BACKGROUND:Umbilical cord blood transplantation can ameliorate hepatic and immunologic function,repair hepatic injury,and promote hepatic regeneration,however,the differentiation mechanism and biological characteristics remain poorly understood,and the long-term efficiency need to be explored.OBJECTIVE:To investigate the long-term therapeutic efficacy of infusing umbilical cord blood and blood plasma in treating chronic severe hepatitis B patients.METHODS:Totally 50 chronic severe hepatitis B patients received treatment at the Second Xiangya Hospital,Central South University from January 2003 to January 2004 were randomly divided into the treatment and control groups,with 25 cases in each group.All patient were accepted an ordinary synthetic treatment,and the differences between age,pathogenetic condition,medication had no significance.The umbilical cord blood was obtained from healthy full-term spontaneous delivery parturient,centrifugated,remained karyotes and cord plasma,and used within 24 hours.Patients in the treatment group were received umbilical cord blood infusion,200 mL once,1 2 times per week,totally,each patients infused 4-8 times(mean 5 times);those in the control group were infused with adult fresh blood plasma.The changes of hemogram and hepatic function were measured.RESULTS AND CONCLUSION:All the patients were followed-up for 1 year.The hemogram and hepatic function indexes were similar in the 2 groups before treatment(P ＞ 0.05).The hemogram index had no obviously difference at 1 year after treatment (P ＞ 0.05),but the alanine aminotransferase and total bilirubin levels were decreased in the treatment compared with the control group(P ＜ 0.05),but the albumin was significantly increased(P ＜ 0.05).Compared with before treatment,the platelet level had no significant changes at 1 year after treatment,but the alanine aminotransferase and total bilirubin levels were deeply decreased(P＜ 0.05),albumin was significantly increased(P ＜ 0.05);the platelet and albumin levels were dramatically decreased in the control group(P ＜ 0.05).It suggested that umbilical cord blood infusion can improve the hepatic function and hemogram;therefore,it can be served as supplementary therapeutic measure for severe hepatitis.

Defecography was performed in 110 patients without any anorectal symptoms which included 57 male and 53 female with an average age of 43. 15. Normal defecography was found in 82 cases and abnormal one in 28. The normal features of defecography in 82 patients were as follows;1.There was an increase of anorectal angle during defecation. The increase was 21. 27 degrees measured-with precise axis method and 36. 72 degrees with approximate axis method.2. Reduction or obliteration of the impression of the puborectal muscle.3. There was a shortening of the anal canal by 1. 20 cm and a widening of the caliber of the anal canal to an average of 2. 23 cm.4. The resistance of the pelvic floor was good and the decending of the perineum was smaller than 3 cm during straining. The rectovaginal septum of female subjects was not deformed during straining.5. The barium paste in the distal rectum was largely or totally evacuated with an average e-vacuation rate of 90. 55%.

