Objective To explore the treatment of sepsis in patients with severe sepsis, the use of CBP (continuous blood purification) effect on lactic acid and hemodynamics in patients with blood.MethodsIn 40 cases of patients with severe sepsis treated by conventional methods, and classified as the control group, the other 40 patients using CBP (continuous blood purification treatment;blood lactic acid) after evaluation and hemodynamics of two groups of patients before and after treatment, and compared between groups, the patients were treated in our hospital from January 2015 to October 2016.ResultsThere was no significant difference in blood lactate level of the two groups of patients before treatment, after grouping After treatment, the patients in the observation group decreased more significantly, while the monitoring of patients in different time period, showed its obvious difference;hemodynamics of two groups were observed and compared, found before treatment all indexes had no significant difference after the treatment group were improved more obviously in patients in the observation group, group are P<0.05 shows obvious differences.ConclusionAnalysis of the influence of the dynamics of CBP in severe sepsis patients blood lactic acid and blood flow, which can significantly improve the patient's level of lactic acid, which decreased gradually, while helping the hemodynamic situation of the patient to recover, it is worthy of reference.

ObjectiveTo evaluate the reliability and validity of Chinese version of Postoperative Pain Assessment Nursing Practice Questionnaire (PPA-NPQ).MethodsA forward-backward translation procedure was followed to develop the Chinese version of PPA-NPQ.A total of 258 surgical nurses were investigated by the revised Chinese version dimensions of PPA-NPQ,then the results were tested on reliability and validity by SPSS17.0.ResultsThe cronbach's α of the Chinese version of PPA-NPQ was 0.889.The split- half coefficient and testretest reliability of PPA-NPQ were 0.729,0.875 respectively ; the Cronbach's a,split- half coefficient and test-retest reliability of each sub-scale were ranged from 0.820-0.857,0.797-0.862,0.846-0.902 respectively.The correlation between each sub-scale and total scale were ranged from 0.704-0.818 (P ＜ 0.01 ).ConclusionThe revised Chinese PPA-NPQ is reliable and valid,and can be used to test the level of postoperative pain assessment practice by surgical nurse.

84 eyes that underwent femtosecond laser-assisted laser in situ keratomileusis ( FS-LASIK) , and 110 eyes that underwent small incision lenticule extraction ( SMILE) surgery were included in this prospective case se-ries study. HOAs included ( total HOAs, spherical aberration, horizontal coma aberration, and vertical coma aber-ration) were measured preoperatively after 1 week, 1 month , and 3 months postoperatively by Pentacam. The ab-errations were described as Zernike polynomials. Significantly increased total HOAs and SA and significantly de-creased vertical coma were noted at 1 week, 1 month, and 3 months after FS-LASIK ( P<0.05 ) . However, no significant increase was found in postoperatively horizontal coma. There were significant increases in total HOAs, SA, and horizontal coma and a decrease in the vertical coma at each postoperative examination in SIMLE group ( P<0.05 ) . The total HOAs and SA were significantly smaller in SMILE group than that in FS-LASIK group at 1 week, 1 month, and 3 months postoperatively. The changes in total HOAs and SA were also significantly smaller in SMILE group than that in FS-LASIK group at each postoperative examination. Compared with FS-LASIK, SMILE can induce fewer total higher-order aberrations and spherical aberration after operation.

Objective To explore the relationship between first-episode schizophrenia and metabolic syndrome (MS). Methods 231 first-episode schizophrenia patients (schizophrenia group) and 63 healthy controls (healthy group) were selected to detect the height, weight, waistline, fasting plasma glucose (FPG), blood lipid and blood pressure. International Diabetes Federation (IDF) MS Diagnostic Criterion (2005) was used to diagnose MS. Results The FPG and Total Cholesterol (TC) of the schizophrenia group were significantly higher than the control group (P<0.001). The MS detection rate in the schizophrenia group was higher than in the control group (P=0.021). Conclusion First-episode schizophrenia patients could have glucose-lipid metabolism disorder during the early stage.

