Objective To study the feasibility of mouse nerve growth factor for injection in treatment of incision pain after inguinal hernia repair. Methods Eighty unilateral inguinal hernia patients who had underwent inguinal hernia repair were divided into 2 groups according to the sequential order with 40 cases each. The patients of odd number were divided into control group, and the patients of dual number were divided into treatment group. All patients were performed Lichtenstein tension free repair operation, and were given the basic treatment of inguinal hernia. At the 3rd d after operation, the patients in control group were given 2 ml water for injection through intramuscular injection, and the patients in treatment group were given 20 μg mouse nerve growth factor for injection through intramuscular injection. One course of treatment was 14 d. At 3 d, 15 d, 30 d, 3 months and 6 months after operation, the pain degree, the pain range, and the effect of pain on behavior was observed and evaluated according to visual analogue score (VAS), the innervation range of the inguinal region, and behavioral rating scale-6 (BRS-6) respectively. Results There were no statistical differences in VAS, pain range score and BRS-6 score 3 d after operation between 2 groups (P>0.05). The VAS, pain range score and BRS-6 score 15 and 30 d after operation in treatment group were significantly lower than those in control group, 15 d after operation:(1.64 ± 0.92) scores vs. (2.28 ± 1.06) scores, (1.23 ± 0.43) scores vs. (1.61 ± 0.56) scores and (1.02 ± 0.56) scores vs. (1.57 ± 0.73) scores, and 30 d after operation:(0. 98 ± 0.56) scores vs. (1.61 ± 1.04) scores, (0.87 ± 0.43) scores vs. (1.16 ± 0.56) scores and (0.86 ± 0.32) scores vs. (1.16 ± 0.73) scores, there were statistical differences (P<0.05). There were no statistical differences in the incidences of chronic pain 3 and 6 months after operation between 2 groups (P>0.05). Conclusions Injecting mouse nerve growth factor for injection is effective for pain treatment after inguinal hernia repair.

Objective To investigate the influences of Xuebijing injection on organs' ultra-microstructure in septic shock rats. Methods Fifteen male Sprague-Dawley (SD) rats of clean grade were selected. According to the method of random digits table, all of them were divided into three groups: sham operation group, model group and Xuebijing treated group, 5 rats being in each group. Cecal ligation and puncture (CLP) was adopted to reproduce abdominal cavity infection leading to sepsis model formation. While the rats in sham operation group just underwent abdominal median incision, abdominal exploration and closure of abdominal wall after flipping retrocecal region. In the Xuebijing treated group, within 1 hour after the operation, Xuebijing injection (4 mL/kg) was transfused through the catheter inserted in the femoral vein, and then normal saline (2 mL·kg-1·h-1) was continuously transfused until the rat being sacrificed. In the sham operation group and model group, equal volume of normal saline was given after operation. The blood pressure of all the rats was monitored continuously by a pressure device connected with a catheter inserted in the right carotid artery. The rats were observed for 12 hours, afterwards they were sacrificed, the samples of heart, lung, kidney and liver were taken, and their ultrastructural changes were observed under an electron microscope. Results The blood pressure of sham operation group was decreased a little with time extension, but within normal limits. The mean arterial pressure (MAP) of model group and Xuebijing treated group developed into a state of sepsis shock at 9 hours and 10 hours after operation respectively, and MAP were lower than 70 mmHg (1 mmHg=0.133 kPa). The MAP levels of model and Xuebijing groups at 11 hours after operation were lower significantly than those of sham operation group (mmHg:58.7±7.0, 58.7±8.3 vs. 91.0±8.2, both P<0.01), and they were persistently decreased at 12 hours after operation;the MAP in Xuebijing group was a little higher than that of model group at the same period (mmHg:55.4±4.0 vs. 48.8±12.9, P>0.05). The results of the observation with electron microscope:the structures of heart, lung, liver and kidney in sham operation group were basically normal;all the organs of model group appeared different degrees of structural damage. Compared with model group, the injury of heart and lung in Xuebijing treated group was milder, especially, the changes of cellular mitochondria were obvious;however, there was no significant difference in injury of kidney and liver between the model and Xuebijing treated groups. Conclusion Xuebijing injection can play a certain role in stabilizing the circulatory system in rats with septic shock, and can possibly ameliorate the heart and lung damage caused by infection and shock.

