Objective:To compare and analyze clinical features between patients with early and non‐early acute coro‐nary syndrome (ACS) .Methods :A total of 120 ACS patients were selected ,including 71 patients with early ACS (early ACS group ,onset time≤12h) and 49 patients with non‐early ACS (non‐early ACS group ,onset time >12h) . Risk factors ,clinical features ,mortality ,incidence rates of myocardial infarction ,rehospitalization and major ad‐verse cardiovascular events (MACE) were compared and analyzed between two groups .Results:There were no sig‐nificant difference in percentage of each ACS risk factor between two groups , P>0.05. Compared with non‐early ACS group ,there was significant reduction in incidence rate of heart failure (73.5% vs .54.9% ) ,significant rise in incidence rates of obvious chest pain (32.7% vs .73.2% ) and shock (46.9% vs .62.0% ) in early ACS group (P<0.05 all) ,but there was no significant difference in incidence rate of arrhythmia between two groups (P>0.05) . After one‐year follow‐up , compared with non‐early ACS group , there were significant reduction in mortality (18.4% vs .4.2% ) ,incidence rates of myocardial infarction (18.4% vs .4.2% ) ,rehospitalization (30.6% vs . 14. 1% ) and MACE (38. 8% vs .16. 9% ) in early ACS group , P<0. 05 all .Conclusion:Initial symptom is more ob‐vious ,but related complications are fewer and the prognosis is better in patients with early acute coronary syndrome .

ObjectiveThe study was designed to understand the education training situation and demand of rural doctors,identify problems in training and provide theoretical basis for the relevant government departments to further the development of rural doctors education,explore the pattem of ru ral health education and improve the effectiveness of training.MethodsThe participants were a sample of rural doctors among the east and center-west region in China (Beijing Municipality,Jiangsu,Zhejiang,Hainan,Shanxi,Guangxi Zhuang Autonomous Region,Guizhou,Yunan and Gansu).20 288questionnaires were issued,18 259 of them were taken back,which occupied 90.1％ recovery rate.Group interview method and stratification-cluster sample method were conducted in the Cross-sectional study.Results70.2％ were male doctors,with an average age of 44.3 ±10.9 years,63.0％ of whom received technical school education and technical secondary school Training time was mainly less than 12 days per year (48.8％),training content was mainly about clinical skills(80.6％),and traning mode was mainly conference traning (56.6％).There was a certain gap between training status and demand.ConclusionThe on-site clinically guide-based,comprehensive and short-term non-job training should be demand-orientedly carried out aiming at young doctors in rural areas.

Objective To study the relationships of health risk factors and health-related presenteeism in medical personnel of a tertiary grade A hospital. Methods A literature review and expert consultation were used to identify 14 health risk factors included in the survey, and the Michigan's Health Risk Appraisal Questionnaire was modified. Medical personnel of a tertiary grade A hospital in Beijing were selected for this cross-sectional study, including doctors, nurses, medical technicians, pharmacists, as well as scientific researchers, and staff members responsible for education, medical affairs, journal editors and other work. Physical measurement and questionnaire survey were conducted to collect demographic data, distribution of health risk factors of medical staff, and productivity information. Results Among 14 health risk factors, pressure or stress had the highest proportion (80.2%), followed by poor quality of sleep (63.7%), high blood lipid (33.8%), low physical activity (30.9%), and unreasonable diet (29.6%). Medical staff of different ages( c 2=16.141, P=0.001) and different occupations( c 2=15.982, P=0.003) had different probability of presenteeism. Medical staff under 30 years of age were most likely to be presenteeism (38.3%). The probability of presenteeism in nurse was the highest(56.2%). Under a high pressure and taking relax medicine seemed more likely to be presenteeism. Conclusion In the 14 kinds of health risk factors, pressure and taking relax medicine in medical staff may be associated with health-related presenteeism.

