diagnosis was made after birth as the missed diagnosis group.(3)In 185 cases (15.26%,185/1212), the diagnosis was made prenatally but excluded after birth as the misdiagnosis group. The disease classification was made, and the risk factors, clinical manifestations, lab results, the time of termination and perinatal outcomes were recorded in the 3 groups. The reasons of missed diagnosis and misdiagnosis were analyzed. Results (1) In the 1212 cases, the diagnosis of placental abruption was confirmed in 1027 cases, with the incidence of 0.76%(1027/135584). The rate of missed diagnosis was 30.38%(312/1027), and the rate of misdiagnosis was 0.14%(185/134557). (2) There were significant differences in the degree of placental abruption among the 3 groups (P＜0.05). (3)Significant differences were found among the 3 groups regarding the ratio of hypertensive disorders, trauma, induced labor and advanced maternal age (all P＜0.05). (4) There were statistically significant differences among the 3 groups regarding the incidence of vaginal bleeding, persistent abdominal pain and uterine tenderness, bloody amniotic fluid, increased uterine tension and stillbirth (all P＜0.05). (5) There was no significant difference in the rate of abnormal fetal heart rate mornitoring among the 3 groups (P=0.22). The differences were statistically significant among the 3 groups when regarding the incidence of abnormal ultrasound finding and abnormal blood coagulation (P＜0.01), with the highest incidence of abnormal ultrasound in the diagnosis group (68.1%) and the highest incidence of abnormal coagulation in the misdiagnosis group (24.9%). (6)There was statistically significant difference among the 3 groups when comparing the ratio of termination of pregnancy within 24 hours (P=0.01). (7) There were statistically significant differences among the 3 groups when the ratios of postpartum hemorrhage, DIC, neonatal asphyxia and perinatal death were compared (all P＜0.05). The highest incidence of postpartum hemorrhage was in the diagnosis group (17.9%) and the lowest was in the misdiagnosis group (5.4%). The highest incidence of DIC was in the diagnosis group (3.9%) and the lowest was in the misdiagnosis group (0). The highest incidence of neonatal asphyxia was in the diagnosis group (30.6%) and the lowest was in the misdiagnosis group (7.6%). And for perinatal death, the highest incidence was in the diagnosis group (12.6%), the lowest was in the misdiagnosis group (2.2%). Conclusions Placental abruption could be misdiagnosed when depending on risk factors, such as trauma. And it could be missed diagnosis during the induction of labor. Uterine contraction, abnormal fetal heart rate mornitoring, abnormal ultrasound and abnormal coagulation function are important in the diagnosis of placental abruption.

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Objective? To understand the status quo of humanistic care quality of psychiatric nurses in Beijing and its influencing factors. Methods? From May to August 2018, This study selected all the psychiatric hospitals in Beijing and stratified by the tertiary, secondary and first-level psychiatric hospitals. Through random number sampling, 2 to 3 hospitals were selected from each group to conduct cluster surveys. To analyze the humanistic care quality of psychiatric nurses and its influencing factors, 890 psychiatric nurses were surveyed using general information questionnaire, Nursing Caring Characters Assessment Tool (NCCAT), Perceived Organizational Support Scale (POS) and Nurses Professional Values Scale-Revised (NPVS-R). 861 valid surveys were returned with the response rate of 96.74%. SPSS 18.0 was used for data input and statistical analysis. Results? In 861 psychiatric nurses, NCCAT score was 86.36% (125.22±19.79); POS total score was 72.16% (45.46±10.87); NPVS-R score was 81.73% (106.25±21.31). Univariate analysis showed that there were statistically significant differences in the scores of nurses of different levels of hospitals, education backgrounds, professional titles, job satisfaction, parental support, voluntariness, family support, and humanistic training (P＜0.05). Pearson correlation analysis showed that the dimensions of humanistic care of psychiatric nurses were positively correlated with organizational support (r=0.593,P＜0.01), and professional values (r=0.712,P＜0.01). Multiple linear regression analysis showed that hospital level, education, voluntariness, humanistic training, organizational support and professional values were the influencing factors of psychiatric nurses' humanistic care quality (P＜ 0.01). Conclusions? The quality of humanistic care of psychiatric nurses in Beijing is at a high level. Through humanistic training, strengthening on-the-job education, increasing organizational support, and improving professional values can improve the quality of psychiatric nurses' humanistic care.

Objective To evaluate the efficacy of transforanminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation complicated with Ⅰ degree stability of lumbar spondylolisthesis.Methods Thirty-two patients with lumbar disc herniation,aged 51-82 yr,weighing 52-93 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were randomly divided into 2 groups (n=16 each) according to whether patients had lumbar spondylolisthesis:lumbar disc herniation group (Y group) and lumbar disc herniation combined with Ⅰ degree stability of lumbar spondylolisthesis group (Y+Z group).Extirpated protrusion,plasty ligamenum flavum and posterior longitudinal ligament and nerve root decompression were carried out using TESSYS technique in two groups,and in addition excision of osseous neoplasias and retro-positioned posterior margin of lumbar vertebral body was done in group Y+Z.Pain was assessed using Visual Analogue Scale (VAS) score at 1 day before surgery and 3 days and 1,3,6 and 12 months after surgery.Patient's function was assessed by using the Oswestry Disability Index (ODI) at 1 day before surgery and 12 months after surgery.The therapeutic effect was evaluated using modified Macnab criteria at 12 months after surgery.Results Compared with the baseline at 1 day before surgery,VAS scores were significantly decreased at each time point after surgery,and ODI was decreased at 12 months after surgery in two groups (P＜0.05).Compared with group Y,VAS scores were significantly decreased at 3 and 6 months after surgery (P＜0.05),and no significant change was found in ODI at each time point or VAS scores and Macnab outcome grade at 12 months after surgery in group Y+Z (P＞ 0.05).Conclusion TESSYS technique can be used to treat lumbar disc herniation complicated with Ⅰ degree stability of lumbar spondylolisthesis.

