Objective To analyze causes of complication of long bone fracture of inferior extremity treated with interlocking intramedullary nail,and put forward prophylaxis and treatment measures.Methods Retrospective research on 140 patients of long bone fracture of inferior extremity treated with interlocking intramedullary nail from Oct.2002 to Oct.2005,to find out post-operative complications and put forward prophylaxis and treatment measures.Results All fractures were bone union,and complications occurd in 25 patients.Conclusion Interlocking intramedullary nail is preferred surgery to long bone fracture of inferior extremity.

Objective To explore the effects of micro channel (mPCNL)and standard channel percutaneous lithotripsy (sPCNL)on hemodynamics and blood gas analysis in patients with renal calculi.Methods From March 2007 to June 2015,180 patients with kidney stones were selected as the research subjects,through digital said method,the patients were randomly divided into MPCNL group and sPCNL group,the former F16 plastics through established channels of percutaneous nephrolithotomy.The latter F24 plastics through established channels of percuta-neous nephrolithotomy.The changes of hemodynamics and blood gas analysis were observed and compared in the two groups during perioperative period .Results In MPCNL group ,theoperation time was significantly shorter in sPCNL group(t =-6.018),the perfusion fluid was higher than that of sPCNL group(t =20.506,P <0.05).The perfusion of MAP and CVP of the two groups were significantly lower than those before anesthesia,and irrigation flow after dif-ferent time and postoperative were significantly higher than those before hemoperfusion,60 min,120min,after opera-tion MAP value of MPCNL group,test value was as follows(t60min =5.878,t120min =6.802,tpostoperative =7.070,all P <0.05);60min,120min,after operation CVP value of MPCNL group,test value was as follows (t60min =5.987,t120min =6.505,tpostoperative =7.180,all P <0.05).60min,120min,postoperative MAP value of sPCNL group,test value was as follows (t60min =5.613,t120min =7.238,tpostoperative =7.170,all P <0.05);60min,120min,postoperative the CVP value of sPCNL group,test value was as follows (t60min =7.682,t120min =7.135,t[postoperative]=9.218,all P <0.05). Blood gas analysis showed that the two groups of postoperative Na +,Cl - compared with before anesthesia had no sta-tistically significant difference(P >0.05).Two groups of postoperative K +,pH,BE,Hb were lower than before anes-thesia,the differences were statistically significant (P <0.05).The two groups of patients with no postoperative urina-ry sepsis and other serious complications.Conclusion With the increase of operation time filling fluid absorption on hemodynamics and arterial blood gas analysis of influence gradually increased;in heart,lung and normal renal function patients,due to the compensatory organ function,caused by MPCNL and sPCNL irrigation fluid absorption differences in the amount is not enough to cause different hemodynamics and blood gas analysis.

Objective To investigate the insulin and glucagon levels in the patients with different islet cell antibody (ICA) subtypes and to explore the pathogenesis of latent autoimmune diabetes of adult (LADA). Methods Subjects were classified by immunohistology and 29 ICA-peripheral-positive DM patients, 28 ICA-diffused-positive DM patients and 17 controls (ICA-negative) were included. Serum glucose, insulin and plasma glucagon were measured at 0, 30, 60, 120 min after standard meal. Results (1) As compared with controls, glucagon in ICA positive groups were higher (both P

Objective To investigate the prevalence of macula choroidal neovascularization(CNV) in high myopia patients and the associated risk factors.Methods Fifty-six outpatients(112 eyes) with high myopia were medically examined from Mar.2008 to Jun.2009.The inspection items,including A scan,B scan,diopter and optical coherence tomography(OCT),were carried out to check whether CNV existed and its growth fashion.The patients' basic status,main symptoms and the pathologic change in macula were recorded.Results The prevalence of CNV in the 56 outpatients(112 eyes) was 14.3%.Gender showed no correlation with CNV(r=-0.015,P=0.879),while age(r=0.629,P=0.000),diopter(r=0.725,P=0.000),axial length(r=0.236,P=0.013),posterior scleral staphyloma(r=0.344,P=0.000),atrophy of choroid and retina in posterior pole(r=0.421,P=0.000),lacquer crack(r=0.421,P=0.000) and Fuchs spot(r=0.519,P=0.000) were significantly correlated with the prevalence of CNV.Conclusions CNV may highly occurred in the patients with high myopia.Posterior scleral staphyloma,atrophy of choroid and retina in posterior pole,lacquer crack,Fuchs spot,age,axial length and diopter seem to be the risk factors for the occurence of CNV.

