Objective To investigate morbidity and analyze high risk factors of nosocomial infection in patients who underwent orthotopic liver transplantation (OLT) in our ICU, in order to draft possible preventive strategies. Methods The clinical data of 56 OLT patients from Apr 2002 to Dec 2004 were analyzed. Results Significantly high APACHE Ⅱ scores and total plasma bilirubin, low platelet count were found in patients with nosocomial infection. The number of patients who had received an additional operation and broad-spectrum antibiotics before OLT were greater in nosocomial infection (NI) group than in none-nosocomial infection (NNI) group. Notably, the longer the broad-spectrum antibiotics used before OLT, the higher the morbidity rate of nosocomial infection. No significant difference was found in age, Child-Pugh grade and plasma albumin level between the two groups. In addition, APACHE Ⅱ scores and total bilirubin level were significantly higher in patients acquired enterococcal infection than in those infected with other pathogenic microorganisms. Conclusions High APACHE Ⅱ score, high total bilirubin level, low platelet count and length of use of broad-spectrum antibiotics before OLT were closely associated with nosocomial infection. As an important indicator, change in total bilirubin level not only represented the liver function ,but also was one of the high risk factors to nosocomial infection in patients undergoing OLT.

0.05).61 patients received no sedatives nor analgesics showed significantly higher incidence of SUE compared with those patients received either sedatives or analgesics(73.8% vs 37.3%,P

Objective To compare the incidences of agitation and circulatory fluctuation in mechanically ventilated patients receiving different sedatives for daily arousal,and develop a safe sedation strategy.Methods Ninety four patients in ICU,who received mechanical ventilation over 24 hours,were selected from five clinical centers.Based on the analgesia with continuous pumping of fentanyl,patients were randomly given midazolam(M group),propofol(P group)or sequential midazolam-propofol(M-P group)for sedation.The depth of sedation was maintained within SAS 2-4 by close monitoring.The administration of all sedatives and analgesics was terminated at 9:00 am till patients were fully waked up.The incidence of agitation,blood pressure,heart rate fluctuation,patients' arousal time,and their recollection to actual mechanical ventilation events after been transferred out of ICU were investigated.Results The mean SAS scores showed no difference in each group.The arousal time was significantly longer in group M than that in other two groups(P

Objective Post-operative hypoxemia occurred frequently after extubation in patients who underwent orthotopic liver transplantation (OLT) in ICU. This study is to investigate the efficiency of hyperoxia solution in improving oxygenation. Methods Ten OLT cases, who post-operatively manifested hypoxemia after extubation, were enrolled in this study. Hyperoxia Ringer's solution (500ml) prepared by Jing-Shu-Yang (an apparatus of oxygen supply, Vanform Co., Shandong) was infused at a rate of 200ml/hr. Hemodynamic parameters, blood gas, and blood lactate were determined at the beginning, end of infusion, and 1 hour after the infusion, with recording of the following data: heart rate (HR), mean arterial pressure (MAP), pulmonary arterial pressure (PAP), and pulmonary capillaries wedged pressure (PCWP). Results Compared with the levels at the beginning of infusion, SpO2 and SvO2 increased significantly at the end of the infusion of 500 ml hyperoxia Ringer's solution, and they returned to the baselines 1 hour later, although regular Ringer′s solution was coutinuously given by the same infusion rate. HR, MAP and PCWP were kept stable with the solution infusion. Notably, PAP was decreased markedly at the end of infusion, and blood lactate level remained unchanged after the intervention. Conclusion Hyperoxia Ringer's solution infusion improved oxygenation in OLT patients who suffered from acute lung injury with hypoxemia postoperatively. PAP decreased markedly as hypoxemia was corrected.

