Objective To evaluate the diagnostic value of MRCP and Gd -EOB-DTPA-enhanced MR for biliary obstruction dis -ease, and provide basis to choose the suitable method for this patient .Methods A respectively analysis was carried out from 2011 to 2013in 138 biliary obstruction cases.All the cases had undergone both MRCP and Gd -EOB-DTPA-enhanced MR examinations and fi -nally proven by pathology .A comparison was made in these two methods .Results All the 138 cases by MRCP and Gd-EOB-DTPA-enhanced MR were successful.The same diagnosis based on MRCP and Gd -EOB-DTPA-enhanced MR was 86 cases (62.3%).The different diagnosis was 52 cases.In the 52 different cases, MRCP was tumor, Gd-EOB-DTPA-enhanced MR was stone and MRCP was stone, Gd-EOB-DTPA-enhanced MR was normal.Conclusions MRCP is a noninvasive diagnostic modality capable of producing high quality imagines of bile duct and pancreatic tract .It has a high sensitivity and specificity in the evaluation of the bile duct and pancreatic tract.The efficacy of Gd-EOB-DTPA-enhanced MR is sufficient to justify its use in the diagnosis of bile duct and pancreatic tract diseases.Gd-EOB-DTPA-enhanced MR has a similar diagnosis effectiveness in bile duct obstruction .

Objective:According to the existing hospital static mixing method, the problem of dynamic allocation model for half a year period is put forward, in order to solve emergency equipment safe are deployed in a timely manner. Methods: The hospital can allocate all emergency equipment evaluation, grade and tabulation, according to the score for sorting, system of sorting table provides emergency center allocate use half a year. Results: According to the deployment of table realized in emergency equipment safety in time in case of major events are deployed and able to skillfully use effect. Conclusion: The use of emergency equipment dynamic allocation model can not only improve the social benefit of the hospital, and reduce the pressure of the functions of the hospital departments.

The left ventricular systolic function before and after right ventricular pacing was studied in 26 patients by Doppler and M-mode echocardiography. The results showed that there were increases in cardiac output and heart rate, respectively (P

Objective To investigate the nursing points of the vacuum sealing drainage technology in children with refractory soft tissue infection in the limb.Methods A total of 9 children with refractory soft tissue infection in the limb were treated with vacuum sealing drainage technology from December 2010 to October 2012.Results All children who underwent vacuum sealing drainage technology were successful,among which 7 cases underwent continuous vacuum sealing drainage for 7 days and 2 cases replaced VSD material after continuous vacuum sealing drainage for 10 days and all wound with skin graft healed,without any complication.Conclusions Vacuum sealing drainage can remove thoroughly necrotic tissue of the wound and promote wound healing,the key points of nursing are to keep drainage tube unobstructed,adjust appropriate negative pressure and give close observation.

Objective To investigate effects of intrathecal injection of sufentanil combined with bupivacaine on postoperative analgesia and immunity function in elderly patients under lower extremity orthopaedic surgery.Methods Totally 60 elderly patients with ASA Ⅰ or Ⅲ under lower extremity orthopaedic surgery were randomly divided into two groups:bupivacaine and sufentanil group (each n =30).3 ml bupivacaine (2 ml 0.75％ bupivacaine plus 1 ml 0.9％ normal saline) were given in bupivacaine after successful spinal anesthesia and 3 ml sufentanil (1 ml 0.75 ％ bupivacaine plus 1 ml 0.9％ normal saline and 1 ml with 5 μg sufentanil) were used in sufentanil group respectively.The anesthetic feeling and block level before operation recovery time were recorded postoperation.Visual analogue scale (VAS) and adverse reaction were recorded at 1,6,12,24 and 48 h after surgery.Cellular and humoral immunity function were recorded at the following time points:T0,the day before surgery; T1,the day after surgery; T2,the first 5 postoperative days; T3,the first 10 postoperative days; T4,the first 15 postoperative days.Results The sensory and motor block levels in sufentanil group were T9～～T10 and T11～T12 respectively,which were higher than in bupivacaine (T7～T8 and T8～T10).The recovery time in sufentanil group was shorter than in the bupivacaine (P＜0.05).There were no significant differences in VAS scale between the two groups at any postoperative time points (P＜0.05).The incidence of skin pruritus was higher in sufentanil group (6 cases) than in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell between time points of T2[(48.7±2.3)％,(33.4±1.8)％,(10.2±1.8)％,(0.75±0.07)％,(1.02±0.16)％,(3.12 ±0.19) ％,(2.53±0.14)％,respectively] and T0 in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell at T2 between sufentanil group [(54.5 ± 2.4) ％,(36.3 ± 1.7) ％,(15.1±1.6)％,(1.32±0.11)％,(1.25±0.14)％,(4.96±0.25)％,(4.17±0.10)％,respectively] and bupivacaine (P＜0.05).Conclusions Intrathecal injection of 5 μg sufentanil combined with low concentration bupivacaine can be safely and effectively applied in elderly patients under lower extremity orthopaedic surgery,and can reduce local anesthetic concentration,shorten recovery time of anesthesia and accelerate the recovery of postoperative immunity function.

