Objective To explore clinical diagnosis and surgical treatment for the traumatic liver rupture.Methods The clinical data of 60 cases with traumatic liver rupture were retrospectively cralyzed to explore the diagnosis and surgical treatment.Results 45 injury patients were diagmosed by,patient history,signs and imaging studies.15 cases of blunt injury,five cases diagnosed by above methods,10 cases of diagnostic peritoneal puncture are positive diagnosis.28 cases received the left hepatic lobe partial resection,20 cases right lobe partial resection,12 cases had the left hepatic lobe and right lobe partial nephrectomy.Among 60 patients,5 cases(8.33％) were dead and the other 55 patients,8 cases occured postoperative complications,were discharged after symptomatic treatment,the average length of stay was (15.6 ± 3.5) days.Conclusion Traumatic liver rupture is a critical illness,rapid and correct diagnosis before surgery,and choose the correct surgical approach,focusing on merger deal with injuries to postoperative complications,and improve the treatment success rate.

Objective To investigate the influence of self-management and education on behaviors of medical compliance of patients undergoing vitrectomy combined with tamponade.Methods Sixty-four patients undergoing vitrectomy combined with tamponade were randomized equally into the control group and observation group in the order of admission.The control group received routine care and health education,while the observation group received self-management education follow-ups besides the routine nursing.The two groups were compared in terms of the cumulative time of the correct position,compliance behavior and the incidence of postoperative complications.Results The cumulative time of the correct position of observation group was longer than that of the control group after operation.The observation group did better in compliance behavior than the control group and the incidence of postoperative complications in the former group was lower than the latter(P<0.05).Conclusion Self-management and education can enhance patients’behaviors in medical compliance and decrease postoperative complications and promote the success of the surgery.

OBJECTIVETo evaluate the clinical effectiveness of Yiqi Huoxue Tongyang Xiezhuo Recipe (YHTXR, capable of supplementing qi, activating blood, warming yang, and discharge turbidity) in treating coronary atherosclerotic heart disease (CAHD). and chronic heart failure (CHF) with carotid plaque patients, and to explore new ways of Chinese medicine (CM).

METHODSTotally 69 CAHD-CHF patients of qi deficiency phlegm stasis syndrome (QDPSS) with carotid plaque were recruited in this study using parallel cohort method. They were assigned to the treatment group (35 cases) and the control group (34 cases). Patients in the control group received routine treatment of Western medicine, while those in the treatment group were additionally treated with YHTXR (twice daily). The therapeutic course for all was three months. Cardiac function levels, echocardiography, carotid plaque, blood lipids and safety indicators were observed before and after treatment.

RESULTSAfter treatment the improvement of cardiac function levels was better in the treatment group than in the control group (P < 0.05). Decreased LDL-C levels were higher in the treatment group than in the control group (P < 0.01). There was statistical difference in left ventricular ejection fraction (LVEF), carotid intima-media thickness (IMT), LDL-C, TC, TG in the treatment group between before and after treatment (P < 0.05). LDL-C and TG also decreased in the control group after treatment (P <0.05). There was no significant difference in the left ventricular ejection fraction, carotid IMT, or TC in the control group between before and after treatment (P > 0.05). There was no significant difference in stroke volume, left ventricular end-diastolic diameter, the area of carotid artery plaque, or HDL-C in the two groups between before and after treatment (P > 0.05).

CONCLUSIONSYHTXR could effectively improve cardiac functions of CAHD-CHF patients of QDPSS with carotid plaque, reduce blood lipids and IMT. It had no significant adverse reactions for elderly patients in short term.

