Objective To review our experiences on perioperative anesthetic management for patients who received percutaneous nephroscopic peripancreatic necrectomy for acute necrotizing pancreatitis.Method The clinical data on 18 patients with acute necrotizing pancreatitis who received percutaneous nephroscopic peripancreatic necrectomy in our hospital from August 2008 to January 2011 were retrospectively analyzed.Results There was a marked fluctuation in hemodynamic status of the patients which required the use of vasoactive drugs during perioperative period.PETCO2 significantly increased after pneumoperitoneum.Tracheal extubation was possible in 11 patients immediately after surgery in the operation room,while 7 patients required tracheal intuhation to be transported back to the surgical intensive care unit (SICU).Conclusion Most patients who underwent percutaneous nephroscopic peripancreatic necrectomy had a varying degree of shock and multi-organ injury before operation.Proper anesthetic induction and maintenance,correct use of vasoactive drugs and lung protective ventilation strategy,and active fluid resuscitation are the keys to good perioperative anesthetic management and to improve treatment results.

Objective To explore the differences of gene expression of peripheral blood mononuclear cell (PBMC) between the anti-cyclic citrullinated peptide antibody (ACCPA) positive and ACCPA negative patients with rheumatoid arthritis (RA) by microarray analysis.Methods Total RNA was extracted from PBMC of 5 ACCPA positive and ACCPA negative patients with RA,and age-and sex-matched control subjects respectively.Ⅲumina oligonucleotide microarray was used to characterize 47231gene expression profile for each sample.Results Among the target genes,88 differentially expressed genes were identified in RA patients.Fifty-one up-regulated genes and 37 down-regulated genes were found in RA patients compared to those in control subjects (fold change＞1.5).The differential expression of genes were associated with apoptosis,cytokine,signal identification protein,chemotaxis factor etc.There were 20 differential expression genes between the ACCPA positive and ACCPA negative patients with RA,9 up-regulated genes and 11 downregulated genes were found.The differential expression genes were associated with protein biding,,translation control,signal identification protein,cell cycle,metabolism etc.Conclusion There are differential gene expression between the ACCPA positive and ACCPA negative patients with RA.Genes screened from the target such as IFI,KIR,CHI3L1 can provi-de important information for further study and treatment of RA.

Microbial lipase,one of important industrial biocatalysts,has been used widely in many industrial and agricultural fields.It is always the research focus to screen,mine and develop the microbial lipases with novel catalytic activity and high stability.This paper introduces briefly the pathways and methods to mine novel microbial lipase resources from six aspects,including extremophile,metagenome,genome database,protein engineering,immobilization,chemical modification,etc.

Objective:To explore the factors affecting the antiviral treatment efficacy of acquired immunodeficiency syndrome (AIDS) patients.Methods:A total of 107 patients diagnosed with human immunodeficiency virus (HIV) infection in the clinic of Beihai People′s Hospital from January 2016 to June 2018 were selected.The patients were divided into two groups according to whether they voluntarily accepted traditional Chinese medicine treatment, including treatment group who received highly active anti-retroviral therapy (HAART) and traditional Chinese medicine prescription of Ping Gan Jie Du (42 cases), and control group who were only treated with HAART (65 cases). The virological and immunological responses were compared between the two groups at 48 weeks of treatment. The interleukin-28B (IL-28B) rs12979860 genotypes were measured by using the direct sequencing of polymerase chain reaction products. Logistic regression was used to analyze the influencing factors of antiviral efficacy in AIDS patients.Comparison between groups was performed by independent sample t test、matched sample t test or chi-square test. Results:At week 48 of treatment, 41 (97.62%) of the 42 patients in the HAART plus Ping Gan Jie Du group obtained virological response, while 58 (89.23%) of the 65 patients in the HAART group alone acquired virological response, which was not significantly different ( χ2=0.100, P>0.05). The numbers of CD4 + T lymphocytes increased at week 48 of treatment in the HAART plus Ping Gan Jie Du group and HAART group were (244.32±101.83)/μL and (211.56±112.50)/μL, respectively. The was no statistically significant difference ( t=1.522, P>0.05). Among the 92 patients with IL-28B CC genotype, 88 (95.65%) acquired virological response, while 11 of the 15 patients with non-IL-28B CC genotype acquired virological response, which was not significantly different ( χ2=0.394, P>0.05). And CD4 + T lymphocytes in patients with IL-28B CC genotype increased ((229.72±101.17)/μL), which was higher than that without IL-28B CC genotype ((173.40±89.64)/μL), with statistically significant difference ( t=2.028, P=0.045). Multivariate logistic regression analysis showed that baseline CD4 + T lymphocyte count≤200/μL, IL-28B CC genotype, and treatment plan including protease inhibitor were helpful to improve the antiviral efficacy. Conclusion:Baseline CD4 + T lymphocyte count ≤200/μL, IL-28B CC genotype, and protease inhibitor in HAART regimen are the influencing factors of antiviral efficacy in AIDS patients.

OBJECTIVETo reconstruct a penis with sensation and erectile function maintained by corpora cavernosa lengthening and skin flap transferring in the penis defect cases.

METHODSThe procedure was based on the use of releasing the suspensory ligaments and part of crus, various flaps were designed as coverage material. Penis residual stump was advanced to anterior portion of the newly reconstruction penile body as "glans".

RESULTS40 patients with penis defect have been operated by the above methods. In the cases, length of the penis varied from 0.5-4.0 cm in the flaccid, 1.5-5.0 cm in erect state before operation. And after operation, it turned to 5.0-8.5 cm in the flaccid, 7.0-12.5 cm in erect state. Most of the patients recovered gross tactile sensation and had satisfactory erectile function.

