Objective To analyze the learning curve of microendoscopic lumbar discectomy (MED) and summarize the operative experience. Methods From July 2010 to March 2012, the first 100 patients with single level lumbar disc herniation managed with MED were divided into chronological groups (A, B, C and D), 30 patients in group A, B, C and 10 patients in group D. The comparsons were conducted in terms of operative time , estimated blood loss , number of cases with transition from MED to open surgey or for reoperation , rate of complications and postoperative efficacy. Results The mean operative time and the mean estimated blood loss in each group was valuated respectively. In group A , the operative time and estimated blood loss were significantly decreased as compared with those in group B, C and D respectively (P < 0.05), but those in group B were not significantly different from those in group C and D (P > 0.05). There were 6 complications in group A, 1 complication in group B and C respectively and no complication in group D. The leg pain visual analogue scale and Oswestry disability index at the first month and the twelfth month postoperatively were all improved respectively as compared with those preoperatively (P < 0.01). Conclusion The learning curve of microendoscopic lumbar discectomy generally may reach the plateau when about 30 cases are operated on. The key procedure to pass over the learning curve includes puncture and location , flavectomy , anatomy mark identification, and precaution of damage in dural sac.

Objective To explore the effects of different time spans for off-bed activities on postoperative rehabiliatioin of patients with liver transplantation. Methods The clinical data of 42 patients having undergone allogeneic liver transplantation during Jan. 2014 to Oct. 2015 were assigned as the observation group. Another 44 patitents during the same period , matched to those in the observation group in terms of general data , were assigned as the control group . The clinical data of two groupos were reviewed to make comparisons in terms of the time for anus exhaust , the time spans for gastric tube and urinary catheter indwelling , abdominal cavity effusion and hemorrhage and pulmonary infection 3 days after operation. Result The time for anus exhaust and the time spans for gastric tube and urinary catheter indwelling in the observation group were all significantly shorter than the control gorup (P<0.05), but there were insignifiant differences between the groups in abdominal cavity effusion and hemorrhage and pulmonary infection. Conclusion Off-bed activities 3 days after operation is safe and feasible for the patients having undergone allogeneic liver transplantation. It can promote their process of rehabilitation.

Objective To summarize nursing experience of digestive tract fistula after orthotopic liver transplantation (OLT). Methods From January 2000 to December 2010,1173 patients received liver transplantation,among whom 61 recipients got digestive tract fistula during early stage after operation.The clinical data and major nursing measures of 61 patients were studied retrospectively. Results The incidence rate of digestive tract fistula after OLT was 5.20％.The incidence rate of bile leakage,gastric fistula,duodenal fistula,jejunal fistula,ileal fistula and transverse colon fistula were 3.90％,0.42％,0.08％,0.34％,0.08％ and 0.34％,respectively.The onset time of digestive tract fistula was from 3 to 24 days post transplantation,and atypical symptoms such as fever,abdominal pain,abdominal distention,weakened enterocinesia and even septic shock were presented.And the rising or descending of white blood cells counts,rising of level of transaminase and total bilirubin in laboratory examination were simultaneously presented.Four patients died of bile leakage,and other seven patients died of intestinal fistula throughout conservative or operative treatment.The rest of 50 were discharged healthily. Conclusions The morbidity of digestive tract fistula after OLT is low,but its mortality rate is high.It is necessary to closely observe patients' condition and confirm diagnosis in early stage,in order to promote the healing of digestive tract fistula after OLT.At the same time,psychological,basic and dietary nursing should be given in order to enhance the survival rate and quality of life of patients.

[ ABSTRACT] AIM:To compare the differences of the genome-wide methylation levels and methylated regions be-tween nasopharyngeal carcinoma ( NPC) cells in the same genetic background but different radiation resistance ( CNE-2 cells and CNE-2R cells).METHODS:Using the method which was developed by Doctor Zhao Cun-you, based on using methyl-sensitive restriction enzyme to measure the genome-wide methylation levels.In addition, MeDIP-Seq was used to analyze the methylated regions in 6 gene functional elements, including the upstream 2k sequence, 5’ UTR, coding se-quence, intron, 3’UTR and downstream 2k sequence, between CNE-2 cells and CNE-2R cells.RESULTS:The genome-wide methylation level was approximately 30%lower in CNE-2R cells than that in CNE-2 cells.No obvious difference on the amount of genes and the coverage of the peak in the 6 gene functional elements was observed.However, the methylation pattern of plentiful genes had altered in the gene function elements.CONCLUSION:The genome-wide methylation levels and methylated regions between NPC cells in the same genetic background but different radiation resistance were quite dif-ferent, indicating that the DNA methylation may be associated with NPC radioresistance.

