Objective To explore the best plan of perioperative individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods Eighty elderly patients with coronary heart disease undergoing gastrointestinal surgery were divided into experimental group and control group by random digits table method with 40 cases each.Conventional capcity treatment was given during surgery and postoperative period in control group.Individualized fluid therapy was used during surgery and postoperative period in intensive care unit of 24 h in experimental group,which was determined based on target controlled fluid therapy according to the cardiac index,stroke volume,and stroke volume variation.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.The two groups were compared in terms of postoperative hemodynamic parameters,total fluid volume,incidence of adverse cardiac events,and recovery of gastrointestinal function.Results The mean arterial pressure at the beginning of the operation,the cardiac index at operation begining 1 h and at the end of operation were (80.4 ± 6.4) mmHg (1 mmHg =0.133 kPa),(4.0 ± 0.6) L/(min ·m2),(4.1 ± 0.8) L/(min ·m2) in experimental group and (76.9 ± 8.0) mmHg,(3.5 ± 0.4) L/(min· m2),(3.6 ± 0.3) L/(min · mè) in control group,and there were significant differences between two groups (P ＜ 0.05).During surgery and 24±hour stay in intensive care unit,the total fluid volume,crystal usage,urine and colloid usage were (2 915 ± 650),(2 715 ± 415),(1 515 ± 315),(1 225 ± 385),(419 ± 233),(619 ± 285),(1 015 ± 220),(1 535 ± 455) ml in experimental group and (3 645 ±770),(3 355 ±750),(2 315 ±320),(1 855 ±325),(602 ±31),(875 ±423),(805 ±250),(1 135 ± 205) ml in control group,and there were significant differences between two groups (P ＜ 0.05).The perioperative adverse cardiac events rate was 30％ (12/40) in experimental group,lower than 45％ (18/40) in control group,but the difference was no statistically significance (P ＞ 0.05).Conclusion In the elderly patients with coronary artery disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.

BACKGROUND:Previous research has demonstrated human bone marrow mesenchymal stem cells(HMSCs)differentiate into hepatocyte-like cells;however,biological characteristics and differentiation mechanism remain unclear,and differentiation system remains immature.OBJECTIVE:To investigate the feasibility of hepatocyte growth factor(HGF)and epidermal growth factor(EGF)to induce the differentiation of HMSCs into hepatocyte-like cells.METHODS:HMSC5 were obtained from patients with esophageal cancer and were separated by density gradient centrifugation combined with attachment method.The phenotypes of MSCs were identified by flow cytometry.The third-passage HMSCs were divided into four groups:HGF(adding 20 μg/L HGF),EGF(adding 20 μg/L EGF),HGF+EGF,and blank control groups.Morphology was observed using inverted microscope.At days 7 and 14 after induction,α-fetoprotein and albumin mRNA expressions were detected using RT-PCR assay.RESULTS AND CONCLUSION:The HMSCs did not express hematopoietic cell CD34 and CD35,but strongly expressed β1-integrin CD29 and matrix receptor CD44.HMSCs changed from long fusiform shape to polygon or similar round shape in the HGF,EGF,and HGF+EGF groups.At days 7 and 14 after induction,α-fetoprotein and albumin mRNA expressions were positive.However,polygon cells were not observed in the blank control group,and α-fetoprotein and albumin mRNA expressions were negative.This suggested that HGF,EGF,and HGF+EGF could induce the differentiation of HMSCs into hepatocyte-like cells;however,their differentiation ability still needs to be further semi-quantitatively analyzed using immunohistochemical staining.

Objective To summarize our operational experience in using unusual renal allografts.Methods The plastic operations of 326 unusual renal allografts were retrospectively and the renal transplant outcome was compared with 542 normal renal allografts an the same time. Results All the 326 unusual renal allografts were utilized. There was no significant difference between unusual renal allografts and usual ones in average serum creatinine level, acute tubular necrosis (ATN) and the survival rate of renal allgraft after 1 year. There was no complications related to plastic operation during or after kidney transplantation.Conclusions By making good use of various kinds of plastic operation, abnormal or injuried renal allografts can also be used safely without affecting the outcome after renal transplantation.

Objective:To introduce the clinical application of the coil-spring utility arch for orthodontic treatment. Methods:A 35-year-old male patient with mild skeletal anterior crossbite was treated by fixed appliance combined with coil-spring utility arch for 16 months. Cephalometric analysis was conducted before and after treatment.Results:After treatment, the patient's appearance was improved,and the cephalometric analysis showed that SNA increased by 2?,SNB decreased by 1?,ANB increased by 3?,U1-NA increased by 1?,L1-NB increased by 3?.Conclusion:Coil-spring utility arch can expand anterior dental arch continuously and stably.