BACKGROUND: Recently biodegradable hydrogel has been extensively used to delivery anticancer drug and bioactive macromolecule. However, to protect the activity of the bioactive macromolecule, we need to obtain series of hydrogel which have milder hydrogelation conditions and shorter hydroglation time.OBJECTIVE: To prepare enantiomeric poly(L-Lactic acid) (PLLA)-poly(ethylene glycol (PEG)-PLLA/ poly(D-Lactic acid) (PDLA)-PEG-PDLA stereocomplex hydrogel which has shorter hydroglation time, to physically encapsulate a model drug-lysozyme and sustained release it from the hydrogel. METHODS: Triblock copolymers of PLLA-PEG-PLLA and PDLA-PEG-PDLA were synthesized by ring-opening polymerization of L(D)-lactide using PEG as the initiator and Sn(Oct)2 as the catalyst. The triblock copolymers were characterized by 1H nuclear magnetic resonance, FT-IR and X-Ray diffractometry. A hydrogel was prepared from an aqueous mixture of PLLA20-PEG227-PLLA20 and PDLA21-PEG227-PDLA21 (10 wt% concentration) at room temperature for 12 hours. X-Ray diffractometry test was used to research the gelation mechanism. The release profile of the lysozyme as a model drug from the hydrogel was tested. The morphology of the freeze-dried hydrogel was investigated by scanning electron microscope. The cytotoxicity of the hydrogel was evaluated by 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyl tetrazolium bromide) assay.RESULTS AND CONCLUSION: Triblock copolymers of PLLA-PEG-PLLA and PDLA-PEG-PDLA were obtained. Both the PEG and PLA blocks in the copolymers could crystallize, but the crystallization of the PEG block was predominant. The stereocomplex formation between the PLLA and PDLA blocks within the hydrogel was confirmed by the X-Ray diffractometry analysis. The release profile of the lysozyme from the hydrogel exhibited a sustained-release pattern with a duration period of 7 days. The hydrogel exhibited a 3D interconnected porous structure with 50-100 μm pore size after being freeze-dried. The mouse fibroblast cell viability percentage was 99.3% after the cells contacted with the 100% extracted liquid for 72 hours.

Objective:To investigate the efficacy and safety of programmed death-1 (PD1) inhibitor combined with transcatheter arterial chemoembolization (TACE) in the treatment of huge primary liver cancer.Methods:From June 2016 to December 2019, the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed. The tumor size ranged from 10.1 to 18.8 cm, with an average of (14.2±2.3) cm. The patients were divided into TACE group (TACE treatment, 18 cases) and combined group (one week after TACE, patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days, 13 cases), according to whether patients receiving PD1 inhibitors. The patients were followed up. The disease control rate (DCR) were compared between the two groups using Mann-Whitney U test. The median overall survival (OS) and progression free survival (PFS) were calculated by Kaplan-Meier method. Results:The DCR in combined group (53.8%, 7/13) was higher than that in TACE group (22.2%, 4/18), and the difference was statistically significant ( Z=-2.13, P=0.04). The median PFS (5.0 months) in combined group was longer than that in TACE group (3.0 months), the difference was statistically significant (χ2=4.39, P=0.04). The median OS (15 months) in combined group was longer than that in control group (9 months), and the difference was statistically significant (χ2=5.51, P=0.02). Conclusion:The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.

