0 05) HR in group A was faster than that in group B at T 3 (P

Objective To investigate the clinical efficacy of laparoscopic Soave's surgery for the treatment of congenital Hirschsprung's disease in infants (age ＜ 2 months).Methods The clinical data of 368 infants with congenital Hirschsprung's disease who received laparoscopic Soave's surgery at the Children's Hospital of Xuzhou City from June 2005 to June 2012 were retrospectively analyzed.Three Trocars with diameter of 0.5 cm were used.The colic ligament was freed and the mesentery was ligated laparoscopically,then the rectal mucosa was stripped for 5-7 cm in length,and was pulled out through the rectal muscle sheath.Patients were followed up via out-patient examination at postoperative month 1,3,6,12 to learn the frequency of defecation,constipation and anal stenosis.The follow-up was ended in June of 2013.Results Two patients were converted to open surgery,and the remaining 366 patients received laparoscopic surgery successfully,with no incidence of wound infection.The operation time,volume of blood loss and duration of hospital stay were (100 ±20)minutes,(5.4 ± 1.5) mL and (7.3 ± 1.5) days,respectively.The average time for antibiotics usage was (3.5 ± 1.6) days and the time for infusion was (3.8 ± 1.4) days.All the infants were followed up,and the mean time for postoperative follow-up was 4.5 years (range,1.0-8.0 years).Eleven patients were complicated with Hirschsprung's disease associated enteritis,7 patients with constipation,5 with anal stenosis,4 with fecal pollution.The condition of the infants was improved after conservative treatment.Conclusion Laparoscopic Soave's surgery is suitable for the treatment of congenital Hirschsprung's diseases in infants aged under 2 months,it has the advantages of small trauma,quick recovery,better cosmetic effects and few complications.

ObjectiveTo investigate the difference in the outcomes in patients with acute anterior circulation stroke having achieved the Thrombolysis in Cerebral Infarction (TICI) 2b and TICI 3 recanalization after mechanical thrombectomy.MethodsThe patients with acute anterior circulation stroke having achieved successful recanalization after mechanical thrombectomy were enrolled retrospectively.They were divided into TICI 2b (almost complete recanalization) group and TICI 3 (complete recanalization) group.The good outcome was defined as the modified Rankin Scale score 0-2 at 3 months after onset.ResultsA total of 83 patients were enrolled in the study, including 38 patients (45.8%) with TICI 2b and 45 (54.2%) with TICI 3;49 (59.0%) had good outcome, and 34 (40.9%) had poor outcome.The good outcome rate in the TICI 3 group was significantly higher than that in the TICI 2b group (68.9% vs.47.4%;χ2=3.946, P=0.047).After adjusting for age, hypertension, diabetes, baseline systolic blood pressure, triglyceride, intravenous thrombolysis, and ASITN/SIR collateral grades, TICI 3 was an independent predictor for good outcome at 3 months after onset (odds ratio [OR] 3.759, 95% confidence interval [CI] 1.098-12.871;P=0.035), while the higher baseline National Institutes of Health Stroke Scale score (OR 0.820, 95% CI 0.715-0.941;P=0.005) and higher fasting glucose (OR 0.610, 95% CI 0.410-0.906;P=0.014) were the independent predictors for poor outcome at 3 months after onset.ConclusionsThere are difference in the outcomes in patients with successful recanalization in anterior circulation stroke treated with mechanical thrombectomy.The outcome is substantially better in TICI 3 than TICI 2b patients.

