Objective To investigate indications of thoracoscopic resection of esophageal carcinomas. Methods A total of 75 patients with esophageal carcinomas underwent video-assisted thoracoscopic surgery (VATS) from July 1997 to July 2003. The dissection of the esophagus and radical resection of lymph nodes were performed using a right-sided VATS approach. Then the stomach was dissociated through an upper-abdominal incision and was pulled up for esophago-gastric anastomosis in the left neck. Results A conversion to open surgery was required in 3 patients, in 2 of whom the tumors had enroded into the hilum and the posterior wall of the heart, and in 1 of whom the azygous vein was ruptured. The operation time was 160~220 min, with the intrathoracic operation time accounting for 60~90 min. The postoperative blood loss was 300~400 ml. No surgery-related deaths were noted. Postoperative complications included 1 case of volvulus of stomach, 2 cases of anastomotic leakage, 1 case of anastomotic stenosis, and 1 case of chylothorax. Follow-up checkups in 60 patients for 3 months ~ 7 years (mean, 4 years) found 2 cases of supraclavicular lymph node metastasis and 1 case of abdominal lymph node metastasis. The 1-, 3- and 5-year survival rates were 85.0% (51/60), 51.7% (31/60) and 40.0% (24/60), respectively. Conclusions Video-assisted thoracoscopic resection of esophageal carcinomas is feasibly suited to patients with localized lesions at phaseⅠ or Ⅱ.

Objective To investigate the primary target of injury resulting from cold preservation/reperfusion after liver transplantation in rats. Methods Male SD rats were divided into three groups randomly: sham group,UW 1-h group and UW 12-h group. Orthotopic liver transplantation was performed by using the technique described by Kamada with a modification. Survival rate of rats within 168 h postoperation was observed. Liver tissue specimens and blood samples were collected at 8 time points predetermined as 1,6,12,24,48,72,96 and 168 h postoperation. Six animals were used per time-point. The liver function was evaluated by serum ALT,AST and HA levels. Morphology was observed under light microscopy and TEM. Additionally,the incidence of apoptosis (AI) in hepatocytes and sinusoidal endothelial cells (SECs) were measured separately by TUNEL method.Results The survival rate at 168 h in UW 12-h group was 50 %,significantly lower than that in UW 1-h group (F= 6.39 ,P

Objective To investigate the effects of cold preservation and reperfusion injury on the regen-eration of donor liver and to study the mechanisms. Methods Male SD rats were divided in to sham group (6 rats), UW 1 h group (48 rats) and UW 12 h group (48 rats). Liver tissue specimens were collected at different time points after orthotopic liver transplantation or sham operation. The morphology of liver tissue was observed via light microscope and transmission electron microscope. Proliferation of hepatocytes and sinusoidal endothelial cells (SECs) were assessed by a double immunostaining technique using antibodies against rat endothelial cell antigen-1 and bromodeoxyuridine (BrdU). Expression of vascular endothelial growth factor (VEGF) and its receptors, fins-like tyrosine kinase-1 (flt-1) and fetal liver kinase-1 (flk-1) was evaluated by immunohistochemistry. The mRNA expression of flt-1 was detected by a RT-PCR method. Mean comparison in groups was conducted by one-way ANOVA or t test. Results BrdU labeling indexes of hepatocytes and SECs in UW 12 h group was significantly higher than those in UW 1 h group (F = 61.45,41.4, P < 0.05). The proliferation of hepatocytes peaked at 48 h after operation in both UW 1 h group and UW 12 h group. However, the proliferation of SECs was fallen behind compared to hepatocytes, with a peak appeared at 72 h in UW 1 h group and at 96 h in UW 12 h group, respec-tively. The expression of VEGF was up-regulated in both UW 1 h group and UW 12 h group compared to sham group. Furthermore, expression of flt-1 and flk-1 was found to be mainly limited in SECs, with a peak in expres-sion occurring between 72 h and 96 h, coinciding with the peak in SECs proliferation in UW 1 h group. Conversely, flt-1 was found to be reduced significantly on mRNA level at any time throughout the experiment in UW 12 h group compared to sham group (F = 141.67, P < 0.05). Conclusion Reduced expression of flt-1 results in a retarded regeneration of SECs, and then the recovery of rat donor liver function is delayed after cold-preserved transplantation.

