Objective To study the relevance between blood loss, widespread brain contusion injury and consumptive coagulopathy. Methods One hundred and fifty-three cases with severe brain injury was studied about their coagulation data. Analyzed the relationship between blood loss group according to ≥3000 ml and ＜ 3000 ml and coagulation features, the relationship between widespread brain contusion injury and disorder of coagulation;according to whether with brain contusion injury,kinds of bloods transplant and prognosis were asseseed;according to whether with widespread brain contusion injury in ≥ 3000 ml blood loss group,kinds of bloods transplant and prognosis were assessed. Results Compared with ＜ 3000 ml blood loss patients, ≥ 3000 ml patients' blood coagulation changed obviously, with PT prolonging, Fbg and Plt decreasing, the differences were statistically significant (P ＜ 0.05). Compared with no extensive brain contusion injury patients, in extensive brain contusion injury patients, APTT, PT, TT prolonged, Fbg and Plt decreased,and the difference was statistically significant (P ＜0.05). Extensive brain contusion injury patients with blood loss compared with those without such loss, needed more blood transfusion volume,larger amount of input of fresh frozen plasma Plt volume,the former survival rate was lower [68.29%(28/41)vs. 96.43%(108/112)], the difference between them was statistically significant (P＜ 0.05 ). In 41 patients who had brain widespread contusion ,the cases with extensive blood loss ( ≥ 3000 ml) were compared with those ＜ 3000 ml, and the differences in blood transfusion treatment, fresh frozen plasma, Plt volume,survival rate were statistically significant (P ＜ 0.05). Conclusion When blood loss ≥ 3000 ml after trauma,patients show various degrees of coagulopathy,and when accompanied with extensive brain tissue injury,coagulation disorders are more obvious, and the prognosis is even worse.

Objective To investigate the salty, efficacy and feasiblify on eholedochotomy with endobiliary drainage and prumary closure of the common bile duct. Methods There were 20 partients without introhepatic or re-tained stones and biliary stricture underwent common bile duet exploration. 20 of them with endobiliary tube drainage and primary CBD closure and the other 20 patients with T tube drainage. Results The average of the time to return routine home was (9. 2 ±1. 3)d, (15. 2 ± 3.6) d(P < 0. 01). The hospital expense of postoperation was (3 252± 312)Yuan,(4 116±388)Yuan(P<0.01). Conclusion Choledochotomy with endobiliary catheter and primary closure of CBD is a safe, effective and feasible procedure for the management of choledochohthiasis.

The tralning system for orthopedic surgeon in Britaln is mature and complete. After completing education in medical college, medical students receive a 2-year base tralning (FY1, FY2), which focus on learning and consolidating basic medical knowledge and clinical skill, followed by a 6-year specialist tralning, which subdivides into tralning of ankle and foot, hand, should and elbow, hip, knee, spine, and pediatric surgery, provided by several district hospital (Peripheral hospitals). Students are required to return to teaching center for review, ward inspection, case discussion at regular inter-vals. Compared with the specialist tralning system based on the hospital staffs in chi-na, the role ofsocial workersin British during the period of tralning makes better mobility of tralnee among medical institutions and medical treatments, which makes the tralning more comprehensive and professional. In addition, there is no consistent system for examination and admittance of specialist, and awareness of specialist tralning among medical institutions and doctors is weak. Therefore, it should be done to form a single tralning system and unify the tralning specification and assessment standard.

