Objective To compare the effects of different levels of controlled low central venous pressure (CVP) on blood loss in patients undergoing hepatic lobectomy. Methods One hundred ASAⅠ -Ⅱ patients, aged 28-78 yr, weighing 39-90 kg, undergoing elective hepatic lobectomy under general anesthesia, were randomly divided into S groups ( n = 20 each) with CVP controlled at 1, 2, 3, 4 and 5 mm Hg during the course of operationrespectively (groups CVP1-5 ) . Anesthesia was induced with midazolam, fentanyl, etomidate and vecuronium. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with iv infusion of propofol and remifentanil, inhalation of isoflurane and intermittent iv boluses of vecuronium. CVP was maintained at the predetermined levels by restricted infusion or by administration of diuretics or vasoactive agents and so on during operation. The blood loss before, during and after removal of the diseased liver parenchyma ( V1-3 ) was recorded.The liver parenchyma transection area ( TA) was determined and the blood loss per transaction area ( VTA ) was calculated. Fluid infusion and blood transfusion were recorded during the three time periods mentioned above. MAP and HR were recorded before operation, at 5 min after removal of the diseased liver parenchyma was started and at the end of operation. Results Compared with group CVP5, the MAP during removal of the diseased liver parenchyma in groups CVP1,2 , V2 and VTA in groups CVP1-3,and the percentage of patients who needed blood transfusion during operation and the amount of fluid infused before completion of removal of the diseased liver parenchyma in groups CVP1-4 were significantly decreased ( P ＜ 0.05) . Compared with group CVP4 , V2 , VTA and MAP during removal of the diseased liver parenchyma were significantly decreased in group CVP2 and the amount of fluid infused was significantly increased before removal of the diseased liver parenchyma was completed in group CVP,( P ＜ 0.05) .Conclusion When CVP is controlled at 3 mm Hg, the hemodynamics is stable and blood loss is less during hepatic lobectomy.

Objective To explore the clinical effect of ulinastatin on capillary injury improvement of renal syndrome hemorrhagic fever and renal leakage. Methods Patients were divided into 2 groups according to the random number table. The experimental group(25 cases)was given with ulinastatin and the control group(25 cases) was given 5% sugar solution as a blank control. All patients were treated with nutritional support ,rehydration , prevention of bleeding and other symptoms. In addition,according to the number of days of fever in the experimental group,the patients were divided into two groups. The experimental group A(9 cases)had fever 1 ~ 4 days;the experimental group B(16 cases)had fever 5 ~ 7 days. All patients were measured in microalbuminuria ,serum creatinine,plasma albumin and other clinical indicators after 7 day treatment. Results Compared with the control group,microalbuminuria of the experimental group was significantly decreased;Creatinine recovery rate was faster than that in the control group;Plasma albumin had significantly increased;The number of symptomatic days of concurrent perfusion of other tissues had also significantly reduced. Compared with the experimental group B , microalbuminuria of the experimental group A was significantly decreased;Creatinine recovery rate was faster than that in the experimental group B;Plasma albumin had significantly increased;The number of symptomatic days of concurrent perfusion of other tissues was also significantly reduced. Conclusion Ulinastatin could effectively treat vascular injury and syndrome due to capillary leakage caused by epidemic hemorrhagic fever virus ,and the best effect occurs in early application in the fever.