Objective To establish a reproducible and controllable experimental swine model of abdominal multiple organ trauma.Method Fifteen pigs were included in the present study,and the method adopted conformed to the animal ethics.With the self-made explosive device,the electric firecrackers consisting of 0.3g,0.2g and 0.2g black powder were put respectively onto the surface of left lateral lobe of liver,lower pole of spleen and tail of pancreas to produce injuries by explosion.The operation time of exploratory laparotomy and isolation of the organs,blood loss,the maximum diameter and area of injury to the liver and spleen due to explosion,the length and extent of the pancreas that was injured in explosion,as well as the changes in mean arterial pressure(MAP) during the operation were detected and recorded.Finally,the injury severity score(ISS) was calculated.Results The damaged liver area was 9.2?0.3cm2,the maximum diameter of damaged liver was 5.4?0.2cm,the damaged spleen area was 5.2?0.1cm2,the maximum diameter of damaged spleen was 5.6?0.2cm,the damaged pancreas length was 6.3?0.2cm,the time for MAP's to lower by half was 8.8?0.5min,the blood loss for depression of MAP by half was 704.7?14.6ml,the time from injury to death in the first 5 pigs was 25.4?1.8min,ISS was 28.0?0.8.The experimental swine model of abdominal multiple organ trauma was reproduced successfully.Conclusions By using the self-made explosion device and electric firecrackers,the abdominal multiple organ trauma model is reproducible,controllable and stable.It can be generally used in the research of war trauma and traffic accident trauma.

Objective To evaluate the correlation between plasma high sensitivity C reactive protein (hs-CRP) level and global registry of acute coronary events (GRACE) scores,and its predictive value for long-term (5 years) cardiovascular events in middle-aged and elderly patients with acute coronary syndrome (ACS).Methods 138 middle aged and elderly patients with ACS were divided into three groups according to GRACE scores:low risk group,middle risk group,high risk group.And based on quartiles of hs-CRP levels,subjects were segregated into 4 groups (Q1 to Q4).All subjects were followed up for about 5 years and adverse cardiovascular disease events were recorded.Results The hs-CRP level was gradually increased along with increasing risk according to GRACE risk stratification (hs-CRP low risk group,0.09 ± 0.22 ; middle risk group,0.21 ± 0.04 ;high risk group,0.43±0.23,P＜0.001).Meantime,GRACE risk scores were gradually increased along with increasing hs-CRP levels from Q1 to Q4 (Q1:133.0 ± 43.6; Q2:161.9 ± 60.2; Q3:169.3±52.6; Q4:188.4±47.5; all P＜0.001).Regression analysis showed that hs-CRP level was positively correlated with GRACE risk scores (r=0.576,P＜0.001).During a follow-up period of about 5 years,96 cardiovascular events were recorded.Receiver operating characteristic(ROC) curve analysis showed that area under the ROC curve (AUC) of hs-CRP was 0.821 (95 ％CI:0.749-0.892,P＜0.001) and AUC of GRACE risk score was 0.869 (95％CI:0.801 0.938,P＜0.001) in the evaluation of the long-term risk of incident cardiovascular events.The differences in prediction of long-term cardiovascular events in middle-aged and elderly patients with ACS were not significant (P =0.237) between GRACE risk score and hs CRP level.Conclusions Plasma hs-CRP level is positively associated with GRACE score.Both of them can predict long-term adverse cardiovascular events in middle-aged and elderly patients with acute coronary syndrome.

Objective To evaluate Western blot analysis in diagnosing limb-girdle muscular dystrophy type 2A (LGMD2A). Methods The clinical records including their pathological and biochemical results of 4 patients with LGMD type 2 were reviewed. Histochemical and immunohistochemical staining were performed on muscle biopsy specimens from the four patients. The expressions of dysferlin and calpain-3 in muscles were analyzed by Western biol. Results All 4 LGMD patients shared some common clinical features, such as dorsal muscular atrophy of lower limbs and remarkably elevated CK. The immunohistochemical results showed partial or complete deficiency of dysferlin staining in all 4 LGMD patients. However, Western blot revealed that the calpain-3 protein in the muscle of patient 1 was completely absent, who was later diagnosed with LGMD2A. The other 3 patients had complete dysferlin deficiency with reduced calpain-3 expression and they were confirmed to be LGMD2B. Conclusions Western blot analysis of calpain-3 and dysfcrlin can be used to differentiate LGMD2A which shows absence of calpain-3 from other LGMD types which show dysferlin deficiency. Western blot is an invaluable method in clinical diagnosis of LGMD2A.

Objective To explore the effect of reduced glutathione and venous systemic oxygen perfusion on apoptosis and ultrastructure of hepatocytes in rat steatotic liver grafts. Methods Before liver transplantation grade Ⅱ steatotic liver model was established by a diet consisting of 79% standard diet,20% lard and 1% cholesterol for 6 weeks. In pretreatment group, the donor received intraperitoneal injection of reduced glutathione at a dosage of 500 mg/kg/body weight 3 times a day for 2 days, and intrahepatic venous oxygen perfusion for 6 hours while kept in cold preservation. Results Preconditioning measures in steatotic liver grafts significantly decreased the hepatocytes necrosis (38?10)% vs (17?6)%, P

