Flail chest is the common chest trauma, which causes abnormal respiration and mediastinal swing affecting the respiratory and circulatory function after injury. Fixation of ribs of flail chest has been used for half a century, methods and equipment of which varied, and domestic and foreign scholars have verified its efficacy in clinical practice. This article summarizes its main great progresses.

Objective To study the CT appearances of sacroiliac joint with ankylosing spondylitis(AS) and evaluate the pathology's degree,in order to improve the early diagnosis of AS.Methods 65 cases with AS were examined with CT.52 cases were males and 13 cases were female.The age ranged from 16 years to 52 years with average age of 23.6 years.Results In 65 cases,CT showed Ⅰ degree in 11 cases(16.9%),Ⅱdegree in 22 cases(33.8%),Ⅲdegree in 24 cases(36.9%) and Ⅳdegree in 8 cases(12.3%).Bilateral sacroiliac joint were involved in 54 cases(83.1%) and one side involved in 11 cases(16.9%).Early CT findings included coarse articular facet,interrupted joint cortex,vague articular face,subcortical microcysts and sclerotic articular surface,while joint space was normal.CT findings in progressive stage were uneven articular facet,serrated bony cortex,subcartilaginous bone microcysts,obviously sclerotic articular surfaces,extended joint space.In stable stage,CT findings included joint ankylosis and articular space disappearance.Conclusion CT examination is favourable for early diagnosis of AS.

Objective To explore smoking -related health knowledge and attitudes and their association with smoking behaviors among high school students in Shanghai. Methods With stratified random sampling, 9239 students aged 11~20 years old from 57 high schools (19 from each of primary, secondary and professional schools) distributing in whole city were investigated with questionnaire which self -completed anonymously by the students. The contents of the questionnaire included smoking behavior, relation between smoking and health, and attitude to tobacco control policies. Results Of those 9 239 students, there were 19.5% (male 28.2%, female 10.2%) of them who ever smoked; the total mean score of their knowledge and attitude to smoking and health-related issues was 54.42?7.274 (the maximum was 65), and the ratio of total mean score and the maximum score was 0.8065, the highest ratio (0.9767) was found in awareness that smoking was harmful and the lowest (0.3825) in awareness of tobacco control rules and regulations. The scores of each smoking and health -related knowledge and attitude were decreased with increase of cigarette number smoked by students. Compared with other high schools, the lowest scores of each indexes and the highest rate of smoking were found in vocational schools. Conclusion It was found that the smoking behavior was related with their knowledge and attitude that smoking was harmful among high school students in Shanghai. And the tobacco control and intervention should be mainly developed in students of vocational schools.

Objective To study anesthesia management in the laparoscopic excision of pheochromocytoma. Methods Thirty-seven cases of the epidural associated general anesthesia cured with diazepam 10 mg and scopolamine 0.3 mg administered 30 min before operation , anesthesia was induced with fentanyl 2?g ?kg -1 ,propofol 2mg?kg -1 , vecuronium 0.12mg?kg -1 and maintained with isoflurane,propofol and fentanyl. Vasoactive drugs were used to maintain blood pressure. All cases were sent into surgery intensive care unit after operation, ropivacaine and morphine for analgesia. Results The anesthetic effects and analgesia were satisfactory; all patients were cured. Conclusion Approach of anesthesia management in the laparoscopic excision of pheochromocytoma is feasible.

To observe the changes in mucosal blood flow and permeability after esophageal "Z"stenting, 12 adult healthy dogs were divided into two groups, and an esophageal stent was placed in each dog. Mucosal blood flow was measured with Dopplar blood flowmeter. Two hours after stenting PEG400 was instilled into the esophagus continuously under a constant pressure for two hours in the first group. The amount of PEG400 in the stented tissue was measured with gas liquid chromatography.In the second group the same experiment was carried out 24 hours after stenting. The mucosal structure was examined with electron microscope after stenting. It was found that the mucosal blood flow decreased evidently, and the amount of PEG400 was much greater in tissue after being stented as compared with that in normal esophagus. Electron microscopy revealed that the number of desmosome of epithelium decreased, and it was disrupted significantly after stenting. The interval epithelial cells were enlarged, basement membrane was damaged. Stenting might lead to evident decrease of esophageal mucosal blood flow, which significantly impaired the junction of epithelial cells and mucosal structure, and the permeability for PEG400 was increased significantly. All these findings demonstrate that stenting might impair the esophageal mucosa.

