Objective To explore the correlation of serum procalcitonin and prognosis of neonatal sepsis. Methods 113 cases of infection were selected as the objects of study,which were divided into the observation group ( sepsis) and control group ( non sepsis) according to the presence of sepsis.2mL venous blood was selected when patients were admitted to hospital before antibiotic treatment.The level of PCT was detected by immunoluminometric assay.PCT level at admission and after treatment were used to analyze the relationship between changes and the severity and prognosis of patients.Results PCT level of the observation group [(11.03 ±6.21)ng/mL] were higher than that of the control group [(0.81 ±1.61)ng/mL] (t=8.507,P<0.01),Sepsis and death in patients with serum PCT values increased significantly over time (F=5.061,P<0.05);invalid value of serum PCT in patients with disease exacerbation was significantly higher(F=4.793,P<0.05);improved serum PCT values in patients with the disease better reduced(F=6.009,P<0.05).While PCT<14.86ng/mL mortality rate (14.89%) was significantly lower than the PCT≥14.86ng/mL mortality rate (72.22%).Conclusion PCT shows important clinical efficacy in forcasting prognosis of neonatal sepsis.It is worthy of wider promotion and application.

ObjectiveTo investigate the incidence of de novo malignancies in liver transplantation recipients.MethodsWe retrospectively assessed data of 475 patients undergoing liver transplantation from May 2000 to December 2008. ResultsAmong the 475 recipients followed-up for 6 months at minimum,5 patients developed de novo malignancy and the total incidence rate was 1.1％.The median elapsed time from transplant to the diagnosis of de novo malignancy was 14 months (range 6 to 72).The patients were all males,including one of rectal cancer which was cured by radical resection,2 of hepatocellular carcinoma who died 6 and 14 months respectively after the diagnosis,1 of neuroendocrine carcinoma of the lung dying after 16 months,1 of Bukitt lymphoma who died within 2 months.Conclusions De novo malignancy is an uncommon event in liver transplantation recipients,but the outome is very poor.

BACKGROUND:In senile osteoporosis patients, capacity of pedicle screw fixation is relatively poor due to fragile bone substance. Currently, augmentation of pedicle screw fixation with bone cement can improve the ability of screw fixation, but bone cement leakage and difficulties in screw removal become the problem to be solved. OBJECTIVE:To develop a novel pourable pedicle bone cement and to investigate its biomechanical properties, safety and practicality, thus providing the basis for clinical treatment of osteoporosis and spinal diseases.
METHODS:Six cases of complete wetting spines were colected at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2013 to January 2015, including 42 vertebrae. Pedicle screw fixation with X-ray assisted bone cement injection (2 mL) was performed unilateraly as experimental group, and conventional pedicle screw fixation was done contralateraly as control group. Bone cement dispersion was observed in the two groups. RESULTS AND CONCLUSION:It was 3-4 minutes for bone cement to agglomerate. Injection of bone cement paste into the infusion cylinder using a syringe was more convenient. The cylinder was connected tightly with the tail-end of the screw with no leakage. The push bar could provide sufficient perfusion force. Bone cement dispersion was found in the holow part and side holes of the screw. Side holes arranged regularly, and the hole pitch was equal. Compared with the control group, the yield load and yield displacement were significantly higher in the experimental group (P < 0.05), but the ultimate strength and ultimate displacement were significantly lower in the experimental group (P < 0.05). Bone cement around the pourable cement screw dispersed regularly, which was diffused into the surround cancelous bone and integrated with adjacent bone cement mass. The axial withdrawal force was increased by 114% in the experimental group compared with the control group (P < 0.05). The maximum rotary torque was significantly higher in the experimental group than the control group (P< 0.05). These finding suggest that the new pourable cement screw combined with bone cement putter and infusion cylinder is applied more convenient, can effectively control the leakage of bone cement, and can improve the stability of the pedicle in osteoporosis patients, which has been widely used.

Objective To analyze clinical features,surgical treatment efficacy and prognostic factors of bone metastasis patients after liver transplantation for hepatocellular carcinoma.Methods A retrospective clinical data of 20 bone metastasis patients after liver transplantation for hepatocellular carcinoma from July 2000 to January 2010 were received.The effect of surgery aimed at bone metastasis was evaluated.Univariate and multivariate prognostic risk factors were analyzed.Results The median survival time of these patients was 7.5 months and 1-year survival rate was only 20％.Surgical treatment could relieve pain and promote patients' peformance status significantly.Univariate and multivariate analysis found that tumor microvascular invasion within the removed recipient liver was the only prognostic risk factor.Conclusions Patients of bone metastasis after liver transplantation for HCC had poor prognosis.Surgical treatment helps improve patient's quality of life.Tumor microvascular invasion is the risk factor of surgical prognosis.

