Objective To understand the common complications of PICC in olinical use. Methods Retrospectively summarize the data of PICC used in patients of SICU in 1999. Results In 1999, there were 14 pateints using PICC, among them 12 patients were male and the others were female. The average age was 71 years old. Embolus 4 cases' PICC were pulled out. Phlebitis occured in only one case. There are 2 patients presenting hyperpyrexia pulled the PICC out. But the cultures of PICC were negative. Conclusions The common complications of PICC are embolism,phlebitis and infection.

Carotid body tumors (CBT) were rare. One case with a mass in the right neck side suspected as CBT after preoperative examination was reported with hemorrhage, and artery repair in the resection of the mass, which was finally diagnosed as CBT by pathological examination. Its resection methods, postoperative complications and artery repair methods were discussed.
Adult ; Arteries ; surgery ; Blood Loss, Surgical ; Carotid Body Tumor ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Treatment Outcome

Objective To investigate the influence of hydroxyethyl starch solution on exogenous coagulation and active protein C (APC) in the patients with septic shock.Methods A single-center prospective study was conducted.Eighty-four consecutive patients with septic shock admitted to intensive care unit (ICU) of Peking University People's Hospital from November 2009 to October 2014 were enrolled.The patients were randomized into two study groups by random digits table:Ringer lactate solution group (RL group,n =40) and hydroxyethyl starch group (HES group,n =44),and Ringer lactate solution or hydroxyethl starch 130/0.4 was used for resuscitation respectively.Peripheral blood was collected at four time points:before resuscitation,6,12,and 24 hours after resuscitation.The prothrombin time (PT),tissue factor (TF),tissue factor pathway inhibitor (TFPI) and APC were determined,and the length of ICU stay and the mortality were recorded.Results There were no significant differences in PT,TF,TFPI,and APC before and after resuscitation in RL group.No change in PT was found after resuscitation in HES group,and no significant difference was found as compared with RL group.TF after resuscitation in HES group was decreased gradually,and the level at the 24 hours after resuscitation was significantly lower than that before resuscitation (U/L:15.80±7.32 vs.31.40±2.75,P ＜ 0.05); but there was no significant difference at all time points when compared with that of RL group (all P ＞ 0.05).TFPI at 12 hours and 24 hours after resuscitation in HES group was increased when compared with before resuscitation (μg/L:1.32±0.22,1.14±0.09 vs.0.63±0.54).TFPI in HES group was significantly higher than that in RL group (μg/L:0.84 ± 0.69,0.95 ± 0.30),but there was no significant differences between two groups (both P ＞ 0.05).APC after resuscitation in HES group was decreased gradually,which was significantly lower than that in RL group at 6,12,24 hours after resuscitation (mg/L:3.38±3.00 vs.5.98±4.12,3.31 ± 1.94 vs.5.33 ± 3.71,3.42 ± 2.64 vs.7.53 ± 4.67,P ＜ 0.05 or P ＜ 0.01).The length of ICU stay in HES group was significantly shorter than that in RL group (days:12.50 ± 8.83 vs.17.10± 16.60,t =9.037,P ＜ 0.001),but there was no significant difference in mortality between HES group and RL group [40.9％ (18/44) vs.60.0％ (24/40),x 2=2.339,P =0.126].Conclusions Both RL and hydroxyethyl starch fluid resuscitation did not affect the PT of the patients.The use of hydroxyethyl starch probably inhibits excessive activation of the exogenous coagulation and hyper-coagulation in the early stage of sepsis,and inhibits activation of protein C as well.

Objective To investigate the influences of Xuebijing injection on organs' ultra-microstructure in septic shock rats. Methods Fifteen male Sprague-Dawley (SD) rats of clean grade were selected. According to the method of random digits table, all of them were divided into three groups: sham operation group, model group and Xuebijing treated group, 5 rats being in each group. Cecal ligation and puncture (CLP) was adopted to reproduce abdominal cavity infection leading to sepsis model formation. While the rats in sham operation group just underwent abdominal median incision, abdominal exploration and closure of abdominal wall after flipping retrocecal region. In the Xuebijing treated group, within 1 hour after the operation, Xuebijing injection (4 mL/kg) was transfused through the catheter inserted in the femoral vein, and then normal saline (2 mL·kg-1·h-1) was continuously transfused until the rat being sacrificed. In the sham operation group and model group, equal volume of normal saline was given after operation. The blood pressure of all the rats was monitored continuously by a pressure device connected with a catheter inserted in the right carotid artery. The rats were observed for 12 hours, afterwards they were sacrificed, the samples of heart, lung, kidney and liver were taken, and their ultrastructural changes were observed under an electron microscope. Results The blood pressure of sham operation group was decreased a little with time extension, but within normal limits. The mean arterial pressure (MAP) of model group and Xuebijing treated group developed into a state of sepsis shock at 9 hours and 10 hours after operation respectively, and MAP were lower than 70 mmHg (1 mmHg=0.133 kPa). The MAP levels of model and Xuebijing groups at 11 hours after operation were lower significantly than those of sham operation group (mmHg:58.7±7.0, 58.7±8.3 vs. 91.0±8.2, both P<0.01), and they were persistently decreased at 12 hours after operation;the MAP in Xuebijing group was a little higher than that of model group at the same period (mmHg:55.4±4.0 vs. 48.8±12.9, P>0.05). The results of the observation with electron microscope:the structures of heart, lung, liver and kidney in sham operation group were basically normal;all the organs of model group appeared different degrees of structural damage. Compared with model group, the injury of heart and lung in Xuebijing treated group was milder, especially, the changes of cellular mitochondria were obvious;however, there was no significant difference in injury of kidney and liver between the model and Xuebijing treated groups. Conclusion Xuebijing injection can play a certain role in stabilizing the circulatory system in rats with septic shock, and can possibly ameliorate the heart and lung damage caused by infection and shock.