Objective To discuss the 3D printing modeling used to assist minimally invasive fixation with hollow screws for unstable pelvic fractures.Methods From January 2014 to January 2016,137 patients with unstable pelvic fracture received minimally invasive fixation with hollow screws and obtained complete follow-up at our department.In 65 of them,the fixation was assisted by 3D printing modeling;they were 37 men and 28 women,with an average age of 33.1 ± 4.9 years.In the other 72 cases,conventional fixation was performed without assistance of 3D printing modeling;they were 45 men and 27 women,with an average age of 32.6 ±4.7 years.The 2 groups were compared in terms of operation time,frequency of intraoperative fluoroscopy,reduction quality and curative effect.Results This cohort were followed up for 6 to 15 months (average,9 months).The 3D printing modeling group needed significantly less operation time (58.6 ± 13.4 min) and intraoperative fluoroscopy (29.3 ± 3.6 frequencies) than the conventional group (72.4 ± 12.4 min and 36.6 ± 2.8 frequencies) (P ＜ 0.05).According to the Matta scoring criteria,the quality of pelvic reduction was evaluated as excellent in 21 cases,as good in 30 cases,as fair in 13 cases and as poor in one in the 3D printing group,yielding an excellent and good rate of 78.5％ while as excellent in 22 cases,as good in 36 cases,as fair in 12 cases and as poor in 2 cases in the conventional group,yielding an excellent and good rate of 80.6％.According to the Majeed scoring criteria,the curative effect was evaluated at the last follow-up as excellent in 27 cases,as good in 26 cases,as fair in 11 cases and poor in one in the 3D printing group,giving an excellent and good rate of 81.5％ while as excellent in 30 cases,as good in 28 cases,as fair in 13 cases and as poor in one in the conventional group,giving an excellent and good rate of 80.6％.There were no statistically significant differences between the 2 groups in reduction quality or curative effect (P ＞ 0.05).No nonunion or iatrogenic neurovascular lesions happened during the follow-up period.Conclusion 3D-printing modeling is helpful for a good reduction and minimally invasive fixation with hollow screws for unstable pelvic fractures by reducing operation time and intraoperative fluoroscopy.

Objective To investigate the levels of the mRNA expression of TIM-3 and Galectin-9 in peripheral blood mono-cytes (PBMCs)of acute exacerbation asthma patients and their clinical significances.Methods 60 patients with acute exac-erbation asthma (eliminating 15 cases of non-conform to the regulations)and 30 cases of healthy subjects were collected from January to October of 2014.Used fluorescence quantitative real-time reverse transcription-polymerase chain reaction to measure the mRNA expression of TIM-3 and Galectin-9 in PBMCs of patients with asthma and healthy controls.Results The expression of TIM-3,Galectin-9 and IFN-γmRNA in the PBMCs from acute exacerbation asthma patients were all ab-normally higher than healthy controls (U =458.5,P =0.019;U =437.5,P =0.010;U =260,P <0.001).There were statis-tically significant differences between them.Conclusion TIM-3/Galectin-9 pathway may participate in the occurrence,devel-opment of asthma.TIM-3 or (and)Galectin-9 may prove to be an important target for treatments to asthma.

Objective To evaluate the efficacy of laparoscopic Habib 4X (Habib 4X,Angio Dynamics US),a new bipolar radiofrequency (RF) device,in laparoscopic liver resection.Methods Thirty one patients who underwent laparoscopic liver resection using the laparoscopic Habib 4X from Sept 2009 to Apr 2012 were studied retrospectively.Results The laparoscopic Habib 4X was success fully used in 30 patients (malignant,n=18; benign,n=12).The procedures performed included left lateral sectionectomy (n=12),left hemi-hepatectomy (n=1),Ⅴ or Ⅵ segmentectomy (n=9),Ⅴ and Ⅵ bi-segmentectomy (n=2) and wedge exclusion (n=6).The time required for precoagulation and resection was 10～68 min (median 24 min).The mean intraoperative blood loss was 145±75ml (range 8-370 ml).Mild abnormal liver function which returned to normal in 3 to 5 days was detected postoperatively.The mean hospital stay was 7.8±2.6 d (range 3～12 days).There was no patient who developed postoperative bleeding,bile leakage or abdominal abscess.For cancer patients,there was no local recurrence on follow-up.Conclusion Laparoscopic Habib 4X,a device when used in laparoscopic liver resection,resulted in minimal blood loss and quick recovery.It had only mild effect on liver function and it had low morbidity.In addition,it might reduce the risk of local recurrence in malignant tumours.

