Objective To evaluate the effectiveness and safety of total pelvic floor reconstruction treating female pelvic organ prolapse with prolift system .Methods The effectiveness and complications 24 cases genital pro-lapse according to POP Q stages who underwent total pelvic floor reconstruction surgery with prolift system were retro -spectively reviewed.Results The mean operative time was (97.5 ±23.3) min.The average blood loss (68.5 ± 28.1)mL.The mean postoperative hospital′s day was (8.9 ±2.3)days.The symptoms of all patients with peivic floor prolapse disappeared .2 cases sufferd pain and mesh erosion ,1 case had buttock abscess during follow-up.All recov-ered after treatment .Conclusion The short-term curative of total pelvic floor reconstruction surgery with prolift sys-tem is good.These cases have some postoperative complication .Such operation mode should be selected comprehen-sively.

Refresher training is the most important ways of continuing medical education. This paper introduces the training situation of refresher doctors of Children's Hospital of Fudan University by distribution of professional title, education departments and experience in training. We have sum-marized the management mode of refresher doctors from such aspects as the entrance management, pre-job training, authorization to work, strengthening clinical practice to expand knowledge, clinical research training, self-learning ability improvement, strengthening emotional communication, humani-zation management, emotional bonds establishment and creation of a follow-up development environment.

UNLABELLEDABSTRA CT OBJECTIVE To compare the complications and clinical outcome of titanium elastic nail (TEN) versus plate-screw fixation (PF) for the treatment of upper segment fractures of femoral shaft in children.

METHODSFrom May 2006 and August 2012,32 consecutive children with upper segment fractures of femoral shaft were studied prospectively. They were randomly divided into TEN group and PF group. Ninteen patients were treated with titanic elastic nail (TEN) fixation including 11 males and 8 females with an average age of (6.9?2.2) years old ranging from 3 to 11,11 cases of them were type A, 6 cases were type B,2 cases were type C according to AO classification. The other 13 patients were treated with plate-screw fixation (PF) including 9 males and 4 females with an average age of (7.5±2.1) years old ranging from 5 to 12 years, and 3 cases of them were type A,6 cases were type B,2 cases were type C. Operative time, blood loss,incision length,the time of hospitalization,fracture healing time, postoperative complications and function recovery between two groups were compared and evaluated.

RESULTSThe average follow-up period of the patients was 25.3 months (ranging from 15 to 48 months) in TEN group, and 36.2 months (ranging from 13 to 36 months) in the PF group. The operation time, time of hospitalization, the time of implants removed after the initial surgery, fracture healing time in TEN group were respectively (56.7±11.2) min, (6.6±3.9) d, (8.1±2.3) months, (12.6+3.8) weeks; and in PF group were respectively (51.5±8.3) min, (7.8±4.8) d, (7.8±1.6) months, (11.8±2.8) weeks, there was no significant difference between two groups (P>0.05). However, the length of incisions was (4.3±1.7) cm and the intraoperative blood loss was (12.7+3.2) ml in TEN group,which were significantly less than that in PF group respectively (89.2±21.1) ml and (11.6?2.3) cm (P<0.05). There was no statistically difference in postoperative in complication between two groups, but the patients in TEN group had a higher incidence of soft tissue irritation and misalignment. Outcome scores according to Sanders had no significant difference between two groups (P>0.05). In TEN group,the result was excellent in 13 cases, good in 3,fair in 2, and poor in 1, while in PF group excellent in 10, good in 2, fair in 1.

CONCLUSIONThere is no significant difference in therapeutic effects between TEN and PF for children with upper segment fractures of femoral shaft. The internal fixation should be selected according to the associated fracture type, weight, the expected value of the parents, scars, and so on.

Blood Loss, Surgical ; Bone Nails ; Bone Plates ; Bone Screws ; Child ; Child, Preschool ; Female ; Femoral Fractures ; complications ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; Fracture Healing ; Hip ; physiopathology ; Humans ; Male ; Operative Time ; Postoperative Complications ; epidemiology ; Prospective Studies ; Treatment Outcome

To assess the effectiveness and safety ofinside-out (TVT-O) vs. outside-in transobturator-tape procedures (TOT) in the surgical management of female stress urinary incontinence (SUI).A total of 8 randomized controlled trials were retrieved from the literature and analyzed by metaanalysis with RevMan 5.0 software.Meta-analysis showed that no statistical differences existed in objective cure rate,objective failure,postoperative voiding dysfunction,groin/thigh pain and sling exposure in both procedures (P ＞ 0.05).These preliminary results suggest there is no evidence of significant differences in the efficacy and safety between TVT-O and TOT.

Anticonvulsants ; adverse effects ; Humans ; Seizures ; chemically induced

Objective To investigate the changes of brain function in moderate and high myopia patients using fractional amplitude of low frequency fluctuation (fALFF),and discuss the correlation between brain function changes and clinical data of patients with myopia.Methods Totally 21 moderate and high myopia patients (myopia group),and 21 healthy volunteers (normal control group) who were matched with myopia patients in age and gender,were selected to take rs-fMRI examination.The difference of fALFF of brain functional activity in patients with myopia and normal controls was compared,and the correlation between the changes of fALFF and clinical data of patients with myopia was analyzed,Results Compared with normal control group,the fALFF values of myopia group in the region of the left inferior frontal gyrus,putamen and right inferior frontal gyrus,putamen and insula were significantly lower (all P ＜ 0.05,AlphaSim corrected).However,in bilateral cingulate gyrus,bilateral anterior cingulate gyrus,left postcentral gyrus,left superior parietal lobule and region,fALFF values were increased (all P ＜ 0.05,AlphaSim corrected).Conclusion Patients with myopia are accompanied by abnormal neuronal activity in many brain areas,which may reflect the dysfunction of language understanding and attention control in myopic patients.

