Objective To review the causes of 21 cases of exteric fistula after surgery,treatment and prognosis,and to explore the clinical treatment of exteric fistula after surgery.Methods To collection the Xinjiang Uygur Autonomous Region People's Hospital of Gastrointestinal Surgery from Aug 2013 to Aug.2016 admitted during the period of parenteral fistula patients after abdominal surgery,21 patients with intestinal fistula outside,12 cases were male,9 were female cases.According to the case records of descriptive statistics,the treatment methods was summarized and analyzed retrospectively.Results Au patients with intestinal fistula outside,12 cases were male,female 9 cases.Conservative treatment of 11 cases,healing in 2 cases,5 cases,4 cases died and the sigmoid colon perforation repair 1 case,postoperative ileus postoperative renal function failure in 1 case,gastric cancer by intraperitoneal hemorrhage after early postoperative restrictive ploration in 2 cases;Early surgical treatment of 10 cases,of which the deterministic operation in 1 case,late deterministic surgery in 9,were cured.Conclusions The early diagnosis of parenteral fistula and rapid processing,taken on the basis of the condition of the patients with timely complete drainage,infection control,reasonable nutrition support and correct homeostasis imbalance as the main content of a comprehensive individualized treatment,most patients can improve the self-healing,cannot heal patients to choose the appropriate surgical timing and proper operation method,can improve the cure rate and reduce the case fatality rate.

The chronological and spatial rules of changes during focal cerebral ischemia and reperfusion in different brain regions with magnetic resonance diffusion-weighted imaging (DWI) in a model of occlusion of middle cerebral artery (MCAO) and the development of cytotoxic edema in acute phase were explored. Fifteen healthy S-D rats with MCA occluded by thread-emboli were randomly divided into three groups. 15 min after the operation, the serial imaging was scanned on DWI for the three groups. The relative mean signal intensity (RMSI) of the frontal lobe, parietal lobe, lateral cauda-putamen, medial cauda-putamen and the volume of regions of hyperintense signal on DWI were calculated. After the last DWI scanning, T2 WI was performed for the three groups. After 15 min ischemia, the rats was presented hyperintense signals on DWI. The regions of hyperintense signal were enlarged with prolonging ischemia time. The regions of hyperintense signal were back to normal after 60 min reperfusion with a small part remaining to show hyperintense signal. The RMSIs of parietal lobe and lateral cauda-putamen were higher than that of the frontal lobe and medial cauda-putamen both in ischemia phase and recanalization phase. The three groups were normal on T2 WI imaging. DWI had good sensitivity to acute cerebral ischemia, which was used to study the chronological and spatial rules of development of early cell edema in ischemia regions.
Brain Ischemia/*pathology ; Diffusion Magnetic Resonance Imaging/*methods ; Early Diagnosis ; Infarction, Middle Cerebral Artery/pathology ; Random Allocation ; Rats, Sprague-Dawley ; Reperfusion Injury/*pathology ; Time Factors

Using different models of focal cerebral ischemia, the temporal and spatial rules of metabolism and energy changes in the post-ischemia brain tissue were measured by proton magnetic resonance spectroscopy (1HMRS) to provide valuable information for judging the prognosis of acute focal cerebral ischemia and carrying out effective therapy. Nine healthy Sprague-Dawly rats (both sexes) were randomly divided into two groups: The rats in the group A (n = 4) were occluded with self-thrombus for 1 h; The rats in the group B (n = 5) were occluded with thread-emboli for 1 h. The 1H MRS at 30, 40, 50, 60 min respectively was examined and the metabolic changes of NAA, Cho and Lac in the regions of interest were semiquantitatively analyzed. The spectrum integral calculus area ratio of NAA, Cho, Lac to Pcr + Cr was set as the criterion. The values of NAA.Cho in the regions of interest were declined gradually within 1 h after ischemia, especially, the ratio of Cho/(Pcr + Cr), NAA/(Pcr + Cr) at 60 min had significant difference with that at 50 min (P < 0.05). The ratio of Lac/(Pcr + Cr) began to decrease at 40 min from initial increase of Lac in both A and B groups. MR proton spectrum analysis was a non-invasive, direct and comprehensive tool for the study of cellular metabolism and the status of the biochemical energy in acute ischemia stroke.
Brain Ischemia/*diagnosis ; Energy Metabolism ; Infarction, Middle Cerebral Artery/diagnosis ; *Magnetic Resonance Spectroscopy ; Phosphorylcholine/metabolism ; Random Allocation ; Rats, Sprague-Dawley