CONCLUSIONWith this method, the reconstructed penis tends to have a better appearance and function. It's a more optimal method compared with the conventional operation.

Adult ; Humans ; Male ; Penile Erection ; Penis ; injuries ; innervation ; surgery ; Reconstructive Surgical Procedures ; methods ; Sensation

Objective To study the sources and the relationship between the management and the outcome of hemorrhage after cephalic pancreatoduodenectomy.Methods The clinical data of 370 patients who underwent pancreatic resection at the Lihuili Hospital and the Second Affiliated Hospital of Zhejiang University were retrospectively analyzed.Results Postoperative bleeding occurred in 35 patients with 11 deaths.Among those intraabominal bleeding occurred in 14 cases and gastrointestinal hemorrhage occurred in 22,with one case suffering from both.Bleediug developing within 72 hours after operation in 12 cases (early-stage group),which was caused by improper intraoperative homeostasis.In other 23 cases,bleeding 72 hours after operation(later stage group)was caused by the erosion following pancreatic and/or bile leakage.Relaparotomy was performed in 13 cases and endoscopic homeostasis was performed in 3. Relaparotomy or endoscopic homeostasis was superior to that of conservative therapy in the early-stage group (P0.05).Pancreatic or bile leakage was identified as the significant risk factors for the postoperative bleeding.Conclusions In order to prevent the postoperative hemorrhage and to reduce the mortality of pancreatic resection,skillful techniques,expeditious homeostasis,proper management of stump pancreas and the prevention of pancreatic and bile leakage are essential.

The proposed registration algorithm based on wavelet transform is a multi-resolution block matching one, which exploits the hierarchical self-similarity of Digital Subtraction Angiography images. This method befittingly trades off between the estimation precision and computational complexity, because the registration precision is from coarse to fine, which reduces the searching complexity of motion vector. This technique has been proved that the convergence speed is exponential. The proposed method takes full advantage of the precise location both temporally and frequently which characterizes the wavelet transform. Both the matching speed and consistency are boosted without the loss of matching performance.
Algorithms ; Angiography, Digital Subtraction ; methods ; Artifacts ; Artificial Intelligence ; Brain ; diagnostic imaging ; Image Enhancement ; methods ; Motion ; Sensitivity and Specificity

G mutation of SLC26A4, the parents and the second child were carriers of the same mutation, while the fetus had a wild-type form. Conclusion It is feasible to identify deafness related genes by screening for GJB2 and SLC26A4 mutation, thus providing correct prenatal diagnosis and avoiding deaf delivery of baby.

Background Researches showed that multifocal electroretinogram (mfERG) is able to assess the retinal function in the eyes with acute Vogt-Koyanagi-Harada ( VKH ) syndrome. But the mfERG characteristics of convalescence stage of VKH are still below clear. Objective Present study was to compare and follow up the variation process of visual acuity and mfERG in acute and recovery stages of VKH syndrome. Methods This was a clinic-based retrospective study. Visual acuity, mfERG and fundus fluorescence angiography ( FFA ) were recorded from 35 eyes of 18 acute VKH cases. The period of follow-up in recovery stage lasted about 18 months with the repetitive recording results for 4 times. Results In this study, the visual acuity range in acute stage VKH was 0. 01 to 1.0, and 91.4% (32/35 eyes) was below 0.6. Compared with normal control group, the visual acuity was significantly decreased (P＜0.01). The response densities (amplitudes) of N1 ,P1 waves of the first-order kernel were significantly lowed in all the 6 rings,and the implicit times of 1-4 rings of both waves were significantly prolonged in acute VKH eyes(P＜0. 05). The abnormalities of retinal function showed a regional difference at the posterior pole retina with the dominant change in the first ring,showing a cutting off78% in the P1 amplitude. The abnormal degree of mfERG was more serious as the the increase of retinal eccentricity. In 2 months of convalescence after glucocorticosteroids therapy,the range of visual acuity were 0. 1-1.2 ,and the amplitudes of N1, P1 of 1-2 rings were greatly elevated in comparison with acute on-set (P＜0. 05 ). However, there was still a remarkable difference in the amplitudes of from 1 through 6 rings,comparing with normal. The response density of P1 wave from whole recording region was only 44% of normal. Though the visual acuity was stable during the follow-up duration, a decreasing tendency in N1 and P1 amplitudes were seen. The implicit times of both wave shortened only in 1-3 rings in recovery stages of VKH (P＜0.05). Conclusion VKH syndrome cause serious damage of posterior retinal function.Macular region is the site with greater retinal functional lesion and restore before and after medication. This hardly recovery of retinal function can last over one and half year,even satisfied visual acuity is stable after proper treatment.

An autopsy case of sudden death induced by alimentary tract hemorrhage was presented, which was caused by the unexpected rupture of clinically unrecognized tuberculous abdominal aortic aneurysm (TAAA). The initial diagnosis was made of the syndrome of coronary heart disease and hypertensive disease. The detailed autopsy showed that the alimentary tract hemorrhage was caused by a sudden rupture of the mass after posture changing was ascertained as the cause of death. The diagnosis of TAAA was determined by the autopsy findings. Analysis for the medical dispute of TAAA was described, and the difficulty of the diagnosis and medico-legal implications were also discussed.
Aneurysm, Ruptured/diagnosis* ; Aortic Aneurysm, Abdominal/diagnosis* ; Autopsy ; Death, Sudden ; Hemorrhage/etiology* ; Humans ; Tuberculosis/diagnosis*