Hemostasis, Surgical ; Hepatectomy ; methods ; Humans ; Laparoscopy

[Objective]To study the best time for infusing antibiotics as prophylaxis against infection in hip arthroplasty.[Method]Ninty cases of hip arthroplasty were divided into 6 groups randomly with 15 cases each.Ampicillin(UNASYN,1.5g) and cefuroxime axetil(Zinacef, 2.0g) was administered by intravenous infusion respectively one day or one hour before operation or 30 minutes after the operation began.Blood samples from peripheral vein,cancellous bone of acetabulum when reaming,medullary canal of femur when rasping and catheter right after the operation were harvested.Serum Bactericidal Activities(SBAs) were determined by minim dilution technique and were compared between the groups.[Result]SBAs of UNASYN and Zinacef are similar to the bacteria most commonly causing infection after prosthesis implantation such as staphylococcus.Percentage at SBA≥1:8 of UNASYN and Zinacef is significantly more at the beginning of operation and when reaming acetabulum than the other groups(P

Objective To study the diagnosis and treatment of the inappropriate antidiuretic hormone secretion(SIADH) syndrome after cerebral injury. Methods A retrospective analysis was conducted on 12 patients suffered from SIADH after cerebral injury. The clinical features were similar to common hyponatremia, no specific manifestation. Most of the hyponatremia were detected by routine examination. The first of all,sodium losing in these patients with hyponatremia was routine supplied according the amont of true salt losing.If natremia was not raised or still more descended 2～3 days after treatment, and amount of supplying salt was correspond to that of natriuresis, SIADH should be considered,using restricting water therapy,substituted for salt supplement.furosemide plus albumin were the first choice for dehydration therapy. Results 24～48h after restricting water and natrium, 12 patient's natremia level was back up in different degree. Except for 2 death whose natremia was not corrected completely, 8 patient's natremia was corrected completely in 1 week, 1 patient's in 14 days, and 1 in 3 months after injury. Conclusions Diagnosis of SIADH is very difficult before treatment, but effective treatment can be obtained if we adopt correcting strategy. In these patients, the diagnosis of SIADH was confirmed with the course of treatment,we call it as therapeutic diagnosis.

Objective · To explore whether stiffness parameter β could help carotid intima-media thickness (IMT) to predict ischemic stroke.Methods · Ninety-nine patients with acute ischemic stroke and transient ischemic attacks were retrospectively evaluated by routine ultrasound and divided into increased IMT group and normal IMT group. The normal IMT group cases were further divided into 30~ 39 years, 40 ~ 49 years, 50 ~ 59 years and ≥ 60 years groups, and were compared with healthy crowd respectively. Results · ① The common carotid artery wall β of both increased IMT group and normal IMT group were significantly higher than healthy crowd (each P=0.000). ② Further analysis showed that β of ≥ 60 years group were significantly higher than healthy crowd (left side P=0.047, right side P=0.007); while the difference was not found across younger age groups (30 ~ 39 years,40 ~ 49 years and 50 ~ 59 years). Conclusion · Stiffness parameter β may help carotid intima-media IMT to predict ischemic stroke in high risk subjects≥ 60 years old without morphology changes.

The clinical data of 30 patients with vesical calculus of 1.5 cm to 4 cm in diameter,who underwent combination of transurethral pneumatic and ultrasonic cystolithotripsy,were retrospectively analyzed.During the procedure the resectoscopic sheath was inserted into bladder through urethra,then the nephroscope was placed through the sheath.When the stone was located,the ultrasonic and pneumatic devices were used for lithotripsy and the fragments were cleared out.The procedures lasted from 10 to 25 min,all operations were successful.Transurethral resection of prostates (TURP) was performed simultaneously in 28 patients.No serious bleeding,bladder injury or transurethral resection syndrome occurred.One patient with simultaneous TURP developed bladder neck contracture one month after surgery and was later cured by endoresection.No residual chip or stone recurrence was detected.This procedure appears to be safe and highly efficient with low rate of urethrostenosis and is suitable for simotaneous prostate surgery.

Drug Stability ; Methylprednisolone Hemisuccinate ; administration & dosage

Objective To explore the effect of enteral nutrition applied to bowel preparation of diabetes patients before electronic colonoscopy. Methods A total of 172 diabetes patients were randomly allocated to the experimental group and the control group with 86 patients in each group. The experimental groups executed no dietary restriction within 3 days before the examination, and received Ensure 1h before colonoscopy. However,the control group was given low residue diet within 3 days before the examination, and received no Ensure before colonoscopy. The enteral cleanness and incidence of hypoglycemic reaction, abdominal pain and horror was compared between the two groups. Results 72 cases(83.72%) of the experimental group and 70 cases (81.40%) of the control group had better enteral cleanness, and there was no statistical difference in intestinal cleanness between the two groups. In the experimental group the incidence of hypoglycemic reaction, abdominal pain, horror was significantly lower than those in the control group. Conclusions Bowel preparation with unrestricted diet and ingested ensure before colonoscopy can not only ensure intestinal cleanness but also enhance endurance of colonoscopy.

