Objective To investigate the diagnosis and treatment of abdominal compartment syn-drome (ACS)aftergiantabdominal incisional hernia surgery.Methods The diagnosis and treatment of eight cases of ACS after giantabdominal incisional hernia surgery in our hospital from June 201 0 to June 201 4 were retrospectively analyzed.Results Seven cases of ACS were cured,with a cure rate of 87.5%. One case with chronic pulmonary heart diseasedied ofsevere lung infection caused by ARDS,with a mor-tality of 1 2.5%.The cured patients discharged and werefollowedup for threeto six months,without any signs of recurrence and organ dysfunction.Conclusion Abdominal compartment syndrome is a serious complication aftergiantabdominal incisional hernia surgery,with treatment difficult and high mortality.The keysinreducingmortalityare early diagnosis and comprehensive treatment.

Objective To investigate the changes of the serum vascular adhesion protein-1(VAP-1)and high sensitivity C reac-tive protein(hs-CRP) in diabetic nephropathy(DN) and the effects in the development of diabetic nephropathy .Methods 40 cases of DN were enrolled as the DN group ,39 cases of type 2 diabetic mellitus were enrolled as the T2DM group ,and 46 cases of healthy persons were enrolled as the control group .The levels of the serum VAP-1 and hs-CRP were tested by ELISA ,the blood glucose (Glu) was tested by autochemistry analyzer and the concentrations of glycosylated hemoglobin A-1(GHbA-1) was tested by high performance liquid chromatography(HPLC) .All the resoults were compared with that of the control group .Results the differences of the levels of VAP-1 ,hs-CRP ,Glu ,GHbA-1 in different groups were ststisticlly significant (P<0 .05) ,the levels of VAP-1 and hs-CRP were higher in DN group than that of T2DM group and the control group ,and the level of hs CRP was higher in T2DM group than that of control group .The positive correlation was found in T2DM group between VAP-1 with hs-CRP and Glu(r=0 .568 ,0 .755 ,P<0 .05 ,0 .01) ,hs-CRP with Glu and GHbA-1(r= 0 .886 ,0 .475 ,P< 0 .01 ,0 .05) ,and Glu with GHbA-1(r=0 .471 ,P<0 .05) .In DN group ,the level of VAP-1 has positive correlation with the levels of hs-CRP ,GHbA-1 ,Glu(r= 0 .521 , 0 .830 ,0 .454 ,P<0 .05 ,0 .01 ,0 .05) ,the levels of hs-CRP has positive correlation with that of Glu (r=0 .690 ,P<0 .001) .Conclu-sion the changes of the levels of Glu and GHbA-1 in patients with T2DM could affect the increase of VAP-1 and hs CRP ,high content of VAP-1 could cause microangiopathy and renal function damage .Antagonist therapy of VAP-1 is important for the pre-vention of the DM complication .

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique.Methods Normal pelvic CT scans of 52 adults (27 males and 25 females;aged from 18 to 74 years,averaging 47.2 years) were obtained to create pelvic 3D models.After the acetabulum was thickened by 5 mm,the width (d) of the safe zone for placement of the medial iliosciatic plate was measured.After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured,the ratio (r) of d/w was calculated.The recombined innominatum model was cut through the center of the acetabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch.The cross-section was marked as M.In males,4 points at distances of 1.0 cm,1.5 cm,2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked.At the 4 points,the angulations (∠ a,∠b,∠ c and ∠ d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M.In females,3 points at distances of 1.0 cm,1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a,∠b,and ∠c were measured.The differences in the above parameters were compared between males and females.Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56 ±2.44 mm in males and 24.36 ±2.47 mm in females;the ratio (r) was 0.61 ± 0.07 in males and 0.54 ± 0.05 in females.The safe angulations for screw placement in males,∠ a,∠b,∠cand ∠d,were 88.04°±3.18°,77.81°±3.85°,68.01°±4.11°and56.81°±4.81° while those in females,∠a,∠b and ∠c,were 91.29°±4.52°,76.23°±3.82° and 62.79°±3.51°,respectively.There were statistically significant differences between males and females in values of d,r,∠ a and ∠ c (P ＜ 0.05).Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate,the differences between males and females should be taken into account.Besides,specific safe angles should be chosen according to the position of the plate.

