OBJECTIVE To investigate the status of hospital acquired infection correctly,and to clarify the difficulty of dealing with it as well as to improve the survey and management level.METHODS Thirty-four cases of hospital acquired infection were diagnosed by cross-sectional survey,followed and then analyzed.RESULTS The incidence of hospital acquired infection was 7.6% in our hospital,the average time of hospitalization was 38.68 days which 3.98 times of the average hospitalization time of whole patients.The average hospitalization fee was 24 065.9 Yuan,4.5 times of the average fee of whole patients.CONCLUSIONS Patients susceptible to hospital acquired infection include old patients(≥60-year-old),basic illness≥3,and operated patients,the main risk factors of hospital acquired infection in our hospital include invasive cathelization,operation,combination using of more than 2 antibiotics and using of steroid.

BACKGROUND:Many internal fixations,such as dynamic hip screw,Gamma screw,proximal femoral nail,angle steel plate,as well as locking proximac femoral plate,are utilized in treating intertrochanteric fractures,especially the dynamic hip screw However,the failure rate is gradually increased.OBJECTIVE:To explore the application and clinical efficacy of total hip replacement for the treatment of elderly intertrochanteric fracture fixation after failure of dynamic hip screw.METHODS:A total of four cases with intertrochanteric fractures were treated by total hip replacement after failure of dynamic hip screw fixation was selected.According to Evans typing,one case were type Ⅱ,two cases were type Ⅲ A,and one case was typeⅢB.Internal fixation displacement could be found at half to 1 year after dynamic hip screw fixation.Because of bone disunion,coxa adducta and pain,the patients could not walk.Sequentially,total hip replacement was performed with 45°abduct angle and10°-15°anteversion angle The clinical efficacy was evaluated by Harris scoring criteria.RESULTS AND CONCLUSION:All the cases were operated smoothly,with 1.5-2 hour operation duration and 400-600 mL blood loss.No case appeared allergic response to bone cement.By 3-12 months follow-up,4 successful operative cases do not appear prosthesis loosening,subsidence and are satisfied with well hip function.The average Harris score were 81 points.The results revealed that application of total hip replacement after the failure of DHS in elderly intertrochanteric fracture fixation,which shortened the time patients stay in bed to reduce complications and improved the hip joint function.

Objective To compare the clinical effects of intramedullary nails and locking compression plate in the treatment of femur shaft fracture.Methods The clinical data and follow-up records of 43 patients with femur shaft fracture treated by intramedullary nails and locking compression plate were retrospectively reviewed.Including 31 males and 12 females with an average age of 40.07 years(25 to73).According to AO classification:5 cases were type A,24 cases were type B,14 cases were type C.26 patients in group A treated by intramedullary nails and 17 patients in group B treated by locking compression plate.Operation time,fracture union time,blood loss and complications were compared between the two groups.The Karlstrom and Olerud result were compared and analyzed.Results All patients were followed up at an average of 15 months(range 5-24) after surgery.According to Karlstrom and Olerud score system,the excellent and good rate of group A was 88.4％,higher than the group B 82.3％.But there was no significant difference between the two groups.In group A:the operation time (113.77 ±20.14)min,the blood loss in the operation (386.74 ± 65.16) ml,clinical bone healing (15.52 ± 1.77) weeks.All these outcomes were better than group B (P ＜ 0.01).One case in group A appeared screw loose,but X-ray showed the nail stable,the bone wasn't displacement.One case in group B appeared broken plate 1 month after operation,and received twice operation,the clinical outcome was good as well.Another 1 case with fracture delayed union in group B,after internal fixation removed,we check the X-ray showed bone union.Conclusion Two methods of treatment femur shaft fracture can all reach the above requirement.Fixation of intramedullary interlocking nail is the preferred surgery than locking compression plate.