Objective To observe the formation process with 3.0 T MRI dynamically, and to discuss the feasibility of molecular imaging studies on restenosis. Methods The models were built with balloon (2.0 F) injury which were separated into restenosis group (n=48) and control group (n=48). Zero h, 24 h, 1 week, 2 week, 4 week and 8 week after surgery, 3.0 T MRI scanning (T1WI, T2WI, PDWI) was performed respectively, the vascular of injured side were obtained for HE staining to observe the pathological changes, to analyze the measurement of neointimal area (IA), intimal proliferation index (IHI), lumen area (LA) and stenosis rates, correlation between HE staining measurements and MR images were analyzed. Two weeks after the injury, the restenosis model of rats (n=8) and control rats (n=8) were injected ultrasmall superparamagntiec iron oxide (USPIO,1 mmol/kg) by tail vein, respectively. 3.0 T MRI scanning (T2WI) was underwent at 0 h and 24 h after injection, the change of the arterial wall T2 signal was quantitatively analyzed and the relative signal intensity (rSI) and relative change rate (rSIC) of the vessel wall were calculated. Reference to MRI images, corresponding line segments were taken for Perl's blue staining and immunohistochemically staining of macrophages. One-way ANOVA, Pearson and t test were used for statistical analysis. Results In the early?term (0 h,24 h), the wall and surrounding high signal organization boundary was not clear, there was no obvious morphological change of the lumen. In the medium?term (1, 2 week), signal of the injured wall increased with different extents, wall thickening and luminal narrowing was progressive, the inwall was coarse. In the later?term (4, 8 week) wall signal got slightly lower, wall thickness, lumen change were not significant, the wall area and LA were significantly associated with pathologic measurement result (r value were 0.978, 0.732; P<0.05). In the control group, signal of wall and lumen morphological change were not significant among the different time points. IA were (0.131 ± 0.011) mm2, (0.588 ± 0.017) mm2, (1.061 ± 0.033) mm2, (1.192 ± 0.034) mm2;1, 2, 4, 8 week after injury, respectively, IHI were 0.235 ± 0.022, 0.578 ± 0.013, 0.715 ± 0.011, 0.737 ± 0.009, respectively, stenosis rates were (5.586 ± 0.987)%, (25.395 ± 1.112)%, (40.019 ± 1.298)%, (41.890 ± 0.951)%, respectively, difference between groups were statistically (P<0.05). In the control group, there was no significant differences of medium area, luminal stenosis and neointimal formation respectively at different time points (P>0.05). rSI was 1.582±0.051 after the injection of USPIO, then 24 h after injection of USPIO, T2 signal of the vessel wall was reduced significantly, rSI was 1.260 ± 0.088, rSIC was (-20.249 ± 6.489) % with statistical difference (t value was 8.924,P<0.05). But there was no statistical difference in control rats (P>0.05). Perl's staining combined with immunohistochemical staining confirmed that the iron particles were taken by the macrophage's phagocytosis just in the neointimal. Conclusion 3.0 T MRI is capable of demonstrating the vessel wall and lumen changes dynamically, and the measurements are correlated with pathological results. USPIO can be consumed by macrophages in the neointimal, resulting in T2 signal of the vessel wall decreased significantly.

Objective To summarize and analyze the epidemiological and clinical characteristics of patients with subacute thyroiditis(SAT),so as to provide a basis for prevention and treatment.Methods The epidemiological and clinical data of 1 865 patients with SAT,who were treated in the Shandong Institute of Prevention and Control for Endemic Disease in 2015-2006,were collected.The SAT patients' sex,age,urban and rural areas,occupation and time of onset distributions,summary onset clinical manifestations,laboratory findings,treatment and outcome were analyzed retrospectively.Results The average age of the 1 865 patients with SAT was 42.16 years old,the youngest was 9 years old,and the oldest was 74 years old.Most of the patients were 21-50 years old,which was accounted for 62.36％ (1 163/1 865),and most of the patients were female,which was accounted for 83.70％ (1 561/1 865).Most of the patients lived in rural areas,which was accounted for 60.54％ (1 129/1 865).Most patients were onset in January,accounted for 20.48％ (382/1 865),and the least in July,accounted for 1.77％ (33/1865).For the clinical classification,the moderate type and the light type were the largest part with 1 716 cases,accounted for 92.01％,while the severe type was 149 cases,accounted for 7.99％.The clinical manifestations were as follows:the neck discomfort in 1 701 cases,accounted for 91.21％;neck pain,sore throat and palpitate in 1 439 cases,1 351 cases and 1 341 cases,accounted for 77.16％,72.44％ and 71.90％,respectively.Laboratory test results were as following:1 865 cases of thyroid 131I absorption rate reduced(100％);1 396 cases of thyroid nodules increased(74.85％);532 cases of FT3 and FT4 significantly increased,while TSH significandy decreased (28.53 ％);949 cases of FT3 and FT4 increased,while TSH decreased (50.88％);53 cases of FT3 and FT4 decreased,while TSH increased (2.84％);331 cases of FT3,FT4 and TSH in the normal range(17.75％).The thyroid 13I absorption rate significantly increased and thyroid nodules significantly reduced with treatment,the difference was statistically significant (t =-34.93,133.2,all P ＜ 0.001).1 813 patients were cured,while 52 cases arised hypothyroidism.Conclusion Majority of SAT patients are young women.The peak of the incidence of SAT lies in autumn and winter.The proportion of the moderate type is the highest.Early diagnosis and treatment is the key to improve the prognosis of patients with SAT.

