OBJECTIVE To investigate the nosocomial infection circumstance in the acute cerebral vascular accident(CVA) in recently two years,and explore the risk factors of nosocomial infection,so that can obtain the methods of controlling the infection.METHODS An restrospective analysis of nosocomial infection circumstance had been accomplished among 656 acute CVA cases from our department ward from Jul 2004 to Jun 2006.RESULTS It was showed cases with nosocomial infection were found among 656 cases.The nosocomial infection rate was 32.67% among inpatients of acute CVA.Nosocomial infection mostly took place within the first 2 weeks after patients hospitalized.Among inpatients with nosocomial infection,the lower respiratory tract infection was the highest(59.15%),the second one was the urinary tract(16.90%).Pathogenic bacteria were mostly the conditional ones.Nosocomial infection was closely related with such factors as the invasive operation,disorder of consciousness,diabetes,age,chronic bronchitis,antibiotic prophylaxis,hospitalization days,and plasma total protein.CONCLUSIONS Nosocomial infection is still a high frequent complication in acute CVA and those related factors should be paid attenion.It is the most important step for the effective control of nosocomial infection and rehabilitation of acute CVA.

Guided by TCM treatment on the basis of syndrome differentiation, the author has treated 33 cases of hysteromyoma, which are divided into stagnation of liver-qi and blood stasis (SLQBS) type, and qi-deficiency and blood stasis (QDBS) type, by acupuncture-moxibus -tion and Tuina. After 3 therapeutic courses, the total ef -fective rate is 81.8%. The therapeutic effect has no close relationship with the TCM syndrome differentiation.

Objective To compare merits and shortages between minimally invasive small incision surgical repair and interventional device closure for isolated secundum atrial septal defect (ASD). Methods A retrospective analysis was made on clinical results of 69 patients with isolated secundum ASD from January 2004 to June 2006. Among them 37 patients underwent minimally invasive small incision surgical repair on the beating heart (Small Incision Group) and 32 patients underwent interventional device closure of ASD (Interventional Group). Results There were no deaths in either group. The small incision surgical repair was successfully completed in all the 37 patients, with the procedure time, cardiopulmonary bypass time, and hospital stay being 145.86?27.84 min, 35.11?8.45 min, and 15.46?3.09 d, respectively. Major and minor complications occurred in 2 and 6 patients, respectively. The hospitalization costs was 21 900?3600 yuan. In the Interventional Group, the closure was successfully performed in 30 out of 32 patients. The procedure time and hospital stay were 88.59?7.75 min and 10.81?5.02 d, respectively. Major and minor complications occurred in 1 and 2 patients, respectively. The hospitalization costs was 27 800?3900 yuan. Follow-up observations were performed in the Small Incision Group for 3~12 months in 20 patients and for 12~30 months in 17 patients, and in the Interventional Group for 3~12 months in 16 patients and for 12~30 months in 14 patients. No residual shunt was found. Conclusions Both of minimally invasive methods are safe and effective for isolated secundum ASD. Small incision surgical repair involves lower costs, higher successful rate, and broader indications, whereas interventional device closure offers shorter hospital stay, milder trauma, and better cosmetic results.

OBJECTIVE To explore the risk factors and control strategies of nosocomial infection in clinical immunology laboratory.METHODS The positive detection rates of HBV marker and antibodies to HAV,HCV,HEV,HIV,TP,and TB in total of 91 877 samples in clinical immunology laboratory during Jul 2004 and Jul 2005 were retrospectively surveyed and statistically analyzed.RESULTS The number of positive specimens of HBV marker and antibodies to HAV,HCV,HEV,HIV,TP,and TB were respectively 8 376,7,26,24,107,3,522,and 52 and the positive detection rates of these items were respectively 16.68%,0.43%,0.20%,2.22%,6.49%,0.03%,4.75%,and 4.61%.CONCLUSIONS It is very important to understand the infection sources and risk factors in clinical immunology laboratory in order to strengthen management of hospital infection and protection of occupational exposure.