Objective To investigate the influence of hydroxyethyl starch solution on exogenous coagulation and active protein C (APC) in the patients with septic shock.Methods A single-center prospective study was conducted.Eighty-four consecutive patients with septic shock admitted to intensive care unit (ICU) of Peking University People's Hospital from November 2009 to October 2014 were enrolled.The patients were randomized into two study groups by random digits table:Ringer lactate solution group (RL group,n =40) and hydroxyethyl starch group (HES group,n =44),and Ringer lactate solution or hydroxyethl starch 130/0.4 was used for resuscitation respectively.Peripheral blood was collected at four time points:before resuscitation,6,12,and 24 hours after resuscitation.The prothrombin time (PT),tissue factor (TF),tissue factor pathway inhibitor (TFPI) and APC were determined,and the length of ICU stay and the mortality were recorded.Results There were no significant differences in PT,TF,TFPI,and APC before and after resuscitation in RL group.No change in PT was found after resuscitation in HES group,and no significant difference was found as compared with RL group.TF after resuscitation in HES group was decreased gradually,and the level at the 24 hours after resuscitation was significantly lower than that before resuscitation (U/L:15.80±7.32 vs.31.40±2.75,P ＜ 0.05); but there was no significant difference at all time points when compared with that of RL group (all P ＞ 0.05).TFPI at 12 hours and 24 hours after resuscitation in HES group was increased when compared with before resuscitation (μg/L:1.32±0.22,1.14±0.09 vs.0.63±0.54).TFPI in HES group was significantly higher than that in RL group (μg/L:0.84 ± 0.69,0.95 ± 0.30),but there was no significant differences between two groups (both P ＞ 0.05).APC after resuscitation in HES group was decreased gradually,which was significantly lower than that in RL group at 6,12,24 hours after resuscitation (mg/L:3.38±3.00 vs.5.98±4.12,3.31 ± 1.94 vs.5.33 ± 3.71,3.42 ± 2.64 vs.7.53 ± 4.67,P ＜ 0.05 or P ＜ 0.01).The length of ICU stay in HES group was significantly shorter than that in RL group (days:12.50 ± 8.83 vs.17.10± 16.60,t =9.037,P ＜ 0.001),but there was no significant difference in mortality between HES group and RL group [40.9％ (18/44) vs.60.0％ (24/40),x 2=2.339,P =0.126].Conclusions Both RL and hydroxyethyl starch fluid resuscitation did not affect the PT of the patients.The use of hydroxyethyl starch probably inhibits excessive activation of the exogenous coagulation and hyper-coagulation in the early stage of sepsis,and inhibits activation of protein C as well.

[Summary] Thyroid nodules are the most common endocrine and metabolic diseases,and most of them are accidental nodules.How to distinguish the state between benign and malignant thyroid nodules is the clinical core problems in diagnosis and treatment.In addition to detailed history collecting and physical examination,highresolution ultrasound,serum thyrotrophin levels,and fine needle aspiration biopsy (FNAB) form the basis for the diagnosis of thyroid nodules.Endocrinologists should grasp the indications of FNAB.When the pathological finding is unable to distinguish between benign and malignant nodules,molecular or genetic diagnosis should be adopted for further diagnosis.Appropriate treatment is selected according to the definitive results.In this article,we share the whole process that one case with thyroid nodule was diagnosed as papillary thyroid carcinoma and eventually treated with surgery,so as to make clinicians pay more attention to thyroid nodules with standardized clinical diagnosis and treatment.

Total 786 cases of acute uncomplicated appendicitis(UCAA) were included for analysis.All the cases were given antibiotics as a main treatment.Clinical cure rate and the number of cases requiring surgery were observed.Patients with conservative treatment were followed up and the recurrence was observed.Logistic regression was applied to analyze the risk factors of recurrence.Among 786 cases,774 (98.5％) were treated conservatively and achieved clinical cure;68 cases (9.0％) had recurrence during follow-up,the median time to recurrence was 11 months (1-33 months).Logistic regression analysis showed that age(OR =1.124,95％ CI:1.067-3.790,x2 =2.767,P =0.041) and appendix bezoar (OR =1.649,95％ CI:1.281-4.055,x2 =3.935,P =0.027) were independent risk factors for recurrence.Non-operative treatment for acute uncomplicated appendicitis shows a good short and long term effects.Surgical excision may be a better choice for the patients with high risks of recurrence.

This study compared he importance of food service, views to the performance, management objectives, and recognition gap about the contract contents towards the dietetic departments of hospitals that manage the patients' food service and managers of contract managed companies, and dieticians. It conducted questionnaires and survey towards the vice director and dieticians of 17 hospitals, over 500 beds, and the persons responsible for contract managed companies and dietitians who were in charge of food service. The hospitals showed significantly(p<0.05) higher the importance scores in menu planning, the distribution of meal, sanitation management, and leadership than those of the contract managed companies. In the difference of hospitals and contract managed companies about performance, it appeared high in the contract managed companies. In the importance of the foodservice management objective, the hospital had significantly(p<0.05) higher scores in the management of client's satisfaction and quality improvement element through management innovation than those of the contract managed companies. In the importance of contract term, the contract method, expense, and payment condition of commission fee were significantly(p<0.05) high scores in the contract managed companies, compared to the hospital.
Fees and Charges ; Food Services ; Humans ; Leadership ; Meals ; Menu Planning ; Nutritionists* ; Quality Improvement ; Surveys and Questionnaires ; Sanitation

Objective:To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.Results:A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change. Conclusions:The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.

