With the development of clinical education,Urology Department in Xiangya Hospital has identified teaching object and scheme,and improved the condition and modality of teaching and the level and development of clinical teaching.

Objective To investigate the ultrasonic atomization anesthesia time guided needle aspiration biopsy for endobronchial ultrasound (EBUS-TBNA) effect of anesthesia in patients. Methods A total of 60 patients of EBUS-TBNA were divided into A group, B group and C group by random digits table method, each group of 20 cases. Three groups of patients were treated with topical anesthesia with 2%lidocaine aerosol inhalation, atomizing inhalation time:A group 20 min;B group 25 min;C group 30 min. Fiberoptic bronchoscopy was performed in accordance with operating procedures after anesthesia. The changes of vital signs were observed. The patients were investigated by questionnaire. Results A, B, C three groups of the highest blood pressure were (141.90±3.24), (132.30±3.06), (131.15±3.42) mmHg (1 mmHg=0.133 kPa), heart rate was (98.25 ± 3.39), (90.50 ± 3.85), (92.20 ± 5.12) beats/min, breath respectively was (20.45±1.43), (19.15±1.23), (19.00±1.38) beats/min, blood oxygen saturation was 0.9150± 0.0248, 0.9750±0.0128, 0.9735±0.0114, the B and C group was more stable than the A group (P<0.05), B, C two groups were not statistically significant (P>0.05). A, B, C three groups of patients with bronchoscopy insert a successful number of cases were 55%(11/20), 90%(18/20), 90%(18/20), A group was lower than B, C two group (χ2=6.144, P<0.05). The subjective comfort of the three groups were (28.40± 1.82), (37.10 ± 2.02), (36.15 ± 1.42)points, A group and B, C two groups were statistically significant (P<0.05), B, C two groups were not statistically significant (P>0.05). There was significant difference in the effect of anesthesia among three groups (Z=2.105, P<0.05). Conclusions Using 2%lidocaine ultrasonic atomization inhalation anesthesia for patients with local anesthesia, the effect of anesthesia is 25 min and the patient′s tolerance is the best.

Objectives:To evaluate the effect of early enteral nutrition(EEN) on the structure and function of the gut, the bacterial and endotoxin translocation. Methods:SAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and trypsin into the pancreas via pancreatic duct.15 dogs were divided into PN group and EEN group.Systemic plasma endotoxin levels was quantified.Both portal and systemic blood sample were obtained before and 1?4?7 d following SAP,and cultured for aerobic as well as anaerobic bacterial growth.Specimens of tissue from mesentery lymph nodes,lung and pulmonary portal nodes and pancreas were removed,weighed and homogenized at the 7th day. Results:The levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and cycle blood and distant organs were significantly reduced the protein and DNA content of the small intestine and colon increased,and the height of the villi and the thickness of mucosa and whole bowel wall of the intestinel and colon improved in EEN group as compared with those in PN group. Conclusions:We conclude that EEN can improve gut metabolism,decrease the extent of mucosal atrophy,and assist in the maintenance of the mucosal barrier function.It is effective touse EEN in severe acute pancreatitis.

OBJECTIVE To investigate the pathogenic causes of lower respiratory tract infections(LRTIs) in the elderly in Guangzhou area.METHODS Pathogens obtained from 107 patients with LRTIs were performed by multiple diagnostic tools that including bacterial culture,PCR and specific immunological assays.RESULTS A bacterial cause was established in 42(68.5%) and an atypical pathogen cause in 25(31.6%) of the 107 patients.Mycoplasma pneumoniae and Haemophilus influenzae remained the most important pathogens for LRTIs.CONCLUSIONS In the prescription of antibiotics in the elderly with LRTIs,not only bacteria but also atypical pathogens should be taken into account.

AIMTo investigate whether free fatty acid impair insulin signaling proteins to inhibit insulin action in rat islet cells.

