Objective To improve the diagnostic accurate rate by studying best values of chest posterior-anterior digital medical images in soft-copy reading. Methods 100 normal adults’ chest posterior-anterior digital medical images in recent 10 days in our hospital were randomly chosen. Five specialists of our department were invited to see these images by soft-copy reading and the best WW/WL values of different parts of the chest they selected were recorded. All the data were analyzed in statistics and the best WW/WL was got. Results The best WW/WL values of soft tissues of chest wall were 2 083/4 840,ribs 2 667/4 908,lung fiber 2 067/4 960,hilum of lung 1 848/5 130,heart and large vessels 2 206/5 438,mediastinum and diaphragm 2 180/5 530,thoracic vertebrae 1 471/5 801,ribs that covered by heart and diaphragm1 428/5 975. Conclusion Different parts in chest poster -anterior digital medical images need special WW/WL in soft-copy reading for better diagnosis of images.

Objective To investigate the therapeutic effect of artificial tiger bone powder on osteoporosis.Methods The postmenopausal women with osteoporosis were randomly divided into treatment group and control group,31 cases in each group.The treatment group orally received artificial tiger bone powder,the control group orally received Caltrate D.At the beginning and 3,6 months after treatment,European health index (EQ-5D),Barthel index (BI) and Faces Pain Scale-Revised (FPS-R) were used to evaluate the curative effect.Results There were no significant differences in EQ-5D,BI and FPS-R between the two groups at the beginning of treatment.At 3,6 months after treatment,EQ-5D of the two groups were (0.83 ± 0.09) points vs.(0.77 ± 0.08) points,(0.89 ± 0.07) points vs.(0.84 ± 0.08) points;BI were (74.61 ± 8.39) points vs.(70.07 ± 8.51) points,(77.24 ± 7.15) points vs.(73.31 ±7.41) points;FPS-R were (3.14 ± 1.06) points vs.(3.79 ± 1.12) points,(2.31 ± 0.92) points vs.(2.98 ±0.87) points,which in the treatment group were better than those in the control group (t =2.774,2.619,2.115,2.125,2.347,2.946,all P ＜ 0.05).Conclusion Artificial tiger bone powder can relieve pain in postmenopausal osteoporosis patients,improve the patients' ability and improve their quality of life.And artificial tiger bone powder can effectively treat postmenopausal osteoporosis.

Objective To observe the clinical efficacy of treating congestive heart failure with the combination of Astragalus,Danhong and Nitroglycerin injection.Methods 73 cases with congestive heart failure were selected.randomly recruited into a control group and a treatment group.The control group was treated with conventional therapy,and the treatment group was treated with Astragalus injection,Danhong and nitroglycerin injection on the basis of conventional mompy.Both groups were treated for one course of therapy of 21 days.Such indexes as clinical signs and symptoms,cardiac function,the amount of output per bo(SV),each sub-output(CO),cardiac index(CI),left ventricular ejection fraction(EF),and blood the rheology were observed before and after the treatment.Reselts The total effective ratewas 97.29%and 88.89%in the treatment group and the control group respectively,showing statistically differences between the two groups(P＜0.05):SV CO,CI and EF showed significant difference in both groups after the treatment(P＜0.01 or P＜0.05),and significant difference between the two groups(P＜0.05).Blood theology wag decreased after the treatment,and such clecreasing in the treatment was greater than that in the control group(P＜0.01).Conclusion The combination therapy of astragalus,Danhong injection and nitroglycerin injection is effective in treating congestive heart failure.

