BACKGROUND:K-wire and steel wire tension band wiring is the most commonly method for the treatment of patel ar fracture. However, there have been many reports of complications related to the mental implants. Based on the reasons above, some scholars begin to replace the steel wire with braided polyester sutures for the treatment of patel ar fracture. OBJECTIVE:To observe the effect of patel ar ring pins and FiberWire braided polyblend sutures tension band fixation for treatment of patel ar fracture. METHODS:We performed a retrospective analysis involving 26 patients with patel ar fracture (16 males, 10 females, at the age of 36-54 years with a mean age of 44.6 years) who were treated with patel ar ring pins and FiberWire braided polyblend sutures tension band fixation. RESULTS AND CONCLUSION:Al the patients were fol owed-up for 6-18 months, average of 12 months. Al patients were primary healing and achieved bone union in 8-16 weeks, averaged in 12 weeks from surgery. There was no fracture fragment displacement, internal fixation loosening and break. No pins protruding from the subcutaneous and irritate the skin. According to the Lysholm&Gil quist scales, 18 cases were excellent, four cases were good, and four cases were fair, with the excellent and good rate of 85%. Tension band fixation using patel ar ring pins and FiberWire braided polyblend sutures resulted in good outcomes with few complications.

The rehabilitation therapeutic method of dysphagia after stroke included movement therapy and compensatory technology (including neurodevelopmental therapy), neuromuscular electrical stimulation, surface electromygraphy biofeedback training, non-invasive brain stimulation, balloon ductal dilatation technique, acupuncture and moxibustion, drug, and surgical treatment. The movement therapy and compensatory technology were the basis of therapy and the upward and forward movements of tongue-throat complex were the core of therapy. The combined treatments of early, initiative, individual, and various methods were emphasized, while the nutrition and the preven-tion and cure of aspiration pneumonia of patients should be paid attention to.

Objective To evaluate the effects of hypogastric artery ligation to treat massive hemorrhage in pelvic fractures with abdominal organ injuries. Methods The pelvic fractures of 16 patients were classified as Tile B type in 10 cases and C type in 6. Among them there were 6 open fractures and 20 sites of abdominal visceral injuries. The capacity of retroperitoneal hematoma, which was ruptured in 6 cases, ranged from 800 ～2 500ml with 1 400ml on average. The bleeding volume in the survivals was 1 500～5 800ml with 2 600ml on average. Ligation of bilateral hypogastric artery was carried out in all patients with intra abdominal injuries within 6h. Of them, skeletal traction was used in 7 cases while pelvic external fixation in 5 cases. Results One death occured dut to consumptive coagulopathy with hematorrhea. Of the 15 survivals, bleeding was controlled in 8 cases, decreased in 5 and uncontrolled in 2. The effective rate was 81.3%(13/16) and the survival rate 93.8%(15/16). Conclusion When emergency celiotomy is performed for abdominal injuries, a rational application of hypogastric artery ligation can play a positive role in control of pelvic hematorrhea.

Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 64 patients who underwent laparoscopic splenectomy combined with pericardial devascularization at the Second Affiliated Hospital of Kunming Medical University from April 2012 to June 2015 were collected.Observed indexes included (1) treatment outcomes,including surgical procedures,operation time,volume of intraoperative blood loss,time of postoperative enteral recovery,time of postoperative drainage tube removal,duration of postoperative hospital stay,occurrence of complications,(2) follow-up situation.The follow-up using reexaminations of blood routine,liver function,coagulation function,gastroscopy and color Doppler ultrasonography of portal vein was performed regularly at postoperative month 1,2,3,6,12,24 until reemergence of gastrointestinal hemorrhage.The final deadline was death of patients and performance of liver transplantation.Measurement data with normal distribution were presented as-x ± s.Results (1) Treatment outcomes:of 64 patients,62 underwent total laparoscopic splenectomy combined with pericardial devascularization successfully.One patient was transffered to hand-assisted laparoscopic splenectomy combined with pericardial devascularization due to uncontrollable hemorrhage.One patient received laparoscopic cholecystectomy firstly with volume of blood loss of about 1 500 mL and terminated surgery after infusion of suspension red blood cells of 6 U and plasma of 900 mL,and underwent laparoscopic splenectomy combined with pericardial devascularization again next week.No postoperative hemorrhage,pancreatic leakage or death occurred during the perioperative period.The operation time,volume of intraoperative blood loss,time of postoperative enteral recovery,time of postoperative drainage tube removal and duration of postoperative hospital stay were (146 ± 33) minutes,(214 ± 31) mL,(24 ± 4) hours,7 days and (14 ± 6) days,respectively.Nine patients had postoperative pleural effusion and recovered after thoracic drainage and thoracentesis.(2) Follow-up situation:All the 64 patients were followed up for an average time of 19.7 months (range,3.0-23.0 months).Reexamination of gastroscopy showed improvement of varicosed veins of lower esophagus and fundus of stomach.During the postoperative 3 months,4 patients had portal vein thrombosis with level of PLT ＞ 700 × 109/L.For patients with D-Dimer ＞ 5,low molecular weight heparin of 0.4 U was injected subcutaneously until D-Dimer ＜ 2.Three patients were loss to follow-up at postoperative month 6 without upper gastrointestinal hemorrhage,hepatic encephalopathy or liver failure.Conclusion Laparoscopic splenectomy combined with pericardial devascularization is safe and effective for portal hypertension,and rigorous perioperative management offers guarantee for surgical safety.

