Objective To identify the risk factors for surgical site infections after operation of laparoscopic cholecystectomy (LC), so as to provide warning signs for preventing such incidents. Methods The data of 4042 LC patients from January 2003 to December 2015 were analyzed retrospectively. The risk factors for surgical site infections were identified among demographic data, preoperative patients′history, and operative data using multivariate Logistic regression analysis. Results Surgical site infections after LC was seen in 7.2% (291/4042) of the patients. Multivariate analysis identified the following parameters as risk factors for surgical site infections: additional surgical procedure ( OR 4.011, 95%CI 2.149-7.486), age over 55 years (OR 2.398, 95%CI 1.777-3.235), conversion to open procedure (OR 2.647, 95%CI 1.935-3.621), postoperative hematoma (OR 1.910, 95%CI 1.192-3.060), duration of operation >60 min (OR 2.493, 95%CI 1.710-3.635), cystic stump insufficiency (OR 12.451, 95%CI 4.169-37.189), gallbladder perforation (OR 6.161, 95%CI 2.365-16.047), gallbladder empyema (OR 1.704, 95%CI 1.080-2.689), and surgical revision (OR 15.725, 95%CI 10.439-23.686). Surgical site infections were associated with a significantly prolonged hospital stay (P<0.01), higher postoperative mortality (P<0.01), and increased rate of surgical revision (P<0.01). Conclusions Additional surgical procedure is identified as a strong risk factor for surgical site infections after LC. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for surgical site infections after LC.

Intracerebral hemorrhage accounts for about 10%-30% of all stroke types.It is characterized by rapid onset, rapid progress, varied clinical symptoms, high morbidity and mortality, and poor prognosis.After the intracerebral hemorrhage, various inflammatory mediators result in white matter lesions and cognitive impairment.Thrombin acting on thrombin receptors at low concentration induces neuroprotection and at high concentration causes brain injury.This article reviews the role and mechanism of thrombin in white matter injury after intracerebral hemorrhage.

The mechanism of coronary artery thrombosis(CAT)caused by Kawasaki disease is not clear yet.Endothelial injury,hypercoagulability and hemodynamic change of coronary arteries are now considered as the main causes in recent studies.As The clinical symptom of acute thrombus caused by Kawasaki disease is un-conspicuous,cardiac ultrasound should be use actively and thrombolytic therapy should be performed within 12 hours after thrombus formation or the onset of acute myocardial infarction.Intervention or intravenous thrombol-ysis are both proved to be effective.Treatment with oral antitplatelet drugs,such as aspirin,combine with warfa-rin is suggested to relieve acute myocardial infarction in the chronic phase.The adverse reactions of antithrom-botic and anticoagulant drugs should be monitored though they are minor.

Objective To investigate antibiotic resistance and Staphylococcal cassette chromosome mec (SCC-mec) genotype of methicillin-resistant Staphylococcus aureus (MRSA)in Dalian Area .Methods Antimicrobial susceptibility of MRSA was detected by Kirby-Bauer method and SCCmec genotype by multiple PCR method .Results 38 strains of MRSA were all multidrug-resistant strains ,but susceptible to vancomycin and chloramphenicol .The most common SCCmec genotype was type Ⅱ (86 .84% ) ,type Ⅲwas in the second place(10 .53% ) ,and unidentified type accounted for 2 .6% .Conclusion MRSA strains in Dalian area are charac-terized by multidrug resistance ,type Ⅱ is the most common SCCmec genotype .

ObjectiveTo explore the effect of brain derived neurotrophic factor(BDNF) on regeneration of distal axon in sciatic nerve after cfrush injury. MethodDistal axon was assessed by quantitavtive and qualitative analysis of pathology ResultLight microscope indicated thedensity of large diameter of peroneal-nerve was higher in study group compared with control group( P ＜0.01 ). No differences in density of littlediameter fiber were found between study and control group. EM showed the density of non-medullated fibers with diameter ＜0.5μm in studygroup was higher than that of control group. The numbers of layer in myelin was positively related to transverse axonal area( P ＜0.01 ) . The re-gression codfficient in study group wsa higher compared with control group( P = 0. 0023).ConclusionBDNF may promoted maturation ofsensoy nerve and formation of the myeline.