Carotid Intima-Media Thickness ; Coronary Disease ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Heart ; Heart Failure ; drug therapy ; Humans ; Lipids ; Plaque, Atherosclerotic ; drug therapy ; Qi ; Ventricular Function, Left

The inter-species differences of thienorphine metabolism were investigated in human, Beagle dog and rat liver microsomes, by comparing enzyme kinetics of the parent drug and the formation of its major metabolites. The incubation systems of thienorphine with liver microsomes of the three species were optimized in terms of thienorphine concentration, microsomal protein content and incubation time. The concentrations of thienorphine and its metabolites in incubates were measured by a LC-MS/MS method. The biotransformation of thienorphine by human liver microsomes was the lowest among the three species. The K(m), V(max), CL(int) and T1/2 of thienorphine obtained from human liver microsomes were (4.00 +/- 0.59) micromol x L(-1), (0.21 +/- 0.06) micromol x L(-1) x min(-1), (117 +/- 3.19) mL x min(-1) x kg(-1) and (223 +/- 6.10) min, respectively. The corresponding kinetic parameters for dog and rat liver microsomes were (3.57 +/- 0.69) and (3.28 +/- 0.50) micromol x L(-1), (0.18 +/- 0.04) and (0.14 +/- 0.04) micromol x L(-1) x min(-1), (213 +/- 1.06) and (527 +/- 7.79) mL x min(-1) x kg(-1), (244 +/- 1.21) and (70.7 +/- 1.05) min, respectively. A total of six phase I metabolites were observed in liver microsomes, including one N-dealkylated metabolite, three oxidative metabolites and two N-dealkylated oxidation metabolites. All these six metabolites were detected in the liver microsomes of the three species. However, the relative amounts of the metabolites generated were different in three species. The results indicated that the major phase I metabolic pathway of thienorphine was similar in the liver microsomes from all three species. However, the inter-species differences observed were relative amounts of the metabolites as well as the metabolic characteristics of thienorphine in liver microsomal incubates.
Animals ; Biotransformation ; Buprenorphine ; analogs & derivatives ; metabolism ; pharmacokinetics ; Chromatography, High Pressure Liquid ; methods ; Dogs ; Humans ; Male ; Microsomes, Liver ; metabolism ; Rats ; Rats, Sprague-Dawley ; Species Specificity ; Tandem Mass Spectrometry ; methods

Objective To validate the effectiveness of nursing intervention on alleviating negative emotions and improving quality of cancer patients′ life based on story theory. Methods This study adopted the method of quasi-experimental research,100 patients with cancer chemotherapy were divided into the experimental group(50 cases),and the control group(50 cases).Based on conventional care,the experimental group received 3 weeks of nursing intervention based on story theory.The scores of mood and quality of life were collected in the 1st day and 23rd day after chemotherapy by using Profile of Mood States-Short Form(POMS-SF)and Quality of Life Questionnaire-core(QLQ-C30),thus evaluated the effect of intervention. Results The scores of POMS-SF in the 1st day and 23rd day after chemotherapy were (17.28±5.41),(35.84±12.35)points in the experimental group,and the difference was significant(t=7.54, P<0.05).The scores of QLQ-C30 in the 1st day and 23rd day after chemotherapy were(7.72±1.53),(8.17± 0.94) points in the control group, and the difference was significant(t =-4.07, P<0.05). There was no statistical difference in the scores of POMS-SF and QLQ-C30 between the 1st day and 23rd day after chemotherapy in the control group(P>0.05). Conclusions The nursing intervention based on story theory demonstrated significant improvement of negative emotions and quality of life, which is a quite practical psychological care for cancer chemotherapy patients.

Objective:To explore the relationship of resilience and post-traumatic growth (PTG) among young people affected by acquired immunodeficiency syndrome (AIDS).Methods:A sample of 209 young people affected by AIDS were selected.They were healthy college students or college graduates whose parent or parents was/were infected by human immunodeficiency virus (HIV).The Conner-Davidson Resilience scale (CDRS),Event Related Rumination Inventory (ERRI),Self-Esteem Scale (SES) and Post-traumatic Growth Inventory (PTGI) were used to evaluate resilience,rumination,self-esteem and PTG respectively.Results:Firstly,the score of PTGI was (3.6 ±0.9) among young people affected by AIDS.Secondly,CDRS score could affect PTGI score directly (direct effect:0.49),via deliberate rumination score indirectly (indirect effect:0.12),also via the indirect way which intrusive rumination score influenced deliberate rumination score (indirect effect:0.03).Thirdly,the SES score moderated the pathway from CDRS score to intrusive rumination score,only for persons with low self-esteem,CDRS score could predict intrusive rumination score effectively (simple slope =0.57),but not for the high self-esteem group (simple slope =0.10).Conclusion:For young people affected by HIV/AIDS,resilience could affect PTG directly,also via the multiple mediation effects of rumination.Moreover,resilience could influence PTG via the indirect way which intrusive rumination influenced deliberate rumination among young people with low selfesteem.