Objective To study the results of intraventricular tunnel procedure for double outlet right ventricle(DORV) with subaortic ventricular septal defect(VSD).Methods Nine children with DORV complicated with subaortic VSD underwent intraventricular tunnel procedure.Five of them had stenosis of pulmonary valve or subpulmonary stenosis,and one had double-chambered right ventricle. An intraventricular tunnel procedure was performed under cardiopulmonary bypass. Right ventriculotomy was made to repair the VSD with teflon patch. An internal tunnel was made between the left ventricle and the aorta.The right ventricle connected with the main pulmonary artery. Results All children survived and recovered finally. Echocardiography showed that the internal tunnel function was well.Conclusion With correct diagnosis and selection of procedure, intraventricular tunnel procedure is a satisfactory method for the treatment of DORV with subaortic VSD.

Objective To explore the difference of four calculating methods used to determine the obesity. Methods Two thousand four hundred and forty six (2446) men and three hundred and seventy nine (379) women were measured height and body mass, Standard body mass, BMI, body fat ratio and obesity index(OI) were calculated with formula. According to the BMI≥ 25 kg/m2 , BMI ≥ 27 kg/m2 and BMI≥28 kg/m2, the obese adults were 1419,680 and 435 respectively;there were 649 adults that their body mass was over 20％standard body mass; there were 639 adults that their body fat ratio was over 25％(male)and 33％(female). Results For obesity determination, the adults who were 20％overweight and over standard body fat ratio were significantly different from those whose BMI were over 25 kg/m2 ( P＜0. 05 ) ;Those who were 20％overweight and over standard body fat ratio were not significantly different from those whose BMI were over 27 kg/m2 ( P＞0.05 ) ; Those who were 20％overweight and over standard body fat ratio were significantly different from those whose BMI were over 28 kg/m2 ( P＜0. 05 ). Conclusion Determining obesity with BMI≥27 kg/m2 is feasible and rational.

BACKGROUND: Intrapulmonary vascular abnormalities result in the right-to-left shunting and severe hypoxemia in liver transplantation candidates. Currently, a convenient, sensitive and effective method is absent to screen the intrapulmonary vascular dilatations.OBJECTIVE: To evaluate the role of contrast-enhanced echocardiography on clinical diagnosis of intrapulmonary shunting in liver transplantation candidates.DESIGN, TIME AND SETTING: The experiment, prospective controlled observation based on cases, was performed at the Hepatology Unit of the 458 Hospital of PLA (Guangzhou, Guangdong, China) from February 2004 to February 2006.PARTICIPANTS: Twenty-four consecutive liver transplantation candidates were recruited from the Hepatology Unit of the 458Hospital of PLA.METHODS: Routine examination was conducted under the condition without any regimen of vascular dilatation drugs.Contrast-enhanced echocardiography was applied to detect the prevalence of right-to-left shunting in the patients with end-stage liver disease. The microvesicle of the left ventricle in patients was qualitatively assessed by a score from 1+ to 3+. Accordingly, all patients were divided into two groups: intrapulmonary shunting and non-intrapulmonary shunting.MAIN OUTCOME MEASURES: The prevalence of right-to-left shunting and clinical characteristics of liver transplantation candidates were determined.RESULTS: Ten (41.7%) of 24 patients with positive contrast-enhanced echocardiography were proved to develop the intrapulmonary right-to-left shunting, including 6 for l+ and 4 for 2+ by left ventricle abnormality, which emerged after 6-10 cardiac cycles of right ventricle abnormality. There were no significant differences in age, gender, arterial blood gas analysis and liver function tests between the two groups (P > 0.05). Echocardiography results demonstrated that, the upper digestive tract hemorrhage,spleen thickness that indicated portal hypertension, pulmonary artery systolic pressure and Tei index were significandy higher in the patients of intrapulmonary shunting than in those of non-intrapulmonary shunting (P<0.05-0.01 ).CONCLUSION: Intrapulmonary vascular dilatation occurs frequently in liver transplantation candidates associated with intrapulmonary shunting but without hypoxemia. Contrast-enhanced echocardiography is a sensitive and non-invasive method for the early diagnosis of intrapulmonary vascular dilatation. The pathogenic cause is portal hypertension. Tel index can be used as an important parameter for evaluating right ventricular function in patients of intrapulmonary vascular dilatation.

Objective To investigate the effect of the nursing care of critically ill patients in intensive care unit(ICU) with non-invasive ventilation assisted by sedation simultaneously. Methods During the intervention phase from June 2012 to June 2013 of 28 patients in ICU treated by non-invasive ventilation, sedatives were adjusted according to Ramsay Scale, and the parameters of the life signs (heart rate, blood pressure, oxygen saturation,etc) were measured by nurses. Results 89.3%(25/28) patients obtained the improvement of the disease despite of the complications such as over-sedation and instable hemodynamics. Conclusion The key points can increase tolerance of non-invasive ventilation and improve clinical outcomes, develop comprehensive nursing strategies on safety and effectiveness of sedation and non-invasive ventilation .