Objective To get known the existing problems in rural primary physicians training in Gansu province, so as to explore an appropriate training mode for Gansu province. Methods This study conducted a comprehensive analysis by combining literature analysis, on-site survey and interview. Such databases as CNKI, VIP and CBM were searched to include literature published before November 2011, and the references of the included literature were also retrieved. The qualitative analysis was performed after assessing the methodological quality of the included literature according to self-designed criteria. Additionally, the rural primary hospitals in Gansu province were classified according to their geographical position and economic development level, total 10 township hospitals were randomly selected by cluster sampling, and the following stuffs participated various trainings in past 3 years were on-site-investigated: clinical doctors, nurses, medical technicians, and medical administrators, in aspects of training time, place, contents, modes, and effects. Results The existing problems in primary physicians training modes in Gansu were as follows: uneven training levels, lack of targeted contents, neglect of skill training and process management, and absence of quality assessment of training processes and effects. Conclusion The training modes require that: a) specific plans and schemes; b) unified organization to integrate educational resources effectively; c) reasonable arrangement of implementation process, and d) innovation of training methods and contents to fully play the role of general hospitals and universities; and well control and feedback to promote the integration and perfection of training modes.
Objective To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). MethodsTwenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others.Results All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64.7% and 37.5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.
Twenty-three patients (28 extremities) suffering secondary ulcer after high ligation and stripping of great saphenous vein were chosen to receive muscle flap formation of potiteal vein. Of which, 21 patients (25 extremities) ulcer scabbed within one week and healed in 2 weeks after operation. The other s were cured in 5 weeks. All patients were followed up 6-12 months with no recurrence and satisfactory results.
Abstract： Tricuspid insufficiency founded in the setting of left-sided heart disease is usually secondary tricuspid insufficiency caused by tricuspid valve annular dilation. Some patients had rheumatic tricuspid valve diseases. Tricuspid valve repair rather than valve replacement is recommend for functional tricuspid regurgitation. Linear annuloplasty and ring annuloplasty are two main tricuspid valve repair methods. However, the indications for treatment of secondary tricuspid regurgitation remain controversial. The optimal surgical repair technique to eliminate secondary tricuspid regurgitation remains challenging. In this article, we review the assessment of tricuspid valve lesions, criteria for correction, and surgical management of secondary tricuspid insufficiency.methods. However, the indications for treatment of secondary tricus
Objective To summarize the research progress of secondary fracture of adjacent vertebral body after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Methods Recent literature concerning PVP and PKP was extensively reviewed and summarized. Results The main reasons of secondary fracture of adjacent vertebral body after PVP and PKP are the natural process of osteoporosis, the initial fracture type, the bone cement, the surgical approach, the bone mineral density, and other factors. Conclusion Secondary fracture of adjacent vertebral body after PVP and PKP is a challenge for the clinician, a variety of factors need to be suficiently considered and be confirmed by a lot of basic and clinical epidemiological studies.
【Abstract】 Objective To explore the effect of recurrent anterior shoulder dislocation on the secondary intra-articular injuries through analyzing the correlation between the number of dislocation, disease duration, and the secondary intra-articular injuries. Methods The clinical data were analyzed retrospectively from 59 patients with recurrent anterior shoulder dislocation who underwent arthroscopic Bankart reconstruction using suture anchor between January 2005 and June 2009. There were 48 males and 11 females, and the average age was 27.6 years (range, 15-42 years). The causes of first dislocation included contact sports (21 cases), non-contact sports (13 cases), daily activities (11 cases), and trauma (14 cases). The average number of preoperative dislocations was 10.6 times (range, 3-32 times). The time between first dislocation and surgery was 11 months to 12 years (median, 5.9 years). The results of apprehension test and relocation test were positive in all patients. The University of California Los Angeles (UCLA) score was 22.3 ± 2.4, and Constant-Murley score was 73.1 ± 5.8 preoperatively. According to the arthroscopic findings, the effect of recurrent anterior shoulder dislocation on the secondary intra-articular injuries was analyzed. Results All incisions healed by first intention, and no early complication occurred. All 59 patients were followed up 37.3 months on average (range, 16-58 months). At last follow-up, UCLA score was 34.6 ± 1.7 and Constant-Murley score was 86.7 ± 6.1, showing significant differences when compared with preoperative scores (P lt; 0.05). The number of preoperative dislocations was positively correlated with the severity of secondary articular cartilage injury (rs=0.345, P=0.007) and the severity of Hill-Sachs injury (rs=0.708, P=0.000). The time between first dislocation and surgery had a positive correlation with the severity of secondary articular cartilage injury (rs=0.498, P=0.000), but it had no correlation with the severity of Hill-Sachs injury (rs=0.021, P=0.874). Conclusion For patients with recurrent anterior shoulder dislocation, early Bankart reconstruction is benefit to functional recovery of shoulder and can avoid or delay the occurrence or development of secondary intra-articular injuries.
