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 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.

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.

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 evaluate the safety and efifcacy of cutting balloon combining main branch single stent cross-over technique for treating the patients with coronary bifurcation lesions. Methods: A total of 113 patients with 121 bifurcation lesions treated in our hospital from 2012-01 to 2014-01 were enrolled. Cutting balloon pre-dilation was applied in both main and side branches followed by drug-eluting stent implantation at main branch. The procedural success rates, side branch blood lfow status and complications were observed. Follow-up studied for MACE occurrence was conducted at 9 months after the operation. Results: Quantitative coronary angiography (QCA) presented that the minimum lumen diameters at pre- and post-operation in main branches were (2.12 ± 1.07) mm and (3.24 ± 0.87) mm, in side branches were (1.44 ± 0.73) mm and (1.82 ± 0.64) mm respectively,P<0.05-0.01, the procedural success rate was 100%. There were 11 (9.1%) lesions with dissection at proximal side branch, 5 (4.1%) lesions with side branch TIMI blood lfow

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 evaluate the feasibility, safety, and efficacy of Y-shaped jogged stent in patients with malignant hilar biliary obstruction. Methods During the period of January 2010 to June 2015,We retrospectively reviewed 98 cases of malignant hilar biliary obstruction who were received implantation of biliary tract stent. 17 consecutive patients who were treated with Y-shaped jogged stent were identified (group A) during January 2012 to June 2015. Group A was carefully matched according to patients' age, sex, type of tumor, stage, type of biliary obstruction, level of bilirubin at diagnosis, presence of metastasis and treatment, and 17 patients who were underwent unilateral stent placement alone with PTCD were chosen as control group (group B). Patients' baseline characteristics, stenting strategy, complications, stent patency time and survival rates were analyzed, and continuous variables of the two groups were compared using Student's t-test. Categorical variables were analyzed using the Fisher exact test. Results Y-shaped jogged stent implantation group and control groups were closely matched in terms of patients' age, sex, type of tumor, stage, type of biliary obstruction, level of bilirubin at diagnosis, presence of metastasis and treatment ( P>0.05). The bilirubin decreased rate in the two groups was 88.2%and 53.0%respectively (P<0.05). The median time of stent patency after stent implantation was(7.3 ± 1.0)months and(5.7 ± 0.9) months respectively (χ2=4.04,P=0.044), and the median survival time was(9.1 ± 1.5)months and(7.2 ± 1.1)months (χ2=4.60,P=0.032), with significant difference according to Kaplan-Meier analysis. There were no severe complications such as massive hemorrhage, perforation, biliary fistula and severe pancreatitis, which were associated with stent implantation. Conclusions The application of Y-shaped jogged stent is safe, feasible and effective in patients with malignant hilar biliary obstruction. It can relieve the clinical symptoms of biliary obstruction effectively with prolongation of stent patency time and survival rate significantly.

Objective To explore the effect of exercise preconditioning on apoptosis and expression of P53 protein in ischemic penum-bra in rats after cerebral ischemia-reperfusion. Methods Thirty-six Sprague-Dawley rats were randomly divided into sham group, model group and exercise preconditioning group, with twelve rats in each group. The middle cerebral artery occlusion (MCAO) model was estab-lished with modified Longa's method. TUNEL method was used to observe the apoptosis of neural cells in the ischemic penumbra. Western blotting was used to detect the expression of P53 protein in the ischemic penumbra. Results Twenty-four hours after cerebral ischemia-reper-fusion, the number of TUNEL positive cells was more in the model group than in the sham group (P<0.01), and was less in the exercise pre-conditioning group than in the model group (P<0.01). The expression of P53 protein was higher in the model group than in the sham group (P<0.01), and was lower in the exercise preconditioning group than in the model group (P<0.01). Conclusion Exercise preconditioning coud down-regulate the expression of P53 protein in the ischemic penumbra, and inhibit the apoptosis of cortical cells.