Objective To investigate antibiotics resistant characteristics and carbapenemases genotype of Acinetobacter baumannii in Intensive Care Unit (ICU),so as to provide theoretical basis for clinical prevention and treatment.Methods Retrospective study was made on 90 non-duplicated clinical isolates of Acinetobacter baumannii,which were collected From January 2013 to January 2014 in three tertiary hospitals of Qingdao.All strains were identified by VITEK2 automated microbiology analyzer;K-B method was used to do drug susceptibility test;polymerase chain reaction (PCR) was used to amplify the OXA-23,OXA-24,OXA-51,OXA-58,KPC-2,VIM,IMP genes,and the positive products of genes were sequenced;the chi-square test was used to compare the difference of the resistance rates.Results The detection rate of multi-drug resistant A.baumannii (MDRAB)and Pan-drug resistant A.baumannii (PDRAB)was 61.11% (55/90) and 17.78% (16/90).In the 32 strains of imipenem-resistant Acinetobacter baumannii,the resistant rates to Cefoperazone/sulbactam,Polymyxin B was lower,while the resistant rates to other drugs tested were more than 85%.The difference of the resistance rates to 9 drugs between imipenem resistant group and Imipenem sensitive group were statistically significant (P≤0.05).PCR result showed: 32 strains detected OXA-51 gene,28 strains detected OXA-23 gene,and 3 strains detected VIM gene,the detection rates of which were 100%,87.50% and 9.38% respectively.All strains were not detected OXA-24,OXA-58,KPC-2 and IMP genes.The sequenced results were absolutely homology with the corresponding genes in genbank.Conclusions The resistance of A.baumannii in ICU is serious in this region,especially imipenem-resistant A.baumannii,which were nearly no-sensitive to most of the drugs commonly used in clinical.The gene existence of carbapenemase and carbapenemase producing is one of the main resistance mechanism of Acinetobacter baumannii to carbapenem antibiotics.OXA-23 was the major genotypes in this region.

Objective To investigate the effects of early hemofiltration combined with traditional Chinese medicine on nasal feeding on severe acute pancreatitis (SAP) patients. Methods Seventy four patients were divided into traditional Chinese medicine group (group A, 35 cases) and traditional Chinese medicine+hemofiltration group (group B, 39 cases). In group A, patients were given a serious of procedure including fasting, gastrointestinal decompression, fluid resuscitation, inhi-bition of pancreatic secretion, antibiotic prophylaxis, parenteral nutrition and traditional Chinese medicine on nasal feeding;In group B, patients received continuous veno-venous hemofiltration treatment(also called Continuous Renal Replacement Therapy,CRRT) in addition to the procedures receiving by group A. On admission and the first, 3rd, 7th days post-treatment, the scores of acute physiology and chronic health evaluation (APACHEⅡ), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) levels were recorded. Length of hospital stay, local and systematic complications, surgical inter-vention, mortality and hospitalization expenses were compared between two groups. Results On admission, no statistical significance was seen in the hematocrit, white blood cell count, lactic acid dehydrogenase, blood urea nitrogen, blood glu-cose, APACHEⅡscore, Ranson’s score and classification of etiology between these two groups (P>0.05). But APACHEⅡ, TNF-α, IL-6, IL-8 were decreased significantly in group B than in group A, after the first, 3rd, 7th days post-treatment (P＜0.05). Compared with group A, the length of hospital stay, local complications, systemic complications, surgical interven-tion, mortality and hospitalization expense were lower in group B. Conclusion Traditional Chinese medicine on nasal feed-ing combined with early hemofiltration could effectively reduce complications, incidence of organ dysfunction and could im-prove the prognosis of SAP patients.

Objective To study the radiation dose distribution in the X-ray room,and provide the strategy of radiation protection for the medical staff and the patient’s nursing who had to enter the room while the X-ray was exposing.Methods The thermolumi-nescent dosemeters(TLDs)was placed around the center of the X-ray tube with the same level of the bed.Then,exposure parame-ters,including the X-ray tube voltage value and the field of view,were changed for different groups while exposing.All of the TLDs were taken back to the lab for analysis.Results The differences between the two groups which had the same distance in different di-rections were statistically significant (P <0.01).With the same radiographic condition and direction,the radiation dose on the site of 10 cm from X-ray tube center was the maximum,while the site of 120 cm was the minimum.With the same radiographic condition and distance,the radiation dose on the anode side of the X-ray tube in the room was relative lower,while the site behind the X-ray tube was relative higher.With the same voltage value,distance and direction,the same sites that had the smaller FOV(34 cm×34 cm) received lower radiation dose than those with larger FOV(52.6 cm× 52.6 cm).Meanwhile,the sites with the voltage of 70 kV re-ceived the lower radiation dose than that with the voltage value of 120 kV.Conclusion In the X-ray room,the medical staff and the patient’s nursing can choose the area on the right side(anode side),keep far away from the X-ray tube center,avoid the rear of the X-ray tube and the cathodic direction of the X-ray tube to reduce the radiation dose.