ObjectiveTo investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. MethodsThe clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. ResultsThere was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. ConclusionsCompared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.

Objective To explore the clinical features of diabetic macular edema (DME) with optical coherence tomography (OCT) and correlation with visual function. Methods Forty-nine eyes from 40 patients with DME (DME group) and 31 eyes from 31 patients without DME (control group) were examined with OCT,pattern reversal visual evoked potentials (P-VEP),macular perimetry. According to proliferative diabetic retinopathy (PDR), 49 eyes with DME were divided into group A (without PDR, 30eyes) and group B (with PDR, 19 eyes). Results The retinal macular thickness of central fovea in DME group [(299.25±63.87)μm] was more than that in contol group [(204.35 ± 37.94)μm], visual acuity and macular visual field in DME group were significantly different than those in control group, respectively (P ＜ 0.05). The retinal macular thickness of central fovea,visual acuity and visual field were no significant differences between group A and group B (P＞0.05). OCT macular thickness and visual correlation coefficient was -0.437(P＜ 0.05 ); OCT macular thickness and mean defect correlation coefficient was 0.441(P ＜ 0.05). Conclusions OCT can provide a useful tool for monitoring the occurrence and development of DME, can assess the response to treatment. With increasing of the macular retinal thickness, the visual acuity and macular visual field of visual function are more damaged.

Eight phenolic compounds were isolated from Rhododendron phaeochrysum var. agglutinatum and their sructures were identified as phaeochrysin (1), (2R)-4-(3',4'-dihydroxyphenyl) -2-butanol (2), (-) -rhododendrol (3), rhododendrin (4), (+) -isolariciresinol (5), (-) -lyoniresinol (6), lyoniresinol-9'-O-β-D-xylopyranoside (7), and dihydrodehydrodiconiferyl-3a-O-α-L-rhamnopyranoside (8). Compound 1 is new, and compounds 2, 5-8 were isolated from this plant for the first time.
Drugs, Chinese Herbal ; chemistry ; Mass Spectrometry ; Molecular Structure ; Phenols ; chemistry ; Rhododendron ; chemistry

Objective To investigate the morbidity,clinical feature,diagnosis and therapy of ovarian disease in children.Methods Eighty-two children with ovarian disease were admitted and treated in Nanjing children's hospital from Jan.1992 to Jan.2007,were analyzed retrospectively with age,emergency admissions or not,dwell,pathology and method of operation.Results The age of 82 patients ranged from 1 day to 14 years old and the mean age was 6.7 years old.Thirty-one cases(37.8%) were emergency admissions and 51 cases(62.2%) were routine admissions.Twenty-seven cases(32.9%) were rural patients and 55 cases(67.1%) were urban patients.Forty-five cases(54.8%) were nontumorous disorder,31 cases(37.8%) were benign tumor and only 6 cases(7.4%) were malignant tumor.About the morbidity,12 patients(14.6%)were admitted from 1992 to 1996,24 patients(29.5%) from 1997 to 2001 and 46 patients(55.9%) from 2002 to 2007.Chemotherapy were carried out in 6 cases with malignant tumor in internal medicine,2 cases with sexual precosity kept observation,the others were cured.Conclusions Ovarian disease can occur at any age in children.The clinical manifestation is characterized mainly by acute abdomen.The incidence of ovarian disease of children in urban areas is higher than that children in rural areas.The morbidity continues to show an upward tendency and the pathologic manifestations are mostly benign,laparoscopic operation has obviously superiority.

Biotechnology supremacy is a newly-advanced power theory. It is a superior dominance of military biotechnological application based on the microcosm of life structure within a certain period of time. The advancement of biotechnology supremacy and modern biotechnology has created the concept of bio-micro-frontier, which involves information and defense resources of all living ultra-micro-organisms with national and regional characteristics. Being feasible both in theory and practice, the implementation of bio-micro-frontier system is strategically important. This article explores the implementation of bio-micro-frontier in terms of strategy and tactics, which will add a unique dimension to future military transformation and active defense.