Objective To assess the public health service quality objectively in Shenzhen,and promote the equity of basic public health services.Methods The criterion and method of the assessment were established by municipal health administrative department,the assessment of institutions and regions were conducted by experts selected by municipal professional institutions.Regional assessment was the comprehensive evaluation of public health service qualities of professional public health institutions,medical institutions and the community health centers.The assessment of the degree of public health service quality satisfaction was accomplished by a third-party institution.Results The accomplishment ratio of indicators for public health service quality was 93.2％.This ratio has witnessed a high increase with mental health institutions,occupational disease prevention and control institutions and health education institutions on one hand.On the other,it has dropped with institutions of disease control,chronic disease control and medical institutions within the region.On the whole,this ratio has increased with all the districts to different extents.Despite the overall improvement of public health capabilities citywide,imbalances are found among districts and institutions as well.Conclusion It is imperative to further improve the public health service system and equity while carrying out specific tasks in this respect.

Objective To discuss the method and surgical technique in treatment of the displaced acetabular fracture.Methods The study involved 66 patients with displaced acetabular fracture treated operatively with reconstruction plates from August 2005 to June 2009.Based on the fracture typing,the surgical techniques including anterior ilioinguinal,posterior Kocher-Langenbeck,combined ilioinguinal and Kocher-Langenbeck and Y shaped approach were performed in 12,30,22 and 2 patients,respectively.Results The operation time was mean 3.4 hours(1.5-6.5 hours),with mean blood loss of 550 ml(range,350-1 200 ml).All patients were followed up for average 29 months(range,12-46 months).According to Matta evaluation standard,the reduction of acetabular fracture was anatomical in 34 patients,imperfect in 25 and unsatisfactory in seven.According to the modified Merled' Aubigne and Postel clinical evaluation standard,the clinical outcome was graded as excellent in 23 patients,good in 29,fair in eight and poor in six.Conclusion The factors key to successful operation include correct fracture classification,good approach anatomy,proficient technique of reduction and fixation,and reasonable perioperation measures.

Objective To explore the diagnosis,treatment,risk factors and prognosis factors of postpancreaticoduodenectomy hemorrhage (PPH).Methods The retrospective case-control study was adopted.The clinical data of 703 patients who underwent pancreatoduodenectomy at Hospital 401 of the People's Liberation Army from January 2008 to July 2013 were collected.Standard pancreatoduodenectomy was carried out for the malignant tumors of the head of pancreas or ampulla,pylorus-preserving pancreatoduodenectomy was operated for the benign tumor or the duodenal papilla tumor.The corresponding treatment was adopted for PPH.The observation indicators included:(1) the surgical situation (surgical method,operation time and the volume of intraoperative blood loss),(2) diagnosis of PPH,(3) treatment of PPH,(4) univariate and multivariate analyses for the risk factors affecting the occurrence of PPH,(5) univariate and multivariate analyses for the risk factors affecting prognosis of PPH patients.The measurement data with normal distribution were represented as x ± s.The measurement data with skewed distribution were represented as M (range).The chi-square test or Fisher exact probability was used for univariate analysis.Logistic regression model was used for multivariate analysis.Results (1) The surgical situation:among 703 patients,409 patients underwent standard pancreatoduodenectomy and 294 underwent pylorus-preserving pancreatoduodenectomy,including 1 combined with right hemihepatectomy,27 with portal vein reconstruction and 2 with hepatic artery reconstruction.Pancreaticojejunostomy was applied to 658 patients using mucosa anastomosis of the pancreatic duct to jejunum and 45 patients using invagination anastomosis.Supporting tube was routinely deposed in the pancreatic duct,598 patients had internal drainage and 105 patients had external drainage.The end-to-side anastomosis between common bile duct and jejunum was used for choledochojejunostomy.The 409 patients received the gastrojejunostomy using side-to-side anastomosis of gastric part and jejunum and 294 patients using end-to-side anastomosis of duodenum and jejunum.Operation time and volume of intraoperative blood loss were (324 ± 54) minutes and (428 ± 118) mL.(2) The diagnosis of PPH:among 703 patients after pancreatoduodenectomy,62 patients had PPH,the hemorrhage reasons of 38 patients had been identified,and the hemorrhage reasons of 24 patients had not been identified (A level in 5 patients,B level in 17 patients,C level in 2 patients).① The site of hemorrhage:the hemorrhage outside the cavity were detect in 27 patients,the hemorrhage inside the cavity in 28 patients,and the hemorrhage from both outside and inside part of the cavity in 7 patients.② The time of hemorrhage:early-stage hemorrhage were detected in 5 patients and the delayed hemorrhage in 57 patients.③The volume of postoperative blood loss was (885 ± 253)mL,30 patients had mild hemorrhage and 32 patients had severe hemorrhage.④ The clinical classification of PPH:5,32 and 25 patients were detected in level A,B,C,and 19 patients combined with sentinel hemorrhage.(3) The treatment of PPH:①5 patients with PPH in A level were given clinical observation,blood volume supplement and other treatment,then the symptoms gradually turned better.② Among 32 patients with PPH in B level,15 patients became better after symptomatic and supportive treatments,6 patients received successful hemostasis after guglielmi detachable colis embolization,4 patients received successful hemostasis under gastroscopic hemostasis,7 patients received emergency exploratory laparotomy.Thirty-two patients were improved and then out of hospital after treatment,without occurrence of death.③ Among 25 patients with PPH in C level,4 patients received successful hemostasis after guglielmi detachable colis embolization,17 patients received hemostasis by emergency exploratory laparotomy,4 patients with undiscovered bleeding points received the treatment of fluid infusion,blood volume supplement and antacid.Among 25 patients after corresponding treatment,10 patients were improved and 15 patients were dead.(4) The result of univariate analysis showed that the combined hypertension,vascular resection and reconstruction,postoperative pancreatic leakage and postoperative intraabdominal infection were risk factors affecting the occurrence of PPH (x2 =4.950,5.300,7.568,5.505,P ＜ 0.05).The results of multivariate analysis showed that the combined pancreatic leakage and postoperative intraabdominal infection were independent risk factors affecting the occurrence of PPH [OR =2.761,2.216,95％ confidence interval (CI):1.389-5.489,1.198-4.101,P ＜ 0.05].(5) The risk factors affecting the prognosis of PPH patients:the results of univariate analysis showed that postoperative sentinel hemorrhage,postoperative pancreatic leakage,site,degree and level of hemorrhage were risk factors affecting the prognosis of PPH patients (x2 =8.022,4.448,11.853,18.551,28.285,P ＜ 0.05).The results of multivariate analysis showed that postoperative sentinel hemorrhage and site of hemorrhage (outside and inside part of the cavity) were independent risk factors affecting the prognosis of PPH patients (OR =5.550,0.233,95％ CI:1.595-19.314,0.086-0.635,P ＜ 0.05).Conclusions Pancreatic leakage and intraabdominal infection are independent risk factors after pancreatoduodenectomy.The treatment effect of the early-stage hemorrhage is better than that of the delayed hemorrhage,and angiographic embolization is the first choice of diagnosis and treatment for the delayed hemorrhage.Sentinel hemorrhage could result from aneurysm or continuous arterial hemorrhage of vascular erosion,it is the independent risk factor affecting the death of hemorrhage after pancreatoduodenectomy.

