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.

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.

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 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.

Objective Background and objective The Cox maze Ⅲ procedure has been considered the gold standard for the surgical treatment of atrial fibrillation (AF) and the modified Cox maze use bipolar radiofrequency ablation instead of the cut-and-sew technique,while also reducing the connecting lines in left atrium.This study was to understand whether completely isolation the posterior left atrium by increasing left atrium ablation lines can enhance the survival after modified Cox maze procedure.Methods From Jan 2009 to Dec 2009,all the patients underwent the Cox maze procedure,following the same examination,were divided into two groups (case-control): box lesion group (n =60),which is means the right and lefi pulmonary vein lesions were connected inferiorly by adding ablation lines,thereby completely isolating the posterior left atrium and the non-box lesion group (n =60).Similar interventions were given during the perioperative periods.Comparing the risk factors before surgeries,then follow-up was 100％ complete,and the mean follow-up was 9 ± 8.4 months.Results Except the box lesion had long time of extracorporeal circulation,the characteristics of the 2 groups were similar because there were no differences in age,AF duration,left atrial diameter,left ventricular ejection fraction or homochronous operation between the groups and there was no operative death.No patient was lost to follow-up.In the mean follow-up duration,a patient was died of intracerebral hemorrhage at 2 months postoperationly in the box lesion group and a patient suffered from stroke at 12 months postoperationly in the non-box lesion.The overall freedom from AF recurrence was higher in the box lesion group at 1 (70％ vs 51.2％,P =0.039) and 3 (78.3％ vs 60％,P =0.030) months.While it was 80％ vs 71.7％ (P =0.286) at 6 months.Eight patients wrere readmitted because of the recurrence of AF,4 and 2 patients underwent catheter ablation in box and non-box group respectively,one patient in each group underwent electrical conversion.After treatment,all of the patients were recovered to sinus rhythm and continued to take cordarone.Conclusion Compared to the single connecting between right and left pulmonary vein,isolating the entire posterior left atrium by creating a box lesion showed higher freedom from AF in the earlier months (1-3months).However,half a year after the surgery,there were no significant differences between the two groups.

Objective To evaluate the effect of percutaneous transhepatic obliteration(PTO)of gastroesophageal varices in liver cirrhosis.Methods Fifty-six cirrhotic patients suffering from gastroesophageal varices were treated with PTO,including 35 during emergency bleeding,10 after stoppage of hemorrhage and 11 with severe gastroesophageal varices for prevention of bleeding.Results Catheterization and embolization of gastroesophageal varices were successfully performed in all 56 patients(100%).Bleeding stopped after PTO as an emergency treatment was achieved in 35 patients with upper gastrointestinal bleeding.Among them,PTO was performed in 11 patients for preventing variceal hemorrhage,gastroesophageal varices disappeared in 7 and alleviation was obtained evidently in 4.47 patients were followed up for 2-60 months with recurrent bleeding in 5,death in 4 on causes of rebleeding of alimentary tract(1 case),hepatic failure(1 case), hepatocellular carcinoma(2 cases).Conclusion PTO is a safe and effective treatment for gastroesophageal varices in cirrhotic patients and should be recommended extensively.

A microwave digestion system was preparation for the digestion of the sediment samples of 16 stations in the Southe mid_Atlantic ridge by using HNO3_H2 O2_HF as the digestion reagent. The rare earth elements ( RE ) in sediments were determined by inductively coupled plasma mass spectrometry, and distribution characteristics of rare earth elements were studied. The microwave digestion_ICP_MS method was used for the determination of rare earth elements with a good linear relationship ( r=0 . 9997-1 . 0000 ) for each element. The detection limit reached ng/L level, the relative standard deviation ( RSD, n=3 ) was less than 3% and the relative error was 6%. The total amount of rare earth elements (ΣRE) in sediment samples from 16 stations varied in the range of 37. 25-134. 77 μg/g, the ratio range of light RE/heavy RE ( LRE/HRE) was 0 . 61-1 . 70 , the average value was 1 . 27 , and the enrichment of light rare earth elements in sediments was slightly obvious. The RE distribution patterns were basically the same in each station with obvious fractionation between LRE and HRE. The RE distribution patterns were also similar in sediments from different sources with slightly difference between terrestrial and marine sediments. The δEu and δCe in the sediments had negative anomaly which showed that the rare earth elements in sediments came from the seawater. This study first analyzed the content and distribution of rare earth elements in the southern Atlantic, providing data and technical support for further study of the distribution of rare earth elements in the Atlantic.

BACKGROUND:During the healing of fractures, removal of sciatic nerve can result in insufficient mechanical rigidity of newborn woven bone. However, there are less reports concerning the denervation effects during distraction osteogenesis. OBJECTIVE:To observe the effect of removal of the sciatic nerve on bone regeneration and the expression of Runt-related transcription factor 2 (Runx2) protein during distraction osteogenesis in a rabbit model. METHODS:Twenty-four adult male New Zealand rabbits were selected and underwent left tibial osteodistraction to construct animal models of distraction osteogenesis. Before distraction, the animals were randomly divided into group R (resecting the left sciatic nerve) and group I (intact left sciatic nerve). Six weeks after completion of distraction, the animals were kil ed and the lengthened tibias were harvested for radiography, three-dimensional CT reconstruction, histological evaluation, connectivity density (Conn.D) evaluation. RESULTS AND CONCLUSION:New regenerated bone was present and Runx2 protein was expressed in the distraction gaps of al animals at the end of the study, as revealed by radiography, three-dimensional CT reconstruction, and histological observation. However, less new bone formation and a lower degree of mineralization and expression of Runx2 protein were observed in group R compared with group I. The results suggest that the denervation appears to have an inhibitory effect on bone formation and the expression of Runx2 protein during distraction osteogenesis.