Objective To study the relationship between blood lead levels and hearing threshold changes among children. Methods The lead levels in whole blood of 62 children aged 5~7 years were determined by graphite furnance atomic absorption spectrophotometry.The levels of air mediated hearing threshold were determined by Madsen Model DB77 audiometer and headphone at frequencies of 250,500,1 000, 2 000,4 000 and 6 000 Hz. Results The average levels and range of blood lead were 181.97 ?g/L and 39.1~393.6 ?g/L respectively.The spearman correlation analysis revealed a significant positive correlation between the levels of hearing threshold and the blood lead levels with r =0.33~0.74 among childen( P

Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group (nasojejunal group,n = 26)or an asogastric feeding tube nutrition support group (asogastric group,n = 28)according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations (enteral nutritional emulsion,TPF-D)from the second day after admission to intensive care unit (ICU). The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index (albumin and hemoglobin),the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results (1)According to the body weight to calculate calorie demand, the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group (3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d). There was significant difference between the 2 groups (P < 0. 01). The time of the combined parenteral nutrition support in the nasojejunal group was reduced significantly compared with the asogastric group (2. 0 ±0. 8 d vs. 6. 7 ±2. 5 d). There was significant difference between the 2 groups (P <0. 01). (2)At day 30after treatment,the levels of total serum protein and hemoglobin in the nasojejunal group were higher than those of the asogastric group (64 ± 6 g/ L vs. 61 ± 6 g/ L and 120 ± 17 g/ L vs. 106 ± 16 g/ L,respectively. There were significant differences (P < 0. 05). (3)The mean length of stay in the ICU was obviously shorter in nasojejunal group compared with the asogastric group (11 ± 5 d vs. 14 ± 6 d). There was significant difference between the 2 groups (P < 0. 05). (4)There were no significant differences in complications of the patients,such as the incidences of pulmonary infection,hyperglycemia,and diarrhea between the 2 groups (P > 0. 05). Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.

Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.

Objective To investigate the therapeutic effect and safety of plasma exchange in the treatment of patients with severe liver disease in pregnancy. Methods Clinical data of 28 patients with severe liver disease in pregnancy in Surgical Intensive Care Unit (SICU), the Third Afifliated Hospital of Sun Yat-sen University from March 2009 to October 2013 were analyzed retrospectively. According to the therapeutic schedule, the patients were divided into treatment group (n=12, age range:21 to 28 years old, median age:25 years old) and control group (n=16, age range:18 to 29 years old, median age:24 years old). The informed consents of all patients were obtained and the ethical committee approval was received. All patients were transferred to SICU after childbirth and received treatments of anti-infection, anti-virus, liver protection, reducing jaundice, supplying human albumin and gamma globulin, infusing blood coagulation and so on. And patients in treatment group received the treatment of exchange of homotype fresh plasma on the basic of the above treatments. The differences between 2 groups in clinical examination indicators and therapeutic effect were compared. The adverse reactions after plasma exchange in treatment group were observed. The examination indicators of 2 groups were compared using t test and the ratios were compared using Chi-square test. Results The blood total bilirubin (TB), albumin (ALB) , serum creatinine (Scr), fasting blood glucose (FPG) , prothrombin time activity (PTA) and arterial lactic acid (Lac) were (197±69)μmol/L, (30±7)g/L, (111±42)μmol/L, (5.7±2.4)mmol/L, (55±24)%, (2.3±0.6)mmol/L respectively in treatment group and were (299±113)μmol/L, (24±6)g/L, (165±82)μmol/L, (3.7±1.7)mmol/L, (33±11)%, (4.4±1.5)mmol/L respectively in control group. The indicators in treatment group were signiifcantly improved compared with those in control group (t=-3.453, 2.389,-4.892, 2.798, 6.079, -3.339; P<0.05). The effective rate in treatment group (92%,11/12) was signiifcantly higher than that in control group (56%,9/16) ( χ2=4.215, P<0.05). One case in treatment group suffered transitional hypotension after plasma infusion and the blood pressure returned to normal 1 h later after giving a small dose of vasoactive drugs. Conclusions Plasma exchange can improve the clinical examination indicators and therapeutic effect of patients with severe liver disease in pregnancy. It is a safe and effective treatment.

