Objective To investigate the effect total hip arthroplasty and hemiarthroplasty in treatment of displaced femoral neck fractures in elderly .Methods 83 cases of elderly patients with displaced femoral neck fractures were divided into two groups according the order randomly.The control group(n=53) was given hemiarthroplasty while the observation group ( n=30) took total hip arthroplasty .The clinical efficacy and occurrence of complications after surgery were compared.Results The observation group excellent rate was 90.00%(27/30), significantly higher than the 79.25%(42/53) (χ2 =11.23,P<0.05);The observation group′s operative time,blood loss and postoperative drainage were (145.33 ±6.21)min,(575.65 ±26.84)mL and (278.51 ±14.15)mL,which was more than the control group(80.12 ±5.36)min,(322.52 ±25.34)mL and (185.46 ±12.48)mL significantly(t=9.56, 8.83,10.03,all P<0.05);The observation group′s incidence of complications was 10.00%(3/30),which was sig-nificantly lower than the control group′s 22.64%(12/53) (χ2 =12.16,P <0.05).Conclusion The total hip arthroplasty has a significant effect in the treatment of femoral neck fractures in elderly ,patients have good recovery of joint function with a low incidence of complications which can be used as the preferred solution for clinical treatment .

Objective To detect the serum levels of carbohydrate antigen 199(CA199),carbohydrate antigen 125 (CA125)and carcino-embryonic antigen(CEA)in different population,and to explore their significances in diagnosis of pancreatic cancer.Methods The serum levels of CA199,CA125 and CEA in 56 patients with pancreatic cancer (pancreatic cancer group ), 5 6 patients with benign pancreatic disease (benign pancreatic disease group ) and 56 healthy volunteers(normal control group)were detected,then the positive rates of CA199,CA125 and CEA and the sensitivities and specificities of CA199,CEA and CA125 for the diagnosis of pancreatic cancer were compared among three groups.Results The levels of serum CA199,CA125 and CEA of the patients in pancreatic cancer group were significantly higher than those in benign pancreatic disease group and normal control group (P<0.05). The positive rates of CA199,CEA and CA125 in pancreatic cancer group were 87.50 %,71.42%,and 60.71%, respectively. The positive rates of the three tumor markers of the patients in pancreatic cancer group were obviously higher than those in other two groups (P<0.05).The sensitivity of CA199(87.50%)was the highest,while the specificity of CEA (9 1.9 6%)was the highest. The method of parallel combined testing increased the diagnostic sensitivity to 95.12% and negative predictive value to 90.47%,but its specificity and the positive predictive value were decreased. Serial combined examination increased the diagnostic specificity to 92.86% and the positive predictive value to 89.19%,but its sensitivity and negative predictive value were decreased.Conclusion Combined detection of serum levels of CA199,CA125 and CEA has higher sensitivity and specificity than single-marker detection in the diagnosis of pancreatic cancer.

In the past decades, epidemiological trends of the gastric cancer and esophagogastric junction (EGJ) cancer have changed all over the world. The morbidity and mortality of gastric cancer is on the decline, while the incidence and mortality of EGJ cancer is on the rise. This article summarizes the pathological types and the descriptive epidemiology, including the incidence, mortality, survival rate and its tendency in different gastric cancers and EGJ cancer. It also discusses the influencing factors of gastric cancer and EGJ cancer including environmental and genetic factors, which provides new ideas for the further study of the two kinds of cancers.