Objective To study the clinical efficacy of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis (KOA) and evaluate whether the age,body mass index and grade of KOA are associated with the treatment outcomes.Methods Using the prospective,randomized,controlled study,100 KOA patients hospitalized between December 2013 and November 2014 were enrolled.Twentyeight patients were men and 72 were women.Mean age was 58 years (range,35-85 years).Degenerative arthritis occurred in 68 patients and traumatic arthritis in 32 patients.Kellgren-Lawrence (K-L) score was grade Ⅱ in 35 patients,grade Ⅱ in 46 and grade Ⅲ in 19.The patients were assigned to receive hyaluronic acid (HA) (HA group,n =50) and PRP (PRP group,n =50) by an intraarticular route once weekly for 3 weeks,according to the random number table.Between-group differences were insignificant in age,gender,body mass index (BMI) and K-L grade.Western Ontario and McMaster Universities Arthritis Index (WOMAC),visual analog scale (VAS) and cartilage lesions score (CaLs) were used for clinical and MRI evaluations.At follow-up evaluation,the effective rate was defined at least 36％ improvement from the baseline WOMAC score.Results All patients were followed up for 6 months.The effective rate in PRP group was 84％ versus 68％ in HA group after the last treatment (P ＞0.05),and was 60％ versus 36％ in HA group at the final follow-up (P ＜ 0.05).WOMAC score in both groups had significant improvement after operation,while VAS improved only in PRP group (P ＜ 0.01).In PRP group patients with K-L grade I had better VAS and WOMAC scores than those with grade Ⅱ (P ＜0.05),and patients with grade Ⅱ had better WOAMC score than those with grade Ⅲ (P ＜ 0.05).MRI findings showed seven patients in PRP group had similar CaLs before and after operation (P ＞ 0.05),and the area of abnormal signal in subchondral bone and the depth of cartilage lesion gradually decreased in one of them.Follow-up study showed the outcomes had negative correlation with age and K-L grade (P ＜0.05),but no certain correlation with BMI in PRP group (P ＞ 0.05).Clinical effects in both groups were decreased over time.Conclusions Intraarticular injection of PRP benefits to pain relief,decreased inflammation and tissue repair,and has much better outcome in patients with younger age and lower K-L grade.However,BMI is not associated with the outcome.

OBJECTIVE:To establish a method for the content determination of carbohydrates in Osseous and cucumis extract injection. METHODS:Ion chromatography was conducted on the column of Dionex CarboPac PA20 with mobile phase of water-1 mol/L Sodium acetate solution-250 mmol/L Sodium hydroxide solution(gradient elution)at flow rate of 0.45 ml/min,column tem-perature was 35 ℃,and injection volume was 10 μl,detector was electrochemical analysis detector. RESULTS:The linear ranges of galactose,glucose,mannose,sucrose and fructose were 0.5-10.0μg/ml(r>0.998 0);RSDs of precision,stability and reproduc-ibility tests were lower than 2%;recovery was 94.8%-99.1%(RSD=0.52%-0.89%,n=9). CONCLUSIONS:The method is sim-ple,fast and accurate,and can be used for the determination of carbohydrates in Osseous and cucumis extract injection.

Objective To analyze clinical features and sum up experience for the treatment of ischemic bowel disease. Methods Clinical data of 73 patients with the diagnosis of ischemic bowel disease were retrospectively analyzed. ResultsTwenty-eight patients were male and 45 patients were female. The median of age was 65 years (range of 38 to 89 years). Forty-eight patients were associated with hypertension, 23%(17/73) patients had a history of coronary disease and 15% (11/73) had diabetes. Seventy patients presented symptom of abdominal pain and 93% (68/73) had hematochezia. Symptoms relieved by conservative treatment in 96% (63/66) patients. Nine patients underwent a surgery. One patient died of sepsis postoperatively. One suffered from colostomy necrosis and leakage of the rectum segment. Conclusion 1. Elder patients presenting symptoms of abdominal pain and hematochezia, especially with a history of cardio-cerebrovascular disease and diabetes should be considered for the possibility of ischemic bowel disease. 2. Most patients with ischemic bowel disease could be successfully treated by conservative therapy. 3. Surgery for patients with chronic relapsing and nonresponsible symptoms was difficult and patients often suffer from high postoperative complications.