Autoimmune Diseases ; diagnosis ; etiology ; therapy ; Humans ; Immunoglobulin G ; adverse effects ; blood ; chemistry

Objective To investigate the applicetion value of combined ultrasonic scalpel in laparoscopic cholecystectomy(LC).Methods 140 patients with acute and chronic cholecystitis,gallbladder stone patients,received intraoperative ultrasound combined electrosurgical knife,suction devices auxiliary red line LC.The clinical effects were observed.Results 138 cases were completed cholecystectomy.Blood loss ( 8.16 ± 1.85 ) ml,operation time(38.13 ±4.35) min,Postoperative hospital stay(3.25 ± 1.18)d,4 cases of intraoperative rupture of the gallbladder,Hepatobiliary burns in 1 case,2 cases because of dense adhesions around the gallbladder and gallbladder more extensive anatomical triangle unclear laparotomy.Conclusion The rational use of combined high-frequency ultrasonic scalpel knife,suction devices auxiliary red laparoscopic cholecystectomy,surgical conditions that meet medicalrecords,are safe and reliable,quicker recovery can be achieved by minimally invasive medical treatments.

Antineoplastic agents-induced pulmonary toxicity is one of important reasons causing respiratory failure,which clinical manifestations are pulmonary inflammation,allergic reaction,vascular permeability reaction and pulmonary vascular disease.All of these may be caused by drug toxicity,immune response and increased capillary permeability and so on.Because of the nonspecific performance,it is important to exclude the other lung diseases.Once the diagnosis is clear,the antineoplastic gents should be immediately stopped and the patients should be timely administered high-dose eorticosteroid therapy.How to reduce the pulmonary toxicity induced by antineoplastic agents is becoming one of the future focuses about antineoplastic agents research.

Objective To assess the role of MRI in the preoperative characterization and local staging of testicular neoplasms.Methods A retrospective study of 24 patients suspected of testicular neoplasm was conducted.The histological diagnosis of testicular neoplasms was made and local extension of testicular malignancy was evaluated.The MRI findings were correlated with the pathologic results.Results Histological examination revealed 26 intratesticular lesions,14 of which were nalignant,including 4 cases of diffuse large B cell lymphoma,7 cases of seminoma,2 cases of embryonal carcinoma,one case of teratoma.Twelve lesions were benign,including 5 cases of epidermoid cyst,2 cases of simple cyst,2 cases of inflammatory granuloma,2 cases of testicular mediastinal tubular expansion and one case of testicular pseudo fibroma.Six malignant testicular tumors were confined within the testis,4 invaded the testicular tunicae or epididymis,2 invaded the spermatic cord,and 2 invaded the scrotal wall.The accuracy of MRI in the diagnosis of intratesticular lesions was 92％.The accuracy of MRI diagnosis in the local staging of testicular tunors was 86％.Conclusions MRI is highly accurate in the preoperative characterization and local staging of testicular neoplasms.It is of great significance to the clinical diagnosis and treatment.

Objective To evaluate effectiveness of clinical pharmacists'intervention in perioperative antimicrobial use in type Ⅰ incisional surgery.Methods Clinical data of 1398 patients undergoing type Ⅰ incisional surgery in a hospital between January and December 2014 were analyzed retrospectively,633 patients who underwent surgery between January and June were as pre-intervention group,765 patients who underwent surgery between July and December were as post-intervention group (clinical pharmacists were assigned to strengthen the management and control of rational antimicrobial use),antimicrobial prophylaxis between pre-intervention group and post-interven-tion group were compared.Results In pre- and post-intervention groups,antimicrobial prophylaxis were 56.71%and 28.37% respectively(χ2= 113.26,P<0.05). Rational selection rates of antimicrobial types were 60.45% and 89.86% respectively,rational rates of administration time were 49.58% and 82.49% respectively,the rates of anti-microbial prophylaxis course≤24 hours were 11.42% and 29.95% respectively,>24 hours were 88.58% and 70.05% respectively,combination antimicrobial use were 10.31% and 0 respectively,the differences between before and after intervention were all statistically significant (all P<0.05). Incidence of surgical site infection in pre-and post-intervention groups were 0.79% (5/633)and 0.26% (2/765)respectively(P= 0.255).Conclusion Through clini-cal pharmacists'intervention in perioperative antimicrobial prophylaxis in type Ⅰ incisional surgery,antimicrobial prophylax-is rate decreased dramatically,antimicrobial management is more standardized,scientific and systematic.