Objective To establish the allele-specific real-time polymerase chain reaction (ASPCR) for detection of neonatal hyperbilirubinemia related gene SLCO1B1 A388G polymorphism and apply this assay to identify the clinical samples.Methods According to SLCO1B1 A388G polymorphism loci,specific primers were designed and the assay was established.Wide type plasmid and mutant plasmid were constructed.Fifty clinical samples were selected,including 30 samples of neonatal hyperbilirubinemia that had been diagnosed with SLCO1B1 A388G mutant and 20 samples of healthy newborns without SLCO1B1 A388G mutant were selected as the controls.Wide type plasmid,mutant plasmid and clinical samples were tested by specific and non-specific primers.A388G polymorphism was determined by difference in Ct (cycle threshold) between specific and non-specific primers.Then,the accuracy,sensitivity and specificity of assay were evaluated.Results The difference in Ct (cycle threshold) between specific and non-specific primers that amplified equivalent wide type template was 13.97 ±0.75.The assay could correctly distinguish the wide type and mutant plasmid.Probit regression analysis showed the sensitivity of the assay could reach to 5.28 copies/μL.For clinical samples,the Ct values of the samples with A388G mutation was less than 37.75 and showed positive results,while the samples without A388G mutation did not show any amplification nor Ct values were larger than 37.75,which showed negative results.Conclusions ASPCR is a fast,simple and effective method for SLCO1B1 A388G polymorphism detection of the clinical simples.It can be used for large sample screening for neonatal hyperbilirubinemia gene loci.

Objective:To analyze the benefit incidence and evaluate the implementation effects on catastrophic disease insurance under the New Rural Cooperative Medical System ( NRCMS) in Jilin Province and put forward sug-gestions to perfect the catastrophic disease insurance under NRCMS. Method: In-depth interviews with related staff were conducted to gain an understanding of the operating status of catastrophic disease insurance under NRCMS;cat-astrophic disease patient data of Jilin Province from 2013 were collected, with a comparative analysis of implementa-tion effects among nine districts;the benefit incidence was analyzed by means of the Sperman rank correlation analy-sis; Results: The policy of catastrophic disease insurance under the NRCMS exhibited sound implementation effects and played an important role in reducing the economic burden of catastrophic disease patients. The average individual expenditure decreased by 4336. 52 yuan, while the reimbursement rate increased by 11. 15% after NRCMS cata-strophic disease insurance reimbursements. Additionally, statistical analysis results showed that there was a weak cor-relation between benefit incidence and economic level, the benefit equality of catastrophic disease insurance under NRCMS was relatively good, but the benefit level of rich patients was slightly higher. Conclusion:The reimbursement scheme of catastrophic disease insurance under NRCMS should be refined and improved, and the benefit fairness of different districts must be ensured, thus achieving the goal of relieving the“poverty caused by illness” phenomenon.

Objective To explore the effect of different controlled hypotension method on the blood flow of the vertebral vein by measuring of blood flow of vertebral vein in rabbits. Methods Eighteen New Zealand rabbits,weighing 2-3 kg,were rando mly divided into three groups (n =6 each).Group S maintained MAP (90±5)mm Hg,group GTN reduced MAP to the base value of (70±10)% by using nitroglycerin 0.5 μg·kg-1 ·min-1 and esmolol 2.5 μg·kg-1 ·min-1 (ni-troglycerin∶esmolol= 1∶5 ),group SNP reduced MAP to the base value of (70 ± 10 )% by using sodium nitroprusside 0.5 μg·kg-1 ·min-1 and esmolol 2.5 μg·kg-1 ·min-1 (sodium nitroprusside∶es-molol=1∶5).The controlled hypotension model was established after intravenous general anesthesia. The blood flow of vertebral vein in rabbits were measured by ultrasonic measurement system (Terason 2 000 system ) before controlled hypotension and 1 hour after controlled hypotension. Results The MAP before controlled hypotension in group S (89.0 ± 5.2 )mm Hg,group GTN (91.5± 9.6 )mm Hg,group SNP (92.0 ± 5.7 )mm Hg had no significant difference.The blood pressure before and after the experiment had no significantly difference in group S.The blood pressure after controlled hypotension had no significant difference in group GTN and group SNP,but lower than that before controlled hypotension (P <0.05).Compared with group S,the blood flow of verte-bral vein in group GTN and group SNP were significantly reduced (P < 0.05 ).The blood flow in group GTN was significantly reduced compared with that in group SNP (P <0.05 ).Conclusion In the experiment,the combination of nitroglycerin and esmolol can better reduce blood flow of vertebral vein than that of nitroprusside and esmolol,that it is suitable for the control of hypotension in spinal surgery.

