Objective: To design a biodegradable aerosol film for treating various wound and diffuse hemorrhage in various organs. Methods: Uniform design was used to screen prescription. Ultraviolet spectrophotometry was used to assay the release in vitro . Results: Time of film formation was less than 30 s. The release in vitro was about 50% in 15 min and stabilized gradually after 15 min. Conclusion:The film formation and release in vitro are well acceptable. [

The peroneal artery chimeric bone flap combined with chimeric flap of lateral femoral circumflex artery was applied in the repair of a case defects of both ulna and radius arteries combined with large extensive ring-like soft tissue defects of forearm in November, 2018, causing no blood supply to the hand. In the one-stage surgical procedure, anastomosis of the ulnar and radial arteries with the pedicle of the 2 flaps by Flow-through anastomosis were performed and the blood supply of the forearm and hand was restored. Six months after the surgery, the rotation functions of forearm, wrist joint and fingers were recovered. The patient was able to carry out daily activities and some of precision tasks.

Objective To explore the effect of evidence-based medicine combined withcase based learning(CBL) in pediatric residency training.Methods Totally 52 residents were equally divided into two groups:experiment group and control group.Method of CBL combined with the evidencebased medicine (Taking two residents as one group,firstly teacher posed the questions and then residents searched for references when off duty and made evidence-based case presentation at fixed time when doing teaching ward around,after wards all personnel in the department made case discussion,finally teacher made the summary) was used in experimental group while traditional teaching method (teacher guided the residents to analyze the case by clinical experiences,residents took notes and sometimes asked questions,teacher directly gave the answers)was used in control group.The teaching effect is evaluated by questionnaire,theory test and clinical skills assessment.Statistical analysis was carried out on appraisal results with SPSS 16.0 software,test results and appraisal results were expressed as ((x-) ±s) and t test was performed,P ＜ 0.05 was taken as statistically significant.Results Residents in experimental group had more advantages in self-study ability,literature retrieval ability,physician teamwork spirit,clinical thinking,PowerPoint making and language expression after receiving CBL combined with evidence-based medicine.Theory examination showed that average score of experimental group was better than that of control group (75.46 ± 6.646) vs.(71.38 ±4.758),with statistically significantly differences (P =0.014),especially in subjective items.Clinical skills assessment showed that experimental group was better than control group in writing medical records and doing clinical thinking.Conclusions Teaching method of evidence-based medicine combined with CBL is significantly better than traditional indoctrination teaching in improving the abilities of self-study,cultivating clinical thinking,literature retrieval,language performance and other skills.This teaching method is more suitable for pediatric residency training.

Adolescent ; Adult ; Aged ; Electrodes ; Epistaxis ; surgery ; Female ; Hemostasis, Endoscopic ; methods ; Humans ; Male ; Middle Aged ; Young Adult

Intracranial branch atheromatous disease (BAD) was proposed by Caplan in 1989.It has been widely studied in Japan in recent years.With the application of high-resolution magnetic resonance,BAD has become a hot topic.This article reviews the concept,etiology,pathology,diagnosis and treatment of BAD as well as its relationship with ischemic stroke.

Objective To observe the recent effects and toxicity in advanced gastric carcinoma by two kinds of neoadjuvant chemotherapies ( PF and FOLFOX).Methods A total of 60 patients with advanced gastric cancer ( Ⅲ ～ Ⅳ ),they were randomly divided into 2 groups; PF group ( 30 cases) and FOLFOX group ( 30 cases).All patients were given 3 cycles of docetaxel or L-OHP chemotherapy preoperatively,to observe the recent effects and toxicity in advanced gastric carcinoma.Results The total effective rate in PF group was 77.67％,while it was 50.00％ in FOLFOX group,it had significant difference between in two groups ( x2 =4.59,P ＜ 0.05 ).There is no difference in the incidence of neutropenia,transaminase elevation,nausea and diarrhea two groups.The incidence of hair loss in PF group is higher than in FOLFOX group,but there is no difference between two groups; The incidence of peripheral nerve paresthesia in FOLFOX group is higher than that in PF group( x2 =5.08,P ＜0.05).Conclusion PF as neoadjuvant chemotherapy is a very effective and well-tolerated regimen in patients with advanced gastric cancer.

