Objective To introduce the method,characteristics and indication of unreamed in-tramedullery nailing in treatment of open tibia fractures.Methods 28 cases were classified according to the Gustilo method:18 belonged to type I,8 type II and 2 type III a.26 nails with 8mm in diameter and 2 nails with 7mm in diameter were used.Results All cases were fixed successfully with unreamed nailing without any X-ray aids.All of fractures had no infection,and healed in an average time of 5.6 months.There were no broken nails and screws in this series.Conclusion The unreamed intramedullary nailing is an advantageous therapeutic method with simple management,little trauma and wide indication in management of open tibia fractures.

Objective To evaluate the results and relating factors in the treatment of proximal humeral fractures by replacement of humeral head prosthesis. Methods From March 2000 to March 2003, 21 cases with proximal humeral fractures, which were 10 males and 11 females aging from 62 to 82 years with an average of 72.3 years, were admitted to our hospital. All the patients were underwent one-stage operation of humeral head hemiarthroplasty through the anteromedial approach of shoulder joint. The average operative time was 60 minutes (range, 40 to 80 minutes) with a blood loss ranging form 200 ml to 300 ml. According to Neer classification, 6 cases were three-part fractures, 13 four-part fractures, and 2 head-splitting fractures. There were 18 fresh fractures and 3 old fractures. All the fractures were treated with replacement of humeral head prosthesis. After operation, the upper extremity was immobilized for 6 weeks, however, physical therapy, including pendulum, isometric elbow, and wrist and hand exercises, was begun on the first day after surgery. Results The follow-up ranged from 6 to 36 months with a mean period of 14.6 months. No lessening prosthesis, prosthesis dislocation, postoperative infection, nerve damage or periprosthesis fractures occurred. According to the scoring system modification for hemiarthroplasty (SSMH) of UCLA (Los. Angeles, California, USA) based on shoulder pain, functional status, muscle strength and range of motion, the average score was 24.5. Furthermore, the score was above 27 (excellent) in 3 cases, and 24 to 27 (good) in 14, and the excellent rate was 86%. The average score of pain was 9.3, function 8.6, muscle strength 8.2 in 21 cases. Conclusion Replacement of humeral head prosthesis is a preferable method for the treatment of proximal humeral fractures in the elderly patients, with significant effects in keeping the function and relieving the pain of the shoulder joint postoperatively.

Objective To study the valid correct method for reagent selection, calibration of analyzers, and internal quality control protocol. Methods Reagents were selected by comparing with BRENGER Mannheim(BM)reagent used in Hitachi 7170A. Analyzers were calibrated once a week. One internal quality control chart was set up for three analyzers. Specimens were analyzed by the three machines respectively. Results Except for amylase, all the results obtained from the three analyzers were not significant. Conclusion The recommended quality control protocol is useful to obtain comparable results from different automatic biochemistry analyzers.

Objective To investigate the effects and mechanisms of valproic acid on brain edema,neurobehavioral outcome and inflammatory response after traumatic brain injury (TBI) in rats.Methods TBI animal models were established using Feeney's method.Fifty-four SD male rats,weighting 220-250 g,were randomly divided into 3 groups (n =18):sham operation group (group sham),traumatic brain injury group (group TBI) and valproic acid treatment group (group TBI + VPA).Experimental rats were treated with valproic acid (300 mg/kg,twice daily) by intraperitoneal injection.Rat behavioral outcomes were measured by modified neurologic severity score (mNSS) tests at day 1,3,and 7 after TBI.Brain water content was measured with wet-dry weight method.The blood cells infiltration into cerebral cortex were tested with immunohistochemistry staining against ED-1 for macrophage.Inflammatory cytokines (INF-γ,tumor necrosis factor-α,interleukin-6) were measured by Western blotting.The statistical analysis were performed by ANOVA and chi-square tests using the statistical software program SPSS 13.0.Results Compared with the Sham group,the levels of brain edema,mNSS and macrophage cell infiltration were significantly increased after TBI (all P =0.00).The expressions of inflammatory cytokines were also increased significantly (all P =0.00).Compared with the TBI group,TBI + VAP group had significantly lower brain water content[3day:(80.12 ±0.59)％ vs.(82.14 ±0.67)％,P=0.04;7day:(74.74 ±0.72)％ vs.(77.93 ±0.48)％,P=0.01],and mNSS scores [3 day:(10.53 ±0.32) vs.(11.74 ±0.48),P =0.02;7 day:(7.97 ± 0.32) vs.(10.73 ± 0.42),P =0.01].VPA suppressed macrophage cell infiltration into cerebral cortex [(36.44 ± 0.72) ％ vs.(25.93 ± 0.48) ％ P =0.00].Meanwhile,VPA inhibited the expressions of inflammatory cytokines (INF-γ,TNF-α,IL-6) (P ＜ 0.05).Conclusions Treatment with VPA markedly reduced brain edema and improved neurological outcomes after TBI,possibly mediated by inhibited TBI-induced cerebral inflammatory responses and macrophage cell infiltrating into cerebral cortex.

Since human society entered the 21st century, the rapid development of medical technology also gave birth to a series of negative effects:medical service technology first, trust crisis of the doctor-patient relation-ship, and medical industry money worship. Especially in recent years, due to the lack of humanistic spirit in medi-cal institutions, the doctor -patient relationship is of the worst state in the history. Therefore, it is urgent to strengthen the medical humanities education in the construction of hospital culture. Aiming at the problems existing in the current medical industry, this paper expounds the importance of strengthening the humanistic education in the construction of hospital culture.

