BACKGROUND:Sunshine time in northem region is short in winter,the infants and young children are vulnerable to lack of vitamin D. Up-to-date textbooks and the guidelines formulated by Chinese Medical Association account that glass block ultraviolet and indoor exposure to human is meaningless. Early studies have shown that sunlight exposure through glass had meaning in rats,but it was difficult to accurately quantify,while outdoor exposure in rats is difficult to continue. This expedment uses B-band ultraviolet rays,which has the impact on vitamin D metabolism in some wavelengths,to facilitate further study.OBJECTIVE:To study the effect of ultraviolet B exposure in laboratory on 25-hydroxy vitamin D(25-OHD)level and bone metabolism in the serum of growing rats.DESIGN,TIME AND SETTING:A randomized controlled animal experiment was performed in June 2007 in the ExperimantalAnimal Center of Chinese PLA General Hospital.MATERIALS:Forty male 21-day-old Wistar rats were employed in this study. Ultraviolet waves were sourced from an artificial UV light instrument(wavelength 280-350 μm,irradiation intensity 5.5μW/cm~2).METHODS:Forty Wistar rats were divided into four groups by random sampling table,exposed to different doses of ultraviolet Bwave. Direct exposure group:direct exposure for 20 minutes at an irradiation dose of 4.2 mJ/(cm~2·d);Indirect exposure 60 and 120 min groups:exposure through a single pane of glass for 60 and 120 minutes at an irradiation dose of 0.36 and 0.72 mJ/(cm~2·d).Control group:no exposure was given. For the direct exposure group,the lamp was placed above the cage. A 3-mm-thick pane of glass(common window glass) was placed underneath the lamp in the indirect exposure groups. Exposure groups were given irradiation for successive 20 days.MAIN OUTCOME MEASURES:Serum 25-OHD,bone alkaline phosphatase (BALP),and bone mineral density (BMD) were measured on day 21.RESULTS:25-OHD was significantly higher in all exposure groups compared with the control group (P＜0.001),but there was no difference between the direct exposure group and two indirect exposure groups. BALP was significantly lower in the exposure groups than control group (P＜0.001),it was also significantly lower in the 120-min indirect group than in the 60-min indirect group (P=0.022). There was a positive correlation between exposure dose and 25-OHD (r=0.555,P=0.002) and a negative correlation between exposure dose and BALP (r=0.595,P=0.001),also a negative correlation between 25-OHD and BALP (r=0.569,P=0.002),but there were no differences between groups for BMD. Exposure dose exhibited a threshold,serum 25-OHD and BALP no longer increased or decreased when it was 0.36 mJ/(cm~2·d).CONCLUSION:Midwave ultraviolet rays might affect serum 25-OHD and BALP levels in the growing rats through glass exposure,with no significant difference compared to direct exposure. The B-band ultraviolet exposure dose may play an important role in serum 25-OHD synthesis,but there is a threshold dose for the synthesis. Low-dose and prolonged exposure time also achieve threshold exposure.

Objective To study the application of intraoperative drug administration in simultaneous pancreas-kidney transplantation(SPK), in order to achieve favorable postoperative results. Methods In the 19 cases of SPK,we primarily administered albumin 1.5~2.0g/kg to increase blood volume. Intraoperative electrocyte fluid dosage was 30~50mL/kg. Isoptin, 5mg/12h and prostaglandin E1(PGE1) 100?g/12h was given to lessen preservation injury and somatostatin(3mg/12h) to inhibit exocrine secretion of the transplanted pancreas. Results After reperfusion,the 19 transplanted pancreas grafts secreted amylase averaging 20 800U/L,and the transplanted kidneys produced urine,through the ureters,in 2~10min.In the 19cases,exogeneous insulin was withdrawn within 1.5h~9d and kidney function returned to normal within 2~4d. Conclusions In the SPK recipients, the rational use of albumin, vasodilators and somatostatin plays an important role in obtaining better function of transplanted pancreas and kidney.