ObjectiveTo investigate the effectiveness of the mortise-tenon orbicularis oris muscle flap for philtrum column deformity secondary to the unilateral cleft lip repair. MethodsBetween January 2009 and August 2011, 43 patients with philtrum column deformity secondary to unilateral cleft lip repair were treated. There were 23 males and 20 females with an average age of 23.6 years (range, 18-31 years). The left philtrum column was involved in 26 cases, and the right side in 17 cases. Cleft lip was repaired with Millard I in 15 cases and with Millard II in 28 cases. The time between cleft lip repair and philtrum column deformity correction was 15-30 years (mean, 21.7 years). The bilateral double orbicularis oris muscle flap was obtained, and then was divided horizontally into two layers. The overlapping suture of the bilateral lower muscle flap was perfomed, and the upper layer muscle was designed into the mortise-tenon orbicularis oris muscle flap and was sutured with contralateral skin. ResultsAll incisions healed by first intention. Forty cases were followed up 13.4 months on average (range, 6-34 months). The patients achieved satisfactory effects in bilateral symmetry philtrum column and normal concave shape. At 6 months after operation, significant improvement was observed in 38 cases and no obvious improvement in 2 cases. ConclusionThe mortise-tenon orbicularis oris muscle flap is a simple operation and can obtain good results in the appearance and function of the upper lip in the correction of philtrum column deformities secondary to the unilateral cleft lip repair.
Objective To investigate the expression pattern of hypoxia-inducible factor 1α (HIF-1α) in experimental secondary spinal cord injury (SSCI) in rats and its potential effects on SSCI. Methods A total of 66 SD rats (female or male) with weight (250 ± 20) g were randomly divided into 3 groups: normal control group (group A, n=6), pseudo injury group (group B, n=6), and spinal cord injury (SCI) group (group C, n=54). In group A, no treatment was given as normal control. In groupB, only laminectomy was appl ied. In group C, laminectomy was appl ied and static compression model of SCI was built at T10 level. The expression of HIF-1α was measured with HE and immunohistochemical staining in groups A, B (1 hour after pseudo injury), and C (1, 3, 6, 12 hours and 1, 2, 3, 7, 14 days after SCI). Results All rats survived to the end of the experiment. HE staining showed that the spinal tissue of groups A and B were dense and the nucleus were round and big with l ight staining and clear nucleolus. The injured neuron at 1-12 hours after SCI of group C presented pyknosis and deep eosin staining. The swelling axon with bubbles and the disintegrated and disorganized medullary sheath in white matter appeared at 1-3 days after SCI. The hyperplasia of gl ial cells were obvious and gray matter cells were broken and apoptosis with cavities in injured spinal segment was observed at 7 and 14 days after SCI. Immunohistochemical staining showed that HIF-1α was poorly expressed in group A and increased a l ittle in group B. The positive expression in group C increased at 3 hours after SCI, which was found in spinal cord anterior horn neurons and a small amount of gangl ion cells. It reached peak at 1 day, maintained at a high level during 1-3 days and then decl ined. At 14 days, it appeared only in a small amount of gangl ion cells of white matter. There was no significant difference in the number of HIF-1α positive cells between groups A and B (t=1.325, P=0.137). The number of HIF-1α positive cells at each time point in group C was more than those in groups A and B (P lt; 0.05), and there were significant differences between all time points in group C (P lt; 0.05). Conclusion The expression of HIF-1α increases after SCI, it is related to the ischemia hypoxia after SSCI, and the expression pattern was correlated with the injury time.
