Objective To identify the changes of mesenteric lymph fluid in cases of uncontrolled hemor-rhagic shock (UHS), which is most often occurred in modem trauma and battle injury. The lymph of gut plays an important role during shock and MODS. The objective of this experiment is to identify the change of mesenteric lymph fluid in UHS. Method Thirty-eight SD rats were canulated with PE 50 catheters separately into right carotid artery,left femoral artery and femoral vein. A serf-made steel catheter was inserted into main mesenteric lymph duct and the mesenteric lymph fluid was collected. The rots were divided into three groups: control group (n=10), controlled hemorrhagic shock (CHS) group (n=10) and UHS group (n=10). After the mean blood pressure was dropped to 40 mmHg by exsanguination, hemorrhage was made by amputation of 75% tail in length and let the stump keep open to bleed. The volume of mesenteric lymph fluid was recorded, and the protein and endotoxin in it were examined, too. Data were analyzed using ANOVA and Chi-square test. Results The mesenteric lymph fluid was decreasing remarkably during shock until it was below 1/4 of normal. After hemorrhage was controlled, the mesentefic lymph fluid increased slowly. However, it kept decreasing persistently in cases of UHS. So did the protein content. The eudotoxin in lymph fluid increased 2 hours after CHS and one hour after UHS. There was significant difference in endotoxin between CHS and UHS 2 hours after shock (P<0.05). Con-dusions The volume and protein content of mesenteric lymph fluid decreased mare significantly in UHS than that in CHS. And contrarily, the endotoxin in lymph fluid increased more significantly in UHS than that in CHS. The change of the mesenteric lymph fluid may be an important cause of MODS after UHS.

Objective To study the early resuscitation with intravenous administration of liquor in uncontrolled hemorrhagic shock model by four-staged abdominal aorta injury in rats in order to settle the controversy over the issue of volume resuscitation.Method Forty Sprague-Dawley rats were canulated with catheters into the left ventricle,femoral artery and femoral vein,respectively.Animals were subjected to vaseular injury of infrarenal pierced with a 25G needle leading to uncontrolled hemorrhagic shock.After aorta injury,the models were processed into 4 stages:early injured stage,early rescue stage,delayed rescue stage and observation stage.The rescue with rapid infusion of 45 ml/kg lactated Ringer's solution in 15 minutes in the early stage and the followed rescue in the late stage;and(4)sham-rescued.The MAP,CVP,lactic acid and Hct were monitored.The volume of blood loss and the survival time of rats were recorded too.Results After aorta injury,The MAP dropped from 94.3 mmHg to 25.8 mmHg and rised quickly after early resuscitation with rapid infusion of liquor and then again fell soon,and CVP did likewise.Lactic acid was increased and reached 3-4 times of baseline at 4 h in all group except Sham-resuced group.The Hct levels decreased quickly after resuscitation with liquor in early rescue stage and delayed rescue stage.The blood loss in abdomen increased after rapid infusion of lactated Ringer's solution in early rescue stage(blood loss increased from 22.8 ml/kg to 27.7ml/kg,P＜0.05).There Was no significant difference in mortality between those groups.Conclusions Rapid volume resuscitation at early stage of abdominal aorta injured with uncontrolled hemorrhagic shock cannot increase the circulatory blood volume for maintaining stable blood pressure norminimize the elevation of blood lactic acid.On the contrary,resuscitation with rapid administration of liquor at early stage can enhance blood loss and decrease the level of Hct.The survival time and survival rate can't be increased by early rescue with rapid liquor infusion.

Objective To establish an abdominal-trauma-induced uncontrolled hemorrhagic shock (UHS) model, and explore the effect of staged resuscitation. Methods Indwelling catheters were inserted into left ventricle, femoral artery and femoral vein of 50 Sprague-Dawley rats, and then laparotomy was performed. 42 out of the 50 animals were subjected to vascular injury to simulate UHS by infra-renal arterial puncture with 25G needles, and the model was successfully established in 32 rats, for which the animals were divided into 3 groups: control group (n=10), with no resuscitation; hospital-resuscitation group (n=11), resuscitated in early injured stage; and staged-resuscitation group (n=11), resuscitated pre-hospital and then in-hospital. 8 out of the 50 rats, which were not subjected to vascular injury, served as sham-operated group. The mean aortic pressure (MAP), central venous pressure (CVP), serum lactic acid, alanine aminotransferase (ALT) and creatinine (Cr) were determined, and the volume of blood loss and survival time were recorded. Results The MAP decreased from 94.7mmHg to 28.9mmHg 15min after aortic injury in control group and rose slowly after continuous transfusion in staged-resuscitation group. Similar change was found in CVP. Serum lactic acid, ALT and Cr were increased in control group and hospital-resuscitation group at early injured stage, but the increase was delayed in staged-resuscitation group. The mean survival time in control group, hospital-resuscitation group and staged-resuscitation group were 76, 846 and 2480 min, respectively. The 72 h mortalities of the three groups were 100%, 72.7% and 36.4%, respectively. Conclusion Staged resuscitation which is characterized by slowly continuous transfusion at early aid stage cannot increase the blood pressure and circulating blood volume to normal level in UHS, but can reduce the level of serum lactic acid, ALT and Cr, and dose not increase the blood loss. The survival rate and mean survival time can be increased by this method.