METHODSAfter rat islet cells were incubated with palmitate (0.25 mmol/L) or oleate (0.125 mmol/L) for 12 hours, 24 hours and 36 hours, western bolt was used to assess the protein abundance of cPKCalpha, Grb2 and FERK2.

RESULTSThe protein content of cPKCalpha were significantly upregulated and the protein abundance of Grb2 and ERK2 was decreased comparing with control in rat islet cells after incubated with free fatty acids.

CONCLUSIONSFree fatty acids may inhibit insulin activity in rat islet cells through up-regulating the expression of cPKCalpha or down-regulating the expression of Grb2 and ERK2.

Animals ; Cells, Cultured ; Fatty Acids, Nonesterified ; blood ; GRB2 Adaptor Protein ; metabolism ; Insulin ; metabolism ; Islets of Langerhans ; metabolism ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Protein Kinase C-alpha ; metabolism ; Rats ; Rats, Sprague-Dawley ; Signal Transduction

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; blood ; genetics ; Male ; Middle Aged ; Mutation ; Tumor Suppressor Protein p53 ; blood ; genetics

OBJECTIVETo investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures.

METHODSBetween June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function.

RESULTSAll patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor.

CONCLUSIONAsian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

Adult ; Bone Nails ; Female ; Femoral Fractures ; surgery ; Femur ; injuries ; surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective To monitor the dynamic changes of liver and kidney functions in the first week after liver transplantation and to assess the value of liver and kidney functions in predicting patient's survival. Methods clinical data of 161 recipients with benign liver diseases were retrospectively reviewed.Total bilirubin ( TB ), aminoleucine transferase ( ALT), aspartate aminotransferase ( AST), prothrombin time (PT) and serum creatinine (SCr) were recorded and analyzed during the first post-transplant week.The data collected at dl were analyzed in the multivariate COX regression. Results From d1 to d7 post-transplant, the median value changed from 116. 2 mmol/L to 66. 7 mmol/L ( Z = 5.901, P < 0. 01 ) for TB,19.4 s to 15.0 s (Z = 11. 657, P <0.01 ) for PT, 285 U/L to 100 U/L (Z = 12.619, P<0. 01 ) for ALT,264 U/L to 50 U/L (Z =9. 776, P <0. 01 ) for AST, 103.4 mmol/L to 86. 6 mmol/L (Z = 1. 353, P 0. 05 ) for SCr. Post-transplant SCr ( RR = 3. 477, P < 0. 001 ) and TB ( RR = 2. 088, P < 0. 05) levels wereindependent factors influencing patient survival. A prognostic score formula was then established as 1. 276 ×InSCr (mg/dL) + 0. 730 × InTB (mg/dL). Conclusion In a successful liver transplantation,transplanted liver function recovers promtly within one week. SCr and TB levels on post-transplant d1 have good prognostic value.

Objective　To investigate the relationship betwee n tricuspid insufficiency (TI) and the function of the right ventricle, degree o f pulmonary vascular pathological change in patients with rheumatic heart diseas e so as to provide the indication of operation for treating TI. Methods 　41 cases of rheumatic heart disease with TI accompanying with bicuspid pathological changes were reviewed. Correlation analysis was done between the s everity of TI and the right ventricular size(RVS), pulmonary artery pressure(PAP ), pulmonary artery resistance(PAR) etc. Results　It was found t hat the size of the right ventricle, PAP, PAR were positively correlated to th e degree of TI. Tricuspid annuloplasty should be carried out in patients with RV D>40 mm, PAR >48 kPa*s/L, PAP>8 kPa. Conclusion　TI resulted ma inly from insufficient function of the right ventricle and marked patholog ical changes of the pulmonary blood vessels. Doppler echocardiography evaluation for the function of right ventricle and pathological condition of pulmonary blo od vessels might be of significant in deciding whether tricuspid annuloplasty sh ould be performed simutaneously in patients of bicuspid valve replacement.