OBJECTIVE: To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. METHODS: A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment. RESULTS: Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology. CONCLUSION The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.
Dissent and Disputes ; Expert Testimony ; Forensic Medicine ; Gynecology/statistics & numerical data* ; Hospital Departments/statistics & numerical data* ; Humans ; Incidence ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Retrospective Studies ; Time Factors

Objective To discuss the technique and value of preoperative reformatting with three-dimensional computed tomography technique for C_2 pedicle screw track.Methods GE Light Speed 16 Pro spinal CT scans of 15 adult dry vertebrae were loaded into an imaging station (software ADW4.2).Two methods of C_2 pedicle screw techniques were analyzed through virtual screw trajectory by VR (volume rendering) and MPR (multiple planar reformatting) techniques,in method A,screw entry point was the intersection between the media-vertical and the cranial line of C_2 inferior facet joint,in method B,the screw track was from the cranial and medial quadrant of the dorsal part of C_2 inferior facet joint.Results The screw track could be observed dynamically from any plane.Two vertebrae were ob- served with smaller height in isthmus and the medial edge of the transverse foramen since no space was a- vailable for the screw.The screw trajectories data were compared between method A and method B,which showed that the angles towards the cephalad (in sagittal plane) and midline (in transverse plane) were bigger in method A than in method B (P＜0.05,0.01),but the safe screw diameter was smaller in method A than in method B (P＜0.05),and there was no difference of the screw length between the two methods(P＜0.05 ).Conclusion In this research,the individual C_2 pedicle screw entry points, screw diameter and security screw angle can be simulated,and the screw track can be observed dynami- cally to make sure if it transits the bone structure completely.Preoperative three-dimensional computed tomography reformatting for pedicle screw track is of great value in clinical and basic researches.

Objective To evaluate therapeutic ERCP in the treatment and preventing the recurrence of acute biliary pancreatitis(ABP).Methods One hundred and seventeen patients of ABP were randomly divided into two groups,ERCP treatment group(n=49)and non-ERCP control group(n=68).Changes of clinical symptoms and laboratory indexes were recorded accordingly.Follow-up study was for all the patients. Results Of the 117 with ABP,99 cases were mild(MABP)and 18 ones were severe(SABP).The days of relief of abdominal pains,normalization of hepatic function indexes and hospitalization were significantly shorter in ERCP treatment group than that in control group.The complications related to endoscopic therapy were not found.All patients had got followed-up visits for average 20(range 5-37)months(94.0%).The re- currence rate in the ERCP group 0(0/46)were significantly lower than that in the control group 46.8%(29/ 62)(P

Clinical medicine is a comprehensive discipline integrating natural science and hu-manities and social science. Lemology is closely related with basic medicine and medical microbiology and medical immunology are the basis of lemology. Therefore, in the process of cultivating postgradu-ates of lemology, we should not only should attach importance to the cultivation of basic medical knowl-edge and clinical professional quality, but also pay more attention to the development of the intelligence factors and non-intelligence factors. Meanwhile education on humanity, social sciences and relevant laws and regulations should be enhanced to cultivate doctors' professional quality. Reverse thinking and lateral thinking in the clinical diagnosis should be strengthened to achieve the training objectives of cultivating international medical talents.

