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.

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.

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 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 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.

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 investigate the effects of hydrophilic polymers on the stability of self-microemulsifying drug deliv-ery systems (SMEDDS). METHODS:Taking felodipine (FDP) as model drug,the content of FDP was determined by HPLC method. The effects of pure water,0.5% Kollidon VA64,HPMC E5,HPMC K100LV,HPMC K4M,PVP K30 solution,while 0.1%,0.5% and 1.0% HPMC E5 and Kollidon VA64 on residual content of dissolved FDP were determined in SMEDDS. RE-SULTS:The residual contents of dissolved FDP in SMEDDS placed in Kollidon VA64,HPMC E5,HPMC K100LV,PVP K30, HPMC K4M and pure water for 1 h were 92.7%,63.6%,50.2%,46.2%,36.0%and 24.0%,respectively. The order of maintain-ing the supersaturation state was Kollidon VA64>HPMC E5>HPMC K100LV>PVP K30>HPMC K4M>pure water. The residu-al contents of dissolved FDP in SMEDDS placed in 0.1%,0.5%,1% Kollidon VA64 and HPMC E5 and pure water for 1 h were 93.2%,95.1%,96.0% and 48.4%,62.1%,75.1%. CONCLUSIONS:Kollidon VA64 and HPMC E5 can significantly inhibit drug release in SMEDDS and be used as stabilizer of SMEDDS,wherein Kollidon VA64 was better.

AIM: To evaluate the repeatability and reproducibility of thickness profile measurement of intra-retinal layers determined by an automated algorithm applied to OCT images from Cirrus optical coherence tomography (OCT) instrument.METHODS: In this prospective cross-sectional study,retinal thickness images at 6mm×6mm around fovea were obtained from 86 eyes of 43 normal subjects with Cirrus HD-OCT instrument.The retinal images from patients were analysis by Cirrus automated algorithm GCA software,including ganglion cell layer and inner plexiform layer(GCIPL).During this study,operator A would make 2 times measurements to all patients,after that operator B would make another 2 times measurements by Repeat scan model.All the data,including GCL average thickness,min thickness,12 clock average thickness,2 clock average thickness,4 clock average thickness,6 clock average thickness,8 clock average thickness and 10 clock average thickness were measured by SPSS 15.0 software.Standard deviation (SD),coefficient of variation (CV) and interclass correlation coefficient (ICC) were calculated from the results of three-times tests by different examiner to evaluate the repeatability and from the results of two different examiners to assess the reproducibility.Written informed consent was obtained from each subject prior to any medical procedure.RESULTS: The average GCIPL thickness of OD was 85.12±3.95μm;the minimum average GCIPL thickness was 83.21±4.41μm;the standard deviation of OD in clock map was from 3.79μm to 4.84μm;CV(95%CI) was between 0.26 and 0.93;ICC was from 0.939 to 0.989.The average GCL+IPL thickness of OS was 84.65±8.73μm;the minimum average GCPL thickness was 81±13.08μm;the standard deviation of OS in clock map was from 8.24μm to 10.56μm;CV(95%CI) was between 0.92 and 4.94;ICC was from 0.264 to 0.968.CONCLUSION: Cirrus HD-OCT GCA software with automated algorithm can offer accurate and repeatable thickness profile of OCT retinal image.GCA is a useful and reliable approach to the measurement of intra-retinal layer thickness,which may improve the diagnosis and monitoring of retinal diseases.

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.