Objective To investigate the process of Stark cesarean section (CS) and analyze its key procedures and patients outcomes in order to understand its advantages and promote its standardization. Methods Elective Stark CS cases were divided into two groups according to time sequence and procedure difference. Group A refered to cases underwent modified approaches before standardization (n=362), and group B refered to cases afterward (n= 302). Duration of operation, time interval from incision to delivery, intraoperative hemorrhage, postoperative flatus time, postoperative morbidity, duration of retained urinary catheter, urinary tract irritation, wound infection, and abdominopelvie adhesion in the second operation were compared between the two groups. Results The average duration of the operations and time interval from incision to delivery in group B, which were (27.7± 10. 8) min and (4.92±1.21) min, respectively, were significantly shorter than those in group A, which were (35.6±15.2) min and (7.81±2. 79) min, respectively (P<0. 05). No significant differences was found with regard to average intraoperative hemorrhage between group A and B [(214.34±62. 1) ml vs (201.54-53.1) ml, P>0.05]. Postoperative flatus time in group B was significantly shorter than that in group A [(16.85±11.8) h vs (25.9±12. 7) h, P<0. 05]. Postoperative morbidity in group B was significantly lower than that in group A [1.3%(4/302) vs 4.7%(17/362), P<0.05]. The average duration of retained urinary catheter in group B was significantly shorter than that in group A [(15.6±5.3)h vs (26. 2±6.1)h, P<0. 05], and the urinary tract irritation rate in group B was also lower than that in group A [2. 5%(9/362) vs 0(0/302), P < 0. 05)], No incisional infection or delayed healing was found in either group. Rectus muscles, fascia and peritoneum adhesions were found in three cases with second surgery in group A and none in group B. No omentum, peritoneum and visceral peritoneum adhesion was found in either group. Conclusions Compared to the modified Stark operation, standardized procedure decreases operation associated complications and improves maternal outcomes. Therefore, standardized Stark CS should be promoted for better operative outcomes.

Objective To analyze clinical Value of serum homocysteine(Hcy)and cystatin C(Cys C) in patients with cerebral in‐farction .Methods From August 2010 to December 2014 ,our hospital 118 patients with cerebral infarction and 62 healthy subjects for the study were divided into the control group and the observation group .The observation group was further divided into light , medium and heavy groups .Test results for the two groups were related to the study of serum homocysteine and Cys C were ana‐lyzed separately and compared between two groups of Hcy levels Cys C contact with cerebral infarction .Results Serum Hcy ,Cys C levels significantly higher in the observation group than that of control group ,differences were statistically significant(P<0 .05);The serum Hcy ,Cys C of patients with severe cerebral infarction group were significantly higher than that of light and medium cer‐ebral infarction group;Serum Hcy ,Cys C levels of patients with medium cerebral infarction group were also significantly higher than the light cerebral infarction group ,differences were statistically significant(P<0 .05) .Conclusion The serum Hcy and Cys C has important clinical value of detecting the disease assessment and treatment of patients with cerebral infarction .

Objective: To explore diagnostic value of dynamic electrocardiogram (DCG) on coronary artery disease. Methods: A total of 100 inpatients with “angina pectoris” history from our hospital were enrolled and received 24h DCG measurement. The DCG examination results were compared with those of coronary angiography (CAG) and analyzed then. Results: Among the 100 patients, there were 85 patients with positive DCG, including 70 cases with positive CAG and 15 cases with negative CAG; and 15 patients with normal (negative) DCG, including 10 cases with negative CAG and five cases with positive CAG. With CAG as golden standard, sensitivity, specificity, positive predictive value (accuracy) and negative predictive value of DCG in diagnosis of coronary heart disease were 93.3%, 40.0%, 82.4% and 66.7% respectively. Partial patients had “angina pectoris”, no stenosis in CAG but there’s slow blood flow. Conclusion: Dynamic electrocardiography is one of important measuring methods diagnosing coronary heart disease. It is simple, practical, safe, economic and appropriate for wide application in clinic, but its specificity is just 40.0%, so coronary heart disease cannot be excluded in negative patients.

Clinical teaching and studying is suffering increasing hardship.This article analysises the present condition of clinical education problems and causes,and researches whether patients are obliged to coorperate clinical teaching and studying when they protect their rights.It also researches how to practice clinical teaching and studying in educational hospital and looks for effective pathway to go out of the clinical education problem.

AIM: To establish a RP-HPLC for determing the contents of naringin,hesperidin and baicalin in Qingfei Huatan Pill(Arisaema Cumbile,Fructus Aurantii,Pericarpium Citrireticulatae,Radix Scutellariae,etc.). METHODS: Naringin,hesperidin and baicalin were separated on a RP C_(18) column.Acetonitrile-water(20(∶)80)(adjusted to pH 2.2 with phosphoric acid) was used as the mobile phase.The detective wavelength was set at 280 nm. RESULTS: The linear ranges were in 1.24-6.2 ?g for naringin (r=(0.999 7))、1.1-5.5 ?g for hesperidin(r=(0.999 8)) and 2.32-11.6 ?g for baicalin(r=(0.999 9)).The recoveries were 99.29% with RSD of 1.78% for naringin、100.08% with RSD of 1.44% for hesperidin and 98.76% with RSD of 1.42% for baicalin respectively. CONCLUSION: The method is simple,accurate and reproducible.It may well be used for the quality control of this product.