Between January 2011 and December 2011,86 patients undergoing operation for anorectal disease were randomized in a double-blind manner to receive a mixed injection of methylene blue,ropivacaine and sodium chloride (observation group,n =43) or traditional analgesic methods (control group,n =43).Patients in observation group had less visual analog scale (VAS) scores of pain at 6-48 h postoperation than control group (P ＜0.05).The scores had no significant difference at 72 h postoperation between two groups (P ＞ 0.05).The total postoperative complications (8,19％) and hospitalization duration [(5.3 ± 2.2) days] in observation group were significantly less than those [15,35 ％ and (6.4 ±1.7) days] in control group (P ＜ 0.05).A mixed injection of methylene blue and ropivacaine intraoperatively can relieve the postoperative pain of patients with anorectal disease and reduce the incidence of postoperative complications and the duration of hospitalization.

Objective To study the effects of postoperative immune-enhancing enteral nutrition (IEEN)on the liver function and postoperative infectious complications after hepatectomy in patients with hepatocellular carcinoma.Methods Between January 2010 and December 2011,96 patients undergoing hepatectomy for hepatocellular carcinoma were randomized in a double-blind manner to receive postoperative enteral nutrition with IEEN (IEEN group,n =48) or standard enteral nutrition (control group,n =48) for 5 days,respectively.Calorie and nitrogen of the same quantity were provided for both groups from the first day after surgery.The liver function tests and routine blood tests were performed.The postoperative hospital stay and postoperative infectious complications were also compared between these two groups.Results The serum albumin,prealbumin,alanine aminotransferase,and total bilirubin levels had no significant differences between the two groups (all P ＞ 0.05).On the 6th day after operation,the level of total lymphocyte count was significantly higher in the IEEN group than that in the control group [(2106 ± 1057) vs.(1648 ± 1079) / μL,P =0.038).The postoperative hospital stay was (10.3 ±5.6) days in the IEEN group and (13.4 ±6.7) days in the control group (P =0.016).Postoperative infectious complications were observed in 8 (16.7％) patients in the IEEN group and 17 (35.4％) patients in the control group (P =0.036).Conclusion Early postoperative IEEN can improve the clinical outcomes of liver cancer patients after hepatectomy.

[Objective] To explore whether diabetes mellitus (DM) can influence the early bacterial translocation (BT) and progression of acute necrotizing pancreatitis (ANP) for guiding the early clinical treatment.[Methods] 35 Wistar male rats were randomly allocated to 4 groups,Group ANP associatcd with DM (DM+ANP,n =10):DM underwent induction of ANP;Group DM (n =10):DM underwent laparotomy with only manipulation of the pancreas and duodenum;Group ANP (n =10):non-DM underwent induction of ANP;Group sham operation (SO,n =5):non-DM underwent SO.After 12 h of the induction of ANP or laparotomy,the following parameters were analyzed:bacterial culture and identification of portal vein blood,mesenteric lymph nodes (MLNs),pancreas and liver,and calculate the total incidence of BT;serum amylase and endotoxin levels of portal vein blood;histological assessment of pancreas and ileum lesions.[Results] All animals except 3 in group DM+ANP (mortality rates:30％) and 1 in group ANP (mortality rates:10％) survived the experiment.The total incidence of BT was 23/28 (82.1％) in group DM+ANP whereas 16/36 (44.4％) in group ANP (P =0.002).Gram-positive bacteria were 17/23 (73.9％),3/16 (18.8％) in group DM+ANP and group ANP,respectively (P =0.001).Amylase activity (2302 ± 346) U/L in group ANP increased significantly (P =0.000) compared with other groups.However,group DM+ANP (501 ± 142) U/L decreased significantly (P =0.001) in comparison to group SO.Regarding to endotoxin concentrations and the severity of pancreas and ileum lesions,group DM + ANP increased significantly compared with group ANP,group DM and group SO (P ＜ 0.05).[Conclusion] Gram-positive bacteria translocates more frequently than Gram-negative bacteria in the early period of DM+ANP rats.DM aggravates the progression of ANP and increases early bacterial translocation,endotoxemia and severity of pancreas and ileum lesions.