Objective:To optimize 3.0T MRI diagnosis indicator in breast cancer and to select the best MRI scan program.
Methods:Totally 45 patients with breast cancers were collected, and another 35 patients with benign breast tumor served as the control group. All patients underwent 3.0T MRI, including T1-weighted imaging (T1WI), fat suppression of the T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), 1H magnetic resonance spectroscopy (1H-MRS) and dynamic contrast enhanced (DCE) sequence. With operation pathology results as the gold standard in the diagnosis of breast diseases, the pathological results of benign and malignant served as dependent variables, and the diagnostic indicators of MRI were taken as independent variables. We put all the indicators of MRI examination under Logistic regression analysis, established the Logistic model, and optimized the diagnosis indicators of MRI examination to further improve MRI scan of breast cancer.
Results:By Logistic regression analysis, some indicators were selected in the equation, including the edge feature of the tumor, the time-signal intensity curve (TIC) type and the apparent diffusion coeffcient (ADC) value when b=500 s/mm2. hTe regression equation was Logit (P)=-21.936+20.478X6+3.267X7+21.488X3.
Conclusion:Valuable indicators in the diagnosis of breast cancer are the edge feature of the tumor, the TIC type and the ADC value when b=500 s/mm2. Combining conventional MRI scan, DWI and dynamic enhanced MRI is a better examination program, while MRS is the complementary program when diagnosis is diffcult.

Objective Non-alcoholic fatty liver ( NAFL) is a metabolic disease and levocarnitine can be used to improve the energy metabolism of the patient .This study aimed to evaluate the clinical efficacy of levocarnitine in the treatment of NAFL . Methods We retrospectively analyzed 85 cases of NAFL treated by lifestyle intervention (control group, n=40) or by lifestyle intervention +levo-carnitine medication (medication group, n=45).In addition to lifestyle intervention, the patients in the medication group received oral levocarnitine at 10 mL tid for 4 weeks followed by a reduced dose of 10 mL bid for another 8 weeks. Results Twelve weeks after treat-ment, 37 cases (82.2%) in the medication group showed remarkable improvement and the other 8 failed to respond.In the control group, 23 cases (57.5%) were improved and 17 cases remained unimproved .There were statistically significant differences in the rate of therapeutic effectiveness between the two groups of patients (P<0.01).No adverse effects were observed during the levocarnitine medi-cation. Conclusion Lifestyle intervention +levocarnitine medication can improve NAFL .

Objective To explore the relationship between insluin resistance(IR)and plasma fibrinogen, blood lipids levels in patients with gestational diabetes mellitus (GMD).Methods Totally 127cases pregnant women in their 24 -28 gestational weeks were divided into GDM group(n =37),gestational impaired glucose tolerance test (GIGT)group(n =30)and normal glucose tolerance(NGT)group(n =60)based on the American Diabetes Associ-ation(ADA)2009 GDMdiagnostic standards.All selected cases's height,weight,fasting blood glucose (FBG),fasting insulin (FIN),blood lipids and fibrinogen(FIB)level were tested,and their body mass index(BMI)and IR index (HOMA -IR)were calculated.Results During the mid -trimester,the levels of BMI,FIB,HOMA -IR,FBG,FIN, triglyceride (TG),cholesterol(TC),low density lipoprotein -cholesterol (LDL -C)in the GDM group were signifi-cantly higher than the GIGT and NGT groups.However,high density lipoprotein -cholesterol (HDL -C)was signifi-cantly lower (F =69.29,98.15,70.32、141.43、61.92,106.06,157.06,90.59,25.25,all P <0.01).FIB was sig-nificantly positively correlated with BMI,FBG,FIN,HOMA -IR,TC,TG,LDL - C (r =0.441,0.682,0.506, 0.599,0.493,0.591,0.633,all P <0.01 ),and negatively correlated with HDL -C(r =-0.419,P <0.01 ).Multiple stepwise regression analysis indicated that BMI,LDL -C,FBG and TG were independent risk factors affect-ing FIB(t =7.683,2.678,3.184,3.844,all P <0.01);FIB,BMI,FBG,FIN and TC were independent risk factors influencing HOMA -IR(t =68.784,3.201,29.702,58.100,2.904,all P <0.01).Conclusion Pregnant women have IR and blood lipid disorders during the mid -trimester,the overexpression of FIB is closely related to it.

Objective To evaluate the feasibility and clinical efficacy of lateral femoral circumflex artery perforator flaps and fit together in the treatment of limbs complex wound surface.Methods From January 2010 to March 2012,use the characteristics that the descending branch of lateral femoral circumflex artery extend its branches over the flap,fascia and skin,to form lenticulostriate arteries,which contain 2 to 3 different species tissues fits together,flaps cover the important tissues such as vessel,nerves and bones.Fascia covers the tendinous tissues etc.Muscle can not only cover the tissues,but also fill in the space,and followed by skin grafting.This research was to perform the treatment for 4 cases of lacking limbs ring tissue,three cases of multiple wound surface,six cases of hand avulsion injury of skin and 9 cases of Gustilo grade-Ⅲ C.Results As for the 22 cases in the research,nineteen cases of flaps survived,the other 3 cases were necrosis with length of 1cm to 2 cm at distal and self-healed later.During 6 months to 2 years followed-up of 18 cases,external flaps were satisfactory,skin grafting over the fascia layers develops very well,smooth with great elasticity,no recoil,and no color change.Conclusion Lateral femoral circumflex artery is one of effective restoration methods for limbs with complex wound surface.