To observe the changes in hemorheology, endotoxin and TNF ? in blood after hemoperfusion(HP) with adsorbent immobilized polymyxin B (PMB) on sepsis in rats. Wistar rats were randomly divided into three groups:LPS+HP+PMB,LPS+HP and LPS. All the rats received intravenously injection of lipopolysaccharide (LPS, Escherichia coil O111:B4,1mg/kg). Plasma of the rats in the group of LPS+HP+PMB was passed through a column containing sepharose coated activated charcoal immobilized polymyxin B at the 4th hour after LPS injection. The treated plasma was transfused bak after being mixed with blood cells. In LPS+HP group, the column did not contain immobilized polymyxin B. The animals of LPS group received LPS only. Quantitative endotoxin determination in blood was done with limulus amebocyte lysate test,TNF ? of the plasma assayed with ELISA, and hemorheology parameters were also observed after hemoperfusion. In LPS+HP+PMB group, the concentration of plasma was significantly decreased after hemoperfusion, but it was still significantly higher than the baseline value, and there was a decrease of blood cell ratio after hemoperfusion. The results suggest that specific adsorbent could remove endotoxin in the circulation and improve hemorheology.

Response surface analysis (uniform precision of central composite design, SAS 9.1.3 software) was applied to optimize the four major factors (ratio of soybean meal to water, enzyme quantity, fermentation time and inoculation quantity) for soybean meal solid fermentation. According to the change of the hydrolyzation degree of soybean protein, the equation of polynomial regression was established between those factors and the response. The result showed that the optimum condition included as follows: ratio of soybean meal to water 1∶1.00,enzyme quantity 2.55%, fermentation time 65h and inoculation quantity 1.00%. Under the optimum level, the degree of hydrolyzation reached 13.3%, which increased 56% over pre-optimization.

Objective To investigate the effect of sumical resection in the management of gestafional trophoblastic neoplasia(GTN)patients with pulmonary metastases.Methods A retrospective review of the medical records of 62 GTN patients who underwent pulmonary resection was carried out.The cases were divided into recurrent group(group A,,l=10),drug-resistant group(group B,n=28),and the group with satisfactory response to chemotherapy but residual pulmonary lesion(s)(group C,n=25).One patient underwent lobectomy twice,and she was allocated simultaneously to groups A and B.The patients'median age,antecedent pregnancy,International Federation of Gynecology and Obstetrics(NGO)risk score,number of preoperative chemotherapy courses,preoperative β-human chorionic gonadotrophin (β-hCG)titer,lesion size,number of lobes affected,positive rate of histology,follow-ups and prognosis were compared between the three groups.Results The proportion of hish-risk patients in the three groups wag 90%,82%and 44%,respectively.The complete remission rates of the three groups were 90%,79%and 100%,with relapse mtes of 2/8,15%and zero,respectively.Positive histology of the resected specimen wasmore frequently recognized in recurrent and drug-resistant groups(A 60%,B 36%,C 12%).In the drug-resistant group there were more preoperative chemotherapy 8essiorls(A 3,B 7,C 5)and more patients with abnormal preoperative B-hCG titer(A 50%,B 61%,C 12%).Conclusions Surgical resection is effective in the treatment of pulmonary metastases of GTN.Surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug—resistance and the lesions are relatively localized.Surgical resection is not recommended for patients with satisfactory response to chemotherapy but residual pulmonary lesions.

Objective To discuss the efficacy of the modified subinguinal approach for the treatment of acetabular anterior column and wall fractures.Methods A clinical retrospective study was performed of the 5 patients who had been treated at our department from January 2011 to April 2015 for acetabular anterior column and wall fractures and conformed to follow-ups.They were 3 males and 2 females,aged from 19 to 45 years (mean,35.6 years).The duration from injury to surgery averaged 7.6 days (range,from 4 to 10 days).The subinguinal ligament approach was adopted in the 5 cases,through which the inguinal ligament was preserved intact after sharp dissection of its insertion at the anterior superior iliac spine and medial-upper advancement,the advantage of expanded exposure of the first window by the Farid sub-ilioinguinal approach was retained,and additional lesions due to iliac osteotomy were avoided.The operation time,intraoperative bleeding,postoperative reduction and time for fracture union were documented.Merle d' Aubigne and Postel scoring system was used to assess the hip joint function of the affected limb at the final follow-ups.Results The operation time ranged from 110 to 150 minutes (mean,125 minutes);the intraoperative bleeding ranged from 415 to 550 mL (mean,450.2 mL).By the Matta's criteria,the postoperative reduction was rated as excellent in 4 cases and good in one.The 5 patients were followed up for an average of 32.4 months (range,from 6 to 43 months).Their fractures united clinically after an average of 4.6 months (range,from 3 to 6 months).The hip joint function was rated as excellent in 2 and good in 3 by the Merle d' Aubigne and Postel scoring system at the final follow-ups.Follow-ups observed no serious complications like inguinal hernia,internal fixation failure,myositis ossificans,or avascular necrosis of the femoral head.Conclusions As the modified subinguinal approach can provide a broad surgical exposure,lead to minimal injury to the inguinal ligament,avoid lesions caused by iliac osteotomy,and decrease operation time and bleeding,it may be a better approach for acetabular anterior column and wall fractures.