Objective To determine the predictive parameters of impacted ureteral stones and evaluate the predictive value of ureteral wall thickness for impacted ureteral stones.Methods A total of 93 patients with proximal ureteral stones from January 2017 to December 2017 were included in the study [71 males and 22 females,aged 30-80 years,and body mass index (23.7 ± 2.7) kg/m2].Both clinical and computed tomography urography (CTU) data were compared between patients with or without impacted ureteral stone,including sex,age,body mass index,renal pelvic diameter,longitudinal size of stone,transverse size of stone,stone surface area,stone volume,hounsfield units of stone,diameter of the ureter proximal to the stone,and ureteral wall thickness at the impacted ureteral stone site.The receiver operating characteristic curve (ROC) was used to analyze the performance of each of the above-mentioned parameters for predicting the impacted ureteral stones.Multivariate logistic regression analysis was used to select the independent risk factors of impacted ureteral stones.Results Among 93 patients,38 (40.8％) patients were with impacted stones and 55 (59.1％) without impacted stones.Univariate analysis showed significant difference in ureteral wall thickness (t =6.344,P ＜ 0.001),diameter of the ureter proximal to the stone (U =607.5,P =0.001),longitudinal size of stone(U =580.5,P ＜0.001),transverse size of stone(t =4.172,P ＜0.001),stone surface area(U =508.5,P ＜ 0.001),stone volume (U =508.5,P ＜ 0.001) and hounsfield units of stone (t =6.344,P =0.006) between patients with or without impacted stones.Ureteral wall thickness(UWT)showed the largest area under curve (AUC) among those parameters (AUC =0.825,P ＜ 0.001),followed by stone surface area and stone volume.The optimal cut-off value of ureteral wall thickness was 3.16 mm,with sensitivity of 71.1％ and specificity of 85.5％.Multivariate analysis showed that ureteral wall thickness (Wald =18.709,P ＜ 0.001) and stone volume (Wald =8.391,P =0.004) were independent predictors of impacted stones.Conclusion Ureteral wall thickness was related to the presence of impacted ureteral stones and could be used for predicting impacted ureteral stones.

Objective:To observe the analgesic effect of local anesthesia combined with nerve block anesthesia on golden microneedles for improving facial aging.Methods:Between December 2018 and December 2019 in Burn and Plastic Surgery of Nanchong Central Hospital, sixty female patients (between 30 and 58 years old, with an average of 45.2 years old) with natural facial skin aging were randomly divided into two groups: Group A: surface anesthesia group (30 cases); Group B: local anesthesia combined with nerve block anesthesia (30 cases). Intraoperative and postoperative pain scores, length of operation, and incidence of adverse reactions were compared between groups A and B.Results:Pain score during surgery was (6.90±0.96) points in Group A, (3.63±0.72) points in Group B. The difference between the two groups was statistically significant ( t=14.93, P<0.05); Pain score at 30 minutes after operation was (2.03±0.62) in Group A, (0.77±0.73) in Group B, the difference between the two groups was statistically significant ( t=7.28, P<0.05). There was no statistically significant difference between the two groups in the pain score at 24 hours after operation ( P>0.05); The operation process in group B was simplified, and the treatment time was significantly shortened. The difference between the two groups was statistically significant ( t=17.93, P<0.05). Conclusions:The method of local anesthesia combined with nerve block anesthesia is used in the treatment of gold microneedles to improve the analgesic effect in facial aging, which significantly shortens the treatment time and has fewer adverse reactions. This method is worth popularizing.

【Objective】 To explore the expression and clinical significance of prostate cancer tissue-specific lncRNAs. 【Methods】 The gene differences of 492 prostate cancer tissues and 152 adjacent tissues in TCGA and GEO genomic databases were analyzed with bioinformatics methods. A total of 5 lncRNAs were screened out, and their specificity in prostate tissues and impact on the prognosis of patients were analyzed. 【Results】 The 5 lncRNAs included PCAT14, PCA3, CTBP1-AS, DRAIC, and GPC5-AS1. PCAT14 and PCA3 were specifically expressed in prostate cancer tissues, and elevated expression was related to the prognosis. Moreover, they were well correlated with prostate cancer-specific antigens such as KLK3, AMACR, SLC45A3, and so on. GO function enrichment analysis and KEGG pathway enrichment analysis showed that the differential expression of PCA3 was closely related to phagocytosis, cell recognition, defense response to bacteria, immunoglobulin complex, Golgi apparatus, antigen binding, chemokine receptor binding, white matter digestion and absorption, renin-angiotensin system and other signaling pathways, while the differential expression of PCAT14 was closely related to the activity of Golgi apparatus and ion channels, renin secretion, cAMP signaling pathway, and gonadotropin secretion-related signaling pathway. 【Conclusion】 PCA3 and PCAT14 are specifically expressed in prostate cancer tissues, not in normal tissues, which can be used as potential indicators for the diagnosis of prostate cancer.

OBJECTIVE: To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates. METHODS: Clinical data of 114 neonates with annular pancreas admitted in the Children's Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters (gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed. RESULTS: One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography (UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was (7.8±2.7) d, and the mean length of hospital stay was (16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group (<0.05); the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group (<0.05). CONCLUSIONS Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.
Duodenal Obstruction ; diagnostic imaging ; surgery ; Humans ; Infant, Newborn ; Laparoscopy ; Pancreas ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Pancreatic Diseases ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies

OBJECTIVE: To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst. METHODS: One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (=65) and control group (=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups. RESULTS: Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation,time required for the volume of peritoneal drainage fluid to be less than 50 mL,time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (<0.05 or <0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (<0.01), but the incidence of edema after operation was lower (<0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (<0.05) and the total cost of hospitalization was reduced (<0.01). CONCLUSIONS ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.
Case-Control Studies ; Child ; Choledochal Cyst ; economics ; surgery ; Enhanced Recovery After Surgery ; standards ; Humans ; Length of Stay ; Postoperative Complications ; prevention & control