Objective To explore the instructive value of preoperative splenic artery CTA examination on Laparoscopic splenectomy (LS). Methods From January 2008 to February 2010,36 cases requiring Laparoscopic splenectomy (LS) were selected randomly and divided into two groups: CTA group and non-CTA group, 18 cases in each group. As for the CTA group,splenic artery CTA examination was performed before operation,to understand splenic artery and its branches anatomy type and track and then individualized surgical treatment was developed. As for the non-CTA group,a routine surgical procedure was performed. The indices before and during the operation were recorded and compared through χ2 test The operating time and the amount of bleeding in the two groups were compared using t-test Results There were no significant difference between the indices recorded by splenic artery CTA examination and those by laparoscopic splenectomy intraoperation ( P > 0. 05 ) . The operating time was (124. 32 ±21.43) mins in the CTA group, which was significantly shorter than that in the non-CTA group ((148.27 ±28. 36)mins) (P <0. 05). The amount of blood in the CTA group was significantly less than that in the non-CTA group( ( 80. 50 ± 16. 42) ml vs. (101. 35 ± 26.25 ) ml). Conclusions Splenic artery CTA can identify splenic artery and its branches anatomy type and track before LS,therefore guide the development of individualized surgical treatment It increases the safety of LS, reduces bleeding and shortens the operational time. It has an instrutive value to laparoscopic splenectomy.

Objective To investigate the efficacy and safety of laparoscopic splenectomy (LS) in the treatment of immune throm-bocytopenia(ITP) .Methods 230 cases of ITP were collected in this hospital from December 2011 to December 2012 and randomly divided into two groups with 115 cases in each group .Among them ,the control group was treated by the conventional treatment of open splenectomy(OS) ,while the observation group was treated by LS .The differences of the operative time ,hospitalization dura-tion ,intraoperative blood loss and platelet count ,clinical effects and the occurrence situation of adverse reactions were compared be-tween the two kinds of operation method .Results The operative time and the length of hospital stay in the observation group were significantly shortened compared with the control group (t=14 .706 ,t=13 .625 ,P<0 .05);intraoperative blood loss was significant-ly decreased(t=18 .238 ,P<0 .05) and the platelet count was significantly increased (t=17 .248 ,P<0 .05);the total effective rate of the observation group was 96 .52% ,which was significantly higher than 86 .09% of the control group ,(χ2 =9 .35 ,P<0 .05);the adverse reaction rate and the recurrence rate in the observation group were 6 .09% and 6 .96% respectively ,which were significantly lower than 10 .43% and 19 .13% in the control group(χ2 =8 .35 ,χ2 =8 .75 ,P<0 .05) .Conclusion LS for treating immune throm-bocytopenia has definite efficacy with high effective rate ,low adverse reactions and low recurrence rate .

Pang Zanxiang was a famous ophthalmologist of Chinese medicine. Based on his family experience and combined with his clinical practice, he has written the book Clinical practice of ophthalmology in traditional Chinese medicine. In the book, the theory of stagnation of Qi and blood leading to disease was put forward, and radix stellariae was used most frequently in treating eye disease. From literature interview, we found that pang’s experience of radix stellariae in treating eye disease was its function of replenishing vital essence to improve eyesight.

