Objective To investigate the multi-slice spiral computed tomography (MSCT) features of crush maxillofacial frac-tures in the massive Wenchuan earthquake. Methods MSCT data of 85 patients with crush maxillofacial fractures caused by earth-quake were retrospectively analyzed. The anatomic distribution of fractures was evaluated. Results In 85 patients, single bone frac-tures (59 patients) were more common than multiple bone fractures (26 patients) (P<0.05). The fractures involved isolated mid-face, isolated mandible, and both were found in 49 patients (57.6%), 24(28.2%), and 12(14.2%), respectively. Midface frac-tures were most frequent (P<0.05). The fractures of condyle, posterolateral and anterior wall of maxillary sinus, zygomatic arch and lateral orbital wall accounted for 47.1%(24/51) ,41.5%(22/53) , 37.7%(20/53),71.9% (23/32) and 63.2%(24/38) of the total fractures of the corresponding maxillofacial bones. Conclusion Isolated bone fracture and midface factures are the main fea-tures of crush maxillofacial fractures resulted from the massive earthquake. MSCT and three-dimensional reconstruction images can demonstrate maxillofacial fractures well.

Objective:To present the learning curve of robotic assisted laparoscopic partial nephrectomy by a single surgeon.Methods:The clinical data of 100 patients with renal tumor who underwent robot assisted laparoscopic partial nephrectomy in Peking Union Medical College Hospital from February 2016 to April 2018 were retrospectively analyzed. There were 64 males and 36 females. The average age was 51.5(18-79) years. The average body mass index (BMI) was 24.9(19-31)kg/m 2. TNM stage was T 1N 0M 0, which indicated partial nephrectomy. The tumors were located on the left in 38 cases and on the right in 62 cases. The average maximum diameter of tumor was 3.9(1.0-6.7) cm, and the average R. E.N.A.L. score was 6.7(4-11). All operations were performed by a single surgeon. This group of operations were the first 100 robot cases for this surgeon. The mean machines docking time was 14(10-30) min, the mean operation time was 119.2(60-240) min, the mean warm ischemia time was 16.7(0-45) min, and the estimated mean blood loss was 105.2(30-500) ml. There was no conversion to open surgery or laparoscopic radical nephrectomy. No serious complications occurred (Dindo calvein grade ≥ grade Ⅲ). There were 1 case of lower extremity intramuscular venous thrombosis, 1 case of urinary fistula, 1 case of pulmonary infection and 1 case of peri-kidney hematoma after operation. All patients were cured after conservative treatment without further operation or intervention. Cumulative Sum (CUSUM) test was used to fit the learning curve of docking time and operation time, and to judge the three different learning stages of robot surgery according to the inflection of the curve (CUSUM stop rising, and CUSUM begin to decline). The characteristics of patients and perioperative data of different learning stages were compared. Result:According to the CUSUM, the learning curve of robot assisted laparoscopic partial nephrectomy was 19 cases. According to the inflection point of operation time learning curve, 100 cases could be divided into three stages, 1st-19th cases were learning stage, 20th-43rd cases were mastering stage and 44th-100th cases are proficient stage. There were no significant differences in age, gender, tumor side, intraoperative bleeding volume, postoperative pathological type, total cost of hospitalization and incidence of complications among the three stages ( P>0.05). The median BMI in the learning stage was significantly lower than that in the mastery stage and the proficiency stage (23 kg/m 2, 26 kg/m 2, 25 kg/m 2, P=0.02). The median docking time(20 min, 12 min, 12 min), median operation time (150 min, 120 min, 100 min) and median warm ischemia time (21 min, 18 min, 15 min)were gradually shortened in the learning stage, mastering stage and proficient stage ( P<0.001). The median length of postoperative hospital stay in mastering stage and proficient stage was shorter than that in learning stage (7 d, 6 d, 6 d, P=0.011). The median maximum diameter of tumor (3.7 cm, 3.9 cm, 4.0 cm)and median R. E.N.A.L. score (6, 7, 7)increased gradually in learning stage, mastering stage and proficient stage, but the difference was not statistically significant( P=0.75, P=0.16). Conclusions:The learning curve of robotic assisted laparoscopic partial nephrectomy for an experienced surgeon is about 19 cases. After the completion of the learning curve, the docking time, operation time, warm ischemia time and postoperative hospital stay of patients can be significantly shortened than the initial period, and more difficult renal tumor operations can be accomplished.

