0.05). However, the reduction of intracranial pressure were gender and age dependent (P

Doctor-patient communication is the very important part of the relationship between patients and doctors.It builds the trust from patients and protects the interests of doctors and patients.The communication is the useful way to reduce the medical dispute.This paper discusses the importance of communication and gives advices on how to communicate between patients and doctors.

[Objective]To evaluate the safety outcome of the 12 patients with simultaneous multiple joint replacement(≥3) in the recent three years.[Method]The complication rates,blood loss,transfusion volume,and hospital stay were analyzed in details.[Result]The mean operating time was 9 hours and 8 minutes(6 hours and 25 minutes to 12 hours).The mean overall volume of blood loss was 3140ml(1 000 ml-5 600 ml.Complications included reactive digestive ulcer in one case,acetabular component position error in one case,and deep infection in one hip of one case.[Conclusion]Simultaneous multiple joint replacement is an alternative protocol to the patients with multiple joint disorders.finished under a single aesthesia and in a single hospital stay.So the overall economical cost will be decreased,and rehabilitation being accelerated.Disadvantages include serious trauma,increased blood loss,and complications may be some how increased.

Objective To explore the effect of minimally invasive clinical pathway in patients after car-diac interventional therapy. Methods One hundred and twenty patients who received cardiac interventional therapy from June 2005 to October 2006 were divided into the control group and the observation group.The control group received routine nursing while the observation group adopted minimally invasive clinical pathway of nursing.The nursing effect in the two groups was compared. Results The mean hospitalized duration, sat-isfaction degree and health knowledge level in the observation group were superior to those of the control group (P ＜ 0.05). Conclusions The adoption of minimally invasive clinical pathway in patients after cardiac inter-ventional therapy could increase working efficiency nd ensure the nusing quality.

BACKGROUND: Flash visual evoked potential(fVEP) can reflect the integrity of visual pathway from retina to pulvinar cortex. The utilization of its characters can accurately evaluate the injury situation of visual conduction pathway.OBJECTIVE: To investigate the feasibility and effects of fVEP on non-traumatic monitoring of intracranial pressure.DESIGN: A repeated measurement design based on patients.PARTICIPANTS: Totally 197 patients with brain injury including 138males and 59 females with an average of(38 ±9) years old were selected from the First Affiliated Hospital of Chongqing Medical University and Xuanwu Hospital Affiliated to Capital University of Medical Sciences. The selected diseases were: epidural hematoma( n=20),subdural hematoma(n = 26),cerebral contusion( n = 4),subdural hematoma companied with cerebral contusion( n = 92),and cerebral contusion companied with intracerebral hematoma( n = 55).METHODS: The level of intracranial pressure of 197 patients with brain trauma was detected with fVEP and epidural manometry. Data of traumatic surveillance were collected after the completion of fVEP. Changes of blood pressure and heart rate in patients were recorded simultaneously.MAIN OUTCOME MEASURES: fVEP results,and levels of intracranial pressure.RESULTS: The average intracranial pressure of 197 patients with brain trauma was(2.75 ± 0.64) kPa,( 1.54 - 4. 02 kPa) . The dispersion of both traumatic and non-traumatic surveillance was relatively big in patients with confirmed visual pathway injury. No typical wave was induced by fVEP in2.79% of patients. Scatter diagram suggested that the consistence between fVEP and epidural manometry was relatively good. Linear regression analysis showed that heart rate was the most sensitive one to the fluctuation of intracranial pressure (β = -0. 369) followed by systolic pressure (β= 0. 316),while diastolic pressure was not so sensitive (β = 0. 147). There was negative correlation between heart rate and intracranial pressure,which could quite sensitively reflect the fluctuation of intracranial pressure,systolic pressure was the next,and diastolic pressure was not easily to be affected by the changes of intracranial pressure.CONCLUSION: Non-traumatic surveillance,fVEP,has favorable consistence with traumatic detection,which can quantitatively evaluate the changes of intracranial pressure non-traumatically.

Objective To identify the biomarkers associated closely with migraine by proteomics analysis of cerebrospinal fluid (CSF).MethodsForty-five patients were involved in the present study and they were divided into the following two groups:25 with migraine (5 with aura and 20 without aura) were assigned to migraine group,and 20 with giddiness or peripheral neuropathy were assigned to control group.The patients' CSF was collected,and the protein of CSF was extracted by acetone precipitation.The two-dimensional electrophoresis (2D-PAGE) with immobilized pH gradient (IPG) was performed to display the differently expressed protein spots.These spots were then identified by two-dimensional liquid chromatography and tandem mass spectrometry (2D-LC/MS-MS),and semi-quantitatively analyzed by Western blotting.ResultsDifferences were found in the results of 2D-PAGE between migraine group and control group.Ten spots of 9 kinds of proteins were successfully identified,of which 7 spots were down regulated,including transthyretin (TTR),CBX6 53 kDa protein (CBX6),agrin precursor (AGRN),FAM3C precursor (FAM3C),neuronal pentraxin receptor (NPR),dermcidin-isform2 (DCD) and albumin (ALB);whereas junction plakoglobin (JUP) and H2A histone family,member J (H2AFJ) were up-regulated.The results of Western blotting revealed that the net protein retention (NPR) in migraineurs group (0.3351?0.0275) was obviously decreased compared with that of control group (0.8854?0.0957,P