Objective To investigate changes of synaptic interface structural in the hippocampus Cal in high and low conditioned place preference(CPP) rats after chronic morphine treatment.Methods The male SD rats were randomly distributed to experiment group 130 cases(intraperitoneal injected morphine twice a day for ten days in an ascending dosage schedule) and control group 30 cases(injected saline of the same volume at same time).The rats in experiment group were re-classified into high preference group(HP),middle group and low preference group(LP) according to the numerical value of the CPP.The middle group was rejected.The rats in HP and LP were scarified at the time of 3h,3d and 14d after the last injection.The hippocampus Cal were removed and prepared for electron microscope specimen.The synaptie interface structure parameter were analyzed by image processing technique.Results ①No significant difference of pretest scores staying at the non-preference chambet existed among the three groups(F=0.78,P=0.47).However,the test scores of the CPP minus the time stayed at pretest natural preference in the high group was significantly higher than that of the low group(P=0.00).②At the 3h and 3d,the PSD of the high group((15.20±-3.65)nm) was significantly lower than low group((17.63±6.61)nm,P<0.01);the synaptic cleft of high group((5.77±2.08)nm) was significantly higher than low group ((4.92±1.65)nm,P<0.05).At the 14d,the PSD of the high group((16.22±4.93)nm) was significantly lower than low group((18.42±3.78)nm,P<0.01).Conclusion In hippocampal Cal area the synaptic cleft in the HP group was higher than that of LP group,the post-synaptic density in the HP group was lower than that of LP group.These changes may be the synaptic basic of the different susceptibility.

Objective To investigate the possible mechanism for the different CPI susceptibili-ties. Methods Using a conditioned place preference (CPP) model, rats were selected into high and low preference groups. Using in situ hybridization, we examined the mRNA expression of 5-hydroxytryptamine transporter (5-HTT) and 5 -hydroxytryptamine 1 A receptor (5-HT1 AR) in 3 cruci-al regions in addiction, namely the ventral tegmental area (VTA) , the nucleus accumbens (NAc) ,and the medial prefrontal cortex (mPFC) , during the dependence and withdrawal. Results During dependence state, the expression of 5-HTT mRNA in each of the regions in the high preference group was significantly lower than that of the low preference group, while higher expression of 5-HT1AR mRNA in each of the regions in the high preference group than that of the low preference group was found (P<0.05). During withdrawal state, the expression of 5-HTT mRNA in each of the regions in high preference group was significantly higher than that of the low preference group, while lower expres-sion of 5-HTIAR mRNA in each of the regions in the high preference group than that of the low prefe-rence group was found (P<0.05). Conclusion 5-HTT and 5-HT1 AR may play a role in diffe-rences in susceptibility to morphine.

Objective To evaluate right hepatic veins exclusion in the prevention of massive bleeding and air embolism during the resection of huge hepatic cavernous hemangioma near the second hepatic portal. Method This is a retrospective study on the clinical data of 12 hepatic hemangioma patients at the Live Surgery Department of Zhejiang Provincial People's Hospital from 2004. 1 to 2010.3. In all patients the huge hepatic cavernous hemangioma was adjoining the second hepatic portal. Block webbing or vascular clamp were used to exclude the right hepatic veins. Among the 11 patients without hepatic cirrhosis Pringle maneuvre was applied in 5 cases and selective hepatic inflow occlusion in 6 cases. Patients with hepatic cirrhosis used hemi-hepatic blood inflow occlusion. Results During the surgery no rupture of right hepatic vein happened. Nine patients used vascular block webbing and 3 patients used vascular clamp.Six patients without cirrhosis used the complete hepatic inflow occlusion and other patients without cirrhosis used hemi-hepatic blood inflow occlusion. Cirrhotic patients used hemi-hepatic blood inflow occlusion. All the operations were successful. Intraoperative blood loss ranged from 200 - 5800 ml, averaging 680 ml. Three patients needed not blood transfusion. There was no right hepatic vein rupture or air embolism. Conclusion Right hepatic veins exclusion is a useful technique to prevent massive bleeding and air embolism caused by the rupture of right hepatic vein during the resection of huge hepatic cavernous hemangioma.

Objective:To analyze the value of low dose enteral nutrition (EN) in treatment of septic shock combined with acute gastrointestinal injury Ⅲ (AGI Ⅲ).Methods:Clinical data of septic shock patients combined with AGI Ⅲ admitted at our hospital were analyzed.Patients were divided into two groups according to the nutrition therapy they received:treatment group (EN,n =41) and control group (no EN,n =46).The mortality and ICU hospital stays were collected.The intestinal barrier,inflammatory cytokines,and oxidative stress were evaluated before and after EN treatment.Results:For patients in the treatment group,the dosages of EN ranged from 200 to 410 kcal/d,with the median dose of 350 kcal/d.No significant differences were found on death rates between the two groups (24.4％vs 32.6％,P =0.398).Patients in the treatment group had shorter ICU hospital stays than those of the control group (11.8 ± 3.7 vs 16.2 ± 5.3,P ＜0.01).After one week EN treatment,patients in the treatment group had lower levels of CRP,IL-6,TNF-α,diamine oxidase,endotoxin and D-lactate than those of the control group (P ＜ 0.05).Conclusion:For septic shock patients combined with AGI Ⅲ,low dose EN can improve the intestinal barrier function and systemic inflammatory responses.

