Objective To compare the effects of different surgical methods for the recovery of elderly patients with acute cholecystitis and provide reference for its clinical treatment. Methods 60 Patients aged 65 years or older undergoing laparoscopic cholecystectomy for acute cholecystitis between January 2010 and December 2013 were selected from the database. The comparison group comprised 76 patients from the same age-group who underwent open cholecystectomy for acute cholecystitis. Then the curative effects of two groups were compared and analyzed. Results 76 patients underwent laparoscopic surgery and 60 had open surgery. The demographic data and co-morbidities were compared between the two groups. The postoperative hospital stay was significantly shorter for patients undergoing laparoscopy (P < 0.05). The overall complication rate was significantly lower for patients undergoing laparoscopy (P < 0.05). There was no statistical significant difference in the operating time and the bleeding among the operation. Conclusions Laparoscopic cholecystectomy is a safe procedure for acute cholecystitis in elderly patients , resulting in fewer complications and shorter hospital stay than open cholecystectomy. Laparoscopic cholecystectomy is worth in the clinical application.

OBJECTIVE:To explore the effect of sodium selenite intervention on the activity of NF-?B in renal tissue of rats with different stages of diabetes mellitus(DM).METHODS:SD rats were randomly divided into these groups after the diabetics model were established successfully:DM2 group(DM rats at 2 months),DM4 group(DM rats at 4 months),DM+Se2 group(Se-treated DM rats at 2 months),DM+Se4 group(Se-treated DM rats at 4 months),and set up CON2 group(normal control group at 2 months)and CON4 group(normal control group at 4 months)stimultaneously.All these groups were treated by corresponding methods after feeding different diets for 2 or 4 months,UAER was computed;Scr,BUN,Ucr and the activity of NF-?B in renal tissue were detected.RESULTS:UAER level and activity of NF-?B in DM+Se2 group were all higher than in CON2 group(P

Objective To perform comparative study on database performance before and after upgrading hardware & software of database. Methods The comparison was carried out from the aspects of hardware expansibility, processing ability, system stability and database performance. Results The reasons for the change of performance and the change law were analyzed. Conclusion After upgrading, the system performance is enhanced greatly.

Objective To study the relationship between umbilical cord leptin levels and fetal growth as well as neonatal birth weight. Methods One hundred and forty - two neonates selected from February 2009 to June 2013 in Shangqiu First People's Hospital according to the different gestational age and birth weight were divided into 3 groups. Group A included 44 cases(small for gestational age,birth weight below the average weight of the 10th percentile at the same gestational age),23 boy cases,21 girl cases;group B included 56 cases(appropriate for gestational age,birth weight at the average weight of the 10th to 90th percentile at the same gestational age),30 boy cases,26 girl cases;group C included 42 cases(large for gestational age,birth weight above the average weight of the 90th percentile at the same gestational age),22 boy cases,20 girl cases. Neonatal body mass index,birth weight,placenta weight and umbilical lep-tin levels of three groups were compared. Results Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group A were significantly lower than those of group B,having statistically significant difference(all P ﹤ 0. 001);Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group C were significantly higher than those in group B,with statistically significant difference( all P ﹤0. 001). Neonatal birth weight in the boy group was obviously higher than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). Neonatal leptin levels in the boy group were significantly lower than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). There were positive correlations between the umbili-cal cord leptin levels and the neonatal birth weight,neonatal length,neonatal weight index and the placenta weight(r =0. 382,0. 276,0. 358,0. 412,all P ﹤ 0. 01). Conclusions The umbilical cord leptin levels are closely associated with neonatal birth weight and intrauterine growth retardation,and it can be used as one of the important indicators for reflec-ting neonatal birth weight and fetal growth.