Objective To identify the clinical and demographical features that may impact the duration of mechanical ventilation(DMV) in the patients with post-thymectomy myasthenic crisis(PTMC).Methods Reviewed the patients who had PTMC from June 2008 to November 2015.Cox proportional hazard regression analysis was used to identify potential prognostic factors that may impact DMV and long-term survival,respectively.One-way ANOVA analysis was used to compare the four groups with continuous variates.Statistical powers were calculated by using XLSTAT.Results In total,seventy patients with PTMC were enrolled.Alcoholic abuse,high MGFA classification and Clavien-Dindo classification were the critical factors that remarkably delayed early extubation.Postoperative lung infection(PLI) as sole complication did not prolong DMV as compared to those without any complication,however,PLI with other more severe complications requiring at least pharmacological treatment seemed to remarkably prolong DMV,as compared to those without any complication.Conclusion Preoperative abstinence,proper treatment of MG and postoperative complications can decrease the incidence of PTMC,shorten the use of ventilator time and improve the prognosis of patients.

Objective To evaluate the efficacy and safety of wuling capsule compared with deanxit in treatment of patients with depression or anxiety status. Methods A total of 139 patients with depression or anxiety status were enrolled in a multi-center double blind clinical trial. All patients were randomized into two groups, 67 patients in wuling capsule group and 73 patients in deanxit group. Efficacy and adverse effects were evaluated with Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD),Pittsburgh Sleep Quality Index (PSQI) and Treatment Emergent Symptoms Scale (TESS) before treatment and 1, 2, 4, 6 weeks after treatment to verify the noninferiority of wuling capsule. Results There was no significant difference in score decline of HAMA and HAMD between the two groups (HAMA: wuling vs deanxit group: 9.0 ± 5.4 vs 10.3 ± 5.4, F = 2.11, P =0.148 ; HAMD: wuling vs deanxit: 9.1±5.6 vs 10.5±5.7, F = 1.61, P=0.207). There was no significant difference in response rate and remission rate between the two groups. No significant difference was found in score decline of PSQI between the two groups (wuling vs deanxit group: 4.1±4.5 vs 5.0 ± 4.2, F = 0.72, P=0.192). The incidence of adverse events was 41% in the wuling group and 55% in the deanxit group respectively. The main adverse effects were symptoms of gastrointestinal and neurology system. Conclusion Safe and well tolerated, wuling capsule improves the anxiety, depression and insomnia symptoms of patients with depression or anxiety status.

Objective To investigate the effect of vascular endothelial growth factor C (VEGF-C) on apoptosis of pancreatic cancer cell. Methods Human pancreatic cancer cell line PANC-1 orthotopic implantation tumor model was established in nude mice. Primary pancreatic cancer cells and that derived from lymphatic metastasis were primarily cultured. Expression of VEGF-C was inhibited through antisense oligodeoxynucleotide in vitro transfection. Reverse transcription polynlerase chain reaction (RT-PCR) and flow cytometer were used to detect the effect of VEGF-C on apoptosis of pancreatic cancer cells and bcl-2. Results After in vitro transfection, mRNA expression level of VEGF-C in PANC-1 pancreatic cancer cells significantly decreased (P ＜0. 01 ). Apoptosis rate of pancreatic cancer cells derived from spontaneous lymphatic metastasis was (2. 83 ± 1.01 ) %, ( 4. 98 ± 2. 05 ) %,and ( 13.22 ±2. 17) % respectively for control group, SODN group and ASODN group after in vitro transfection among which apoptosis rate in ASODN group increased significantly (P ＜0. 01 ). However, apoptosis rate for pancreatic cancer cells derived from primary tumor had no obvious change (P ＞0.05), with (3.51 ±1.38)%, (4.76 ±2. 16 ) %, and (5. 33 ± 2. 18 ) % respectively in control group, SODN group and ASODN group. The expression level of bcl-2 in pancreatic cancer cells derived from spontaneous lymphatic metastasis decreased significantly (P ＜0. 05) while it had no obvious change in primary pancreatic cancer cells (P ＞ 0. 05). Conclusion To inhibit expression of VEGF-C in pancreatic cancer cell can promote apoptosis of pancreatic cancer cell, which is relevant to downregulation of bcl-2;however, it has no obvious effect on primary pancreatic cancer.