OBJECTIVE:To provide theoretical support for the scientific and reasonable policy-making of 23-valent pneumococ-cal polysaccharide vaccine(PPV-23)in elderly. METHODS:Retrieved from CJFD,Wanfang Database,Elsevier and PubMed,lit-erature about the pharmacoeconomics evaluation of PPV-23 in elder were selected and statistically analyzed in respects of cost stud-ies,effect indexes and research perspectives. RESULTS:Totally 13 literatures were included,involving 900 472 patients,who were older than 60 years old. Study locations were mainly Colombia,the United States,Italy,Belgium and China. Study results showed,each additional quality-adjusted life-year(QALY)cost was between $ 9 239-$ 33 000 in respect of cost;cost-effectiveness ratio was between $ 9 239-$ 45 161/QALY in respect of effect indexes. Most researches showed PPV-23 in elderly older than 65 years old had certain cast-effectiveness. Only a research in Netherlands held the idea that PPV-23 in elderly was not considered cost-effectiveness.CONCLUSIONS:Putting PPV-23 inelderly has certain cost-effecctiveness and most countries has put it into nation-al immunization program. The present researches can't ensure the economy of putting ppv-23 in elderly in china,so it needs more researches with high quality to ensure it.

Objective In this study,the phenotype heterogeneity of 2 male patients with X-linked Alport syndrome from one family was analyzed and the likely reasons were discussed by reviewing the literature.Methods The clinical data at the time of diagnosis and during 5 years follow-up of 2-male patients with X-linked Alport syndrome from one family were collected.The α5 (Ⅳ) chain expression in the epidermal basement membrane was detected by indirect immunofluorescence method.COL4A5 gene mutations in skin fibroblasts and genomic DNA were detected by using reverse transcription polymerase chain reaction and direct sequencing and PCR sequencing methods from skin fibroblasts and genomic DNA,respectively.Results The diagnostic age of patient Ⅲ 1 was 14 years old.He had only microscopic hematuria,and proteinuria was negative.A negative α5 (Ⅳ) chain staining pattern was detected in his epidermal basement membrane.After 5 years follow-up without drug treatment,he was 19 years old,had persistent microscopic hematuria and normal renal function.The urinary microalbumin was 19.2-31.8 mg/L.The diagnosis age of patient Ⅱ 4 was 29 years old.The hematuria and proteinuria were found at 22 years old.He was treated with tripterygium wilfordii for 1 year.His disease progressed to an end stage of renal disease and he received hemodialysis therapy at 24 years old.He had the renal transplantation surgery at 29 years old,just 2 months before he came to hospital.And his renal function was restored.After 5 years follow-up,his urine examination and renal function were normal.Both patients had a missense mutation c.3650G ＞ A(p.G1217D) in exon 41 in COL4A5 gene.Conclusions The different phenotypes of 2 male patients from one family with X-linked Alport syndrome were reported.The most possible reason for this is somatic mosaic variants in COL4A5 gene based on literature review.Physicians should be alert to phenotype heterogeneity in male X-linked Alport syndrome despite having the same gene mutation.

Objective: To evaluate the clinical effectiveness of multi-directional mechanical traction (MT) for the treatment of patients with lumbar disc herniation (LDH) compared with longitudinal traction (LT) as control. Method: This prospective, single-blind, randomized clinical trial was performed in Qi Lu Hospital, Shandong University from January 2008 to December 2008. One hundred and twenty outpatients with LDH were randomly divided into MT group or LT group. MT group was treated with computer-controlled multi-directional mechanical traction.LTgroupwastreatedwithlongitudinaltraction.RolandMorrisLowBackPainandDisability Questionnaire (RMDQ), visual analogue scale (VAS), and straight leg raising (SLR) angle were measured for every patient pre-, 4 weeks post-, and 1 year post-treatment.Result: The results of clinical observations showed significant improvements inRMDQ, VAS, and SLR angle assessments (all P＜0.05) in both groups 4 weeks post- and 1 year post-treatment compared with pre-treatment. Score of RMDQ in MT group was significantly lower than that in LT group(P＜0.05), however, there was no significant difference between two groups in VAS score and SLR angle (P＞0.05). The differences in improvement ratios between two groups were not significant (all P＞0.05). The clinical outcomes were negatively correlated with patient's age and disease duration.Conclusion: The effect of MT is equivalent and probably superior to that of LT in improving the symptoms and clinical findings of patients with LDH.

Objective To investigate the clinical value of laparoscopic treatment of myoma in the broad uterine ligament.Methods A retrospective comparison was made on clinical data between 26 patients who had received laparoscopic enucleation of myoma in the broad uterine ligament and 12 patients who had received traditional open resection in the same period.Results Both laparoscopic and traditional operations were successfully completed.As compared with open surgery,the laparoscopic surgery had longer operative time(92.5?15.8 min vs 63.0?15.8 min;t=5.350,P=0.000),similar blood loss during operation(99.2?32.9 m1 vs 91.7?30.7 m1; t=0.667,P=0.509),and shorter time of postoperative hospital stay(4.5?0.7 d vs 7.7?0.9 d;t=-11.960,P=0.000),respectively.Conclusions Laparoscopic enucleation of myoma in the broad uterine ligament is safe and effective and offers a rapid postoperative recovery.

Objective: To work out a screening checklist for childhood autism and explore its reliability and validity. Methods: Items were selected based on the knowledge of clinical manifestation and diagnostic criteria of childhood autism. The autism diagnostic interview-revised version was used to refine the draft. Three groups (childhood autism, mental retardation and normal control) were used to test the reliability and validity of the new screening tool. Results: The checklist had satisfying reliability including good inter-rater reliability, test-retest reliability, split half reliability and internal consistency. The differential validity of the checklist and the differential diagnostic validity of the items were good, so as the construct validity and the criterion validity. The cut-off point for screening and diagnosis were 21 and 24 respectively. Conclusion: The childhood autism checklist has good reliability and validity, and fit for the situation of Chinese children with the disorder.