0.05).The average fading time of the lymph nodes stained by PB and MB+PB was 13.06min and 82.13min,we observed the lymph nodes stained by MB 120 min,they were still stained deeply.There were dramatically differences among three groups(P=0.000).Conclusion Application of MB and PB possess their advantage and disadvantage in sentinel node biopsy.The mixture of patent blue and methylene blue could overcome the shortage of the two vital dyes in the experimental study and be an ideal tracer for the use.

[Objective] To evaluate the treatment with total hip arthroplasty(THA)using Zweym?ller system for short females with Crowe-Ⅲ and Ⅳ developmental dysplasia hip(DDH).[Method]From January 2004 to December 2006,thirteen THA procedures were performed in 12 female patients with 13 hips.The age of the patients was from 28 to 62 years old(average 51 years).The height was from 1.48 to 1.55 meters.Based on Crowe classification,8 patients with 9 hips were type-Ⅲ,and 4 patients with 4 hips were type-Ⅳ.before surgery,the discrepancy of lower limbs was from 3 cm to 5 cm.All patieds had severe hip pain and dysfunction.The Harris hip score ranged from 35 to 64 points with 40 points on the average.In all procedures the soft tissue was released entirely,the acetabular component was placed in the true acetabulum without femoral osteotomy.[Result]After operation,the legs lengthened from 2 to 5 cm.During the follow-up of 12 to 36 months(average 24 months),no femoral fracture,femoral or sciatic nerve palsy or loosening was detected except one dislocation according to clinical outcomes and X-ray findings.The Harris score was improved from 60 to 95.There was significant difference between before and after operation(P

Objective In view of the schizophrenia risk factors during the recovery,to explore a supportive intervention program suitable for the rehabilitative schizophrenic patients.Methods Totally 64 rehabilitative schizophrenic patients were divided into the experimental group and the control group with 32 cases in each group.All the patients received the same treatment with antipsychotic drugs.The patients in the control group received the routine health education.In addition,the patients in the experimental group received supportive intervention for 4 months.The patients were assessed by IBS,APGAR,GSES and SDSS before and after intervention.Results Main effect of group factor and time factor of GSES,SDSS,APGAR and IBS had statistical significances.There were significant interaction in the scores of SDSS,APGAR and IBS.Simple effect analysis demonstrated the scores of GSES,SDSS,APGAR and IBS in the experimental group were higher than those of the control group after the intervention.Except the score of GSES,there was no differences in other scales before and after the intervention of the control group.Conclusions Supportive intervention program for the rehabilitative schizophrenic patients have good practice guidance.It can improve the patients' self-efficacy,family function and social function,also can correct irrational beliefs and to help patients better adapt to society.

BACKGROUND: Patients with hip instability due to cerebral palsy, hemiplegia, infantile paralysis and extensive damage in gluteus medius, appear with high dislocation rate after arthroplasty, which is a great challenge for clinicians.OBJECTIVE: To investigate the reconstruction of the hip joint stability with the dual-mobility acetabular cup, and to prevent the dislocation after replacement in patients with hip neuromuscular lesions.METHODS: Twelve cases of hemiplegia, infantile paralysis, developmental dysplasia of the hip and recurrent dislocation after hip arthroplasty admitted in the Orthopedic Treatment Center, the Second Affiliated Hospital of Henan University of Chinese Medicine from January 2010 to July 2014 were enrolled, then underwent joint replacement or revision with dual-mobility cup, and the dynamic stability of the hip was achieved by adjusting the abductor lever arm.RESULTS AND CONCLUSION: (1) The followed-up time was from 20 to 60 months. (2) One year later, one case suffered Vancouver A right femoral fracture and received conservative treatment at 1 year postoperatively; one case of dislocation at postoperative 1 week, and dislocation, infection and loosening occurred in none cases. (3) These results manifest that those patients with neuromuscular disease and hip instability treated with hip joint arthroplasty using dual-mobility acetabular cup can reconstruct the stability of the hip joint and prevent the occurrence of postoperative dislocation.

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients.Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012.There were 22 males and 30 females,with a mean age of 61.3 years (range,55 to 70 years).Fracture level was T11 in 8 patients,T12in 20,L1 in 22 and L2 in 12.Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B).Operation time,intraoperative blood loss,anterior vertebral body height,sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups.Results All patients were followed up for average 46.5 months (range,36 to 58 months).Operation time in Group A [(82.6 ±16.2) min] was shorter than that in Group B [(96.8 ± 20.6) min] (P ＜ 0.05).Blood loss in Group B [(40.5 ± 10.2) ml] was less than that in Group A [(52.2 ± 15.5) ml] (P ＜ 0.05).Before operation and 3 days and 1 year after operation,the anterior vertebral body height and sagittal Cobb angle in Group A showed no significant differences compared to Group B (all P ＞ 0.05).At the final follow-up,the ratio of anterior vertebral height and Cobb angle in Group B [(87.8 ± 2.5) ％,(7.8 ± 3.5) °] were better than these in Group A [(82.6 ±3.2)％,(9.1 ± 1.8)°] (P＜0.05).VAS showed no statistical significance between the two groups before and after operation (P ＞ 0.05).Bone cement leakage was seen in four patients in Group B.During the perioperative period,there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B.No implant failure occurred in both groups.Conclusion Both procedures are effective in treating elderly patients with OVCF,but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis.