Objective To analyze the current status of neonatal resuscitation in medical institutions in China.Methods With the number of obstetric beds as the inclusion criteria,the survey was conducted in 163 medical institutions randomly selected in 11 provinces (including 51 tertiary hospitals,88 secondary hospitals and 24 primary hospitals) from October 1 to December 31 in 2011.The mail-questionnaire was sent to collect information about system establishment,personnel training,neonatal resuscitation equipment etc.Statistical data was analyzed by t-test,variance analysis and Chi-square test.Results The incidence of neonatal asphyxia among live birth babies was 2.15％ (3328/154 853) in tertiary hospitals,1.41％ (2829/200 731) in secondary hospitals and 1.50％ (701/46 695) in primary hospitals (x2=298.559,P＜0.01).The mortality rate during delivery was 0.41‰ (63/154 853),0.24‰ (48/200 731) and 0.60‰ (28/46 695) at the three different level hospitals,respectively (x2=16.993,P＜0.01).The mortality rate within 24 hours after delivery was 0.42‰ (65/154 853) in tertiary hospitals,0.24‰ (49/200 731) in secondary hospitals and 0.62‰ (29/46 695) in primary hospitals (x2 18.075,P＜0.01).About 86.5％ (141/163) of the included hospitals maintained routine neonatal resuscitation trainings,but only 73.0％ (119/163) applied resuscitation training equipments during the trainings.The outfit rate of basic neonatal resuscitation equipments (such as neonatal laryngoscope,radiant heater) was high in most hospitals,but the outfit rate of equipments recommended by the new guideline (such as umbilical venous catheter,T piece and oxygen saturation meter) was low.For example,the outfit rate of umbilical venous catheter was 23.5％ (12/51),10.2％ (9/88) and 4.2％ (1/24) in tertiary,secondary and primary hospitals respectively (x2 =6.992,P ＜ 0.05).47.9％ (78/163) of the hospitals had set up neonatal intensive care unit,with the proportion in tertiary,secondary and primary hospitals being 80.4％ (41/51),34.1％ (30/88) and 27.2％ (7/24),respectively (x2=31.677,P＜0.01).Most of the hospitals (80.4％,131/163) could ensure the pediatricians being presented in the delivery room for high risk women,and the proportion was 94.1％ (48/51),79.5％ (70/88) and 54.2％ (13/24) in tertiary,secondary and primary hospitals,respectively (x2 =16.591,P＜0.01).There were 88.3％ (144/163) of the hospitals had routine neonatal resuscitation case audit,with the proportion in the three different level hospitals being 94.1％ (48/51),92.0％ (81/88) and 62.5％ (15/24),respectively (x2 =18.388,P＜0.01).Conclusions Strengthen the training,equipment and system establishment in primary medical institutions is conducive to promote neonatal resuscitation.

Objective To investigate the clinical application of anti-β2 glyeoprotein Ⅰ antibodies (IgG, IgM, IgA)in systemic lupus erythematosus(SLE). Methods The anti-β2-GP Ⅰ antibodies and anti-cardiolipin antibodies(ACL) level were measured by ELISA in 100 SLE patients, 39 other rheumatoid arthri-tis patients and 30 healthy control people. Their clinical application was analyzed in SLE diagnose and thera-py. Results The level of anti-β2-GP Ⅰ (IgG, IgM, IgA)were significantly higher in SLE than that in healthy (P < 0. 01 ). Sensitivity, specificity, positive predictive value and negative predictive value were 17.2%, 95.7%, 85.0% and 44. 6%, respectively. There was a significant and positive correlation be-tween anti-β2-GP Ⅰ antibodies and ACL antibodies ( IgG, IgM, IgA) (r = 0.418, 0. 624, 0.518, 0. 583, P <0.01). In multivariate analysis the factors(anti-β2-GP Ⅰ antibodies, ACL antibodies, dsDAN, u1-RNP, Sm, SSA, SSB, Jo-1, Scl-70, P-protein, PT, APTT) associated with SLE disease activity index(SLEDAI) were anti-β2-GP Ⅰ (IgG) and dsDNA. Conclusion anti-β2-GP Ⅰ antibody has high specificity and positive predict value, also is associated with SLE's thrombosis. It has some values in the clinical application.

ObjectiveTo evaluate the mid-term clinical effect of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) intervertebral fusion cage in treatment of thoracolumbar burst fractures.Methods A total of 87 patients with thoracolumbar burst fractures were managed by thoracolumbar body resection combined with n-HA/PA66 intervertebral fusion cage from December 2007 to September 2008.The clinical effect, safety and radiographic outcomes were evaluated.Results No nerve damage was deteriorated in all the patients.The neural function was improved for 1-2 grade except for four patients at Frankel grade A.The patients were followed up for mean 21.3 months (17-24 months).The kyphosis was (14.4 ± 12.6)° preoperatively, (3.7 ± 8.7) ° immediately after surgery and (4.0 ± 8.3)° at final follow-up.The distance between the upper and lower vertebral bodies was (96.9 ± 17.2) mm preoperatively, (109.5 ± 17.1) mm immediately after surgery and (108.3 ± 16.4) mm at final follow-up.No cage replacement, internal fixation breakage or neurologic impairment were observed during follow-up period.There were 58 patients with grade E fusion, 22 with grade D fusion and 7 with grade C fusion.ConclusionsAnterior decompression combined with n-HA/PA66 intervertebral fusion cage is an effective method for treatment of thoracolumbar burst fracture.The kyphosis is rectified and the intervertebral distance is corrected, with a high rate of fusion.

