Objective To explore the changes of bone mineral density and risk factors of OP in old female patients with type Ⅱ diabetes.Methods 737 cases of old female patients with type Ⅱ diabetes in Department of Endocrinology were analyzed.All patients were first divided into two groups(Group A,with OP;Group B,without OP)according to OP.Then,the changes of bone mineral density and related risk factors were analyzed with Logistic regression approach.Results In the comparison of Group A and Group B,the results are shown as follows.In Group A:ICTP(7.34±1.84)μg/L,FBG(7.12±1.14)mmol/L,BMI(22.45±2.37)kg/m2,BMD,A(62.45±17.56);InGroup B,the corresponding levels were(4.13±1.07)μg/L,(8.48±1.28)mmol/L,(15.46±6.78)mmol/L,(89.75±14.56)respectively.The resuhs presented statistical differences.(t=29.958、-14.405、16.262、-22.665,both P＜0.05).In Group A,HbAle(7.33±0.32)%,serum calcium(2.35±0.72)mmol/L,serum phosphorus(1.03±0.23)mmol/L,the corresponding values in Group B are(7.21±0.24)%,(2.42±0.34)mmol/L,(1.02±0.28)mmol/L.There sxe no statistical differences in two groups(both P＞0.05).In Group A,FN(52.50±18.40)pmol/L,UALB was(8.03 ±1.86)mg/L,Leptin was(5.14 ±1.19)μg/L;the Values in Group B were (40.70±16.34)pmol/L,(5.91±1.24)mg/L,(5.63±1.23)μg/L,The values of FN,UALB in both groups had statistical differences(t=7.469、18.515,both P＜0.05);the values of Loptin in two groups had no statistical difference(P＞0.05).Based on the incidence of OP among old female patients,the leveh of HbAlc,serum calcium,serum phosphorus,ICTP,FBG,BMI、BMD,FN,UALB,Leptin,course of disease,losing body mass,were taken as independent variables and to analyze use Logistic Regression approach.Conclusion FN,UALB,course of disease,BMI and losing body mass were the independent risk factors of OP in old female patients with type Ⅱ diabetes.

Objective To discuss the effect of the modified structure of oxygen equipment on oxygen inhalation effect of patients receiving oxygen therapy.Methods The structure of oxygen equipment was modified.and 80 patients who required oxygen therapy were divided into the modified group and the non-modified group according to odd and even number of hospital admission sequence randomly with 40 patients in each group.The modified group used the modified oxygen equipment,the non-modified group used traditional one.The differences of respiration,heart rate and blood oxygen saturation rate between the two groups before oxygen inhalation,30 minutes and 2 hours after oxygen were compared.Results There was no significant difference in the respiration,heart rate and blood oxygen saturation rate between the two groups.Conclusions The modified oxygen equipment doesn't affect the oxygen therapy effect of patients,besides,it avoids the problems of pollution and the complicated disinfection procedure of the structure of the humidifier bottle,fluid and breathing vessel of the traditional equipment.

Objective To evaluate the effect of perioperative enteral immunotrition(IMPACT) on liver regeneration in cirrhotic rats with hepatectomy. Methods Forty-eight cirrhotic rats were randomly divided into two groups: Group A, perioperative standard enteral nutrition group(n=24), receiving standard enteral nutrient NUTRISON during hepatectomy. Group B, perioperative enteral immunonutrition group(n=24), receiving enteral immunonutrient IMPACT after hepatectomy. According to the different time of taking specimens, each group was separated into four subgroups, each subgroup had six rats. The rats in the two groups received equal daily nutritional supplement intragastrically, which was 690kJ/kg per day. Before the 68% hepatectomy, the rats were fed with enteral nutrient for 8 days, and after operation were fed until the day of taking specimens. On the day before hepatectomy and 1st, 4th and 8th postoperative day(POD), MI (mitotic index) of liver cell and PCNA (proliferating cell nuclear antigen) labeling index of hepatocyte were determined. Results MI increased significantly in both group on 4th and 8th postoperative day(P