Objective To investigate the nursing points of pancreatic leakage after upper abdominal multiple organ transplantation. Methods A retrospective study was conducted on the nursing experience of two patients with end-stage liver disease and type 2 diabetes mellitus who were complicated with pancreatic leakage after upper abdominal multiple organ transplantation from March 2009 to July 2015. Results The blood glucose of these patients returned to normal level within 1 week after operation and insulin was discontinued. Pancreatic leakage was occurred in the two patients at 14 and 21 days after operation, respectively. They were both successfully discharged after active treatments and nursing cares including completely drainage, the application of drugs that inhibited the secretion of pancreatic enzymes and digestive tract glands, strengthening infection control, nutritional support and other conservative treatments. Conclusions It is the key to improve the recovery of pancreatic leakage after upper abdominal multiple organ transplantation with careful observation of abdominal signs and abdominal drainage tube, accurate use of somatostatin, nutritional support, maintenance of water and electrolyte balance, and psychological intervention.

Objective To investigate the nursing of the adult recipients who accept children organ donations after cardiac death(DCD)complicated with portal venous thrombosis after liver transplantation. Methods We retrospectively analyzed 1 case completed in 2015 related to the adult recipients who accept children organ donations after cardiac death with portal venous thrombosis after liver transplantation in clinical situation,in view of the portal vein thrombosis of portal vein catheter thrombolysis,portal vein carotid stenting, close observation and nursing are used for patients′condition change. Results After positive clinical therapy and careful nursing,portal venous thrombolysis effect is good, and portal venous blood flowing after carotid stenting,clinical symptoms were alleviated. The liver function recovered well after surgery, and the patient discharged successfully,followed by regular visits from the hospital. Conclusions Children organ donations after cardiac death for liver can be successfully applied in the adult recipients,but the understanding of related complications after surgery need to be strengthened.The symptom observation,early detection,active nursing intervention,are conducive to the prognosis of patients.

Objective To summarize the perioperative nursing care of a patient with ischemia-free liver transplantation. Methods The nursing measures were developed according to the characteristics of the disease and the individual conditions of the patients: including preoperative psychological care;preoperative preparation; prevention of postoperative infection; meticulous observation of the patient′s conditions, transplanted liver function and postoperative complications; the early guidance of rehabilitation activity, nutritional support treatment and the care of water and electrolyte balance. Results The patient recovered well with careful nursing care and no nursing-related complications occurred, and he was discharged successfully on the 18th day after surgery. Conclusion According to the patient's condition and individual situation, the development of nursing measures can effectively prevent the potential infection, timely discover the changes of the patient′s condition, understand the recovery of the transplanted liver function and observe the related postoperative complications, and help to promote the early recovery of patients.

From among the patients who visited the Dept. of Rehabilitation of West China Hospital for arthalgia in the period from Aug. 2003 to Dec. 2005, we recruited 566 male patients who were over 40 years of age and did not have hyperostosis in the lumbar spine, and whose T scores were each less than--1. Their ages ranged from 40 to 93 years, and the average age was 62.93 +/- 13.50. The dual-energy X-ray absorptiometry from DMS Company in France was used to measure the bone density of the L2-4 anterior-posterior. The basic data about the subjects, containing the age, height, weight, diabetes mellitus, exercise and smoking or not, were recorded. Then the body mass index were calculated. In accordance to the T score, the subjects were separated into two groups: osteopenia group and osteoporosis group. In comparison of the basic data between groups, BMI of osteoporosis group was significantly higher than that of the osteopenia group, but the number of the subjects who exercised was smaller (P < 0.05). Multiple linear regression analysis revealed that in the case BMI increased by 1 kg/m2, BMD significantly decreased by 0.003 g/cm2 (P = 0.002), and the age negatively correlated with BMD (B = -0.001, P = 0.035). "Exercise or not" was positively related to BMD (B = 0.028, P = 0.000). "Smoking or not" and BMD were not significantly correlated (P = 0.837). In conclusion, increase of BMI, or we may say, increase of fat, would decrease the lumbar spine average BMD in the patients of osteoporosis or osteopenia. Some reports have pointed out that only by increasing BMI with increased amount of muscles, but not with increased amount of fat, would be beneficial to the prevention of osteoporosis. So we concluded that the muscle amount in the subjects should be taken into account when we probe into the relation between BMI and BMD.
Adult ; Aged ; Aged, 80 and over ; Body Composition ; Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; metabolism ; Humans ; Lumbar Vertebrae ; metabolism ; Male ; Middle Aged ; Osteoporosis ; metabolism

Exploratory experiment is the key to the experimental physiology,which is universally applicable training of innovative talents.More importantly,it is an important way to cultivate innovative talents of medicine.On the basis of the original multi-subject evaluation system,we have formed a comprehensive evaluation system through refining the scoring item for teachers and students,enriching the forms of student evaluation,and building the student self-assessment.This comprehensive evaluation system is set to promote the development of experimental physiology,especially the exploratory experiments.The practice of this evaluation system effectively improve the objectivity of the evaluation,provide a basis for reform of exploratory experiment,and then promote the training of innovative talents.

Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.