Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.

Adolescent ; Adrenergic beta-Agonists ; therapeutic use ; Albuterol ; analogs & derivatives ; therapeutic use ; Asthma ; drug therapy ; physiopathology ; Child ; Child, Preschool ; Female ; Forced Expiratory Volume ; drug effects ; Humans ; Male ; Salmeterol Xinafoate

Objective To study the diagnosis, therapy and prevention of bile duct carcinomas in choledochal cysts. Methods We retrospectively analysed clinico pathologic data, the ways of operation and living time of 11 patients with bile duct carcinomas in choledochal cysts in two hospitals from 1986 to 1997. Results There were complete excision of the choledochal cysts associated with choledochojejunostomy in 4 patients, exploration of bile duct and drainage with T shape tube in 3 patients. And there were also the excision of the wall of bile duct cysts and the tumor and cholangioplasty, choledochocystoduodenostomy, biopsy, pancreaticoduodenectomy and cholangiojejunostomy at the porta hepatis, resection of original rhynchostoma of choledochojejunostomy in one patient, respectively. One patient has lived for 3.6 years after radical resection. Others lived for 13.6 months after operation. Conclusions It is the key of improving and lengthening lives to find this disease in the early stage and to resect radically as early as possible.

Abstract: This retrospective analysis examines the diagnosis and treatment of a case of chronic liver disease infected with Vibrio vulnificus, admitted to the First Affiliated Hospital of Hainan Medical University on August 8, 2023. The patient, a 34-year-old male fisherman, had chronic viral hepatitis B. He sustained a leg abrasion while fishing on August 3, and developed fever and continuous swelling pain in both lower limbs, more severe in the left limb, on the night of the injury. On the fourth day of the disease, he went to the local hospital where he received antibiotic treatment and was transferred to the First Affiliated Hospital of Hainan Medical College on August 8. Upon admission, the patient exhibited low blood pressure, high lower limb skin temperature, poor peripheral blood transport, visible scab, and signs of infectious shock. Within 12 hours of admission, an abscess incision and drainage procedure was performed on his left calf, along with negative pressure wound therapy, and tissue samples from the infected left lower limb were sent for microbial culture.The pathogen culture indicated a Vibrio vulnificus infection, and the histopathology results confirmed necrotizing fasciitis. Treatment included meropenem combined with vancomycin for infection control, maintenance of blood pressure and electrolyte balance, tenofovir disoproxil fumarate for antiviral therapy, and polyene phosphatidylcholine capsules for liver protection based on the drug sensitivity results. Additionally, levofloxacin and cefotaxime were administered for infection control and debridement was performed based on wound conditions. After 17 days of hospitalization, the infection was substantially controlled, but the liver function enzyme was still higher than the normal level, and the wound still had blood and exudation. The patient and his family members requested discharge; however, due to poor wound healing, he was readmitted on September 11, 2023, receiving antiviral and liver preservation treatment. On the fifth day,the secretion culture identified a co-infection with Corynebacterium striatum and Providencia stuartii infection. Corynebacterium striatum was subsequently reported as multidrug-resistant, prompting an immediate switch to sensitive antibiotics and supportive care. Sixteen days after readmission, the patient's general condition improved, but the liver function enzyme levels were still higher than normal, so he was discharged. Four months after discharge, a follow-up phone call revealed that the patient had actively pursued antiviral treatment and abstained from alcohol, showing reasonable wound recovery. The patient's case, with a typical exposure history and clinical manifestations, matches the characteristics of septic shock and necrotizing fasciitis caused by V. vulnificus. Clinically, it is crucial todiagnose and treat V. vulnificus infection early according to its pathological characteristics and clinical characteristics to improve the prognosis of patients.

