Objective To investigate the related factors of encephalopathy following orthotopic liver transplantation (OLT).Methods The clinical data of 128 patients who underwent liver transplantation consecutively between October 2001 and October 2003 were analyzed retrospectively by SPSS 10.0 . All clinical factors were analyzed by Crosstabs or independent-samples t test. A mutivariative analysis of these significant factors was done by using the Binary Logistic Regression.Results Encephalopathy occurred in 21 cases within the first week after operation, including 19 cases of Child-pugh C and 2 cases of Child-pugh B. There was a higher occurrence in the patients with chronic severe hepatitis or undergoing re-transplantation ( P 0.05 ). In the encephalopathy group the incidence of renal failure after transplantation and infection pre- or postoperation was higher than in control group ( P

Objective To improve the rate of early diagnosis and prolong the survival of patients with gallbladder carcinoma.Method Clinical data of 111 cases of primary carcinoma of the gallbladder undergoing surgery from Jan 2002 to Dec 2010 were analyzed retrospectively.Result The preoperative diagnositic rate was 61.3％.Among the 111 cases of primary carcinoma of the gallbladder,22 patients received simple cholecystectomy,47 patients received radical resection,18 patients received extended radical resection,12 patients received palliative operation while the other 12 patients only got biopsy due to widespread intraabdominal metastasis.The 3 years survival rate of the patients was 29.7％ (33/111) while the 5 years survival rate was 9.9％ ( 11/111 ).Conclusions B-ultrasonography and CT are the mainstay for the diagnosis of primary carcinoma of the gallbladder.For those suspected of having the carcinoma,an exploration is recommended.

Desmoid tumor also known as aggressive fibromatosis,are rare fibroblastic tumors which are derived from deep fascia planes or muscuofascia structures.Resectable extra-abdominal and abdominal desmoid tumor should always be treated with the aim of achieving a negative margin through wide radical resection with margins above 2 cm.Ifthis is not feasible,function-sparing surgical resection is suggested.Adjuvant radiation should be considered for patients with positive margins,recirrent tumors or unresectable diseases.Intra-abdominal desmoid tumor is common in patients with familial adenomatous polyposis.It has a high recurring rate after surgical resection and therefore a high dosage of tamoxifen and sulindac are recommended as first-line treatment.Due to the variable nature of the outcome and vague reaction to drug therapy,individualized treatments,including the wait and see policy,has been widely investigated and thought to be a promising strategy for the future.

Objective:To compare the preventive effects of dezocine or parecoxib used alone or combination on emergence pain and agitation in the patients undergoing radical hysterectomy. Methods: Sixty ASA Ⅰ~Ⅱ patients undergoing radical hysterectomy were randomly divided into three groups. At the time of sewing incision, the dezocine group (group D, n=20) received dezocine in-travenous injection at the dosage of 0. 1 mg·kg-1, the parecoxib group (group P, n=20) received parecoxib intravenous injection at the dosage of 0.8 mg·kg-1, and the combination group (group DP, n=20) received 0.1 mg·kg-1dezocine and 0.8 mg·kg-1 parecoxib. When the operation was finished, the patients were transferred to the recovery room with endotracheal tubes, and recovered and extubated without the administration of reversal agents. Visual analogue scale ( VAS) for pain and Aono' s four-point scale for e-mergence agitation ( EA) were measured. The recovery time, extubation time, VAS, degree of EA and side effects such as nausea, vomiting, respiratory depression and hypersomnia during the emergence were also evaluated and recorded. Results:There were no sig-nificant differences in recovery time and extubation time among the three groups (P >0. 05). The VAS score and degree of EA in group DP were lower than that in group D (4. 65 ± 1. 69) and group P (5. 95 ± 1. 82) (P<0. 05), and the VAS score in group D was lower than that in group P (P<0. 05). The incidence of moderate and severe pain during the emergence in group DP (20%) was low-er than that in group D and group P (75% and 85%, respectively, P<0. 05), and that was lower in group D when compared with that in group P(P<0. 05). There were no significant differences in the incidence of degree of EA higher than 3 among the three groups (P>0. 05), and no side effects such as nausea, vomiting, respiratory depression and hypersomnia were detected during the emergence. Conclusion:Intravenous injection of 0. 1 mg·kg-1 dezocine combined with 0. 8 mg·kg-1 parecoxib at the time of sewing incision shows effective analgesia and emergence agitation reduction without obvious complications in the patients undergoing radical hysterecto-my.

OBJECTIVE The status and risk factors of nosocomial infections in intensive care unit(ICU) were investigated to make the intervention strategy. METHODS Use prospective monitoring and retrospective investigation to analyze the 198 nosocomial infections patients. RESULTS The lower respiratory tract infection was the main infection in ICU,about 69.4%.The risk factors were old ages,long hospitalization time,the use of many antibiotics,severe underlying illness,invasive operation manipulation and so on. CONCLUSIONS General intervention strategy should be adopt in the control of ICU nosocomial infections to low the infection rate and raise the rate of rescue.

