Objective To evaluate the feasibility and efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL)in the lateral position.Methods A total of 48 patients with staghorn(12 cases,2.2 to 5.8 cm in diameter)or multiple renal calculi(31)or upper ureteral stones(5)were treated with MPCNL in our hospital between July 2004 to October 2007.The patients were placed in a lateral position with the head 10? lower and the feet 20? lower.The puncture was made under the guidance of X-ray or ultrasonography,and then Holmium laser or EMS lithotripter was used for stone fragmentation.The stone debris was removed by irrigation.Results The procedure was completed in all of the 48 patients except one,who was converted to a supine position because of the difficulty in puncture.Among the 47 cases,41 were cured with the first operation,the other 6 received catheterization in the first procedure,and then underwent calculi removal in a second-stage operation.None of the patients were converted to open surgery.The mean operation time in this series was(137.5?39.6)min.The one-stage cure rate in our patients was 82.9%(34/41).None of the cases had massive blood loss,or injuries to the pleura and other organs.Follow-up was available in 21 cases for 1 to 3 months.During the period,among the 17 patients who had hydronephrosis,11 were cured and 6 were improved;and among the 4 who had residual stones,1 received ESWL in 1 months after the first operation and was cured afterwards;the other 3 were treated by traditional Chinese medicine,2 of them were cured.Conclusions The MPCNL performed on the patients in the lateral position is an effective alternative for renal calculi,and favorable to intra-operative anesthesia monitor.

Objective To investigate the recurrence and influence factors of spontaneous pneumothorax in patients after thoracoscope surgery. Methods From March 2009 to March 2011,218 patients with spontaneous pneumothorax after thoracoscope surgery in our hospital were surveyed by the self-made general data questionnaire. The clinical data were analyzed by descriptive statistics and binary classification logistic regression analysis of SPSS 19. 0 to find out the infection influential factors of spontaneous pneumothorax for patients after thoraco-scope surgery in order to provide reference basis for reducing postoperative recurrence. Results The recurrence rate of spontaneous pneumo-thorax was 5. 05%(11/218). Multiple logistic regression analysis showed that recurrent pneumothorax ( OR=2. 432,P=0. 000) and multi-ple pulmonary bulla (OR=1. 918,P=0. 000) were the risk factors of spontaneous pneumothorax for patients after thoracoscope surgery. Conclusion The recurrence rate of spontaneous pneumothorax is high,we should strengthen the management of high-risk population and im-prove the prognosis of patients.

Aged ; Case-Control Studies ; Cerebral Hemorrhage ; etiology ; Cerebral Infarction ; etiology ; Female ; Humans ; Intercellular Signaling Peptides and Proteins ; genetics ; metabolism ; Male ; Middle Aged ; Plasma ; chemistry ; Polymorphism, Genetic

Objective To develop a quick quantitative detecting method for point of care testing (POCT) of human serum procalcitonin (PCT) by fluorescence immunochromatographic technology.Methods Applying a double-antibody sandwich immunofluorescent assay (one antibody coated on the nitrocellulose membrane and the other antibody labeled with fluorescent micropaticles) to develop a PCT quantitative detecting kit by immunochromatography technology.The kit was used to test PCT in 472 serum samples from suspected bacterial infection patients of Guangzhou Red Cross Hospital,including 240 male and 232 female patients.The methodology and diagnostic performance were evaluated in the aspects of linearity,precision,accuracy,specificity,stability experiments and comparison with foreign PCT detecting kits.Results The report range of the PCT quantitative diagnostic kit was 0.1-125.0 μg/L The coefficient of variation (CV)values of repeat 20 tests for low,median,and high concentration control samples respectively were all less than 15％ and bias can be acceptable (P ＞ 0.05).Common interfering substances in human serum specimens such as bilirubin (2.0 g/L),triglyceride (30.0 g/L) and cholesterol (15.0 g/L) were found no significant affect on quantitative detection of PCT.The shelf time of the PCT diagnostic kit should be longer than 12 months as the relative deviation of detected concentrations of 0.5,1.0,22.0,65.0 μg/L PCTcontrol sample can be controlled less than 20％ within 14 months.Considering VIDAS BRAHMS PCT to be the standard quantitative test for PCT,472 serum samples were detected by both our kit and the control VIDAS BRAHMS PCT kit simultaneously,which showed high correlation (YVIDAS =0.180 + 1.006Xwondfo,R2 =0.988,P ＜ 0.01) and low deviation (Z =-1.6,P ＞ 0.05) without statistic significance between two methods.And the results of these two diagnostic kits showed good consistency as the area under curve of the receiver operating characteristic (ROC) of Wondfo-PCT at the three cut-off values (0.5,2.0,10.0 μg/L)were 0.997,0.994,0.998 respectively,P ＜ 0.01,using diagnostic result of the control product as standard.Kappa values were 0.899,0.905,0.973 respectively.Conclusions The method of quantitative detection of PCT by fluorescence immunochromatography for POCT was established in this study.All the observed indicators reached the clinical diagnostic requirements and can be applied for the quick detection of clinical human serum PCT.