Objective To investigate the effect of normal saline(NS)of different temperature on morphological changes and nitric oxide synthase(NOS)expression of spinal cord.Methods The spinal canal of 96 SD adult rats was opened at T9.which of 24 rats was flushed with 37 ℃ NS,24 with 20 ℃ NS,24 with 4 ℃ NS respectively,and which of 24 rats in control group received no flushing.The spinal canal was closed one hour later,and the spinal cord was taken out 24 hours later.Then the water content in spinal cord was determined by dry-wet method.The morphological changes of spinal cord were observed under light microscope and the electronic microscope.The amount of NOS-positive neuron was measured by ?-NADPH histochemical methods.Results The water content in spinal cord was(66.53?0.61)% in control group,(66.75?1.00)% in 37 ℃ group,(70.55?0.77)% in 20 ℃ group,(71.92?2.50)% in 4 ℃ group.The spinal cord of control group and 37 ℃ group contained less water than that of 20 ℃ group and 4 ℃ group.There were no obvious morphological changes in the control group and 37 ℃ group.In 20 ℃ and 4 ℃ groups,the demyelination of axon,swelling of cell body and the disappearance of tigroid body were observed under light microscope,the partial disaggregation of medullary sheath,swelling of mitochondria and disappearance of mitochondria crista could be observed under electron microscope.The amount of NOS-positive neuron in spinal cord was(18.75?2.12),(18.63?1.41),(14.75?1.67),(8.13?1.25)in control,37 ℃,20 ℃ and 4 ℃ groups,respectively.The control group and 37 ℃ group showed more NOS-positive neuron than those of 20 ℃ group and 4 ℃ group.Conclusion NS below 20 ℃ can injury spinal cord.It is suitable to choose 37 ℃ NS to flush brain and spinal card during operation.

Objective To investigate the influence of iloprost on the expression of lung endothelin-1(ET-1) in rats with hypoxic pulmonary hypertension(HPH).Methods Thirty-two male SD rats were randomly divided into four groups:normal control (NC) group,normal treatment(NT) group,hypoxia control(HC) group,hypoxia treatment (HT) group.NC group and NT group raised under normal Oxygen conditions 3 weeks.HC and HT group placed in a low Oxygen chamber (O2 10％) were treated 3 weeks of hypoxia 8 hours per day.NT and HT group were treated daily iloprost by inhalation therapy (2μg/kg).Affer three weeks,measured mean pulmonary arterial pressure (mPAP),right ventricular systolic pressure (RVSP),index of right ventricular hypertrophy.HE staining was used to observe the morphological changes of pulmonary arteries and image analysis system was used to calculate the percentage of vascular wall thickness of small pulmonary arteries in each group,RT-PCR technique was used to assess the trends of ET-1 in lung tissue homogenates.Results The hemodynamics in HC group was significantly higher than other groups(P＜0.05),there was no significant statistically difference of the hemodynamics in HT group compare with normal control group.Pulmonary arteries morphology,vessel wall thickening and vessel lumina stenosis in HC group than NC、NT、group.These indicators were significant improved in HT group.ET-1 expression in lung tissue were significantly increased in HC group than NC groups.No significant difference was found between and NC group HT group.Conclusion Aerosol inhalation of iloprost has exact therapeutic effect for rats with HPH.Iloprost reduced ET-1 overexpression in lung tissue in HPH rats and prevent pulmonary vascular remodeling.

