Objective To explore the correlation of serum procalcitonin and prognosis of neonatal sepsis. Methods 113 cases of infection were selected as the objects of study,which were divided into the observation group ( sepsis) and control group ( non sepsis) according to the presence of sepsis.2mL venous blood was selected when patients were admitted to hospital before antibiotic treatment.The level of PCT was detected by immunoluminometric assay.PCT level at admission and after treatment were used to analyze the relationship between changes and the severity and prognosis of patients.Results PCT level of the observation group [(11.03 ±6.21)ng/mL] were higher than that of the control group [(0.81 ±1.61)ng/mL] (t=8.507,P<0.01),Sepsis and death in patients with serum PCT values increased significantly over time (F=5.061,P<0.05);invalid value of serum PCT in patients with disease exacerbation was significantly higher(F=4.793,P<0.05);improved serum PCT values in patients with the disease better reduced(F=6.009,P<0.05).While PCT<14.86ng/mL mortality rate (14.89%) was significantly lower than the PCT≥14.86ng/mL mortality rate (72.22%).Conclusion PCT shows important clinical efficacy in forcasting prognosis of neonatal sepsis.It is worthy of wider promotion and application.

Objective To investigate the effect of normal saline(NS)of different temperature on morphological changes and nitric oxide synthase(NOS)expression of spinal cord.Methods The spinal canal of 96 SD adult rats was opened at T9.which of 24 rats was flushed with 37 ℃ NS,24 with 20 ℃ NS,24 with 4 ℃ NS respectively,and which of 24 rats in control group received no flushing.The spinal canal was closed one hour later,and the spinal cord was taken out 24 hours later.Then the water content in spinal cord was determined by dry-wet method.The morphological changes of spinal cord were observed under light microscope and the electronic microscope.The amount of NOS-positive neuron was measured by ?-NADPH histochemical methods.Results The water content in spinal cord was(66.53?0.61)% in control group,(66.75?1.00)% in 37 ℃ group,(70.55?0.77)% in 20 ℃ group,(71.92?2.50)% in 4 ℃ group.The spinal cord of control group and 37 ℃ group contained less water than that of 20 ℃ group and 4 ℃ group.There were no obvious morphological changes in the control group and 37 ℃ group.In 20 ℃ and 4 ℃ groups,the demyelination of axon,swelling of cell body and the disappearance of tigroid body were observed under light microscope,the partial disaggregation of medullary sheath,swelling of mitochondria and disappearance of mitochondria crista could be observed under electron microscope.The amount of NOS-positive neuron in spinal cord was(18.75?2.12),(18.63?1.41),(14.75?1.67),(8.13?1.25)in control,37 ℃,20 ℃ and 4 ℃ groups,respectively.The control group and 37 ℃ group showed more NOS-positive neuron than those of 20 ℃ group and 4 ℃ group.Conclusion NS below 20 ℃ can injury spinal cord.It is suitable to choose 37 ℃ NS to flush brain and spinal card during operation.

Objective:To investigate the outcome of liver transplantation(LT) for end stage liver disease with portal vein thrombosis(PVT) in different processes.Methods: Data from 308 patients who underwent LT from July 2004 to February 2008 were retrospectively assessed.The processes of varies grades of PVT during LT were analyzed and estimated for whether the outcome of LT was different between patients with or without PVT.Results: There were 46 patients with PVT,including 11 of grade 1,14 of grade 2,18 of grade 3 and 3 of grade 4.LT performed in grade 1 and 2 PVT patients without special intervention.LT was performed in 16 patients with grade 3 PVT after simple thrombectomy or thrombus-extraction.The other 2 patients with grade 3 PVT received the donor superior mesenteric vein to act as a bridge between the donor portal vein and host superior mesenteric vein.Two cases with grade 4 PVT received a cavo-portal hemitransposition,and the other one anastomosis between graft portal vein and varicose coronary vein.The postoperative 1-year survival rates of patients without PVT and patients with PVT were 91.6%(240/262),80.5%(211/262)vs 86.9%(40/46),76.1%(35/46),respectively.The patients with PVT had a recurrence rate of 4.3%(2/46).Conclusion: Most patients suffering from end stage liver disease with PVT can be successfully treated by LT.However,the result of the patients with diffused PVT undergoing LT is relatively poor.