Objective: To investigate the shortterm efficiency of overflow fecal incontinence treated by biofeedback and electrical stimulating therapy. Methods: Twenty children with overflow fecal incontinence were given combined therapy, biofeedback and electricalstimulating therapy,for four weeks. Every therapy cost 20 to 30 minutes. The grading of clinical incontinence degree ,measurement of pressure of the anus and rectum, electromyogram of muscles of solum plevis were done before and after the therapy. Results: Followup was done for a mean of 4.5 years (range 3 to 5), the subjective scores, maximum contractive pressure of anus, last contractive time, rectal volume at sensory threshold, contraction amplitude of external anal sphincter and pudenda neural latency were significantly different from the ones before treatment (P

Objective To analyze the correlation factors that promote or impede the residents to preferentially use essential medicines.Methods Adopting stratified random sampling method,1 700 households selected from 5 cities of Shandong province were investigated with a questionnaire.The framework of Andersen behavior model of health service utilization was used as the framework,with such methods as descriptive analysis and univariate logistic regression models for the analysis and evaluation of relevant information.Results The residents′ tendency factor,ability factor and environmental factor influence their preference to use essential medicines,while the requirement factor plays a minimal role.There was a significant difference for the preference of combined medication,first visit preference and self-medication experience,the efficacy and policy response of essential medicine from logistic regression analysis.Conclusion At present,the government should focus on the construction of the formation mechanism of the residents′drug use behavior and the policy response mechanism of essential medicine system.

Objective To analyze the outcomes of the subsidy mechanism reform for China's public hospitals through a financial perspective.Methods An evaluation index system was built using data from China's health (family planning) statistics yearbooks 2009-2016, for comparison of the constituent ratio and chain relative ratio growths of public hospitals in various years.Results Year 2015 found a lower growth rate of medical revenues of these hospitals;year-by-year drop of drug income ratio, yet a gradual rise of income from examinations and materials, and a drop of technical service income growth and its ratio of the total income;a year-by-year drop of drug income surplus growth, and an expanding deficit in medical services;a slower growth of medicine expense growth, with the asset-liability ratio rising to 45.3%, and salary ratio rising to 30.6%.Conclusions The reform on compensating mechanism at public hospitals is demonstrating its impacts on public hospitals, namely slower growth of medical revenue, weakened compensating role of drug income, lower surplus, and higher asset-liability ratio among other financial risk exposure.These hospitals are encouraged to take proactive measures to control costs, including tighter medical service cost control,to secure sufficient and timely government fiscal subsidy, and other funding measures to cope with debts of the hospitals.

Objective To analyze the residents′ willingness to hierarchical medical system and their intention of first visit hospitals.Methods Customized questionnaire was used for in-home survey of 1 500 households in three cities of Shandong province,with 773 of the residents aware of hierarchical medical system used as the study samples.Descriptive analysis and multi factor Logistic regression were employed for statistical analysis of their intention.Results 85.0% the residents expressed willingness to embrace hierarchical medical system.55.0% of the residents prefer primary medical institutions as their first visit in case of mild illness,a choice chosen by more rural residents(58.9%)than urban residents(48.0%),a difference of statistical significance(P<0.01).In the case of severe illness,87.3% of them prefer major hospitals as their first visit,and more urban residents(94.3%)take this option than the rural residents(83.3%),a difference of statistical significance(P<0.01).Service ability of medical institutions and residents′ concept for medical service played a key role in their choice of first visit hospitals.Conclusions The key to ensuring the implementation effect of hierarchical medical system lies in better service ability of primary medical institutions and correction of residents′ irrational medication concepts.

Objective To explore the influence of glucose-lowering rate on left ventricular function in patients with type 2 diabetes mellitus (T2DM). Methods One hundred and thirty-two cases of type 2 diabetes mellitus and 135 cases of type 2 diabetes mellitus with coronary heart disease (T2DM+CHD)received intensive glucose lowering therapy. Then, after measuring left ventricular ejection fraction (LVEF) and E/A ratio, the variation was analyzed. Results LVEF was significantly higher than that before intensive therapy in T2DMsubgroup with glucose-lowering rate less than 6 m mol · L-1 · d-1( P＜0.05 ). So was T2DM+CHD subgroup with glucose-lowering rate less than 4 mmol· L-1 · d-1 (P＜0.05). LVEF was significantly lower than that before intensive therapy in T2DM+CHD subgroup with glucose-lowering rate greater than 4 mmol · L-1 · d-1( P＜0. 05 ),while by the end of following up for 3 months, LVEF stepped up and no significant difference was observed between subgroups ( P ＞ 0. 05 ). The E/A ratio stepped up in both subgroups after intensive therapy ( P ＜ 0. 05 ).Conclusions For T2DM patients with coronary heart disease, excessively fast glucose-lowering rate may impair left ventricular function. Long-term good control of blood glucose restores the impaired left ventricular function causes by excessively fast glucose-lowering rate. After intensive therapy, left ventricular diastolic function finally improves in both subgroups regardless of the glucose-lowering rate and coronary heart disease.