Sixty-two elderly patients with distal radius fractures after fixation with small splints were enrolled in the study from January to December 2014.Patients were randomly divided into intervention and control groups with 31 cases in each group.Patients in both groups received comprehensive prevention for hand swelling, those in intervention group were given additional external administration of sodium aescinate gel (SAG), 1 g, t.i.d for 7 d.Swelling score and visual analogue scale (VAS) were documented before and 3, 7 d after intervention.At the time of fracture healing, the wrist functions, including motions of flexion-extension, motions of radial-ulnar and motions of pronation-supination were examined.At 3 and 7 d after intervention, the swelling score(1.22 ±0.69 vs.1.65 ±0.75 and 0.64 ±0.42 vs.0.96 ±0.71) and VAS(1.96 ±1.27 vs.2.85 ±1.40 and 1.11 ±0.65 vs.1.86 ±1.09)of intervention group were lower than those of control group (all P<0.05).At the time of fracture healing, the wrist motions of flexion-extension [(83.7 ±8.6) vs.(77.6 ±7.1)%], motions of radial-ulnar [(83.0 ±7.6) vs.(78.2 ±8.7)%] and motions of pronation-supination [(81.0 ±7.0) vs.(76.2 ±7.5)%] of intervention group were higher than those of control group ( P <0.05 ) .The results indicate that SAG can reduce swelling, relief pain and promote the recovery of wrist function in elderly patients with distal radius fractures.

The conduction of performance appraisal in the hospital is of great significance to the perfection of the appraisal system and the improvement of the managerial efficiency of the hospital. The authors suggest that in the process of establishing an appraisal system of hospital performance, it is necessary to use for reference enterprises' experience in performance appraisal and the theories of performance management. Firstly, single-faceted pursuit of economic benefits should be avoided, the establishment of an external hospital appraisal system and the establishment of an internal hospital appraisal system should be combined, and attention should be paid to the overall application of performance appraisal in performance management. Secondly, in light of their own experience in hospital management, the authors put forward the suggestion of establishing a performance appraisal system of three levels: the hospital , the department and the post. They also argue that attention should be given to the selection of comprehensive appraisal methods, continuous communication about performance, and readjustment in a timely manner.

Objective To investigate the clinical effects of the sural nerve and saphenous nerve nutrient vascular island flaps in repairing pediatric ankle or foot soft tissue defect.Methods From June 2009 to January 2013,19 cases of heel soft tissue defect were collected in hospitalized children,in which 10 cases of ankle or foot soft tissue defects were repaired with reversed sural nerve nutrient vascular island flaps and 9 cases with ankle or foot soft tissue defects with reversed saphenous nerve nutrient vascular island flaps.The skin defect areas were from 3 cm× 5 cm～5 cm× 13 cm.Results All neurocutaneous vascular flaps survived after transplantation,the wound of donor area and recipient area healed,and texture and color of flap were good.The postoperative follow-up for 3-30 months (an average 14 months) showed no secondary infection,sensory recovery for S3-S4,texture and color were similar to normal skin,and the limb shape and function were satisfactory.Conclusions The sural nerve and saphenous nerve nutrient vascular island flaps are reliable of blood supply,which do not damage the main vessel,and could reconstruct feeling.Such flaps are ideal to repair foot or ankle soft tissue defects.

