Objective To analyze the significance of time to positivity(TTP)of blood culture in differentiating bloodstream infection(BSI)from contamination during blood withdrawal.Methods Clinical data and TTP of blood culture in patients hospitalized in different departments from November 2013 to November 2014 were compared retrospectively,role of TTP in differential diagnosis of BSI was evaluated.Results Of 2 605 blood culture specimens,137 were positive for blood culture,78 (56.93%)of which were pathogenic bacteria and 59(43.07%) were contaminated bacteria,coagulase negative staphylococcus had the highest contamination rate(75.76%),while Escherichia coli had the lowest contamination rate(12.50%).TTP of pathogenic bacteria was shorter than that of contaminated bacteria ([13.86 ±8.19]h vs [40.72 ±20.96]h,P <0.05 ).Of pathogenic bacteria,Enterococcus had the earliest TTP ([10.20±8.00]h),followed by Escherichia coli ([11 .12 ±3.91 ]h),Staphylococcus aureus ([12.22±5.08]h),Klebsiella pneumoniae ([14.72±10.45]h),the other gram-negative bacteria([16.11 ±12.97] h),and coagulase negative staphylococci([16.42±5.74]h),fungi had the latest TTP ([29.04±3.67]h ).TTP of gram-negative bacteria was ≤16.59 h,sensitivity and specificity of BSI were 84.09% and 100.00% respectively;TTP of gram-positive bacteria was ≤20.96 h,sensitivity and specificity of BSI were 96.77% and 94.44% respec-tively.Conclusion Combination of TTP of blood culture and other clinical indications can provide reference for early differentiating isolated pathogenic bacteria from contaminated bacteria.

Objective To evaluate the clinical results of arthroscopic reconstruction of posterior cruciate ligament (PCL) via posteromedial,posterolateral and posterior trans-septal portals with the preservation of intact meniscofemoral ligaments and remnant PCL fibers.Methods Nine patients with PCL injuries were treated with autogenous hamstring tendons arthroscopically through routine arthroscopic portal,posteromedial portal,posterolateral portal and posterior trans-septal portal with preservation of intact meniscofemoral ligaments and remnant PCL fibers.Tibial tunnel of 1-1.5 cm was made below the lateral articular surface of PCL tibial attachment via arthroscopic posterolateral approach.Femoral tunnel of 1 cm was made posterior to the articular cartilage of the medial femoral condyle through anterolateral approach.Autogenous tendon graft was positioned in the knee joint through the navigation of tibial and femoral double-folded silk loops that traversed the bone tunnels and was fixed with bioabsorbable interface screws at both ends.Knee function was evaluated with Lysholm scale six months postoperatively.Results All patients were followed up for average 8.6 months (range,7-14 months).None of the patients had knee extension limitation six months postoperatively,but there were two patients with 10°-15° flexion limitation and one withⅠ degree positive result in posterior drawer test.Lysholm knee score was increased from preoperative (47.6 ± 14.9)points to (92.9 ±4.6) points at six months postoperatively (P ＜0.01).Conclusion PCL reconstruction via posteromedial,posterolateral and posterior trans-septal portals can obtain clear vision (with no blind area),safe operation,accurate positioning of tibial attachment and affirmative short term treatment results.

Objective To investigate the effect of c-myc ASODN on the proliferation and invasion of human bile duct carcinoma cell line QBC939. Methods QBC939 cells was conventionally cultured. C-myc ASODN was designed and transfected into QBC939 cell line. MTT assay and transwell experiment were used to study cell proliferation and invasion of QBC939 cells. Results MTT assay showed that cell survival rate in ASODN group was significantly lower than that in blank group(P < 0.05). Transwell experiment showed that the num-ber of cells penetrated in ASODN group was significantly lower than that in blank group(P<0.01). The cell survival rate and the number of cells penetrated in vechicle group had no difference with blank comparison group(P>0.05). Conclusions C- myc ASODN can inhibit the proliferation and invasion of QBC939 cells.