Objective To assess the role of dynamic contrast-enhanced MRI for diagnosis and differential diagnosis of prostatic cancer. Methods Six volunteers, 32 patients with benign prostatic hyperplasia and 13 patients with biopsy-proven prostatic cancer underwent MR imaging. Dynamic MR with Gd-DTPA (gadolinium-diethylene triamine pentaacetic acid) bolus enhancement was performed followed by post-contrast T 1-weighed imaging. The signal intensive value in dynamic MRI was measured and calculated to draw the time-signal intensity curve of normal peripheral zone, prostatic cancer and benign hyperplasia. Results In dynamic MRI, the normal peripheral zone were enhanced mildly and slowly. The lesion enhancement of benign prostatic hyperplasia in 32 patients were obvious in early phase (60 s) and strengthened gradually, and then went to decrease in late phase (240 s) after peak value. The lesions in 9 of 13 cases with prostate cancer were enhanced obviously in early phase (60 s) and washed out rapidly in late phase, and the peak value was located on early phase. Conclusions In dynamic MRI, the enhancement of normal peripheral zone, prostate cancer and benign hyperplasia were different significantly. Dynamic MRI was very useful in the diagnosis and differentiation of prostate cance.

Objective To retrospectively assess the diagnostic value of nuchal translucency (NT) thickness and facial profile ultrasonic markers [including frontomaxillary facial (FMF) angle,and the ratio of prenasal thickness to nasal bone length (PT/NBL)] for trisomy 21 syndrome in first-trimester fetuses.Methods Ultrasonograhic images of 35 fetuses with trisomy 21 syndrome and 70 gestational age matched normal fetuses were analyzed in first-trimester.NT,FMF angle and the PT/NBL ratio were measured retrospectively in stored images from digital database between January 2012 and December 2015.The diagnostic value of NT,FMF angle and PT/NBL ratio were compared with different combinations.Results (1) The mean NT was significantly higher in the trisomy 21 group than that in controls (t =7.401,P =0.00).The NT above 2.5mm was observed in 20 trisomy 21 fetuses (57.1％) and in 3 normal fetuses (4.3％).(2) The mean FMF angle was significantly higher in the trisomy 21 group than that in controls (t =-5.283,P =0.00).The FMF angle above the 95th percentile (93.6°) was observed in 13 trisomy 21 fetuses (37.1％) and in 1 normal fetus (1.4％).(3) The mean PT/NBL ratio was significantly higher in the trisomy 21 group than that in controls (t =-7.826,P =0.00).The PT/NBL ratio above the 95th percentile (0.93) was observed in 19 trisomy 21 fetuses (54.3％) and in 4 normal fetuses (5.7％).(4) The sensitivity and Youden index for trisomy 21 increased gradually,which were 57.1 ％ and 0.528 by using NT,and 74.3％ and 0.686 by using NT and FMF angle,and 91.4％ and 0.828 by using NT,FMF angle and PT/NBL ratio.There were significant differences in the detection rates of trisomy 21 among the three strategies,while the diagnostic specificity of the three strategies were more than 90％.Conclusions The three parameters are significantly increased in trisomy 21 fetus in first-trimester.First,increased NT was most commonly detected,followed by increased PT/NBL ratio,and increased FMF angle again.Detection rates for trisomy 21 fetuses in first-trimester by ultrasound screening can be significantly improved if combination of all three parameters rather than just one parameter are performed.