0.05.3 year survival rate was 36.67%(A) and 57.14%(B),P

Objective To study the pattern of cellular proliferation and apoptosis in different part of colorectal cancer and its relation to patients' prognosis. Methods The expression of PCNA and Fas protein were investigated by immunohistochemistry in cancer mucosa, cancer adjacent mucosa and cancer distant mucosa of 76 cases of colorectal cancer, and the patients prognosis were investigated too. Results The PCNA expression in cancer mucosa is significantly higher than that in cancer adjacent tissue(P

Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.

Objective To investigate the consumption rate of non-iodized salt,and evaluate the iodine status and goiter prevalence among school children in high water iodine areas of Henan Province from 2014 to 2015.Methods In the 20 counties with high water iodine,one township was randomly selected from each location (east,west,south,north and middle) in each county;secondly,4 villages were selected from each chosen township;thirdly,15 households were selected to collect salt samples from each chosen village.In the 10 chosen counties,one village with high water iodine was selected and water samples were collected;one school was sequentially selected from the chosen village and 100 school children aged 8-10 were chosen to collect their urine samples and measure their thyroid volume.Salt iodine was tested by semi-quantitative method;iodine contents of urine and water were tested by arsenic cerium catalytic spectrophometry;thyroid volume was measured by ultrasound method.Results In the 20 counties with high water iodine,4 440 salt samples were collected and tested both in 2014 and 2015;the rates of non-iodized salt were 98.2％ (4 363/4 440) in 2014 and 98.3％ (4 366/4 440) in 2015.In the 10 chosen counties,the median water iodine contents from the chosen villages were 202.0 μg/L in 2014 and 235.0 μg/L in 2015;970and 999 urine samples of the students from the chosen villages were collected and tested in 2014 and 2015,and the median urinary iodine contents were 251.9 μg/L in 2014 and 290.6 μg/L in 2015;937 and 948 students were examined in 2014 and 2015,the goiter rates were 3.4％ (32/937) in 2014 and 7.8％ (74/948) in 2015.Stratified by water iodine,the urinary iodine contents and goiter rates of school children increased with the rise of water iodine content.When the water iodine content exceeded 300 μg/L,goiter rate of school children was 8.4％,which was higher than other groups (P ＜ 0.05).Conclusions After stopping the supple of iodized salt in high water iodine areas,the current iodine status and goiter rate of school children are still higher than normal levels.Both noniodized salt supply and water improvement to reduce water iodine content should be taken in the areas with water iodine higher than 150 μg/L.

Objective There are quite a few chemotherapeutic adjuvants for the treatment of advanced oral squamous cell carcinoma, but all have their adverse effects. This study was to evaluate the efficacy and adverse effects of the induction chemotherapy of S?1 plus docetaxel and cisplatin in the treatment of advanced oral squamous cell carcinoma. Methods Totally, 84 patients with advanced oral squamous cell carcinoma were randomly divided into an observation and a control group of equal number, the former trea?ted with S?1 plus docetaxel and cisplatin and the latter with 5?fluorouracil, docetaxel and cisplatinand, both for two cycles ( 1 cycle =21 d) . Then the effects and adverse events were evaluated and compared between the two groups of patients. Results No statistically significant differences were observed in the response rate between the observation and control groups of patients (76.19% vs 73.81%, P>0.05). The incidence rates of adverse events, such as nausea and vomiting (66.67% vs 88.10%, P<0.05) and phlebitis (0 vs 19.05%, P<0.05) , were remarkably lower in the former than in the latter group. Conclusion S?1 plus docetaxel and cisplatin is a reli?able induction chemotherapy with few adverse effects in the treatment of advanced oral squamous cell carcinoma.