BACKGROUND:A variety of factors contribute to biliary injury that is difficult to be repaired. Stent implantation is extensively used for bile duct injury, but either scaffolds made by metal or plastics can lead to certain adverse reactions. OBJECTIVE:To explore the biological characteristics of a novel biodegradable scaffold and its repair effects on bile duct injury. METHODS:The biological characteristics of the novel biodegradable scaffold were detected by fresh bile, and its degradation was observed at different time points. Thirty Bama mini pigs were included and were randomly divided into observation group (n=15) and control group (n=15). After bile duct injury models were prepared, the control group was subjected to the bile duct interrupted suture, while the observation group was subjected to the novel biodegradable scaffold combined with omentum majus. The biological properties of the scaffolds were observed. Hepatic enzymes and serum total bilirubin levels were detected, as wel as hematoxylin-eosin staining, Masson staining and immunohistochemistry detection ofα-smooth muscle actin were performed. RESULTS AND CONCLUSION:Before and 1, 3 and 6 months after surgery, hepatic enzymes and total bilirubin of two groups were detected, and neither intra-group nor intergroup comparisons had significant differences (P>0.05). Hematoxylin-eosin staining and Masson staining revealed that inflammatory reactions and fiber hyperplasia at the anastomotic site in the observation group were lighter than those in the control group at different time points after surgery. Theα-smooth muscle actin-positive scores in both two groups were in a rise at 1 and 3 months after surgery, and peaked at the 3rd month, and then began to decline. Moreover, theα-smooth muscle actin-positive scores in the observation group were significantly lower than those in the control group at 3 and 6 months after surgery (P<0.05). These results show that the novel biodegradable scaffold has good biological characteristics and can obtain ideal repair effects in the bile duct injury.

measured to compare the correlation between the changes of T lymphocyte subsets before and after operation and the change of platelet. Results Thirty-one patients were underwent laparoscopic splenectomy. The T lymphocyte subsets and CD3 + ,CD4 + and CD3 + / CD4 + in all patients showed an increase trend as the time prolonged after operation,and the differences were significant( F = 6. 91,3. 93,4. 18;P = 0. 023,0. 004,0. 011). While the ratio of CD3 + / CD8 + and CD3 + CD4 + / CD3 + CD8 + were decreased as time increased,and differences were statistically significant( F = 2. 59,3. 67;P = 0. 001,0. 002). They were related with platelet change after operation and correlation statistics analysis showed R values were 0. 332,0. 271,0. 345,- 0. 119,- 0. 164,and the P value were 0. 039,0. 021,0. 002,0. 017,0. 023. Conclusion ITP patients have the imbalance of T lymphocyte subsets,and splenectomy can improve the imbalance of T lymphocyte subsets in patients with ITP. T lymphocyte subsets may serve as a reference index to indicate the prognosis of the patients.

Objective To determine the contents and dynamics of excitatory amino acids (EAAs), glutamate (GLU) and aspartate (ASP) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of EAAs with clinical features and outcomes.Methods Forty-two adults with acute head injury were included. Glasgow coma scale (GCS) obtained at admission and Glasgow outcome scale (GOS) obtained three months post-injury were assessed. Samples of CSF were obtained via ventricular or lumbar puncture every 24 hours. GLU and ASP in CSF were analyzed by reversed-phase HPLC with a fluorescent detector. Nine control subjects were adults with lumbar anesthesia but without neurological diseases.Results The peak concentration of GLU and ASP of head-injured group was significantly higher than that of the control group. Dynamic research on severely injured ones indicated that the peak value of GLU mostly appeared within 48 hours post-injury; it decreased with the improving or remaining of the neurological status, and increased with the deterioration, but was still higher than that of the control seven days post-injury. The peak value of EAAs of severely injured patients was conspicuously higher than that of mildly injured group. There was a significant negative correlation between the peak values of GCS and EAAs. The peak value of EAAs in patients with poor outcome was remarkably higher than that in patients with good outcome. GOS was closely correlated to the peak value of EAAs. When the concentration of GLU was over 7 μmol/L, the rate of poor-outcome increased markedly. Conclusion The content of EAAs in CSF increases following acute head injury and remains higher at least a week post-injury in severely injured patients. The more severe the trauma, the more obvious the excitotoxicity induced by EAAs; the more serious the secondary brain insult and the brain edema will be, the worse the outcome, naturally.

