Objective To discuss the relativity between serum procalcitonin(PCT) level and renal impairment (RI) in critically ill patients. Methods A perspective study was performed in 60 critically ill patients. They were divided into 2 groups on the serum PCT level within 24 h: abnormal group (PCT ≥ 0.5 μg/L,38 cases) and normal group(PCT < 0.5 μg/L,22 cases). The serum creatinine (SCr) and blood urea nitrogen (BUN) were observed. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) of the patients were recorded. Calculated the sensitivity and specificity for prediction of RI as well as acute renal dysfunction (ARD). Results SCr [(188.91 ± 199.48) μmol/L]and BUN [(13.03 ±9.19)mmol/L]in abnormal group were significantly higher than those in normal group [(67.40 ± 15.35) μ mol/L and (6.91 ± 2.06) mmol/L](P< 0.01). The sensitivity of PCT forecast RI was 71.79%, and specificity was 52.38%. The sensitivity of PCT forecast ARD was 91.67% , and negative predictive value was 95.45%. Conclusion Serum PCT level has an important value for judgement of RI and ARD in critically ill patients.

In order to evaluate appropriately the role of lipid metabolism by the refined konjac meal (RKM), a new source of dietary fiber, the effects of RKM on the level of serum and liver lipids, hepatic histopathology and on the composition and output of fecal bile acids in comparison with pectin, algin and agar were studied.The RKM contained about 75-80% of glucomannan. All four kinds of dietary fiber "were given at a level of 5% in the diet to the young male Wistar rats fed on a lipid-rich diet containing 5% lard, 1% cholesterol and 0.25% chplate. The control group was fed on a lipid-rich diet alone withput fiber. The normal group was fed on a basal diet without extra lipid added. Feeding period was 9 weeks.The results obtained were as follows;1)All the dietary fibers tested have the similar effects on serum lipid composition. At the end of 2-week of the experiment, the serum total cholesterol levels of the four experimental groups were only 62% to 75% of that of the control group, and at the end of 7-week they were lowered to the same level of the normal group. The level of the triglyceride in serum did not change in all groups during the experiment.2)Relative liver weights were lower in four experimental groups than in control group. Hepatic hisiopathological examinations showed lipotropic effect in RKM, pectin and algin groups. Both of the above effects appeared most significantly in RKM group. The concentrations of total cholesterol and triglyceride in liver in RKM group were lower than those in control group as well as other three experimental groups.3)No harmful effects on the intake of food and growing of rats were found when feeding these four kinds of dietary fiber at the level of 5%.4)The daily output of fecal bile acids (CDCA + GDCA) was significantly increased in four experimental groups.The increase of fecal output of bile acids, especially CDCA, may be one of the mechanisms of hypocholesterola-emic effect of dietary fibers.It could be concluded that RKM has the same significant hypocholestero-lemic effect as the pectin, algin and agar, but its lipotropic effect is more potent.

Syndrome of cachexia,which is a common feature of many types of cancer,characterized by loss of adipose tissue and skeletal muscle,is responsible not only for a poor quality of life and poor response to chemotherapy,but also a decreased survival time.It can not be fully explained by the accompanying anorexia,because increasing nutrient support is unable to reverse the wasting syndrome.Although patients with cachexia frequently show an elevated resting energy expenditure,cachexia can occur with a normal energy expenditure.Lipid mobilizing factor and proteolysis inducing factor,two tumor-derived factors,can directly mobilize fatty acids and amino acids from adipose tissue and skeletal muscle respectively.It is important of the knowledge about the roles and mechanism of LMF and PIF in the development of cancer cachexia,which should lead to the development of new therapeutic methods.

Objective To investigate the value of ureteropyeloscopy and B-type ultrasonography in the treatment of staghorn calculi. Methods Pneumatic lithotripsy was performed and the residual stone and stone fragments were removed under the assistance of ureteropyeloscope and B-type ultrasonograph in 40 patients. Results The stone fragments were small enough to remove and the calculi removal rate was 92.5% (37/40). The rate of complications mainly including hemorrhage and residual stones was 7.5% (3/40). Conclusion The application of ureteropyeloscopy and B-type ultrasonography in the treatment of staghorn calculi is safe and less invasive, and can reduce effectively the incidence of residual stones.

Objective To compare the safety and effectiveness of temporary occlusion techniques with different balloons in performing cesarean section for patients with pernicious placenta previa.Methods The clinical data of 15 patients with pernicious placenta previa,who received cesarean section during the period from March 2014 to April 2016,were retrospectively analyzed.In order to reduce bleeding during operation and to preserve the uterus as far as possible,temporary occlusion of abdominal aorta with balloon was adopted in 7 patients (group A),and temporary balloon occlusion of bilateral internal iliac arteries was employed in 8 patients (group B).The intraoperative radiation dose,the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications were documented,and the results were compared between the two groups.Results All the 15 patients were suffered from central type of placenta praevia complicated by extensive placenta accreta.With the help of temporary balloon occlusion technique,the cesarean section was successfully accomplished in all 15 patients.Subtotal hysterectomy had to be done in 7 patients,including 4 patients of group A and 3 patients of group B,and every one patient from each group developed arterial thrombosis of lower limb.The intraoperative radiation dose of group A was significantly lower than that of group B (P＜0.01),besides the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications of group A were all lower than those of group B,but because of the limited number of cases these differences were not statistically significant (P＞0.05).Conclusion For the treatment of pernicious placenta previa,temporary balloon occlusion technique-assisted cesarean section is safe and effective.The intraoperative radiation dose in the group using temporary balloon occlusion of abdominal aorta is remarkably lower than that in the group using temporary balloon occlusion of bilateral internal iliac arteries.

Objective To investigate the effects of surgical method on the falx paraneoplastic parasagittal meningiomas.Methods 30 cases of surgical treatment in sagittal sinus and falx meningioma patients with imaging data,surgical approach,microsurgical resection of the tumor method and efficacy were analyzed.Results 30 patients resected by Simpson standard,Ⅰ grade resection 23 cases,Ⅱ grade resection in 7 cases,no operative mortality.1-5 years of follow-up,2 patients relapsed,all secondary surgical cure.Conclusion To be familiar with microscopic neuroanatomical relationship,using microsurgical resection of the superior sagittal sinus,falx meningioma,tumor removal rate can be increased to reduce the important functional areas of damage,reduce complications and improve quality of life of patients.

According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.

Objective To explore a convenient and safety way for surgical treatment of juxtra-papillary duodenal diverticulum.Methods A total of eighteen patients with juxtra-papillary duodenal diverticulum admitted to Hunan Provincial People's Hospital from May 2011 to May 2013 were involved in this study for retrospective analysis.Results Most of patients were old people and the average age was (55.5 ± 11.2) years in this group.All 18 patients accepted diverticulectomy without operation-mortality.No postoperative complications such as bleeding,duodenal fistula,biliary fistula and traumatic pancreatitis were happened.The average operation time was (2.5 ±0.6) hours.The average blood loss was (35.1 ± 14.2)ml.A total of 16 patients had been accepted follow-up survey.Mean length of follow-up was (10.5 ±2.0)months.Good result rate was 100％.Conclusions Do-not-open the duodenum diverticulectomy is the ideal surgical treatment of juxtra-papillary duodenal diverticulum.