In order to evaluate the pharmacokinetic profile of cefotiam hexetil hydrochloride tablet in Chinese healthy volunteers, a sensitive, specific and rapidprotein precipitation-liquid chromatography-tandem mass spectrometry method was developed and validated in human plasma. Chromatographic separation was achieved on a Waters Symmtry-C18 column (50 mm × 4. 6 mm, 5 μm), using a gradient mobile phase consisting of methanol and 1 mmol/ L ammonium acetate in water at a flow rate of 1. 0 mL/ min. Cefotiam and diazepam (internal standard) were detected without interference in the multiple reaction monitoring (MRM) mode with positive electrospray ionization. The calibration curve was linear from 5. 0 ng / mL to 5000 ng / mL (r>0. 99) with limit of quantitation of 5. 0 ng / mL. The assay met the published acceptance criteria. This rapid, sensitive and reproducible method was successfully applied to the pharmacokinetic study of cefotiam hexetil hydrochloride tablet in healthy Chinese volunteers and therefore provided a considerable mirror for quantification of other cephalosporins in human matrix.

We herein overviewed the history,achievement and plan of the twelfth-five program for the development of key medical disciplines in Zhejiang Province.We summarized the practice and characteristics of establishing of the key medical discipline in the Zhejiang Province,and a systemic survey was conducted on the effectiveness of the program.We then proposed several improvements strategies including academic training,multidiscipline coordination,and fund managements to eventually establish the new pattern of discipline development.

Objective To discuss the reasons,surgical procedures and prognosis of multiple-operations for intra-and extrahepatic cholangiolithiasis.Methods The retrospective cohort study was adopted.The clinical data of 85 patients with intra-and extrahepatic cholangiolithiasis who underwent multiple-operations at the Second Affiliated Hospital of Anhui Medical University from January 2006 to January 2015 were collected.Individualized operations were determined according to the distribution of stones and liver functional reserve,including stones removal by incising bile duct and external biliary drainage,Roux-en-Y hepaticojejunostomy and hepatolobectomy or segmental hepatectomy.The treatment followed the principles as complete removal of stones,complete resection of lesions,correction of stenosis and adequate drainage.Bile was extracted during operation for bacilli culture.Patients received the postoperative symptomatic treatments,including anti-inflammation,hemostasis,liver protection,acid inhibition and nutritional support.The observation indicators included reoperation reasons,operation method,operation time,volume of intraoperative blood loss and transfusion,hepatic inflow occlusion,stone clearance rate,postoperative complications and treatments,bacilli culture of bile,results of pathological examination and duration of hospital stay,results of follow-up.The follow-up using outpatient examination and telephone interview was performed to detect postoperative living conditions and results of abdominal ultrasound once every 3 or 6 months in patients without stone residue and once every 1 month in patients with stone residue from postoperative week 6 to December 2015.Measurement data with normal distribution and with skewed distribution were represented as x ± s and M (range),respectively.Results (1) Reasons of reoperation:85 patients had stone residue or recurrence,including 7 combined with stenosis of bilioenteric anastomosis,5 with secondary malignant biliary tumors and 2 with gastrointestinal stromal tumor invading intrahepatic bile duct.(2) Intraoperative status of reoperation:of 85 patients,25 received partial hepatectomy + stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage,21 received partial hepatectomy + stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,13 received stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage,8 received stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,5 received partial hepatectomy + removal of former bilioenteric anastomosis + choledochoscopy exploration + T-tube drainage,4 received former intestinal Y-loop resection + stones removal by choledochoscopy + Roux-en-Y hepaticojejunostomy,3 received stones removal by incising intrahepatic bile duct + choledochoscopy exploration + T-tube drainage,3 received partial hepatectomy + residual gallbladder resection + stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,2 received partial hepatectomy + residual gallbladder resection + stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage and 1 received residual gallbladder resection + removal of former bilioenteric anastomosis + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy.Operation time and volume of intraoperative blood loss of the 85 patients were (259 ± 66) minutes and (180 ± 142) mL,respectively.Seven patients underwent intraoperative blood transfusion and 17 underwent first hepatic hilum occlusion.ALl the 85 patients received intraoperative choledochoscopy exploration.The immediate and final stone clearance rates were 62.4％ (53/85) and 87.0％ (67/77).(3) Postoperative status of reoperations:of 85 patients,45 had postoperative complications.Sixteen patients with incision infection were improved by wound drainage and dressing,anti-infection and supporting treatments without other treatments.Ten patients with pleural effusion were out of hospital after effective anti-infection and nutritional support treatments.Eight patients with biliary fistula were discharged from hospital after abdominal drainage.Six patients with incision infection combined with pleural effusion were discharged from hospital after wound drainage and dressing,anti-infection and nutritional support treatments.Among 5 patients with bile duct bleeding,1 was self-healing,1 underwent reoperation and 3 were improved by conservative treatment.The bacilli culture of bile in 68 patients was positive,and bacteria mainly consisted of Escherichia coli,Enterobacter cloacae,Pseudomonas aeruginosa and Klebsiella pneumoniae.Of 85 patients,78,5 and 2 patients were respectively confirmed with hepatolithiasis,bile duct cell adenocarcinoma combined with stone recurrence and choledocholithiasis combined with interstitialoma by pathological examination.Duration of hospital stay was (21 ±8)days.(4) Results of follow-up:77 patients were followed up for a median time of 32 months (range,6-108 months) with an overall follow-up rate of 90.6％ (77/85).During follow-up,50 patients had good survival,27 had poor survival including 11 with stone residue,9 with stone recurrence and 7 with bile duct canceration,and 7 died of no operation of secondary tumors.Conclusions Stone residue and recurrence are the main reasons for reoperation.The individualized surgical methods are determined according to preoperative stone distribution,with or without atrophy of liver lobe,with or without canceration and condition of liver function,which can increase the stone clerance rate,reduce the stone residue and recurrence rates and avoid reoperation.

