Objective To investige the risk factors of urosepsis after percutaneous nephrolithotomy (PCNL).Methods We retrospectively analyzed 204 renal calculi or proximally ureter calcui patients,who underwent ultrasound-guided PCNL,from January 2013 to January 2014.Among them,there were 140 men and 64 women,whose mean age was 49 years (range from 29 to 75 years).Eighty-four operations were performed via standard channel and 120 operations were performed via micro channels.Fifty one patients had staghorn stones.Before operation,the urine culture positive rate was 14.7％ (30/204).The creatinine level ranged from 46 to 340 μmol/L [mean (87.9±33.9) μmol/L].Average stone diameter was (2.3±0.8) cm (range 1.0-7.0 cm).Mean operative time was (68.4±26.9) min (range 23-219 min).The chi-square test and a logistic regression model were used to identify key risk factors.Results The operation duration ranged from 23 to 219 min,mean (68.4±26.9) min.Of 204 patients,9 (4.4％) suffered septic shock,including 7 female patients and 2 male patients.Their mean age was (52.6± 15.2) years (20-73 years).Five operations were performed via standard channels and four operations were performed via micro channels.Five patients had staghorn stones.Urine culture positive rate was 77.8％ (7/9).The average stone diameter was (2.5±0.6) cm (range 1.8-3.5 cm).Mean operative time was (86±53) min (range 47-219 min).In univariate analysis,significant associations was observed between female gender (P =0.005),positive urine culture (P＜0.01),staghorn calculi (P =0.035),operative duration＞90 min (P =0.042) and sepsis after PCNL.While in multivariate analysis,female gender (OR=6.001,95％CI=1.190-30.276,P=0.03) and positive urine culture pre-operation (OR=19.647,95％CI=3.918-98.562,P＜0.01) were identified as independent risk factors for post-MPCNL septic shock.Conclusions Female gender and positive urine culture before operation are the key risk factors of urosepsis after percutaneous nephrolithotomy.

The medical engineering department is an important part in modern hospitals,but the status and functions of medical engineers are ignored,which result in the drain of the experts in this field.This paper analyses the reason and gives the countermeasure.

0.05) ; Compared with group A and B , contents of brain water and MDA were significantly increased at 3 hours after ACCI (P

Objective Study on the inhibitory effect of gallnut extract extract on MRSA β-lactamase. Methods Determination of inhibitory effect of gallnut extract on MRSA3002 by TTC method. β-lactamase was repeated by freezing and thawing method . Synergistic effect of gallnut extract and gentamicin was detected by TTC. Results The MIC and MBC of MRSA3002 by gallnut extract were 8mg/mL and 32mg/mL.Gallnut extract can reduce strains of β-lactamase activity,the MRSA300224h 1/2MIC after the effect of gallnut extract, beta lactam enzyme activity inhibition compared with the control group there were significant differences (P<0.01),compared with the positive control group, the difference was not significant. Synergistic effect of gallnut extract and gentamicin can significantly reduce the MIC of MRSA3002. Conclusion Gallnut extract can reduce β-lactamase activity recovery sensitivity of drug-resistant bacteria.

ObjectiveTo study the situation of neural invasion in pancreatic cancer and investigate its related clinical factors. Methods The neural invasion in 73 cases of pancreatic cancer patients was retrospective analysed. The correlation between neural invasion and clinicopathological parameters,and survival rate was investigated.Results In 73 cases of pancreatic cancer,neural invasion occurred in 38(52.1％) patients,among whom intra-pancreatic neural invasion rate was 15.8％ (n =6) ; and both intrapancreatic and external pancreatic plexus invasion rate was 84.2％ ( n =32).Neural invasion was not related with gender,age,and pathological type,degree of differentiation,tumor size and lymph node metastasis (P ＞ 0.05 ).But the presence of abdominal pain,vascular invasion,the expression of EGFR and VEGF in tumor tissue was significantly related with neural invasion (P ＜0.01 ).The median survival of patients in neural invasion group was 8 months,which were significantly shorter than that of in patients without neural invasion (13 months,x2 =4.69,P =0.030).Conclusions Neural invasion has a high incidence in pancreatic cancer,and it can cause obvious abdominal pain.And it is related with vascular invasion and the expression of EGFR and VEGF in tumor tissue.Neural invasion is one of the factors affecting the survival rate.

Objective To study the effect of inhalation combined salmeterol plus fluticasone propionate in treatment of asthma in children between 4 ～ 5 years old.Methods Seventy-four children (age range,4 ～ 5 years) were enrolled for our study,they were randomly divided into 2 groups (one group inhaled combined salmeterol plus fluticasone,37 children;the other group inhaled fluticasone,37 children).Comparative studies of clinical efficacy,quantified symptom score,and regular follow-up observations were conducted at the interval of one week,one month,three months.Results In the first week and first month during the treatment,there were no difference between salmeterol plus fluticasone group and fluticasone group (P ＞ 0.05).In the third month during the treatment,the daytime ratings(0.16 ± 0.09 vs 0.32 ± 0.11,P ＜ 0.05) and night ratings(0.04 ± 0.01 vs 0.14 ±0.00,P ＜0.05) of salmeterol plus fluticasone group were significantly better than those of fluticasone group.After three months,more children in salmeterol plus fluticasone group were responsive to the decreased dose of the drug than those of fluticasone group (x2 =4.57,P ＜ 0.05).Conclusion In the follow-up of exacerbatious,treatment with combined salmeterol and fluticasone propionate was as efficient as that of fluticasone in alleviating symptoms.During remission of asthma,combined salmeterol and fluticasone propionate was probably better than fluticasone for control of symptoms.