In order to observe the effect of Bushenantai recipe on the expression of endometrial leukemia-inhibitory factor (LIF) in mice with embryonic implantation dysfunction (EID), 120 Kunming mice post coition were randomized into three groups: normal control group, model group and traditional Chinese medicine group (TCM group) (n=40 in each group). Uterus was collected on the pregnancy day (Pd) 4, 5, 6 after an intravenous injection of Evan's blue. The endometrium was dyed by Evan's blue and the mean points of response were observed on Pd 5. The expression of LIF mRNA and protein was detected by RT-PCR and immunohistochemistry respectively and analyzed statistically by image system. The results showed that the number of implantation sites in model group was remarkably less than in normal control group and TCM group. There was no significant difference between normal control group and TCM group. The expression of LIF mRNA and protein in model group was delayed. Bushenantai recipe could increase the expression of LIF mRNA and protein in endometria of mice with EID. It was suggested that Bushenantai recipe could improve embryo implantation of mice with EID by promoting the endometrial LIF expression and endometrial decidualization.
Blastocyst/cytology ; Embryo Implantation ; Endometrium/*metabolism ; Gene Expression ; Gene Expression Regulation, Developmental ; Leukemia Inhibitory Factor/*biosynthesis ; Leukemia Inhibitory Factor/*genetics ; Medicine, Chinese Traditional ; Models, Biological ; Plant Extracts/pharmacology ; RNA, Messenger/metabolism ; Time Factors

Objective To discuss the characteristics of extended-spectrum beta-lactamases(ESBLs)-producing Shigella and the relation between them and drug-resistance plasmid. Methods The suspicious ESBLs-producing isolates were screened by K-B disc diffusion method, and the ESBLs-producing strains were confirmed by confirmatory test recommended by the National Committee for Clinical Laboratory Standards. Furthermore, the partial blageneof these isolates were detected by PCR using universal primers for TEM, SHV, CTX-M-1 group, CTX-M-2 group and CTX-M-9 group, respectively. The entire blaCTX-M-9 and blaTEM were amplified by PCR using the primers outside the open reading frame (ORF) of these β-1actamases and products were directly sequenced. The conjugation experiment was performed to determine whether the resistance was transferable. Minimal inhibitory concentration (MIC) was detected with double agar dilution method. Results Of the 275 isolates, 12 strains were identified as ESBLs producers. Among them, 8 strains were CTX-M-14 carriers and 4 strains were CTX-M-3 carriers. All ESBLs-producing isolates are positive for plasmid conjugative transfer test. The transconjugants are only resistance to betalactams. Conclusions High resistance to beta-laetams in Shigella is caused by production of ESBLs in the local area. The ESBLs-produeing isolates can transfer the drug resistance through lateral transfer of plasmid.

Objective To compare high-frequency ultrasonography and MRI in diagnosis of medial patellofemoral ligament (MPFL) injury after acute lateral traumatic patellar dislocation(LTPD).Methods According to surgical data of 35 patients with acute LTPD,the incidence and sites of MPFL injury were analyzed.Further,based on high frequency ultrasonography and MRI data,the sensitivity,specificity and accuracy of high-frequency ultrasonography and MRI in different MPFL injuries were analyzed and compared.Results Among 35 patients,there were 21 cases with complete MPFL tear and 14 cases with partial MPFL tear.Tear of MPFL at the femoral attachment in 19 cases,at the patellar attachment in 15 cases,and at the mid-substance in 1 case.The sensitivity,specificity,accuracy of high-frequency ultrasonography diagnosis were 78.6％,95.2％,88.6％ respectively on partial MPFL tear and 95.2％,78.6 ％,88.6 ％ respectively on complete MPFL tear.The sensitivity,specificity,accuracy of MRI diagnosis were 85.7％,90.5％,88.6％ respectively on partial MPFL tear and 90.5％,85.7％,88.6％ respectively on complete MPFL tear.There were no significant difference between high-frequency ultrasonography and MRI in diagnosis of partial and complete MPFL injury (x2 =0.243,0.267; P =0.622,0.599).Conclusions MPFL formoral attachment is most vulnerable to damage,followed by patellar attachment.High-frequency ultrasonography,as well as MRI,can be used clearly to diagnose MPFL injury and accurately classify the damage,and it is also an easy,reliable,rapid method,which can be applied routinely to diagnose MPFL injury after actue LTPD.