Objective To study the value of score for neonatal acute physiology Ⅱ(SNAP]Ⅱ) and its extension version Ⅱ (SNAPPE-Ⅱ) in predicting neonatal necrotizing enterocolitis (NEC) outcome.Methods We explored 73 NEC patients by statistics who were treated in our hospital from January 2002 to January 2012.The patients were divided into two groups:surgery group and non-surgery group,then they were divided into subgroups:alive group and death group.The general information including birth weight,age,clinical manifestations,treatment of patients were collected.Every patient was checked and scored by the methods SNAP-Ⅱ] and SNAPPE-Ⅱ in time.Results The scores (27.0 ± 2.3,26.5 ± 1.8) of surgery group including SNAP-Ⅱ and SNAPPE-Ⅱ were higher than those (14.0 ± 2.1,15.0 ± 2.5) in the non-surgery group(P ＜ 0.01).The scores(31.0 ± 3.2,31.0 ± 3.4) of the death group including SNAP-Ⅱ and SNAPPE-Ⅱ were higher than those(11.0 ± 2.5,10.0 ± 3.6) in the alive group(P ＜ 0.01).According to the area under the curve(AUC) analyzed by the receiver operating characteristic(ROC) curve for measuring the scores of surgery predicting,AUC was 0.726 for SNAP-Ⅱ and 0.732 for SNAPPE-Ⅱ.The value of predicting surgery risk was 20 and 24 respectively.According to the AUC analyzed by the ROC curve for measuring the scores for surgery predicting,AUC was 0.752 for SNAP-Ⅱ and 0.825 for SNAPPE-Ⅱ.The value of predicting mortality risk was 31 and 33 respectively.All P values were less than 0.01 and there were significant differences.Conclusion The two kinds of score for neonatal acute physiology have an important significance in predicting surgery and mortality risk of NEC.

Objective:To analyze the application of functional residual capacity (FRC)-guided optimal positive end-expiratory pressure (PEEP) in pulmonary retention in patients with acute respiratory distress syndrome (ARDS), and to explore the correlation between FRC and trans-pulmonary pressure and their predictive value for prognosis.Methods:Seventy-eight ARDS patients on mechanical ventilation admitted to department of critical care medicine of the First Affiliated Hospital of Jinzhou Medical University from March 2018 to May 2019 were enrolled. According to random number table method, the patients were divided into experimental group and the control group. PEEP of all patients were gradually increased in recruitment after fully sedation and analgesia. The best PEEP was set by monitoring FRC in the experimental group, and by monitoring maximum oxygen in the control group set. The differences before and after 30 minutes and 2 hours recruitment manoeuvres in dynamic compliance (Cdyn), oxygenation index (PaO 2/FiO 2), and mechanical power (MP) were compared between the two groups. Pearson method was used to analyze the correlation between FRC and trans-pulmonary pressure. The predictive value of FRC and trans-pulmonary pressure for 28-day mortality in patients with ARDS was analyzed by receiver operating characteristic (ROC) curve. Results:The optimal PEEP was (16.24±1.57) cmH 2O (1 cmH 2O = 0.098 kPa) in the experimental group and (14.11±1.15) cmH 2O in the control group in recruitment maneuvres, with statistically significant difference between the two groups ( t = 5.678, P = 0.000). Pearson correlation analysis showed that there was a significant correlation between FRC and trans-pulmonary pressure in ARDS patients ( r = 0.759, P = 0.000). Cdyn and PaO 2/FiO 2 in the experimental group were higher than the control group at 30 minutes and 2 hours after recruitment maneuvres [Cdyn (mL/cmH 2O): 61.16±3.55 vs. 58.54±5.25, 58.59±2.82 vs. 56.86±3.40; PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 245.27±14.86 vs. 239.00±5.34, 192.25±5.11 vs. 188.86±5.07], MP was lower than the control group (J/min: 16.32±1.11 vs. 17.05±1.22, 15.22±1.25 vs. 17.03±1.50), the difference was statistically significant (all P < 0.05). The ROC curve analysis showed that both FRC and trans-pulmonary pressure had predictive value for the 28-day mortality of ARDS patients, and the area under the ROC curve (AUC) was 0.868, and 0.828 respectively (both P < 0.01). Conclusions:Measuring FRC in patients with ARDS during recruitment maneuvres can guide optimal PEEP. FRC was significantly correlated with trans-pulmonary pressure, and both of them had predictive value for 28-day mortality in ARDS patients.