Objective To compare the efficacy of retroperitoneal laparoscopy with open pyeloplasty for ureteropelvic junction obstruction(UPJO).Methods Retroperitoneal laparoscopy was performed under general anesthesia with the patients placed in lateral position.Three trocars were inserted at the midaxillary line above the iliac crest,and the pre- and post-axillary lines beneath the 12th rib.A fourth port was placed at the preaxillary line above the iliac crest.Over the medial margin of the psoas major,Gerota’s fascia was opened to expose the ureter.And then,the tissues around the ureter were cut to show the lower pole of the kidney.Afterwards,the redundant renal pelvis and the strictured segment of the ureter were resected,pelvi-ureteric anastomosis was completed with absorbable sutures,and a double-J stent was inserted.Open pyeloplasty was also carried out under general anesthesia with the patients in lateral position.An incision was made beneath the 12th rib to expose the ureteropelvic junction,and then the renal pelvis was cut at 2 cm away from the renal parenchyma,and the strictured segment of the ureter was resected.Double-J stent was indwelled after pelvi-ureteric anastomosis.The patient was placed in a lateral position under general anesthesia or epidural anesthesia.Subcostal incision was made.The lower pole of the kidney,the dilated renal pelvis and the upper ureter were mobilized in front of the psoas major.Cut the pelvis 2 cm away from the parenchyma and the PUJ was dismembered.The pelvi-ureteric anastomosis was completed with absorbable sutures and then a D-J stent was inserted.Results Compared with the open surgery group,the laparoscopy group experienced significantly longer operation time [(156.9?69.2) min vs(111.9?78.1) min,t=2.514,P=0.014],but less blood loss [mean:35(20-70)ml vs 110(60-175)ml,t=7.502,P=0.000],and shorter analgesic treatment and postoperative hospital stay [(0.7?0.3) d and(8.5?6.1) d vs(1.3?0.5) d and(15.5?10.8) d;t=-5.842,and -3.193;P=0.000 was found and 0.002].No significant difference in the occurrence of postoperative complications and hydronephrosis between the 2 groups was found [laparoscopy vs open surgery:urinary leakage:3 cases vs 3 cases,?2=0.000,P=1.000;incisional infection:0 vs 1,?2=0.000,P=1.000;and recurrence of UPJO:1 vs 0,?2=0.000,P=1.000;hydronephrosis:?2=5.192,P=0.182].Conclusions The efficacy of retroperitoneal laparoscopic pyeloplasty is comparable to open surgery.The procedure results in less blood loss and quicker recovery.

Objective To compare the feasibility and safety of laparoscopic Roux-en-Y choledochojejunostomy versus open Roux-en-Y choledochojejunostomy.Methods From October 2011 to June 2013,37 patients underwent laparoscopic Roux-en-Y choledochojejunostomy (observation group) and 42 underwent open Roux-en-Y choledochojejunostomy (control group).We retrospectively compare the two groups in terms of operation time,intraoperative blood loss,length of incision,postoperative hospital stay,postoperative gastrointestinal function recovery time,incision infection rate and the incidence of biliary fistula after surgery.Results In observation group operation time was (275.43 t 12.28) min,higher than that of control group (189.12 ± 19.35) min (P =0.031),intraoperative blood loss was (83.13 ±6.34) ml,incision length (5.76 ±0.7) cm,postoperative recovery time of gastrointestinal tract of (43.33 ±3.15) h,postoperative hospital stay (12.65 ± 2.19) d,were in favor of the observation group which were respectively (180.37 ±9.67) ml,(18.51 ±1.9) cm,(70.45 ±4.97) h and (22.16 ±4.61) d (t =33.17,36.73,33.17,P ＜ 0.05).Postoperative incision infection rate in observation group was 5.4％,lower than the control group (19.07％) (chi-square =22.12,P ＜ 0.05).Between the two groups there was no significant difference in the incidence of biliary fistula.Conclusions Laparoscopic Roux-en-Y hepatojejunostomy is safe,effective,and less traumatic procedure.