Objective To investigate the remission rate of the therapy of integrated TCM into intensive insulin treatment, and the relationship between each factor and the remission rate. The effect of TCM on improving ?-cell fimction and remission rate was also studied. Methods Forty-seven newly diagnosed type 2 diabetic patients were shortly treated with both continuous subcutaneous insulin infusion (CSII) and Chinese medicine. The remission rate was observed. The relationship between each factor and remission was analyzed by logistic regression. The ?-cell function of patients in remission group were evluated at the end of the treatment and during the period of follow-up. Results After treatment of (11.8?2.5)d, BMI and the ratio of the days of blood glucose reaching the standard and the total treatment days were the mainly factors affecting the remission. The remission rate at the end of treatment, one month after treatment and follow-up period (about six month) was 46.8%, 55.3%, 53.3% respectively. In following up, the remission rate in the Chinese medicine group and the control group was 66.7%, 44.4% respectively. Conclusions About half of newly diagnosed type 2 diabetic patients obtain clinical remission after the short-term intensive treatment of integrated insulin and Chinese medicine. Chinese medicine may have positive impaction on remission and extending honeymoon period.

Objective To investigate the efficacy and safety of intraarterial or intravenous recombinant tissue plasminogen activator(rtPA) for patients with acute cerebral infarction.Methods 60 patients consistent with the inclusion criteria were divided into intra-arterial thrombolysis group, intravenous thrombolysis group and control group. rtPA of 10～20 mg was infused over the course of 30 minutes in intra-arterial thrombolysis group. rtPA was administered in a dose of 0.7～0.8 mg/kg(maximum dose 50 mg),with 100% as a constant infusion over a period of 90 minutes in intravenous thrombolysis group.24 hours late, both groups were followed by subcutaneous injection of low molecular weight heparin(0.4 ml,twice daily) for 7 days. The control group received only routine treatment. European Stroke Scale(ESS) and Barthel Index(BI) were used to evaluate the recovery of neurological functions.Results The efficacy in both thrombolysis groups was significantly higher than that in the control group(all P 0.05).But in intraarterial group, the stenosis of intracranial arteries or extracranial arteries could be found, and new thrombosis could be prevented by transluminal stent-assistant angioplasty. One case of intracerebral hemorrhage and one case of asymptomatic hemorrhage occurred in intraarterial thrombolysis group. One case of asymptomatic hemorrhage was found in intravenous thrombolysis group and control group respectively. No dead case was found in the three groups.Conclusion Thrombolytic therapy of intra-arterial and intravenous rtPA can be performed safely and efficaciously in patients with acute cerebral infarction within 6 hours from the onset.

[Objective] To compare the expression of matrix metalloproteinase 2(MMP-2)and matrix metalloproteinase 9(MMP-9)induced by alumina and ultra-high-molecular-weight polyethylene(UHMWPE)wear particles,and investigate the role of MMP-2 and MMP-9 in the mechanism of the periprosthetic osteolysis induced by wear debris during aseptic loosening.[Methods]Seventy-two Kunmin mice were divided into 3 groups(24 per group)in a murine air pouch model of inflammation.The air pouches were injected with 3ml of suspension containing 1?108 /ml alumina particles in group A,while UHMWPE particles in group B,and control pouches received 3ml of sterile PBS.All animals were sacrificed at 3、7、14 days after injection.Histological changes and cell counting were assessed by light microscope.RT-PCR and immunohistochemistry method were applied to detect the gene and protein expression of MMP-2 and MMP-9 in the pouches.[Results]Increased cell infiltration and MMP-2,MMP-9 mRNA and immunoreactivity expression were detected in group A and B,and compared to control group,cell number and gene and protein expression of MMP-2 and MMP-9 in group A and B was significantly higher(P