Objective To analyze the risk factors for hypertension in patients with chronic kidney disease stage 5(CKD5) . Methods The basic information of 390 CKD5 patients complicated with hypertension was collected for univariate analysis ,in‐cluding gender ,age ,primary disease ,dialysis method ,body mass index(BMI) ,complications(hyperlipidemia ,high uric acid ,car‐diac insufficiency) ,level of education ,parathyroid hormone(PTH)level.Univariate variables that showed statistical significance were then subjected to the multivariate analysis(Logistic regression)to identify the risk factors for hypertension in CKD5 pa‐tients.The defined daily dose(DDD)that satisfied the criteria interms of different stages was evaluated.Results Overall hyper‐tension control rate was 22.8%.Univariate analysis showed that the following variables were significantly associated with hy‐pertension in CKD5 patients :>40 years old ,male ,diabetic nephropathy ,hypertensive nephropathy ,hemodialysis ,hyperlipemia , high uric acid level ,and high PTH level(P<0.05).Logistic multivariate analysis showed that diabetic nephropathy ,hyperlipi‐demia ,high PT H level were the independent risk factors for hypertension in patients with CKD5.In hypertension segmented standard ,there was no difference in the DDD between stage 0 and 1(P>0.05) ,and DDD at stage 2 and 3 was increased signifi‐cantly when compared with that at 0 and 1 standard(P<0.05).Conclusion Overall hypertension control rate is very low in pa‐tients with CKD5.Diabetics ,hyperlipidemia ,high PTH level are independent risk factors for hypertension in patients with CKD5.

Objective To assess the application of the phage amplified biologically assay (PhaB) in the detection of the mycobacterium tuberculosis (TB) in sputum.Methods To determine the TB patients in the 53 suspected patients we detected 53 sputum samples by PhaB method,BACTEC MGIT960 rapid culture method,and conventional methods (direct auramine smear microscopy and concentrated auramine smear microscopy) individually.Results TB positive samples detected by PhaB,BACTEC MGIT960 rapid culture,direct auramine smear microscopy and concentrated auramine smear microscopy were 24,22,11 and 17 respectively.Thus the sensitivity,specificity,positive predictive value and negative predictive value were 86.4%,83.9%,79.2% and 89.7%,when the PhaB is combined with concentrated auramine smear microscopy,the sensitivity,specificity,positive predictive value and negative predictive value were increased up to 90.9%,83.9%,80.8% and 92.9%.Conclusion PhaB method is a simple and rapid method to detect the Mycobacterium Tuberculosis in sputum with a relatively higher sensitivity and specificity than the conventional methods.When combined with concentrated auramine smear microscopy,PhaB method is even more sensitive.Thus the PhaB method is accessible and applicable in the clinical use of the TB detection.

Objective To compare the value of ultrasound International Ovarian of Tumor Analysis (IOTA) simple rules and gynecologic imaging reporting and data system (GI-RADS) ultrasonographie stratification in the diagnosis of adnexal masses.Methods A total of 463 patients with adnexal masses were classified according to IOTA simple rules by senior doctor.The benign and malignant masses were enrolled in the study.Then the masses were judged according to GI-RADS classification and IOTA simple rules by senior and junior doctors.And junior doctorn in diagnosis of adnexal masses with IOTA was group A1,senior doctor in diagnosis of adnexal masses with IOTA was group B1,junior doctor in diagnosis of adnexal masses with GI-RADS was A2,senior doctor in diagnosis of adnexal masses with GI-RADS was B2.The efficacy of the two methods were compared.Results Among the 463 cases,there were 411 cases (411/463,88.77％) of benign mass and malignant mass by IOTA and 52 cases (52/463,11.23 ％) of uncertain mass.The specificity,positive predictive value,diagnostic accuracy had statistical differences between groups A2 and B2,A1 and A2 (all P＜0.05),and sensitivity and negative predictive value had no statistical differences (all P＞0.05).Diagnostic efficacy index had no statistial signifi cance between group A1 and B1,B1 and B2 (all P＞0.05).Conclusion The diagnostic efficacy of IOTA simple rules and GI-RADS is high and similar in diagnosis of benign and malignant adnexal masse.IOTA simple rules do not depend on experience,but they are not suitable for the diagnosis of all adnexal masses.