Objective:To investigate the safety and efficacy of domestic Kangduo robotic surgery system in adrenalectomy.Methods:This study summarized the clinical data of patients with adrenal adenoma who were operated by domestic kangduo robot from November 2020 to April 2021. This study was approved by the hospital ethics committee, and the clinical trials of medical devices were filed. Inclusion criteria: age 18-75 years old; all of them in accordance with the indication of adrenalectomy; tumor volume≤6 cm; agree to sign the informed consent, follow the doctor's advice and follow up regularly. Exclusion criteria: patients with ipsilateral upper abdominal surgery history; patients with severe uncontrolled disease or acute infection; patients with cardiovascular and cerebrovascular diseases, blood system diseases and immune system diseases that are not controlled and can not reach the operation standard; pregnant or lactating women. All patients underwent robot assisted adrenalectomy. The general information and perioperative data of the patients were summarized.Results:Five patients were included in this study, including 1 male and 4 female. The average age was 49 (34-61)years old. There were 2 cases on the left and 3 cases on the right. The average diameter of tumor was 2.2 (1.1-3.7) cm. All patients showed adenoma by CT examination. Two cases were diagnosed as primary aldosteronism, one as Cushing's syndrome, and two as nonfunctional adenoma. All the operations were successfully completed in 5 cases, including 4 cases via retroperitoneal approach and 1 case via peritoneal approach. The average docking time was 3.8 (3-6) min, the average operation time was 56.2 (21-92) min, and the average blood loss was 34 (20-50) ml. The postoperative pathology was adrenal cortical adenoma. The average postoperative hospital stay was 3.6 (3-5) days. No postoperative complications occurred in 5 cases. Two patients with primary aldosteronism had hypertension and hypokalemia before operation, and they needed oral antihypertensive drugs to control them. They did not need medication after operation, and their blood pressure and potassium were maintained at normal levels. All patients were followed up for average 1.5(0.5-5.0)months.Conclusions:Domestic robot assisted laparoscopic adrenalectomy has the advantages of few blood loss, short operation time, few complications. It’s a safe and effective operation, but the conclusion needs to be further verified by large sample and multi-center study.

Objective To study the initial experience and outcomes of laparoscopic enucleation with preoperative selective arterial embolization ( PSAE) for the treatment of renal angiomyolipomas. Methods A total of 43 patients with sporadic renal angiomyolipomas from July 2013 to November 2014 underwent laparoscopic nephron-sparing surgery ( NSS) .The patients were divided into either PSAE group ( n =19 ) or non-PSAE group ( n =24 ) .The data of patient demographics, success rate of surgery, perioperative complications rate, operating time ( OT ) , warm ischemia time ( WIT ) , estimated blood loss ( EBL ) , length of hospitalization, kidney estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) level over 3 months, and ipsilateral recurrence were collected and compared between the two groups. Results Enucleation was successful in 100%patients (19/19) of the PSAE group and in 62.5%patients (15/24) of the non-PSAE group,with no significant difference ( Fisher' s test, P=0.105) The EBL was (46.4 ±20.6) ml in the PSAE group, which was significantly less than the non-PSAE group [(89.5 ±30.4) ml, t=-5.287, P=0.000].The OT and WIT were significantly shorter in the PSAE group than those in the non-PSAE group [(90.3 ± 21.1) min vs.(131.7 ±18.6) min, t=-6.831,P=0.000;(9.5 ±5.7) min vs.(24.2 ±4.8) min, t=-9.181, P=0.000]. The length of hospitalization was significantly longer in the PSAE group than that in the non-PSAE group [(7.7 ±1.1) d vs.(6.3 ± 1.3) d, t=3.748, P=0.000].No severe complications occurred in the PSAE group, whereas the non-PSAE group had 1 case of urinary leakage and 1 case of hematoma.The Scr level over 3 months after surgery was more ideal in the PSAE group [(70.1 ±13.7)μmol/L vs.(84.2 ±9.1) μmol/L, t=-4.045, P=0.000].No statistically significant difference was found in the eGFR between the PSAE group and the non-PSAE group [(72.6 ±12.8) ml· min-1· 1.73 m-2 vs.(68.0 ±10.7) ml· min-1· 1.73 m-2, t=1.284, P=0.206].No evidence of recurrence was found during follow-up period in both groups. Conclusions Laparoscopic enucleation with PSAE is a safe and effective minimally invasive procedure for the treatment of renal angiomyolipomas.As compared to traditional laparoscopic partial nephrectomy, it has advantages of less WIT, less EBL, and better protection of renal functions.It can be recommended in well-selected patients.