Objective Aprotinin, a serine proteinase inhibitor, has been reported to reduce blood loss significantly in patients undergoing cardiac surgery with CPB, heart and liver transplantation. The aim of this study was to evaluate the effect of aprotinin on intraoperative blood loss, transfusion requirement and blood coagulation during liver cancer resection.Methods Eighty-two ASA Ⅰ -Ⅲ patients ( 51 male, 31 female ) aged 33-65 yr undergoing liver cancer resection ( 61 partial hepatectomy, 21 extirpation of liver cancer) were studied. The patients were randomly divided into 2 groups : aprotinin group received a bolus of aprotinin 1 112 EPU after induction of anesthesia, followed by continuous aprotinin infusion at 278 EPU?h-1 until 2 h after operation ( n = 40); control group received normal saline instead of aprotinin ( n = 42) . The patients were premedicated with sodium luminal, droperidol-fentanyl and atropine. Anesthesia was induced with midazolam 2 mg, thiopental 5 mg?kg-1 and succinylcholine 1.5 mg? kg-1 . After tracheal intubation the patient was mechanically ventilated (VT = 8-12 ml?kg-1 ) and PaCO2 was maintained at about 35 mm Hg, Anesthesia was maintained with N2O/O2 , fentanyl and vecuroniurn. Venous blood samples were taken before induction of anesthesia (baseline) , 0.5 h, 2 h and 4 h after skin incision and 6 h and 12 h after operation for routine blood tests, thromboelastography ( TEG), and determination of activated partial thromboplastin time (APTT), thromboplastin time (TT) prothrombin time (PT) and plasma fibrinogen concentration (Fig) . Intraoperative blood loss and amount of blood transfused were recorded. Results The preoperative hypercoagulable state was ameliorated and coagulation was maintained within the normal range in aprotinin group; while in control group the hypercoagulable state was aggravated during operation and at the end of operation it changed to hypocoagulable state. The intraoperative blood loss and amount of blood infused were significantly less in aprotinin group than in control group. Conclusion The use of aprotinin during liver cancer resection results in reduction in intraoperative blood loss and less transfusion requirement.

OBJECTIVE:To evaluate the economic effects of different doses of methylprednisolone treatment regimes on traumatic reaction in patients with cervical spondylotic myelopathy after anterior decompressive operation.METHODS:56cervical spondylotic myelopathy cases who have been subjected to anterior decompressive operation were chosen to be the sub-jects.The56cases were divided into3groups and treated with different dosage of methylprednisolone,the initial dose for group A(18cases,low dose group)was80mg;the initial dose for group B(21cases,medium dose group)was600mg and that for group C(17cases,large dose group)was1000mg,the improvement of clinical symptom of each group was observed re-spectively and the cost-effectivenesses of the three groups were compared.RESULTS:The costs of the A,B,C groups were990.00,1339.10and1886.70yuan respectively;the effectiveness rates(E)of the A,B,C groups were5.56%,14.29%and35.29%respectively;The costs for each unit of obvious effectiveness(C/E)of the A,B,C groups were178.06,93.71and53.46yuan respectively;On the basis of group A,the needed costs of group B and C were39.99and30.16yuan respectively for each obvious effectiveness unit increase(?C/?E).CONCLUSION:Compared with group A and B,the effectiveness rates of group C had a bigger increase while the needed cost for each unit of obvious effectiveness was the lowest,therefore,the dose regimen of group C is more rational.