Objective To investigate MRI signal features and MRI appearances of patients with advanced stage in polyacrylamide hydrophilic gel injection for facial plasty.Methods In this study,MRI of 11 cases with 23 polyacrylamide hydrophilic gel injection of facial plasty for 6 to 10 years were retrospectively reviewed.All images were acquired with GE 3.0T MR imaging unit.MR sequences,including FSE T1WI,FSE FS T2WI,and STIR were applied with 8-channel brain coil.MRIs sliced through the maxillofacial region in the transverse,coronal and sagittal planes.Results In 11 cases of 23 polyacrylamide hydrophilic gel injection,there were different degrees of capsule rupture and induration in 6 polyacrylamide hydrophilic gel injection,and the images showed sporadic callosities such as subcutaneous nodules and nodules in glands or muscles ; hydrogel migration in 8 polyacrylamide hydrophilic gel injection.Secondary deformity occured in 80 ％ cases,in which the most cases were induced by hydrogel migration.Conclusions Magnetic resonance imaging can make clear of the type of rupture and the distribution leakage of polyacrylamide hydrophilic gel for facial plasty and it is an ideal approach for advanced patients with polyacrylamide hydrophilic gel injection for follow-up.

Objective To investigate the relation between plasma matrix metalloproteinase 9 (MMP 9) levels and transcranial Doppler (TCD) detected microemboli in patients with cerebral infarction and evaluate the clinical significance. Methods The plasma MMP 9 levels were quantified by ELISA and the microemboli were detected with TCD in 50 stroke patients and 20 controls. Results The level of plasma MMP 9 was significantly higher in microembolic signal positive patients than that in negative ones [median (392.87?210.90) ng/ml for those with emboli versus (202.27?153.40) ng/ml for those without, P

Objective To analyze the clinical effects of internal radiation of iodine-125 seed implantation in the treatment of advanced pancreatic carcinoma.Methods Ten patients with unresectable and advanced pancreatic carcinoma admitted from Sept.2002 to June 2004 were treated by the internal and interstitial radiation using iodine-125 seed implantation. Sex:male 6, female 4. Age: median 60.8(45-81) years. Site by pre-operative CT: pancreatic head 4, body 2 and tail 4. Diameter: 6?cm 3. Pathology: all proved to be pancreatic adenocarcinoma. Staging(UICC 1997): stage Ⅲ 3, IV 7. Pain degree: Ⅲ 3,IV 7. Weight loss: median 5?kg(3-10?kg). Results All patients have been followed for 2-13 months, median 6 months. Survival of 12 months was observed in 1 patient,6 months in 3 patients, 3 months in 4 and 1 month in 2, with an average of 4.6 months. Among the 10 patients, complete response was obtained in 2, partial response in 3, no response in 4, and the other showing PD. The response rate (CR+PR) was 50%. The pain relieving rate was 60%. The seed number conformal rate was 100% by X-ray film, yet that of seed spatial distribution was only 30%. Conclusion Intra-operative internal radiation by iodine-125 seed implantation does show some therapeutic effects for advanced pancreatic carcinoma.Yet,the seed spatial distribution by seed computer treatment planning system does needs further consummate.

Objective To determine the half-effective target plasma concentration(EC50)of remifentanil inhibiting airway response when combined with propofol by TCI in patients undergoing fiberoptic bronchoscopy.Methods Forty ASAⅠorⅡ patients,aged 20-64 yr, undergoing elective fiberoptic bronchoscopy, were randomly divided into 2 groups (n = 20 each).Anesthesia was performed with TCI of remifentanil and propofol in both groups. The target effect site concentration of propofol was 3 μg/ml.The target effect site concentration of remifentanil was determined by up-and-down sequential hial. The target effect site concentration of remifentanil was set at 5 μg/ml in the first patient and the ratio of the target concentrations between the two consecutive patients was 1.1. BIS ≤ 60 was defined as the suitable depth of anesthesia in group A.The airway response≤grade Ⅱ was defined as the suitable depth of anesthesia in group B. The EC50 and 95% confidence interval (CI) required to inhibit the airway response were calculated in the two groups.Results The EC50 and 95% CI of remifentanil required to inhibit the airway response were 4.50μg/L (95% CI 3.88-5.36 μg/L)in group A and 4.10μg/L(95% GI 3.31-5.00 μg/L) in group B. The EC50 of remifentanil inhibiting airway response was significantly higher in group A than in group B. Conclusion The EC50 of remifentanil inhibiting airway response is 4.10 μg/L when combined with propofol by TGI (effect site concentration 3μg/ml)in patients undergoing bronchoscopy. BIS is not a suitable index assessing the depth of propofol-remifentanil anesthesia.