OBJECTIVE To investigate the current situation of sporadic hepatitis E and analyze its epidemiologic feature among inpatients in our hospital from 2002 to 2004. METHODS The clinical records of inpatients with positive results of HEV-IgM and diagnosed for sporadic hepatitis E during the period of Jan 2002 to Dec 2004 were analyzed with epidemiological method. RESULTS Totally 329 inpatients′ HEV-IgM antibody was positive among(4 641) detected inpatients′ sera.There were 239 male inpatients who accounted for 72.64% and(90 female) inpatients who accounted for 27.36% of the total inpatients whose HEV-IgM antibody was positive.There were 272 inpatients,presenting rate of 82.67%,comed from rural areas and 57 inpatients,presenting rate of 17.33%,comed from urban areas.The case rate of sporadic hepatitis E was respectively 4.92%,6.93% and 9.17% from 2002 to 2004. CONCLUSIONS The incidence of hepatitis E is increasing in recent years,in which male inpatients are higher than females′ and rural inpatients are higher than urban ones.

OBJECTIVETo discuss the necessity of MRI as a routine examination for diagnosis of glomus tumor.

METHODSFrom Nov. 2013 to July 2014, 7 cases of glomus tumor were treated in our department. All patients had typical clinical symptoms of glomus tumor and received preoperative X-ray and/or MRI examination. The diagnosis was confirmed by postoperative histopathologic examination. All the patients were retrospectively analyzed by reviewing the preoperative examination results and PubMed search results.

RESULTS2 cases underwent only X-ray examination before operation with no positive results. 3 cases underwent both X-ray and MRI. No positive finding happened in X-ray, while MRI showed glomus tumor characteristic on T1- and T2-weighted images which demonstreated a more intense signal after injection of gadolinium. The last 2 cases underwent only MRI examination, which revealed positive images of glomus tumor.

CONCLUSIONSMRI plays an important role in diagnosis of glomus tumor and should be adopted as a routine examination.

Objective To report our clinical outcomes of treating tibial defects combined with soft tissue defects using Ilizarov technique.Methods From May 2010 to February 2015,52 patients with combined bone and soft tissue defects of the tibia were treated at our department.They were 41 males and 11 females,aged from 19 to 65 years (average,37.7 years).By Gustilo classification,49 cases were type ⅢB and 3 type ⅢC.The areas of soft tissue defect ranged from 7 cm ×3 cm to 28 cm × 15 cm,and the tibial defects ranged from 5 cm to 15 cm in length (average,12.6 cm).The schemes of Ilizarov technique depended on the location and size of the tibial defects.Open wound dressing combined with bone transport was adopted in 21 cases,limb shortening followed by bone lengthening with compression at the fracture ends in 12 cases,and tissue flap transplantation combined with bone transport or lengthening in 19 cases.Results The follow-up time of the 52 patients ranged from 13 to 61 months (average,27.1 months).The distance of bone transport or lengthening ranged from 5.0 cm to 13.6 cm (average,10.8 cm);the bone transport speed averaged 0.81 mm/day.The tibiae united in all the 52 patients;the time for external fixation ranged from 13 to 21 months (average,15.3 months);the external fixation index was 2.3 months/cm.According to the Paley functional criteria,23 cases were excellent,19 good,9 fair,and one poor,yielding an excellent to good rate of 80.7％.Conclusion According to the location and size of the bone and soft tissue defects of the tibia,the 3 schemes of Ilizarov technique can be rationally chosen to obtain fine clinical outcomes.