Objective To investigate antimicrobial resistance among gram-positive cocci in China in 2006.Methods From Jun 2006 to Dec 2006,674 consecutive and non-repetitive gram-positive bacteria were collected from 7 teaching hospitals.The minimal inhibitory concentration(MICs)of antibacterial agents were determined by agar dilution method.Results The prevalence of penicillin.resistant(ease)and pemcllhn. intermediate S.pneumoniae(PISP)among 100 isolates was l%and 19%,respectively.Teicoplanin and vancomycin were the most active agents against S.pneumoniae.97% and 98% S.pneumoniae isolates were susceptible to levofloxacin and moxifloxacin,respectively.The susceptibility of amoxicillin/clavulanic acid, ceftriaxone and chloramphenicol are 96%,87% and 73%,respectively.The susceptible rates of penicillin. susceptible S.pneumoniae(PSSP)to cefprozil and cefaclor were 62% and 55.7%,respectively.All the PISP and PRSP isolates were resistance to the two antibiotics.The susceptibility to macrolides,trimethoprim/ sulfamethoxazole and tetracycline was lower than 35%.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA)and methicillin.resistant coagulase-negative Staphylococci(MRSCON)was 48%(33%-84%)and 81%(69%-94%),respectively.The susceptible rates of MRSA to trimethoprim/ sulfamethoxazole,chloramphenicol,rifampin,and the other antibiotics in this study were 72%,66%and 45%,respectively.The susceptible rate of MRSA to marcrolides,aminoglycosides,tetracyclines and quinolones were not more than 18%.56%(30%-86%)of E.faecalis and 80%(50%.100%)of E.faecium were highly resistant to gentamicin.The susceptibility of E.faecalis to all the antibiotics except chloramphenicol and tetracycline were higher than E.faecium.All isolates of S.aureus,CoNS and E.faecalis tested were susceptible to vacomycin and teicoplanin.There were two vacomycin.resistant E.faecium strains isolated from Hangzhou.Conclusions Antimicrobial resistance patterns of gram.positive cocci differed in different regions.The resistance of gram-positive cocci to the antibiotics in this study this year was a little higher than the data of the year of 2005.Teicoplanin and vancomycin remained very high activity to gram-positive cocci.

Objective:To detect the expressions of Krüppel-like factor 12 (KLF12)protein in the cancer tissue and serum of the patients with colorectal cancer,and to investigate their clinical values.Methods:A total of 120 colorectal cancer patients were selected as case group,and 100 normal cases were regarded as control group. The cancer tissue and adjacent mucosa tissue were collected.Immunohistochemical method was used to detect the expressions of KLF12,nm23,CyclinE1,matrix metalloproteinase-2 (MMP-2),and MMP-9 proteins,and the relationships among these proteins were evaluated.ELISA assay was applied to detect the serum KLF12 levels of the patients in case group before operation and 1 month after operation the levels of serum KLF12 of the subjects in control group.Results:The positive expression rates of KLF12,CyclinE1,MMP-2 and MMP-9 proteins in cancer tissue were higher than those in adjacent mucosa tissue (χ2 =66.155,52.795,64.515,52.632;P <0.001),while the positive expression rate of nm23 protein in cancer tissue was lower than that in adjacent mucosa tissue (χ2 =13.019,P <0.001).The Spearman analysis results showed that the expression of KLF12 protein was positively correlated with the expressions of MMP-2 and MMP-9 proteins (r=0.3963,P <0.001;r=0.3264,P <0.001);the expression of KLF12 was negatively correlated with the expression of nm23 protein (r = - 0.2273,P =0.013).The level of serum KLF12 of the patients in case group before operation was higher than that in control group.The cut-off value of ROC curve of serum KLF12 protein expression level was 3.795 μg·L-1 ,and the area under the ROC curve was 0.834.The sensitivity and specificity were 60.8% and 94.0%,respectively. After operation,the serum level of KLF12 protein in the patients in case group was decreased,which was still higher than that in control group (t=2.708,P =0.007).The expression level of KLF12 protein in cancer tissue was positively correlated with the level of serum KLF12 protein (r =0.4069,P <0.001).According to degree of lymph node metastasis,and the serum level of KLF12 protein in N3 group was the highest,and the lowest serum level of KLF12 protein was found in N0 group (F =21.731,P <0.001).Conclusion:KLF12 protein might be involved in the invasion and metastasis of colorectal cancer,and the detection of serum level of KLF12 protein could be valuable for the judgement of disease and prediction of lymph node metastasis of the patients.

