Objective To investigate the significance of early blood lactic acid and lactic acid clearance in patients with post-cardiac arrest syndrome(PCAS).Methods 87 cases were divided into the survival group(26 cases) and the death group(61 cases).The clinical data of two groups were analyzed statistically.Results The 6h blood lactate (8.46 ± 2.37) mmoL/L,6h blood lactate clearance rate (34.53 ± 14.75) ％,the residual alkali (-3.08 ± 3.68) mmol/L,6h SevO2 (68.35 ± 6.33) ％,APACHE Ⅲ score (19.64 ± 2.48) points in the survival group were significantly better than those of the death group [blood lactic acid value (12.32 ± 3.56) mmol/L,6h blood lactate clearance rate (27.71 ± 11.38) ％,the residual alkali (-5.61 ± 4.14) mmol/L,6h SevO2 (63.22 ± 5.94) ％,APACHE Ⅲ score (24.32 ± 5.33) points],with significant differences between two groups (t =5.99,2.36,2.73,3.66,5.62,all P ＜ 0.05).The 6h blood lactate clearance rate,6h SevO2 and APACHE Ⅲ score were independent risk factors for the prognosis of PCAS (OR =1.23,1.64,1.28,all P ＜ 0.05).Conclusion The early blood lactate clearance rate can be used as a sensitive indicator for evaluating the prognosis of PCAS.

BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.

Objective: To evaluate therapeutic effect of aortic endovascular stent-graft exclusion (EVGE) combined percutaneous coronary intervention (PCI) on patients with descending thoracic aortic dissection (DTAD) complicated coronary heart disease (CHD).Methods: A total of 58 DTAD + CHD patients undergoing aortic EVGE combined PCI were regarded as EVGE group (received aortic EVGE at first, then PCI on 3d after operation).Another 60 DTAD+CHD patients undergoing open surgery combined PCI in our hospital were selected as open surgery group.Both groups were observed and followed up, and their therapeutic effects were compared.Results: Compared with open surgery group, there was significant rise in complete cut closure rate (78.33% vs.91.38%), and significant reductions in bleeding volume during operation [(919.83±242.12) ml vs.(58.17±9.53) ml], postoperative infection rate (15.0% vs.3.4%) and hospital stay [(16.40±0.96)d vs.(9.10±0.83)d] in EVGE group, P<0.05 or <0.01.Success rate of PCI was 100% in EVGE group, and there was no PCI-related severe complications.During follow-up, coronary restenosis rate within 12 months in EVGE group was significantly lower than that of open surgery group (5.20% vs.15.30%, P=0.04).Conclusion:It is safe and possesses significant effective to treat descending thoracic aortic dissection complicated coronary heart disease using aortic endovascular stent-graft exclusion combined percutaneous coronary intervention, which is worth extending.

Radiotherapy and interventional thearapy are the main means for unresectable advanced primary hepatic carcinoma.However,the efficacies are restricted by their respective adaptability.The development of radiotherapy,especially the application of radiotherapy combined with transcatheter hepatic artery chemoembolization provide more suitable treatment means for patients.

OBJECTIVETo explore the effect of lappaconitine on patient-controlled intravenous analgesia (PCIA) and serum complement 3 and 4 (C3 and C4) levels of cancer patients undergoing rectum surgery.

METHODSTotally 60 patients, who were scheduled for rectum carcinoma surgery, were recruited to the study and assigned in 3 groups, the blank control group, the tramadol group, and the lappaconitine group, 20 in each group. Lappaconitine (8 mg) was intravenously dripped to patients in the lappaconitine group 30 min before ending the operation. PCIA started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Patients of the tramadol group were treated with tramadol (100 mg) intravenously within 30 min before ending the operation. The dripping was completed within 30 min. PCIA was started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Tramadol (100 mg) was intravenously dripped to patients in the tramadol group 30 min before ending the operation. PICA was started as soon as the end of the surgery and the total dose of tramadol was 900 mg. Pethidine (50 mg) and droperidol (2. 5 mg) was intramuscularly injected to patients in the blank control group for pain relief according to their complaints. Pain degrees were assessed by visual analog scale (VAS) 12 h before surgery, 12, 24, 48, and 72 h after surgery. Blood samples were withdrawn at the same time point. Contents of serum C3 and C4 were determined by immunoturbidimetry.

RESULTSVAS scores of the blank control group were significantly higher after surgery than before surgery (P <0. 01). There was no statistical difference in VAS scores between before surgery and after surgery in the tramadol group and the lappaconitine group (P >0. 05). VAS scores were significantly lower at each post-surgery time point in the tramadol group and the lappaconitine group than in the blank control group with statistical difference (P < 0.01). There was no statistical difference in VAS scores at each post-surgery time point between the tramadol group and the lappaconitine group (P >0. 05). Compared with before surgery, contents of serum C3 and C4 significantly decreased in all of the three groups at 12, 24, and 48 h after surgery (P < 0.05, P < 0.01). They recovered to the pre-surgery level till 72 h after surgery (P > 0.05). Serum C3 and C4 contents at 48 h after surgery were higher in the tramadol group than in the blank control group (P < 0.05). Serum C3 and C4 contents at 24 and 48 h after surgery were higher in the lappaconitine group than in the blank control group (P < 0.05). There was no statistical difference in serum C3 and C4 contents at each time point between the tramadol group and the lappaconitine group (P > 0.05). VAS scores were obviously negatively correlated with serum contents of C3 and C4 (r = -0.622, r = -0.649, P < 0.01).