ObjectiveTo investigate the effects of early enteral nutrition on the recovery of patients with severe hepatitis after liver transplantation (LT).MethodsThirty-two patients with severe hepatitis undergoing allogeneic orthotopic LT in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and April 2014 were included in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were randomized into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Among the 14 patients in the enteral nutrition group, all patients were males with the average age of (42±9) years old. Among the 16 patients in the parenteral nutrition group, 14 were males and 2 were females with the average age of (44±10) years old. Patients in the enteral nutrition group were given warm water and lactulose through gastro-jejunal tube 1 d after LT. Enteral nutritional suspension was offered 2 d after LT and gradually increased to 1 000 ml/d, meanwhile, parenteral nutrition was reduced gradually. Patients in the parenteral nutrition group were given parenteral nutrition. Patients in both groups started normal diet after full recovery of the intestinal function. Venous blood was collected before LT and 1, 10 d after LT to examine hepatic and renal function. The recovery of gastroenteric function, hepatic and renal function and incidence of infection were observed 2 weeks after LT. The comparison of the observed indexes of two groups was conducted usingt test or rank-sum test and the rate comparison was conducted using Fisher's exact test.Results The postoperative recovery time of gastroenteric function of the enteral nutrition group was (6.1±1.4) d, which was significantly shorter than (10.6±3.8) of the parenteral nutrition group (t=-4.21,P<0.05). The median ALT, AST, TB, prealbumin and blood urea-nitrogen (BUN) in the enteral nutrition group 10 d after LT were respectively 106 (50-163) U/L, 62 (27-135) U/L, 67 (35-116) μmol/L, 201 (105-389) mg/L and 12.5 (6.4-18.8) mmol/L, and those in the parenteral nutrition group were respectively 276 (46-716) U/L, 119 (33-447) U/L, 131 (89-391) μmol/L, 162 (103-238) mg/L and 26.1(12.9-37.6) mmol/L. Signiifcant difference was observed (Z=-3.76,-3.15,-4.01, 2.93,-3.79;P<0.05). The incidence of infection of the enteral nutrition group 2 weeks after LT was 43% (6/14), which was signiifcantly lower than 69% (11/16) of the parenteral nutrition group (P<0.05). ConclusionCompared with parenteral nutrition, early enteral nutrition after LT may promote the recovery of gastroenteric function, improve the hepatic and renal function and nutritional situation and reduce the incidence of postoperative infection, which is beneficial to postoperative recovery.

ObjectiveTo investigate the infection and drug resistance ofAcinetobacter baumannii in the Third Afifliated Hospital of Sun Yat-sen University.MethodsClinical data of 209 patients infected withAcinetobacter baumanniiin the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and December 2014 were retrospectively analyzed. Among the patients, 160 were males and 49 were females with the average age of (55±18) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The specimen source, ward distribution and drug resistance of Acinetobacter baumannii were observed. The comparison of drug resistance was conducted using Chi-square test and Bonferroni test.ResultsTwo hundred and thirty-six strains ofAcinetobacter baumannii were isolated in the hospital, and most were isolated from Department of Liver Transplantation (50 strains, 21.2%), the next were Department of Rehabilitation (34 strains, 14.4%) and Surgical Intensive Care Unit (SICU) (21 strains, 8.9%). Sputum specimens were the main source ofAcinetobacter baumannii, respectively accouting for 84%, 76% and 71% in the three wards, whereAcinetobacter baumannii had high drug resistance to the common antibiotics used in clinical. The drug resistance rate to sulfamethoxazole ofAcinetobacter baumannii in Department of Liver Transplantation was 76%, signiifcantly higher than 33% of SICU (χ2=11.60,P<0.017).ConclusionsAcinetobacter baumannii is found most in Department of Liver Transplantation, which is followed by Department of Rehabilitation and SICU. Sputum specimen is the main source ofAcinetobacter baumannii.Acinetobacter baumannii detected in the three wards has a high drug resistance to common antibiotics.

Objective To investigate the sexual function and its impact factors in recipients after liver transplantation (LT). Methods Clinical data of 69 recipients undergoing LT in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University from June 2007 to July 2012 were analyzed retrospectively. The informed consents of all recipients were obtained and the ethical committee approval was received. All the recipients were male with age ranging from 30 to 55 years old and a median of 43 years old. The sexual function was normal in all patients before being diseased. The recipients were surveyed using self-designed questionnaire on sexual life quality of liver transplant recipients and direct inquiry. The recipients were divided into sexual dysfunction group (n=23) and intact sexual function group (n=46). The correlation between sexual dysfunction and clinical indexes of the recipients was analyzed. The ratio of two groups was compared by Chi-square test. Results The incidence of sexual dysfunction of liver transplant recipients after operation was 33% (23/69), which was significantly lower than that before operation [88% (61/69) ] (χ2=7.56, P<0.05). The incidence of sexual dysfunction after operation in recipients with chronic severe hepatitis and decompensated liver cirrhosis [49% (17/35)] was significantly higher than those with compensated liver cirrhosis and liver inflammatory granuloma [18% (6/34)] (χ2=4.52, P<0.05). The incidence of sexual dysfunction was significantly higher in recipients who considered that sexual life causing adverse impacts on the liver graft [83% (20/24)], compared with those who considered that sexual life causing no impacts on the liver graft [7% (3/45) (χ2=11.63, P<0.05)]. Conclusions The sexual function of the recipients after LT improved significantly, compared with that before LT. The incidence of sexual function is closely related with the primary diseases and the cognition on sexual life of the recipients.