ObjectiveTo study the safety and effectiveness of acute hypervolemic hemodilution (AHH) combined with tranexamic acid(TA) in neurosurgical operation. Methods Forty patients underwent selective neurosurgical operation were divided into two groups by radom digits table with 20 cases each, both groups were infused HES(130/0.4) 20 ml/kg for AHH after anesthesia, TA intravenous injection of loading 10 mg/kg, 1 mg/(kg·h) continuous infusion until the end of surgery in experimental group,only for AHH in control group. The mean arterial blood pressure(MAP), central venous pressure(CVP), heart rate (HR), pulse oxygen saturation (SpO2) were measured before AHH (T0), A HH immediately (T1), 1 h after AHH (T2), at the end of operation (T3), and in the corresponding time hemoglobin (Hb), hematocrit (Hct),prothrombin time (PT), activated partial thromboplastin time (APTT), platelet ( Plt ), fibrinogen ( FIB ) were measured; the intraoperative bleeding, blood transfusion and transfusion rate were counted in both groups.ResultsThere was no significant difference in HR and MAP at different time between two groups (P ＞0.05),compaued with T0,CVP at T1,T2 was increased (P＜0.05),Hb and Hct at T1,T2,T3 were decreased (P＜ 0.05 ). PT and APTT at T2,T3 were longer than that at T0 in control group (P＜ 0.05 ) ;Plt at T1 ,T2,T3 was lower in control group than that at T0 in two groups (P ＜ 0.05 ), Plt at T2, T3 was obviously increased in control group compared with experimental group (P ＜ 0.01 ) ; FIB at T2, T3 was lower than that at T0 in control group (P ＜0.05). The intraoperative bleeding, blood transfusion and transfusion rate in experimental group [(650 ±560) nl, (150 ± 50)ml,30％(6/20)]were lower than those in control group [(820 ±410) ml,(380 ±290) ml,60％ (12/20)],there were significant differences between two groups(P ＜0.05).ConclusionAHH combined with TA has obvious effect of saving blood and hemodynamic stability with less influence on coagulation in neurosurgical operation.

Objective To study the level of cyclooxygenase-2 (COX-2) and platelet-activating factor acetyl-hydrolase(PAF-AH) and high sensitive C reactive protein(hsCRP) on peripheral blood mononuclear cells in Acute Coronary Syndrome(ACS) patients and the effect of atorvastatin on them and the clinical significance. Methods To measure and compare the content of COX-2,PAF-AH and hsCRP in normal control group and ACS group(before and after treatment). Result The content of COX-2,PAF-AH and hsCRP are significantly different between normal con-trol group and ACS group (before treatment) (P < 0.05), and between ACS group (before treatment) and ACS group (after treatment) too(P < 0.05). Conclusions The inflammatory cytokines COX-2,PAF-AH and haCRP have sig-nificant correlation with the occurance of ACS. Atorvastatin can decrease COX-2 and hsCRP level, and can increase PAF-AH level. So atorvastatin takes an important role in lessening inflamatory reaction level in ACS patients.

Objective To investigate the clinical manifestation of convulsive status epilepticus (CSE) associated with the outcome of children contracted this illness in order to make an effort to prevent and treat those children. Method The patients with CSE admitted from October 1998 to October 2008 were prospectively and consecutively enrolled. All the patients met the diagnostic criteria set by International Anti-epilepsy Union (ILAE) in 1993. The prognosis predictors of outcome were analyzed with the Rank sum test, Chi-square analysis and Logistic regression analysis. Results A total of 169 patients with CSE were enrolled. Of them, 92 patients were from rural areas (54.4% ). The primary cause was central nervous system infection, and the minor ones were a reduction of dose or withdrawal of the antiepileptics, and cerebral hemorrhage. The duration of CSE before treatment was longer in rural patients than in urban residents ( P < 0.01) . The duration of CSE before treatment and the total persistence time of CSE was significantly associated with the mortality 14.2% . The source of patients, the duration before treatment, and respiratory depression were independent prognostic predictor variables of CSE (P < 0.05) .Conclusions The rural patients account for the major ratio of convulsive status epilepticus. Central nervous system infection is the primary cause. The duration before treatment and total persistence time of CSE are highly related to the mortality and morbidity.