Objective To analyze the correlation between LC-MS/MS method and enzymatic cycling assay for determination of homocysteine concentration in human serum,and the application of two methods in the determination of homocysteine concentration.Methods Homocysteine concentrations of 63 serum samples were collected and determined by LC-MS/MS method and enzymatic cycling assay,respectively.The correlation between the concentrations by different methods was analyzed and evaluated.Results The concentrations were(19.11 ± 15.69) μmol/L by LC-MS/MS method and(16.95 ± 14.41) μmol/L by enzymatic cycling assay,the P value evaluated by paired-samples T test showed that there was statistical difference among the concentrations determined by two different methods (t =6.25,P ＜ 0.05).The conversion formula was YLC-MS/MS method =1.074Xenzymatic cycling assay + 0.892,R =0.987.Conclusion There is good correlation between LC-MS/MS method and enzymatic cycling assay for the determination of homocysteine concentration in serum,providing a theoretical basis for estimating the concentrations in the same serum sample by the two methods.

Objective To evaluate the clinical effectiveness of laparoscopic (LDP) versus open distal pancreatectomy (ODP) using meta-analysis.Methods Comprehensive literature search was conducted on articles only in English published from 2006 to 2012 on MEDLINE,EMbase,Cochrane Central Registry of Controlled Trials to compare LDP with ODP for Pancreatic disease.Data were extracted and evaluated by two reviewers independently.The quality of the included trials was evaluated.Meta-analyses were conducted using the Cochrane Collaboration's RevMan 5.1 software.Results Fourteen controlled clinical trials (n=1417) were included.The LDP group was significantly longer than the ODP group in operation time,and was significantly larger in the number of patients with spleen preservation [(MD-273.10,95％ CI-354.39-191.081,P＜0.01),(OR 2.42,95％ CI 1.78-3.30,P＜0.01) respectively].The LDP group was significantly less than the ODP group in intraoperative blood loss,time to oral intake,and length of hospital stay [(MD-273.10,95％ CI -354.39-191.81,P＜0.01),(MD-1.78,95％ CI-2.36-1.20,P＜0.01),(MD-3.15,95％ CI-3.97-2.33,P＜0.01) respectively].There were no significant differences in blood transfusion,pancreatic fistula rate,and mortality between the two groups.Conclusions LDP is feasible and safe in treating pancreatic disease.When compared with ODP,LDP has the advantages of having less intraoperative blood loss,quicker recovery and more patients with spleen preservation.