Objective To compare the efficacies of 4 risk models (THRIVE[Totaled Health Risks in Vascular Events],MSS[Multicenter Stroke Survey],HIAT[Houston Intra-Arterial Therapy],and GRASPS[Glucose at presentation,Race,Age,Sex,Systolic blood pressure,Severity of stroke at presentation]) in predicting intracranial hemorrhage and poor outcomes in acute anterior circulation ischemic stroke after mechanical thrombectomy.Methods From May 2013 to March 2016,153 consecutive patients with acute anterior circulation vascular occlusion conducted mechanical thrombectomy within 6 hours after onset and admitted to the Departments of Neurology,Jinling Hospital,Nanjing University School of Medicine and Zhongshan Hospital,Xiamen University were enrolled prospectively.Logistic regression analysis and the area under the receiver operating characteristic (ROC) curve (AUC) were used to investigate the efficacies of 4 risk models (the THRIVE,MSS,HIAT,and GRASPS scores) for predicting intracerebral hemorrhage (including any intracranial hemorrhage events and symptomatic intracranial hemorrhage) and poor outcomes (including 90 d all-cause death and modified Rankin Scale[mRS] score≥3) in acute anterior circulation ischemic stroke after mechanical thrombectomy.Results The MSS score (AUC 0.639,95%CI 0.548-0.730,P=0.004) and GRASPS score (AUC 0.616,95%CI 0.525-0.706,P=0.017) could predict any intracranial hemorrhage events,but the predictive accuracy was low.They had the predictive value for death within 90 d after mechanical thrombectomy,and the GRASPS score (AUC 0.783,95%CI 0.706-0.860,P<0.001) had the moderate predictive accuracy,and the AUC of the other 3 models was all<0.7,the predictive accuracy was low.The models could predict the poor prognosis at 90 d (90 d mRS≥3).The AUCs of both the GRASPS score and THRIVE score were >0.7.The AUC of GRASPS score was the largest (AUC 0.782,95%CI 0.708-0.885,P<0.01).Both had moderate predictive accuracy.Conclusion The GRASPS score had a better clinical predictive value for all-cause death and poor prognosis within 90 d after mechanical thrombectomy.The THRIVE score had a better clinical predictive value for poor prognosis at 90 d.The 4 models predictive value for intracranial hemorrhage events after mechanical thrombectomy should be further examined.

Objective To systematically evaluate the efficacy and adverse effects of duloxetine in the treatment of domestic depression patients,and compare with those who were treated with SSRIs drugs in the same period to explore the difference between them to guide the clinical medication.Methods A search was conducted in CBMdisc,Wanfang database,CNKI,VIP,Pubmed.The double-blind randomized controlled trials on duloxetine for depression in China were collected.The quality of the included trials was assessed according to the Cochrane Handbook 5.0,and the systematic analysis was conducted by using RevMan 5.3 soft ware.Results Seven double-blind randomized controlled trials (two of duloxetine versus fluoxetine,five of duloxetine versus paroxetine) involving 1 193 patients were included.The results of rmeta-analysis showed that:①After 6-8 weeks of treatment,there were no significant differences in the effective rate (RR =1.02,95％CI=0.78-1.32,Z=0.12,P=0.90),and the final cure rate (RR=0.95,95％CI=0.75-1.19,Z=0.47,P=0.64) between the duloxetine and fluoxetine/paroxetine groups.②Adverse reactions:the incidence rate was not significantly different between duloxetine and fluoxetine/paroxetine groups (RR =1.03,95％ CI =0.86-1.23,Z=0.32,P=0.75).Conclusion After 6-8 weeks of treatment,there are no significant differences in the effective rate and the final cure rate between duloxetine and fluoxetine/paroxetine.There is no significantly difference in common adverse reactions.

Bovine interferon-gamma (BoIFN-gamma) gene was amplified by reverse transcription polymerase chain reaction (RT-PCR) from total RNA of bovine spleen lymphocytes stimulated with ConA. The products of RT-PCR were cloned into pVAX1 vector, positive recombinant clone was identified by restriction enzyme digestion and sequencing. The recombinant plasmid pVAX1-BolFN-gamma was transfected into COS-7 cells mediated by lipofectine, indirect immunofluorescent assay analysis confirmed that rBoIFN-gamma was expressed in COS-7 cells. BoIFN-gamma gene (without signal peptide) was cloned into pET-30a(+) and pGEX-6p-1 vector, and transformed into the Escherichia coli cells. After optimizing the induction condition, SDS-PAGE analysis showed that the expression products were all found in soluble form and had a molecular weight of 23 kDa and 43 kDa respectively. BoLFN-gamma precursor gene (with signal peptide) was cloned into transfer vector pFastBac 1, and transformated into DH10Bac E. coli cells. By site-specific transposition, BoIFN-gamma gene was integrated into shuttle vector Bacmid, and transfected into the Sf9 insect cells mediated by lipofectine to produce recombinant baculovirus. Indirect immunofluorescent assay analysis confirmed that rBac-BoLFN-gamma was expressed successfully in Baculovirus vector system. The antiviral activities of rHis-BoIFN-gamma, rGST-BoIFN-gamma and rBac-BoIFN-gamma were up to 8.389 x10(7) U/mg, 6.554 x10(5) U/mg and 4.096 x 10(4) U/mL respectively, which were analyzed in MDBK/VSV system. A sandwich ELISA was established using monoclonal antibodies 3E6 and 5G4, which can detect BoIFN-gamma in quantity and provide a useful method for the clinical practice and research of BolFN-gamma.
Animals ; Antiviral Agents ; pharmacology ; Baculoviridae ; genetics ; metabolism ; COS Cells ; Cattle ; Cercopithecus aethiops ; Escherichia coli ; genetics ; metabolism ; Genetic Vectors ; genetics ; Interferon-gamma ; biosynthesis ; genetics ; pharmacology ; Recombinant Proteins ; biosynthesis ; genetics ; pharmacology ; Transfection