Objective To evaluate the curative effect of endscopic sinus surgery (ESS) and to investgate the causes and prevention of the complication of ESS.Methods 1800 patients with chronic sinusitis and nasal polyps were retrospectively analyzed by ESS treatment from Aug 1993 to Jun 2001.Results Patients with clinical types and stages from Ⅰ to Ⅲ were 171 cases(9 5%),1003 cases (55 7%),626 cases(34 8%) respectively.The clinical cure rate from Ⅰ to Ⅲ were 91 2%,71 1%,36 2% respectively.The total cure rate was 61 0%,complications were noted in 96 cases(5 3%).The types of complication included papyraceous lamina injury in 15 cases(0 83%),hemorrhage in 16 cases(0 89%),adhesion in 63 cases(3 5%),transient blindness in 2 cases(0 11%).Conclusions ESS is effective and safe in the treatment of chronic sinusitis and nasal ployps.The operation outcome is directly related to the typing and phasing of the disease.It is important to find and treat complications timely and accurately.

Objective To observe the metabolism characters of plasma glucagon-like peptide 1 (GLP-1) in surgical critical ill patients.Methods Totally 64 selective surgical patients were prospectively enrolled and randomly divided into two groups:enteral nutrition (EN) group (50％ glucose 100 ml orally administered or through nasogastric tube on the next day after operation) and parenteral nutrition (PN) group (50％ glucose 100 ml intravenously infused on the next day after operation).Blood glucose and plasma GLP-1 were determined before operation,after operation,and 0 min,30 min,90 min,and 180 min after the 50％ glucose was used.Then,the EN group was divided into stress hyperglycemia (SH) subgroup and non-stress hyperglycemia (non-SH) subgroup.In both subgroups,plasma tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected before operation,after operation,and the next day after operation.Blood glucose,plasma insulin,C-peptide,and GLP-1 were measured before operation,after operation,and 0 min,30 min,90 min,and 180 min after 50％ glucose was used.Results The plasma GLP-1 level (pmol/L) of EN group increased significantly after 50％ glucose was used,and reached the peak at the time of 30 min.In contrast,it did not change in PN group,and were significantly lower than EN group at the time of 30 min [(5.69 ± 2.92) pmol/L vs (33.52 ± 12.32) pmol/L,P ＜0.01] and 90 min [(5.71 ±2.14) pmol/L vs (15.92 ±6.63) pmol/L,P =0.00].Plasma insulin level in SH subgroup were significantly higher than in non-SH group after operation [(18.17±6.18) mU/Lvs (12.10±3.60) mU/L,P=0.01] and30 min [(56.02±14.78) mU/Lvs (43.39±15.60) mU/L,P=0.03] and 90min [(114.58±25.11) mU/Lvs (90.45±25.91) mU/L,P=0.03] after 50％ glucose was used.Plasma C-peptide level in SH subgroup was also significantly higher at the time of 30min [(6.86 ±1.15) μg/L vs (4.76 ± 1.06) μg/L,P=0.04] and 90 min[(12.17 ± 1.96) μg/L vs (9.81 ± 2.35) μg/L,P =0.03] after 50％ glucose was used when compared with non-SH subgroup.Plasma GLP-1 level in SH subgroup was significantly lower than in non-SH group at the time of 30 min [28.76 ± 9.61) pmol/L vs (37.36 ± 10.51) pmol/L,P =0.03] and 90 min [(13.49±4.26) pmol/Lvs (17.33±5.57) pmoL/L,P=0.04] after 50％ glucose was used.Conclusions Early post-operative PN increases plasma GLP-1 level and reduces the SH incidence.In SH patients,endogenous insulin expression increases while plasma GLP-1 level decreases.Post-surgery inflammatory reaction may result in low plasma GLP-1 level and high blood glucose level.

