Objective To explore clinical effects of transcatheter aneurysm embolization and cerebrospinal fluid replacement therapy for the treatment of subarachnoid hemorrhage .Methods Clinical path data of 85 cases of subarachnoid hemorrhage patients from January 2010 to August 2012 were analyzed ,and all were used transcatheter aneurysm embolization and cerebrospinal fluid re-placement therapy to observe the clinical effects .Results A total of 85 patients with 84 cases were cured or improved(98 .82% ) , died in 1 case(1 .18% ) and occur complications in 10 cases(11 .76% ) .68 cases of those were followed up for 0 .5-2 .0 years and no case occurred rebleeding .85 patients were hospitalized for 10 to 40 days ,and the average hospital stay was(17 .5 ± 13 .0)d .Conclu-sion Transcatheter aneurysm embolization is a safe ,effective method treating subarachnoid hemorrhage ,combined with cerebrospi-nal fluid replacement therapy to shorten the course ,reduce complications and improve the cure rate .

Medical ethics courses play a main channel role in the cultivation of applicable medical profession-als, who have both virtue and professional competence. To adapt to clinical medical education comprehensive re-form on the need for educating and training outstanding doctor and strengthen medical students′professional ethics and ethical practice ability, we must further optimize the medical ethics teaching reform:optimizing medical ethics education philosophy that to enhance the students′ability of ethical practice as the goal;optimizing implementation of the interactive case teaching that to strengthen the students′ethical thinking and decision-making skills as the basis;optimizing the channels and methods of research that to strengthen the students′ability of scientific research ethics as the promotion;optimizing evaluation method of medical ethics that to strengthen the formative assessment methods as the sudden breaking.

OBJECTIVE To obtain primary knowledge of drug resistance to aztreonam(ATM) in commonly encounterd Gram-negative bacilli in our hospital thereby to bring the situation under control.METHODS A total of 3 928 strains of pathogenic bacteria were isolated from patients from 2001 to 2005,and drug resistance of these strains to ATM was examined.RESULTS Resistance of Pseudomonas aeruginosa,Klebsiella pneumoniae,Enterobacter cloacae and Acinetobacter spp to ATM was found to be tend increasing from 13%,14%,29% and 40% in 2001 to 28%,29%,40% and 77% in 2005.CONCLUSIONS The percentages of commonly encountered Gram-negative bacilli that are resistant to ATM have been considerably high and tend to increase further.ATM abuse needs to be given appropriate attention to.

Objective To explore the differences of using different analytic quality requirements in the comparable validation of blood cell analysis multi-system range test comparable schemes for establishing appropriate analysis quality standards for laboratory.Methods According to WS/T 407-2012 Guideline for Comparability Verification of Quantitative Results in Medical Institution,the range test comparable method was established.According to different sources of analytic quality requirements from the WS/T 406-2012 Analysis Quality Requirements of Clinical Hematological Detection Routine Items,the US Clinical Laboratory Improvement Amendment (88),GB/T 20470-2006 Requirements of External Quality Assessment for Clinical Laboratories and biological variations,corresponding analysis quality requirements standard was designed.Results With the standards designed by using WS/T 406-2012,CLIA′-88 and GB/T 20470-2006 as the analysis quality requirements,only the comparison results of low concentration levels in 3 items of HBC,PLT and HCT were not passed,while other results all were passed;all results passed the consistency verification by suitably revising the analytic quality requirements of low value concentrations.With the biological variations as the analysis quality requirement,the comparison results in WBC three concentration levels,and HBG high and low concentration levels were passed,but other results were not passed.Conclusion The biological variations analytical quality requirements are relative demanding.Using WS/T 406-2012 Analysis Quality Requirements of Clinical Hematological Detection Routine Items and GB/T 20470-2006 Requirements of External Quality Assessment for Clinical Laboratories,fully considering the suitability of low concentration quality requirements and formulating appropriate analysis quality standards of laboratory are the important contents of laboratory comparable validation scheme.