Objective To sum up our experience on the diagnosis and treatment of rare hepatic tumors. Methods The data of 25 patients with rare liver tumors admitted in our hospital from May 2005 to January 2010 were analyzed retrospectively. Results The final pathologic diagnosis of focal nodular hyperplasia was made in 6 cases, and the diagnosis of vascular leiomyoma, hilar neurilemoma, intrahepatic aneurysm, biliary cystadenoma, hepatic hamartoma, biliary villous adenoma, and hepatic diffuse large B-cell lymphoma was established in one each case, respectively. The diagnosis of angiomyolipoma in 2patients, primary liver gastroimestinal stromal tumor in 2 patients, hepatoblastoma in 5 patients and liver undifferentiated sarcoma in 3 patients was established. Preoperative ultrasonography, CT and MRI were performed in 24, 22 and 6 patients respectively. Preoperative tentative diagnosis was finally confirmed by pathology in only 3 (16.7%) cases, all by CT report. Preoperative diagnosis was consistent with postoperative pathology in 5 patients (20%); All patients underwent liver resection including hemihepatectomy in 7 patients, hepatic lobectomy in 7 patients, segmentectomy in 9 patients and tumor enucleation in 2 patients; There was no recurrence after resection of benign, low malignant tumors and hepatic diffuse large B-cell lymphoma; Postoperative follow-up was made for all the 5 cases of malignant tumours, and there was recurrence in 3 cases. These 3 eases underwent second resection and there were no recurrences after reoperation. The two recurrent patients died with a mean survival of 4 months.Conclusions The preoperative correct imaging diagnostic rate for rare hepatic tumors is low. Surgery is the most effective therapy and reoperation should always be attempted for tumor recurrence in order to prolong survival.

Objective To investigate the effect of postoperative prophylactic transcatheter arterial Chemoembolization(TACE) on preventing recurrence in 54 high-risk patients with hepatocellular carcinoma.Methods These 54 HCC cases were greded as high risk for recurrence and put on close follow up after radical resection.Risk factors included tumor thrombus,cancer satellite or multiple cancer nodules,postoperative high AFP level.Among them 42 cage (target group) received TACE,in which liver function was of Child A,and hepatitis virus replication was controlled in 1000 copies/ml.12 cases(centrol group) didn't receive TACE.The recurrent rate of HCC was compared between the cases with prophylactic TACE and those without through two years of follow-up. Result The recurrence rate of HCC was significantly lower in the cases with prophylactic TACE(19.O%) than those without(50%) within 1 year after the radical operation,and 2 years (52.3% vs 83.3%). Conclusion Postoperative TACE contributes to reducing the short-term HCC recurrence rate.

Objective To comparative evaluation the application value of high frequency ultrasound (HFU)and magnetic reso-nance imaging (MRI)in the diagnosis of rotator cuff tears(RCT).Methods 86 patients of unilateral RCT confirmed by shoulder ar-throscopy were chosen.The detection rate by HFU and MRI before the surgery was compared.Shoulder arthroscopic finding was as the evaluation standard,the accuracy of HFU and MRI in the diagnosis of RCT was calculated which included:total (full and partial) RCT,full RCT,partial RCT.Chi-square test was used to compare the accuracy rate.Results Among 86 patients,30 patients with full RCT and 56 patients with partial RCT were detected by shoulder arthroscopy,in which 28 patients with full RCT and 43 patients with partial RCT were found by HFU,and 28 patients with full RCT and 5 1 patients with partial RCT were found by MRI respec-tively.The accuracy of HFU and MRI in the diagnosis of total,full,partial tear RCT were 82.6%,93.3%,76.8% and 91.9%,93.3%, 91.6% respectively.There was no significant difference between HFU and MRI in diagnosing total and full RCT(P >0.05),the ac-curacy on HFU in diagnosing partial RCT was slightly lower than that on MRI (P <0.05).Conclusion Both HFU and MRI have relatively high accuracy in diagnosing full RCT,HFU is slightly lower than MRI in diagnosing partial RCT.