Objective To investigate the clinical efficacy of atlantoaxial pedicle screw fixation plus bony fusion in treatment of traumatic upper cervical instability.Methods From October 2009 to August 2013,29 patients with traumatic upper cervical spine instability were treated with posterior atlantoaxial pedicle screws.The patients underwent autografting (n =19) and allografting (n =10) for spinal fusion.Surrcal outcomes were recorded including intraopcrativc blood loss,operation time,with or without nerve,blood vessel and spinal cord injury,wound healing and bone fusion rate.Results All operations were completed smoothly with operation time of 110 minutes (range,85-135 minutes) and blood loss of 150 ml (range,80-500 ml).At the follow-up of 10 months to 5 years (mean 18 months),bony fusion was detected for all the patients.Postoperative radiographs verified all patients were bony fusion with satisfactory cervical spine stability.No complications of reduction loss,fixation failure,and spinal cord or vertebral artery injury were observed except for 1 patient with low viruleut infection and 2 with delayed wound healing.Conclusion Single posterior atlantoaxial pedicle screw fixation provides security and reliable stability in treatment of upper cervical instability,however wound healing problems should be taken seriously.

Objective To explore the surgical treatments through anterior and posterior approaches for anterior and posterior compression of cervical spinal cord. Methods The clinical data of 25 cases of anterior and posterior compression of cervical spinal cord from June 1999 to November 2003 were summarized retrospectively. There were 18 males and seven females with age range of 28-56 years (average 36.4 years). Of all,18 cases were with tricolumnae fractures of cervical spine caused by traffic injury,five with cervical herniation and two with malignant macrophage tumor in vertebral body and annex and vertebral lamina. Results All 25 cases underwent internal fixation decompression with I-stage combination operation of anterior and posterior approaches. Of 18 cases with tricolumnae fractures,one died and 17 recovered in various degrees. In five cases with cervical herniation,the positive sign disappeared basically. Two cases of malignant giant-cell tumor appeared metastatic carcinoma in the lungs 10 months after operation. Conclusions The I-stage combination operation of anterior and posterior approaches is an ideal way for the patients suffering from anteropsterospinal compression in cervical spinal cord. It can not only decompress completely the cervical spinal cord,stabilize the wounded cervical vertebra,but also facilitate nursing and function training and be beneficial to the recovery of spinal cord function.

Background Whether serum uric acid are related with ischemic stroke in essential hypertension (EH) is controversial. Objective To delineate the relationship between serum uric acid and ischemic stroke in EH. Methods A retrospective study was conducted in a cohort of 729 EH patients. Patients were classified into four groups according to serum uric acid level. The odds ratio for ischemic stroke was calculated with the lowest quartile as the reference. Results The prevalence of ischemic stroke in EH with quartile 4 of uric acid was higher than that in EH with quartile 1(37.9% vs 17.6%,P