Objective To analyse the correlative factors of secondary vertebral fracture after percutaneous kyphoplasty (PKP) in treatment of osteoporotic vertebral compression fracture (OVCF) at different levels (adjacent and/or nonadjacent levels). Methods Between December 2002 and May 2008, 84 patients with OVCF were treated with PKP, and the cl inical data were analysed retrospectively. There were 11 males and 73 females with an average age of 70.1 years (range, 55-90 years). All patients were followed up 24-96 months (mean, 38 months). Secondary vertebral fracture occurred in 12 cases at 3-52 months after PKP (secondary fracture group), no secondary fracture in 72 cases (control group) at over 24months. The preoperative bone mineral density, postoperative vertebral height compression rate, postoperative Cobb angle, amount of injected bone cement per vertebra, puncture pathway (uni- or bilateral puncture), age, gender, number of fracture segment, and cement intradiscal leakage were compared between 2 groups to find correlative factors of secondary vertebral fractures. Results There was no significant difference in preoperative bone mineral density, postoperative vertebral height compression rate, postoperative Cobb angle, amount of injected bone cement per vertebra, puncture pathway, age, gender, and number of fracture segment between 2 groups (P gt; 0.05). But the incidence of cement intradiscal leakage was much higher in secondary fracture group than in control group (χ2=5.294, P=0.032). Conclusion Cement intradiscal leakage may be the correlative factor of secondary vertebral fracture after PKP in OVCF.
Objective To evaluate the operative methods and therapeutic effects of nasal septum cartilage-sil ica gel complex for two-stage repair of nasal deformities of unilateral cleft l ip. Methods From June 2001 to June 2007, 38 cases of secondary nasal deformity and septum deviation of cleft l ip were treated with transplanting nasal septum cartilage-sil ica gelcomplex. Among of them, there were 21 males and 17 females, aging 14-23 years with an average of 17.6 years. All cases were with nasal deformities of unilateral cleft l ip, including 21 cases of complete cleft l ip and 17 cases of incomplete cleft l ip. The locations were left side in 26 cases and right side in 12 cases. Nasal deformities were columella nasi deflexion, flattened nasal tip, pteleorrhine and alanasi collapse. The patients received 1-4 times operations, and the interval of two operations was 3-10 years (mean 5.5 years). According to nasal deformity, the nasal septum cartilage of 1.8 cm × 1.2 cm was cut, and transplanted into the nose point phantom surface forming “the shield” to extend nose column and to raise the tip of the nose. At the same time the nasal tip fat-connective tissue flap graft with fat knot was given. After fixation, the nasal alar cartilage and soft tissues were reduced to normal position. Results Primary heal ing of the incisions was achieved in all cases. The nasal deformity was corrected. The postoperative follow-up period was 12-18 months with an average of 15.6 months. All the patients of regional cartilage scars had no compl ication. The figure of nose was sl inky, the height of apex of nose and the shape of nose was natural,the apex of nose, nasal ala, nostrils and nasal columella were satisfactory [(the results were satisfactory in 30 cases (78.9%), general in 8 cases (21.1%)]. The nose department overall esthetics shape was improved in all the patients, no compl ications of the phantom sl iding, shifting and exposure, hemorrhage and infection occurred. Conclusion The nasal septum cartilagesil ica gel complex to repair the nasal deformities of unilateral cleft l ip is an ideal operation style.