Objective To investigate the significance of early blood lactic acid and lactic acid clearance in patients with post-cardiac arrest syndrome(PCAS).Methods 87 cases were divided into the survival group(26 cases) and the death group(61 cases).The clinical data of two groups were analyzed statistically.Results The 6h blood lactate (8.46 ± 2.37) mmoL/L,6h blood lactate clearance rate (34.53 ± 14.75) ％,the residual alkali (-3.08 ± 3.68) mmol/L,6h SevO2 (68.35 ± 6.33) ％,APACHE Ⅲ score (19.64 ± 2.48) points in the survival group were significantly better than those of the death group [blood lactic acid value (12.32 ± 3.56) mmol/L,6h blood lactate clearance rate (27.71 ± 11.38) ％,the residual alkali (-5.61 ± 4.14) mmol/L,6h SevO2 (63.22 ± 5.94) ％,APACHE Ⅲ score (24.32 ± 5.33) points],with significant differences between two groups (t =5.99,2.36,2.73,3.66,5.62,all P ＜ 0.05).The 6h blood lactate clearance rate,6h SevO2 and APACHE Ⅲ score were independent risk factors for the prognosis of PCAS (OR =1.23,1.64,1.28,all P ＜ 0.05).Conclusion The early blood lactate clearance rate can be used as a sensitive indicator for evaluating the prognosis of PCAS.

Objective: To evaluate therapeutic effect of aortic endovascular stent-graft exclusion (EVGE) combined percutaneous coronary intervention (PCI) on patients with descending thoracic aortic dissection (DTAD) complicated coronary heart disease (CHD).Methods: A total of 58 DTAD + CHD patients undergoing aortic EVGE combined PCI were regarded as EVGE group (received aortic EVGE at first, then PCI on 3d after operation).Another 60 DTAD+CHD patients undergoing open surgery combined PCI in our hospital were selected as open surgery group.Both groups were observed and followed up, and their therapeutic effects were compared.Results: Compared with open surgery group, there was significant rise in complete cut closure rate (78.33% vs.91.38%), and significant reductions in bleeding volume during operation [(919.83±242.12) ml vs.(58.17±9.53) ml], postoperative infection rate (15.0% vs.3.4%) and hospital stay [(16.40±0.96)d vs.(9.10±0.83)d] in EVGE group, P<0.05 or <0.01.Success rate of PCI was 100% in EVGE group, and there was no PCI-related severe complications.During follow-up, coronary restenosis rate within 12 months in EVGE group was significantly lower than that of open surgery group (5.20% vs.15.30%, P=0.04).Conclusion:It is safe and possesses significant effective to treat descending thoracic aortic dissection complicated coronary heart disease using aortic endovascular stent-graft exclusion combined percutaneous coronary intervention, which is worth extending.

BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.

Radiotherapy and interventional thearapy are the main means for unresectable advanced primary hepatic carcinoma.However,the efficacies are restricted by their respective adaptability.The development of radiotherapy,especially the application of radiotherapy combined with transcatheter hepatic artery chemoembolization provide more suitable treatment means for patients.

OBJECTIVETo explore the effect of lappaconitine on patient-controlled intravenous analgesia (PCIA) and serum complement 3 and 4 (C3 and C4) levels of cancer patients undergoing rectum surgery.

METHODSTotally 60 patients, who were scheduled for rectum carcinoma surgery, were recruited to the study and assigned in 3 groups, the blank control group, the tramadol group, and the lappaconitine group, 20 in each group. Lappaconitine (8 mg) was intravenously dripped to patients in the lappaconitine group 30 min before ending the operation. PCIA started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Patients of the tramadol group were treated with tramadol (100 mg) intravenously within 30 min before ending the operation. The dripping was completed within 30 min. PCIA was started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Tramadol (100 mg) was intravenously dripped to patients in the tramadol group 30 min before ending the operation. PICA was started as soon as the end of the surgery and the total dose of tramadol was 900 mg. Pethidine (50 mg) and droperidol (2. 5 mg) was intramuscularly injected to patients in the blank control group for pain relief according to their complaints. Pain degrees were assessed by visual analog scale (VAS) 12 h before surgery, 12, 24, 48, and 72 h after surgery. Blood samples were withdrawn at the same time point. Contents of serum C3 and C4 were determined by immunoturbidimetry.

RESULTSVAS scores of the blank control group were significantly higher after surgery than before surgery (P <0. 01). There was no statistical difference in VAS scores between before surgery and after surgery in the tramadol group and the lappaconitine group (P >0. 05). VAS scores were significantly lower at each post-surgery time point in the tramadol group and the lappaconitine group than in the blank control group with statistical difference (P < 0.01). There was no statistical difference in VAS scores at each post-surgery time point between the tramadol group and the lappaconitine group (P >0. 05). Compared with before surgery, contents of serum C3 and C4 significantly decreased in all of the three groups at 12, 24, and 48 h after surgery (P < 0.05, P < 0.01). They recovered to the pre-surgery level till 72 h after surgery (P > 0.05). Serum C3 and C4 contents at 48 h after surgery were higher in the tramadol group than in the blank control group (P < 0.05). Serum C3 and C4 contents at 24 and 48 h after surgery were higher in the lappaconitine group than in the blank control group (P < 0.05). There was no statistical difference in serum C3 and C4 contents at each time point between the tramadol group and the lappaconitine group (P > 0.05). VAS scores were obviously negatively correlated with serum contents of C3 and C4 (r = -0.622, r = -0.649, P < 0.01).