Objective To explore the relationship among HBV DNA load, HBeAg/Anti-HBe and ALT in patients with chronic hepatitis B infection. Methods HBV markers in 134 patients with chronic HBV infection were detected by ELISA,and patients were divided into group Ⅰ (HBeAg +/Anti-HBe-,43 patients) ,group Ⅱ (HBeAg-/Anti-HBe + ,69 patients)and group Ⅲ (HBeAg-/Anti-Hbe-,22 patients)according to the results of presence of HBeAg/Anti-HBe. HBV DNA load and ALT were tested respectively by fluorescence quantitative polymerase chain reaction technology and successive monitor reaction. Results Both the positive rate and the HBV DNA load quantification in group Ⅰ were higher than in group Ⅱ and Ⅲ (P＜0.01). Abnormality rate of ALT in HBV DNA positive patients was higher than the patients with HBV DNA negitive(P＜0.01). There was no relationship between HBV DNA load and ALT in HBV DNA positive patients. Conclusion There was a certain corelation among HBV DNA load, HBeAg/Anti-HBe and ALT,but the active degree of HBV replication could not to be assessed by HBeAg/Anti-HBe or ALT alone. It was necessary for the padient with chronic HBV infection to examine them together.

Objective To investigate the therapeutic effects of orthotopic urinary diversion in women. Methods From September 1995 to December 2003,34 female patients (mean age,58 years;range,53-64 years) with bladder cancer were included.Of them,30 cases were of primary tumors and 4,of recurrent ones.Pathology showed transitional cell carcinoma in 30 cases,bladder adenocarcinoma in 3 and squamous cell carcinoma in 1.Radical cystectomy was performed in all the 34 cases;and the technique of cystectomy with nerve-sparing was performed in 24 of them. Intraoperative frozen section of the distal urethra surgical margin showed no evidence of tumor,and ileal neobladder was formed in all.The clinical therapeutic effects were analyzed retrospectively. Results The mean operative time was 360 min(range,280-420 min),and mean blood transfusion was 600 ml(range,300-1000 ml).Thirty cases were followed up for a mean of 61 months(range,6-108 months).At 6 months after surgery the continence rate was 90%(27/30) during the day and 86%(26/30) at night.Twenty-three cases could empty the neobladder one time and 2 needed intermittent catheterization due to hyper-continence; the other 5 needed pushing the abdomen to empty the neobladder. Twenty-three patients had good urodynamic findings;the vesical capacity ranged 300-520 ml and maximum intravesical pressure were

Objective To investigate the feasibility and clinical effects of laparoscopic operation for liver rupture . Methods A retrospective analysis was made on 62 cases of traumatic rupture of liver in this hospital from June 2012 to April 2014.The techniques of hemostasis included coagulation , hemostasis gauze packing , rupture suture , hepatic artery ligation , and debridement hepatectomy. Results The laparoscopic operation was successfully completed in 56 cases, with a success rate of 90.3%(56/62). Conversion to open surgery was required in 6 cases due to massive hemorrhage and difficult location of lesions , including 2 cases of grade Ⅲliver rupture , 3 cases of grade Ⅳ, and 1 case of grade Ⅴ.Patients with liver rupture of grade Ⅰ and Ⅱwere all operated without conversions to laparotomy .One patient with grade Ⅲwas complicated with biliary leakage .In patients with grade Ⅳ, one was complicated by biliary leakage and another by obstructive jaundice .In patients with grade Ⅴ, one was complicated by systemic multiple organ dysfunction leading to death and another by biliary tract bleeding who was cured by active symptomatic treatment .The complication rate was 8.1%(5/62).The mortality rate was 1.6%(1/62).All the patients were followed up for three months .All the patients recovered well . Conclusion For grade Ⅰ,Ⅱ, andⅢliver rupture , laparoscopic surgery is safe and feasible .But for grade Ⅳand Ⅴpatients, laparoscopic surgery bears high rates of converting to open operation and postoperative complications , so we suggest open surgery as the first choice .