To detect the expression of p16 protein and Ki-67 antigen in gastric mucosa-associated lymphoid tissue lymphoma(MALTL)and normal gastric mucosa and to investigate the clinical significance of their expression in the occurrence and development of gastric MALTL.Methods 47 samples of gastric MALTL diagnosed pathologically in the department of pathology of the PLA General Hospital from March 1993 to June 2005 were collected.By using immunohistochemial methods,the expression of p16 protein and Ki-67 antigen was detected in 20 samples of normal gastric tissue and the 47 samples of gastric MALTL.Results The positive rate of p16 protein Was 21.3%(10/47)and 90.0% in gastric MALTL and normal gastric tissue respectively.The positive rate of p16 protein in gastric MALTL was lower than that in normal gastric tissue(P<0.05).The expression of p16 was related to the degree of lymph node metastasis.The positive rate of Ki-67 labelling index(LI)in gnstric MALTL was hiigher than that in normal gastric tissue.A negative correlation was found between the expression of p16 protein and Ki-67 LI(P<0.05). Conclusions Detection p16 and Ki-67 may help to predict the possibility of lymph node metastasis and prognosis in gastric MALTL.

Cestode Infections ; parasitology ; Humans ; Infant ; Male

Objective To evaluate the anesthetic efficacy of propofol used to supplement spinal anesthesia for sedation in the pediatric patients undergoing lower abdominal or lower extremity operations.Methods One hundred twenty pediatric patients of both sexes, aged 2-5 yr, weighing 11-21 kg, of ASA physical status Ⅰ or Ⅱ , scheduled for elective lower abdominal or lower extremity operations were randomly divided into 3 groups (n =40 each) using a random number table: general anesthesia group (group G), propofol used to supplement caudal block for sedation group (group PS+CB) , and propofol used to supplement spinal anesthesia for sedation group (group PS+SA).In group G, after induction of anesthesia, laryngeal mask airway was inserted, the patients were then mechanically ventilated, and anesthesia was maintained with iv infusion of propofol (5-7 mg· kg-1 · h-1), remifentanil (20-25 μg· kg-1 · h 1) and cisatracurium besylate (0.1 mg· kg-1 · h 1).In group PS+CB, caudal block was performed with the mixture 0.8 ml/kg of 1％ lidocaine and 0.25％ bupivacaine.In group PS+SA, spinal anesthesia was performed with isobaric bupivacaine 1.0 mg/age.Propofol was then infused at 3-5 mg · kg-1 · h-1 for sedation in PS+CB and PS+SA groups.Before anesthesia (baseline, T0) and at 1, 5 and 10 min after emergence from anesthesia (T1-3) , heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded.The emergence time, time for recovery of orientation, and duration of stay in postanesthesia care unit were recorded.Pain was assessed and scored, and agitation was graded at 5 min after emergence from anesthesia, and the occurrence of intraoperative traction reaction, body movement and nausea and vomiting within 24 h after operation was recorded.Results No intraoperative traction reaction and body movement was found in group PS+SA, and no patients stayed in postanesthesia care unit in PS+CB and PS+SA groups.HR and MAP were significantly higher at T1-3 than at T0 in group G (P＜0.05).Compare with group G, the HR, MAP at T1-3, pain scores, agitation scores, incidence of nausea and vomiting were significantly decreased, and the emergence time and time for recovery of orientation were shortened in groups PS+CB and PS+SA (P＜0.05).Conclusion Propofol used to supplement spinal anesthesia for sedation is effective and provides faster recovery from anesthesia with fewer complications in the pediatric patients undergoing lower abdominal or lower extremity operations.

Objective:To promote the rational drug use in the patients treated with ambulatory chemotherapy. Methods:A model of integrated pharmaceutical care was established using such service as the real-time prescription examination, configuration standardi-zation, active care and prescription review. Results:The integrated pharmaceutical care could effectively reduce the unreasonable drug use, optimize drug use structure, lower the medical expenses and provide supporting data for clinical decision-making. Conclusion:The development of integrated pharmaceutical care in the patients treated with ambulatory chemotherapy is an important field for phar-macists displaying professional skills, which can promote the rational drug use. The treatment efficacy and life quality of cancer patients can be improved with the cooperation of doctors, nurses and pharmacists.