Objective To explore the clinical features and surgical management of aged patients with acute cholecystitis,and try to command the opportunity and procedure of laparoseopic cholecystectomy(LC)better.Meth- ods Clinical data of 52 aged cases with acute cholecystits undergone LC were analyzed retrospectively.Results All of the patients(within 48h of the acute attack)were successfully recovered without serious operative complications. Conclusion Aged acute cholecystitis progressed rapidly and its operative difficulty and risk were higher;only if more attention was paid to perioperative managements and operative time and technical skill were mastered,early LC for the patients was safe and feasible.Therefore.it should be recommended in the great majority of cases except the des- perate patients whose general condition was too poor to operate.

Objective To investigate the efficacy of precise hemihepatectomy guided by middle hepatic vein(MHV),and to study the value of preoperative hepatic vein evaluation.Methods The clinical data of 68 patients who received hemihepatectomy at the Nanjing Drum Tower Hospital from October 2007 to September 2009were prospectively studied.Of the 68 patients,30 received precise hemihepatectomy guided by MHV(precise group)and 38 received anatomical hemihepatectomy(traditional group).The types of hepatic vein in the precise group were evaluated and classified preoperatively.The operation time,operative blood loss,volume of blood transfusion,liver function,morbidity and length of hospital stay of the 2 groups were compared.All data were analyzed using the t test,rank sum test,chi-square test and Fisher exact probability.Results According to the Nakamura's classification,there were 17(57%)patients with type Ⅰ,8(27%)with type Ⅱ and 5(16%)with type Ⅲ;according to the Kawasaki's classification,there were 11 patients with type Ⅰ(37%)and 19 with type Ⅱ(63%).There were 13 patients received right hepatectomy with MHV preservation,15 received left hepatectomy with MHV preservation,1 received right hepatectomy without MHV preservation and 1 received left hepatectomy without MHV preservation.There were no significant difference in the volume of operative blood loss and blood transfusion,level of alanine transaminase,total bilirubin,cholinesterase at postoperative day 3,total length of hospital stay and length of postoperative hospital stay between the 2 groups(t = 1.07,0.92,0.07,0.21,0.63,0.63,0.75,P ＞ 0.05).The operation time,levels of albumin at postoperative day 3 and complication rate were (342 ± 113)minutes,(35 ±3)g/L and 40%(12/30)in the precise group,and(270 ±73)minutes,(33 ±3)g/Land 66%(25/38)in the traditional group,respectively,with significant differences between the 2 groups(t =2.79,2.19;x2 =4.49,P＜0.05).The positive rates of the resection margin were 5%(1/19)in the precise group and 35%(8/23)in the traditional group,there was a significant difference between the 2 groups(P ＜0.05).ConclusionPreoperative hepatic vein evaluation and precise hemihepateetomy guided by MHV can preserve the functional liver tissues with venous drainage,achieve adequate tumor-free resection margin and reduce the postoperative complication rate.

OBJECTIVETo explore the effect of Tongfu Jinghua Decoction (TJD) on hemodynamics and tissue oxygen metabolism in patients with post-traumatic sepsis shock.

METHODSTotally 60 patients were randomly assigned to the treatment group and the control group, 30 in each group. Patients in the treatment group took TJD or were administered with TJD by nasal feeding in combined with conventional Western medical treatment, while patients in the control group only received conventional Western medical treatment. Changes of each index in hemodynamics and tissue oxygen metabolism were observed before treatment, and at 6, 12, 24, and 48 h after treatment.

RESULTSCompared with before treatment in the same group, hemodynamic changes were significantly improved at each time point in the two groups. All indices of tissue oxygen metabolism at each time point of the two groups were significantly improved, except changes of O2 extraction ratio (ER) after treatment in the control group (P < 0.05, P < 0.01). Compared with the control group in the same period, heart rate (HR), systemic vascular resist- ance (SVR), and cardiac output (CO) were significantly improved with statistical difference (P < 0.05, P < 0.01). Mean arterial pressure (MAP), central venous pressure (CVP), and cardiac index (CI) were significantly improved at 6, 12, and 24 h after treatment with statistical difference (P < 0.05, P < 0.01). Each index of tissue oxygen metabolism in the treatment group were all improved at each time point with statistical difference (P < 0.05, P < 0.01).

CONCLUSIONTJD combined with conventional Western medical treatment could quickly improve hemodynamics and tissue oxygen metabolism disorder in patients with septic shock, and its curative effect was superior to that of conventional Western medical treatment alone.

Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Heart Rate ; Hemodynamics ; drug effects ; Humans ; Oxygen ; metabolism ; Sepsis ; Shock, Septic ; drug therapy ; metabolism

Objective To investigate whether elevated pre-procedural C-reactive protein (CRP) and Interleukin-6 (IL-6) concentrations may be relevant to early outcome in patients undergoing PCI.Method 100 consecutive patients undergoing pereutaneuous coronary intervention (PCI) were included in our study.Peripheral blood samples for CRP and IL-6 testing were withdrawn before PCI.Acute vascular complications resulted from PCI were determined by subsequently coronary angiography.The early coronary events during hospitalization were clinically followed.Results Thirty patients developed acute vessel occlusion,and another one developed subacute coronary thrombosis at 2 days after PCI.Increased levels of CRP correlated well with the occurrence of vascular complications as regards the significant difference existing amongⅠvsⅢandⅠvsⅣquartile groups,P

Animals ; Antiviral Agents ; pharmacology ; therapeutic use ; DNA-Directed RNA Polymerases ; antagonists & inhibitors ; Drug Discovery ; Hemagglutinin Glycoproteins, Influenza Virus ; chemistry ; metabolism ; Humans ; Influenza A virus ; drug effects ; genetics ; metabolism ; Influenza, Human ; drug therapy ; Molecular Targeted Therapy ; Neuraminidase ; antagonists & inhibitors ; RNA-Binding Proteins ; antagonists & inhibitors ; Signal Transduction ; drug effects ; Viral Core Proteins ; antagonists & inhibitors ; Viral Matrix Proteins ; antagonists & inhibitors

Objective:To observe the motor capacity of patients early after cardiac surgery using a cardiopulmonary exercise test.Methods:Patients who had performed a cardiopulmonary exercise test within 3 months after cardiac surgery were included in this retrospective study. Patients who took the test within 30 days of the operation formed a discharge group ( n=20), those within 30 to 60 days and 60 to 90 days formed the one month and two month groups ( n=10 for both). The discharge group was further divided into an aortic surgery group ( n=9), a bypass surgery group ( n=6) and a valve surgery group ( n=5) according to their procedure. The exercise capacity of each person was measured in terms of the changes in heart rate and systolic pressure from the resting to the anaerobic threshold stage. Anaerobic threshold, peak oxygen uptake and carbon dioxide ventilation equivalent were also recorded. Results:All of the patients completed the cardiopulmonary exercise test above the anaerobic threshold, and no adverse events such as exercise accidents occurred. At the anaerobic threshold the average heart rate of the discharge group was (8.8±7.1)bpm, significantly lower than the averages of the one month and two months groups: (17.0±5.9) and (18.3±10.5)bpm respectively. The average anaerobic thresholds and peak oxygen uptakes of the 1 month and 2 months groups were not significantly different, but they were all significantly higher than the discharge group′s averages. There were, however, no significant differences among the groups in the average changes in their systolic pressure and carbon dioxide ventilation equivalent. Moreover, the average anaerobic threshold and peak oxygen uptake of the aortic surgery group and the bypass surgery group were significantly lower than the valve surgery group′s averages.Conclusions:Postoperative motor ability after cardiac surgery improves significantly for at least 30 days. Patients who have received aortic or bypass surgery have significantly lower exercise capacity than those after valve surgery.

AIM To evaluate saponins in Paris Polyphylla Smith var.chinensis (Franch.) Hara from twentyone growing areas.METHODS HPLC was adopted in the content determination of pennogenins { pennogenin-3-O-β-D-glu (1→3) [α-L-rha (1→2)]-β-D-glu (PGGR),polyphyllinsⅥ,Ⅶ,H} and dioscins (gracillin,polyphyllins Ⅰ,Ⅱ,Ⅴ),then SPSS 22.0 software was used for principal component analysis and cluster analysis.RESULTS Pennogenin was the main kind of Paris Polyphylla var.chinensis saponins,and PGGR,polyphyllins Ⅰ,Ⅴ,Ⅶ,H were the main effective constituents of this medicinal material.The comprehension scores of seven growing areas were more than zero,which was in sequence of Bazhong ＞ Qingchuan ＞ Yanjin ＞ Tongjiang ＞ Nanchuan ＞ Chongzhou ＞ Hongya.Twenty-one batches of samples were divided into four types,which was similar to cluster analysis results.CONCLUSION Bazhong,Qingchuan,Chongzhou,Hongya,Tongjiang in Sichuan,Yanjin in Yunnan,and Nanchuan in Chongqing are suitable for cultivating Paris Polyphylla var.chinensis,which can guarantee the stability of saponins.