From 1975 to 1976,in Linxian county of Henan province,52 patients with early stage easophageal carcinoma were treated by radiotherapy alone. After 10-year follow-up, the 5-and 10-year surving rates were 73.1%(38/52) and 50.0%(56/52), respectively. Local recurrence was considered as the major cause of death and distance metastasis as the minor. We believe that it is very important to do the "three early "(find early, diagnose early and treat early ) and D T5000～5500cGy/5～5.5wks may be the best dose for radiotherapy alone for early easophageal carcinoma.

Objective To study the protective effect of interleukin-33 (IL-33) on mouse warm hepatic ischemia-reperfusion (I/R) injury.Methods On a mouse warm hepatic I/R injury model IL-33 mRNA and protein levels during hepatic ischemia and reperfusion period were determined,and then mice were divided into control group,model group,recombinant IL-33 intervention group and anti ST2L antibody intervention group,and mice were sacrificed after 6 hours of reperfusion.Serum aspartate aminotransferase (AST),alanine aminotransferase (ALT) protein levels were determined.Liver pathology was observed by transmission electron microscopy and serum cytokine level (tumor necrosis factor-α,interferon-γ,IL-4,IL-5,IL-13) were measured by flow cytometry CBA method.Results The level of IL-33 mRNA and protein were significantly higher in the reperfusion stage (t2 h =-3.574,t6 h =-4.147 ; P ＜ 0.05).After intervention by recombinant IL-33,the level of serum ALT and AST decreased significantly (tALT =4.592,tAST =3.471 ; P ＜ 0.05),the severity of pathological damage was reduced,the levels of IL-4,IL-5,IL-13 increased and that of IFN-γ decreased,with statistically significant difference in comparison with the control groups (tIL-4 =-4.995,tIL-5 =-4.584,tIL-13 =-4.431 ; P ＜ 0.05).Anti-ST2L antibody intervention effected the opposite.Serum TNF-α level did not change in intervention groups compared with that in model group (tTNF-α =0.261,P ＞ 0.05).Conclusions IL-33 mRNA and protein level increased in mice with hepatic I/P injury.IL-33 exerts a protective effect on the I/R injured liver after binding to its receptor ST2L.

Objective:To study the clinical manifestations and treatment of the primary cervical tracheal malig-nant tumor of children. Method:Five cases diagnosed as primary tracheal malignant tumor with fibrolaryngoscopy, CT scan and pathology were retrospectively analyzed and reviewed. Extraction of malignant tumor was performed with tracheoscope and nasal endoscope after emergent tracheotomy below the tumor in 4 cases, and tracheotomy after intubation in 1 case. After operation, 4 children received radiotherapy, and 1 case received laser therapy add radiotherapy. Result:Five cases were followed up for three to eight years, and no recurrence was found. Conclu-sion: There was no specific manifestation in early tracheal malignant tumor, but it was critical and emergent during symptoms appear. Imaging examination was a very invaluable dignosis method. Optimal and effective therapeutic protocol is tracheostomy under local anesthesia to keep upper airway patency followed by surgical extraction and radiotherapy. It was not appropriate to have tracheal wall resection for children.

Objective To study the clinicopathological significance of Skp2 and E2F1 in the rhinosinus squamous cell carcinoma and chronic sinusitis. Methods Immunohistochemical method was used to detect the expression of Skp2 and E2F1 in the routinely paraffin-embed-ded sections of specimens from patients with rhinosinus squamoas cell carcinoma (n=49), chronic sinusitis (n=28). Results The expres-sive positive rates and scores of Skp2 and E2F1 in rhinosinus sqnamous cell carcinoma were significantly higher than those in chronic sinusitis (P<0.01). The expression positive rates and scores were significantly decreased in middle-differentiated rhinosinus squamous cell carcino-ma. The maximal diameter of mass was less than 3cm, and no-metastasis of lymphnode or no-infiltration of regional rhinosinus can be found in T1N0M0. While in the low-differentiated rhinosinus squamous cell carcinoma, the maximal diameter of mass was larger than 3cm, and metasta-sis of lymphnode or infiltration of regional rhinosinus can be found(T3N1M0,T3N2M0) (P<0.01). The closely positive correlation was found between the expression of Skp2 and E2F1 in the rhinosinus squamoas cell carcinoma. Conclusions Skp2 and E2F1 might be important biologi-cal markers for carcinogenesis, progression, biological behaviors and prognosis of rhinosinus squamous cell carcinoma.