Objective: To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis. Methods: One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170 μmol/L) caused by choledocholithiasis, aged 51-63 yr, with body mass index of 20-28 kg/m², of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Mini-Mental State Examination (MMSE) scores≥20, scheduled for elective cholecystectomy and choledocholithotomy, were divided into 3 groups (n=40 each) using a random number table method: control group (C group) and dexmedetomindine 0.4 μg·kg^-1·h^-1 group (D1 group) and dexmedetomindine 0.6 μg·kg^-1·h^-1 group (D2 group). After induction of anesthesia, dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg, followed by an infusion of 0.4 and 0.6 μg·kg^-1·h^-1 until the end of operation in D1 and D2 groups, respectively.The equal volume of normal saline was given instead in group C. with preoperative scores≥20, MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T₀) and 1, 3, 5 and 7 days after operation (T_1-4). The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above, and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzyme-linked immunosorbent assay. Results: Compared with group C, MoCA scores were significantly increased at T₁ in group D₁, and MMSE scores at T₁ and MoCA scores at T₁ and T₂ were significantly increased, and the plasma concentrations of Aβ42 were decreased at T_2-4 in group D2, and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P<0.05). Compared with group D1, MoCA scores were significantly increased at T₁, and the plasma concentrations of Aβ42 were decreased at T_2-4 in group D2 (P<0.05). Conclusion Dexmedetomidine can improve postoperative cognitive function, and intravenous infusion at a rate of 0.6 μg·kg^-1 · h^-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.

Objective:To explore implementation of post training in Central Sterile Supply Department (CSSD) based on Analysis, Design, Development, Implementation and Evaluation model (ADDIE model) , so as to explore its training effects.Methods:From January to August 2021, the development of post training courses for CSSD were completed according to ADDIE model, and 54 CSSD staff in the Second Hospital of Jilin University were selected by the convenient sampling method for post training. After the training, the Korotkoff evaluation method was used to evaluate the training effect from the aspects of CSSD staff satisfaction, theoretical assessment results and implementation rate of key technologies.Results:The satisfaction of CSSD staff with post training based on the ADDIE model was (88.44±4.01) , which was higher than the (79.72±4.90) of traditional training, and the difference was statistically significant ( P<0.01) . After the post training based on the ADDIE model, the theoretical assessment score of CSSD staff was (90.07±6.09) , and the score before training was (81.30±7.28) , and the difference was statistically significant ( P<0.05) . In addition, the implementation rate of the key technologies of the posts was higher than before the training. Except for the sterilization post, there were statistically significant differences in the cleaning post, packaging post, distribution post and receiving post ( P<0.05) , and the frequency of adverse events was 0. Conclusions:Post training based on the ADDIE model can effectively improve the ability of CSSD staff and promote positive changes in their work behavior. Both CSSD staff and hospitals have a high degree of recognition for this training.

OBJECTIVETo investigate the feasibility and safety of totally laparoscopic distal gastrectomy.

METHODSClinical data of 25 patients with distal gastric cancer undergoing totally laparoscopic distal gastrectomy between December 2011 and January 2013 were analyzed retrospectively. Only laparoscopic linear stapler was used in intracorporeal delta-shaped or Roux-en-Y anastomosis for reconstruction.

RESULTSNo patient required conversion to laparoscopy-assisted or open surgery. The mean total operative time and anastomotic time were (256±23.6) min and (35.7±8.4) min respectively in patients with delta-shaped anastomosis, and (287±11.5) min and (46.4±12.1) min in those with Roux-en-Y anastomosis. The mean blood loss was(109.6±42.3) ml, and the mean number of stapler used was 5.6. The mean time to the first flatus was (2.8±1.2) d, and mean time liquid diet to resume was (3.5±0.9) d. Postoperative complication occurred in 3 patients(12.0%).

CONCLUSIONTotally laparoscopic distal gastrectomy with intracorporeal anastomosis using laparoscopic linear stapler is safe and feasible.