Objective To develop a methodology for auditing dosimetric parameters using TLD for photon and electron beams in non-reference conditions.Methods The correction experiments have been developed for non-linear dose response,PAAM holder,energy,fading and dispersion using TLD for 60Co γ-ray,high energy X-ray and electron beams.The measuring method was set up for absorbed dose estimation by TLDs in water.3 photon beams and 2 electron beams were selected for research purposes,and 5 photon beams and 4 electron beams for reliability research.Results The research results were evaluated for60Co source,6,10,15 and 18 MV photon beams in non-reference conditions at off-axis,with the relative deviation within-0.1％-7.2％ at-off axis (IAEA's acceptable deviation:± 7.0％).The verification results were evaluated for 5 photon beams in non-reference conditions at on-axis,with the relative deviation are within 0.1％-7.0％.The verification results were evaluated for 4 electron beams in non-reference conditions,with the relative deviation within 0-4.7％ (IAEA's acceptable deviation:±5.0％).Conclusions It is convenient and accurate to use TLD method for quality audits for clinic dosimetry parameters in radiotherapy.Two kinds of IAEA TLD holders are feasible for use in TLD audits.Absorbed doses for high energy electron beam were corrected using plane parallel chambers and verified using TLD,with good results obtained.

Objective To explore the neurovascular distribution around multifidus muscles in the low back and its clinical significance via regional dissection.Methods Five cadavers were dissected in the low back.The anatomical relationships between the longissimus thoracis,iliocostalis and the start-stop,direction and position of multifidus muscles were observed.Branches,distribution and the characteristics of the erector spinae muscle,the lateral branches of spinal nerves and blood vessels were examined.Then measured the distances from the emerging point of the lateral cutaneous branches of spinal nerves to the spinous processes.Results After removed the deep fascia,the longissimus thoracis was found medially and the iliocostalis was found laterally.The muhifidus muscles located deeply to the longissimus and the iliocostalis muscles.The lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar blood vessels run in the multifidus muscle gaps.Conclusion The multifidus muscle gaps contain plenty of neurovascular bundles.Surgery involving the low back often takes the advantage of the gaps between multifidus muscles.Therefore,surgeons should take caution to avoid damaging the lateral branches of the posterior rami of the spinal nerves and the dorsal branches of lumbar vessels during low back surgery.

Objective To evaluate the effects of intrathecal 2-PMPA on chronic inflammatory pain in rats . Methods Twenty four male Sprague-Dawley rats ,aged 4-6 months ,weighing 200-250 g ,were randomly divided into 3 groups (n=8 each) using a random number table :normal saline (NS) group ,complete Freund′s adjuvant (CFA ) group and N-acetylaspartylglutamate peptidase inhibitor 2-PMPA group (group 2-PMPA ) . Chronic inflammatory pain was induced by injecting 100μl of CFA into the plantar surface of the left hindpaw .Immediately after injection of CFA ,2-PMPA 100 μg was injected intrathecally once a day for 3 consecutive days in group 2-PMPA ,while the equal volume of NS was given instead of 2-PMPA in NS and CFA groups .The paw withdrawal latency to thermal nociceptive stimulus (TWL ) and paw withdrawal threshold (PWT ) to von Frey filament stimulation were measured before injection of CFA (baseline ,T1 ) and after the last injection of CFA (T2 ) .Then the rats were sacrificed and the L4 ,5 segments of the spinal cord were removed for determination of NR2B expression by Western blot .Results Compared with group NS ,TWL and PWT were significantly decreased at T2 and the expression of NR2B was up-regulated in CFA and 2-PMPA groups ( P<0.05 ) .Compared with group CFA ,TWL and PWT were significantly increased at T2 and the expression of NR2B was down-regulated in group 2-PMPA ( P<0.05) .Conclusion Intrathecal 2-PMPA can alleviate CFA-induced chronic inflammatory pain in rats ,and inhibition of NR2B expression in the spinal cord is involved in the mechanism .