Objective To understand the clinical features of acute renal failure(ARF)as the initial presentation of systemic lupus erythematosus(SLE).Methods Eight cases of ARF in SLE from Jan 1995 to Apt 2006 were investigated,descriptive analysis and literature review were performed.Results①The symp- tom of ARF in SLE was mainly oliguria,with severe accompany symptoms and complications.②The level of leucocyte and hemoglobin was low in laboratory tests,also the complement level decreased significantly.The most frequent renal pathology was typeⅣ,Ⅳ+ⅤLN.③Large dose steroid and CTX were the mainstay of treatment.In addition,SCUF,CVVHDF and hemodialysis could be used for lethal conditions.Conclusion ARF can be the first manifestation of SLE and it usually represents more severe disease and more complica- tions.Large dose steroid and CTX can improve prognois.In cases refractory to steroid and if the effect is obso- lete,CTX treatment SCUF,CVVHDF and hemodialysis can be use.

OBJECTIVETo compare the clinical efficacy on upper limb motor impairment in stroke between the interactive dynamic scalp acupuncture therapy and the traditional scalp acupuncture therapy.

METHODSThe randomized controlled trial and MINIMIZE layering randomization software were adopted. Seventy patients of upper limb with III to V grade in Brunnstrom scale after stroke were randomized into an interactive dynamic scalp acupuncture group and a traditional scalp acupuncture group, 35 cases in each one. In the interactive dynamic scalp acupuncture group, the middle 2/5 of Dingnieqianxiexian (anterior oblique line of vertex-temporal), the middle 2/5 of Dingniehouxiexian (posterior oblique line of vertex-temporal) and Dingpangerxian (lateral line 2 of vertex) on the affected side were selected as the stimulation areas. Additionally, the rehabilitation training was applied during scalp acupuncture treatment. In the traditional scalp acupuncture group, the scalp stimulation areas were same as the interactive dynamic scalp acupuncture group. But the rehabilitation training was applied separately. The rehabilitation training was applied in the morning and the scalp acupuncture was done in the afternoon. The results in Fugl-Meyer for the upper limb motor function (U-FMA), the Wolf motor function measure scale (WM- FT) and the modified Barthel index in the two groups were compared between the two groups before treatment and in 1 and 2 months of treatment, respectively.

RESULTSAfter treatment, the U-FMA score, WMFT score and the score of the modified Barthel index were all apparently improved as compared with those before treatment (all P < 0.01). The improvement in the U-FMA score after treatment in the interactive dynamic scalp acupuncture group was better than that in the traditional scalp acupuncture group (P < 0.05). For the patients of IV to V grade in Brunnstrom scale, WMFT score in 2 months of treatment and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were improved apparently as compared with those in the traditional scalp acupuncture group (P < 0.05, P < 0.01). But, for the patients of III grade in Brunnstrom scale, WMFT score and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were not different significantly as compared with those in the traditional scalp acupuncture group (both P > 0.05).

CONCLUSIONFor the patients of IV to V grade in Brunnstrom scale in stroke, the interactive dynamic scalp acupuncture therapy achieves the superior improvements of the upper limb motor function and the activity of daily life as compared with the traditional scalp acupuncture therapy, and the longer the treatment lasts, the more apparent the improvements are. For the patients of III grade in Brunnstrom scale, the interactive dynamic scalp acupuncture therapy achieves the similar improvement in the upper limb motor impairment as compared with the traditional scalp acupuncture therapy.

Activities of Daily Living ; Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Occupational Therapy ; Scalp ; Stroke ; physiopathology ; therapy ; Stroke Rehabilitation ; Treatment Outcome ; Upper Extremity ; physiopathology