Objective To investigate the application of selective hepatopetal blood occlusion techniques in anatomic hepatectomy.Methods We retrospectively reviewed the clinical data of 259 patients with hepatolithiasis or liver tumor undergoing anatomic hepatectomy under selective hepatopetal blood occlusion from January 2006 to December 2009.Results Totally,183 cases with hepatolithiasis and 76 cases with liver tumor underwent anatomic hepatectomy under selective hepatopetal blood occlusion.The average intra-operation blood loss was 210 mL(120-1 600 mL);post-operation incidence of complications and the rate of residual stones was 10.9% and 4.2%,respectively.Thre was no operative death in this series.The intrahepatic recurrence and metastasis rate of liver tumor was 23.6% and the median recurrence was 16.3 months.Conclusions The use of a appropriate selective hepatopetal blood occlusion during anatomic hepatectomy for hepatolithiasis and liver tumors is an effective measure to reduce surgical complications and improve outcome.

OBJECTIVE To investigate the protein kinase C (PKC) activity in peripheral blood T lymphocytes and its significance in patients with allergic rhinitis (AR) and the relationship between PKC activity and Th2 cytokines, interleukin 4 (IL-4) and interleukin 5 (IL-5) . METHODS Twenty seasona allergic rhinitis patients and 20 normal control persons participated in the study. T lymphocytes isolated and purified from blood of each person were divided into 2 groups:stimulated with and without phorbol 12-myristate 13-acetate (PMA) . The total PKC activity was detected by non-radioactive assay. The expression of IL-4 and IL-5 protein in supernatants was measured with ELISA RESULTS PKC activity, the expression of IL-4 and IL-5 protein in supernatants in AR T lymphocyte stimulated with PMA were significantly higher than those of AR T lymphocyte stimulated without PMA and those of norma (P

Objective To study the operative procedure for stage III and IV hilar cholangiocarcinoma. Methods A crescent shape excision on the edges of multiple hepatic segments followed by a 'skirt edge′ form hepatoenterostomy to drain the multiple hepatic ducts was used to treat unresectable stage III,IV hilar cholangiocarcinoma, . Results (1)the mean survival time was 15.65 months;(2)the patient comfortable index was 81.5%;(4)there was no operative death in the series. Conclusions The 'skirt edge' form hepatoenterostomy is a feasible and effective palliative method for unresectable stage III,IV cholangiocarcinoma.

BACKGROUND: The maximal problem of patient with serious hepatitis and surgical doctor is whether they can get donator and rational therapy timely. Looking for the suitable preoperative therapy method to enhance the success rate of operation and improve patient's prognosis is the focus of this domain.OBJECTIVE: To investigate the therapeutic effect of artificial liver support system (ALSS) combining with allotransplantation of the liver on patients with serious hepatitis.DESIGN: Retrospective case analysis. SETTING: Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University.PARTICIPANTS: Five male patients with serious hepatitis who underwent allograft liver transplantation were selected from Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University form June 2004 to May 2005. Their age ranged from 25 to 48 years. Inclusion criteria: The diagnosis was in accordance with phase standard established at the National Infectious Disease and Parasitology Academic Meeting in September 2000; all patients had signs of routine liver transplantation; their patients fiercely requested the operation.METHODS: Plasma exchange (PE) combined with continuous veno-venous hemofiltration (CVVH) technique was used in this study. Donor who supplied lives was from 20-38-year patients. All of them and their family agreed to donate their organ and signed the donate file before operation. All of 5 patients were used classical no-by-pass orthotopic liver transplantation (OLT). MAIN OUTCOME MEASURES: They were follow-up visited for 21-32 months for rechecking liver and kidney function,RESULTS: All of 5 patients' operation was succeeded. One continued coma postoperative and his serum creatinine and urea nitrogen raised up progressively and complicated by pulmonary infection 1 week after operation and died 2 weeks after operation although given medical treatment hemodialysis positively. The rest recovered well. All of them discharged one month after operation smoothly.CONCLUSION: Allotransplantation of the liver is an utilizable method to treat serious hepatitis. ALSS can be used as an effective method of supportive treatment preoperatively.