Objective To investigate the expression of Na+/H + exchanger isoform-1 (NHE-1) during ischemia-reperfusion (IR)in rat lung tissue and determine whether cariporide preconditioning protects lung from inflammatory injury via inhibiting NHE-1 protein expression.Methods Twenty i-solated perfused lungs were randomly divided into 4 groups:the lungs in control group (group C) were continuously perfused for 120 min;the lungs in group IR were subjected to 30 min perfusion, followed by 60 min ischemia and 30 min reperfusion;in group LiCl preconditioning,the lungs were preconditioned with LiCl for 30 min,then continuously perfused for 90 min;in cariporide precondi-tioning+IR (CIR)group,the lungs were preconditioned with cariporide for 30 min,following 60 min ischemia and 30 min reperfusion.After reperfusion,the NHE-1 protein expression was determined by immunohistochemistry and the histopathologic change and pathology scores were ascertained from HE sections.Results The NHE-1 protein expression in lung tissue in groups IR and LiCl were signifi-cantly increased compared with groups C and CIR (P <0.05),and there was no difference between groups C and CIR.Histological examination revealed marked inflammatory changes in groups IR and LiCl,whereas no significant changes in lungs of groups C and CIR.The pathology score of lung in groups IR and LiCl were higher than that in groups C and CIR (P <0.05),and there was no differ-ence between the last two groups.Conclusion IR results in an increased NHE-1 protein expression in rat isolated perfused lung,and the selective NHE-1 inhibitor cariporide could repress the NHE-1 pro-tein expression,thereby decrease the lung inflammatory injury after IR.

Objective The new lung cancer TNM staging for T staging the new grading.The aim of this study was to investigate the relationship between the T staging and grading of the Seventh Edition and lymph node metastasis of lung cancer.Methods In 513 cases of non-small cell lung cancer primary tumor size and lymph node metastasis were analyzed,and explore the situation of different size,lymph node metastasis in primary tumors.To analyse the collected data with SPSS software.Results The total lymph node metastatic rates in tumor diameter biggest ≤2 cm(T1a) 、2 cm ＜ ～ ≤3 cm(T1b) 、3 cm ＜ ～ ≤5 cm (T2a) 、5 cm ＜ ～ ≤7 cm(T2b) 、＞ 7 cm(T3) were 14.47％ 、28.89％ 、37.59％ 、36.37％ 、37.89％.The lymph node metastatic rate of T1a was significantly different,compared with T1b 、T2a 、T2b and T3,respectively.There were no differences between every two groups of T1b,T2a,T2b and T3.The N1 metastaic rates of T1a 、T1b 、T2a 、T2b 、T3 were compared by chi-square(P ＜0.05),The lymph node metastatic rates of T1a and T2a (P =0.001),T1a and T2b (P =0.024).The N2 metastaic rates of T1a 、T1b 、T2a 、T2b 、T3 were compared by chi-square(P ＜0.05),The lymph node metastatic rate of T 1 a was significantly different,compared with T1b 、T2a and T2b,respectively.The lymph node metastatic rate of T1 b was significantly different,compared with T2a 、T2b and T3,respectively.Conclusion The new T staging of tumor the size of the new classification is associated with lymph node metastasis rate,especially in N2.low T la lymph node metastasis rate.

ObjectiveTo analyze the differences of United States (US) and France (Fr) Risser grading systems in determining the growth potentiality of girls with adolescent idiopathic scoliosis (AIS).Methods Girls with AIS undergoing posterior spinal correction with autogenous bone graft were recruited.The Risser grades were recorded for the non-dominant side iliac crest apophysis according to the US and Fr grading systems.Iliac crest cartilage biopsies were harvested during surgery then standard histologic grades(HGs) of proliferation activity of iliac cartilage were analyzed on histological section.The agreement of two grading systems was analyzed by kappa statistics while the correlation between Risser grades and HGs were analyzed by Spearman correlation analysis.Receiver Operating Characteristic (ROC) curve was employed for selecting the best parameter in determining growth cessation of girls with AIS.ResultsFifty-three AIS girls with an average age of 14.0 years were recruited.The agreement of two grading systems was poor.The US system showed higher correlation with HGs compared to Fr system.Growth cessation could be determined by Risser grade 5 of US system or Risser grade 4 of Fr system,also older than 16 years or three years after menarche.When combining the results of ROC curve analysis,the Risser grade 4-5 of US system with two years after menarche could be used in determining growth cessation with the highest sensitivity,specificity and accuracy.Furthermore,the mean age of patients with growth cessation determined by this method was 15.2 years,showed 0.9-1.4 years earlier than the age determined by other methods.ConclusionThe US Risser grading system is better in determining maturity of AIS girls compared to Fr Risser grading system.By combining years since menarche,the accuracy of Risser grades in determining growth cessation could be enhanced,and the time of weaning from a brace could be advanced.

OBJECTIVETo discuss the hemostasis of the different polarities of Platycladi Cacumen Carbonisatum (PCC) on the blood heat and hemorrhage syndrome rat model induced by dry yeast.