OBJECTIVE: To investigate the strategies of posterior short-segment fixation and plant iliac fusion surgery, and the clinical efficacy of them on the treatment of upper cervical vertebra trauma. METHODS: Three hundred and thirty-four patients with upper cervical vertebra trauma admitted into our hospital from June, 2005 to April, 2010 were studied retrospectively. Thirty-six were treated by posterior short-segment fusion, which included 22 and 14 male and female patients, respectively. Among them, 23 or 6 patients were related to traffic or falling accident, 5 or 2 patients were related to crashing object or fight. The clinical efficacy was evaluated by head and neck pain VAS score, JOA scores of nerve function and the rate of graft bone fusion. RESULTS: The postoperative VAS scores were lower than that of pre-operation, and the difference was significant (P<0.001). The postoperative JOA scores of nerve function was superior to preoperative scores (P<0.05). During follow-up, no internal fixation failure happened while bony fusion could be seen. CONCLUSION The method of posterior short-segment fixation and bone graft fusion in treating patients with cervical spine injury is highly efficacy, which possesses great clinical value.
Bone Transplantation ; Cervical Vertebrae ; injuries ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Reconstructive Surgical Procedures ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

Objective:To investigate the influence of the teaching model based on the synergy of medical education on the objective structured clinical examination (OSCE) scores and critical thinking ability of interns in emergency department.Methods:A total of 84 students who studied as interns in Emergency Department of our hospital from January 2020 to 2021 were selected as research subjects, and they were divided into observation group and control group using a random number table, with 42 students in each group. The students in the control group were taught using traditional methods, while those in the observation group were taught based on the synergy of medical education. Both groups received an OSCE examination, and the two groups were compared in terms of OSCE score, critical thinking ability, and evaluation of teaching. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the observation group had significantly higher scores of theoretical assessment, disease assessment, first aid measures, special skills, use of medical instruments, communication skills with SP, and medical record writing and a significantly higher total score of OSCE assessment ( P<0.05). After teaching, both groups had a significant increase in the score of critical thinking ability, and the observation group had a significantly higher score than the control group [(306.38±25.76) vs. (280.39±20.17)]. The observation group had a significantly higher degree of satisfaction with teaching than the control group ( P<0.05). Conclusion:The teaching model based on the synergy of medical education can improve the OSCE score of interns in emergency department and cultivate their critical thinking ability, and there is a relatively high degree of satisfaction with this teaching model.

Objective:To investigate the clinical value of 125I seeds implantation in the treatment of primary liver cancer with portal vein tumor thrombus. Methods:A total of 218 patients (184 males and 34 females, age: (53.8±9.2) years) with primary liver cancer with portal vein tumor thrombus between January 2015 and June 2018 were retrospectively analyzed. All patients underwent 125I seeds implantation under CT guidance. CT examination and liver function test were repeated 2-3 months after the implantation, and the portal vein tumor thrombus diameter, liver function parameters and ascites before and after treatment were compared. All patients were followed up for 2-26 months and the survival time were calculated. Paired t test was used for data analysis. Results:Among 218 patients, 8 patients (3.7%) had complete remission of tumor thrombus, 111 patients (50.9%) had partial remission, 80 patients (36.7%) had no change, and 19 patients (8.7%) had disease progression 2-3 months after the implantation. The total effective rate was 91.3%(199/218). The diameter of tumor thrombus after treatment was (12.63±4.64) mm, which was significantly smaller than that before treatment ((26.65±10.88) mm; t=18.74, P<0.01); serum bilirubin, the direct bilirubin after treatment were different compared with those before treatment: (20.59±10.29) vs (24.27±12.65) pg/L ( t=5.37, P<0.05), (11.40±8.37) vs (15.64±7.99) pg/L ( t=8.44, P<0.05); the indirect bilirubin after treatment was not significantly different from that before treatment ( t=0.85, P>0.05). Ascites in 86/142 patients were better after the implantation. No serious complications associated with treatment were seen. There were 162 patients died and 56 patients survived till the end of follow-up. The survival time of all patients was (9.23±0.59) months. Conclusion:125I seeds implantation can safely and effectively treat the portal vein tumor thrombus in patients with primary liver cancer, and improve the clinical symptoms such as ascites.