Payment by diagnosis related groups(DRG)is an important research direction in China's current medical insurance payment reform.However,it limits the clinical development and utilization of innovative medicines to a certain extent.Additional payments for innovative medicines have been thoroughly studied in many countries.This paper conducted an analysis and summary of the global experience regarding additional payment for innovative medicines under the DRG payment system.U-sing the United States,France,and Germany as case studies,this paper also examined the current state of medical insurance pay-ment for innovative medicines in China and the influence of DRG payment on the development of such medicine.In addition,it has put forward explicit policy recommendations,including the establishment of inclusion criteria,the selection of appropriate payment modes,the implementation of dynamic adjustment mechanisms,the enhancement of payment methods,etc.This paper aims to provide references to comprehensively promote DRG payment reform while further establishing and enhancing medical in-surance payment mechanisms related to innovative medicines in the context of China's national conditions.

Objective To explore the effects of Chinese medicine meridian exercises combined with rehabilitation training on prognosis of patients with heart bypass surgery. Methods A total of 60 patients with cardiac bypass surgery from June 2012 to June 2014 were divided into three groups according to the random number table method: blank control group (20 cases, routine nursing), rehabilitation training control group (20 cases; routine nursing, rehabilitation training) and meridian exercise group (20 cases; routine nursing, rehabilitation training; Chinese medicine meridian exercises ) . Clinical symptoms scores were recorded and exercise endurance was evaluated by the six-minute walk test (6-MWT) on the first and the fifteenth days after operation. Psychological symptoms were assessed by Hamilton anxiety scale ( HAMA) and Hamilton depression scale. Results 2 weeks after rehabilitation intervention, scores of clinical symptoms except for constipation of patients in rehabilitation training control group and meridian exercise group were significantly lower than those before rehabilitation intervention ( P<0. 01). Results of 6-MWT were (330. 6 ± 45. 7) m for blank control group, (408. 6 ± 52. 3) m for rehabilitation training control group and (485. 9 ± 72. 4) m for meridian exercise group (P<0. 01). Scores of HAMA and HAMD in rehabilitation training control group and meridian exercise group were (2. 46 ± 2. 65), (2. 17 ± 2. 15) and (2. 86 ± 3. 12), (2. 26 ± 2. 01) which were significantly lower than those before rehabilitation intervention (P<0. 01). Conclusions Effects of Chinese medicine meridian exercises combined with rehabilitation training are significant and they deserve to be popularized in clinic.

Objective To investigate the influence of WeChat + family centered health intervention on the self-efficacy of elderly hypertensive patients in General clinic. Methods A total of 102 elderly hypertensive patients aged≥60 years in General clinic from February 2017 to July 2017 were enrolled.They were divided into experimental group and control group with the table of random number, with 51 cases in each group. The experimental group used the WeChat+ family centered health intervention model,while the control group adopted the traditional health education model.The changes of blood pressure and self-efficacy were evaluated before intervention, 3 months and 6 months after intervention respectively. Results There were no statistic significant difference in blood pressure and self-efficacy total score between the two groups before intervention(P>0.05). At 3 months after intervention,the blood pressure(systolic pressure/diastolic pressure)of the patients were(144.20±4.60), (80.00±5.00)mmHg(1 mmHg=0.133 kPa)in the experimental group,those of which were(154.20±7.16), (87.00±3.81)mmHg in the control group,the differences were statistically significant (t=-2.628,-2.490,P<0.05).At 6 months after intervention,the blood pressure(systolic pressure/diastolic pressure)of the patients were(141.60±6.43),(76.00±4.85)mmHg in the experimental group,those of which were(151.60± 5.94),(85.40±4.56)mmHg in the control group,the differences were statistically significant (t=-2.555,-3.158,P<0.05).There were differences in systolic and diastolic pressure in patients with different groups at different time,and the differences were statistically significant(F=18.668,18.174,P<0.01).The total score of self-efficacy at 3 months and 6 months after intervention was(30.14±0.43),(32.56±0.23)points in the experimental group and (28.14 ± 0.15), (29.40 ± 0.19) points in the control group, the difference was statistically significant(t=9.736, 23.819, P<0.05). The differences in the total score of patients′self-efficacy in different groups at different time had statistically significance (F=2 631.551, P<0.01). Conclusions The WeChat+family centered health intervention model can significantly improve the self-efficacy of the elderly patients with high blood pressure in the General clinic.