Objective To investigate the clinical characteristics, management and prognosis of gestational trophoblastic disease in women aged 50 years or more. Methods Thirty-eight cases of gestational trophoblastic disease in women aged 50 years or more, who were treated in Peking Union Medical College Hospital between 1992 and 2002, were reviewed retrospectively. Results The median age was 52 years (range from 50 to 58 years ). The lesions included 5 hydatidiform moles (13%), 19 invasive moles (50%), 12 choriocarcinomas (32%) and 2 placenta site trophoblastic tumors (5%). All of 38 cases presented with abnormal vaginal bleeding. Twenty-three cases of hydatidiform moles were diagnosed at their first visit to the hospital, and 15 of them received prophylactic chemotherapy, of whom 10 progressed to invasive mole, 3 developed lung metastasis. All of the other 8 cases without prophylactic chemotherapy progressed to malignant changes with metastasis of lung. The use of prophylactic chemotherapy reduced the incidence of subsequent metastasis. All of 38 cases received chemotherapy. Thirty-two cases underwent hysterectomy, complete remission was achieved in 91% of patients; complete remission was achieved in 2 of 6 patients without hysterectomy. Conclusions The diagnosis of pregnancy and pregnancy-related disease should be considered in the elderly women presenting with abnormal vaginal bleeding. Once gestational trophoblastic disease in women aged 50 years or more is diagnosed, chemotherapy should be given as soon as possible. Hysterectomy is frequently required to improve the prognosis of gestational trophoblastic disease in the elderly women.

Objective To explore expression of plexinA1 and Ki-67 in tissue of human brain glioma cells and their clinical significance.Methods 43 specimens from patients with brain glioma were collected.Immunohistochemical (IHC) staining was used for detecting the expression of tissue plexinA1 and Ki-67 in human glioma cells of 43 cases of patients with brain glioma.The positive expression rate of plexinA1 and Ki-67 among the different pathological grade tissues and their clinical significance were analyzed.So did correlation studies about plexinA1 and Ki-67.Results The positive expression rates of plexinA1 in Ⅰ-Ⅱ grade group (18 cases) and Ⅲ-Ⅳ grade group (25 cases) were 22.22 ％ (4/18) and 72.00 ％ (18/25) (P ＜ 0.05).The positive expression rates of Ki-67 in Ⅰ-Ⅱ grade group and Ⅲ-Ⅳ grade group were 16.67 ％ (3/18) and 56.00 ％ (14/25),respectively (P ＜ 0.05).PlxinA1 and Ki-67 expression in the tissue of human brain glioma were positively correlated (r =0.997,P ＜ 0.05).Conclusions The positive expression rate of plexinA1 is higher in high malignancy human glioma group than that in low malignancy group which has an important reference value in the estimation of prognosis for human glioma.PlexinA1 and Ki-67 maybe synergism in occurrence and development of glioma.

Objective To analyze the effects of Ileus tube (IT) along with somatostatin (SS) used for treatment of patients with severe acute pancreatitis (SAP).Methods Under conventional treatment,75 patients with SAP were divided into three groups as per different additional treatments,namely group A (IT and SS),group B (nasogastric decompression tube and SS),and group C (IT alone),and the therapeutic efficacies of those treatments were evaluated in respects of improvement of physical signs and symptems,dynamic changes in decompression drainage and prognosis.Results Therapeutic efficacy was 100％ in group A,84％ in group B and 80％ in group C.The difference between group A and B was x2 =8.26 (P ＜0.01) ; group B vs.C was x2 =0.38 (P ＞ 0.05).The physical signs and symptoms in group A were improved more rapid than those in group B and C (P ＜ 0.05),but there was no significant differences in those signs and symptoms between group B and group C (P ＞ 0.05).In comparison of decompression drainage,the t value of group A vs.group B was 2.14,group B vs.group C was 3.83,and group A vs.group C was 2.23 (P ＜ 0.05).As cure rate of patients with SAP in hospital on the 14th day,rate of transferring to surgical treatment as a last resort and mortality in group A were compared with group B and C,the differences were statistically significant (P ＜ 0.05),while group B vs.C,the difference was not statistically significant (P ＞ 0.05).Conclusions Application of IT combined with SS can significantly improve the condition of patients with SAP,thereby reducing the operation rate,shortening hospital stay,lowering mortality and improving the outcome,and it is worthy of clinical popularization.

Objective To investigate the prognostic factors and survival of patients with bronchopulmonary carcinoid tumors (BPC) after surgical treatment .Methods The clinical data of 87 patients undergoing surgery for BPC from Jan .2002 to Dec .2008 were reviewed retrospectively .Kaplan-Meier method was used to analyze the survival of the patients .The risk factors such as age , gender ,smoking history ,histological type ,tumor size ,were analyzed by Cox proportional hazards regression model .Results The 1-,3-and 5-year overall survival rates were 85 .1% ,71 .3% and 63 .2% .Univariate analysis revealed that age (P=0 .016) ,smoking history(P=0 .007) ,histological type(P=0 .000) ,tumor stage(P= 0 .000) ,tumor size(P= 0 .006) lymph node metastasis(P=0 .000) ,surgery type (P= 0 .045) and postoperative chemotherapy (P= 0 .000) were prognostic factors .Multivariate analysis showed that histological type(P=0 .008) ,tumor stage(P=0 .000) ,lymph node metastasis(P=0 .033) were independent prognostic factor .Conclusion The survival rate of the BPC patient after surgical treatment is high ,histological type ,tumor stage and lymph node metastasis were independent prognostic factors .