OBJECTIVETo study the signaling pathways associated with lipopolysaccharide (LPS)-induced inflammation in islet micro-endothelial cells (IMECs) and the mechanism of pravastatin intervention.

METHODSIMECs exposed to LPS, SB203580, pravastatin, or SB203580+pravastatin were examined for cell apoptosis with Hoechst staining and flow cytometry and for expression levels of total-p38, photophosphorylation-p38 (p-p38) and iNOS with Western blotting.

RESULTSThe apoptosis rate and expression levels of total-p38, p-p38, iNOS in IMECs all increased after LPS exposure. Pravastatin, SB203580, and their combination significantly attenuated LPS-induced enhancement of cell apoptosis and total-p38, p-p38, and iNOS expressions in IMECs.

CONCLUSIONLPS-induced inflammatory toxicity in IMECs is associated with the activation of P38MAPK and iNOS/NO signaling pathways. Pravastatin can inhibit these pathways and suppress the apoptosis and necrosis of IMECs to relieve the cell inflammatory injuries.

Animals ; Apoptosis ; Endothelial Cells ; drug effects ; metabolism ; Endothelium, Vascular ; cytology ; Inflammation ; Islets of Langerhans ; blood supply ; MAP Kinase Signaling System ; drug effects ; Mice ; Nitric Oxide Synthase Type II ; metabolism ; Phosphorylation ; Pravastatin ; pharmacology ; p38 Mitogen-Activated Protein Kinases ; metabolism

Objective:To explore the diagnostic value of virtual monoenergetic image (VMI) and electron density map (EDM) generated by non-contrast dual-layer spectral detector CT in acute pulmonary embolism(APE).Methods:The clinical and imaging data of 27 patients (41 lesions) who underwent CT pulmonary angiography (CTPA) using dual-layer spectral detector CT and were diagnosed with APE in the Third Affiliated Hospital of Sun Yat-sen University from October 2022 to May 2023 were retrospectively analyzed. All patients received a dual-layer spectral detector CT non-contrast scan. Based on the non-contrast scan data, conventional 120 kVp polyenergetic images (PI), virtual monoenergetic images (40, 70, 100 keV VMI), electron density maps (EDM), and effective atomic number maps (Z eff) were respectively reconstructed. Taking CTPA as the gold standard, the detection rate of APE in different reconstruction images of non-contrast scan were evaluated. The vascular lesion was used as the pulmonary embolism group and the corresponding position of the normal vessel at the same level of the diseased vessel as the control group, and the Wilcoxon rank-sum test was used to compare the differences of CT values on PI and 40, 70, and 100 keV VMI (CT PI, CT 40 keV, CT 70 keV, CT 100 keV) as well as the ED values on the EDM, and the Z eff value on the Z eff images between the 2 groups. Parameters with statistically significant differences were included in a multifactor logistic regression, resulting in the construction of a logistic regression model. Receiver operator characteristic curve and area under curve (AUC) were applied to evaluate the diagnostic efficiency of different spectral quantitative parameters and logistic regression model in identifying pulmonary embolism group from normal control group. Results:The detection rates of APE on PI, EDM, Z eff map, and EDM and Z eff map fusion images were 14.6% (6/41), 82.9% (34/41), 51.2% (21/41), and 97.6% (40/41), respectively. CT PI, ED, CT 40 keV, CT 70 keV and CT 100 keV in pulmonary embolism group were statistically higher than those in control group ( Z values were 1 009.00, 1 024.50, 1 038.00, 1 079.00 and 1 076.00, respectively, P<0.05). Finally, CT PI, CT 40 keV, and CT 100 keV were selected to construct the logistic regression model. The AUC, sensitivity, specificity, and accuracy of the logistic regression model for distinguishing the embolism group from the control group were 0.771, 0.769, 0.744, and 0.756, respectively. Conclusion:Non-contrast images of dual-layer spectral detector CT VMI and EDM have some clinical value in detecting and diagnosing APE.