OBJECTIVE: To explore surgical reconstruction and clinical effect of arthroscopic double-bundle double-tunnel reconstruction of anterior cruciate ligament (ACL) with multi-strand hamstring tendons autograft. METHODS: Twenty-one patients (13 males and 8 females) with ACL deficiency were diagnosed with arthroscopy, with an average age of 25.4 (17 approximately 50) years. The 2 separate tibial tunnels and 2 femoral tunnels were drilled on the footprint of the ACL to reconstruct the anteromedial and posterolateral bundles with arthroscopy.Tendons were fixed with Endo-button/polyester tape constructs at the femoral side and with biodegradable interference screw at the tibial side. RESULTS: All patients were followed up for 15.8 (13 approximately 23) months. The anterior drawer test was positive in all patients and Lachman test was positive in all but 2 preoperatively. The postoperative results of anterior drawer test were negative in all but 1 at 90 degree of knee flextion. Lachman test was positive in 1, suspiciously positive in 1 and negative in other patients. The Lysholm knee score increased from 36 approximately 58 preoperatively to 71 approximately 95 postoperatively and the fineness rate was 95.2%. CONCLUSION Arthroscopic double-bundle double-tunnel reconstruction ACL with multi-strand hamstring tendons autograft is effective and reliable to restore the better dynamic stability of the knee.
Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; methods ; Bone Screws ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Tendons ; transplantation ; Transplantation, Autologous ; Young Adult

This study was aimed to quickly identify Chinese medicine Olibanum.Thermal analysis method was used on the quality analysis of Chinese materia medica (CMM).A total of 25 batches of Olibanum on the market were collected.This study examined three important factors of temperature range,heating rate,powder mesh on the TGA and DTA thermal analysis experiments.And a method of rapid authentication of medicinal materials using TGA and DTA feature maps was built.Methods of the first-order points,connection on thermogravimetric analysis and heat enthalpy calculation were adopted in the quantitative analysis of Olibanum.The results showed that the best condition of TGA and DTA experiment on Olibanum was confirmed.The temperature range is 50-750℃.The heating rate is 20℃· min-1.The powder mesh is 100 mesh.Under these conditions,good quality goods of Olibanum,counterfeit Olibanum and adulterants of Olibanum could be distinguished through the characteristic peak (T1=447 ± 5℃,T2=549 ± 5℃,T3=350 ± 5℃),thermogravimetric analysis (TV-max,△W2+△W3) and thermal enthalpy analysis (△H).It was concluded that the TGA-DTA technology was simple.It was thought to be a rapid,accurate and simple new method for Olibanum identification and quality analysis.

Objective To observe the short-term clinical outcomes of arthroscopic single-tibial tunnel Pushlock fixation in the treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).Methods From December 2015 to January 2018,15 patients with tibial avulsion fracture of PCL were treated at Department of Articular Surgery,The Third Affiliated Hospital to Hebei Medical University.They were treated with arthroscopic single-tibial tunnel Pushlock fixation.All the fractures were fresh.They were 9 males and 6 females,aged from 14 to 64 years (average,33.6 years).The short-term outcomes were evaluated by comparing their preoperative and postoperative flexion of the knee,International Knee Documentation Committee (IKDC) and Lysholm scores.Results The operation lasted from 40 to 70 minutes (average,53 minutes).The 15 patients were successfully followed up for 10 to 18 months (average,12.2 months).All the fractures united well within 3 months after operation.All the posterior drawer tests were negative,showing no displacements or no complications like lesions of popliteal fossa,nerves and vessels,or impaired knee extension.At 6 months after surgery,the knee flexion (123.4°± 6.5°),the Lysholm scores (91.8 ± 3.5) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5°±13.1°,46.8 ±8.9 and 37.0±8.9) (P ＜0.05).Conclusion The tibial avulsion fracture of PCL can be treated by arthroscopic single-tibial tunnel Pushlock fixation with satisfactory early outcomes.

Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.