CONCLUSIONSLappaconitine (used at the dose in this study) showed better pain relief effect after surgery. Besides, it could inhibit the surgic wound and pain, and elevate serum contents of C3 and C4.

Aconitine ; analogs & derivatives ; therapeutic use ; Analgesia, Patient-Controlled ; methods ; Analgesics, Non-Narcotic ; therapeutic use ; Complement C3 ; metabolism ; Digestive System Surgical Procedures ; Humans ; Neoplasms ; Orthopedic Procedures ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Rectum ; surgery ; Tramadol

Portal vein tumor thrombus (PVTT) influence the prognosis of hepatocellular carcinoma.The development of PVTT is a multi-factor,multi-part process.According to anatomic features of the portal vein in the liver and tumor thrombus of HCC developing modes,a uniform tumor thrombus types system (typesⅠ -Ⅳ) is recommended.Multi-modal therapy based on surgery,interventional therapy and radiotherapy can improve the curative effect enormously.

Sixty cases of simple obesity of stomach-intestine excessive heat type were randomly divided into acupuncture-Tuina groupand single acupuncture group, 30 cases in each group, and were given acupuncture-Tuina and single acupuncture respectively. The clinical effects of two groups were analyzed and compared by obesity and fat indexes before and after treatment. The total effective rates in acupuncture-Tuina and simple acupuncture group were 90.0% and 73.3% respectively. The effect of acupuncture-Tuina in treating simple obesity with stomach-intestine excessive heat type was satisfactory, and better than that of acupuncture(P<0.05).

Objective To analyze the pregnancy outcomes and measures to prevention and cure for pregnancy women with pulmonary hypertension.Methods Clinical data of 40 women with pulmonary hypertension were analyzed and they were divided into three groups on the basis of Doppler transthoracic echocardiography detections.Results(1)The proportions of rheumatic heart disease and congenital heart disease were 22.64% and 45.38%;8 cases appeared with the perinatal heart disease and 5 cases' hearts structure were normal.(2)49 cases applied cesarean section and 2 delivery naturally.2 women were induction of labour in second trimester.In midrange and severity groups,prematurity and small gestational age were significently higher than those of gentle group.(3)3 women died of congestive heart failure and pulmonary embolism.6 women were treated by SICU and physician because of serious illness.Conclusion Women with midrange and severely pulmonary hypertension should avoid pregnancy.Pregnant women with pulmonary hypertension needed monitor closely and being treated with pulmonary vasodilator added decoagulant would improve outcomes of mather and infant.

Objectives To verify if chemotherapy drug gemcitabine could induce a change of protein expression in pancreatic cancer cell line SW-1990, and to provide evidence for clinical therapy. Methods We use two-dimensional gel eleclrophoresis(2-DE), mass speclrornetry and bio-information methods to compare the change of protein expression before and after gemcitabine and 5-FU treatment of cell line SW-1990, and identify the discrepant protein expression. Results The concentration of gemcitabine, that can suppress 50 percent of the pancreatic cancer cells was 1-100 ng/ml, while same suppression for 5-FU was 250-2500 ng/ml. Six discrepant protein expressions, one in 5-FU group and 5 in gemcitabine group were found. Conclusions Gemcitabine has better therapeutic effects on the growth of pancreatic cancer cell line SW-1990 than that of 5-FU. Gemcilabine was involved in sugar and fat metabolism, and it could induce some changes of protein expression, for example ?-actin and MGC: 19713, which is of somewhat importance for clinical investigation of pancreatic cancer therapy.

Objective To evaluate the efficacy of three-dimensional conformal radiotherapy(3D-CRT) combined with transcatheter hepatic arterial chemoembolization(TACE) for patients with primary liver cancer.Methods From July 2003 to July 2006,followed by transcatheter hepatic arterial chemoembolization(TACE,mitomycin + 5-fluorouracil + pirarubicin) 3 times in 6 weeks,59 patients with primary hepatic cancer received noncoplanarity multifield 3D-CRT by using Leibinger three-dimensional stereotactic conformal radiotherapy planning system,Varian 600C/D 6MeV X liner accelerator and multileaf collimator at a dose of 60-65Gy/9-11 fractions/15-22 days.Results Of 59 patients,58 cases received a complete course of 3D-CRT combined with TACE.CT results showed that the rates of complete response(CR),partial response(PR),no change(NC) and progression(PD) rate were 57.6%(34/59),35.6%(21/59),3.4%(2/59) and 3.4%(2/59),respectively.Overall response rate(CR+PR) was 93.2%(55/59).Jaundice occurred one week after treatment in one patient,who died of acute hepatic function failure.No serious adverse effects or intoxication were found in the remaining 58 patients.Conclusions The combination of 3D-RCT with TACE was an effective treatment for patients with primary hepatic cancer.