OBJECTIVE:To provide reference for the improvement of pharmacy management in primary hospital.METHODS:Some problems about pharmacy management and its operation process in primary hospital were introduced briefly.Reasons of above problems were investigated and analyzed,and relevant countermeasures were put forward.RESULTS & CONCLUSION:Pharmacy management of primary hospital should be strengthened,standardized and improved.More efforts should be put into the pharmacy work of primary hospital in order to make primary hospital become a great contributor for primary medical care.

Objective To investigate the maternal attitude and demands for Institute of Postpartum Care in order to provide targeted services.Methods 285 women were a investigated about maternal attitude and demands towards Institute of Postpartum Care with self-designed questionnaire.Results 97.9％ (279/285) women thought sitting the month (puerperal period) was very important,50.2％ (143/285)women were interested in Institute of Postpartum Care.They thought the main three advantages were energy saving,medical expertise and technology and avoidance of family conflicts;The three major issues were high price,lack of monitoring mechanism and unfamiliar environment and less family company;33 items of services demands over four points accounted for 78.6％,the three modules with highest scores were cleaning services scored 4.64±0.47,newborn services scored 4.45±0.41,consultation service scored 4.41:±0.53.Conclusions Professional postnatal care services have been a trend and social need,and a large proportion of women have great interest and demand on Institute of Postpartum Care which should make full use of its concentrate resources,and provide specific services according to maternal demands for services.It is urgent to build unified service standards and evaluation indicators to improve service quality.

Objective　To observe the effects of residual perfluorocarbon liquid(PFCL) droplets in the anterior chamber in patients after vitreoretinal(VR) surgery for complicated retinal detachments.Methods　The study group consisted of nine patients(nine eyes)aged 16～64 in whom droplets of perfluorodeclin liquid(PFDL) appeared in the anterior chamber subsequent to VR surgery for complicated retinal detachments involving scleral bucking, vitrectomy and/or lensectomy, the peeling of pre-retinal membrane, perfluorodecalin injection, and perfluorodeclin liquid-silicone oil or fluid-air exchange. Mean follow-up was 10.3 months.Results　Three to 30 droplets of perfluorodeclin liquid were found in the anterior chambers in 9 eyes. There was no corneal complication or inflammatory reactions or blood vessel invasion into the corneal stroma or increased intraocular pressure.Conclusion　Residual perfluorodeclin liquid droplets in the anterior chamber are well tolerated and do not induce corneal damage or ocular inflammation.

Objective To compare the advantages and disadvantages of botulinum toxin A (BTX-A) and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group (375 cases) and a control group (45 cases).The children were aged from 1 to 22 years ( average age 6 years).The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU (average 130.5 IU).The children in the control group were treated with a 5％ phenol solution block at a dosage of 0.5 to 4.6 ml ( average 2.2 ml).Children of both groups were given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale (PRS) and the modified Ashworth scale (MAS) before and after the blocking.Effectiveness rates,effectiveness durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups.After treatment,spasticity had been significantly reduced in both groups.The effectiveness rate was 98.4％ in the experimental group and 95.6％ in the control group,a difference which was not significant.The average effectiveness duration was ( 24.9 ± 5.76 ) weeks in the experimental group and ( 69.2 ± 13.76) weeks in the control group,significantly longer.The side effects rate was 5.33 ％ in the experimental group and 15.56％ in the control group,also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility.