20% ) were assigned to 2 groups according to study intervention: group A ( n =72) receiving DFPP and group B ( n =41) as controls.Group A was subdivided into 2 groups:group A1 ( n =44) was treated by DFPP alone and group A2 ( n =28) was treated by DFPP plus Dac.The incidence rates of HAR,AR,adverse reaction,patie nt/kidney survival,kidney function were observed. All the patients obtained a fo llow-up ≥12 months. Results In 72 patients of group A ,the level of PRA decreased from (60.5?17.7)% to (19.3?11.2)%,with a mean of (41.2?16.9)% ( P 0.05),with 1 kidney-year survival of 94.4% in group A and 78.0 % in group B ( P 0.05);those of AR were 36.4% and 14.3%,respectively ( P 0.05).No difference in infection episodes an d adverse events between group A and PRA-negative recipients, the same as those between group A1 and A2. Conclusions DFPP can decrease the level of PRA significantly before transplantation by selectively eliminating the sensitive antibody,especially when combined with Dac,which can make sensiti zed recipients get the chance of transplanting and further reduce the incidence of AR.The patient/kidney survival rates of 1 year are satisfactory.Being well to lerated by the sensitized patients,treatment of DFPP combined with Dac is safe a nd effective.

Follicular lymphoma (FL) is a kind of indolent Non-Hodgkin lymphoma (NHL),which stems from follicle germinal center.A lot of research reported the latest development about treatment of FL in the 56th American Society of Hematology (ASH) annual meeting.Effect of radiotherapy for patients at low stage was determined,while the outcomes of clinical trials in which monoclonal antibody (GA101) in combination with chemotherapy for the advanced stage FL were exciting.In rituximab era,relapsed/refractory FL patients who receive stem cell transplantation could acquire preferable remissions.Several novel drugs (inhibitor of BTK or PI3K) for relapsed/refractory FL played a role of guidepost with the progression of corresponding trials.

Objective To study the changes of transport protein Mrp2 excreting bilirubin across the canalicular membrane in obstructive jaundice rats. Methods The Mrp2 transcription and protein levels of hepatocytes was measured by RT PCR and immunofluorescence microscopy in obstructive jaundice rats. A correlation analysis of the transcription and protein levels with TNF ? and serum bilirubin was conducted. Results The Mrp2 transcription and protein levels were significantly lower in hepatocytes following bile duct obstruction and negatively correlated with TNF ? and bilirubin in rat serum. Conclusion Overexpression of inflammatory factor TNF ? may cause downregulation of transcription and protein levels of Mrp2 gene in obstructive jaundice rats. Bilirubin secretion across canalicular membrane can be inhibited. These may lead to or exaggerate hyperbilirubinemia.

Idiopathic pulmonary fibrosis is a diffuse pulmonary fibrosis disease.At present,there are still no effective treatments for this disease,so the prognosis is poor and 5 years of survival rates was only 20%.Bone marrow mesenchymal stem cells(BMSCs),derived from bone marrow,is a kind of multipotent stem cells,which have potential to differentiate into many lineages of cells.So,they are considered to have great latent values in clinic.In recent years,related studies had found that BMSCs might participate in the repair of the lung injury,even they can reverse the pathological progress in idiopathic pulmonary fibrosis.But the mechanism is still unclear and needs more research to elucidate.

Objective To explore the role of multidrug resistance-associated protein 1 (Mrp1) on bilirubin metabolism in rat obstructive jaundiced (OJ) models. Methods Eighty Wistar male rats were randomly divided into three groups: sham operation group in which the common bile duct was educed but not ligated; common bile duct ligation (CBDL) group in which the common bile duct was ligated and cut off; bile reflow group in which on day 14 after common bile duct ligation operation, the internal drainage from common bile duct to duodenum by silica gel duct was performed. Serum prealbumin, serum total bilirubin and urine direct bilirubin were assayed routinely. The expressions of mrp1 mRNA and protein were detected in the liver tissues by semi-quantitative RT-PCR and indirect immunofluorescence respectively. Results Serum prealbumin was descending significantly (P

Objective To retrospectively analyse the adverse reactions and complications of Graves' disease after thyroid arteries embolization.Methods 41 patients of Graves' disease underwent interventional embolization have been analysed with its adverse reactions and complications. Polyvinyl alcohol or bletilla microspheres and micro coils were used in these patients. Results Laryngopharyngeal and neck pain occurred in all patients. T 3 and T 4 increased in 3 days to one week after the procedure. Thirty of them showed fever. Dystopic embolism happened in two cases with one of transitory hypoparathyroidism. No hypothyroidism or hypoparathyroidism or hoarseness occur during long term follow up.Conclusions The adverse reactions and complications of Graves disease after thyroid arteries embolization may occur. Some of them are preventable and curable.