BACKGROUND:Research on hand braces is relatively backward, which is difficult to be promoted widely. Zone II extensor tendon has a complex structure, and poor recovery is commonly seen after injury. The main treatment for zone II extensor tendon injury is the fixation with plaster slab, plywood and polymer materials, and up to now, there is no ideal brace for zone II extensor tendon injury.
OBJECTIVE:To evaluate the effect of home-made multi-function hand brace on the repair of zone II extensor tendon injury.
METHODS:Seventy-six patients with zone II extensor tendon injury were randomly divided into test group and control group, with 38 in each group. In the test group, patients were given appropriate rehabilitation education and multi-function hand brace based apart from conventional hand surgery on zone II extensor tendon; in the control group, patients underwent conventional hand surgery and guiding functional training. Total active motion of the extensor tendons of fingers were evaluated at 1, 2, 3 months after treatment; and the manual dexterity and fine motor of the hand were assessed at 2 and 3 months after treatment.
RESULTS AND CONCLUSION:The difference in the total active motion of extensor tendons of fingers was of great significance between the two groups at 1, 2, 3 months after treatment (P < 0.05). The Minnesota manual dexterity and fine motor of the hand also showed significant differences between the two groups at 2 and 3 months after treatment (P < 0.05). Patient’s cost-effectiveness analysis results showed that the total cost of the two groups had no statistical significance (P> 0.05), but less cost was used for one point increase in the above-mentioned three functional scores of the test group than the control group (P < 0.05), indicating the implementation of cost-effective treatment. This home-made brace can prevent adhesions and anchylosis during the postoperative auxiliary exercise; meanwhile, it can improve the range of motion, flexibility and fine motor ability of the hand and has a higher cost performance in the postoperative adjuvant exercise therapy of zone II extensor tendon injury.

Objective Rereach into the pharmaceutical mechnisms of Ganzhixiao Granule which is used to treat fatty liver. Method Build up fatty cirrhosis-rat models by feeding with high-fat food and alcohol. Contract with Dongbaogantai and observe the influence of Ganzhixiao granule on SOD, MDA and the liver function ferment. Result In the group of Ganzhixiao, the activeness of the liver’s SOD can be increased, while the content of MDA and the activeness of ALT and AST can be decreased, that is much better than Dongbaogantai. Conclusion Ganzhixiao granule has strong effect on fatty cirrhosis, and its mechanism may be concerned with the rat’s liver cell membrane and restraining damaging kuffer cell cytokine.

Objective To make a plan for the backup of electronic medical records. Methods The background of electronic medical records backup was analyzed, and NTBACKUP tool and batch technology were used to realize the backup plan. Results An automatic-execution backup plan raised the security of electronic medical records greatly. Conclusion The automatic-execution backup plan satisfies the basic demands for medical information security, though there is room for further improvement in data synchronization.