Objective To investigate changes of serum silent information regulator 1 (Sirt1) and inflammatory cytokines in type 2 diabetes patients with different stages of diabetic nephropathy.To explore the relationship between serum Sirt1 level and inflammatory cytokines in type 2 diabetic patients with different urinary albumin excretion rates.Methods A total of 436 cases with type 2 diabetes were divided into three groups:normoalbuminuric [D1,n =168],microalbuminuric [D2;n =152],and macroalbuminuric [D3,n =116].Serum Sirt1,hypoxia-inducible factor-1α (HIF-1α),early growth response protein 1 (EGR1),insulin-like growth factors-Ⅰ (IGF-Ⅰ),and monocyte chemotactic protein-1 (MCP-1) were determined by enzyme-linked immunosorbent assay (ELISA).Results The levels of serum Sirt1 in type 2 diabetes patients were significantly lower than that in control group,and with the increase of urinary protein excretion rate,the levels of serum Sirt1 in group D1,D2 and D3 were decreased gradually (P ＜ 0.01).Compared to control,serum inflammatory cytokines (HIF-1α,EGR1,IGF-Ⅰ,and MCP-1) levels were significantly increased in type 2 diabetic patients and gradually increased in the patients of D1,D2 and D3 groups (P ＜0.01).Furthermore,Serum Sirt1 was negatively correlated with the levels of inflammatory cytokines.Age,duration,fasting blood glucose (FBG),fasting insulin (FINS),homeostasis model assessment insulin resistance index (HOMA-IR),glycosylated hemoglobin (HbA1c),low density lipoprotein (LDL),total cholesterol (TC),triglyceride (TG),serum creatinine (Scr),blood urea nitrogen (BUN),uric acid (UA),HIF-1α,EGR1,IGF-Ⅰ,and MCP-1 were positively correlated with Ln Koc of urinary albumin to creatinine ratio [Ln(ACR)] (P ＜ 0.05);and Sirt1 were negatively correlated with Ln(ACR)(P ＜ 0.01).HIF-1α,MCP-1,IGF-Ⅰ,duration,BUN,Sirt1,UA,LDL,and EGR1 were independent factors that significantly influenced Ln (ACR) (P ＜ 0.05).Conclusions Serum Sirt1 might be a new target for the treatment of diabetic nephropathy.Enhancing serum Sirt1 levels might have a role in delaying the progression of diabetic nephropathy.

BACKGROUND:Ola rats is a kind of rats with genovariation, who displays Wallerian degeneration after peripheral neuroaxonal damage that is slower than that normal 6J rats, thereby additional damage factor may help fully understand the property of Ola rats.OBJECTIVE: To observe the effect of acrylamide on the degeneration and regeneration of sciatic nerve medullated fibers following crush injury of C57BL/Ola (Ola) rat and C57BL/6J (6J) rat.DESIGN: Randomized controlled experiment.SETTING: Department of Neurology,Second People's hospital of Shenzhen; Department of Neurology of First hospital of Jilin University MATERIALS: This experiment was carried out in the neurological department in the University of Occupational and Environmental, Japan from January to June 1996. Twelve adult Ola rats and 6J rats were adopted and evenly randomly divided into experimental group and comparison group.METHODS: Rats were subjected to general anaesthesia, and then the proximal section of sciatic nerve was exposed and frustrated with hemostatic forceps for 10 s before suture. Rats in the experimental group were given intraperitoneal injection of acrylamide in a total dosage of 350 mg, which replaced by the same volume of physiological saline in comparison group.At 14 days after sciatic nerve torsion injury, all rats were anaesthetized again and the distal section of sciatic nerve was obtained and cut into slices, meanwhile the cross sectional area, the density and size frequency distribution of medullated fibers, as well as the number of medullated fibers in each nerve were determined.MAIN OUTCOME MEASURES: The density and size frequency distribution of sciatic nerve medullated fibers, as well as the number, the maximum diameter and the mean diameter of medullated fibers in two group of 0la rats and 6J rats.RESULTS: Totally 12 Ola rats and 6J rats entered the result analysis.① No Ola rat displayed Wallerian degeneration; But medullated fiber degeneration and following neonatal small diameter medullated fibers could be observed in 6J rats. ②In the experimental group, the total density of sciatic nerve medullated fibers in 6J rats was lower than that of Ola rat (P ＜ 0.05) ;with the total number of medullated fibers in 6J rats also less than that of Ola rat (P ＜ 0.01 ), which predominated by obviously reduced big diameter fibers (P ＜ 0.01); The mean diameter of medullated fiber in 6J rats was also obviously smaller than that of 0la rat (P ＜ 0.01 ).CONCLUSION: The Wallerian degeneration is extremely slow in Ola rat after torsion injury, which cannot be affected by acrylamide; while acrylamide has obvious inhibition on the axonal neogenesis in 6J rat after torsion injury.