OBJECTIVE To investigate the prevalence of ?-lactamases in nosocomial infections of Enterobacter cloacae,study the different genotyping of ?-lactamases,and analyze its independence in drug resistance. METHODS AmpC ?-lactamases and ESBLs were detected by three-dimensional extract tests.PCR was used to determine the genotype of ?-lactamases and their resistance to 13 kinds of antibiotics was detected by Kirby-Bauer method. RESULTS The sensitivity test showed that they were resistant to the most antibiotics.Among the 80 ESBLs strains,29 strains carried ESBLs gene,3 strains carried two different gene.Such as:TEM existed in 6,SHV-Ⅰ existed in 2,CTX-M-2 existed in 5,CTX-M-3 existed in 8 and CTX-M-9 existed in 11 strains.Twenty-six strains carried ampC.The resistant rate of SSBLs-producing E.cloacae to 12 antibiotics except merapenem was 66.7-100.0%.SSBLs strains of E.cloacae were higher than AmpC ?-lactamases in resistance to levofloxacin,cefepime,aztronem and trimethoprim sulpfamethoxazole with significant difference(P

Objective The survey of continuing education demand of our city' s rural health service members and their feel of job satisfacrion provides the basis for overall quality of the rural health service members. Methods We adopted the method of multistage sampling to conduct a questionnaire survey and condoct interview on rural health workers in our city, and then utilized software to analyze them. Results The survey comprises the first education qualification and highest qualification of 120 health workers and 228 rural doctors from health clinics in localities asoond our city, and most of them had technical secondary school education. 80.7% of rural health workers and 91.7% of village health workers were willing to enter medical college to further their education through the "University Student in Every Village Project" . 93.3% of rural health workers and 84.2% of village health workers were willing to take non - qualification education. Among the rural health workers, 29.2% were satisfied with their jobs, 44.2% were not satisfied with them. Among the village health workers, 12.3% were satisfied with their jobs, 67.5% were not satisfied with them. Conclusion We should increase fonding towards rural health workers' education to satisfy the demand of continuing education, solve the problem of pensioner' s insurance, and improve levels of job satisfaction.

Objective To investigate the clinical efficacy and indication of surgical treatment of L5S1 tuberculosis us?ing a medial edge of rectus abdominal muscle and retroperitoneal approach. Methods From Jan. 2010 to Nov. 2014, totally 18 cases of L5S1 tuberculosis were surgically cured by debridement, fusion and internal fixation via a medial edge of rectus ab?dominal muscle and retroperitoneal approach. There were 10 males and 8 females, with an average age of 35.6±10.1 years (21 to 55). The mean course of disease was 5.3±2.2 months. The primary destruction lesions were located at L5S1, and one patient of whom L4 was also involved, three cases S2 involved, and one S3 involved. Abscess pre sacrum was noticed in all cases. Six patients were combined with abscess in vertebral canal. Neural deficiency was detected in 3 patients, all grading as Frankel D. Dubousset's lumbosacral angle was 104°-126°, mean 114.6°±6.0°. Formal anti?tuberculosis medicine treatment was given for at least 2-3 weeks. All patients were treated using a medial edge of rectus abdominal muscle and retroperitoneal approach. Af?ter debridement, a tri?cortical iliac bone was used for structural inter?vertebrae fusion. The iliac bone was fixed to the sacrum by one cortical screw. Operation time, volume of blood loss, and surgery complications, including wound infection, looseness and shift of internal fixation, sinus occurrence, vascular injury, retrograde ejaculation in male patients were evaluated. The X?ray and 3D CT of lumbosacral spine, together with ESR and CRP were used to evaluate the control of tuberculosis during fol?low?up. The Dubousset's lumbosacral angle, visual analogue score, and the Frankel grade were compared between preoperative and postoperative. The bone graft fusion were also observed. Results The operation time was 147±16 min in average. The mean blood lose was 275 ± 77 ml. No vascular or neurological injury was noticed. There was also no retrograde ejaculation happened in this group. All patients were followed up from 18 to 28 months. Dubousset's lumbosacral angle was 122.4°±3.8° post?operatively and 121.4°±3.7° at the final follow?up. There was a significant difference between the lumbosacral angles pre and post operation, whereas no statistical difference between the post operation and the final follow?up. Bone fusion was noticed in all cases. All pa? tients have intact neurological function at the final follow?up. No screw breakage or graft bone migration occurred. VAS was 5.6± 1.09 pre?operation and 0.83±0.71 at the 3rd month's follow?up, and there was a significant difference between them. Conclusion Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdominal muscle and retroperitoneal approach is an effective method in terms of minimal trauma, low rate of modality, good ability in restore and maintenance of lumbosacral junction alignment and high fusion rate.

