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.

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 investigate the current status and the related influencing factors of humanistic care quality of nurses in department of aged homes in Guangzhou,for the future to carry out humanistic care education,and provide a reference for improving humanistic care quality of nurses.Methods 270 nurses from 8 department of aged homes in Guangzhou were investigated by convenience sampling and evaluation table on humanistic care quality of nurses.The affected factors were analyzed by multiple stepwise regression.Results The aggregate score of humanistic care quality of nurses in this study was (113.59±9.78),which was lower than the reference score (118.36±16.75) of humanistic care quality of nurses of some general hospitals in Shanghai in 2010,offered by Liu Yuxiao,the designer of the evaluation table.The scores were correlated with 4 impact factors including home,politics status,care index of colleagues,whether to accept the education and training of humanistic care;multiple stepwise regression analysis indicated that care index of colleagues and whether to accept the education and training of humanistic care were the main factors.Conclusions Humanistic care quality of nurses in department of aged homes in Guangzhou was in lower level,and especially caring ability and the attitude towards caring.Department of aged homes should cooperate with universities,to establish a set of training courses on humanistic care quality of nurses in department of aged homes.Through the systematic,standardized training,to improve humanistic care quality of nurses and the quality of nursing service.

ObjectiveTo evaluate clinical significance of serum free light chains (sFLC) in diagnosis and response to the therapies of patients with multiple myeloma (MM).MethodssFLC (κ,λ and κ / λ ratio)were examed by immumoassay from 62 patients with MM at different stage. The results were analyzed associated with clinical data,and 35 cases of chronic renal failure(CRF)patients and 62 cases of healthy donors were taken as controls.ResultsMedium sFLC of normal κ value was (13.25±6.46) mg/L,λ value was (18.39±11.42) mg/L; and κ / λ ratio was (0.97±0.64) mg/L (range 0.33-1.61).sFLC κ and λ of CRF patients were (200.01±299.87) mg/L,(191.02±245.98) mg/L,significantly higher than that of the normal control group (t =-17.804,-16.894,both P ＜ 0.001),but the κ/λ ratio was at normal range (1.11±0.29).κ value range was at 16.20- 35 250 mg/L in newly diagnosed intact immunoglobulin MM patients with IgGκ,IgAκ and IgDκ type.The range of λ values was 15.70-4885 mg/L in IgGλ,IgAλ,IgDλ type,and κ/λ ratio was abnormal in 96.5 ％ (55/57) patients (＜0.5 or ＞1.5).The κ,λ value and κ/λ ratio were close to that of the normal after remmision.ConclusionsFLC ( κ,λ,and κ / λ ratio) are very good monitoring markers for MM.

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.

Objective To evaluate the safety and efficacy of the newly combined anterior platerod system in treatment of acute thoracolumbar burst fracture combined with neurologic deficit.Methods A retrospective study was carried out on 84 consecutive patients with acute thoracolumbar burst fracture combined with neurologic deficits treated by anterior surgery,bone fusion,and internal fixation with the new plate-rod system.There were 61 males and 23 females with a mean age of 31.4 years (range,19-53 years).Primary pathogenesis was high falls in 67 patients,traffic accidents in 13 patients and others in 4 patients.Fractured segments included T11 in 19 patients,T12 in 22,L1 in 25,and L2 in 18.Visual analogue scale (VAS),spinal canal encroachment,and loss of kyphosis correction were measured for all patients to evaluate radiologic and neurological outcomes.Results Bony union occurred in all patients at the 3-5 months of follow-up.There was no pseudarthrosis or vascular complications related to the fixation device.Percentage of canal encroachment decreased from preoperative 70％ to postoperative 2％.Mean segmental kyphotic angle measured 27.9 ° before operation and 7.4 ° after operation,with a mean correction of 20.5°.All patients demonstrated at least one grade of neurological improvement at final follow-up.Mean VAS was improved significantly from preoperative 7.3 points to postoperative 2.9 points.Conclusion The new anterior plate-rod system is safe and effective in treatment of acute thoracolumbar burst fracture combined with neurologic deficit.

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.

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.