Objective To systematically evaluate the safety of laparoscopic distal pancreatectomy (LDP) compared with open distal pancreatectomy (ODP).Methods Databases including Cochrane library,MEDLINE,EMbase,Google Scholar and Chinese National Knowledge Infrastructure were searched to enroll randomized clinical trials (RCT),controlled clinical trials (CCT) or retrospective case-control studies to compare LDP with ODP.All articles received quality assessment according to the inclusion and exclusion criteria,then the selected indices were analyzed using the Review Manager Version 5.0 software (The Cochrane Collaboration,Oxford,United Kingdom).Results 21 manuscripts with a total of 2 797 patients were enrolled.1 150 patients underwent LDP and the remaining 1 647 patients underwent ODP.In 20 studies (n =2 597),the total postoperative complication rates were 33.90％ for the LDP group versus 46.80％ for the ODP group [RR =0.76,95％ CI(0.69 ～ 0.84),P ＜ 0.01].In 8 studies (n =1 869) there was no significant difference [RR =0.51,95％ CI(0.21 ～ 1.24),P ＞0.05] in the perioperative mortality between LDP (4/703) and ODP (18/1 166).In 20 studies (n =2 757) there was no significant difference [RR =0.89,95％ CI(0.75 ～ 1.06),P ＞ 0.05] in the pancreatic fistula rate between LDP (168/1 132) and ODP (281/1 625).In 11 studies (n =1 840) the wound infection rate of LDP (3.24％) was significantly lower than ODP (10.85％) [RR =0.34,95％ CI(0.23 ～ 0.52),P ＜ 0.01].No significance was found between the two groups in the rates of pulmonary complications,peritoneal infection,urinary tract infection,postoperative bleeding,pseudocyst formation,intestinal obstruction and ascites formation between LDP and ODP.Conclusions When compared with the traditional open procedure,LDP has the advantages of significantlylower rates of postoperative complication and wound infection.There were no significant differences in postoperative mortality,and pancreatic fistula rate between LDP and ODP.This meta-analysis suggests that LDP is a safe and feasible operative method.

Objective To explore the feasibility of la pa roscopic total extraperitoneal hernia repair without the use of the balloon diss ector. Methods Laparoscopic total extraperitoneal hernia repai r using no balloon dissector was completed in 10 cases of groin hernia from Nove mber 2003 to April 2004, including 7 cases of indirect inguinal hernia, 1 case o f occult indirect hernia combined with direct inguinal hernia, and 3 cases of di rect inguinal hernia (1 of which was recurrent hernia). Results All the 10 operations were successful. The mean operation time was 69.5 min, t he mean blood loss was 11 ml, the mean postoperative hospital stay was 2.1 days , and the mean duration to normal activities, 5.2 days.Complications included 1 case of disassociated inferior epigastric artery, 1 case of operation in wrong anatomic layer, and 1 case of laceration of the peritoneum, respectively. Follow -up observations for 1~6 months found no recurrence and neuropathic pain. Conclusions Laparoscopic total extraperitoneal hernia repair without the use of the balloon dissector is feasible, safe and effective.