Objective To investigate the effect of early airway bundle intervention on prevention ventilator-associated pneumonia(VAP) in ICU patients.Methods One hundred and twenty-eight patients with invasive mechanical ventilation in ICU were randomly divided into the control group (64 cases) and observation group(64 cases).Patients in the control group were given conventional airway intervention,and in the observation group were given airway bundle intervention within 4 h including dumping of condensed water in tubing of breathing machine in time,keeping pressure of artificial airbags from 20 to 30 cm H2 O,chest physical therapy 2 h/time,continuous aspiration of subglottic secretion,using moisture exchanger in breathing machine,and mouth rinse by chlorhexidlne 4 h/time.Incidence of VAP,duration of mechanical ventilation,duration of stay in the ICU and mortality within 28-day were recorded.Clinical Pulmonary Infection Score (CPIS) and APACHE Ⅱ at 0,3rd,5th,7th,14th day were recorded respectively.Results The incidence of VAP,duration of mechanical ventilationand duration of stay in the ICU in observation group were 18.75％,(6.26 ± 2.89) d,(11.88 ± 3.97) d respectively,lower than those in control group (35.94％,(10.54 ± 4.36) d,(16.55 ±5.22) d)),and the differences were significant (x2=4.758,t =6.546,t =6.546,P＜0.05 orP＜0.01).At 3rd,5th,7th,14th day after diagnosed VAP,CPIS of patients with confirmed VAP in observation group were 7.01 ±2.24,5.67 ±2.14,4.36 ± 1.44,2.75 ± 1.37 respectively,lower than those in control group(8.74 ± 2.33,7.51 ± 2.27,6.95 ± 2.98,6.53 ± 2.88,and the differences were significant (Finter group =27.22,P ＜ 0.001 ; Fbetween group =29.41,P ＜ 0.001 ; Finteraction =4.35.P ＜ 0.01).APACHE Ⅱ were 17.02 ± 7.06,15.01 ± 6.06,12.40 ± 4.17,8.40 ± 2.57 respectively,significant lower than those in control group ((22.48 ±7.31,19.67 ± 7.14,16.13 ± 5.33,13.10 ± 4.93),and the differences were significant (Finter group =47.43,P ＜ 0.001 ; Fbetween group =45.36,P ＜ 0.001 ; Finteraction =4.25,P ＜ 0.01).Conclusion Early using airway bundle interventions on ICU patients can reduce the incidence of VAP,improve the condition and prognosis.

Objective To analyze the occupational characteristics in patients with avascular necrosis of femoral head and related factors.Methods A random sample of 1062 patients with avascular necrosis of femoral head of inpatient medical record data from 2007 to 2008 was selected, all patients were confirmed by X-ray, CT, MRI or radionuclide bone scan.Patients were assigned to three groups of agriculture (320 cases), non-agricultural (424 cases), the other(318 cases) groups by different occupation.The patient's age, gender, ethnicity, single or bilateral, etiology, staging, time of onset and region were compared in each group.Results The proportions of gender (male/female) were 21.94％ (233/1062) and 8.19％ (87/1062) in agriculture group,32.77％ (348/1062) and 7.16％ (76/1062) , 21.66％ (230/1062) and 8.29％ (88/1062) in non-agricultural and the other groups respectively.The proportions of region (Northeast, North, East, South, Southwest, Northwest of China) were 3.30％ (35/1062), 8.00％ (85/1062), 8.10％ (86/1062), 4.80％ (51/1062), 3.11％(33/1062) ,2.82％ (30/1062) in agriculture group, 8.29％ (88/1062), 10.08％ (107/1062), 7.72％ (82/1062), 7.25％ (77/1062), 2.26％ (24/1062), 4.33％ (46/1062), and 4.05％ (43/1062), 8.38％ (89/1062) ,8.10％(86/1062) ,4.61％(49/1062) ,2.17％(23/1062) ,2.64％(28/1062) in the group of non-agricultural and the other.The proportions of etiology (alcohol, hormones, trauma, two or more, the other) were 5.46％ (58/1062), 6.97％ (74/1062), 4.43％ (47/1062), 0.94％ (10/1062), 12.34％ (131/1062) in agriculture group, 10.55％ (112/1062), 7.72％ (82/1062), 5.74％ (61/1062), 2.26％ (24/1062), 13.65％ (145/1062), and 4.90％ (52/1062), 5.93％ (63/1062), 4.90％ (52/1062), 0.66％ (7/1062), 13.56％ (144/1062) in the group of non-agricultural and the other.The proportions of gender, region, etiology in each group were analyzed by x2 test, the differences were statistically significant (x2 =12.77, 24.55, 26.36, P ＜0.05).The onset time and ARCO staging in each group, the correlations were analyzed by Spearman test, the differences were statistically significant(rs =0.282,0.232,0.208, P＜0.05).The onset of time and average age in different occupational group with different, due to factors such as gender, ethnicity, single or bilateral, region, and so on.Conclusion Patients with avascular necrosis of femoral head in different occupational group have different epidemiological characteristics.The occupational characteristics analysis can provide scientific data for diagnosis,treatment and prevention in patients with avascular necrosis of femoral head.