Objective:To verify the clinical safety and efficacy of new intelligent ventilation mode adaptive minute ventilation (AMV)+IntelliCycle ventilation in patients with mild-to-moderate acute respiratory distress syndrome (ARDS).Methods:The patients with mild-to-moderate ARDS, admitted to intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from February 2018 to February 2019, were enrolled in the study. The patients were divided into synchronous intermittent mandatory ventilation+pressure support ventilation (SIMV+PSV) group and AMV+IntelliCycle group according to the random number table method. All patients were given mechanical ventilation, anti-infection, analgesia and sedation, nutritional support and symptomatic treatment of primary disease after admission. SV800 ventilator was used for mechanical ventilation. In the AMV+IntelliCycle group, after setting the minute ventilation volume (VE), inhaled oxygen concentration (FiO 2) and positive end expiratory pressure (PEEP), the ventilator was turned on the full-automatic mode, and the preset value of VE percentage was 120%. In the SIMV+PSV group, the ventilator parameters were set as follows: the ventilation frequency was 12-20 times/min, the inspiratory expiratory ratio was 1∶1-2, the peak inspiratory pressure (PIP) limit level was 35-45 cmH 2O (1 cmH 2O = 0.098 kPa), and the setting of FiO 2 and PEEP was as the same as that of AMV+IntelliCycle group, the triggering flow was set to 2 L/min. All of the clinical parameters between the two groups were compared. The main outcomes were duration of mechanical ventilation, ventilator alarm times, manual operation times, and the mechanical power; the secondary outcomes were respiratory rate (RR), VE, tidal volume (VT), PIP, mouth occlusion pressure (P0.1), static compliance (Cst), work of breathing (WOB), and time constant at 0, 6, 12, 24, 48, 72, and 120 hours; and the blood gas analysis parameters of patients before and after ventilation were recorded. Results:A total of 92 patients with mild-to-moderate ARDS were admitted during the study period, excluding those who quit the study due to death, abandonment of treatment, accidental extubation of tracheal intubation and so on. Eighty patients were finally enrolled in the analysis, with 40 patients in SIMV+PSV group and AMV+IntelliCycle group respectively. ① Results of main outcomes: compared with the SIMV+PSV mode, AMV+IntelliCycle ventilation mode could shorten the duration of mechanical ventilation (hours: 106.35±55.03 vs. 136.50±73.78), reduce ventilator alarm times (times: 10.35±5.87 vs. 13.93±6.87) and the manual operations times (times: 4.25±2.01 vs. 6.83±3.75), and decrease the mechanical power (J/min: 12.88±4.67 vs. 16.35±5.04, all P < 0.05). But the arterial partial pressure of carbon dioxide (PaCO 2) of AMV+IntelliCycle group was significantly higher than that of SIMV+PSV group [mmHg (1 mmHg = 0.133 kPa): 41.58±6.81 vs. 38.45±5.77, P < 0.05]. ② Results of secondary outcomes: the RR of both groups was improved significantly with the prolongation of ventilation time which showed a time effect ( F = 4.131, P = 0.005). Moreover, compared with SIMV+PSV mode, AMV+IntelliCycle mode could maintain a better level of RR, with intervention effect ( F = 5.008, P = 0.031), but no interaction effect was found ( F = 2.489, P = 0.055). There was no significant difference in VE, PIP, P0.1 or Cst between the two groups, without intervention effect ( F values were 3.343, 2.047, 0.496, 1.456, respectively, all P > 0.05), but they were significantly improved with the prolongation of ventilation time in both groups, with time effect ( F values were 2.923, 12.870, 23.120, 7.851, respectively, all P < 0.05), but no interaction effect was found ( F values were 1.571, 1.291, 0.300, 0.354, respectively, all P > 0.05). The VT, WOB or time constant in both groups showed no significant changes with the prolongation of ventilation time, and no significant difference was found between the two groups, there was neither time effect ( F values were 0.613, 1.049, 2.087, respectively, all P > 0.05) nor intervention effect ( F values were 1.459, 0.514, 0.923, respectively, all P > 0.05). Conclusion:AMV+IntelliCycle ventilation mode can shorten the ventilation time of patients with mild-to-moderate ARDS, reduce mechanical power, and reduce the workload of medical care, but PaCO 2 in the patients with AMV+IntelliCycle mode is higher than that in the patients with SIMV+PSV mode.