Objective To evaluate the multi-slice spiral CT (MSCT) features of crush pulmonary parenchymal injuries in the massive Wenchuan earthquake. Methods One hundred and seventeen patients with crush pulmonary parenchymal injuries in the massive Wenchuan earthquake were reviewed, the location, extent and MSCT appearances of the injuries and associated thoracic injuries were evaluated. The MSCT appearances of the injuries on 1 d, 2--5 d and 6--14 d were compared using Chi-square test. Results One hundred and thirteen patients had pulmonary contusion and bilaterally in 70 cases, 7 had pulmonary laceration. A total of two hundreds and eighty-three lung lobes were involved and 3 or more lobes involved in 47 patients. Ill-defined patchy opacity was detected in 75 patients, associated ground-glass opacity (GGO) in 24 cases. Lung laceration presented as pneumatocele in 4 cases and demarcated hematoma in 3 cases. Coexisted rib fractures were detected in 98 patients and flail chests were in 29 patients. Forty-three patients had coexisted fractures of scapula, clavicle and (or) sternum. Ninety-nine patients had coexisted pleural injuries. Conclusions Crush pulmonary parenchymal injuries in the Wenchuan earthquake are severe. The bilateral, multifocal and multiple lobes involved injuries with a high incidence of coexisted other severe thoracic injuries are the noticeable features.

Aim To establish an ideal hyperlipidemia animal model by a new way.Methods 30 mice were randomly divided into control group, positive control group and model group.The mice of control group were only fed with a standard diet.Those of positive control group were fed with high fat diet.Those of model group were fed with a standard diet and enough milk.After 30 days the TG, TC, HDL-C and LDL-C of serum and hepatic and LI were detected and pathological changes in the liver of mice were observed microscopically.Results Compared with the control group, the mice of model group developed hyperlipidemia with LI and the serum and the hepatic TG, TC, LDL-C elevated significantly, while HDL-C were significantly lower.The histopathological research showed hepatocellular macrovesicular steatosis and hepatitis in the model group.Conclusion An ideal model of hyperlipidemia is successfully established with standard diet and milk fed to mice for 30 days.

Objective To combine the active poly lactic co-glycolic acid (PLGA) nanosperes with adriamycin in side (ADM-NP) on the surface of ultrasound micrbubbles in covalent bonding and to prepare a novel drug-loading ultrasound micrbubble,and observe the physicochemical property.To quantify drug encapsulation efficiency and drug-loading amounts and drug-release properties in vitro and the effect of tumor imaging.Methods ADM-NP were prepared with double emulsification method,The surface carboxyl of ADM-NP was activated with carbodiimide method.Amino ultrasound microbubbles (MB-NH2) were prepared with mechanical shaking.The carboxyl of ADM-NP and the MB-NH2 could take place condensation reaction under a certain condition.Light microscope was used to observe the shape and distribution of the novel micrbubble.High performance liquid chromatography (HPLC) was used to quantify drug encapsulation efficiency and drug loading amounts.This novel microbubbles were put in 2 dialysis bag to observe the releasing properties of ADM in vitro,and one of the bag was using low frequency ultrasound irradiation for 120 s.The effect of tumor imaging using this novel microbubble was observed.Results After 48 hours,a number of ADM-NP attacted to the MB-NH2 like a gar land.Determination of entrapment efficiency and drug loading of it by HPLC weare (86.11 ± 6.76)％ and (8.71 ± 0.46)％.The sustained release in vitro can last for more than 48 hours.More than 90％ of ADM encapsulated in the 2 groups was sustained released for 48 hours.And the release characteristics of the 2 groups in vitro was in accord with Higuchi equation,and no difference was observed in the 2 groups (P ＞0.05).The tumor showed typical enhancement pattems of quick wash-in and quick wash-out.Conclusions To combine the nanospheres to the surface of microbubbles with covalent bonding,it could prepare a novel efficient drug-loading microbubbles for a original technique of ultrasound-targeted microbubble destruction(UTMD).