Objective To investigate the treatment measures of having trigeminocardiac reflex (TCR) for the primary trigeminal neuralgia via microvascular decompression.Methods From January 2016 to December 2016,the clinical data and anesthesia records of 79 consecutive patients with primary trigeminal neuralgia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and treated the first craniotomy microvascular decompression were analyzed retrospectively.They were divided into a no TCR group (n=63) and a TCR group (n=16) according to the intraoperative anesthesia monitoring.The differences of baseline conditions,preoperative complications and pain involved the trigeminal nerve branches were compared between the two groups.The treatment measures and short-term prognosis of the patients with TCR during operation were summarized.Results (1) The proportion of hypertension in the TCR group was 31.2％ (n=5),it was higher than 7.9％ in the no TCR group (n=5).There was significant difference (χ2=6.273,P<0.05).(2) During the operation of microvascular decompression,16 patients in the TCR group had 19-time TCR.The baseline heart rate was 74±10/min before operation,and the heart rate decreased to 51±6/min at onset of TCR.The mean baseline arterial blood pressure was 102±13 mmHg,and the mean arterial blood pressure decreased to 74±8 mmHg at the onset of TCR.There was significant difference (P<0.05).(3) After the onset of TCR,the operation of was stopped,heart rate and the blood pressure recovered spontaneously (n=4).Fifteen patients were treated with medications,including using atropine (12 times,dose 0.2-0.5 mg) and ephedrine hydrochloride (3 times,dose 5-10 mg).Heart rate and blood pressure returned to the baseline level within 20 seconds or 20 seconds after administration of medications.There was no TCR-related cardiac complication or neurological deficit from after procedure to before discharge.Conclusions In microvascular decompression of primary trigeminal neuralgia,if TCR occurs,the selective use of anticholinergic agents or vasoactive agents is needed as early as possible.The risk factors for the occurrence of TCR need to be further verified.

Objective To analyze the surgical treatment of pancreatic duct stones.Methods The clinical data of 46 patients with pancreatic duct stones treated in our hospital from January 2008 to January 2013 were retrospectively analyzed.Results The most common symptoms were abdominal pain in 42 patients,diarrhea in 4 patients,diabetes in 6 patients,increased level of amylase in 4 patients,high level of CA19-9 in 9 patients and concomitant pancreatic cancer in 5 patients.4 patients had history of acute pancreatitis.All patients were diagnosed with pancreatic duct stones by preoperative imaging.The stones were located in the head of the pancreas in 21 cases,in pancreatic body and tail in 17 cases,and in the whole length of the pancreas in 8 cases.7 cases had single stone,28 cases had 2 to 3 stones,and 11 cases had more than three stones.21 cases had stones with a maximum diameter more than 1.0 cm,and 25 cases with a maximum diameter less than 1.0 cm.Pancreatic lithotomy plus pancreaticojejunostomy was performed in 33 cases,pancreatoduodenectomy in 8 and resection of the body and tail of pancreas plus splenectomy in 5 cases.6(13.0％) patients had postoperative complications,and there was no mortality.3(6.5％) patients had postoperative residual stones.39 cases were followed up with follow-up time ranging from 3 months to 57 months.Pain relief rate was 85.7％,Stone occurred in 2 (4.3％) patients.Conclusions Surgery is an important treatment for pancreatic duct stones,and treatments should be adopted based on the situations of individual patients.