0.05),whereas there was a significant difference in cardiac function in patients received atorvastatin(P

Objective To study clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum with less limb damage and complications.Methods From October 1999 to August 2009,18 patients with pelvic tumors around acetabalum (zone Ⅱ of Ennekingl were treated with tumor resection and femoral head exclusion,including 16 males and 2 females with an average age of 54 years(range,18-72).The diagnosis were chondrosarcoma(4 cases),osteosarcoma(2),giant cell tumor of bone(4),synoviosareoma(1),malignant fibrous histiocytoma(1),Ewing sarcoma(1),and metastatic carcinoma(5).Throe cases were treated by selective arterial embolization before operation and 4 cases by temporary block of lower abdominal aorta or common iliac arte.Regular follow-up in clinic was done to observe function of joint and radiographic imaging.Results All patients were followed up for 55 months(range,3-118).The mean surgical time was 170 min(range,120-350 min).The mean blood loss was 1200 ml(range,600-2200 ml).All wounds were healed without infection.One patient with osteosarcoma and 3 with metastatic carcinoma died of multiple organ metastases during 6 months to 2 years after operation.The others had no local relapse.The mean limb discrepancy was 5.0 cm (range,2.0-7.5 cm).The mean Enneking score was 23 (range,20-27).All patients needed custom-made shoes with heightened heel of 2-3 cm.Osteonecrosis of the femoral head was not found in radiographic images.Eight cases had formed artificial acetabulum.One case had gentle lumbar scoliosis.Conclusion The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum had low complications,less pain,low relapse,better function in the recent period.

Objective To retrospectively study the serum IgG and IgM antibodies against toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus type 1&2 in various populations, and analyze the clinical values.Methods From 2008 to 2015, 2 661 pregnant women, 324 infertile women, 2 492 women with abnormal pregnancy history, 623 women with recent abnormal pregnancy, 261 infants with intrauterine growth retardation and other diseases, 170 women for preconceptual examination, and 702 women for physical examination in Beijing were included .Commercial EIA kits were used to detect serum IgG and IgM antibodies to toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus type 1&2. Positive reactions of IgM antibodies to any pathogens were re-tested with another kind of commercial EIA kit. PEMS3.1 software was used for statistical analysis.Results The prevalence of serum IgG or IgM antibodies against toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus type 1& 2 were found within 0.7%-1.6%(0-1.2%) , 85.3%-92.0% ( 0.4%-2.7%) , 89.1%-94.9% ( 0.7%-1.7%) , 74.8%-86.0% ( 0 -0.7%) , 8.1% -17.4% ( 0 -4.1%) respectively in the studied population groups.The prevalence of TORCH IgG and IgM antibodies were not found to be higher in both populations with past suspicious exposure ( infertile women and women with abnormal pregnancy history ) and recent suspicious exposure ( women with recent abnormal pregnancy and infants with intrauterine growth retardation and other diseases) than that in pregnant women and women for preconceptual and physical examination. Conclusion No associations between TORCH infections and the suspicious exposure were found in the populations above.

Objective To evaluate the result of early repair for urinary fistula caused by iatrogenic injury to ureter,bladder and urethra during resection of rectal cancer.Methods We retrospectively analyzed 26 cases of urinary fistula after resection of rectal cancer patients encountered in Department of General Surgery,Henan Tumor Hospital from October 2005 to May 2016.Urinary fistula was divided into four types according to the site of fistula.Results Surgery was performed ever after the diagnosis of the fistula was identified.In type Ⅰ fistula (6 cases of posterior urethral fistula) the treatment was stent placement and packing of the greater omentum.2 cases of bladder top fistula (type Ⅱ),were treated by fistula repair and cystostomy.Type Ⅲ involved 12 cases (bladder triangle fistula).The treatment was ureter stenting replantation,and cystostomy Type Ⅳ:ureteral fistula in 6 cases,the treatment was end-to-end anastomosis and stenting.After surgery 24 cases were cured and 2 cases (all of type Ⅲ fistula) ended up with permanent bilateral ureterocutaneostomy.Conclusion It is safe and effective to make early remedy repair for ureter,bladder and urethral fistula iatrogenically during rectal cancer resection.