ObjectiveTo investigate the incidence of de novo malignancies in liver transplantation recipients.MethodsWe retrospectively assessed data of 475 patients undergoing liver transplantation from May 2000 to December 2008. ResultsAmong the 475 recipients followed-up for 6 months at minimum,5 patients developed de novo malignancy and the total incidence rate was 1.1％.The median elapsed time from transplant to the diagnosis of de novo malignancy was 14 months (range 6 to 72).The patients were all males,including one of rectal cancer which was cured by radical resection,2 of hepatocellular carcinoma who died 6 and 14 months respectively after the diagnosis,1 of neuroendocrine carcinoma of the lung dying after 16 months,1 of Bukitt lymphoma who died within 2 months.Conclusions De novo malignancy is an uncommon event in liver transplantation recipients,but the outome is very poor.

Objective To analyze clinical features,surgical treatment efficacy and prognostic factors of bone metastasis patients after liver transplantation for hepatocellular carcinoma.Methods A retrospective clinical data of 20 bone metastasis patients after liver transplantation for hepatocellular carcinoma from July 2000 to January 2010 were received.The effect of surgery aimed at bone metastasis was evaluated.Univariate and multivariate prognostic risk factors were analyzed.Results The median survival time of these patients was 7.5 months and 1-year survival rate was only 20％.Surgical treatment could relieve pain and promote patients' peformance status significantly.Univariate and multivariate analysis found that tumor microvascular invasion within the removed recipient liver was the only prognostic risk factor.Conclusions Patients of bone metastasis after liver transplantation for HCC had poor prognosis.Surgical treatment helps improve patient's quality of life.Tumor microvascular invasion is the risk factor of surgical prognosis.

Objective To investigate the influence of iloprost on the expression of lung endothelin-1(ET-1) in rats with hypoxic pulmonary hypertension(HPH).Methods Thirty-two male SD rats were randomly divided into four groups:normal control (NC) group,normal treatment(NT) group,hypoxia control(HC) group,hypoxia treatment (HT) group.NC group and NT group raised under normal Oxygen conditions 3 weeks.HC and HT group placed in a low Oxygen chamber (O2 10％) were treated 3 weeks of hypoxia 8 hours per day.NT and HT group were treated daily iloprost by inhalation therapy (2μg/kg).Affer three weeks,measured mean pulmonary arterial pressure (mPAP),right ventricular systolic pressure (RVSP),index of right ventricular hypertrophy.HE staining was used to observe the morphological changes of pulmonary arteries and image analysis system was used to calculate the percentage of vascular wall thickness of small pulmonary arteries in each group,RT-PCR technique was used to assess the trends of ET-1 in lung tissue homogenates.Results The hemodynamics in HC group was significantly higher than other groups(P＜0.05),there was no significant statistically difference of the hemodynamics in HT group compare with normal control group.Pulmonary arteries morphology,vessel wall thickening and vessel lumina stenosis in HC group than NC、NT、group.These indicators were significant improved in HT group.ET-1 expression in lung tissue were significantly increased in HC group than NC groups.No significant difference was found between and NC group HT group.Conclusion Aerosol inhalation of iloprost has exact therapeutic effect for rats with HPH.Iloprost reduced ET-1 overexpression in lung tissue in HPH rats and prevent pulmonary vascular remodeling.

BACKGROUND:In senile osteoporosis patients, capacity of pedicle screw fixation is relatively poor due to fragile bone substance. Currently, augmentation of pedicle screw fixation with bone cement can improve the ability of screw fixation, but bone cement leakage and difficulties in screw removal become the problem to be solved. OBJECTIVE:To develop a novel pourable pedicle bone cement and to investigate its biomechanical properties, safety and practicality, thus providing the basis for clinical treatment of osteoporosis and spinal diseases.
METHODS:Six cases of complete wetting spines were colected at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2013 to January 2015, including 42 vertebrae. Pedicle screw fixation with X-ray assisted bone cement injection (2 mL) was performed unilateraly as experimental group, and conventional pedicle screw fixation was done contralateraly as control group. Bone cement dispersion was observed in the two groups. RESULTS AND CONCLUSION:It was 3-4 minutes for bone cement to agglomerate. Injection of bone cement paste into the infusion cylinder using a syringe was more convenient. The cylinder was connected tightly with the tail-end of the screw with no leakage. The push bar could provide sufficient perfusion force. Bone cement dispersion was found in the holow part and side holes of the screw. Side holes arranged regularly, and the hole pitch was equal. Compared with the control group, the yield load and yield displacement were significantly higher in the experimental group (P < 0.05), but the ultimate strength and ultimate displacement were significantly lower in the experimental group (P < 0.05). Bone cement around the pourable cement screw dispersed regularly, which was diffused into the surround cancelous bone and integrated with adjacent bone cement mass. The axial withdrawal force was increased by 114% in the experimental group compared with the control group (P < 0.05). The maximum rotary torque was significantly higher in the experimental group than the control group (P< 0.05). These finding suggest that the new pourable cement screw combined with bone cement putter and infusion cylinder is applied more convenient, can effectively control the leakage of bone cement, and can improve the stability of the pedicle in osteoporosis patients, which has been widely used.