The biotransformation, CYP reaction phenotyping, the impact of CYP inhibitors and enzyme kinetics of 3-cyanomethyl-4-methyl-DCK (CMDCK), a new anti-HIV preclinical candidate belonging to DCK analogs, were investigated in human intestinal microsomes and recombinant cytochrome P450 (CYP) enzymes. CMDCK (4 micromol L(-1)) was incubated with a panel of rCYP enzymes (CYP1A2, 2C9, 2C19, 2D6 and 3A4) in vitro. The remaining parent drug in incubates was quantitatively analyzed by a LC-MS method. CYP3A4 was identified as the principal CYP isoenzyme responsible for its metabolism in intestinal microsomes. The major metabolic pathway of CMDCK was oxidation and a number of oxidative metabolites were screened with LC-MS. The Km, Vmax, CLint and T1/2 of CMDCK obtained from human intestinal microsome were 45.6 micromol L(-1), 0.33 micromol L(-1) min(-1), 12.1 mL min(-1) kg(-1) and 25.7 min, respectively. Intestinal clearance of CMDCK was estimated from in vitro data to be 3.3 mL min(-1) kg(-1), and was almost equal to the intestinal blood flow rate (4.6 mL min(-1) kg(-1)). The selective CYP3A4 inhibitors, ketoconazole, troleandomycin and ritonavir demonstrated significant inhibitory effects on CMDCK intestinal metabolism, which suggested that co-administration of CMDCK with potent CYP3A inhibitors, such as ritonavir, might decrease its intestinal metabolic clearance and subsequently improve its bioavailability in body.
Anti-HIV Agents ; metabolism ; pharmacokinetics ; Biological Availability ; Bridged Bicyclo Compounds, Heterocyclic ; metabolism ; pharmacokinetics ; Coumarins ; metabolism ; pharmacokinetics ; Cytochrome P-450 CYP3A ; Cytochrome P-450 CYP3A Inhibitors ; Humans ; Intestines ; metabolism ; Ketoconazole ; pharmacology ; Metabolic Clearance Rate ; Microsomes ; metabolism ; Ritonavir ; pharmacology ; Troleandomycin ; pharmacology

OBJECTIVETo investigate the dynamic quantitative changes in expression of hepatitis B virus (HBV) surface antigen (HBsAg) that occurs during the natural recovery course and the short-term antivirus treatment period of patients suffering from flares in chronic hepatitis B (CHB).

METHODSCHB patients presenting for treatment of flare-ups were randomly assigned to receive treatment with Entecavir antiviral (group A, n = 39) or to naturally resolve the acute condition (group B, n = 22). All patients MELD scores were calculated and HBsAg levels and HBV DNA loads were measured upon admission (baseline), at worst-condition stage, and end of treatment/flare-up (discharge). Pairwise comparisons of intergroup differences were made to evaluate the change in the three disease parameters over time in response to the management approach.

RESULTSThe levels of HBsAg were not significantly different between the two groups at baseline, worst-condition stage and discharge (group A: (3.68+/-0.45), (3.84+/-0.19) and (3.69+/-0.58) log10 cut-off index (COI) respectively; group B: (3.59+/-0.54), (3.47+/-0.76) and (3.43+/-0.68) log10 COI respectively; all P more than 0.05). However, the HBV DNA loads were significantly lower in group A than in group B at the worst-condition stage and at discharge (all P less than 0.05). In group A, the MELD scores were significantly higher at baseline and at worst-condition stage than at discharge (all P = 0.000), but the difference between baseline and worst-condition stage was not significant. Also in group A, the HBV DNA load showed a gradually decreasing trend over time (baseline more than worst-condition stage more than discharge, all P less than 0.05). No significant differences were observed over time in the HBsAg levels of group A. In group B, the MELD scores were significantly higher at baseline and at worst-condition stage than at discharge (all P = 0.000), but the difference between baseline and worst-condition stage was not significant (P = 0.619). Also in group B, the HBV DNA loads were significantly higher at baseline and worst-condition stage than at discharge (P = 0.000 and P = 0.003 respectively), but the difference between baseline and worst-condition stage was not significant. Finally, no significant differences were observed over time in the HBsAg levels of group B.