Objective To investigate the relationship between the dynamic changes of interleukin-1β (IL-1β) levels and severity and complications of patients with multiple trauma at the early stage.Methods Among 97 patients with multiple trauma in Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital between August 2015 and May 2016,12 patients were excluded as follows,(1) with burns or chemical injuries;(2) pregnancy or menopausal women;(3) had bacterial infection a week ago;(4) with chronic diseases.The other 85 patients with multiple traumas were classified into three categories according to the injury severity score (ISS).That is,the slight group (22 cases,9≤ ISS ＜ 15),moderate group (35 cases,15 ≤ ISS ＜ 25) and severe group (28 cases,ISS ≥ 25).Their venous blood samples were collected at 6,12,24,48 and 72 hours after trauma respectively,and the serum IL-1 β levels were measured using a specific immunoluminometric assays.The basal conditions including age,the hospitalization days and so on among these three groups were compared via ANOVA.The mean IL-1 β levels at above time intervals among three groups were compared.Finally,the relationship between the peak concentration of IL-1β and injury severity and complications was analyzed by multiple Logistic regression.Results (1) As the increasing severity of trauma,the patients with longer days of hospitalization and higher rate of multiple organ dysfunction syndrome (MODS) (P ＜ 0.05).(2) The levels of IL-1 β in the moderate and severe groups were remarkably higher than those in the slight group (P ＜ 0.02).(3) The IL-1β levels in each group peaked at 6 hours after trauma and began to decline.(4) Multivariate logistic analysis showed that peak concentration of IL-1 β was still an independent predictor for injury severity (moderate group:odds ratio,1.21;95％ confidence interval:1.05-1.39,P =0.007;severe group:odds ratio,1.20;95％ confidence interval:1.03-1.40,P =0.019) and sepsis (odds ratio,1.28;95％ confidence interval:1.10-1.50,P =0.001),but had no significant association with MODS and trauma mortality even after controlling other risk factors.Conclusions The serum IL-1β at 6 hours after injury could be used as an early effective indicator to evaluate the injury severity and infectionrelated complications in patients with multiple trauma.

ObjectiveTo study the proper timing for radical hepatectomy after tumour-down-staging with transcatheter arterial chemoembolization for unresectable primary liver cancer.Method This is a retrospective study of 18 patients with unresectable primary liver cancer who received radical liver resection after tumour-downstaging with transcatheter arterial chemoembolization (TACE) from January 2005 to August 2010 at Zhejiang Province People's Hospital Hepatobiliary Surgery Department.The patients received TACE 1 to 3 times (once n=4,twice n=12,and thrice n=2).After tumour-downstaging,radical liver resection was carried out (right hepatectomy,n =10 ; resection of tumour in right liver + resection of right liver metastases,n=2; resection of tumnour in right liver +radiofrequency ablation of right liver metastasis,n=1; right hepatectomy + removal of portal vein tumour thrombus,n=1 ; left hepatectomy + radiofrequency ablation of right liver metastases,n=2 ;Mesohepatectomy,n=1; and left hepatectomy + excision of liver metastasis,n=1).ResultsAfter TACE,the diameter of the primary tumour reduced by over 30％ in 6 patients (6/18,33.3％);10％～30％ in 8 patients (8/18,44.4％),and 10％ in 4 patients (4/18,22.2％).Before TACE,the tumours were not encapsulated in 6 patients (33.3％).After TACE,only 1 patient (5.6％) had the tumour remained unencapsulated.After TACE in 6 patients,the primary tumour shrunk to be within a hemiliver,and ultrasound and CT showed the tumours to have defined borders and they were away from the porta hepatis and major blood vessels.In another 6 patients,there were metastases to the contralateral hemilivers but these tumours had all shrunk in size.Selective vascular inflow and outflow occlusion technique was routinely used for liver resection.ConclusionFor primary liver cancers which are not resectable,TACE should be used first.When the tumours shrink in size,radical resectional surgery should be performed as soon as possible.The surgical technique should follow the following principles:-preserve as much normal liver parenchyma as possible,use selective vascular inflow and outflow occlusion technique to avoid ischaemia/reperfusion injury to the remnant liver,and to reduce haemorrhage.The surgery should be carried out by experienced surgeon.