Objective:To explore the impact of domestic bivalirudin on platelet function during emergency percutane-ous coronary intervention (PCI) .Methods :A total of 100 patients with acute ST segment elevation myocardial in-farction who recieved emergency PCI were randomly divided into unfractionated heparin group (UFH group ,n=53) and bivalirudin group (n=47) .Adenyl diphosphoric acid (ADP)-induced platelet aggregation rate was meas-ured and statistically compared between two groups before and after PCI .Results:Before emergency PCI ,there was no significant difference in ADP-induced platelet aggregation rate between two groups (P=0.99) .After emergency PCI ,ADP-induced platelet aggregation rate in bivalirudin group was significantly lower than that of UFH group [ (16.46 ± 10.23)% vs .(25.21 ± 15.91) % , P<0.01] .Conclusion:During percutaneous coronary intervention , compared with routine heparin anticoagulation , bivalirudin , as an anticoagulant , can more significantly inhibit platelet aggregation and possess antiplatelet effect .

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children and adolescents, and it is commonly accompanied with other developmental and psychological disorders.The prevalence of obesity in children continues to rise, and it is also a major social public concern that threatens human health.As a somatic comorbidity with ADHD, obesity is characterized by a high incidence.In this paper, the focus would be placed on the underlying mechanisms of ADHD accompanied with obesity from the aspects of genetics, perinatal period, environmental and neurobiological factors, which could provide a theoretical basis and intervention strategies for the early identification, rational treatment and long-term comprehensive management, as well as prevention and treatment effects of ADHD and its comorbidities.

Drug therapy is a common method to cure diseases and relieve symptoms.The value of patient-reported outcome(PRO)in evaluating the effect of drug therapy has been increasingly paid attention.The PRO scale is a standardized questionnaire,which can scientifically evaluate the experiences and subjective effects of drug use from a patient-centered perspective,and help patients and clinicians make more reasonable medication decisions.By reviewing and sorting out relevant global literature,this paper found that the content of the PRO scales relevant to drug therapy focused on five fields:"medication satisfaction""medication adherence""drug treatment burden""medication-related quality of life"and"adverse drug reactions".This paper described the basic information,measurement characteristics and application of common scales in recent years respectively,and summarized and analyzed the problems and enlightenment of scale development,aiming to provide theoretical reference for the selection,application and development of PRO scales.

OBJECTIVE: To investigate the effect of rapamycin on Parkinson's disease (PD) and its underlying mechanism in mice. METHODS: Sixty SPF adult male C57BL/6 mice were randomly divided into control group, model group and treatment group. 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine(MPTP) was used to induce Parkinson's disease in model group and treatment group. All mice were trained to cross the runway and were subjected to computer-assisted CatWalk. The numbers of tyrosine hydroxylase positive (TH) neurons in the substantia nigra (SN) were assessed by unbiased stereology using the optical fractionator method; protein expression was detected by Western blot analysis; and glutathione peroxidase (GSH-Px), malondialdehyde (MDA) and superoxide dismutase (SOD) were detected by spectrophotometry. RESULTS: In the model group, a decrease in stride rate and an increase in variation of stance and swing were noted by CatWalk system (<0.05 or <0.01); the numbers of TH neurons decreased (<0.01); expression of p-Akt, p-S6K, p-S6 and p-ULK increased (all <0.01); LC3-Ⅱ/Ⅰ ratio decreased (<0.01); MDA level was elevated while the levels of SOD and GSH-PX were reduced (all <0.01). Compared with the model group, after treated with rapamycin, the abnormal behavior including the stride length, variation of stance and swing and step patterns induced by MPTP were all improved (<0.05 or <0.01); the numbers of TH neurons increased (<0.05); the expression of p-Akt, p-S6K, p-S6 and p-ULK was suppressed (all <0.01); the LC3-Ⅱ/Ⅰ ratio was upregulated (<0.05); MDA level decreased while the levels of GSH-Px and SOD increased (all <0.01). CONCLUSIONS Rapamycin inhibits the activation of mTOR pathway, which contributes to protect against the loss of dopaminergic neurons and provide behavioral improvements in mice with Parkinson's disease. These results are partially related to the ability of rapamycin in inducing autophagy and reducing oxidative stress.
Animals ; Behavior, Animal ; drug effects ; Disease Models, Animal ; Male ; Mice ; Mice, Inbred C57BL ; Neuroprotective Agents ; pharmacology ; therapeutic use ; Oxidative Stress ; drug effects ; Parkinson Disease ; drug therapy ; Random Allocation ; Sirolimus ; pharmacology ; therapeutic use ; Substantia Nigra ; drug effects