Objective To study the changes of collagen content in the esophageal tissue after stenting. Methods To select healthy adult dogs as experimental subjects.Esophageal stent was installed by the method of “autogenous fascia lata femoris transplantation and fixation",the dogs were killed at the end of 1,2,4 and 8 weeks,and the esophageal tissues with stent were taken out and studied by gross observation,light microscopy and electromicroscopy. The bulk density and distribution of collagen fiber were studied by special staining and computer technology.The content of P I CP and PⅢNP in restenosis tissue were measured by radio immunoassay(RIA).The contents of hydroxyproline and total amino acid(AA) in restenosis tissue were measured by amino acid analyser. Results At week 1 and 2 the inflammatory reaction occurred evidently in stenting esophagus with granulation and fibrosis,in some sites the esophageal tissue began to proliferate towards the lumen where the fibroblasts were in the state of active proliferation and secretion .The contents of hydroxyproline and total amino acid were significantly higher in the esophageal tissue within 1 and 2 weeks of stenting than those in normal esophagus.At week 4 and 8 esophageal lumen narrowed conspicuously,with a lot of fibrotic tissue and a little of inflammatory cells.The staining density of collagen elevated gradually within 4 weeks,there after the content of collagen was stabilized.The change of P I CP and PⅢNP accorded with that of collagen staining.The content of AA at week 4 increased significantly compared with that at week 2,its level was similar to that between 4 and 8 weeks. Conclusions Re-stenosis mainly expressed as fibrosis. At week 4,8 the fibrosis stabilized gradually with the lessening of inflammatory reaction. The content of collagen in re-stenosis tissue elevated within 4 weeks,and stablilized after week 4,it was in accordance with the pathological changes of re-stenosis.

Objective To study the expression of EGF and EGFR in restenosis tissue of animal e-sophagus after several times of stenting in esophagus, and their relation with esophageal restenosis . Methods Animal models of esophageal stenosis after stenting were made from 16 adult healthy dogs, and allocated into 4 groups to take restenosis tissue as experimental samples at week 1,2,4 and 8. In addition, other 6 normal dogs served as control. To study the expression of EGF and EGFR at protein and mRNA level in these samples by immunohistochemistry ( SABC) and RT-PCR. Results At week 1 and 2, EGF and EGFR clearly expressed, the expressing level increased greatly as compared with the normal controls, the expression of EGF and EGFR existed almost in all the tissues. At week 4 the expression lessened greatly, and finally at week 8 disappeared. The positive cells for EGF were mainly macrophages, some vascular endothelial cells and smooth muscle cells, the positive cells for EGFR were mainly macrophages, lymphocyte and Fb. Conclusion After esophageal stenting, lymphocyte, macrophage and Fb in the local tissues were closely related to restenosis, and served as the important regulatory cells in the pathogenesis of restenosis.

Objective To design a wireless oxygen concentration monitoring device to solve the existing problems.Methods The device was composed of an oxygen sensor,an oxygen sensor line,an oxygen concentration monitoring host and a display terminal.HT67F489 was used as the main control chip,KE-25 oxygen concentration sensor was applied to collecting oxygen concentration data,and then through the T82 module wireless transmission of the data was executed to the display terminal of the App software.Results Clinical trials proved the measure value by the device was the same to that by the equipped meter,which facilitated the medical engineer find the faults in the shortest time.Conclusion The device gains advantages in easy installation,stable performances,high accuracy and anti-interference against physical environment,and thus has high social and economic benefits.

OBJECTIVE To discuss the role of head hygiene for nosocomial infection control in operating room.METHODS The head band was weared to improve head hygiene,and enhance the consciousness in control nosocomial infection.RESULTS From Mar 2004 to Mar 2006 there were 2534 cases operated and 23 cases suffered incision infection(0.91%) when surgeon was without use of head band;but from Mar 2004 to Mar 2006 there were 3014 cases operated and the incision infection rate was 0.40%(12 cases) when surgeon was with use of head band.It was an effective method for reducing sweat-inducing contamination by wearing head band to control nosocomial infection in operating room.CONCLUSIONS To improve the head hygiene by wearing head band is arelatively simple practice,it can control nosocomial infection in operating room.

Objective To systematically assess the detection of K-ras gene mutation at codon 12 in pancreatic juice for diagnosis of pancreatic cancer.Methods A comprehensive electronic searching was performed to retrieve relevant studies on K-ras gene mutation in pancreatic juice for diagnosis of pancreatic cancer.Data on accuracy of included studies were extracted,Meta-DiSc1.4,Stata10.0,was applied for further heterogeneity exploring,meta-analysis and publication bias testing.Results Fifteen studies met the inclusion criteria.Heterogeneity was not found among these studies,including threshold effect,different test methods,randomization and blind.Pooled accuracy indicators like sensitivity,specificity and diagnostic odds ratio(DOR) were 0.61(95%CI 0.56-0.66),0.82(95%CI 0.77-0.86) and 6.28(95%CI 4.42-8.91),respectively.Area under curve(AUC) of SROC(summary receiver operating characteristics) was 0.8207 and Q index was 0.7542.Publication bias had little influence on meta-analysis with the fail-safe number of 694.0108.Conclusions This meta-analysis demonstrates that the detection of K-ras gene mutation in pancreatic juice has moderate effect for diagnosis of pancreatic cancer.It is not enough to be an early diagnosing or screening indicator for pancreatic cancer,but it can be used clinically as an important adjunct to cytology,imageology and enzymology in the diagnosis of pancreatic cancer.