Objective To discuss the feasibility of laparoscopic closure of the internal ring and high ligation of the hernial sac in children with indirect inguinal hernia.Methods Laparoscopic closure of the internal ring and high ligation of the hernial sac was conducted in 21 children with indirect inguinal from January 2003 to December 2004 in this hospital.A 5-mm 30? laparoscope was introduced through the umbilicus.The internal ring and the posterior crus(PC) on the side of hernia were identified.A 3-mm dissection forceps was placed on the midline between the umbilicus and pubic symphysis.At the skin projection of the internal ring on the side of hernia,a round-tip needle with 3-0 Prolene suture grasped by a regular needle holder was passed directly into the abdominal cavity to suture the posterior crus and then penetrate out of the abdomen via the roof of the internal ring through the musculoaponeurotic arch of the transversus abdominis.Then the Prolene suture was cut off,and passed by using the Endoclose device into the extraperitoneal cavity at the skin projection of the internal ring.The dissection was continued from without outward around the sac to encircle the neck and an extracorporeal high circumferential ligation of the sac was finished.Results The operation was successfully completed in all the 21 cases.The operating time was 16~50 min(mean,32.9 min),the postoperative duration in hospital was 1~2 d,and the time to normal activity,1~4 d(mean,1.4 d),respectively.No postoperative bleeding,hematoma of scrotum,or incisional infection occurred.Follow-up checkups in the 21 cases for 1~24 months(mean,15 months) showed no recurrence.Conclusions Laparoscopic closure of the internal ring and high ligation of the hernial sac is a novel,feasible,reliable and effective herniorrhaphy for the treatment of pediatric indirect inguinal hernia.

0.05). In both RLC and CLC Group, postoperative levels of CRP, IL-1, IL-6, and TNF were significantly elevated as compared with preoperative levels (P

Objective To investigate the clinical evaluation on endoscopic sequential therapy for senile ACST.Methods The 36 cases of senile ACST were collected and divided into two groups:emergency operation and endoscopic sequential therapy.The results of treatment were compared between two groups.Result Comparing with emergency operation, the mortality of endoscopic sequential therapy was reduced from 27.8%to 5.6%,the rate of complication from 61.1% to 16.6%,the periods of preoperative preparation was shorten from 12.6 hours to 7.5 hours,the periods of postoperative recovery from 6.5 days to 3.5 days,the intervals between two treatments from 43 days to 11 days,the periods of complete treatment from 45 days to 23 days.Conclusion Endoscopic sequential therapy was the ideal alternative for senile ACST,which is characterized by minimal injury,effectiveness and thoroughness.

Objective Our study intended to check whether there are any changes of serum concentrations of tumor markers in patients with chronic kidney disease,and to determine the related factors.Methods Atotal of 232 hospitalized patients in Nephrology Department in Zhongshan Hospital of Fudan University from March to June in 2005 were divided into groups respectively according to their levels of Ccr,Upro and Salb.Then Kruskal-Wallis test was applied to confirm the relationships among Ccr,Upro,Salb and serum tumor markers.Furthermore,multielement logistic regression was used to analyze the independent effect of age,Ccr,effusion in serous cavity,the levels of proteinuria and serum albumin on the levels of these markers in CKD patients.Results The serum levels of CEA,CA 199,NSE and SCC in different Ccr groups,the levels of CA 199,CA125,NSE and SCC in different Salb groups,the levels of CA 125,NSE and SCC in different Upro groups,had significant statistical differences.Age was the risk factor of the increased levels of CEA and PSA;effusion in serous cavity was the risk factor of increased levels of CA 125.The decreased level of Ccr was the risk factor of CA 125 and SCC.The elevated Upro was the risk factor of SCC.The decreased Salb was the risk factor of CA 199,CA 125 and NSE.Conclusion When we diagnose some tumors according to their serum levels of tumor markers such as CEA,CA 199,CA 125,NSE,SCC and PSA,we must note that whether the patients are aged or have complications such as large proteinuria,hypoalbuminemia,effusion in serous cavity or decreased kidney function.

Objective To explore the value of endoscopic duodenal feeding tube placement in severe coma patients with endotracheal tube by tracheostomy. Methods 28 patients, who suffered from severe coma with endotracheal tube by tracheostomy, received endoscopic duodenal feeding tube placement. Results Endoscopic duodenal feeding tube placement in all 28 patients was successful, and complications such as tube blocking or dropping occurred only in one patient. The average time of placing duodenal feeding tube was 16 min. Conclusion Endoscopic duodenal feeding tube placement was an effective, simple,convenient and safe way to set up enteral nutrition for severe coma patients with endotracheal tube by tracheostomy.