Objective To analyze influencing factors of physicians' turnover intention at public county hospitals from career stage perspective.Methods Physicians career life was divided into three stages according to professional ranks and titles.The sample was drawn using stratified multistage random methods from public county hospitals in Shandong province and 677 questionnaires were completed,giving a 90.3％ valid response rate.Data were analyzed using multi-group stepwise linear regression.Results The percentage of responders with middle and high-level turnover intention was 23.0％and 6.5％ respectively,and there was no statistically significant difference in turnover intention across three stage subgroups.In physicians at stage 1,the most important factors to predict turnover intention were superiors ' appreciation (r =-0.22,P ＜ 0.05) and payment rationality (r =-0.21,P＜0.05),while in physicians at stage 2,the most important predicting factors were autonomy (r=-0.39,P＜0.05)and learning demand(r=-0.22,P＜0.05),and in physicians at stage 3 were career development(r=-0.31,P＜0.05)and autonomy(r=-0.21,P＜0.05).Conclusion Autonomy and workload are common factors of turnover intention with different predicting power across three career stages.Physicians adjust their career needs to self-actualization with development of career stage,so welltargeted incentives should be taken to stabilize the medical staff of public county hospitals.

Objective To investigate the long-term safety and efficacy of the domestic biodegradable drug-eluting cor?onary stents (BuMA) in treating coronary heart disease (CHD). Methods Patients (n=440) who received BUMA stents were designated as observation group while patients (n=460) received Resolutestents were designated as control group. The base?line clinical characteristics, extend of pathological change shown by Coronary Arteriography (CAG),the procedure of percu?taneous coronary intervention were similar between these two groups. The patients were followed up for a mean of 24 ± 4 months;the primary endpoint was the occurrence of definite or probable stent thrombosis;secondary endpoint was major ad?verse cardiac events (MACEs) including complex end such as recurrent angina, acute non-fatal myocardial infarction, death, target vessel revascularization (TVR); other endpoints include all- cause mortality, cardiac death, myocardial infarc?tion (MI), target lesion revascularization (TLR), non-target vessel revascularization and stroke. Some patients were lost dur?ing follow up, which include 5 in observation group and 26 in control group. Results Patients in observation groups were in?serted with 615 stents while patients in control group were implanted with 614 stents, both groups with average of implanting 1.41 stent/case. There are no statistical significance differences in the primary endpoint [1.4%(6/435) vs 1.8%(8/434), χ2=0.087], secondary endpoint [12.3%(54/435) vs 10.8%(47/434),χ2=0.524] and other endpoints between the two groups. Con?clusion These data suggest that domestic biodegradable drug-eluting coronary stents (BuMA) are with good long-term safe?ty and efficacy.

ObjectiveTo study the correlation with Genes Coding forESBLs and ClassⅠIntegron in ESBLs-producing Escherichia coli from children.MethodsPCR was used for gene typing detection of 100 strains of ESBLs-producingEsche-richia colistrains. While detection of class I integrase gene in the 100 strains ESBLs-producingEscherichia coli and 100 strains of non-ESBLs producingEscherichia coli were separately performed by PCR. It provides the solid base not only to reveal the relationship between class I integron and drug resistance, but also the relationship between class I integron and ESBLs-producing. ResultsThe most frequently genotyping from ESBLs-producingEscherichia coli in children isCTX-M (84%), followed by TEM-1(63%). The predominant distribution of genotype in ESBL- producing strains isTEM-1 +CTX-M (45%), followed by CTX-M (34%). Class I integrase gene detected in ESBLs- producing and non- ESBLs producing strain were 100 cases (100%) and 25 cases (25%) separately, the difference was statistically signiifcant (P<0.05); drug resistance in class I integron positive strains were signiifcantly higher than in class I integron negative strains, especially in Ciprolfoxacin, Levolfoxacin, and Amino-glycoside (86.4%, 88%, and 80%).ConclusionsThe distribution of Class I integron in ESBLs-producingEscherichia coli is signiifcantly higher than that in non-ESBLs-producing strains, It is rational that Class I integron highly correlate with strong drug resistance in ESBLs-producing strains.

Objective To discuss the clinical features diagnosis and treatment of cerebral schistosomiasis. Methods A to?tal of 166 patients with cerebral schistosomiasis were treated and their clinical data were collected and analyzed retrospectively. Results In 166 cases of cerebral schistosomiasis the confirmative diagnoses of 156 cases were diagnosed according to the clin?ical manifestation etiology immunology and auxiliary examination CT MRI .In among 74 cases were confirmed by pathologi?cal examination 10 cases were diagnosed through to the diagnostic treatment. Totally 102 patients received the oral medication of praziquantel and they all improved and discharged 14?16 days later 64 patients received the craniotomy and praziquantel medication after the operation and 48 patients significantly improved others did not improve or aggravated. There was no opera?tive mortality. Conclusions Neuroimaging and laboratory tests are valuable in the diagnosis of cerebral schistosomiasis. The praziquantel treatment is selected firstly when the diagnosis was established. However in the case of serious intracranial hyper?tension intractable epilepsy and praziquantel treatment fails the surgical treatment is required.