Objective To explore independent risk factors of ventilator associated pneumonia (VAP) on severe craniocerebral injury patients, and propose nursing intervention measures to reduce occurrence of VAP. Methods A retrospective analysis was conducted on 73 severe craniocerebral injury patients with VAP postoperatively from January 2013 to June 2015, and 80 severe craniocerebral injury patients underwent mechanical ventilation without VAP postoperatively at the same time were selected as the control group. Through literature review, questionnaire was designed to collect potential impact factors of VAP in both two groups, the single factor analysis and Logistic regression analysis were applied to explore the VAP independent risk factors, and nursing intervention countermeasures were proposed to improve VAP clinical prevention. Results VAP incidence rate of severe craniocerebral injury patients postoperatively was 23.0%(73/317) , from which 81 strains were detected, the first three strains of strain spectrum were Klebsiella pneumonia (21.0% ), Bauman Acinetobacter (17.3% ) and pseudomonas aeruginosa bacteria (14.8% ). Single factor analysis showed there were significant differences on composition of two groups in age, preoperative Glasgow Coma Scale (GCS) score, operation times, artificial airway type, postoperative mechanical ventilation time, daily airway humidification frequency, daily sputum suction frequency compound injury, daily oral care times (χ2=1.809-11.936, P < 0.01 or 0.05). Logistic regression models showed duration of mechanical ventilation (OR≥7d=3.013; OR≥14d=3.695), secondary surgery (OR =3.111) , preoperative GCS score (OR =2.989), daily airway humidification frequence (OR =2.280), age (OR=2.237) had remarkable influence on occurrence of postoperative VAP (P<0.01 or 0.05). Conclusions The incidence rate of VAP in severe craniocerebral injury patients is higher, age, mechanical ventilation duration, preoperative GCS score, airway humidification degree, second surgery are the independent risk factors of VAP.

OBJECTIVE To investigate the characters of urinary noscomial infection in intensive care unit(ICU)of our hospital in order to reduce its incidence. METHODS The 661 patients in ICU of our hospital from Jan 2005 to Jun 2006 were analyzed,and in which 63 nosocomial urinary infection patients(9.53%) were found.We analyzed the 63 patients retrospectively. RESULTS Nosocomial urinary infection occurred in 9.53% patients admitted to the ICU.Nosocomial urinary infection in ICU was correlated with ages,using of antibiotics and hormones,duration of catheterization and APACHEⅡ score,but not with gender.The most prevalent pathogens of nosocomial urinary infection in ICU were fungi(40.66%),gram-negative bacteria(31.87%) and Gram-positive bacteria(27.46%).The clinical manifestation of nosocomial urinary infection in ICU was atypical. CONCLUSIONS Nosocomial urinary infection in ICU has its own characters which clinicians should pay more attention to.To reduce its incidence,we should avoid abusing of antibiotics and hormones,and make the duration of catheterization as short as possible.

Objective To evaluate the effect of Jian Pi Bu Shen prescription on inflammatory factors and iron metabolism in the brain of T2DM model mice.Methods A total number of 30 healthy 12-week-old male mice were used in the present study.The groups were randomly assigned to one of the following experimental groups:(1) control group:n=5,the mice were maintained on a normal diet for 4 weeks;(2) model group:n=25,the mice were maintained a high fat diet for 4 weeks.Then,the mice were deprived of food for 12 hours before a single intraperitoneal injection of streptozotocin (STZ,30 mg/kg).Then,the blood glucose levels were measured randomly 3 times within 24 hours after injection.The mice whose blood glucose was less than 16.7 mmol/l would receive another single intraperitoneal injection of STZ.Finally,we got a total number of 19 mice meeting the criteria of animal model we described above.The final 19 mice were randomized to 2 groups:diabetes group (n=10)and Jian Pi Bu Shen (JPBS) group(n=9).JPBS group received gavage administration of JPBS Prescription 7.4 g/kg/d(8weeks).Diabetes group and control group were maintained treated with saline for 8 weeks.Mice were decapitated 24 hours after the last drug treatment.The mice brain tissue slices were prepared for pathological observation.To examine the effects of JPBS prescription on neuroinflammation and iron metabolism in cerebrum and hippocampi,the relative mRNA levels of IL-6,IL-1β,DMT1,FPN1 and CP were tested by RT-PCR.Results mRNA levels of IL-6,IL-1β and DMT1 in the brains of diabetes group were higher while the levels of FPN1 and CP were lower than that of the control group (P＜0.01).Compared with diabetes group,in JPBS group,mRNA levels of IL-6,IL-1β and DMTl in cerebrum and hippocampi were decreased while the levels of FPN1 and CP were increased (P＜0.01).The brain tissue slices of diabetes group showed neuron loss and signs of neurodegeneration.But JPBS group attenuated neurodegenerative change.Conclusion JPBS prescription can protect neuron from apoptosis,suppress neuroinflammation and attenuate iron metabolism,which may be one of the mechanisms of traditional Chinese medicine in treating cognitive dysfunction.