At present,transplantation has been the predominant way to solve most of the end-stage diseases,ensued by the use of immunosuppressive drugs.Since the immunosuppressive drugs have narrow therapeutic index,the blood drug concentration is needed to mornior.Pharmacogenetics is one subject which focuses on the interaction between gene and the metabolism of the drug,providing great help for designing the regime of achieving the target drug concentration.Meanwhile,it facilitates the realization of individual therapy.This review thus focuses on the latest advancement on the pharmacogenetics of those immunosupprressants,hoping to provide help for the treatment.

BACKGROUND: AG490 is a newly found JAK kinase inhibitor, which can compete with receptor tyrosine kinase for binding site to block JAK/STAT pathway, inhibit rejection-related cytokine activation such as interferon-gamma (IFN-γ) ultimately inhibiting rejection.OBJECTIVE: To evaluate the possibility and prospect of the AG490 as a potential immunosuppressor, explore its basic mechanism in comparison with Cyclosporine A (CsA).DESIGN, TIME AND SETTING: Comparative observation was performed at the Institute of Urinary Surgery, Fujian Union Hospital from October 2007 to April 2008.MATERIALS: AG490 was purchased from Sigma, USA.METHODS: Human peripheral blood lymphocyte (both T and B) were harvested from 8 healthy donors. Lymphocyte were isolated by density gradient method and cultured with phytohemagglutinin, interleukin-2 (IL-2) or mixed lymphocyte culture to induce human lymphocyte proliferation. MAIN OUTCOME MEASURES: ELISA was used to detect the concentration of IL-2, IFN-γ and IL-6 in different culture systems with the tyrphostin (AG490), CsA or FK506. RESULTS: IL-2 and IFN-γ in culture systems of phytohemagglutinin, IL-2 or mixed lymphocyte culture were inhibited by AG490 (P < 0.05), but IL-6 was not suppressed by AG490 (P < 0.05). This effect was similar to clinical CsA or FK506. CONCLUSION: AG490 may be a potential immunosuppressor.

Objective To evaluate the value of ultrasonic quantitative method in the diagnosis of liver fibrosis in chronic hepatitis B (CHB) patients. Methods Ultrasonography was performed in 186 CHB patients who underwent liver biopsies. Fifteen indices including liver capsule thickness and fourteen texture parameters of gray level co-occurrence matrix were extracted from standard sonograms and compared with fibrosis stages by histopathology. The status of liver fibrosis was divided into five stages from S0 to S4 by histopathology based on the disease severity. ANOVA and Spearman correlation analysis were applied to analyze the differences and relationships between these indices and pathological stage, respectively. Then discriminant analysis models were established based on the indices for quantitative diagnosis of liver fibrosis. Results Among the fifteen indices, including liver capsule thickness, only the variance (F=0. 55, r=0. 06; both P＞0. 05), sum average (F=0.61, both r=0.05 ; P＞0.05), sum entropy (F=1.68, r=0.09; both P≥0.05) and entropy (F=1.39,r=0.12; both P＞0.05) were not significantly associated with the stages and not manifested linear correlation. Using biopsy results as gold standard, the correct rank rate of discriminant analysis model analysis in the patients staged from S0 to S4 were 80. 0%, 64. 9%, 61.3%, 74. 1% and 80.6 %, respectively. There were 73.1% of cross-validated cases who were accurately classified by the model analysis. The sensitivity, specificity and accuracy in patients with stage ≥ 1 were 97. 6%,80.0% and 91.9%, respectively; those in patients with stage≥2 were 92.1%, 89.7% and 90.9%,respectively; those in patients with stage≥3 were 94.8%, 96.1% and 95.7%; and those in patients with stage 4 were 80. 6%, 97.4 % and 94.6%, respectively. When considered S0 as no fibrosis, S1 as mild fibrosis, S2 and S3 as moderate to severe fibrosis and S4 as early cirrhosis, the consistence rates between discriminant analysis model and biopsy result were 81.7%, 78. 4%, 56. 9% and 90.3%,respectively. There were 74.7% of cross-validated cases who were correctly classified. The sensitivity, specificity and accuracy of the models for determining the fibrosis severity in patients≥mild fibrosis were 97.6%, 81.7% and 92.5%, respectively; those in patients ≥ moderate to severe fibrosis were 83. 1%, 94.8% and 89.2%, respectively; those in patients with early cirrhosis were 90.3%, 93.5% and 93.0%, respectively. Conclusion As a novel and noninvasive method, ultrasonic texture analysis could quantitatively determine liver fibrosis in CHB patients and is worthy of further investigation.