Objective To investigate the contamination of clinically used tablet computers,and compare the effec-tiveness of three cleaning and disinfection methods.Methods The front and back surfaces of tablet computers were wiped and detected by handheld adenosine triphosphate (ATP)fluorescence detector,the study was divided into baseline stage and cleaning and disinfection stage.During baseline stage,the tablet computers in use were directly wiped,during cleaning and disinfection stage,the tablet computers were wiped by normal saline-moistened gauze, alcohol-moistened gauze,and wet napkin.Results During baseline stage:20 tablet computers were wiped,the qualified rate was 0,the median of relative light unit (RLU)of ATP detection was 218.00.During cleaning and dis-infection stage,10 tablet computers were wiped in each cleaning and disinfection group,and the qualified rate of normal saline-moistened gauze,alcohol-moistened gauze,and wet napkin groups were 50.00%,0,and 60.00% re-spectively,the median RLU of ATP detection were 28.50,79.00,and 29.00 respectively.Except comparison be-tween saline-moistened gauze and wet napkin groups (P =0.97),multiple comparison of RLU of ATP detection amongthe other groups were significantly different (all P <0.001 ).Conclusion Contamination of medical tablet computers are serious,wet napkin wiping is an ideal method for cleaning and disinfection,but the frequency for cleaning and disinfection needs to be further studied.

Objective To study whether methicillin-resistant Staphylococcus aureus (MRSA)will increase the burden of patients with hospital-acquired pneumonia (HAP).Methods Patients with Staphylococcus aureus HAP in a hospital between January 1 ,2013 and November 31 ,2014 were selected,patients with MRSA HAP were as case group,patients with methicillin-sensitive Staphylococcus aureus (MSSA)HAP were as control group,propen-sity score matching (PSM)analysis were conducted to compare the prognosis of MRSA HAP and MSSA HAP (length of hospital stay, duration from infection to discharge, mortality, total therapeutic cost ). Results APACHE II score in case group was higher than control group before PSM was conducted,length of hos-pital stay and duration from infection to discharge were both longer than control group (40[20,94]d vs 28[21 ,53] d;19[10,46]d vs 17[8,29]d,respectively,both P <0.05).APACHE II score in case group and control group af-ter conducting PSM was not significantly different(P >0.05 ),data were balanced and comparable;there were no significant difference in length of hospital stay between two groups (28[21 ,52]d vs 28[21 ,53]d),duration from in-fection to discharge (15[9,25]d vs17[8,29]d),mortality(10.87% vs 15.22%),and total therapeutic cost (121 013.5[80 747.21 ,176 200]yuan vs 119 911 .2[66 994.08,241 184.7]yuan)(all P >0.05).Conclusion APACHE II score is an important factor affecting prognosis;after balancing this factor,there is no difference in the prognosis of patients with MRSA and MSSA HAP,MRSA HAP can not increase the burden of disease.

Objective To analyze the present medical teaching textbooks and practice skill guidelines,and explore the profound causes of poor hand hygiene idea among doctors.Methods Three sets of unified textbook series used for domestic medical colleges and universities and two sets of manipulation skill guidelines were studies.Statistical method was conducted to analyze whether concepts and methods of hand hygiene,hand-washing and antiseptic han-drubbing were included in these teaching textbooks;as to eight aseptic manipulation skills,coverage of knowledge, steps of hand-washing and antiseptic handrubbing in manipulation skill guidelines were also analyzed.Results The mentioning rate of hand hygiene,hand-washing and antiseptic handrubbing in 8-year and 5-year program teaching textbooks were both 0 ,in nursing teaching textbooks was 1 00 % ;as to 8 aseptic manipulation in 2 sets of skill practice guidelines,mentioning rate of hand washing was 37 .50 % ,and method and steps of antiseptic handrubbing were both 0 .Conclusion School teaching and skill assessment are the basis,it is difficult to form the right idea by only relying on continuing education without basic education.Hand hygiene should be stressed in the written of teaching textbooks,guidelines should be written following the newest progress,so as to form the correct idea of hand hygiene among doctors.

Objective To examine the distribution characteristics the medial branch of the posterior branch of the spinal nerves around the lumbar facet joints, so as to explore the localization and targeting of the medial branch of the posterior branch in neurectomy.MethodsFive corpses were dissected, and the anatomical relationships between the medial branches of the posterior branch of the spinal nerves and the facet joints were examined.Measured the distances from the lateral port of the bone fiber tube,the articular process of the facet joint and the superior articular process to the spinous processes.Results The medial branch of the posterior branch of the spinal nerve was close to the root of the articular process and the transverse process,which was not easy to be explored and dissected.Meanwhile, it was easily traced after the medial branch of the posterior branch of the spinal nerve ran through the fibrous tube.Conclusion It may improve the safety and effective when the techniques of medial branch block is performed after the medial branch ran through the fibrous tube.