BACKGROUND:Based on variational principle and weighting technology of three-dimensional finite element method, human teeth with a complex morphology can be modeled, which helps to understand the stress distribution of dental hard tissue and prosthesis during the dynamic repair process. OBJECTIVE:To comprehensively analyze the three-dimensional finite element studies concerning biomechanics of dental prostheses, focusing on the effects of metal crown, porcelain thickness, root canal preparation and fil ing on the tooth stress. METHODS:A computer-based search of PubMed (1993-04/2012-09), China Academic Journal Network Publishing Database (2001-2008), and VIP (2001-2008) was performed by the first author to retrieve articles concerning the effects of metal crown, porcelain thickness, root canal preparation and fil ing on the tooth stress. The keywords were“porcelain-fused-to-metal, finite element method, stress analysis, root canal”in English and Chinese. Articles with repetitive contents or meta-analysis were ruled out. Then 40 articles were suitable for further analysis.RESULTS AND CONCLUSION:Finite element method has important significance to establish high-fidelity and high-accuracy models in oral medicine, thereby providing effective biomechanical information for the root canal treatment and post-treatment repair. Scholars continue to explore the stress distribution of dental prostheses during chewing. This review summarizes the stress changes of post and core crowns, supporting reference for further research. Three-dimensional finite element method can be used to build nonlinear three-dimensional finite element models with anisotropic biomechanical characteristics, and can gradual yimprove the transition from static analysis to a dynamic analysis, truly achieving accurate simulation of oral biology and dental morphology as wel as chewing function of the teeth.

Objective To access the safety and efficacy of balloon dilation in percutaneous nephrolithotomy for staghorn stones.Methods Clinical data of 64 patients with staghorn stone according to the inclusion criteria in our institution from April 2013 to April 2014 were collected and analyzed retrospectively.According to the dilation methods,the patients were divided into balloon dilation group (dilated to 24 F by balloon dilator,31 cases) and fascial dilation group (dilated to 16 F by Amplatz fascial dilator,33 cases).There was no significant difference in sex,age,body mass index between the 2 groups.The data of duration of percutaneous access,one-attempt success rate of dilation,puncture complications (kidney calices fracture,perinephric fluid collection and postoperative delayed hemorrhage etc.),removing stones time,stone free rate,hemoglobin drop after surgery and number of patients who experienced postoperative fever ＞37.5 ℃ were recorded.Results Compare to fascial dilation group,balloon dilatation group had significant differences in terms of duration of percutaneous access [(5.6± 2.1) min versus (9.4± 1.7) min],oneattempt success rate of dilation[100％ (31/31) versus 88％ (29/33)],removing stone time[(32.4±3.4) min versus (49.5±3.7) min],stone free rate [84％ (26/31) versus 61％ (20/33)],hemoglobin drop after surgery [(16.7±3.3) g/L versus (28.4±2.6) g/L],renal intrapelvic pressure[(19±3) mmHg versus (25±6) mmHg] and rate of patients who experienced postoperative fever ＞37.5 ℃ [16％ (5/31) versus 39％(13/33)] (P＜0.05).No injury of adjacent organs,including pleura,liver,spleen,or bowel was noted in all patients.Conclusions Balloon dilation is quick and safe with less hemorrhage when building percutaneous renal channel.And it has higher stone free rate and less complication rate in percutaneous nephrolithotomy with staghorn stones.

Pancreatic cancer with liver metastases (PCLM) is a refractory malignant tumor characterized by insidious onset, rap-id progress, and poor prognosis. Only a few patients had the opportunity of receiving surgical treatment. PCLM is primarily treated by systemic chemotherapy. The chemotherapeutic regimen of 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin has become the first-line therapy for PCLM patients with good performance status. Gemcitabine-based chemotherapy is still very important in treating PCLM. Nab-paclitaxel plus gemcitabine, which has been found to increase survival, is recommended as a new standard for treating PCLM patients. However, still no breakthrough has been established in the study of gemcitabine plus molecular-targeted therapy. Sys-temic chemotherapy combined with trans-catheter arterial chemoembolization is valuable and may be effectual in prolonging survival. Further investigation of prospective and randomized controlled clinical trials is necessary. Radio frequency ablation and brachy-thera-peutic embolization with yttrium-90 microspheres are still in the exploratory stage. Multimodality treatment of PCLM using chemother-apy, radiation therapy, and Chinese herbal medicine is gaining wide acceptance. This article reviews the recent progress in the treatment of PCLM.

One alkaline protease from Actinomucor elegans AS3.2778 was purified protein. The enzyme was purified using ammonium sulfate precipitation, ion exchange chromatography, hydrophobic chromatography and size exclusion chromatography method, and its properties were also investigated. The molecular weight of this enzyme is 32 kDa with SDS-PAGE method, optimum temperature is 60℃, optimum pH is 8.5 to 10.5, it is stable in the pH range of 6.0 to 9.0 at < 40℃ temperature, and being completely inhibited by the serine protease inhibitor, PMSF, indicated that it belongs to the serine protease family. Specificity test indicated this protease has extensive selectivity to peptide bones, especially to peptide bones composed of Leucine residue.