Objectives To evaluate the effect of N-Acetylcysteine on the airway inflammation and remodeling of obese asthma mice with high-fat diets. Methods Forty female C57BL/6J mice were randomly divided into 4 groups, asthma group (A), obese asthma group (B), treatment group (C) and normal control group (D). Group A were sensitized and challenged by ovalbum (OVA) and normal diets. Group B were sensitized and challenged as group A but fed with high-fat diets, while group C were sensitized, challenged and fed as group B, but administrated N-Acetylcysteine 200 mg/kg. d from the third week after challenge. The cells in BALF were counted and classified after staining, IL-6 and 8-iso-PGF2α(8-iso-PGF2α) in lung tissues were detected by ELISA. WAt, WAm, Pbm, as the remodeling indices, measured in lung pathological section. All parameters were compared among 4 groups. Results In comparison with group D, the leukocytes and EOS in BALF, WAt/Pbm, WAm/Pbm in lung section were increased as well as IL-6 and 8-iso-PGF2α in lung tissue elevated in group A and group B, while the maximum changes were observed in group B (P ＜0. 05). After NAC treatment, the IL-6, 8-iso-PGF2α and WAt/ Pbm were decreased significantly (P ＜0. 05). Pearson correlation analysis showed that WAt/Pbm and IL-6 were in positive correlation with 8-iso-PGF2α (r =0. 817, 0. 737, P ＜0. 01). Conclusions N-Acetylcysteine can alleviate the airway inflammation and remodel reaction of asthma by a substantial inhibition of the oxidative stress reaction in lung.

Objective To investigate the effect of perfusion and preservation with intragraft dipeptidyl peptidase Ⅳ (DPP Ⅳ) catalytic inhibitor on pulmonary function after lung transplantation in rats. Methods Pure SD rats were divided into six groups. Syngeneic rats (SD to SD) served as donors and recipients. Orthotopic lung transplantation model was used. Grafts of control groups (CONI and CON2) were flushed and preserved in LPD-glucoae exposed to 18 h of cold ischemia before transplantation. Peak airway pressure (PIP), blood gas (PO2), wet/dry weight ratio (W/D), the activity of myeloperoxidase (MPO) and the content of malonyldialdehyde (MDA) of CON1 group were analyzed at first day after transplantation. In CON2 group, the 7-day survival rate post-transplantation was observed. Experimental groups were divided into four sub-groups (EXP1-EXP4), and grafts were perfused and stored for 18 h with LPD-glueose plus DPPⅣ catalytic inhibitor. The pulmonary function was detected at 1st (EXP1), 3rd (EXP2), 5th (EXP3), and 7th day (EXP4) posttransplantation, respectively. Results The rats in CON2 were died at 7th day post-transplantation,and all rats in EXP4 group survived to the 7th day post-transplantation. As compared with CON1 group, PIP, W/D, MPO activity and MDA content were reduced (P<0. 01 or 0. 05), and PO2 increased (P<0. 05) in EXP4 group. The pulmonary function of DPPⅣ catalytic inhibitor-perfused grafts from 1 to 7 days was improved and all tested parameters were close to normal at 7th day.Conclusion Perfusion and preservation with an inhibitor of CD26/DPP Ⅳ enzymatic activity obviously reduced severity of ischemia-reperfusion injury and was beneficial to the rehabilitation of grafts'pulmonary function.