Objective Pancreas perfusion is an essential step in human islet isolation.To develop the new methods for introductal canulation,collagenase infusion and to observe their effects on islets isolation.Methods A total of 17 pancreases were digested from March 2005 to April 2010.The pancreases were distended by three methods:the standard method (n =3),the one-cannula method (n =11) and three-cannula method (n =3).In the standard group,the pancreases were completely cut into half at the mid-body.Two catheters were inserted into the main duct:one directed toward the tail and the other to the head.In the one-cannula method group,a long tube was inserted into the duct at the head,advancing to the tail In the three-cannula method group,pancreatic parenchyma was then minimally cut at the mid-body and three catheters were inserted into the main pancreatic duct:one at the head (the first catheter) and two at the mid-body,one toward the tail (the second catheter) and the other toward the head (the third catheter).The pancreases were digested by improved Ricordi technique.Ficoll continuous density/grads centrifuge method was performed to purify the islets.DTZ staining was adopted to identify islets and count islet equivalent (IEQ). AO/EB fluorescence examination was used to count active islet percentage.Static glucose stimulating test (SGS) in vitro was designed to estimate islet function and calculate SI.Results The distension volume of the threecannula method group was 1.24 rnl/g pancreas,and higher than the other groups (for the standard group:0.71 ml/g pancreas; for one-cannula method group:0.96 ml/g pancreas,P＜0.05).The yield of islet in the three-cannula method group and the one-cannula method group was 2514 and 2270 IEQ/g,which was significantly more than that in the standard group (1914 IEQ/g pancreas,P＜0.05).The purity and viability of the islets were 74 ％/79.3 ％,75.6 ％/79.4 ％ and 78.3 ％/84.0 ％ respectively in the three groups with the difference being not significant among the groups.SI in the one cannula method group (4.74) and the three-cannula method group (5.27) was significantly higher than that in the standard group (3.46).ConclusionThe three-cannula method improved collagenase infusion and the islet yields.

Objective To analyze the role of the introperative vessel Doppler sonographic evaluation of the hepatic artery and portal vein. Methods Intraoperative vessel Doppler sonograms of 116 patients were analyzed for peak systolic velocity of hepatic artery and blood flow of the portal vein.In patients having abnormal findings on sonography (peak systolic velocity of hepatic artery less than 30 cm/s, blood flow of the portal vein less than 800 ml/s), the vascular anastomoses were checked.Results Fourteen of 116 cases revealed less hepatic arterial peak systolic velocity than 30 cm/s. In 9 of the 14 cases, the hepatic arterial peak systolic velocity was normal after injection of 0. 5 % lidocaine into celic trunk root, and papaverine and 654-2 into artery, 3 of the 9 cases endured artery thrombosis. In the other 5 of the 14 cases, by-pass anastomoses were done, and the hepatic arterial peak systolic velocity was normal, and no hepatic arterial complication occurred. Five of 116 cases revealed less hepatic portal vein blood flow than 800 ml/rnin. 4 of the 5 cases revealed shunt between portal vein and vena cava. The blood flow was normal after ligation of the shunt, and thrombosis occurred in 1 case of the 4. The another 1 of the 5 cases was presented with portal vein thrombosis of grade m, and the blood flow remained lower than normal when side-to-side anastomosis was done after resection of thrombosis. Then vein by-pass of the superior mesenteric vein to portal vein with donor iliac vein was done, the blood flow became normal, and no complication occurred. Conclusions The vessel Doppler sonography during liver transplantation was of pivotal values in preventing and diagnosing vessel complications. For the patients with abnormal findings though intraoperative vessel Doppler sonography, the close monitoring should be done in order to find out vessel complication as

Objective To summarize experience for hepatic artery reconstruction in orthotopic liver transplantation(OLT).Method A retrospective analysis was made for 183 cases of orthotopic liver transplantation performed in our institute from May 1995 to december 2006.All the arterial reconstructions were performed with 6-0 polypropylene sutures in an interrupted fashion under a 3.5 magnification surgical loupe.Donor hepatic arteries were anastomosed at the origin of the celiac artery with a Carrel's patch or at the level of splenic artery confluence.Extra-anatomic arterial reconstruction was based on recipient aorta using donor iliac artery graft.OLT with routine anatomic arterial construction served as control.Heparin or low-molecule-weight heparin as a prophylactic anticoagulation therapy was maintained during and after operation if prothrombin time is less than eighteen seconds.Follow-up Doppler ultrasonography was used daily in the early postoperative period.Results Overall incidence of hepatic artery complications was 3.28%.Hepatic artery thrombosis(HAT)was observed in 5 cases.Hepatic artery stenosis(HAS)occurred in 1 patient.Routine anatomic arterial construction was performed in 89.07%(163)of cases,and HAT developed in 3(1.84%)cases.Extra-anatomic arterial reconstruction was carried out in 10.93%(20)of the patients;the presence of HAT was identified in 3(15.0%)cases(X2=9.73,P＜0.01).Thrombolysis,balloon angioplasty,and vascular stenting via hepatic artery were performed.One patient suffering from identified hepatic artery thrombosis died of liver failure 19 days post-op.The other 5 patients were cured successfully with patent blood flow by interventional therapy.Mortality related to hepatic artery complication was 16.7%.Conclusion HAT and HAS may be minimized by using gastroduodenal branch-patch anastomosis and postoperative anticoagulation.Close follow-up by Doppler ultrasonography helps to make a prompt diagnosis and reduce HAT-and HAS related graft loss.