Objective To study the risk factors of hepatitis B virus re-infection after liver transplantation. Methods We retrospectively analyze the data of 285 patients who underwent liver transplantation for hepatitis B related diseases basing on data collected during a follow-up of at least 6 months. Results The postoperative follow-up ranges from 6 to 59 months of all the 285 cases after liver transplantation. There were 10 patients diagnosed as hepatitis B virus re-infection after liver transplantation leading to a 3.5% re-infection rate. There were 9 patients being diagnosed as HCC recurrence before HBV re-infection was identified. Patients with HCC recurrence suffered from higher HBV re-infection rate than other patients, and HBsAg and HBcAg was detected in one of the 13 metastatic HCC specimens.Conclusions HBIg combined with nucleotide analogue can effectively prevent HBV re-infention. HCCrecurrence is an important risk factor to HBV re-infection after liver transplantation.

Objective To study clinical characteristics of postoperative recurrence of liver malignant tumor after liver transplantation,the postoperative standard evaluation,and treatment for recurrent tumor. Methods We retrospectively analyzed the data of 81 recurrent cases among 215 patients undergoing liver transplantation for malignant liver tumors,focusing on the recurrent time and location and the result oftreatment.Results The follow-up time ranged from 6 to 108 months of all the 81 patients after liver transplantation.The time of tumor recurrence ranged from 3 to 20 months after transplantation.and lung,abdominal cavity,new liver and bone were among the most common places of recurrence.Local therapy was the mainstay of therapy,including liver lobectomy in 6 cases and gamma knife treatment for pulmonary metastasis in 74 cases;Resection for abdominal mass Was performed in 10 cases.Gamma knife treatment for abdominal lymph node metastasis in 8 eases,resection of hepatic metastatic tumor in 6 cases,ablation therapy in 5 cases,gamma knife treatment in 15 cases,33 cases underwent repeated TACE and 3 cases received re-transplantation for liver metastasis;For bone metastasis 15 cages underwent resection,16 cases did gamma knife treatment and 3 cases underwent internal fixation for bone fracture caused by bone metastasis;For intracranial metastasis 4 cnses received gamma knife treatment.3 cases were cured,6 cases were still alive with recurrent tumor for 21～56 months respectively and the mean survival time was 39 months;72 cnses died with a mean survival time of 15 months.Conclusion The regular and standard close follow-up for liver transplantation recipients suffering from primary liver malignant tumors and aggressive therapy for the recurrent tumors help prolong patient's survival.

Objective To investigate the timing, target and method for the treatment of preoperative coagulopathy in patients undergoing orthotopic liver transplantation. Methods We retrospectively assessed 168 adult patients undergoing orthotopic liver transplantation from 2002 to 2004. Preoperative prothrombin time(PT) , prothrombin activity (PTA) , international normalizing ratio(INR) , activated partial thromboplastin time(APTT) , fibrinogen (FIB) , and platelet count (PLT) were assessed. The relationship between PTA and intraoperative blood loss or use of blood product, preoperative plasma exchange and intraoperative blood loss or use of blood product were analysed. Results Preoperative normocoagulation significantly decreased intraoperative blood loss and blood product' s requirement. PTA level was in negative correlation with intraoperative blood loss and blood transfusion. Preoperative plasma exchange effectively reduced intraoperative bleeding and blood product's requirement. Conclusion Aggressive coagulatory therapy should be adopted to improve coagulation condition in order to reduce intraoperative blood loss and blood product's requirement.