CONCLUSIONSLappaconitine (used at the dose in this study) showed better pain relief effect after surgery. Besides, it could inhibit the surgic wound and pain, and elevate serum contents of C3 and C4.

Aconitine ; analogs & derivatives ; therapeutic use ; Analgesia, Patient-Controlled ; methods ; Analgesics, Non-Narcotic ; therapeutic use ; Complement C3 ; metabolism ; Digestive System Surgical Procedures ; Humans ; Neoplasms ; Orthopedic Procedures ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Rectum ; surgery ; Tramadol

Objective To study the clinical effects of delayed surgery for Maisonneuve fractures.Methods Between January 2006 to June 2011,we treated 21 patients with Maisonneuve fracture by delayed surgery.They were 18 men and 3 women,aged from 17 to 63 years (average,36.8 years).Rupture of inferior tibiofibular ligaments was complicated in all,lateral malleolus fracture in 17 cases,medial malleolus fracture in 14 cases,rupture of deltoid ligament in 7 cases,and posterior malleolus fracture in 15 cases.None of them got timely surgery due to complicated injuries,poor skin condition or missed diagnosis.Six patients had surgery after 2 weeks,11 after 3 weeks and 4 after 4 weeks.The interval from injury to surgery ranged from 14 to 32 days,averaging 21.3 days.Fractures of lateral,medial and posterior malleolus were treated with open reduction and internal fixation.Ruptures of deltoid ligament and anterior ligament of inferior tibiofibula were repaired and reconstructed.Functional recovery of the ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.Results The patients were followed up for 10 to 18 months (average,12.3 months).All the fractures healed after an average time of 12.4 weeks (from 10 to 22 weeks).No infection or implant failure was observed in this group.The affected ankle restored inflexion basically to the range of the contralateral 6 months post-surgery,but was limited in the ranges of varus and valgus.Pain was extensively experienced.At the last follow-up,10 patients (47.6％) showed obvious disparity between the 2 sides,and 5 ones had lateral displacement of the talus and widened ankle mortise.AOFAS results were excellent in 5 cases,good in 9,fair in 4 and poor in 3,yielding a good to excellent rate of 66.7％.Conclusion Because delayed surgery increases the difficulties in surgery and functional recovery,early diagnosis and early surgery are crucial for treatment of Maisonneuve fractures to achieve satisfactory outcomes.

Portal vein tumor thrombus (PVTT) influence the prognosis of hepatocellular carcinoma.The development of PVTT is a multi-factor,multi-part process.According to anatomic features of the portal vein in the liver and tumor thrombus of HCC developing modes,a uniform tumor thrombus types system (typesⅠ -Ⅳ) is recommended.Multi-modal therapy based on surgery,interventional therapy and radiotherapy can improve the curative effect enormously.

Shortages in the fostering of medical humanistic spirits for students majoring medical science of law in medical colleges and universities were discussed from the perspectives of concept establishment,curriculum,clinical teaching and teaching staff.The fostering of medical humanistic spirits for students should be enhanced to achieve the balance between medical humanity and legal professionalism.

Objective To analyse the treatment,clinical features and prognosis of chronic lymphocytic thyroiditis combined with thyroid cancer.Methods Retrospectively analysed 40 cases with chronic lymphocytic thyroiditis combined with thyroid cancer,admitted to the Department of General Surgery of the First Affiliated Hospital of Dalian Medical University from November 2002 to April 2011.All the 40 patients were female.Results Ultrasound diagnosis or suspected diagnosis of chronic lymphocytic thyroiditis was made in 2 patients.Eleven patients underwent CT examination,and 2 patients were found with thyroid adenoma,1 patient found with thyroid cancer and lymph node metastasis,3 patients with chronic lymphocytic thyroiditis.Forty patients underwent surgical treatment,pathological results of 39 patients showed chronic lymphocytic thyroiditis with thyroid papillary carcinoma,1 patient was medullary thyroid carcinoma combined with chronic lymphocytic thyroiditis.Forty patients were administrated levothyroxine tablets.Thirty-six patients were followed up,4 patients were lost,1 relapsed,the others were in stable condition.Conclusions Preoperative diagnosis is difficult for chronic lymphocytic thyoiditis combined with thyroid cancer,which needs through the thyroid antibody tests,imaging examinations and intraoperative,postoperative pathologic examination and other means of comprehensive application.The method of definitive diagnosis for CLT combined with TC is intraoperative,postoperative pathologic diagnosis.The main pathological type is papillary thyroid carcinoma,which small papillary carcinoma occupies a large proportion.Surgery is the main treatment for CLT combined with TC.

Objective To explore clinical effect of self-made traditional Chinese medicine for hand-foot-mouth disease.Methods 118 cases with hand-foot-mouth disease were randomly divided into two groups.The control group(n=59)were treated by regular western medicines.On that basis,the study group(n=59)were treated bys elf-made traditional Chinese medicine.And the curative effects of two groups were observed.Results Fever subsidise time of the study group after treatment was(2.0±0.7)d,which was significantly shorter than that of the control group,with P＜0.05.Rash subsidise time of the study group after treatment was(3.9±0.9)d,was significantly shorter than that of the control group,with P＜0.05.Length of hospital stay of the study group after treatment was(3.5±1.3)d,was significantly shorter than that of the control group,with P＜0.05.Total effective rate of the study group after treatment was 94.9％,which was significantly higher than that of the control group(81.4％),with P＜0.05.Conclusion Self-made traditional Chinese medicine for hand-foot-mouth disease has good clinical curative effect,has high security and reliability.