Objective To assess the safety of intrathecal administration of betamethasone.MethodsTwenty-four adult white rabbits of both sexes were randomly divided into four groups with 6 rabbits in each group.Group Ⅰ (blank control group)in which nothing was injected intrathecally;group Ⅱ(NS control group)in whichnormal saline(NS)0.2ml was injected into the subarachnoid space through great occipital foramen once a weekand the animals were killed at the end of the 3rd week;in group Ⅲ and Ⅳ betamethasone 200 ?g or 400 ?g in 0.2ml was injected intrathecally once a week instead of NS.The animals were anesthetized and killed by intra-aorticinjection of NS and 2% glutaraldehyde.The cervical section of the spinal cord(C_(1-6))was immediately removedand fixed with 2% glutaraldehyde for microscopic examination.Results No neural histo-pathologic changes shownby microscopic examination were observed in group Ⅰ and Ⅱ.In group Ⅲ and Ⅳ microscopic examination showeddifferent degrees of swelling and demyelination of the nerve fibers and edema and vacuolization ofmitochondria.Conclusion Intrathecal betamethasone can damage the spinal cord.

Objective To compare open versus closed reduction in treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours.Methods We retrospectively reviewed 51 children who had been treated at our department for femoral neck fracture between May 2005 and May 2012 after their reduction had been delayed for more than 24 hours.They were 37 boys and 14 girls,1.7 to 15.5 years of age (average,9.1 years).According to Delbet's classification,27 cases belonged to type Ⅱ,18 to type Ⅲ,and 6 to type Ⅳ.Of them,18 underwent closed reduction and 33 open reduction.Their complications were recorded in detail.Their therapeutic results were evaluated according to Ratliff's criteria and compared between the 2 methods of reduction.Results The 51 children were followed up for an average of 36.7 months (range,from 17 to 61 months).Anatomic reduction was achieved in 6 cases in the closed reduction group (33.3％) and 29 cases in the open reduction group (87.9％),respectively.All fractures healed after an average of 10.9 weeks (range,from 9 to 13 weeks),with one exception of nonunion in the closed reduction group.The incidence of femoral head necrosis in the closed reduction group (27.8％,5/18) was significantly higher than that in the open reduction group (15.2％,5/33) (P ＜ 0.05).According to the Ratliff's evaluation at the final follow-ups,the good to excellent rate in the closed reduction group(66.7％,12/18) was significantly lower than that in the open reduction group (84.8％,28/33) (P ＜0.05).Coxa vara occurred in 3 children in the closed reduction group but in none in the open reduction group.Conclusion Open reduction with internal fixation may lead to better outcomes than closed reduction in the treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours,probably because open reduction can result in better reduction quality.

BACKGROUND:Theoreticaly, lumbar semi-rigid fixation can slow down the degeneration of adjacent segments, but there is stil a lack of biomechanical support. OBJECTIVE:To explore the biomechanical effect of semi-rigid fixation system, taking Isobar TTL for instance, on adjacent segment disc by means of finite element analysis. METHODS: The finite element models of USS and Isobar TTL were constructed by putting respective parameters into a validated L2-S5 lumbar model. The angular displacement and von Mises stress of adjacent segments were recorded when the models were subjected to 400 N preload and 7.5 N?m moment of forces under different conditions: flexion, extension, lateral bending and axial rotation. RESULTS AND CONCLUSION:The angular displacement and inter-vertebral disc stress of adjacent segments in the USS and Isobar TTL models were higher than those of an intact state in every condition. But the values in Isobar TTL model were lower than the USS model in varying degrees. Compared with the USS model, the decrease rates of angular displacement in Isobar TTL model for flexion, extension, left bending, right bending, left axial rotation and right axial rotation were 19.2%, 15.1%, 11.1%, 12.2%, 18.4% and 22.1%, respectively. The decrease rates of von Mises stress were 33.0%, 20.2%, 23.9%, 18.6%, 28.8% and 28.0%, respectively. The results suggested that the Isobar TTL, when compared with the USS, partialy reduced the angular displacement and inter-vertebral disc stress of adjacent segments.

OBJECTIVE: To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. METHODS: A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment. RESULTS: Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology. CONCLUSION The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.
Dissent and Disputes ; Expert Testimony ; Forensic Medicine ; Gynecology/statistics & numerical data* ; Hospital Departments/statistics & numerical data* ; Humans ; Incidence ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Retrospective Studies ; Time Factors