METHODThe SD rats were divided into seven groups. Yunnan Baiyao was taken as the positive control drug. The rats in the control group and model group were fed with CMC-Na for 7 days, and the rats in other groups were fed with corresponding drugs simultaneously. On day 7, the blood heat and hemorrhage syndrome rat model was established. Indexes including the whole blood viscosity, plasma viscosity, thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen content (FIB), red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), blood platelet count (PLT), thrombocytocrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW) and the rate of platelet aggregation induced by ADP were detected. Additionally, the pathological examinations of lungs among each group were compared.

RESULTCompared with the control group, the RBC, HGB and HCT of rats in the model group increased significantly, with distinct increase in high, middle and low whole blood viscosity and plasma viscosity of rats in the model group; TT and APTT were notably prolonged, while PT was notably shortened, with significant increase in FIB content; PLT, PCT, MPV and PDW remarkably increased; Additionally, the rate of platelet aggregation induced by ADP significantly decreased. After ig administration of the ethyl acetate extract of PCC, the low whole blood viscosity and plasma viscosity remarkably decreased; TT and APTT were significantly shortened, with notable reduction in PDW and in FIB content Additionally, the rate of platelet aggregation induced by ADP significantly increased. The injury of lungs was also improved in ethyl acetate extract group. The rate of platelet aggregation induced by ADP of n-butanol extract group notablly increased. Plasma viscosity of water extract group remarkably decreased, with TT being significantly shortened. But the effects of n-butanol extract or water extract were weaker than that of ethyl acetate extract. And the effect of petroleum ether extract was the weakest.

CONCLUSIONEthyl acetate extract is the active part of PCC, showing the effect of hemostasis by reducing the low whole blood and plasma viscosity, improving coagulation function mainly by acting on the endogenous coagulation, and ameliorating the function of platelet aggregation.

Animals ; Blood Coagulation ; drug effects ; Blood Viscosity ; drug effects ; Cupressaceae ; chemistry ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Filtration ; Hemostatics ; isolation & purification ; pharmacology ; Male ; Platelet Aggregation ; drug effects ; Rats ; Rats, Sprague-Dawley ; Thrombin Time

Objective To observe the change of plasma neuropeptide Y(NPY) concentration in patients with essential hypertension,and its relevance to target organ damage.Methods The plasma NPY concentration was determined by radioimmunoassay(RIA) in 115 patients with essential hypertension,including 45 patients with single target damage(left ventricle hypertrophy 21,stroke 13,nephropathy 11) and 19 patients with multiple target damage,with 30 normal as controls.Results 1) Plasma NPY concentration in patients with essential hypertension was significantly higher than normal controls(P0.05).Conclusion NPY may involve in the physiopathologic progress of essential hypertension and associate with the development of target organ damage.Evaluation of plasma NPY concentration may be valuable biomarker in estimation the severity of hypertension and target organ damage.

OBJECTIVE To explore the systemic prevention messures of ventilator-associated pneumonia(VAP).METHODS Mesures were taken to 54 patients to prevent infection in 54 from 2006 to 2008 and 52 patients with similar symptoms at the same interval time were chosed as control.RESULTS In the test group VAP occurred in 14.81%,with(11.11%) of mortality.In control group VAP accounted for 42.31%,with(26.92%) of mortality.CONCLUSIONS Systemic prevention messures can decrease VAP occurrance.

Objective To investigate the clinical effect of renal transplantation in elderly patients.Methods Retrospective analysis was held on 49 elderly patients aged over 65 years who underwent renal transplantation,and compared with 87 patients under the age of 50 years who underwent the renal transplantation during the same time.Results The survival rate at one year was 85.7% in elderly patients,and 93.1% in the non-elderly patients(P＜0.05).The graft survival rate at one year was 89.8% in elderly patients,and 90.8% in the non-elderly patients,but no significant difference was found between the two groups.The rate of acute rejection response was 10.2% in elderly patients,significantly lower than that in non-elderly patients(28.7%).The rate of complication of cardio-cerebrovascular diseases in elderly patients(51.1%)were higher than those in non-elderly patients(19.5%,P＜0.05).The dosages of immunosuppressive agent cyclosporine in 3 months,3-6 months and 6-12 months were(3.6?1.1),(3.1?0.9)mg?kg~(-1)?d~(-1) and (2.9?0.7) mg?kg~(-1)?d~(-1)in elderly group,significantly lower than those[(5.4?1.4),(4.6?1.3)mg?kg~(-1)?d~(-1)and(4.1?1.0)mg?kg~(-1)?d~(-1)]in non-elderly group(P＜0.05).Conclusions Renal transplantation in elderly patients is effective and reliable.