Objective To study the influence and solution of pseudothrom bocytopenia (PTCP) caused by anticoagulant EDTA-K2.Methods Sysmex-2100 hematology analyzer was used to analyze PTCP-positive patients' blood samples,count the platelet in samples anticoagulant with EDTA-K2,sodium citrate and heparin,and used the manual counting methods.Results Platelets counts in anticoagulant bood by EDTA-K2 was significantly lower than anticoagulant bood by sodium citrate and heparin.Lots of aggregated platelets were appeared in the EDTA-K2 anticoagulant samples stained by Wright-Giemsa,while there was no aggregated platelets observed in sodium citrate anticoagulant samples and heparin anticoagulant samples.Conclusion Platelet aggregation in patients with PTCP causes patelet counts false reducation.The patients with PTCP is determined by measuring the whole blood (no anticoagulant)by automatic hematology analyzer immediately or manual couting method.

Objective To evaluate the therapeutic effects of Shenfu injection (a Chinese herbal preparation of Aconitum and Ginseng) for the treatment of patients with post-resuscitation syndrome (PCAS) and to investigate its mechanism as well.Methods The data of 80 patients with restoration of spontaneous circulation (ROSC) after cardiac arrest were collected,and the patients were randomly divided into the experimental group and the control group.The patients in experimental group received Shenfu injection in addition to conventional treatment,and the patients in control group just had the conventional treatment.The cerebral performance classification (CPC) scores,Glasgow Coma Scales cores and sequential organ failure assessment (SOFA) scores before treatment and on the 3rd,7th,14th and 28th days after treatment in the patients of two groups were monitored and compared.The length of ventilation time,total expenses and mortality of the patients were calculated and compared between two groups.Results The data of 3 patients were excluded from those of total 80 patients,because the information of those patients was not complete.Finally,there were 37 cases in experimental group and 40 patients in control group.The CPC scores of smrvived cases in experimental group were lower than those in control group on the 3rd,7th,14th and 28th days after treatment (P ＜ 0.05).The Glasgow Coma Scale scores in experimental group were higher than those in control group on the 14th and 28th days after treatment (P ＜ 0.05).The SOFA scores in experimental group were lower than those in control group on the 3rd,7th and 14th days after treatment (P ＜ 0.05).There were no significant differences in length of ventilation time and total expenses between two groups on the 3rd,7th,14th and 28th days after treatment (P ＞ 0.05).The mortality of the experimental group was lower than that in control group at the 28 th day after treatment (P ＜ 0.05).Conclusions The Shenfu injection could improve the prognosis of patients with post cardiac arrest syndrome.

Objective To explore the efficacy and safety of glucocorticoids+cyclophosphamide+tacrolimus capsules (GC+CTX+FK506) in the treatment of patients with type Ⅲ+V and Ⅳ+Vlupus nephritis. Methods The 31 cases with first diagnosis as systemic lupus erythematosus (SLE) with type Ⅲ+V and Ⅳ+Vlupus nephritis (LN) were selected, then divided into group A (CTX+GC) with 16 cases and group B (FK506+CTX+GC) with 15 cases. The group A received CTX+GC during treatment, group B received GC+CTX+FK506 for the first three months, and received FK506+GC for the last three months. The patients were followed up once monthly to observe the efficacy and safety,the efficacy was analysed after 6 months. Results After treatment, the total efficacy in group B was significantly higher than group A (86.7%vs.50.0%, P<0.05). The 24 h urine protein of group B was lower than group A(P<0.05). The plasma albumin of group B was higher than group A (P<0.05). After treatment, the systemic lupus erythematosus disease activity index (SLEDAI) in two groups were lower and C3 level was higher than those pre-treatment(P<0.05), but there was no significant difference in above indicators between two groups. There was one case menelipsis in group A, and one case with transient increasing of creatinine. Conclusion The FK506+CTX+GC could reduce urine protein sifnificantly compared with CTX+GC without serious adverse reaction.