Objective To summarize the experience in surgical management of bile duct injury. Methods The clinical data of 683 patients with bile duct injury who were admitted to the Hunan People's Hospital from August 1990 to December 2008 were retrospectively analyzed. Of all the patients, seven received hepatectomy +T tube drainage, two received liver repair + T tube drainage, four received external biliary drainage + hepatectomy,27 received liver repair or hepatectomy + silicone support, 233 received temporary portal triad clamping + gelatin sponge hemostasis, 72 received biliary repair + T tube drainage, 248 received hepatobiliary basin Roux-en-Y anastomosis, 22 received external biliary drainage, 61 received long arm T tube drainage, two received pancreaticoduodenectomy and five received hepatectomy + T tube drainage. The surgical outcomes were evaluated by analyzing the results of the follow-up. Results The surgical outcomes were ranked excellent, good and poor according to the condition of patients and the results of imaging examination. Six hundred and twelve patients were followed up for 8 months to 19 years, and the surgical outcomes were excellent in 337 patients (55.1%), good in 214 patients (35.0%) and poor in 61 patients ( 10.0% ). Conclusion The surgical outcome of bile duct injury could be satisfactory if the approach of the surgery is properly selected.

Objective To investigate the clinical results of Bi-plane robot navigation for cannulated screw fixation in the treatment of femoral neck fractures.Methods Between May 2011 and May 2015,86 patients with femoral neck fracture who were fixed with cannulated screws were retrospectively analyzed.The patients were divided into navigation group and non-navigation group according to whether the Bi-planar robot used for navigation or not.The patients were matched concerning gender,age and Garden classification.A total of 64 patients were included in the study.In navigation group,there were 32 cases,including 10 males and 22 females.The average age was 59.4±5.6 yr (range,51-68 yr).According to Garden classification,there were 1 case of type Ⅰ,7 cases of type Ⅱ,14 cases of type Ⅲ and 10 cases of type Ⅳ.In non-navigation group,there were 32 cases,including 12 males and 20 females.The average age was 59.1±4.9 yr (range,53-70 yr).According to Garden classification,there were 1 case of type Ⅰ,5 cases of type Ⅱ,18 cases of type Ⅲ and 8 cases of type Ⅳ.Sixty-four cases were all fixed with cannulated screws.The fluoroscopy time,fluoroscopy times,drilling times,times of cannulated screw replacement,cannulated screw insertion time,blood loss,relative position between any two cannulated screws in postoperative AP view and lateral view,the angle between each cannulated screw and the femoral neck axis,fracture healing time and functional score were recorded.Results The parameters in navigation group versus non-navigation group were as follows:the average fluoroscopy time was 10.1±2.9 s vs 36.8±7.5 s,the average fluoroscopy times was 11.4±3.2 vs 43.9±11.0,the average drilling times was 3.9±1.1 vs 18.5±3.2,the average times of cannulated screw replacement was 0.4±0.6 vs 1.0±0.7;the average blood loss was 29.4± 14.7 ml vs 50.2± 17.1 ml,cannulated screws placement time averaged 28.8±7.3 min vs 43.8±7.9 min.The angle between any of two cannulated screws averaged 3.1°±1.1° vs 7.3°± 1.2° in AP view and 2.9°±1.0° vs 4.4°±2.3° in lateral view,the angle between the cannulated screw and the femoral neck axis averaged 4.4°±1.6° vs 7.5°±1.7° in AP view and 4.9°±1.6° vs 8.0°±1.3° in lateral view.Significant differences were found concerning all above parameters between the two groups.Conclusion Bi-plane robot navigation technique helps more accurate cannulated screw fixation in the treatment of femoral neck fracture.This technique is less invasive.It decreases the time of screw insertion and reduces the radiation exposure.

Objective:To investigate the clinical effectiveness of peroneal artery perforator flap with anterior tibial artery perforator in repair of the soft tissue defect of dorsum of forefoot and midfoot.Methods:From February, 2015 to July, 2019, peroneal artery perforator flaps with anterior tibial artery perforator were used to repair dorsal foot soft tissue defect in 42 patients. There were 25 males and 17 females, with an averge age of 62(44-73) years. The size of soft tissue defect ranged from 7 cm×4 cm to 18 cm×5 cm. The recipient sites on forefoot and midfoot were repaired by peroneal artery perforator flaps with anterior tibial artery from the anterolateral aspect of shank. The donor sites were resurfaced with full-thickness skin graft. All patients were followed-up at the outpatient clinic or through WeChat for 3-12 months. The appearance of the flaps and limb recovery were recorded.Results:All flaps survived successfully. The donor sites and recipient sites were well healed. At the last follow-up, the texture and aesthetic of flaps were good, and the appearance and function of the foot were satisfactory.Conclusion:The peroneal artery perforator flaps with anterior tibial artery double blood supply and can be designed to repair large and distanced soft tissue defect of forefoot and midfoot.