OBJECTIVETo increase the success rate of surgical treatment in patients with hypospadias.

METHODS220 cases of hypospadias underwent one-stage urethra plasty. After the penis was straightened, urethra plasty was performed with pediculated preputial entoplastron (Duckett's method) in 195 cases; with combination of scrotal septum and pediculated preputial entoplastron in 20 cases; with free bladder mucosa transplantation in 2 cases. The self-made dual silastic tubes with lateral mini-holes were applied to support new urethra in all the cases.

RESULTSThe patients were followed up for 1 - 8 years. 208 cases achieved successful results. There were 2 cases of urethral fistula, 6 cases of urethral stenosis at anastomosis site, 4 cases of stenosis at urethral orifice.

CONCLUSIONSThe success rate (94.5%) suggests great advantages of the self-made dual tube with lateral mini-holes to support new urethra. It can facilitate drainage and irrigation and reduce the complications such as infection, fistula and stenosis.

Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Stents ; Surgery, Plastic ; methods

OBJECTIVETo investigate the safety and efficiency of the disposable circumcision suture device (DCSD) in the surgical treatment of phimosis and redundant prepuce.

METHODSWe randomly assigned 249 outpatients with phimosis or redundant prepuce to be treated with DCSD (n = 129) and by conventional circumcision (CC, n = 120), respectively. Then we compared the safety and efficiency of the two strategies.

RESULTSComparisons between DCSD and CC showed that the operation time was (4.02 +/- 0.69) vs (30.8 +/- 4.05) min, blood loss was (1.07 +/- 1.29) vs (8.72 +/- 2.15) ml, intraoperative pain score was 0.81 +/- 0.81 vs 2.42 +/- 1.15, 24-hour postoperative pain score was 1.84 +/- 1.02 vs 4.99 +/- 1.36, postoperative complication rate was 13. 95% (18/129) vs 9.17% (11/120), wound healing time was (13.99 +/- 9.06) vs (17.48 +/- 3.49) d, satisfaction with the penile appearance was 98.4% (127/129) vs 95% (109/120), and treatment cost was (2215.62 +/- 17.67) vs (576.47 + 15.58) Y RMB. DCSD exhibited obvious superiority over CC for shorter operation time, less blood loss, milder intraoperative pain, sooner wound healing, and better penile appearance, but it also had a higher rate of postoperative complications (P > 0.05) and involved more treatment cost than the latter (P < 0.05).

CONCLUSIONThe disposable circumcision suture device affords ideal clinical effects and therefore deserves clinical popularization.

Circumcision, Male ; instrumentation ; Disposable Equipment ; Follow-Up Studies ; Humans ; Male ; Phimosis ; surgery ; Surgical Staplers ; Treatment Outcome

Objective To understand the status and influential factors of those neglect of left-behind children in rural area,and to provide bases for the development of intervention measures.Methods 2917 students were selected as the study subjects from Changfeng county of Anhui province with cluster sampling method and were evaluated by a Parents-Child Conflict Tactics Scales and questionnaire on influential factors.Results 1694 left-behind children,accounted for 58.1％ of the total students,were surveyed in this investigation.The prevalence rates of neglect,among total children,left-behind children,non-left-behind children were 67.4％,70.2％,63.5％,respectively.The prevalence of neglect among left-behind children was higher than that among non-left-behind children (x2=14.322,P＜0.000).There were no significant associations with the neglect rate of left-behind children regarding gender or age differences.Result from multivariate logistic regression analysis indicated that the neglect among the left-behind children were associated with family dysfunction(OR values of moderate and serious family dysfunctions compared to good family function were 1.628 and 2.341,respectively)and the rate of keeping in touch with parents(OR values of sometimes and seldom keeping in touch compared to regular in touch were 1.299 and 1.844,respectively).The starting age of being left-behind(OR values of starting age that being left-behind from 6 to 10 and ≤5 years relative to starting age of left-behind ≥11 years were 0.703 and 0.630,respectively)appeared to be the protection factor to the neglect of those left-behind children.Conclusion Our findings indicated that the status of neglect among the left-behind children was serious.Prevention programs on the issue should target on a number of factors,including the characteristics of the chldren them-selves,as well as on the family of the children.