Objective To investigate the effect of oral fluid resuscitation on circulatory oxygen dynamic parameters in dogs with burn shock.Method Eighteen male Beagle dogs were surgically prepared for the cannulation of carotid cartery and jugular vein,subjected to flame injury 50%total body surface area(TBSA)with fullthick ness 24 hours later,and they then randomly divided into 3 equal groups.The oral fluid resuscitation group (OR group)was intragastrieally injected with infusion of glucose-electrolyte solution(GES)according to parkland formula 0.5h after burn with a dose of 4mL·kg-1·% TBSA-1.Intravenous (IV) GES resuscitation group (VR group)was intravenously injected with infusion of GES as the same dose as OR group,and no-fluid resuscitation (NR)group did not receive any treatment during the first 24 hotrs.In the second 24 hours,all dogs received Ⅳ fluid resuscitation.At the end of 72 hours of injury.the mortality in each group was recorded.The mean arterial arterial pressure(MAP),hematocrit(HCT)and blood lactic acid(LAC)were determined,and blood gas analysis was evaluated for oxygen delivery(DO2),oxygen consumption(VO2)and oxygen uptake(O2ext)before injury and 2,4,8,24,48 and 72 hours after injury.Results Burn injury resulted in a 77.1%decrease in MAP,and a 48.5% increase in HCT and 533.7%increase in LAC in NR group,followed by pngressively lowering of DO2,VO2 and Oext till all animals died with in 24 hours after burn.MAP and HCT levels oftwo resuscitation groups gradually returned to the pre-injury levels within 72 hours after burn,but the LAC levels sill remained significantly higher than the pte-injury levels(P＜0.01).The MAPs of OR group were higher at corresponding intervals within 24 hours post burn than those of NR group(P＜0.01),but they were lower than those of VR group(P＜0.01).The serum LAC in OR group was markedly lowered than that in NR group,but it was higher than that in VR group.Twenty-four hours after burn injury,the DO2 level in OR group showed no significant differences compared with that of the VR group,but the levels of the VO2 and Oext were still much lower than those of VR group (P＜0.01).At the end of 72 hours,3 dogs of NR group died and none of IV group died.Caadusions Oral fluid resuscitation improves oxygen dynamic,alleviates hyperlactacidemia and reduces the mortality of animals with severe burn shock.

AIM: To investigate the effect of electro-acupuncture (EA) at Zusanli (ST36) on proinflammatory factors induced-multiple organ dysfunction in rats with sepsis. METHODS: Sixty four male Wastar rats were used to develop the sepsis model by cecal ligation and puncture (CLP). The animals were randomly divided into 4 groups (n=16 in each group): CLP+EA (CLP/EA), CLP+sham EA (CLP/SEA), vagotomy+ CLP+SEA (VA/CLP/SEA) and vagotomy+CLP+EA (VA/CLP/EA). Zusanli point (ST36) was electroacupunctured with constant voltage (2-100 Hz, 2 mA for 0.5 h) 20 min after CLP surgery. Bilateral cervical vagotomies were performed in rats in VA/CL/SEA and VA/CLP/EA groups. Twelve hours after CLP, animals were sacrificed and liver, kidney and jejunum were harvested for evaluating the contents of tumor necrosis factor-α (TNF-α), myeloperoxidase (MPO) and diamine oxidase (DAO). The rate of water content (WCR) of the organs was determined. At the same time, the plasma levels of alanine aminotransferase (ALT) and creatinine (Cr) in each group were also detected. RESULTS: The levels of ALT and Cr in plasma, as well as TNF-α, MPO and WCR in organ tissues were markedly lower, and the activity of DAO in jejunum tissue was obviously higher than that in CLP/SEA group at 12 h after CLP (all P<0.05). The levels of ALT, Cr, TNF-α, MPO and WCR in VA/CLP/SEA group and VA/CLP/EA group were significantly higher, the activity of DAO was obviously lower than that in CLP/SEA group (all P<0.05). No statistical difference in all above measurements between VA/CLP/EA group and VA/CLP/SEA) group was observed (all P>0.05). CONCLUSION: The results indicate that EA at Zusanli point obviously decreases the levels of TNF-α in liver, kidney and jejunum tissues after CLP, and alleviates the tissue edema and dysfunction of those organs. Vagotomy decreases or eliminates the effects of EA, suggesting that activation of cholinergic anti-inflammatory pathway is one of the main mechanisms to induce the effects of EA at ST36 on CLP sepsis.

Objective To investigate the safety and feasibility of a new pancreaticojejunal anastomotic method [the penetrating-suture type of pancreaticojejunostomy (PPJ)] after pancreaticoduodenectomy (PD).Methods From May 2005 to November 2011,a new surgical anastomosis was carriedout between the pancreas stump and jejunal wall with penetrating-suture technique after pancreaticoduodenectomy in 46 patients.The clinical data were reviewed and analysed.Results The anastomosis of the pancreas stump and jejunal wall was completed with six to eight interrupted full-layer sutures.There was no pancreatic anastomotic leakage and hemorrhage.Conclusion The PPJ is a simple and effective approach and can be recommended.