Objective To study the role of maintaining ventilator tubing at low position in prevention of ventilator-associated pneumonia (VAP).Methods From January 2010 through December 2011,110 cases with invasive mechanical ventilation in Intensive Care Unit (ICU) were randomly divided into observation group (n =55) and control group (n =55).The patients of control group were given conventional prevention method including the head elevated 30°-45°.The patients of observation group were given prevention method of keeping ventilator tubing at low position in addition to conventional prevention method so as to avoid the condensate in ventilator tubing into the airway.After mechanical ventilation support for 28 days,the incidence of VAP,duration of mechanical ventilation,length of ICU stay,incidence of condensate flowing back,clinical pulmonary infection score (CPIS) and mortality were respectively recorded.At the same time,risk of mistakenly extubation by nurses was recorded.Results The comparison between two groups showed the incidence of VAP (16.36％ vs.34.55％),duration of mechanical ventilation (5.86 ± 2.66) d vs.(11.24 ± 3.80) d,length of stay in the ICU (13.60 ± 4.83) d vs.(19.58 ±5.27) d,incidence of condensate backflow (3.64％ vs.49.09％),presenting significant differences between two groups (P ＜ 0.05).The CPIS of observation group was lower than that of the control group (P ＜0.05),and the mortality in observation group (21.82％) was lower than that in the control group (27.27％),but the difference was not significant (P ＞0.05).There was no statistically significant difference in risk of mistakenly extubation between two groups (P ＞ 0.05).Conclusion Maintaining the ventilator tubing at low position can reduce the incidence of VAP,improve the prognosis,and the risk of mistakenly extubation did not increase compared with the conventional methods

Objective To investigate the effect of early using periplaneta americana extract on gastrointesti-nal function in critically patients with infection,and to evaluate its possible mechanism.Methods 66 patients with infection in Intensive Care Unit(ICU)were divided into control group and treatment group(33 cases in each group) according to the random number table.All patients in the two groups were given conventional cluster treatment,the patients in the treatment group additionally received periplaneta americana extract.At the beginning of treatment and 3,7 and 10 days after treatment,the indicators of bowel sounds,gastrointestinal function,APACHEⅡ and blood lactic acid level were respectively tested or recorded.Results At the beginning of treatment,there were no statistically sig-nificant differences between the two groups in terms of gastrointestinal function,bowel sounds,APACHE II score and blood lactic acid level(t =0.132,0.201,0.329,0.190,all P >0.05).3,7 days after treatment,the gastrointestinal function[(1.56 ±0.49)points vs.(1.32 ±0.45)points,(1.27 ±0.44)points vs.(1.02 ±0.42)points],bowel sounds[(1.58 ±0.76)times/min vs.(2.27 ±0.75)times/min,(2.15 ±0.91)times/min vs.(3.11 ±0.97)times/min],APACHE II score[(19.61 ±4.02)points vs.(17.50 ±4.37)points,(17.69 ±3.94)points vs.(15.24 ± 3.82)points]and blood lactic acid level[(2.94 ±0.88)mmol/L vs.(2.45 ±0.75)mmol/L,(2.51 ±0.59)mmol/L vs.(2.20 ±0.55)mmol/L],the terms in the treatment were better than those in the control group,the differences were statistically significant(t3 =2.072,t7 =2.361;t3 =3.712,t7 =4.146;t3 =2.041,t7 =2.565;t3 =2.434,t7 =2.208,all P <0.05).Conclusion Early using periplaneta americana extract has protective effect on gastrointestinal function in critically patients with infection,and improve the condition in a certain degree.