Objective:To investigate the outcome of liver transplantation(LT) for end stage liver disease with portal vein thrombosis(PVT) in different processes.Methods: Data from 308 patients who underwent LT from July 2004 to February 2008 were retrospectively assessed.The processes of varies grades of PVT during LT were analyzed and estimated for whether the outcome of LT was different between patients with or without PVT.Results: There were 46 patients with PVT,including 11 of grade 1,14 of grade 2,18 of grade 3 and 3 of grade 4.LT performed in grade 1 and 2 PVT patients without special intervention.LT was performed in 16 patients with grade 3 PVT after simple thrombectomy or thrombus-extraction.The other 2 patients with grade 3 PVT received the donor superior mesenteric vein to act as a bridge between the donor portal vein and host superior mesenteric vein.Two cases with grade 4 PVT received a cavo-portal hemitransposition,and the other one anastomosis between graft portal vein and varicose coronary vein.The postoperative 1-year survival rates of patients without PVT and patients with PVT were 91.6%(240/262),80.5%(211/262)vs 86.9%(40/46),76.1%(35/46),respectively.The patients with PVT had a recurrence rate of 4.3%(2/46).Conclusion: Most patients suffering from end stage liver disease with PVT can be successfully treated by LT.However,the result of the patients with diffused PVT undergoing LT is relatively poor.

Objective To study the risk factors of hepatitis B virus re-infection after liver transplantation. Methods We retrospectively analyze the data of 285 patients who underwent liver transplantation for hepatitis B related diseases basing on data collected during a follow-up of at least 6 months. Results The postoperative follow-up ranges from 6 to 59 months of all the 285 cases after liver transplantation. There were 10 patients diagnosed as hepatitis B virus re-infection after liver transplantation leading to a 3.5% re-infection rate. There were 9 patients being diagnosed as HCC recurrence before HBV re-infection was identified. Patients with HCC recurrence suffered from higher HBV re-infection rate than other patients, and HBsAg and HBcAg was detected in one of the 13 metastatic HCC specimens.Conclusions HBIg combined with nucleotide analogue can effectively prevent HBV re-infention. HCCrecurrence is an important risk factor to HBV re-infection after liver transplantation.

Objective To retrospectively review the results of intraperitoneal placement of composite mesh for the repair of ventral incisional hernia. Methods Ten patients, in which the peritoneum was difficult to close direcdy, underwent repair of ventral incisional hernia with composite mesh between November 2003 and June 2005. The mesh was placed intraperitoneally. The mean duration of follow-up was 18 months (range 6 to 24). Results All the patients (10/10) were cured without postoperative complications such as wound infection, subcutaneous seroma and hematoma. During the follow-up study, no recurrences was observed. There were no long-term complications, such as bowel obstruction, fistula formation and fistulization to the small bowel. All the 10 patients felt comfortable. Conclusions Intraperitoneal placement of composite mesh is a safe and effective repair method for ventral incisional hernia.

Objective To explore the value of dynamic contrast-enhanced (DCE).MRI in the early diagnosis of brucellosis spondylitis.Methods Fifty-six patients (24 female and 32 male) with Brucellosis with average age of (49± 3)years were retrospectively analyzed.Inclusion criteria:The patients with clinically diagnosed brinell coli spondylitis,drops of serum agglutination test degree 1:100＞(++),Hu＞red plate agglutination test (+ +),enzyme-linked immunosorbent assay to detect specific antibody IgG/IgM (+).Exclusion criteria:Pregnant and lactating women,patients with MRI examination contraindications and spinal tuberculosis,myeloma or other spinal disease,patients with the cervical,thoracic and lumbar 5 vertebral body involvement.The patients were classified into early lesion group and lesion group.Early lesion group was defined as low back pain less than a month,enzyme-linked immunosorbent assay positive IgM and negative IgG results,and no abnormality in conventional MR imaging,while lesion group was defined as low back pain for longer than 3 months,enzyme-linked immunosorbent assay positive IgG and negative IgM and marked lesion in conventional MR imaging.All the patients conducted with conventional MRI and DCE-MRI scan.The differences of the Ktrans,Kep,Ve and Vp between the vertebral lesions,early lesions of vertebral body and normal tissues were measured and compared.Results The values of Ktrans,Kep,Ve and Vp were significantly different between the vertebral lesions [(0.856±0.539) ml/min,(1.482±0.711) ml/min,0.542±0.267,0.034±0.017] and normal tissues [(0.315±0.298) ml/min,(0.713±0.548) ml/min,0.358±0.259,0.056±0.03](all P＜0.05).The values of Ktrans,Kep and Vp were significantly different between the early lesions of vertebral body and normal tissues (all P＜0.05),while no difference was found for Ve between the two groups (P＞0.05).Conclusion DCE-MRI quantitative analysis plays a role in the early diagnosis of the brucella spondylitis.