Objective To explore the clinical application of the special use of antibacterial drugs in Department of hepatobiliary surgery by analyzing the typical cases of the use of antibiotics.Methods This paper analyzes and comments on the typical cases of the use of special antibiotics in Department of hepatobiliary surgery.Results Department of hepatobiliary surgery the special use level of antibacterial drugs,should be based on the pathogenic characteristics of drug resistance and drug sensitivity test results and timely adjustment of antimicrobialtherapy,severe infection should be given sufficient medicines in a timely manner,should adjust the antibiotics dose according to liver and kidney function,drug dose attention to drugs with narrow therapeutic index,combined medication,caution should be avoided unnecessary repeat medication.Conclusion Through the analysis of the typical cases of the special use of antibiotics in Department of hepatobiliary surgery,it can promote the rational use of antibiotics.

BACKGROUND: Bone sialoprotein (BSP) gene is expressed in human breast cancer cells, in which bone metastasis occurs easily outside the mineralized tissue. Clinical observation shows that the expression level of BSP of breast cancer cells at bone metastasis is higher that at the primary site;therefore, BSP may be closely related to tumor specific bone metastasis.The study on breast cancer bone metastasis can provide new drug target for clinical prevention and treatment.OBJECTIVE: To establish breast cancer cell strains of BSP with stable expression and observe the effect of BSP in the whole process of breast cancer bone metastasis.DESIGN: Controlled experiment.SETTING: College of Biological Sciences and Engineering, South China University of Science and Technology; Medical Experiment Center,Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA.MATERIALS: This experiment was conducted in the Medical Experimental Center,Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA,betweer November 2003 and March 2004..pIRES2-EGFP vector (5.3 kb) was purchased from BD Biosciences Clontech Inc.; E.Coli.Top10, pB-hBSP plasmid containing the coding region of hbsp, and human breast carcinoma cells, MDA-MB-231BR that was specifically transferred to brain and MDA -MB-231BO that was specifically transferred to bone.METHODS: hbsp gene was subcloned from pB-hBSP vector by PCR. Bg1Ⅱ and Pst Ⅰ restriction enzyme sites were inserted at 5' and 3' ends, orientation cloned to eukaryon expression vector pIRES2-EGFP, and constructed recombinant vector pIRES2-EGFP. The constructed recombinant vector was transfected into MDA-MB-231BR that was specifically transferred to brain and MDA-MB-231BO that was specifically transferred to bone.MAIN OUTCOME MEASURES: Construction of pIRES2-hBSP-EGFP recombinant expression vector; recombinant expression vector pIRES2-hBSP-EGFP transfecting breast cancer cells.Breast cancer strains specific in bone metastasis and brain metastasis were successfully transfected. The fluorescence labeling could be observed under the fluorescence microscope, and BSP had corresponding expression.CONCLUSION: The successful construction and transfection of pIRES2hBSP-EGFP of eukaryon expression vector would lay foundation for further study on the role of BSP in breast cancer metastasizing to bone in vivo or in vitro.

OBJECTIVE:To standardize the clinical use of adjuvant therapy drugs. METHODS:To establish the clinical use management mode of adjuvant therapy drugs in our hospital and summarize the usage amount and irrational drug use of adjuvant therapy drugs before and after implementing the management,and the management effect was assessed. RESULTS:The manage-ment mode of adjuvant treatment drugs in our hospital included ensuring the directory for adjuvant therapy drugs,establishing the management system and ensuring its basic principles,then conducting drug use review with the ranking of drug dosages and mak-ing full use of evidence-based medical evidence,as well as developing principle of classification disposal for the irrational drug use (off-indications,overdose,ultra treatment) of adjuvant therapy drugs. After more than one year of management practice,the use of adjuvant therapy drugs in our hospital is increasingly standardized. The sales amount of adjuvant therapy drugs to all drugs was reduced from 20.90％ before management(Aug. 2014-Jul. 2015)to 15.99％(reduced by 5％)after management(Aug. 2015-Jul. 2016). Compared with Aug. 2015,the sales amount of 48 varieties in the 93 adjuvant therapy drugs was dropped more than 15％in Aug. 2016,and irrational drug use decreased obviously. CONCLUSIONS:The established management mode of adjuvant thera-py drugs in our hospital has effectively improved clinical rational drug use and reduced medical costs.