Objective To explore the feasibility of laparoscopically intracorporeal delta-shaped anastomosis in distal gastrectomy.Methods 82 consecutive patients with distal gastric cancer received laparoscopic distal gastrectomy, including intracorporeal delta-shaped anastomosis in 39 cases, and handassisted Billroth-Ⅰ anastomosis in 43 cases.The operative time, blood loss, anastomosis time were compared between the two groups.Results There were no differences between the two groups with regard to the operative time [(215 ± 24) min vs.(207 ± 13) min, t =0.406, P ＞ 0.05] and blood loss [(56 ±21)ml vs.(65 ± 26)ml, t =1.441, P ＞ 0.05], although the intracorporeal Delta-shaped anastomosis was more time-consuming than the extracorporeal Billroth-Ⅰ anastomosis [(17 ± 8) min vs.(12 ± 3) min, t =2.529, P ＜ 0.05].Conclusions Demanding expertise and some skills, totally laparoscopic distal gastrectomy with intracorporeal delta-shaped anastomosis is safe and feasible.

Objective To investigate the riskf actors associated with sepsis following surgery of con-genital heart disease in children, for early-recognizing and diagnosing, improving prognosis and decreasing mortality.Methods Retrospective study wa s employed,52 patients of sepsis and 104 patients of non-sepsis with similar age,sex,na d the same diseases were enrolled during Jan 2012 to Apr 2015 in cardiac intensive care unit.Variables such as age,sex,preoperative infection,delayed sternum closure,diaphragmatic paralysis, exploraot ry chest,cardiopulmonaryb ypass time, placed invasive catheter were included in the research fac-tors.The Logistic regression model was set up,OR and 95%CI were calculta ed.Results In sepsis group,the more shock and dysfunction organs,longre hospital stays,longer ICU stays and higher mortality were found compared to the non-sepsis group[25.32%vs.6.73%,3.5 ±1.1 vs.1.1 ±0.7,(35.1 ±11.2)d vs.(11.3 ±3.1)d,(21.3 ±7.1)d vs.(7.1 ±2.3)d,19.23%vs.4.81%,P<0.05].In the Logistic regres ion mod-e l,variables significantly associated with sepsisw ere preoperative infection,deal yed sternal closure,explorato-ry chest,and placed more invais ve duct,diahp ragmatic paralysis(P<0.05).OR value (95%CI) were 10.53 (1.73,64.2),26.66(2.69,263.83),19.47(1.87,203.02),4.99(1.36,18.31),8.32 (0.12,16.46 ), respectively.Conclusion Preoperative infection,delayed sternal closure,exploratory chest,placed more inva-sive duct,diaphragmatic paralysis are the risk factors of sepsis.Children with sepsis had poor clinical outcome compared to those without sepsis.