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

Objective To quantitatively assess severity of movement disability by analyzing physical activities recorded by an actigraph monitor in patients with neurology disorders.Methods Eighty-one patients with Parkinson' s disease(PD)and 61 patients with acute cerebral infarction(ACI)accompanying impaired upper limb motor function were included in the study.PD patients and ACI patients were treated using the international PD and ACI treatment guidelines,respectively.The patients were asked to wear an Actigraph monitor for 6 days before the treatment in both PD and ACI patient groups and at 24-38 days post-treatment in PD patients or at 28 days post-treatment in ACI patients.The recorded data was analyzed by power-law exponent(PLE)and detrended fluctuation analysis(DFA).Clinically,before and after the treatments,PD patients were evaluated using the conventional Unified Parkinson Disease Rating Scale (UPDRS),and ACI patients were evaluated by assessing upper limb motor function using Fugl-Meyer Assessment(FMA)and Functional Independence Measure(FIM).The correlation of the UPDRS scores with PLE was analyzed in PD patients,and the correlation of FMA or FIM with DFA in ACI patients.Results Both the UPDRS scores and the PLE values in PD patients were improved after the drug administration(UPDRS total:32.8 ± 16.2 and 28.8 ± 14.7,Z =2.080,P =0.038; UPDRS Ⅲ:18.6 ± 8.2 and 15.7±6.8,Z=2.155,P=0.031; PLE:0.98 ±0.25 and 0.82 ±0.21,Z=2.212,P=0.027,before and after the treatment,respectively).There were a linear correlation coefficient of 0.699 between the improvements of total UPDRS scores and the PLE values,and of 0.823 between the UPDRS Ⅲ and the PLE values.FMA,FIM scores and DFA were improved significantly than before treatment(FMA:12.39 ± 8.21 and 30.28 ±7.29,Z=3.016,P =0.004; FIM:8.98 ±7.29 and 13.21 ±7.6,Z =2.282,P=0.038; DFA:0.86 ±0.31 and 0.98 ±0.27,Z =2.360,P =0.036,before and after the treatment,respectively).It also showed linear correlations between the improvements of FMA scores and DFA(r =0.638),and between FIM scores and DFA(r =0.712,both P ＜0.05).There was no correlation between UPDRS scores and DFA values in PD patients,nor between FIM scores or FMA scores and PLE values in ACI patients.Conclusions Actigraph device can be used to monitor patients activity in movement disorders.Analysis of its PLE can provide a quantitative evaluation in PD while its DFA may provide useful specific assessment of impaired upper limb motor function in ACI patients.It can also be used in quantitatively assessing new drug efficacy.

Objective To summarize the experience in surgical management of hilar cholangiocarcinoma.Methods The clinical data of 88 patients with hilar cholangiocarcinoma who received surgical treatment at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.All the patients were diagnosed by imaging examination.According to the severity of jaundice and predictive remnant liver volume,19 patients received percutaneous transhepatic cholangial drainage (PTCD) and 4 received portal vein embolization.The fundamental operation consisted of hilar cholangiocarcinoma resection,skeletonization of hepatoduodenum ligament and Roux-en-Y cholangiojejunostomy,and the transanastomotic stent was placed for 6 months.The count data were analyzed using the chi-square test; the survival rate was analysed using the Kaplan-Meier method; the survival was analyzed using the Log-rank test.Results Of the 88 patients,58 patients (including 11 patients who received PTCD) received hilar cholangiocarcinoma resection.Of the 58 patients,43 (including 4 patients who received portal vein embolization preoperatively) received R0 resection,and 15 received palliative resection.Thirty patients received internal and (or) external drainage.Commitant partial hepatectomy was performed on 22 patients (including 9 received left hemihepatectomy,2 received extended left hemihepatectomy,7 received left hemihepatectomy + caudate lobectomy,4 received right hemihepatectomy).Commitant pancreatico-duodenectomy was performed on 7 patients,commitant hepatic artery resection on 3 patients,and commitant portal vein resection on 2 patients.According to the modified Bismuth-Corlette classification,there were 17 patients with type Ⅰ,19 with type Ⅱ,21 with type Ⅲa,20 with type Ⅲb,and 11 with type Ⅳ.Of the 58 patients who received hilar cholangiocarcinoma resection,19 had postoperative complications,and 2 patients died within 30 days after operation.Seventy-three patients were followed up,and the overall 1-,3-,5-year survival rates were 68.5％,28.8％,11.0％,respectively.The 1-,3-,5-year survival rates of patients who received R0 resection were 94.6％,43.2％,18.9％,respectively,which were significantly higher than 78.6％,35.7％ and 7.1％ of patients who received palliative resection (x2=4.77,P ＜0.05).The 1-,3-,5-year survival rates of patients who received palliative resection were significantly higher than 18.2％,0,0 of patients who received biliary drainage (x2 =13.26,P ＜ 0.05).Conclusions R0 resection is the best choice for patients with hilar cholangiocarcinoma,and biliary drainage with no resection is the last choice.Sufficient preoperative treatment,optimized choice of surgical procedure and exquisite surgical techniques are important for the improvement of the prognosis.