Objective:To investigate the biomechanical characteristics and clinical outcomes of arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears (MIRCT) using the long head of biceps tendon (LHBT) with tenotomizing its distally or not (the "Chinese way" ).Methods:Eight fresh-frozen cadaveric shoulders were used to create a MIRCT model by detaching the footprints of the supraspinatus and infraspinatus tendons on the greater tuberosity. LHBT autograft was transferred and securely fixed onto the footprint of supraspinatus tendon for superior capsular reconstruction. Further, all cadaveric specimens were assigned to the tenotomy group or reservation group (4 cadaveric specimens in each group) according to whether the distal part of LHBT was tentomized or not. Biomechanical tests were conducted to observe the stiffness, ultimate load of fixed LHBT and to measure the length between LHBT tear site and its insertion on the superior labrum. A total of 41 patients with MIRCT who underwent arthroscopic superior capsular reconstruction using LHBT autograft between July 2016 and December 2018 were enrolled in the study. There were 17 males and 24 females, aged from 46 to 76 years (62.6±7.3 years). All patients were assigned to the tenotomy group (23 cases) or reservation group (18 cases) according to whether the distal part of LHBT was tentomized or not. The visual analogue scale (VAS), University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and Fudan University Shoulder Score (FUSS) were used to evaluate the clinical outcomes. The range of motion (ROM) of shoulder was recorded before and after operation. Magnetic resonance imaging was used to assess the structural integrity of reconstructed tissue at 12 months after operation (refers to the failure of the transposed LHBT, which may be accompanied by a retear of partial repaired supraspinatus tendon).Results:Biomechanical research showed that the stiffness, ultimate load of fixed LHBT and the length between LHBT tear site and its insertion on the superior labrum in the reservation group (54.0±6.6 N/mm, 141.8±15.9 N, 93.3±12.4 mm, respectively) were significantly higher than those in the tenotomy group (25.7±4.2 N/mm, 80.8±8.0 N, 47.4±2.0 mm, respectively) ( P<0.05). All patients were followed up for 12-18 months (14.5±1.8 months) without significant complications and adverse reactions. No matter the distal part of LHBT was tentomized or not, the ROM and clinical scores (VAS score, UCLA score, Constant-Murley score, ASES score and FUSS) of patients improved significantly at 1 year follow-up than that before operation ( P<0.05). However, there were no significant differences between the reservation group and tenotomy group in terms of postoperative ROM [flexion, abduction, external rotation at side, internal rotation (vertebral level) were 144.3°±15.5° vs. 148.0°±10.3°, 145.1°±14.1° vs. 142.3°±11.2°, 67.3°±14.4° vs. 62.7°±11.7°, 8.3±2.1 vs. 7.8±2.5, respectively], VAS scores (2.3±1.6 vs.1.5±1.2), functional scores (Constant-Murley score, UCLA score, ASES score and FUSS were 88.2±11.4 vs. 85.6±9.6, 29.3±2.8 vs. 31.4±3.5, 86.8±11.8 vs. 82.6±9.2, 92.1±10.1 vs. 88.3±8.2, respectively) and structural failures (35.2% vs. 30.0%, P>0.05). Conclusion:Arthroscopic superior capsular reconstruction using LHBT with reserving its distal part could achieve higher mechanics strength. However, the short-term follow-up showed that tenotomizing the distal part of LHBT exerted no obvious influence on postoperative function and structural integrity.