Objective:To understand the present situation of the grassroots medical personnel satisfaction during the implementation of new health care reform , and compared with the survey of 2011 , to further analysis the main factors of affecting the job satisfaction .Methods:Conducted a questionnaire survey to 326 employees of basic medi-cal institutions of Weifang city , Dongying city and Yantai city in Shandong Province , and study with the method of qualitative analysis and quantitative analysis .Results:The number of satisfied with the current basic medical work only is 5.2%, and the overall satisfaction rate is 38.04%.The overall satisfaction to compensation rate is 31.3%. The overall satisfaction to the relationship between doctors and patients is 36 .19%.The overall satisfaction to the hospital management system and performance appraisal is respectively 44 .17%and 40 .79%.Conclusions:Com-pared with the investigation results in 2011 , the overall satisfaction of the grassroots medical personnel has im-proved, but the overall satisfaction is not high .It puts forward constructive countermeasures: strengthen grass -roots hospital ability and talent building;strengthen the policy stability;improve the grassroots personnel′s reasona-ble salary;improve the occupation environment;protect the doctors′interests.

Objective To explore the clinical significance of plasma LP (a) ,Hcy ,hs-CRP and cTnI concentrations in patients with AMI .Methods Plasma LP(a) ,Hcy ,hs-CRP and cTnI concentrations of 162 patients with AMI and 165 healthy people recrui-ted as control group were determined .Immunofluorescent dry quantitative method and electro-chemiluminescence immunoassay were used in the determination ,and statistical analysis were used in data comparison .Results Before treatment ,the plasma LP(a) , Hcy ,hs-CRP and cTnI concentrations in 162 AMI patients were significantly higher than those in control group (P<0 .01) .After treatment ,the plasma hs-CRP concentrations in 97 improved patients returned to normal (t=1 .586 ,P>0 .05) ,but the plasma cTnI concentrations significantly decreased (t=3 .322 ,P<0 .01) .The plasma Hcy ,hs-CRP and cTnI concentrations in 36 died patients were significantly higher(P<0 .01) .Conclusion Plasma LP(a) ,Hcy ,hs-CRP and cTnI determination were valuable for the diagno-sis of AMI patients ,the most valuable indicators for patient prognosis and follow-up were plasma hs-CRP and cTnI .

Objective To determine the optimal volume of plasma that should be used to perfuse through the portal vein (PV) to washout preservation fluid in retrograde reperfusion during liver transplantation.Methods The clinical data of S0 patients who underwent orthotopic liver transplantation (OLT) using retrograde reperfusion via the inferior vena cava (IVC) in our hospital from January 2011 to October 2013 were retrospectively analyzed.The patients were divided into two groups based on the volume of plasma infused via the PV to flush out the preservation fluid.Group 1:27 patients who received 400 ml,and Group 2:23 patients who received 1 200 ml.The preoperative and intraoperative data of the two groups were compared and analyzed.The serum concentrations of K+,Na+,Ca2+,mean arterial pressure (MAP) and pH were continuously monitored in the transplant recipients at different time points during liver transplantation.In addition,for patients in Group 2,the serum K +,Na + and Ca2 + concentrations in the samples of effluent fluid from the liver grafts were collected via the anastomotic stoma of the infrahepatic IVC and measured after infusion of 200 ml,400 ml,600 ml,800 ml,1 000 ml,or 1 200 ml of plasma.Results There were no significant differences in the preoperative and intraoperative data between the two groups.The plasma concentration of K + in Group 1 was significantly higher than that of Group 2 at 1 min after PV revascularization (T3) [(4.31 ± 0.54) mmol/L vs (3.96 ± 0.58) mmol/L,P ＜ 0.05],while the pH was significantly lower in Group 1 than that of in Group 2 (7.26 ± 0.02 vs 7.30 ± 0.04,P ＜ 0.05).The plasma Na + and Ca2 +concentrations,as well as the MAP,were not significantly different between the two groups at this time point.In group 2,no significant changes were observed in Ca2+ concentration in IVC blood following perfusion of 200 ml plasma.The insignificant changes in Na + after perfusion of 400 ml of plasma and for K + after 800 ml of plasma (P ＞ 0.05).Conclusions The electrolyte concentrations,blood pressure and arterial blood pH were fairly normal after resuming flow with PV revascularization after a perfusion volume of 800 ml of plasma.This volume was the most appropriate perfusion volume,balancing its effectiveness with economy to wash out any UW solution during OLT using retrograde reperfusion.