OBJECTIVE:To explore the role and breakthrough point of clinical pharmacist in the anti-infective therapy for a patient with purulent meningitis. METHODS:Clinical pharmacists provided pharmaceutical care for a patient with purulent meningi-tis,assisted physicians to adjust therapy plan of antibiotics,i.e. anti-infective therapy of vancomycin+ceftriaxone sodium,meropen-em+vancomycin,levofloxacin+vancomycin successively;disposed ADR induced by meropenem and levofloxacin. RESULTS:The physicians adopted the suggestions of clinical pharmacists,the infection symptom had been controlled,and ADR disappeared;and then the patient was discharged from hospital. CONCLUSIONS:Clinical pharmacists provide pharmaceutical care for patient with purulent meningitis,assist the physicians to develop safe and effective anti-infective therapy plan,and dispose ADR timely so as to promote rational drug use in the clinic.

In order to improve the quality of medical record written by pediatric interns, the defects of 535 medical records written by pediatric interns were analyzed. The main reasons affecting the quality of medical record written by pediatric interns were found: writing defects among history of present illness,physical examination and personal history. At present, many factors have caused the deficiencies of medical record writing, such as the factor of low-level teachers, the lag of the teaching management, the particularity of pediatric practice, and students' lack of training in school. So some countermeasures have been suggested:firstly, importance should be attached to the construction of the teaching staff. Measures should be taken to inspire the teachers to work more actively with a serious and responsible attitude. With a solid clinic and teaching skills, teachers can use a variety of methods properly. The management of teaching should be enforced. A variety of means can be used to improve the interns' clinical thinking and language expression ability , to establish and improve the medical quality control system of the interns constantly, to make use of pre job training and education reason-ably, to strengthen the intern's legal ideas, to straight their internship attitude, and to help them to adapt to the pediatric practice environment as soon as possible. At last, measures should be taken to cultivate interns' interrogation, physical examination and patient communication skills actively and reform the school education to meet the needs of clinical development as well.

AIM To investigate the protective effects and mechanisms of TMP on accelerated anti-glomerulus basement membrane(GBM) antibody nephritis of rats. METHODS Model of accelerated anti-GBM nephritis was established in rats and TMP was administrated 120 mg?kg -1 ?d -1 by ip since the day before the model established, consecutively for 15 days. Content of 24h urine protein was detected after model established and rats were killed on d 7 and d 14. Contents of blood urine nitrogen (BUN) and serum creatinine (SCr) were detected. Renal cortex cytoplasm and mitochondria were produced and change of content of lipid peroxidation products malondialdehyde(MDA), activities of glutathione peroxidase(GSH-Px) and catalase(CAT) and superoxide dismutase(SOD) were investigated. RESULTS Compared with model group, TMP group showed significant inhibition in changes of proteinuria and BUN, SCr(P

Prostaglandin (PG) D_2 is one of unsaturated fatty acids with 20 carbon atoms, which is synthesized by PGD synthase (PGDS) in the brain. PGD_2 has been identified to be a sleep-inducing substance that becomes bound to the DP receptor (DPR) exclusively localized on the surface of the basal forebrain, leading to an increase in extracellular adenosine levels there. Through A_ 2A receptors (A_ 2A R), the adenosine activates neurons in the ventrolateral preoptic area (VLPO), a putative sleep center, and inhibits neurons in the histaminergic tuberomammillary nucleus (TMN), a putative wake center, via GABA to induce sleep. Studying the effect and the molecular mechanisms of sleep-induced by PGD_2 would be helpful in the development of novel sleeping drugs for more rational treatment of sleep disorders.

Objective To investigate the efficiency of liver cancer with portal vein tumor thrombus (MPVTT),hepatic artery portal vein fistula (APVS) in patients with hepatic artery chemoembolization (TACE) combined with the clinical value of portal vein stent during treatment with APVS embolization.Methods From January 2012 to October 2014,59 cases of HCC patients who accepted the treatment of TACE + stent in portal vein embolization of + APVS surgery,companied with MPVTT and APVS were ret rospectively analyzed.The liver function,portal vein angiography and pressure at different time points were measured and compared before and after treatment,and follow-up and prognosis were recorded.Results After treatment with albumin,platelets (PLT) levels were higher than those before treatment (P ＜ 0.05),with PT values lower than before treatment (P ＜ 0.05).No statistical significance was found for aspartate aminotransferase (AST),alanine aminotransferase (ALT) before and after treatment (P ＞ 0.05).Stent implantation before and after stent implantation,the portal venous pressure of APVS embolization had signif icant difference (P ＜ 0.05).Portal venous pressure level of stent implantation was lower than before stent implantation (P ＜ 0.05).The portal venous pressure level of APVS embolization was lower than the stent implantation before and after stent implantation (P ＜ 0.05).At the 12 months after treatment,28 cases survived (47.46％);24 months after treatment,11 cases survived (18.64％) of the group;a total of 3 patients was lost to follow-up,the median survival time of the patients 24 months 16.5 months.Conclusions Liver cancer with MPVTT and APVS in the TACE combined with portal vein stent in the treatment process using APVS embolization can further improve the portal vein blood flow,and reduce the pressure of Dortal vein.