CONCLUSIONNatural recovery from an acute flare-up of CHB is not accompanied by a change in HBsAg levels. In addition, short-term antiviral treatment to resolve the flare-up has no influence on HBsAg level.

Adult ; Antiviral Agents ; therapeutic use ; Female ; Guanine ; analogs & derivatives ; therapeutic use ; Hepatitis B Surface Antigens ; blood ; Hepatitis B virus ; drug effects ; physiology ; Hepatitis B, Chronic ; blood ; drug therapy ; Humans ; Male ; Middle Aged ; Viral Load

Objective To investigate the distribution of chronic disease and geriatric syndrome in hospitalized elderly patients with multimorbidity by chronic disease investigation and comprehensive geriatric assessment.Methods A total of 176 patients aged ≥60 years admitted into the geriatric department in our hospital were selected,and demographic factors were collected.Their chronic diseases and geriatric syndrome were recorded.The comprehensive geriatric assessment was consummated,and the biochemical indicators for chronic disease and geriatric syndrome were detected.Results All patients suffered from two or more kinds of chronic diseases.The top three most common diseases were hypertension (112 cases),diabetes (94 cases),and respiratory diseases (73cases).The sum of chronic diseases kinds were ≥3 in 137 patients,≥4 in 78 patients,≥5 in 40 patients.The amount of chronic diseases showed an increased tendency along with ageing.Totally 175 patients had more than one geriatric syndrome,the top three most common types were frailty and prefrailty(133 cases),visual impairment (117 cases),impaired daily activities (107 cases).There were significant differences in the number of geriatric syndrome among different age groups(x2 =16.989,P ＜ 0.001).Spearman analysis showed that the number of patients with geriatric syndrome were positively correlated with age(r =0.307,P＜0.001).Conclusions The prevalence of chronic disease and geriatric syndrome is high in hospitalized elderly patients with multimorbidity,which is increased with aging.We should pay attention to the screening of chronic disease and geriatric syndrome in multimorbid elderly patients

Objective To investigate the effect of 100 kVp low tube voltage combined with adaptive statistical iterative reconstruc-tion-Veo(ASIR-V)on the imaging display,image quality and radiation dose of Adamkiewicz artery(AKA).Methods Ninety patients with computed tomography angiography(CTA)of aorta were randomly divided into two groups.In group A,the tube voltage was 100 kVp,and ASIR-V was 80%reconstructed.The tube voltage in group B was 120 kVp,and adaptive statistical iterative recon-struction(ASIR)was 40%reconstructed.The CT value and the standard deviation(SD)value of descending aorta were measured at the 12th thoracic vertebra level,and the CT value and the SD value of the spinal cord were measured at the same level to calculate the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of AKA.According to the continuity between AKA and intercostal artery or lumbar artery,the visualization of AKA was evaluated by two doctors with a double-blinded method and a five-point method,and the radiation doses of group A and group B were compared.Results Compared with group B,the CT value of aorta in group A was sig-nificantly increased by about 22.83%(P<0.001).The background noise of AKA in group A was significantly lower than that in group B(P<0.001),and the SNR and CNR were significantly higher than those in group B(P<0.001).The visualization score of AKA in group A was higher than that in group B(P<0.05).The effective dose(ED)in group A was significantly lower than that in group B by about 41.28%(P<0.001).Conclusion 100 kVp combined with ASIR-V technique for spinal cord AKA imaging can obtain better image quality,improve the sensitivity of AKA display and reduce the radiation dose.