Objective To compare the clinical efficacy of different margins in nephron-sparing operation for patients with small renal cell carcinoma. Methods From September 2008 to April 2013, a total of 64 patients with local renal cell carcinoma (T1a period) and treated with nephron-sparing operation were selected, and the clinic data were analyzed. According to cutting edge size gotten from the surgery, the patients were divided in to A group (cutting edge 1-5 mm group, 30 cases) and B group (cutting edge 6-10 mm group, 34 cases). The operation condition and recurrence rate and survival rate of two groups were compared. Results The operative time in A group was significantly shorter than that in B group:(130.1 ± 24.0) min vs. (152.3 ± 28.0) min, P<0.05. The drainage time and the level of serum creatinine in two groups had no significant differences (P>0.05). The 3-year recurrence rate and 3-year survival rate in two groups had no significant differences (P>0.05). Conclusions The clinical efficacy of different margins in nephron-sparing operation for small renal cell carcinoma is similar. But 1- 5 mm cutting edge size nephron-sparing operation has less complications, and the recurrence rate and survival rate does not increase. It is worthy of spread .

[Objective]To observe the clinical results of percutaneous vertebroplasty in the treatment of painful osteoporotic thoracolumbar vertebral body compression fractures in old people.[Method]Six cases of PVP and 2 cases of kyphoplasty were performed with polymethylmethacrylate(PMMA) through unipedicular or bipedicular under C-arm fluoroscopy.[Result]No leakage of PMMA was found in the operation,the pain was clearly relieved or disappeared postoperatively,no severe complication occurred.[Conclusion]PVP is safe,effective and enconomical in the treatment of painful osteoporotic thoracolumbar vertebral body compression fracture.

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.

ObjectiveTo assess the recent effect of the invasiveness and transsphenoidal microsurgical operation in the treatment of growth hormone-secreting adenom tumor.MethodsThe data of 22 patients with growth hormone(GH) adenomas were collected.All patients were tested preoperative GH level and that within the first 3 days,30 days following surgery.The invasiveness of pituitary adenomas was judged according to Hardy's classification scheme modified by Wilson.ResultsThere were 22 patients with GH-secreting pituitary adenomas,8 males and 14 females,11 patients with invasive adenomas and 11 patients with noninvasive adenomas.The remission rate between the patients with invasive adenomas and the patients with non-invasive adenomas had no statistically significant difference (P ＞ 0.05 ).The postoperative remission rate of patients with GH values ≤ 50μg/L was no significantly lower than that of ＞ 50μg/L( P ＞ 0.05).ConclusionThe recent effects of operation were not significantly different with the invasiveness of tumor.

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 investigate the effects of tranexamic acid (TXA) on perioperative blood loss,D-Dimer and fibrinogen (FIB) in total knee arthroplasty (TKA).Methods A prospective study,from December 2016 to November 2017 patients with end-stage knee osteoarthritis underwent unilateral TKA were randomly divided into two groups.Patients in treatment group received two doses of 15 mg/kg TXA by intravenous inffusion 1 hour pre-operation and before the release of tourniquet;the control group was replaced with the same amount of saline.The preoperative and 3 days post-operation hemoglobin,hematocrit value,drainage,blood transfusion were recorded.The D-Dimer and FIB were dynamically monitored before operation and 1,3,7,14 d after the operation.And there were also observations for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler ultrasonography 14 days after operation.Results The drainage and the total blood loss in treatment group was significantly less than in control group (P ＜ 0.01,P ＜ 0.05).The volume of both allogeneic and autologous blood transfusion in treatment group were significantly less than those in the control group (P ＜0.01).The ratio of allogenic blood transfusion was 14.6％ (6/41) in treatment group,38.1％ (16/42) in control group (P ＜ 0.01).D-dimer at 1,3d post-operation in treatment group was significantly lower than that in the control group (P ＜0.05),but the difference was getting smaller at 7,14d post-operation (P ＞0.05).FIB at any time point between the two groups was no significant difference (P ＞ 0.05).There was no symptomatic deep venous thrombosis (DVT) in all of the three groups within 14 days.Conclusions The TXA infused intravenous can significantly decrease drainage,the total blood loss and blood transfusion without increasing risk for DVT in TKA.but early post-operation TXA could affect the level of D-dimer,thus affecting the value of early warning of DVT.

Objective To summarize the clinical experience of small-for-size graft of pediatric donor liver transplantation in the treatment of acute liver failure in an adult recipient. Methods Clinical data of application of small-for-size graft of pediatric donor liver transplantation in an adult recipient was retrospectively analyzed and literature review was performed. Results The pediatric donor was aged 4.5 years old and the weight of donor liver from donation after brain death was 544.6 g. The body mass of recipient was 52 kg. The graft-to-recipient weight ratio was 1.05%. The classic orthotopic liver transplantation was performed. Postoperative recovery was not satisfying. The recipient suffered from brain edema, stress gastrointestinal bleeding, acute kidney injury, small-for-size liver syndrome, atelectasis, lung infection, fungal infection, abdominal infection, pleural effusion and other postoperative complications. After symptomatic and comprehensive treatment, the function of liver graft was gradually restored and regenerated to the normal size of adult liver at postoperative 2 to 3 weeks. The patient was discharged after 102 d hospitalization. During the follow-up at postoperative 10 months, the liver function was evaluated normal and the quality of life was favorable. Conclusions Pediatric small-for-size donor livers can be successfully transplanted to the adult recipients. Nevertheless, it is necessary to select the appropriate recipients, surgical methods and fine perioperative management according to the conditions of the donor livers.

Objective To investigate the clinical effect of arthroscopy-assisted percutaneous cannulated screw fixation for Ideberg Ⅲ glenoid fractures.Methods A retrospective case series study was conducted to analyze the clinical data of 28 patients with Ideberg Ⅲ glenoid fracture admitted to the Honghui Hospital Mfiliated to Medical College of Xi'an Jiaotong University from January 2014 to January 2017.There were 19 males and nine females,aged 20-49 years [(32.5 ± 3.5)years].All patients were classified as Ideberg Ⅲ glenoid fractures.All patients were treated with arthroscopy-assisted percutaneous cannulated screw fixation.The length of incision,complications and range of motion of shoulder joint were recorded.The shoulder function was evaluated by University of California at Los Angeles (UCLA) score and visual analogue score (VAS) before and after operation.Results All patients were followed up for 24-36 months [(25.6-± 4.5) months].The incision ranged from 2.0 cm to 3.7 cm [(2.3 ± 0.8) cm].No infection,re-displacement or nonunion occurred.One year after operation,the results of range of motion were as follows:anterior flexion (160.7 ± 5.5)°,abduction (150.8 ± 6.8)°,and external rotation (38.4 ± 7.5) °.The mean UCLA score was increased from preoperative (7.2 ± 1.2) points to (33.5 ± 3.2) points (P ＜ 0.05),and the mean VAS score was decreased from preoperative (7.8 ± 3.2) points to (1.3 ± 0.5) points (P ＜ 0.05).Conclusion For Ideberg Ⅲ glenoid fractures arthroscopyassisted percutaneous cannulated screw fixation can relieve the pain and reduce complications,which is beneficial to the recovery of shoulder function.

Objective To summarize the experience of complex hepatic artery reconstruction in orthotopic liver transplantation. Methods Clinical data of 7 liver transplantation recipients who underwent complex hepatic artery reconstruction from January 2015 to March 2019 were retrospectively analyzed. Among them, 4 recipients received classical liver transplantation and 3 cases underwent piggyback liver transplantation. Intraoperative general conditions including anhepatic phase, intraoperative blood loss, hepatic artery anastomosis time and operation time of the recipients were recorded. The clinical prognosis and complications were observed. Results In two donors, variant right hepatic artery was used for vascular reconstruction. The celiac trunk or the common hepatic artery of the donors was anastomosed with the common hepatic artery of the recipients. Iliac artery bypass was employed in 2 cases, and then the hepatic artery of the donors was anastomosed with the abdominal aorta of the recipients. The superior mesenteric artery of 1 donor was end-to-end anastomosed with the common hepatic artery of the recipient. The celiac trunk of 1 donor was anastomosed with the splenic artery of the recipient. Only 1 case was required to undergo secondary liver transplantation due to acute hepatic artery thrombosis after hepatic artery anastomosis. All the 6 recipients successfully completed the liver transplantation. No perioperative death was observed. The anhepatic phase endured from 49 to 77 min. The intraoperative blood loss was ranged from 300 to 1 500 mL. The anastomosis time of hepatic artery was 23-56 min. The operation time was ranged from 5.3 to 11.1 h. The length of postoperative hospital stay was 23-56 d. Neither hepatic artery thrombosis nor stenosis occurred. The liver function of all recipients was basically restored to normal within postoperative 2 weeks. No severe surgical complications occurred. The liver graft achieved excellent function. Conclusions Appropriate identification of the hepatic artery variation, proper management of liver artery of the donors and recipients and reconstructing the blood supply of liver graft are the crucial procedures of liver transplantation.

Objective To analyze the risk factors of multi-drug resistant organism (MDRO) infection after liver transplantation. Methods The clinical data of 77 recipients undergoing liver transplantation were retrospectively analyzed. According to the incidence of MDRO infection, all recipients were divided into the non-MDRO infection group (n=51) and MDRO infection group (n=26). The infection rate and strain distribution of MDRO in liver transplant recipients were summarized. The risk factors of MDRO infection in liver transplant recipients were identified. Clinical prognosis of all recipients was statistically compared between two groups. Results The infection rate of MDRO after liver transplantation was 34% (26/77), mainly carbapenem-resistant MDRO infection. The main sites of infection included lung, abdominal cavity and incision. Univariate analysis showed that postoperative tracheal intubation ≥48 h, length of intensive care unit (ICU) stay ≥72 h, length of hospital stay ≥30 d, re-operation, continuous renal replacement therapy (CRRT) and tacrolimus (Tac) blood concentration ≥15 ng/mL were the risk factors for MDRO infection after liver transplantation. Cox regression analysis indicated that postoperative tracheal intubation≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL were the independent risk factors for MDRO infection after liver transplantation. The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26) vs. 10%(5/51), P=0.01]. Conclusions Postoperative tracheal intubation ≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL may increase the risk of MDRO infection after liver transplantation and affect clinical prognosis of the recipients.